Author Topic: what are your plans for long-term care?  (Read 14952 times)

slughorn

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what are your plans for long-term care?
« on: June 09, 2014, 12:58:13 PM »
Looking ahead to post-retirement: 

Anyone have good ideas what to expect for long-term care/nursing home expenses if you end up that way?  Does your spouse have to be destitute before medicare kicks in?

Of course, we'd all RATHER just go quickly, flying our WWII-plan upside-down through a barn door, but we can't count on ending up that way.

CarDude

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Re: what are your plans for long-term care?
« Reply #1 on: June 09, 2014, 01:03:32 PM »
We're raising our kids like non-Americans so they'll take us in when we're old.

brewer12345

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Re: what are your plans for long-term care?
« Reply #2 on: June 09, 2014, 01:41:42 PM »
I plan to hire a 19 year old nymphomaniac exhibitionist Swedish nurse.

Seriously, I will let you know in 30 years when I am 70.  The Boomer pig going through the LTC snake will change things dramatically, but I have no idea how.

Another Reader

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Re: what are your plans for long-term care?
« Reply #3 on: June 09, 2014, 02:09:53 PM »
Self insure.  I don't plan to draw down assets in retirement, so there should be plenty of money available to pay for care at home with all the trimmings.  I'll skip Brewer's nurse, though....

ShortInSeattle

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Re: what are your plans for long-term care?
« Reply #4 on: June 09, 2014, 02:14:27 PM »
We plan to keep our ridiculously expensive home. If one of us needs LTC that isn't supported by our budget, we'll sell it and the other spouse will move to more modest digs.

LTC is usually (but not always) a short term thing, 1-5 years. If push comes to shove our home equity will probably pay those bills.

Dr. Doom

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Re: what are your plans for long-term care?
« Reply #5 on: June 09, 2014, 02:27:56 PM »
None yet.  It's too far in the future for me.  I'll start thinking about it when I'm 55ish, which is nearly 20 years out. By then there may be significant changes in the landscape.

Workinghard

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Re: what are your plans for long-term care?
« Reply #6 on: June 09, 2014, 04:30:14 PM »
We're raising our kids like non-Americans so they'll take us in when we're old.

+1.  Same here. Actually my daughter-in-law isn't an American and would take me in a heartbeat. No worries there. Because we're close as a family, we decided not to worry about it.

Nords

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Re: what are your plans for long-term care?
« Reply #7 on: June 09, 2014, 06:01:56 PM »
Looking ahead to post-retirement: 
Anyone have good ideas what to expect for long-term care/nursing home expenses if you end up that way?  Does your spouse have to be destitute before medicare kicks in?
Where do you want to be, and in what type of facility? 

If you're in a large metro area like Denver then you might pay $230/day at a mid-size neighborhood full-care facility.  Or if your spouse/children care for you at home then you might pay $0/day with perhaps some senior-center activities or respite care.  The "problem" is that you have no idea where you'll be living when you suddenly need long-term care.  I use the word "suddenly" from experience.

Medicare kicks in when you're age 65 (in most cases) but you might be referring to Medicaid.  Your spouse does not have to be "destitute" for Medicaid but it's certainly a spend down.  State laws differ but many of them allow the spouse to have a home and a certain amount of assets before the state starts picking up the tab.

I've reluctantly concluded that my military pension (and Social Security) will probably cover most of my long-term care expenses (spouse has her own military pension).  I've looked at LTC policies but I'm skeptical that (1) the insurance companies are pricing them correctly and (2) that they'll have the financial stability to pay off when the time comes.  Before I turn 60 I hope that these two problems are mostly corrected with new types of policies.  If it makes sense then we'll buy one.
http://the-military-guide.com/2012/12/06/interview-whats-wrong-with-long-term-care-insurance/

Pegasus

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Re: what are your plans for long-term care?
« Reply #8 on: June 09, 2014, 06:13:41 PM »
I plan to self insure.  The plan my employer offers is priced in a way that is roughly a 7% ROI on the premiums IF you use the benefit to its cap, so made more sense not to get the insurance if one is a disciplined investor.  I think Medicare has you spend your assets first, based on my neighbor's recent experience with his Mom.  My understanding of the LTC insurance market is that the original policies were underpriced (a great bargain), but they've changed prices and terms so as not to go bankrupt.

RootofGood

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Re: what are your plans for long-term care?
« Reply #9 on: June 09, 2014, 06:30:02 PM »
Self insure should I need the care.  I can afford 12-20 years at a reasonably swanky place given the current stache.  I don't have the stats handy, but typical stays are a few years before care is no longer necessary.   

Alternatively, I could hire Brewer's home care nursing assistant at $15/hr and pay $3500 for eight hours of care per day, 7 days per week or $10,000/mo for round the clock care.  I assume I won't need a 4% SWR once I'm in need of round the clock care. 

I also have 3 kids, so I have decent odds that one of them might take pity on me and at least write the checks to Brewer's nursing assistant to keep her coming. 


Mississippi Mudstache

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Re: what are your plans for long-term care?
« Reply #10 on: June 09, 2014, 06:34:51 PM »
Medicare kicks in when you're age 65 (in most cases) but you might be referring to Medicaid.  Your spouse does not have to be "destitute" for Medicaid but it's certainly a spend down.  State laws differ but many of them allow the spouse to have a home and a certain amount of assets before the state starts picking up the tab.

