Author Topic: Not enough  (Read 27957 times)

EnjoyIt

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Not enough
« on: January 17, 2016, 01:14:24 PM »
I wanted to talk about a topic I fear greatly and why I think I don't have enough to retire.  A little about myself first.  I am a physician, married with kids to come in the near future.  I save about 60-70% of my after tax pay with the hope of being able to retire early in my career (more about that in a future thread.) 

My investable assets are $1.25 million.  By most mustachian standards I should be retired right?  Being in the medical profession I feel I need much more money for the future.  I constantly see patients requiring certain medical care that just isn't covered by insurance.  At some point my our lives we will be unable to do all the things that we need to survive.  Not having a good advocate or assistant to help you out can really be a matter of healing appropriately from an ailment or being bed bound for the rest of your miserable life.  I calculate these services costing $50K-$100K a year depending on what assistance you may really require.

Here is a real life example I recently saw.  Patient ends up falling and having a hip fracture.  All the hospital care is covered by insurance, and the patient leaves for a rehab facility to build strength.  Unfortunately the facility which is covered by insurance is unable to care for this person at night. That person confused at night tries to get out of bed, slips and falls, hits their head and has a brain bleed disabling them for the rest of their life.  This would have been avoided by hiring an out of pocket sitter at night.

Another real life example. A patient leaves the hospital to a temporary skilled nursing facility after a very bad wound infection.  These facilities are covered by insurance and everything is paid for. Many times the nurse to patient ratios at these facilities are very high and patients don't always get the best care. This patient ends up developing a urinary tract infection that goes unnoticed.  The patient becomes confused and that is also unnoticed. After 2-3 days it eventually gets realized and the patient is sent to the hospital. The only difference is that they are now in renal failure. This would have been avoided if you were able to hire an advocate who can look in on you on a regular basis to make sure you are getting appropriate care.

I see this stuff all the time and I am concerned. This is why I think we need a minimum of $2.5 million to retire.

Any thoughts or comments are greatly appreciated.

Sjalabais

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Re: Not enough
« Reply #1 on: January 17, 2016, 01:28:06 PM »
Seriously, contemplate moving to a country with a proper social security system. Most of Europe will offer proper health care coverage, and being a doctor, moving to a new country shouldn't be a problem at all. Just work off the remaining years somewhere where this issue won't occur. Here's a random photo from the French alps, imagine living in a cabin with that view, eating cheese all day.



Edit: First and foremost - not all risk can be eliminated. The 4% rule alone can become a shaky thing for early retirement, as is discussed here frequently. The danger of a sudden catastrophe for one's health speaks even more for early retirement than against it, imho.
« Last Edit: January 17, 2016, 01:33:31 PM by Sjalabais »

matchewed

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Re: Not enough
« Reply #2 on: January 17, 2016, 01:31:12 PM »
A)
Quote
By most mustachian standards I should be retired right?
Doesn't actually mean anything. It is all relative to your expenses.

B) If you take care of your body and ensure you live a healthy lifestyle you're doing way more for that future scenario than socking away an extra whatever hundreds of thousands of dollars you're thinking.

C) No consideration of social programs.

ulrichw

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Re: Not enough
« Reply #3 on: January 17, 2016, 01:46:04 PM »
B) If you take care of your body and ensure you live a healthy lifestyle you're doing way more for that future scenario than socking away an extra whatever hundreds of thousands of dollars you're thinking.

As a physician, Beckmaster would probably have accounted for this already, and should be fairly qualified to account for the impact of lifestyle choices.

We all will die eventually, and by taking care of yourself, you're not guaranteeing yourself a sudden death. Sure, you may add 20 years to your lifespan, but when you get close to the end of your life, you may have similar issues as a less healthy individual 20 years your junior.

The one mitigating factor that I see is that Beckmaster may be getting a biased view of the risk. As a physician, you see people/cases when they are at their worst. It is quite possible (perhaps even likely) that the risk of those extreme cases is lower than you'd think from your personal experience.

EnjoyIt

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Re: Not enough
« Reply #4 on: January 17, 2016, 01:52:37 PM »
Sjalabais,
No country has a social network that will fix this problem.  At the end of the day nursing homes and rehab facilities all over the world suck and bring a lot of risk to your life. 

A)
Quote
By most mustachian standards I should be retired right?
Doesn't actually mean anything. It is all relative to your expenses.

B) If you take care of your body and ensure you live a healthy lifestyle you're doing way more for that future scenario than socking away an extra whatever hundreds of thousands of dollars you're thinking.

C) No consideration of social programs.

A) Indeed, I know I don't need much to be happy.
B) No amount of current health will prevent a future hip fracture.  About 4 months ago I took care of a guy who fell of his bike and broke his hip.  He used to ride his bike everywhere.  I believe I live a very healthy lifestyle.  Excersize regularly, eat healthy fresh foods and have cut down work drastically as well allowing me more time to enjoy my life. 
C) Social programs don't protect you from the nursing home or rehab facility.  Actually this statement is the reason why these facilities suck so much.  People really on these social programs that are piss ass poor to begin with and then wonder why they get crummy outcomes.  I fear you need to self insure for this.

B) If you take care of your body and ensure you live a healthy lifestyle you're doing way more for that future scenario than socking away an extra whatever hundreds of thousands of dollars you're thinking.

The one mitigating factor that I see is that Beckmaster may be getting a biased view of the risk. As a physician, you see people/cases when they are at their worst. It is quite possible (perhaps even likely) that the risk of those extreme cases is lower than you'd think from your personal experience.

This is definitely true, I indeed realize I get to see the worst of things.  But reality shows that a large percentage of people end up in a nursing home and they scare the crap out of me.  All the ones that are covered by insurance suck.  You can always pay extra cash for better care though.
« Last Edit: January 17, 2016, 01:55:37 PM by Beckmaster »

Sailor Sam

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Re: Not enough
« Reply #5 on: January 17, 2016, 01:58:10 PM »
I see your point, but I don't necessarily think the solution is money. You can pay someone to watch over you 24/7, but a more robust solution is to build yourself a secure social network. Make friends, and be sure to make them across the generations.

