Long-Term Care Costs for Rural Farmers in North Dakota: Stories of the Haakensons, and Other Farmland Residents in Northern Dakota
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. The Haakensons could not receive government assistance for their care because they were within the five-year Medicaid look-back period.
Friends near and far, both old and new, attended his service. Cindie said that within weeks, fellow farmers were reaching out to her to share their stories of her husband’s passing, many of which were new to her.
“They work their whole life, they pay their own bills,” he said. When they need the most assistance to get to the finish line, they have to destroy everything they have accumulated 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. Now, most people will need long-term care at some point in their life. That means help with bathing, dressing or using the bathroom. It is expensive to get that type of help. It is especially tough for aging farmers who want to afford health care without it costing their farm. Long term care costs can be a problem for small family farms. Joining us now is NPR’s Juliana Kim, who met with farmers in North Dakota. Hey there.
Willow City, a neighborhood for Norwegian immigrants from the Haakensons’ first two visits to Fargo, North Dakota, when he collapsed
When he collapsed at home in October, he had to be taken to the emergency room in Fargo, North Dakota, which was 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 can be difficult for EMTs to find the couple’s home at night. It was not possible for Cindie, who is shorter than her husband, to take him to the hospital herself.
Although the nursing home was just a 20-minute drive from their home, it was hard for him to settle in. The Haakensons never did well far from home. They preferred the quiet and had traveled around the country but their favorite view was from their family room window.
His family was among hundreds of Norwegian immigrants who helped shape Willow City. By the time he was born, the town had nearly 600 residents. Now, it’s just shy of 150 people and the grocery store, the high school, and two bars he once enjoyed are all closed.
Long-Term Care Insurance for Farmland Ownership: What Happens When Farmers Turn Their Heads Around? A Case Study of the Haakensons and German
Moore said owning farmland, particularly that is in the family for generations, is different than owning a stock portfolio that may need to be liquidated. “There’s usually family heritage involved, and continuing that legacy is really important for a lot of farmers.”
It’s possible that farmers can be in a nursing home for a long time and use up resources, which will jeopardize their farm operation for themselves and future generations, Moore said.
There are 1.9 million farms in the United States, of which 40% 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 Haakensons sold their tools and machinery years ago. The Chevy pickup truck would have helped to pay for the two months of care if they had been able to sell it.
Long-term care insurance has its own problems, from complex underwriting to rising premiums. German, who works for thousands of older farmers in the area, said that just a few of his clients use it.
Long-term care insurance is a better option than short-term care policies, said the sales director at Farmers Union Insurance in North Dakota. Their benefits usually last for a year.
The cost of senior care: Why aging farmers fear the nursing home: A case study of the Haakensons family farm in North Dakota
He said that they are very affordable and uncomplicated to understand. 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.
The Department of Health and Human Services states that a third of Americans 65 and older will need a year of nursing home care in their lifetime. A semiprivate room is not normally covered by medicare, costing $8,700 per month. Long-term care insurance exists, but it’s deeply unpopular with older Americans. Many seniors apply for Medicaid because of its own challenges, while others go into their savings or retire to get the care they need.
The Haakensons own over 2,500 acres in North Dakota. Most of the wheat and cattle farm has been in the same family for over 130 years. It survived brutal winters and the farm crisis of the 1980s. Now, the couple confronted a situation many aging family farmers fear: being forced to sell or break up the farm to pay for long-term care.
“We’ve got enough tucked away to keep him for about a year. Cindie is not sure after that. We own farmland that we could sell but it is like taking away part of your legacy.
Source: The cost of senior care: Why aging farmers fear the nursing home
Why farmers worry about the costs of long-term care: A case study in Willow City, N.D. — A conversation with Sherwood Haakenson
Her 74-year-old husband, Sherwood, had been suffering from multiple fainting episodes in recent months due to issues with his heart and kidney. He was finally given the supervision he needed.
KIM: That’s Sherwood Haakenson from Willow City, N.D. He farmed all his life on the land that his great-great-grandfather homesteaded in 1890. I met him in a care center that was in another city.
KIM: They might sell their livestock or machinery, but that only gets them so far. So some farmers apply for Medicaid, the federal insurance program for the poor and elderly. And now it’s a little different in each state, but generally, to be eligible, seniors have to drain their assets. For farmers, that means their land.
Surrounded by trees. I mean, this is a dynamic that’s really tough for a lot of people in a lot of walks of life, but let’s just underscore this. If you’re a farmer, you’re not allowed to own land in order to apply for Medicaid.
KIM: Right. Now, some farmers work around that by transferring their land into an irrevocable trust and naming their children as beneficiaries. 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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