Yes on both counts. My Dad is dealing with this now. My mom was diagnosed with Alzheimer's at 50. She began experiencing symptoms and could no longer work by her early 40's. By age 52, my Dad could no longer take care of her by himself and he had to admit her to a long-term care facility. I think he's paying around $40,000/year, and the cost is only going up. My mom is in good health otherwise and could easily require care for 30-40 years. Fortunately, Dad is able to cover the costs. If she ever requires more extensive care than he can afford, Dad will have to spend down his assets to get her on Medicaid, but be will be able to keep the house. Dementia is scary as fuck and LTC insurance is worthless if you get it.

Mississippi Mudstache

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Re: what are your plans for long-term care?
« Reply #11 on: June 09, 2014, 07:50:54 PM »
I'll also add that my parents' experience with dementia will not cause us to delay early retirement, but rather is one of my primary motivations for pursuing it. If I get early onset Alzheimer's like my mother (which is a significantly higher probability for me than for the general population due to family history), then no amount of retirement savings that I can conceivably stash will end up being "enough", and I would have worked as much as 25 extra years preparing for something that may never come to pass. But if either I or my spouse need care for just a few years (a far more common burden), then our retirement savings should be sufficient to sustain the other partner without too much trouble. So to answer the OP's question, we plan to self-insure.

Nords

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Re: what are your plans for long-term care?
« Reply #12 on: June 09, 2014, 10:51:40 PM »
If I get early onset Alzheimer's like my mother (which is a significantly higher probability for me than for the general population due to family history),
A family history of that type brings all sorts of personal motivational discipline to one's life...

Jamesqf

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Re: what are your plans for long-term care?
« Reply #13 on: June 10, 2014, 12:21:58 AM »
Die first.

Workinghard

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Re: what are your plans for long-term care?
« Reply #14 on: June 10, 2014, 03:17:11 AM »

Where do you want to be, and in what type of facility? 

If you're in a large metro area like Denver then you might pay $230/day at a mid-size neighborhood full-care facility......The "problem" is that you have no idea where you'll be living when you suddenly need long-term care.  I use the word "suddenly" from experience.

I had a patient and his wife who were from New York. When he needed long-term Alzheimer care, she decided to move to Florida because the cost was cheaper. They used to come here every winter, so she was already familiar with the area.

There are also a lot home and private ALF's. Depending on the number of patients, regulations are different. I am seeing more and more people go into that type of settings. One place essentially takes their Social Security check and the residents have around $50 a month for spending. It's not the best but better than living under a bridge.

MelodysMustache

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Re: what are your plans for long-term care?
« Reply #15 on: June 10, 2014, 04:55:04 AM »
I have LTC insurance.

smalllife

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Re: what are your plans for long-term care?
« Reply #16 on: June 10, 2014, 05:08:13 AM »
Die first.

+1  I've watched my grandfather's shell of a body continue to exist for a decade after life left his eyes and his mind.  Similar thing happened to my great-grandmother.  I wouldn't wish long term care on my worst enemy.

I hope that our country gets over it's fear of death before I ever am in a situation where long term care is advisable (and that my SO goes first so he doesn't have to deal with the decision making).  If not, I'll try and move somewhere that my medical directives will actually be followed.   It's too far in the future for me to plan on current structures.

chasesfish

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Re: what are your plans for long-term care?
« Reply #17 on: June 10, 2014, 05:25:45 AM »
I'm going to call for Brewer's nurse, we're ten years apart so I can tolerate a 29 year old nymphomaniac Swedish nurse.

happy

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Re: what are your plans for long-term care?
« Reply #18 on: June 10, 2014, 05:40:36 AM »
I plan to self insure also, although I suspect that in Australia there is more govt subsidy for aged care facility, lowering the cost somewhat.

Personally though, I don't wish to be kept alive to end up in a nursing home and I will have an advanced care directive stating that if I am in a high-level care nursing home I don't wish to be transferred back to acute care for life prolonging treatment such as iv antibiotics. One can probably shorten the time one spends in a highly dependent state by  declining acute treatment for medical emergencies as they arise or trying to ensure that one's appointed decision maker declines if one is no longer competent.

I hope, as a medic, that I might strike it lucky and self diagnose in such a way that I can die peacefully and quickly with the minimum of fuss by letting nature take its course - for example an old colleague of mine was found dead on her front verandah (porch for you US guys) with her head resting on her hands on top of the book she had been reading. Heart attack. She was both  canny and pragmatic and I'm 100% sure she decided to do nothing and not raise the alarm when the big one came.

I've been around long enough to know that you can't necessarily control your fate but I hope I might retain enough insight/control to prevent the health industry prolonging my dying process and avoid a lengthy period of dependency.

Gray Matter

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Re: what are your plans for long-term care?
« Reply #19 on: June 10, 2014, 05:56:55 AM »
I haven't made a decision on this yet, but I am leaning towards either LTC or self-insurance.  Relying on children feels too risky, for both me and them.  They may not be in circumstances where they can provide my care, or they may not want to, or I may need more intensive care than they can provide.  And what if they have jobs?  Are they supposed to quit their jobs to stay home and care for me if I need 'round-the-clock care?  It's not a burden I would want to place on them.  I realize this is an "individualistic" stance and perhaps others view caring for an ill parent as a privilege, not a burden, but I've seen a few really ugly circumstances up close (an Alzheimer's patient in one case and a stroke victim in another) that have influenced my thinking. 