If your friend ends up in a skilled care facility, be the person watching out for their sudden confusion, or worsening wound status. And have young people who will do the same for you.

abhe8

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Re: Not enough
« Reply #6 on: January 17, 2016, 01:58:22 PM »
Well, I'm assuming these examples you give are people on medicaid or medicare. I think private insurance alone will go a long way towards better care. I also think well educated (wrt health care) and attentive family/friends are key to a patients speedy recovery from anything requiring hospitalization. Of course you need an advocate!! But if you want to avoid a nursing home, you can set in place detailed advanced directives. And if you already have 1.25 mil, it should not take you any time at all to double it. Not every mustachian has the same fire number, and that's OK.
« Last Edit: January 17, 2016, 02:03:01 PM by abhe8 »

tipster350

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Re: Not enough
« Reply #7 on: January 17, 2016, 02:13:20 PM »
Your points resonate with me. I am in healthcare, in administration management, with lots of experience in the clinical areas as well as insurance. In addition, I have personal experience with the type of scenarios you present, having been through some horrific times desperately trying to help family members with few resources. I have seen most angles of what happens to a person with inadequate resources. And it is nothing short of tragic and horrifying.

Even an item that could very well be in a lot of our futures--Depends--are very expensive and can significantly add to monthly living expenses.

I have found on this site a tendency in many to be unaware of and underestimate what can happen and how much it would cost to take care of medical and support needs. We also know that no matter how well you take care of yourself, things happen out of your control.

Personally, I will be ready to check out at 1.25 million, probably a little less, but by the time I have that much, I will be around 60 years old.

At some point you will need to roll the dice. There is risk involved in the choice to RE and there is risk in waiting to save more money. No one can say where the line will be for you. It's a tough balance.

Letj

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Re: Not enough
« Reply #8 on: January 17, 2016, 02:13:42 PM »
I see your point, but I don't necessarily think the solution is money. You can pay someone to watch over you 24/7, but a more robust solution is to build yourself a secure social network. Make friends, and be sure to make them across the generations.

If your friend ends up in a skilled care facility, be the person watching out for their sudden confusion, or worsening wound status. And have young people who will do the same for you.

I am afraid that a lot of this is bad luck. No amount of money to buy private care would guarantee that you don't fall and hit your head or develop some kind of infection. I can think of numerous stories where wealthier people hired private care and did not have better outcomes. Here are two real life examples: a wealthy retired engineer developed alzheimer's. He has great insurance and long term care (apparently he made some really good decisions). His family hired home  health aides to be with him 24 hours a day which the insurance pays for. The aids were not trained properly and the poor guy fell twice bursting open his head while the aids were sleeping at night. All he was trying to do was to get to the bathroom. In the 2nd example, a woman from a very wealthy family developed a brain aneurysm and had no short term memory. While out shopping with the aid, she walked right into a glass door and almost knocked her self out. She died not too long after but it may not be related to that incident. She was only about 50. Not too long ago, families were larger and often parents lived with their children who looked after them. My mother was ill recently and we took turns sitting day and night in the hospital with her. Those type of work are better left to the loved ones but we don't live in that world anymore.

EnjoyIt

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Re: Not enough
« Reply #9 on: January 17, 2016, 02:30:59 PM »
Well, I'm assuming these examples you give are people on medicaid or medicare. I think private insurance alone will go a long way towards better care.

Unfortunately no, it makes no difference as these facilities take both private insurance and medicare patients.  Once in, the nurse has no clue how or if you are paying for your care.  In the US pretty much everyone over 65 is medicare.  You can buy supplemental insurance to make it better though.  You can pay out of pocket and make it even better.

I also think well educated (wrt health care) and attentive family/friends are key to a patients speedy recovery from anything requiring hospitalization. Of course you need an advocate!! But if you want to avoid a nursing home, you can set in place detailed advanced directives. And if you already have 1.25 mil, it should not take you any time at all to double it. Not every mustachian has the same fire number, and that's OK.

Example from my life.  Grandma is in a nursing home and my mom checks in on her regularly. Although her organs are very healthy her mind is not all there.  She often does things she should not do and really needs 24/7 care. My mother physically can not take care of her 24/7.  I live far away and can only help over the phone.  I have flown in a couple of times to make sure the right things are done.  Despite our cumulative knowledge and vigilance, my mother went on vacation for 9 days.  When she returned my grandmother was confused and bedridden. It turned out she had a urinary tract infection.  Unfortunately those few days of being bed ridden and the few more treating the disease got her so atrophied she was wheelchair bound for months doing rehab and has never returned to baseline.  If only an advocate was hired to keep an eye on her back then.  And BTW, this is considered one of the best nursing homes in the area.

I see your point, but I don't necessarily think the solution is money. You can pay someone to watch over you 24/7, but a more robust solution is to build yourself a secure social network. Make friends, and be sure to make them across the generations.

If your friend ends up in a skilled care facility, be the person watching out for their sudden confusion, or worsening wound status. And have young people who will do the same for you.

I am afraid that a lot of this is bad luck.

That means I am witness to a huge amount of bad luck because I see this on a daily basis.

Here are two real life examples: a wealthy retired engineer developed alzheimer's. He has great insurance and long term care (apparently he made some really good decisions). His family hired home  health aides to be with him 24 hours a day which the insurance pays for. The aids were not trained properly and the poor guy fell twice bursting open his head while the aids were sleeping at night. All he was trying to do was to get to the bathroom. In the 2nd example, a woman from a very wealthy family developed a brain aneurysm and had no short term memory. While out shopping with the aid, she walked right into a glass door and almost knocked her self out. She died not too long after but it may not be related to that incident. She was only about 50. Not too long ago, families were larger and often parents lived with their children who looked after them. My mother was ill recently and we took turns sitting day and night in the hospital with her. Those type of work are better left to the loved ones but we don't live in that world anymore.

