Why farmers worry about long-term care costs

Rural Health Care for Aging Farmers in North Dakota: Stories from the Haakensons and a Nebraska Farmer’s View on Elderly Care

Cindie made arrangements to transfer their farmland to their son and daughter three years ago. At the time, she thought she was being proactive — believing that she would be the one needing long-term care in the future. But because the Haakensons were within Medicaid’s five-year look-back period, they were unable to receive government assistance for Sherwood’s care.

He had friends near and far attend his service. Many new stories were shared about her husband by fellow farmers after they reached out to give their sympathies.

He said that they all work their lives and pay their own bills. “Then, all of sudden, when they need the most help to get to the finish line, they literally have to wipe out everything they’ve accumulated in life to get that help.”

This week on NPR, we are bringing you stories about rural health care for senior citizens. And today, we are talking about farmers in North Dakota. Most people will need long-term care at some point in their lives. That means help with bathing, dressing or using the bathroom. That type of help is expensive. It is hard for aging farmers to afford health care without affecting their farm. Some experts believe long-term care costs are a threat to small family farms. Today we are joined by NPR’s Kim who met with farmers in North Dakota. Hey, I’m here.

Eleven Minutes to the Emergency Room, and Back again. The Haakensons of Willow City, South Dakota, How Sherwood Moved

Sherwood’s health took a turn for the worse in October, when he collapsed at home and was airlifted from the local hospital to an emergency room in Fargo, N.D., some 200 miles away. Over the course of four months, he was taken to the ER six times, according to Cindie.

Each time felt like a close call. It’s not easy for EMT crews to find the couple’s home — especially at night. It was impossible for Cindie to bring her husband to the hospital on her own.

He was not comfortable at the nursing home that was 20 minutes from their home. The Haakensons never did well far from home. Although they had traveled a lot, they preferred the quiet and the view from their family room window was their favorite.

The Norwegians who helped shape Willow City were his family. The town had almost 600 residents when he was born. Now, it’s just shy of 150 people and the grocery store, the high school, and two bars he once enjoyed are all closed.

Farming with Small Families: The Haakenson’s Case for Long-Term Care in North Dakota, Minnesota, Explained by Ray German, the Managing Attorney at German Law

Small family farmers are often “land rich, cash poor,” meaning their assets are tied up in their farm and equipment, according to Moore from Ohio State University.

Ray German, the lead attorney at German Law in Grand Forks, N.D., said that in his experience, farmers with land that’s worth less than $1 million are at the greatest risk of losing their entire farm over long-term care costs.

40% of the farms in the United States are owned by farmers 65 and older. Despite a trend of consolidation, as of 2022, about three-quarters of farms earned $50,000 or less in sales a year, according to the Department of Agriculture.

The Haakenson’s sold their equipment a long time ago. According to Cindie, the only important thing left to sell is their Chevy pickup truck which would have paid for two months of care.

Long-term care insurance is rife with its own problems, from complex underwriting to rising premiums. German, who has worked with thousands of older farmers to help preserve their estates in North Dakota and Minnesota, said only a tiny fraction of his clients use it.

Short-term care policies are a newer alternative to long-term care insurance, said Lance Boyer, a sales director at Farmers Union Insurance in North Dakota. Their benefits only last about a year.

The cost of senior care: Why aging farmers fear the nursing home: A survey of the Haakensons family farm in Willow City, North Dakota

“They are really affordable and underwriting is pretty simple,” he said. But “it’s yet to be determined how impactful they are in the market because they’re still so new.”

The choices are especially daunting for small farmers, according to Robert Moore, an attorney and researcher at Ohio State University’s Agricultural & Resource Law Program.

A third of Americans 65 and older will need a year of nursing home care in their lifetime, according to the Department of Health and Human Services. A semiprivate room today can cost some $8,700 per month — and it’s generally not covered by Medicare. Long-term care insurance exists, but it’s deeply unpopular with older Americans. So, many seniors dip into their retirement or savings to get the care they need, while others apply for Medicaid, which has its own challenges.

The Haakensons own about 2,600 acres in North Dakota’s Willow City area. Most of the small cattle and wheat farm has been in Sherwood’s family for over 130 years. It survived the farm crisis in the 1980s. Many aging family farmers fear that they will be forced to sell their farm to pay for long-term care, when they reach a point of no return.

We have enough tucked away to keep him for a year. After that, I’m not sure,” Cindie said. It is like giving away part of your legacy when we have farmland that we could sell.

Source: The cost of senior care: Why aging farmers fear the nursing home

Why farmers worry about the costs of long-term care: The story of Sherwood Haakenson and his family farm land in Willow City, North Dakota

The 74-year old husband of her had been having a lot of dizzy spells recently because of his health issues. He desperately needed the 24 hour supervision that he finally received.

KIM: That’s Sherwood Haakenson from Willow City, N.D. He was raised on the land that his great-great-grandfather homesteaded in 1890. I met him in a care center.

KIM: They might sell off their livestock, but that doesn’t mean they are done. So some farmers apply for Medicaid, the federal insurance program for the poor and elderly. In each state, it’s different, but generally, seniors have to give up their assets to be eligible. And for farmers, that means their land.

Deletion: This is a dynamic that is very tough for many people in a lot of walks of life. You can’t own land to apply for Medicaid if you’re a farmer.

KIM: It’s right. Farmers transfer their land into a trust to be used for the benefit of their children. But in North Dakota and in most states, it still takes five years from the application date before Medicaid will pay for long-term care. When I met Sherwood and Cindie, they had already arranged to transfer their farm land to their children, but they were still within that five-year lookback period, so they didn’t get any assistance.

Source: Why farmers worry about the costs of long-term care

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