SCOTT DETROW, HOST:
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. And that type of help is expensive. It is especially tough for aging farmers who want to afford health care without it costing their farm. And that is why some experts say long-term care costs are a big threat to small family farms. Joining us now is NPR's Juliana Kim, who met with farmers in North Dakota. Hey there.
JULIANA KIM, BYLINE: Hi there.
DETROW: So why is the cost of long-term care such a threat to farmers specifically?
KIM: Long-term care can be really expensive, and it's generally not covered by Medicare. And that puts farmers who need nursing home care in a bind, where they might have to sell or break up their farm to pay for it. And that's not easy, especially for those whose farms have been in their family for generations.
SHERWOOD HAAKENSON: I farmed with my dad until he retired, and then I took it over.
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 at a care center in a neighboring city.
DETROW: Why was he there?
KIM: Sherwood needed 24-hour supervision for his heart and kidney issues. The staff took good care of him and gave him company, being away from his wife and cat. But back at home, his wife, Cindie, was really stressed about how they could keep affording his care.
CINDIE: We got farm land that we own. We could sell, but, you know, it's like giving away part of your legacy.
KIM: The problem for most small family farmers is that they're land-rich, cash-poor, meaning they don't have tens of thousands of dollars lying around.
DETROW: Right. So how did the people that you talked to come up with the cash they needed, then?
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. And for farmers, that means their land.
DETROW: 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 can't own land anymore 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.
DETROW: I mean, that is a really long time. Farmers have to plan that far in advance?
KIM: Yeah. I mean, if they don't plan ahead and end up at a nursing home, they might need to sell off their land. I will say most farmers can afford three years or so of care before it gets to that, but it's still a big fear almost every small farmer has.
DETROW: Let's go back to the person we heard from the top, Sherwood. What did he and his wife, Cindie, end up doing?
KIM: Cindie was going to sell their pickup truck, but then two months after I visited, Sherwood died. And so now even as she mourns her husband's death, Cindie is still working to protect their farm. She says as long as she stays healthy for the next two years until Medicaid kicks in, the land can stay in their family.
DETROW: That is NPR's Juliana Kim. Thank you so much.
KIM: Thank you.
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