I would agree that hired help might not save you, but it would definitely decrease your risks.

Your points resonate with me. I am in healthcare, in administration management, with lots of experience in the clinical areas as well as insurance. In addition, I have personal experience with the type of scenarios you present, having been through some horrific times desperately trying to help family members with few resources. I have seen most angles of what happens to a person with inadequate resources. And it is nothing short of tragic and horrifying.

Those in healthcare know what I am talking about.  It is really scary out there.

steveo

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Re: Not enough
« Reply #10 on: January 17, 2016, 02:56:37 PM »
If you take care of your body and ensure you live a healthy lifestyle you're doing way more for that future scenario than socking away an extra whatever hundreds of thousands of dollars you're thinking.

Yep. I think we can really put the odds in our favour when it comes to our health. Good food and exercise along with probably doing some extra stuff for your mind and you have a much better chance of living well for longer.

Beardog

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Re: Not enough
« Reply #11 on: January 17, 2016, 03:48:17 PM »
From EnjoyIt:
Quote
This is definitely true, I indeed realize I get to see the worst of things.  But reality shows that a large percentage of people end up in a nursing home and they scare the crap out of me.  All the ones that are covered by insurance suck.  You can always pay extra cash for better care though.

Page 150 of the following 2014 document indicates that about 3% of the over 65 population was in a nursing home at any one time in 2010:
https://www.census.gov/content/dam/Census/library/publications/2014/demo/p23-212.pdf

I worked in a nursing home when I was in college and the experience didn't make me eager to become a customer.  We all will reach the end of life at some point in time.  If I am lucky enough to live a long life and reach a point at which I am completely unable to take care of myself or am so confused that I am a hazard to myself, I hope that I pass quickly instead of lingering in a nursing home, even if the nursing care I'm receiving is exemplary.  To me, living in a nursing home would not be living.  I would only want to go there as part of a rehabilitative process, not as the end point to my life.


mxt0133

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Re: Not enough
« Reply #12 on: January 17, 2016, 03:49:02 PM »
What I'm hearing is even if you do save up for a higher quality nursing home/long-term care facility you still need to hire a third party advocate that knows the patients exact needs and conditions.  They also need to be around almost 24/7 and not take vacations because their substitute might not know all the patients specific needs.

I guess this becomes a personal decision on how much one wants to save for future possible health care costs vs doing the things that make them happy now.  I think most people approach this situation with the mindset of I'll save what I can for the future but also live a worthwhile and full-fulling life now, so that if something does happen that reduces my quality of life later on or even in the near future then so be it, I have lived a live according to my values and I can die with no regrets, however painful my final moments maybe.

There are just so many things that are out of our control and your perspective from a healthcare perspective is very similar from a financial one.  I'm not saying that your concerns are not valid however there comes a point where trying to prepare for every single outcome becomes impractical or cost prohibitive.

Another thing that I can relate with OP is that nursing homes do scare the crap out of me, but not for the same reasons as the OP.  I'm not so much concerned with the quality of care, other than the abusive ones where there are videos of caregivers clothes lining patients, I am more so concerned about the lost of autonomy and familiar environment.  The book 'Being Mortal' comes close to summarizing how I feel about end of life care.

I have a grandmother that was moved to a nursing home after my grandfather died.  The used to live in their house where they raised five children and were retired for 30 years.  During the last years of my grandfather's live they had two full-time care givers taking care of them.  They were close to family and friends.  Even though they did not get the best medical care, they lived a life worth living.  No my grandmother is in a nursing home that is far away from her old house, family, and friends.  Only her youngest son looks in on her twice a week for an hour or so at a time.  For me I would rather risk falling in my own home, close to friends and family, having the autonomy of eating and bathing when I want than to, than being in a unfamiliar place around people I don't know, being told when to do things. 

I think people not in the situation, such as the patients children and caregivers, put a higher priority on safety than the patients actual happiness, condemning their loved ones to a prolonged and miserable life.

AlwaysBeenASaver

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Re: Not enough
« Reply #13 on: January 17, 2016, 04:10:15 PM »
It has to do with your own personal comfort level, and if you wouldn't be comfortable FIREing until you could pay for these potential situations, you shouldn't - no one else can determine what your personal comfort level is. For me, I know those things can happen and could be problematic financially, however I had to compare those to the possibility of working until death. One of my closest friends died at age 48, still working. Another acquaintance died around age 50 in his sleep - totally unexpected - still working. A friend's son died in his late 20's of an unexpected massive heart attack, still working - turns out he had an undetected heart defect. So I had to take those things into consideration too - the longer I waited to FIRE, the increased potential to die while still working. Life is all about trade offs and making choices, weighing out the possibilities.

Shane

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Re: Not enough
« Reply #14 on: January 17, 2016, 04:16:18 PM »
This is definitely true, I indeed realize I get to see the worst of things.  But reality shows that a large percentage of people end up in a nursing home and they scare the crap out of me.  All the ones that are covered by insurance suck.  You can always pay extra cash for better care though.

Maybe it depends on where you live, but in my state Hospice patients on Medicaid stay in the exact same facility, see the exact same doctors and nurses and get the exact same care as people who have long term care insurance or who can afford to pay $10K-$13K/mo. out of pocket.

Beardog

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Re: Not enough
« Reply #15 on: January 17, 2016, 04:19:39 PM »
... For me, I know those things can happen and could be problematic financially, however I had to compare those to the possibility of working until death. One of my closest friends died at age 48, still working. Another acquaintance died around age 50 in his sleep - totally unexpected - still working. A friend's son died in his late 20's of an unexpected massive heart attack, still working - turns out he had an undetected heart defect. So I had to take those things into consideration too - the longer I waited to FIRE, the increased potential to die while still working. Life is all about trade offs and making choices, weighing out the possibilities.

