In Sickness & In Health

Harley Gordon. In Sickness & In Health: Your Sickness -- Your Family's Health. Financial Strategies Press, 2007. 198 pages.

$19.95

One family member's need for long-term care can have catastrophic financial consequences for the rest of the family. This is why long-term care planning should be thought of not as protection for any one individual but as security for the entire family and its lifestyle, says attorney Harley Gordon in this straight-talking book. And given the recent tightening of Medicaid rules, by far the best form of protection is long-term care insurance, Gordon contends.

Gordon is in the unique position of being an expert in both Medicaid planning and the intricacies of long-term care insurance. He is a founding member of National Academy of Elder Law Attorneys and, more recently, started the Corporation for Long-Term Care Certification, which is independent of the insurance industry and grants the "CLTC" (Certified in Long-Term Care) designation.

Contrary to popular belief, long-term care does not usually mean a lengthy stay in a nursing home, Gordon points out. Nevertheless, it still exacts a devastating toll on family members (usually daughters) who end up in the role of unpaid caregivers. The impact on physical and financial well-being can be ruinous.

After outlining the various care options, Gordon explains the rules for paying for Medicaid coverage of nursing home care following enactment of the draconian Deficit Reduction Act of 2005 (DRA). Here Gordon paints a bleak picture of the prospects of qualifying for coverage while being able to keep some assets in the family. He's right that the rules have gotten far tougher, but in some cases he goes too far. For example, he contends that the DRA effectively eliminates any incentive to purchase an annuity for Medicaid planning purposes, a statement that many other elder law attorneys would take issue with.

But even if Medicaid planning is feasible, Gordon takes a dim view of transferring assets for the "privilege" of going on Medicaid. In most states, all it will buy is the thing he says families are not likely not to want or need -- nursing home care.

A better plan, says Gordon, is long-term care insurance, at least for those who can afford it and are insurable. He says that this type of insurance has come a long way and he compares the restrictive offerings of early policies with the more generous ones today.

Although Gordon fails to mention one mounting concern about this type of coverage -- insurers precipitously raising premiums on policyholders -- he offers valuable step-by-step advice on constructing an affordable long-term care policy out of the available coverage options. Here, Gordon explains such mysteries as the "elimination period," when it's better to opt for simple rather than compound inflation protection, the tax deductibility of long-term care insurance premiums, and the advantages and disadvantages of so-called partnership policies. He even offers suggestions for those who can't qualify for such insurance due to medical conditions.

Gordon's title is based on the remark of one beleaguered caregiver that the marital pledge to care "in sickness and in health" means "His sickness -- my health." His book is a well-timed effort to help families care for a sick member while preserving their financial and physical well-being.