But, I'm hoping to just go quickly when my time comes.  None of those end-of-life options are very appealing.

dude

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Re: what are your plans for long-term care?
« Reply #20 on: June 10, 2014, 06:23:17 AM »
I have LTC insurance through my job, inflation adjusted.  But I honestly don't know if it will be sufficient should the time ever come.  But I will have a pension (roughly indexed to inflation) that would probably cover it, and the 401k nest egg should last well beyond my death, so it should provide a margin of safety.  My wife, however, does not have insurance or a pension.  She does have 401k & IRA, and I've been working on her to get to the max on the 401k.  She also owns her parents' house, so assuming it doesn't have to be liquidated to cover her parents' old age, she will have that.

The Resilent Dame

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Re: what are your plans for long-term care?
« Reply #21 on: June 10, 2014, 06:33:05 AM »
We're raising our kids like non-Americans so they'll take us in when we're old.

+1.  Same here. Actually my daughter-in-law isn't an American and would take me in a heartbeat. No worries there. Because we're close as a family, we decided not to worry about it.

Please, please do not rely on this route. Have a good "Plan B." I own a business in the elder care industry and I see daughters who give up everything and completely burn themselves out when they are faced with a parent who has a major illness, especially Alzheimer's or dementia (including vascular dementia caused by stroke, not by Alzheimer's). Sometimes care is needed 24/7 and nobody can burn the candle at both ends like that for years. Promises made in earlier, healthier years often come back to bite people and I see families torn apart by this sort of thing.

RootofGood

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Re: what are your plans for long-term care?
« Reply #22 on: June 10, 2014, 08:35:36 AM »
There are also a lot home and private ALF's. Depending on the number of patients, regulations are different. I am seeing more and more people go into that type of settings. One place essentially takes their Social Security check and the residents have around $50 a month for spending. It's not the best but better than living under a bridge.

We live in a purely single family residential neighborhood.  However regulations allow "group homes" to exist as long as they aren't within 1000 feet of another group home.  Some group homes are half way houses, others are assisted living facilities.  One of the assisted living facilities is directly across the street from me.  It's a regular house very similar to mine.  They have 24/7 staff and they care for 4 to 6 people at a time.  I'm assuming the guests are developmentally or mentally disabled adults (sorry if those are un-PC terms, not sure how to refer to them).  I've been inside the house a few times to pick up mail or inform them of neighborhood issues.  It's not a disney world in there, but it reminds me of my own grandparent's house (it's a little dated).  Their kitchen actually has newer appliances than my own.  I assume the residents get 3 square meals a day, they go out in a conversion van for outings, and occasionally walk up and down the street to go to the park (I assume). 

I definitely wouldn't mind ending up in a facility like that.  I bet they take medicaid/SS disability and maybe some minor grant money and don't charge a lot more than what these individuals receive from the government.  I think the house is owned by an LLC that probably runs multiple group homes.  The expenses probably aren't that great (24/7 staffing being the largest expense). 

bogart

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Re: what are your plans for long-term care?
« Reply #23 on: June 10, 2014, 08:42:46 AM »
We're raising our kids like non-Americans so they'll take us in when we're old.

+1.  Same here. Actually my daughter-in-law isn't an American and would take me in a heartbeat. No worries there. Because we're close as a family, we decided not to worry about it.

Please, please do not rely on this route. Have a good "Plan B." I own a business in the elder care industry and I see daughters who give up everything and completely burn themselves out when they are faced with a parent who has a major illness, especially Alzheimer's or dementia (including vascular dementia caused by stroke, not by Alzheimer's). Sometimes care is needed 24/7 and nobody can burn the candle at both ends like that for years. Promises made in earlier, healthier years often come back to bite people and I see families torn apart by this sort of thing.

Amen to that.  There is NO WAY I could provide my father, who has Alzheimer's, with the 24/7 care he needs, nor could I manage his care even on a shorter-term basis (e.g. 8 hours/day) given that he is wheelchair-bound and unable to get in and out of the chair (or in and out of bed, or on or off a toilet).  It's not like I can lift the man (on a positive note, at least I can finally be confident he will never again get behind the wheel of a car, though he often thinks his wheelchair IS a car). 

As he refused to plan ahead in any way for such, he's in a nursing home on Medicaid.  Happily my parents are divorced, so his current needs have not affected my mom's financial stability. 

Mississippi Mudstache

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Re: what are your plans for long-term care?
« Reply #24 on: June 10, 2014, 09:54:18 AM »
If I get early onset Alzheimer's like my mother (which is a significantly higher probability for me than for the general population due to family history),
A family history of that type brings all sorts of personal motivational discipline to one's life...

Indeed. I have read some of your stories about dealing with your father's health if I remember correctly. In addition to a mother with early-onset Alzheimer's, both of my grandfathers had heart attacks prior to their 50th birthday. One passed away at 49, the other survived with bypass surgery and is still doing well in his '70s. I am making a strong effort not to follow in their footsteps with better diet and more exercise, but some things are beyond my control.

Die first.

+1  I've watched my grandfather's shell of a body continue to exist for a decade after life left his eyes and his mind.  Similar thing happened to my great-grandmother.  I wouldn't wish long term care on my worst enemy.

I hope that our country gets over it's fear of death before I ever am in a situation where long term care is advisable (and that my SO goes first so he doesn't have to deal with the decision making).  If not, I'll try and move somewhere that my medical directives will actually be followed.   It's too far in the future for me to plan on current structures.