+1

Kris

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Re: Not enough
« Reply #16 on: January 17, 2016, 04:22:26 PM »
... For me, I know those things can happen and could be problematic financially, however I had to compare those to the possibility of working until death. One of my closest friends died at age 48, still working. Another acquaintance died around age 50 in his sleep - totally unexpected - still working. A friend's son died in his late 20's of an unexpected massive heart attack, still working - turns out he had an undetected heart defect. So I had to take those things into consideration too - the longer I waited to FIRE, the increased potential to die while still working. Life is all about trade offs and making choices, weighing out the possibilities.

+1

This. My mom worked and saved to have enough to be completely safe in retirement almost no matter what. And the, 3 days after her 65th birthday and a month before she was set to retire, she was diagnosed with stage 4 cancer. She was dead 6 weeks later.


Shane

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Re: Not enough
« Reply #17 on: January 17, 2016, 04:33:41 PM »
I think people not in the situation, such as the patients children and caregivers, put a higher priority on safety than the patients actual happiness, condemning their loved ones to a prolonged and miserable life.

+1

At the end of my grandfather's 90+ year life all he wanted was to be able to live out his last days in his own home where he and my grandmother had lived for over 60 years. Because of family members' concerns about safety, my grandfather was forced, against his will, to move in to a nursing home where he absolutely HATED it. My grandfather complained constantly about the food in the nursing home, and he tried to escape multiple times. Once, he made it all the way down to McDonald's, a few blocks away, where the nursing home staff captured him while he was eating his cheeseburger and forced him to go back.

Excessive worry about the safety of 90+ year old people makes no sense to me. Who cares if they choke on a peanut and die? Who cares if they fall, hit their heads and die? They're going to die anyway. What the fuck's the difference if they die suddenly from an accident or they die a long, slow, painful death from cancer? I know I'd choose the former any day.

tobitonic

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Re: Not enough
« Reply #18 on: January 17, 2016, 04:51:42 PM »
I don't really get this fear of dying before having retired. It sounds as materialistic as being afraid of dying before having been to Disneyworld or earned a million dollars or owned a sports car.

To the OP, you're looking for a kind of security that you're not going to find with money. What you need, as only a handful of people have pointed out, are people who care about you independently of money.

Although it's very rarely discussed on this forum since the local god is a big ol' stache, having strong social connections (whether through friends or family who frequently see and check in on you) is actually one of the strongest factors correlated with longevity.

Ironically, despite the overwhelming focus on the 'stache and the independence it brings, money is almost completely unrelated to longevity, as evidenced by longevity populations around the world. Or in short, the title of the OP is completely accurate, but not for the reasons OP thinks.
« Last Edit: January 17, 2016, 04:53:36 PM by tobitonic »

Gin1984

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Re: Not enough
« Reply #19 on: January 17, 2016, 05:24:00 PM »
Well, I'm assuming these examples you give are people on medicaid or medicare. I think private insurance alone will go a long way towards better care. I also think well educated (wrt health care) and attentive family/friends are key to a patients speedy recovery from anything requiring hospitalization. Of course you need an advocate!! But if you want to avoid a nursing home, you can set in place detailed advanced directives. And if you already have 1.25 mil, it should not take you any time at all to double it. Not every mustachian has the same fire number, and that's OK.
When my grandmother went into a private pay rehab facility she was told by a CNA to stand up from her wheelchair.  She was there because she had a broken femur and if I had not intervened she would have ended up back in the hospital because of more injuries from the fall, because of course, her broken femur could not hold her full weight nor could her other leg without injury.  My family was able to deal with the CNA and then the RN and then head of facility because of experience with medicine but most families don't have the knowledge.  I have lost track of the amount of friends who have called my mother to come deal with issue, both in the hospital or skilled nursing facilities.  Many of these people were educated but not in medical laws or medicine in general.  I would highly endorse the OP's idea of hiring an advocate especially in the states in which RNs are not legally required to be one (and in non-Union places).

EnjoyIt

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Re: Not enough
« Reply #20 on: January 18, 2016, 06:50:42 AM »
OP here.  I believe there are some very valid points to be made particularly regarding accepting that risk. I agree with all that I would rather die a quick death than to languish for years in a nursing home. Actually my wife and I have agreed to kill the other one off if the other becomes a vegetable. I will teach my kids the same.

In reality there is a very high probability that despite how healthy we eat and how much we bike around town, we will end up at one of these facilities or at home requiring out of pocket extra help. That is a fact. Though if we retire early, I don't think this is something too expensive to save for today particularly if we plan on retiring in our 40s or 50s.

In fact this is just a simple math problem. Let's assume we will need $100K a year for the extra help for 5 years. This doesn't mean we need to save 25 X $100k or $2.5 million. What we need is an extra $500K towards end of life care.  If we are expecting to live into our 80's but retiring at 50, all we need is to save is $115K and let it compound at 5% over the next 30 years.  That number is probably even less since you will be less active in your old age and spend less of your stache anyways. Also, the earlier you retire the more years of compounding you will have to reach your goal.  For example if you have 35 years till you are 80 years old then all you need is an extra $91K to compound over 35 years.

So let's just assume a nice round number of $100K. I understand $100K may seam a lot for some though the closer you get to FIRE the easier it is. For example let's assume a family of 2 with a combined income of $80K/yr who save $30K a year and need $750K to retire. How long will it take to raise an extra $100K to subsidize future health needs? 

An extra 1.5 years of work will provide this couple with the extra $100K now so that in the future they can avoid a nursing home and live a miserable nursing home existence in the last few years of life. I don't think that is too unreasonable.

jim555

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Re: Not enough
« Reply #21 on: January 18, 2016, 07:00:30 AM »
To the OP.  Let me get this straight, you have a very small risk of ending in the situation described.  So to mitigate it you will need an additional 1.25 million.  This will take years of your life to achieve.  Seems like a bad trade off to me.

