Long-Term Care Planning Checklist

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General information	Yes	No	N/A
1. Has relevant personal information been gathered? • Name • Date of birth • Legal state of residence • Health status, including medications being taken • Marital status • Family members available for support • Name, phone number, and address of attorney, physician, geriatric care manager or other advisor	▢	▢	▢
2. Has financial situation been assessed? • Income from Social Security, pension, employment, or other source • Expenses • Assets • Liabilities	▢	▢	▢
Notes:

Long-term care planning	Yes	No	N/A
1. Is the need for long-term care imminent?	▢	▢	▢
2. Are assets sufficient to cover long-term care needs?	▢	▢	▢
3. Have ways to fund long-term care been reviewed/evaluated?	▢	▢	▢
4. If homeowner, has home equity as a use of funds been discussed?	▢	▢	▢
5. Are long-term care insurance benefits available?	▢	▢	▢
6. Have various housing options and their costs been considered? • In-home care • Living with a relative • Continuing care retirement community • Assisted living • Nursing home	▢	▢	▢
Notes:

Insurance planning	Yes	No	N/A
1. Is adequate health insurance available?• Medicare • Medigap • Private health insurance • Prescription plans	▢	▢	▢
2. Have Medicaid planning goals and strategies been considered?	▢	▢	▢
3. Has Medicaid qualification criteria been discussed?	▢	▢	▢
4. Has the need for long-term care insurance been established?	▢	▢	▢
5. Is long-term care insurance coverage available to the client?	▢	▢	▢
6. Have existing long-term care insurance policies been reviewed/evaluated?	▢	▢	▢
7. Does long-term care insurance coverage need to be upgraded?	▢	▢	▢
8. Do long-term care benefits need to be accessed?	▢	▢	▢
Notes:

Estate planning	Yes	No	N/A
1. Has long-term care planning been coordinated with estate planning needs?	▢	▢	▢
2. Have appropriate estate planning documents been prepared? • Will • Trust	▢	▢	▢
3. Have advanced medical directives been prepared? • Durable power of attorney • Living will • Health-care proxy	▢	▢	▢
4. Have letters of instruction been prepared?	▢	▢	▢
5. Has this information been communicated to family members?	▢	▢	▢
Notes:

Other	Yes	No	N/A
1. Has the need for organizing important documents and records been discussed? • Bank account records (statements and passbooks) • Monthly bills to be paid • Stock certificates, bonds, and other investment records • Retirement plan statements • Real estate deeds, mortgages, and other property ownership records • Vehicle titles • Business agreements • Insurance policies • Will, trust, advanced medical directives, letters of instruction, and other documents • Birth certificate, marriage certificate, divorce decree, military service papers	▢	▢	▢
Notes:

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