So, are you arguing for euthanasia? Victims of stroke and dementia are not generally in a state of mind to decide these things for themselves. I will probably have a DNR order drafted when I feel that the time has come, but that is about as far as I would take it personally. I definitely don't want to be kept alive by feeding tubes and respirators for any significant period of time.

smalllife

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Re: what are your plans for long-term care?
« Reply #25 on: June 10, 2014, 10:14:58 AM »
+1  I've watched my grandfather's shell of a body continue to exist for a decade after life left his eyes and his mind.  Similar thing happened to my great-grandmother.  I wouldn't wish long term care on my worst enemy.

I hope that our country gets over it's fear of death before I ever am in a situation where long term care is advisable (and that my SO goes first so he doesn't have to deal with the decision making).  If not, I'll try and move somewhere that my medical directives will actually be followed.   It's too far in the future for me to plan on current structures.

So, are you arguing for euthanasia? Victims of stroke and dementia are not generally in a state of mind to decide these things for themselves. I will probably have a DNR order drafted when I feel that the time has come, but that is about as far as I would take it personally. I definitely don't want to be kept alive by feeding tubes and respirators for any significant period of time.

Among other options, yes.  I would welcome more hospice care, or situations designed to help those on their way out to live the rest of their life comfortably rather than extend the heartbeat as long as possible.  Longer quality life, not necessarily longest life.  I'd rather have two good months with friends and family than 6 spending my time in and out of hospitals always stressed and on heavy medication that makes life miserable.  I think a medical directive is the best course of action, which would spell out when the DNR order would take effect. 

Jamesqf

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Re: what are your plans for long-term care?
« Reply #26 on: June 10, 2014, 10:51:39 AM »
So, are you arguing for euthanasia? Victims of stroke and dementia are not generally in a state of mind to decide these things for themselves.

Not so much euthanasia as a different, and more realistic, definition of death.  We've got the technology to keep the heart & other bodily functions going long after any trace of the mind is gone.  It's like that poor kid out in California last winter (can't remember the name).  Had minor surgury, died of complications, but the parents kept insisting that she'd 'wake up', and AFAIK her corpse is still on 'life support'.
« Last Edit: June 10, 2014, 02:16:15 PM by Jamesqf »

Mississippi Mudstache

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Re: what are your plans for long-term care?
« Reply #27 on: June 10, 2014, 10:57:22 AM »
+1  I've watched my grandfather's shell of a body continue to exist for a decade after life left his eyes and his mind.  Similar thing happened to my great-grandmother.  I wouldn't wish long term care on my worst enemy.

I hope that our country gets over it's fear of death before I ever am in a situation where long term care is advisable (and that my SO goes first so he doesn't have to deal with the decision making).  If not, I'll try and move somewhere that my medical directives will actually be followed.   It's too far in the future for me to plan on current structures.

So, are you arguing for euthanasia? Victims of stroke and dementia are not generally in a state of mind to decide these things for themselves. I will probably have a DNR order drafted when I feel that the time has come, but that is about as far as I would take it personally. I definitely don't want to be kept alive by feeding tubes and respirators for any significant period of time.

Among other options, yes.  I would welcome more hospice care, or situations designed to help those on their way out to live the rest of their life comfortably rather than extend the heartbeat as long as possible.  Longer quality life, not necessarily longest life.  I'd rather have two good months with friends and family than 6 spending my time in and out of hospitals always stressed and on heavy medication that makes life miserable.  I think a medical directive is the best course of action, which would spell out when the DNR order would take effect.

So, are you arguing for euthanasia? Victims of stroke and dementia are not generally in a state of mind to decide these things for themselves.

Not so much euthanasia as a different, and more realistic, definition of death.  We've got the technology to keep the heart & other bodily functions going long after any trace of the mind is gone.  It's like that pook kid out in California last winter (can't remember the name).  Had minor surgury, died of complications, but the parents kept insisting that she'd 'wake up', and AFAIK her corpse is still on 'life support'.

I agree with both of you to some extent, but the circumstances that are most expensive and the difficult are generally the loss of mental faculties while the body remains healthy. My mother does not require medication to stay alive, feeds herself with no problems, and does not have any life-threatening medical conditions. She simply doesn't have her mind. Non-voluntary euthanasia is illegal in all countries and should remain that way. It's hard for me to imagine anyone making a convincing argument i favor of it (and I don't think that's what you're doing, but you seem to assume that you will have a sound mind if LTC becomes a necessity. I wouldn't count on that.)

MooseOutFront

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Re: what are your plans for long-term care?
« Reply #28 on: June 10, 2014, 11:03:19 AM »
I don't intend to make any special provisions for long-term care beyond the general provisions I make for retirement.  I bet when I'm 60 there will either be a decent insurance product available (there's not one now) or the single payer health option will be able to be supplemented well enough for people with means.

smalllife

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Re: what are your plans for long-term care?
« Reply #29 on: June 10, 2014, 11:11:12 AM »
I agree with both of you to some extent, but the circumstances that are most expensive and the difficult are generally the loss of mental faculties while the body remains healthy. My mother does not require medication to stay alive, feeds herself with no problems, and does not have any life-threatening medical conditions. She simply doesn't have her mind. Non-voluntary euthanasia is illegal in all countries and should remain that way. It's hard for me to imagine anyone making a convincing argument i favor of it (and I don't think that's what you're doing, but you seem to assume that you will have a sound mind if LTC becomes a necessity. I wouldn't count on that.)