Gin1984

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Re: Not enough
« Reply #22 on: January 18, 2016, 07:02:31 AM »
To the OP. Let me get this straight, you have a very small risk of ending in the situation described.  So to mitigate it you will need an additional 1.25 million.  This will take years of your life to achieve.  Seems like a bad trade off to me.
Except his experience is telling him the opposite, there is a large chance of ending up in that situation.

jim555

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Re: Not enough
« Reply #23 on: January 18, 2016, 07:04:40 AM »
To the OP. Let me get this straight, you have a very small risk of ending in the situation described.  So to mitigate it you will need an additional 1.25 million.  This will take years of your life to achieve.  Seems like a bad trade off to me.
Except his experience is telling him the opposite, there is a large chance of ending up in that situation.
His experience is in conflict with the actual odds.

Louisville

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Re: Not enough
« Reply #24 on: January 18, 2016, 07:09:25 AM »
Maybe if you are so sick that you need 24/7, expert care, you're supposed to die.

pbkmaine

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Not enough
« Reply #25 on: January 18, 2016, 07:09:32 AM »
OP here.  I believe there are some very valid points to be made particularly regarding accepting that risk. I agree with all that I would rather die a quick death than to languish for years in a nursing home. Actually my wife and I have agreed to kill the other one off if the other becomes a vegetable. I will teach my kids the same.

DH and I feel the same way. In the absence of physician-assisted suicide laws in our state, how do we accomplish this?
« Last Edit: January 18, 2016, 07:11:10 AM by pbkmaine »

Louisville

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Re: Not enough
« Reply #26 on: January 18, 2016, 07:10:31 AM »
To the OP. Let me get this straight, you have a very small risk of ending in the situation described.  So to mitigate it you will need an additional 1.25 million.  This will take years of your life to achieve.  Seems like a bad trade off to me.
Except his experience is telling him the opposite, there is a large chance of ending up in that situation.
His experience is in conflict with the actual odds.
+1. As a doctor, he doesn't see well people day in and day out. He only sees sick people. His sample is WAY biased.

Fishindude

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Re: Not enough
« Reply #27 on: January 18, 2016, 07:15:47 AM »
Even if you take the fear of healthcare costs off the table, I agree with your concerns and don't think you have enough stashed away to FIRE very comfortably.
You are a physician, earning physician income levels, living no doubt a pretty good lifestyle.  Although not shabby, $1.25 mil just won't kick back enough return for you to live very well on.   What happens when you need to replace a car, put a new roof on the house, etc.?
« Last Edit: January 18, 2016, 07:31:29 AM by Fishindude »

Louisville

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Re: Not enough
« Reply #28 on: January 18, 2016, 07:21:51 AM »
I don't really get this fear of dying before having retired. It sounds as materialistic as being afraid of dying before having been to Disneyworld or earned a million dollars or owned a sports car.

To the OP, you're looking for a kind of security that you're not going to find with money. What you need, as only a handful of people have pointed out, are people who care about you independently of money.

Although it's very rarely discussed on this forum since the local god is a big ol' stache, having strong social connections (whether through friends or family who frequently see and check in on you) is actually one of the strongest factors correlated with longevity.

Ironically, despite the overwhelming focus on the 'stache and the independence it brings, money is almost completely unrelated to longevity, as evidenced by longevity populations around the world. Or in short, the title of the OP is completely accurate, but not for the reasons OP thinks.
Agree with the idea that social connections are the key to not only a long life, but a happy one, too.
I have to disagree with your characterization of this community, though. MMM's posts, and the posts of most of the profilific old timers say that money is just a means to an end, the end being a happy, socially connected life. That's why we focus on retiring on a small SWR.

Gin1984

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Re: Not enough
« Reply #29 on: January 18, 2016, 07:38:57 AM »
Maybe if you are so sick that you need 24/7, expert care, you're supposed to die.

Very true, at least if it's a case of needing this for extended periods of time (i.e., more than a week).
My grandmother broke a hip, she needed round the clock care for six weeks.  Then rehab.  If my aunt, my mom and myself had not taken off work the cost would have been over $10,000 just for the care.  The rehab was more.  And if we had not been there, the rehab place would have injured her more.  It is not expert care, in fact part of the problem is that nursing homes are not expert care.
« Last Edit: January 18, 2016, 07:52:00 AM by Gin1984 »

tobitonic

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Re: Not enough
« Reply #30 on: January 18, 2016, 07:44:41 AM »
Maybe if you are so sick that you need 24/7, expert care, you're supposed to die.

Very true, at least if it's a case of needing this for extended periods of time (i.e., more than a week).
My grandmother broke a hip, she needed round the clock care for six weeks.  Then rehab.  If my aunt, my mom and myself had not taken off work the cost would have been over $10,000 just for the care.  The rehab was more.  And if we had not been there, the rehab place would have injured her more.  It is not expert care, in fact we part of the problem is that nursing homes are not expert care.

I'm not sure what happened to my comment; I was trying to edit it and I think I deleted it. But I was going to clarify that I felt this was true for chronic, irreversible conditions, rather than for broken bones or snake bites or otherwise acute situations.

Gin1984

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Re: Not enough
« Reply #31 on: January 18, 2016, 07:47:07 AM »
Maybe if you are so sick that you need 24/7, expert care, you're supposed to die.

Very true, at least if it's a case of needing this for extended periods of time (i.e., more than a week).
My grandmother broke a hip, she needed round the clock care for six weeks.  Then rehab.  If my aunt, my mom and myself had not taken off work the cost would have been over $10,000 just for the care.  The rehab was more.  And if we had not been there, the rehab place would have injured her more.  It is not expert care, in fact we part of the problem is that nursing homes are not expert care.

I'm not sure what happened to my comment; I was trying to edit it and I think I deleted it. But I was going to clarify that I felt this was true for chronic, irreversible conditions, rather than for broken bones or snake bites or otherwise acute situations.
LOL.  Well at least you have record you were trying. ;)
But the problem is that people don't account for the broken bones etc. in their planning.  And I think people are underestimating how much they will spend and what the risk is.  People here are saying the risk is small, with no actual data and saying the person who sees it is biased. 

