Farmers are often “land rich, cash poor.” Those who need nursing home care may have to sell or destroy their farms to pay for it.
SCOTT DETROW, Host:
This week on NPR, we bring you stories about rural health care for senior citizens. And today, we’re talking about farmers in North Dakota. Today, most people need long-term care at some point in their lives. That means help with bathing, dressing or using the bathroom. And that kind of help is expensive. It is especially difficult for elderly farmers who want to pay for health care without farm costs. And that’s why some experts say long-term care costs are a big threat to small family farms. Joining us today is NPR’s Juliana Kim, who met with farmers in North Dakota. Hey.
JULIANA KIM, BYLINE: Hello.
DETROW: So why are long-term care costs a particular threat to farmers?
KIM: Long-term care can be very expensive, and most are not covered by Medicare. And that puts farmers in need of nursing home care, who may have to sell or liquidate their farms to pay for it. And it’s not easy, especially for those whose farms have been in the family for generations.
SHERWOOD HAAKENSON: I farmed with my dad until he retired, then I took over.
KIM: That’s Sherwood Haakenson from Willow City, ND He farmed all his life on the land that his great-grandfather homesteaded in 1890. I met him at a care center in a neighboring town.
DETROW: Why is he there?
KIM: Sherwood needs 24-hour monitoring for heart and kidney problems. The staff took good care of him and gave him company, away from his wife and cat. But at home, his wife, Cindie, is really stressed, how to keep up with her care.
CINDIE: We got the farmland that we own. We can sell it, but, you know, it’s like giving away part of your inheritance.
KIM: The problem with most small family farmers is that they are land rich, cash poor, which means they don’t have tens of thousands of dollars in cash.
DETROW: That’s right. So how do the people you talk to get the money they need?
KIM: They might sell livestock or machinery, but only so far. So some farmers applied for Medicaid, the federal insurance program for the poor and elderly. And now it varies from state to state, but generally, to qualify, seniors must dispose of assets. And for farmers, that means their land.
DETROW: I mean, it’s a dynamic that’s really difficult for a lot of people on a lot of layers, but let’s just outline it. If you are a farmer, can you no longer own land to apply for Medicaid?
KIM: Yes. Today, some farmers are trying to do so by transferring their land into an irrevocable trust and naming their children as beneficiaries. But in North Dakota and in some states, it still takes five years from the date of application before Medicaid will pay for long-term care. When I met Sherwood and Cindie, they had arranged to transfer the farm land to their children, but it was still in the five-year lookback period, so they didn’t get help.
DETROW: I mean, it’s been a long time. Farmers should plan far in advance?
KIM: Yes. I mean, if they don’t plan and end up in a nursing home, they should probably sell their land. I would say that most farmers can provide treatment three years or more in advance, but it is still very scary for almost every small farmer.
DETROW: Let’s go back to the man we heard from above, Sherwood. What did he do with his wife, Cindie?
KIM: Cindie was going to sell the pickup truck, but two months after I visited, Sherwood died. And now even as she mourns her husband, Cindie is still working to protect her farm. He said if he stays healthy for the next two years until Medicaid kicks in, the land can stay in his family.
DETROW: That’s NPR’s Juliana Kim. Thank you very much.
KIM: Thank you.
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