Definitely not what I was suggesting - your mother might not have her mind, but she's also presumably got a pretty good quality of life otherwise.  A medical directive would spell out which measures are acceptable, which would ideally be in place before mental faculties are lost.  If that's not the case then they are stuck with whatever medical care someone else forces upon them, for bettor or worse - involuntary euthanasia would not be on the table.  Just the reminder I needed to put my living will in place :-)

Catbert

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Re: what are your plans for long-term care?
« Reply #30 on: June 10, 2014, 11:55:16 AM »
I'm self insuring.  I think the average cost of a nursing home is 80k a year (probably higher where I am).  My 4% distribution can handle that and my husband can have my pension and the house.  No children so I'm not worried about leaving a large estate.


MrsPete

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Re: what are your plans for long-term care?
« Reply #31 on: June 10, 2014, 12:33:31 PM »
Realistically, I'm younger than my husband, I'm in better health, and I come from a family that tends to be longer lived.  So he's golden:  He will have me to take care of him in his declining years. 

For myself, we're in the process of planning our retirement house -- seems like we've been talking about it and collecting ideas /pictures forever -- and I'm planning a house that will be "elderly friendly": 

- I've read that the ability to bathe goes first, and I do know that my grandmother struggled with this.  So our master bath is going to include a large, no-barrier walk-in shower with both an overhead showerhead and a handheld shower head near a bench. 
- Similarly, we're planning a one-story house, wide hallways, few steps at the entry.  We're including a little "indentation" near the back door that will first house a small chest of drawers, but could one day be a storage spot for a wheelchair that's only needed when we go out.  We're building a garage with a single wide door rather than two smaller doors in case it needs to accomodate a handicapped van.  The bedroom is big enough that we could downsize our king-sized bed to a twin (or double) plus a hospital bed.  We're going with door latches (instead of the old-fashioned glass doorknobs I'd really like to have) and other things that'll just make life a little easier with reduced mobility. We want to make it easy for us to stay in this house. 
- And perhaps most importantly:  We've placed two bedrooms and a bathroom on their own wing so that if, if necessary, one of our children (or future grandchildren) can move into the house and have "a place of her own".  Or this could function for a paid caregiver. 

totoro

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Re: what are your plans for long-term care?
« Reply #32 on: June 10, 2014, 01:17:13 PM »
We will hire a live-in caregiver or two if this program is still around then.  We already reno'd our place for mobility.  We will add a walk-in bath if needed. We have a triplex so maybe one of the kids will live close too.

Workinghard

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Re: what are your plans for long-term care?
« Reply #33 on: June 10, 2014, 01:40:11 PM »
Wow, you're really planning!  Don't forget grab bars in the bathroom and a handicap toilet that sits higher. And if you really want to go all out, a bathroom that is big enough to accommodate a wheelchair makes it easier for a patient ( I mean person) transfer from a wheelchair to the toilet if they can't walk. A recliner and TV in the bedroom is also nice and non-slippery floors. Oh, and a ramp for one of the doors if a person is wheelchair bound.

The separate wing is nice and will give some privacy. 😊

Realistically, I'm younger than my husband, I'm in better health, and I come from a family that tends to be longer lived.  So he's golden:  He will have me to take care of him in his declining years. 

For myself, we're in the process of planning our retirement house -- seems like we've been talking about it and collecting ideas /pictures forever -- and I'm planning a house that will be "elderly friendly": 

- I've read that the ability to bathe goes first, and I do know that my grandmother struggled with this.  So our master bath is going to include a large, no-barrier walk-in shower with both an overhead showerhead and a handheld shower head near a bench. 
- Similarly, we're planning a one-story house, wide hallways, few steps at the entry.  We're including a little "indentation" near the back door that will first house a small chest of drawers, but could one day be a storage spot for a wheelchair that's only needed when we go out.  We're building a garage with a single wide door rather than two smaller doors in case it needs to accomodate a handicapped van.  The bedroom is big enough that we could downsize our king-sized bed to a twin (or double) plus a hospital bed.  We're going with door latches (instead of the old-fashioned glass doorknobs I'd really like to have) and other things that'll just make life a little easier with reduced mobility. We want to make it easy for us to stay in this house. 
- And perhaps most importantly:  We've placed two bedrooms and a bathroom on their own wing so that if, if necessary, one of our children (or future grandchildren) can move into the house and have "a place of her own".  Or this could function for a paid caregiver.

Jamesqf

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Re: what are your plans for long-term care?
« Reply #34 on: June 10, 2014, 02:23:58 PM »
...but you seem to assume that you will have a sound mind if LTC becomes a necessity.

But if I don't have a sound mind, then as far as I'm concerned, I AM dead.  What happens to the still-ambulatory corpse is not really my concern any more, though even with my minimal level of altruism (about sufficient to put an organ donor sticker on my driver's license), I'd rather whatever usable spare parts are left be used while they're still fresh.

Mississippi Mudstache

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Re: what are your plans for long-term care?
« Reply #35 on: June 10, 2014, 02:53:14 PM »
...but you seem to assume that you will have a sound mind if LTC becomes a necessity.

But if I don't have a sound mind, then as far as I'm concerned, I AM dead.  What happens to the still-ambulatory corpse is not really my concern any more, though even with my minimal level of altruism (about sufficient to put an organ donor sticker on my driver's license), I'd rather whatever usable spare parts are left be used while they're still fresh.