Tetsuya Hondo

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Re: Not enough
« Reply #32 on: January 18, 2016, 07:50:02 AM »
To the OP. Let me get this straight, you have a very small risk of ending in the situation described.  So to mitigate it you will need an additional 1.25 million.  This will take years of your life to achieve.  Seems like a bad trade off to me.
Except his experience is telling him the opposite, there is a large chance of ending up in that situation.
His experience is in conflict with the actual odds.
+1. As a doctor, he doesn't see well people day in and day out. He only sees sick people. His sample is WAY biased.

Came here to say the same thing. Yes, the OP's scenarios can happen, but how likely are they? Given the OP's profession and a little quirk in our cognitive machinery known as the availability heuristic, it's easy to overestimate the likelihood of it actually happening. If you apply the same logic to everything with the same or worse odds, you would never leave the house.


Fastfwd

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Re: Not enough
« Reply #33 on: January 18, 2016, 07:55:30 AM »
Living in Canada and thankful for that. I would be really worried if I had to plan for retirement with health care costs of the USA. Then again this could change as there is a clear tendency towards privatization here.

I also have a friend who is a doctor and they really are biased towards worrying about health but in his case it means live now because maybe there is no tomorrow. Not to the point of being reckless or unable to retire in comfort but definitely not delaying dreams today for dreams of tomorrow. I try to think of it as being fair between present me and future me.

elaine amj

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Re: Not enough
« Reply #34 on: January 18, 2016, 08:12:53 AM »
I guess I have a more optimistic view of things. My mother in law lived with me for 10 years. When I returned to work, we hired someone to come 2 hours a day because she was afraid of being home alone all day. While it wasn't all sunshine and roses - I was glad she was able to be a part of our family life and watch the children grow up. A few months ago, she fell and that increased her fears of being alone. She asked to go to a nursing home. She is now in a public nursing home (in Canada) - her payments are geared to income as she has pretty much no assets and very minimal income (i.e. poverty line). They take about 70% of her monthly income, leaving her with under $400 extra a month.

Amazingly, she is happy there. We visit weekly and the nursing staff seem overall a very caring group. In a sense, they don't monitor her diabetes the way we do and I know she eats way too much and I'm sure her sugars are not the greatest. Also, she really doesn't walk there - they push her around in wheelchairs all the time so we feel her muscles are going to atrophy. Still, it's been several months now and she is still doing fine. Best of all, she's in really good spirits. She used to complain ALL the time. And I haven't heard any complaints from her since she moved there. Not even when the laundry loses her socks lol.

My husband will be spending a few days a week there soon to supervise nursing students so he'll get a closer look at the back end of the operation which will give us some peace of mind. We have talked to people who have worked there in the past and they all have good things to say. Keep in mind, this is considered one of the least desirable public nursing homes in the community with the shortest waiting list.

All that said - yes, I am optimistic about my retirement years. Yes, I am probably underestimating some things. It is a risk. But isn't everything?

nereo

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Re: Not enough
« Reply #35 on: January 18, 2016, 08:14:32 AM »
OP here.
...we plan on retiring in our 40s or 50s.

In fact this is just a simple math problem. Let's assume we will need $100K a year for the extra help for 5 years. This doesn't mean we need to save 25 X $100k or $2.5 million. What we need is an extra $500K towards end of life care.  If we are expecting to live into our 80's but retiring at 50, all we need is to save is $115K and let it compound at 5% over the next 30 years.  That number is probably even less since you will be less active in your old age and spend less of your stache anyways. Also, the earlier you retire the more years of compounding you will have to reach your goal.  For example if you have 35 years till you are 80 years old then all you need is an extra $91K to compound over 35 years.
...
An extra 1.5 years of work will provide this couple with the extra $100K now so that in the future they can avoid a nursing home and live a miserable nursing home existence in the last few years of life. I don't think that is too unreasonable.
Hello EnjoyIt.  Nice to see you here

Perhaps you've shifted a bit since starting this thread, but I do not quite understand your posts.  In your OP, you said that you needed/wanted $2.5MM to retire, but in the post (above) you pointed out that saving an extra ~$100k and allowing that to compound for 30-40 years would be sufficient to cover end-of-life care even in nursing homes. 
I believe the math you did above showing you need only an extra $100k is closer to being correct.
I do not understand hwy you would claim to need $2.5MM to RE unless you planned on spending ~$100k/year every single year until you died.

Looking at it still another way, $100k saved today will compound to $700k over the next 40 years at 5% (your chosen annual return rate).  or $551k over 35 years. 

Ultimately though, what matters is how much you have saved, and how much you expect to spend in retirement.  If you have already saved more than 25x future spending you will almost certainly see your 'stach grow over the next 30 years, so the increase in end-of-life care is already factored in there.  Over several decades you will either deplete your 'stach (oops) or have it grow, so at the end of your life you'll have more money than you do the day you retire.

Finally - don't forget assets like your home and SS. 

ETBen

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Re: Not enough
« Reply #36 on: January 18, 2016, 08:25:12 AM »
I was an ER nurse and always thought about these things.  You see the worst. 

I now work as a population health consultant with chronic care.  You have to consider what happens to the average person at older ages.  Or the distribution.  You're more likely to take a lot of Rx at home than be in and out of SNFs.  That's a cost to plan for, but not necessarily a terrible quality of life.  Also, entering older age with an education and at a certain socioeconomic class both affect what you can likely expect.  There will always be outliers, of course. 

SeanMC

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Re: Not enough
« Reply #37 on: January 18, 2016, 08:31:57 AM »
I agree that the biggest "risk" is chronic disability or health issues that are prohibitively expensive. I have a (minor) chronic condition that I was born with, and I worry about having problems when I get older, even if I do eat healthy, exercise, etc. I do not worry about dying. I worry about aging and having my wishes disregarded or needlessly suffering.

I also disagree that this intractable societal problem can be solved by saving "more." At a certain point, you simply cannot save enough to meet the true cost of long-term care, especially if the standard is defined as 24/7 skilled surveillance for an indefinite amount of time. Nor can you predict what ailment or calamity will befall you.