I think you are thinking quite rationally for an unmarried person without kids (right?), although the onset of dementia can be slow enough to be incredibly troubling for the patient who realizes that it's happening (just ask my mom about 10 years ago). Ultimately, I would probably feel the same way if I were in your shoes. But I have a wife and two kids to think about, so I have to look at things from their perspective as well.

Spartana

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Re: what are your plans for long-term care?
« Reply #36 on: June 10, 2014, 05:48:51 PM »
Self-insure. Single, no kids and no real relatives to leave my vast (NOT!) fortune to (it's all ear-marked to charity if my younger sister passes away before me).  I figure they can dump me in a home, use my cash/investments and pension first, then sell my house next, and then put me on Medicaid if I'm still alive and kicking (and drooling and pooping in my Depends!). Of course that's assuming that I don't put myself out of my own misery first - which is probably the option I would take if possible. Of course I probably won't have to worry about either option as I use the VA hospital for my medical care so I figure I'll probably die before I can get an appointment anyways :-(
« Last Edit: June 10, 2014, 05:57:11 PM by Spartana »

penny

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Re: what are your plans for long-term care?
« Reply #37 on: June 10, 2014, 06:43:31 PM »
I'm 36, single and don't plan to have children, so I'm looking into continuing care communities. My house should cover the cost of an entry level apartment. I've priced out LTC insurance and it doesn't make sense now that they keep switching the rules, even though it's relatively cheap in your thirties. I'd love to have the luxury to go quick, or be able to make the decision on my own, but with two close friends in nursing homes before the age of 30, I'm thinking even though they cost way way too much, ccrs's are a good hedge.

Roland of Gilead

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Re: what are your plans for long-term care?
« Reply #38 on: June 10, 2014, 08:20:30 PM »
I bought LTC insurance from Smith and Wesson.  Great company.

Nords

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Re: what are your plans for long-term care?
« Reply #39 on: June 11, 2014, 12:13:34 AM »
Die first.
+1  I've watched my grandfather's shell of a body continue to exist for a decade after life left his eyes and his mind.  Similar thing happened to my great-grandmother.  I wouldn't wish long term care on my worst enemy.

I hope that our country gets over it's fear of death before I ever am in a situation where long term care is advisable (and that my SO goes first so he doesn't have to deal with the decision making).  If not, I'll try and move somewhere that my medical directives will actually be followed.   It's too far in the future for me to plan on current structures.
I used to feel this way until I got to know some Alzheimer's patients... like my father.

So when do you expect the medical directive to kick in against the "heroic lifesaving measures"?  When has your quality of life dipped into negative territory?  When you can't remember how to use your computer?  When you can no longer drive safely?  When you can't remember how many beers you've already had this afternoon, or how to call the fire department when you forget to shut off the stove burner?  When you can no longer spell "Alzheimer's" backwards?  Or when you can't spell "cat" backwards?  When you no longer recognize an occasional grandchild or niece, or when you consistently no longer recognize your spouse or your adult children or your friends?  When aphasia kicks in most of the time?  When you can no longer control your bladder or your bowels?  Does "control" mean "just once in a while" or "every single time"?  When you can no longer safely stand because you've lost the neurons that work with your proprioceptors and your inner ear?  When you can no longer move your vocal cords?  When you can't use a fork, but can still eat with your hands?  When you can no longer chew?  No longer swallow?  Feeding tubes?

My father has been dealing with Alzheimer's symptoms for six years.  He's in a full-care facility, but he's the happiest he's been in at least 53 of his 80 years.  I don't just mean happy in a Lexapro sort of way, but happy in his world view.  In his mind, the care facility has asked him to consult on their electrical engineering problems and they "let" him stay there on weekends (because Dad worries about not being able to find his way home).  The coffee's good, they feed him, they pay his bills, they file his taxes, and they even do his laundry!  He's no longer tormented by the pain of losing a spouse to breast cancer.  He no longer feels the aftereffects of prostate cancer surgery.  He's always happy to see "us boys", even if he no longer remembers that we're his sons.  He gets to hang out in "his back yard" to enjoy the sunshine and the squirrels and the birds without having to worry about maintenance or repairs.  He gets to walk all over the facility and talk to all sorts of fascinating people... and 10 minute later he can do it all over again for the first time.  It's as if he's a kid again on permanent summer vacation.  Who wouldn't be happy with that?  I wish I'd grown up with more of this "happy Dad"... maybe we would have enjoyed more of our life together.

This is not a philosophical exercise, because my ancestors have made me pretty sure that my genetic gun has an entire clip loaded and pointed at my hypothalamus.  However I'm also pretty sure that I'll still be able to surf long past the time when I can remember what last week's surfing was like.  I'll still be curious about tomorrow's sunrise, although it might look an awful lot like the last 30,000 or so that I could have mustered for.  I'll still be interested in the charming women who come to visit me (Brewer's Swedish care staff included) even if I can no longer remember that I'm married to one of them and the parent of another one.  I'll get to read the world's best damn books and watch the best damn movies every hour for the rest of my life. 