For those of us living in the US, we also cannot foresee how our social welfare system for seniors will change in the next 30+ years. I am 40 years old and have some expertise in health law/policy. I cannot tell you what the system rules will be when I am 75. I do agree that the system is currently broken in many ways. One issue is that unless you are super rich enough to be paying everything out of pocket, the long-term system is set up to drain you of all your resources til you have nothing (and to provide everyone the same level of care that still requires you to have outside support network or advocate for yourself).

As I age, I plan to be flexible and aware of how the system is morphing to set myself up as best as possible. I also continue to track my best non-US retirement option that has a different care system (I have a mostly ex-pat family, so for me, this is straightforward & reveals that moving doesn't cure all).

But at the end of the day, I think trying to save enough to insure myself to overcome this is way too high a "premium" to pay on my quality of life.

tobitonic

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Re: Not enough
« Reply #38 on: January 18, 2016, 08:40:13 AM »
Maybe if you are so sick that you need 24/7, expert care, you're supposed to die.

Very true, at least if it's a case of needing this for extended periods of time (i.e., more than a week).
My grandmother broke a hip, she needed round the clock care for six weeks.  Then rehab.  If my aunt, my mom and myself had not taken off work the cost would have been over $10,000 just for the care.  The rehab was more.  And if we had not been there, the rehab place would have injured her more.  It is not expert care, in fact we part of the problem is that nursing homes are not expert care.

I'm not sure what happened to my comment; I was trying to edit it and I think I deleted it. But I was going to clarify that I felt this was true for chronic, irreversible conditions, rather than for broken bones or snake bites or otherwise acute situations.
LOL.  Well at least you have record you were trying. ;)
But the problem is that people don't account for the broken bones etc. in their planning.  And I think people are underestimating how much they will spend and what the risk is.  People here are saying the risk is small, with no actual data and saying the person who sees it is biased.

I think what a lot of folks (or at least what I and a few other folks) are saying is that regardless of the risk of suffering from these misfortunes, it's not a risk you can eliminate with additional savings. The OP either needs a stronger social network (something most Americans need, myself included) or, just as importantly, an acceptance of the fact that a healthy life is finite, and a willingness to die (and perhaps measures in place to ensure that death is a fast one).
« Last Edit: January 18, 2016, 08:42:23 AM by tobitonic »

Ricky

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Re: Not enough
« Reply #39 on: January 18, 2016, 08:44:25 AM »
You're never going to eliminate all risk from your life, and what's the point in trying? Even in the examples you provided, there are plenty of holes and flaws. What's the chances of those exact scenarios happening? You don't know. So don't worry about it. What's are the variables that you haven't accounted for even if all of those scenarios and any other scenario happens that you could think about? You don't know. So don't worry about it.

We live. We die. Do we really need to be concerned with anything? We're not in control of anything. You were born with a specific brain, family, house (hopefully), body, etc. You can't change those things. Change is something we think we have control over, but it's not. Your brain controls everything you will do or say from the moment you're born till you die. So in essence, your life has already been lived. Why worry about it? Do what you want when you want.

It's about taking the leap and just not worrying. The only thing you can really do is do what you can to mitigate risk to acceptable levels (differs from person to person). But you're way off the graph when you start trying to plot variables you can't even fathom.

In short, I'd rather take the chances that are worth it and truly know what it's like to live than live a life full of planning for the worse.*
If it doesn't work out, so what? Gotta leave this world one way or the other.

*Not to be confused with never planning for the future or carelessly spending money. I don't think the two are mutually exclusive. In fact, I think planning for the future IS living. But you have to know when to stop - you can take it too far.
« Last Edit: January 18, 2016, 08:58:50 AM by Ricky »

Rezdent

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Re: Not enough
« Reply #40 on: January 18, 2016, 08:50:23 AM »
To the OP. Let me get this straight, you have a very small risk of ending in the situation described.  So to mitigate it you will need an additional 1.25 million.  This will take years of your life to achieve.  Seems like a bad trade off to me.
Except his experience is telling him the opposite, there is a large chance of ending up in that situation.
His experience is in conflict with the actual odds.
+1. As a doctor, he doesn't see well people day in and day out. He only sees sick people. His sample is WAY biased.

Came here to say the same thing. Yes, the OP's scenarios can happen, but how likely are they? Given the OP's profession and a little quirk in our cognitive machinery known as the availability heuristic, it's easy to overestimate the likelihood of it actually happening. If you apply the same logic to everything with the same or worse odds, you would never leave the house.

I guess the odds that the OP is seeing may be different than the ones others are using?

I use the odds that a person will die, which is 100%.

Of that 100%, how many check out abruptly?  (Accidents, aneurysms, MI, spontaneous combustion?)

Let's say half (I'm being lazy here, I know) die suddenly, and the other half get sick or injured first, which is when doc sees them, and an alarming number of those (100% of the remaining population) finally succumb, often as a result of sub-optimal care at a SNF.  Not saying that they would have lived if the care had been better, just that they would have eventually died differently.

The odds of this happening to me seem high.

Gin1984

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Re: Not enough
« Reply #41 on: January 18, 2016, 09:19:12 AM »
To the OP. Let me get this straight, you have a very small risk of ending in the situation described.  So to mitigate it you will need an additional 1.25 million.  This will take years of your life to achieve.  Seems like a bad trade off to me.
Except his experience is telling him the opposite, there is a large chance of ending up in that situation.
His experience is in conflict with the actual odds.
+1. As a doctor, he doesn't see well people day in and day out. He only sees sick people. His sample is WAY biased.

Came here to say the same thing. Yes, the OP's scenarios can happen, but how likely are they? Given the OP's profession and a little quirk in our cognitive machinery known as the availability heuristic, it's easy to overestimate the likelihood of it actually happening. If you apply the same logic to everything with the same or worse odds, you would never leave the house.

I guess the odds that the OP is seeing may be different than the ones others are using?

I use the odds that a person will die, which is 100%.

Of that 100%, how many check out abruptly?  (Accidents, aneurysms, MI, spontaneous combustion?)

Let's say half (I'm being lazy here, I know) die suddenly, and the other half get sick or injured first, which is when doc sees them, and an alarming number of those (100% of the remaining population) finally succumb, often as a result of sub-optimal care at a SNF.  Not saying that they would have lived if the care had been better, just that they would have eventually died differently.

The odds of this happening to me seem high.
Now a days aneurysms/strokes and heart attacks are not as likely to kill but do equal time in the hospital and possibly paid for care.  If you live, you can bounce back from those and live 30 more years if you get proper care.

Rezdent

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Re: Not enough
« Reply #42 on: January 18, 2016, 09:37:32 AM »
To the OP. Let me get this straight, you have a very small risk of ending in the situation described.  So to mitigate it you will need an additional 1.25 million.  This will take years of your life to achieve.  Seems like a bad trade off to me.
Except his experience is telling him the opposite, there is a large chance of ending up in that situation.
His experience is in conflict with the actual odds.
+1. As a doctor, he doesn't see well people day in and day out. He only sees sick people. His sample is WAY biased.

Came here to say the same thing. Yes, the OP's scenarios can happen, but how likely are they? Given the OP's profession and a little quirk in our cognitive machinery known as the availability heuristic, it's easy to overestimate the likelihood of it actually happening. If you apply the same logic to everything with the same or worse odds, you would never leave the house.

I guess the odds that the OP is seeing may be different than the ones others are using?

I use the odds that a person will die, which is 100%.

Of that 100%, how many check out abruptly?  (Accidents, aneurysms, MI, spontaneous combustion?)

Let's say half (I'm being lazy here, I know) die suddenly, and the other half get sick or injured first, which is when doc sees them, and an alarming number of those (100% of the remaining population) finally succumb, often as a result of sub-optimal care at a SNF.  Not saying that they would have lived if the care had been better, just that they would have eventually died differently.

The odds of this happening to me seem high.
Now a days aneurysms/strokes and heart attacks are not as likely to kill but do equal time in the hospital and possibly paid for care.  If you live, you can bounce back from those and live 30 more years if you get proper care.

Absolutely true.  I was trying to give examples where sudden death would eliminate a portion of the 100% who will die. If survived, then the person would fall into the other camp of needing care and dying of other causes like a medical error in a SNF.

Tetsuya Hondo

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Re: Not enough
« Reply #43 on: January 18, 2016, 09:42:22 AM »
The odds of this happening to me seem high.

Lot's of things seem one way or the other. But, that's not terribly useful and often misleading.

What does the data show? Does anyone know of any data/research that can shed light on this?

pbkmaine

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Re: Not enough
« Reply #44 on: January 18, 2016, 10:07:57 AM »
There's data, there's observation, and there's personal experience. As an example, both of my parents died young (cancer and heart attack) but 3 of their 4 parents lived to a ripe old age. My dad died at 65, but his brother and sister are still alive at 95 and 99. I have no idea what this means for my own longevity, so I saved extra and bought LTC insurance.

bacchi

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Re: Not enough
« Reply #45 on: January 18, 2016, 10:17:33 AM »
In most cases, the SWR yields a bunch of extra money at the end, which can be used for end-of-life care and inheritances. Reducing the SWR slightly can increase the chances of that happening but even at 4% it's very likely.

clarkfan1979

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Re: Not enough
« Reply #46 on: January 18, 2016, 11:10:39 AM »
In most cases, the SWR yields a bunch of extra money at the end, which can be used for end-of-life care and inheritances. Reducing the SWR slightly can increase the chances of that happening but even at 4% it's very likely.

+1

EnjoyIt

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Re: Not enough
« Reply #47 on: January 18, 2016, 11:21:25 AM »
5% of all 65 and over end up in a nursing home. That is 1 out of every 20. The odds are very very high and grow every year you live longer.   I think the odds are very very high.  Especially if we aren't fat bastards who die of a massive heart attack in our sleep. Healthy body with a useless brain.

http://www.agingoptions.com/2011/10/how-many-seniors-really-end-up-in-nursing-homes/

Nereo, thanks for the warm welcome. Yes, my thoughts have shifted a little thanks to the people responding here. I want to make sure myself and my wife will be taken care of, so for us, an extra $100K each is a good idea. 
« Last Edit: January 18, 2016, 11:26:07 AM by EnjoyIt »

nereo

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Re: Not enough
« Reply #48 on: January 18, 2016, 11:36:56 AM »
5% of all 65 and over end up in a nursing home. That is 1 out of every 20. The odds are very very high and grow every year you live longer.   I think the odds are very very high.  Especially if we aren't fat bastards who die of a massive heart attack in our sleep. Healthy body with a useless brain.

http://www.agingoptions.com/2011/10/how-many-seniors-really-end-up-in-nursing-homes/

Nereo, thanks for the warm welcome. Yes, my thoughts have shifted a little thanks to the people responding here. I want to make sure myself and my wife will be taken care of, so for us, an extra $100K each is a good idea.
Ok, so what does your FI picture look like now?  You mentioned you are considering having kids, and possibly retiring in your 40s, so you are.... around 30?  If you can save 60%+ of your post-tax income that gives you an enormous ability to generate a large 'stach very quickly.

I think it's sensible to plan for end-of-life care, but that can be dealt with easily enough if you have 30+ years of compounding.  $100k now sounds sensible.  Also, you still have lots of control once you do FI/RE.  Simply controlling your budget and/or picking up a side gig can ensure that your savings grow over hte next several decades, leaving you with far more money than you had when you officially retire.

frugledoc

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Re: Not enough
« Reply #49 on: January 18, 2016, 11:41:05 AM »
Hopefully religous ideology will stop ruling over common sense and assisted suicide will be widely available by time we are old.  I am a physician and my wife is well aware that if I am unable to make my own decisions due to a lasting loss of mental capacity I am not to be artificially fed or treated for any acute life limiting illness.  Just lots of morphine and happy pills please.

 

Wow, a phone plan for fifteen bucks!