I recommend you subscribe to Bob DeMarco's Alzheimer's Reading Room for at least six months.  You might tire of his stories about his mother, but guest poster Marie Marley has some compelling stories about her life partner Ed.  After a while you might change your opinion of what's really going on behind the outward symptoms.  You might even be convinced that we don't need to solve partial differential equations in our heads to still enjoy life.
http://www.alzheimersreadingroom.com/

I bought LTC insurance from Smith and Wesson.  Great company.
Percocet & Baileys probably tastes better with less pain and a more permanent effect... and if you "miss" with the first attempt then you have a much better chance of getting to try it again.
« Last Edit: June 11, 2014, 08:55:52 AM by Nords »

deborah

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Re: what are your plans for long-term care?
« Reply #40 on: June 11, 2014, 03:45:58 AM »
Yes, Nords, there is a time when people are happy.

I remember my grandmother. She moved to a facility, and worriedly asked people if she was going downhill like her mother had. They all blithely lied to her, and told her it was all OK. She didn't seem to be happy. Then she became more confused and believed my Uncle (her son) was her husband, and my aunt was "the other woman". Then came the terrible day when my Uncle didn't visit her (he visited her every day, but it was his father-in-law's funeral, so he couldn't that day). She got out of the facility, and tried to get run over by the traffic in the very busy road next to the facility. She was going to make him sorry.

She moved somewhere more secure and with less traffic. She couldn't remember things, and she was happy. For a time. Yes, she was happy - I'd forgotten that period. She was like your father.

But that time was when she could still move around, talk, do things. She forgot that she had just eaten, and what you ate, and ate the flowers people brought. She stopped being able to get up. For years she just lay there. No words. My uncle still visited her every day. And then, 8 years after she had obviously been happy, she eventually died. It wasn't that long ago - she was 98.

My parents are not happy. They are in their 80s. They don't have dementia, but they feel as if they are just hanging around until they fall off the perch. My mother has achieved a great deal in her life - but that is not enough. I ring them up each night, and get them both laughing. The pain of arthritis, heart problems, just simply moving around... is continually pulling them down. Dad has cancer, and had an operation last year where the doctor left him with a cut artery. He pressed the button for help, and had emergency surgery at midnight to put it right. He now says he shouldn't have pressed the button.

Which is the better way to get old?

smalllife

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Re: what are your plans for long-term care?
« Reply #41 on: June 11, 2014, 04:39:26 AM »
@Nords: given that I am several decades away, exactly where I would draw the line is still blurry.  You can look at Deborah's testimony - that's my experience with Alzheimer's as well.  Not someone in perpetual childhood, but someone who is perpetually afraid and on edge.   Alternatively, I've dealt with someone who has been chronically depressed since his wife died but his body keeps him alive through good ole Catholic guilt.  Not a pretty sight.  I've also had family die young - 20 - releasing themselves from their troubles.  It was their choice and I respect them for it, who am I to judge?

I hope that elder care would learn enough lessons as the boomers pass on to be able to have frank and thorough conversations with a doctor or patient advocate who will understand my multi-faceted desires - whatever they may be at the time - and put them into play.  Optimistic?  Yes, but why worry my life away? 

I won't have kids to worry about and statistically I would outlive the SO by many years.  I feel like being a parent changes many feelings about long term care, at least given the responses on this thread and others. As a daughter my father fully tells me that if he's a blob or will recover to a blob to turn the switch with no regrets (for him this does mean severely reduced mental faculties, or having his brain but tied to a hospital bed).  I also feel an obligation not to burden the medical care community and limited resources with my old body at the expense of the young with full lives to live, so that also comes in to play. 

Workinghard

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Re: what are your plans for long-term care?
« Reply #42 on: June 11, 2014, 05:10:05 AM »
As far as a Smith and Wesson solving the problem, it may solve the problem for the individual but makes it extremely difficult for family members. Putting that aside, I did laugh at the response. My ex-husband choose to go that route when his health was declining. It was incredibly difficult for both me and our adult son who was in his 30's.

We had been married for over 13 years, and I still cared about him, and we were still in contact regularly. When he was short some cash flow years ago, I lent him the money. He also had me as his beneficiary for his retirement pension.

My current husband and I have been married 23 years, so the divorce was a long time ago, yet we still kept in contact There were other options available for him and my daughter-in-law offered a place for him to live, but he chose not to take that option. Interestingly, I read article yesterday that most physicians do not go ahead with treatment options.  They just let the disease process take it's course and prefer quality over quantity.

As far as elderly people being happy, I really think it depends on the person and their personality versus their situation. As a home health nurse, I deal with the elderly population almost daily. Both in the home and in assisted living facilities and in memory units. Some people who are still functional and mentally alert aren't happy. It doesn't matter what you do or say. Others are engaged with outside activities or engaged in helping others in the ALF. They become caregivers of each other. They look out for one another and check on one another if a person doesn't make it to breakfast or otherwise. The sense of community is really neat to see in action. That ALFs also have different activities and takes them on outings. Course some people, usually the unhappy ones, choose not to participate.

As far as people in memory units, you still see the same thing. Some are happy and some aren't. However, the ones that are totally disengaged from life, don't seem unhappy. Even though they may not talk or do much, I can't help but think they're living in the past with their memories while their basic needs are being met. Yes, Alzheimer's and dementia patients can become violent, but there are medications that help with that.

Obviously, to us looking forward, it doesn't seem like much of a life in comparison to the way we are living or want to live now. However, the majority of people I see appear to be content.

aj_yooper

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Re: what are your plans for long-term care?
« Reply #43 on: June 11, 2014, 05:30:34 AM »
Excellent posts here.

Sadly, an illness or accident could place us, at any age, into needing long term care.  Advanced directives, Five Wishes, and power of attorney or living trusts definitely help.  If I needed ltc and my mental capacity were diminished significantly, I do not want any immunizations, medicine, or procedures that treat illnesses or conditions.  Medications to relieve pain are fine.  Paying for all the mess would not be easy, but could be done with cash flow.  LTC insurance seems ify now.

MayDay

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Re: what are your plans for long-term care?
« Reply #44 on: June 11, 2014, 06:32:36 AM »
I am a bit young to know exactly.  I hope to self insure, but will also definitely get all the needed documents in order such as DNR, living will, etc, when I get closer. 

My grandmother was a stroke patient in a nursing home, with very little memory left.  I don't know that she was happy- they faintly got her on a big dose of antidepressant, which she had probably needed for 20 years, but refused to take.  We had orders for her to not call an ambulance, ever.  Her doctor would come and check on her obviously, but no extreme measures.  A UTI killed her- very common for the elderly to get them, easy to treat (antibiotics) but a fairly pleasant way to go if they don't treat it.  That is the kind of thing I want if I end up in LTC- if my mind is gone, don't spend the resources to keep me alive.  If I can't remember to go eat on my own, don't remind me.  If I get a UTI, let me pass, etc. 

My dad is militantly pro-kill me however you have to, as soon as you can, I better never be in a diaper.  My mom is a nurse (former hospice nurse) so she knows quite a bit about the good drugs.  I bet she can figure out the right martini/Percocet combo to achieve my dad's end of life goals :)

MrsPete

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Re: what are your plans for long-term care?
« Reply #45 on: June 12, 2014, 06:37:12 PM »
Wow, you're really planning!  Don't forget grab bars in the bathroom and a handicap toilet that sits higher. And if you really want to go all out, a bathroom that is big enough to accommodate a wheelchair makes it easier for a patient ( I mean person) transfer from a wheelchair to the toilet if they can't walk. A recliner and TV in the bedroom is also nice and non-slippery floors. Oh, and a ramp for one of the doors if a person is wheelchair bound.
Yes, it's on our minds for two reasons:

1.  We were heavily involved in caring for an elderly relative and saw first-hand the struggles she experienced.
2.  We are currently working on details for a retirement house we plan to build. 

So many times I saw my grandmother struggle with things that could have been avoided.  For example, she had a shower chair in her walk-in shower, but the slight step up in to the shower and the door were difficult for her to handle.  She had no problem using her washer/dryer, but she could not walk while carrying a basket of clothes.  We can't help that one day we may find ourselves in a similar physical condition, but we can plan a no-barrier, walk-in shower.  We can place the laundry room adjacent to our bedroom /closet.  We can do lots of things to help ourselves in the future.




iris lily

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Re: what are your plans for long-term care?
« Reply #46 on: June 12, 2014, 08:08:14 PM »
I would like to die os a massive stroke/heart attack before my family's Alzheimer's kicks in.

I have kinda/sorta, for a while, figured that DH and I might get divorced if/when my family curse kicks in. That way he can have his half of our estate and I'll take the other half. And if mine is eventually exhausted due to nursing home care, his part will still be intact. I am somewhat serious here.

Frankly, I sighed a big sigh of relief when my dad died within a week of being hospitalized. No long, slow, bleed of the parental assets from him, it was all over quickly and my mother was then in sole possession. It's easier that way. Some years after that she she went into a nursing home where she managed to not dip into her assets (she had a 5 year LTC insurance plan) and at the end she started to spend it all and was about 1 year form exhausting her resources and going on the government dole when--she died.

So looking back, I think their timing was charmed. But you know what? They had pretty much sketched out this scenario, they were not far off wrong about what would happen.

iris lily

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Re: what are your plans for long-term care?
« Reply #47 on: June 12, 2014, 08:14:18 PM »
...
Among other options, yes.  I would welcome more hospice care, or situations designed to help those on their way out to live the rest of their life comfortably rather than extend the heartbeat as long as possible.  Longer quality life, not necessarily longest life.  I'd rather have two good months with friends and family than 6 spending my time in and out of hospitals always stressed and on heavy medication that makes life miserable.  I think a medical directive is the best course of action, which would spell out when the DNR order would take effect.

It's not that easy. My mother, me, my brother all agreed on no heroic measures for her, no tubes, no DNR's yet she still lived in a nursing home with Alzheimer's for 6 years.

You seldom have a real choice. The moment she qualified for hospice care we put here in it, but she lived beyond the "six month" rule of hospice.

Workinghard

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Re: what are your plans for long-term care?
« Reply #48 on: June 13, 2014, 02:58:01 AM »
Iris lily, the hospice 6 month rule has changed. I've had patients on it for 2 years. Essentially, their health has to be declining or show no improvement. Having said that, hospice has changed a lot. Years ago a friend's mom was on hospice and  they were there with her 24/7 at the end. When my mom went on hospice they can came once a week. They did pay for all of her meds and inhalers and oxygen so that helped a lot.

Interesting idea about divorce. I told my husband and he asked me when he should file. Ha ha

Kaminoge

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Re: what are your plans for long-term care?
« Reply #49 on: June 13, 2014, 03:57:24 AM »
We're raising our kids like non-Americans so they'll take us in when we're old.

My parents took my grandparents in. But at a certain point they weren't able to care for them any more. Hoping to have your children look after you is a nice plan but it has it's limits.