Author Topic: How to Financially Plan For Long Term Care  (Read 12680 times)

TrumanGrad

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How to Financially Plan For Long Term Care
« on: June 18, 2015, 07:53:44 PM »
How does the possibility of needing long term skilled nursing care fit into the Mustachian (or even general FIRE) philosophy?

My husband's grandpa is in his 90's and while mentally very sharp, physically he is in not so great of shape.  I have been helping his wife tour nursing homes because there is a strong possibility he may need to move into one.  Last Saturday we toured three places.  One was horrible, so I won't go into further detail about it.  One was ok, not great, not horrendous.  The third was wonderful. (I am basing these opinions on not only the tours we took, but other research as well).

The acceptable place was $5000-$6000 a month.  The extraordinary place was $7200-$9000 a month.  So looking at approximately $60,000-$110,000 a year.  And while he is physically weak because of a chronic condition, he is not terminal so it is very possible he could live several more years.

On the bright side, they saved and invested their whole lives and have the money to spend as they wish on his care.

But this got me to thinking, how does long term care fit into a FIRE lifestyle?  My husband and I knew right away if we ever need to go into a skilled nursing facility, our choice would be the third option for several reasons (which I won't get into unless people want to know).  The quality of life seemed much better at the third place.

But even if going to the acceptable place $60000 per year per person is A LOT. That figure doesn't include things like medication, doctor's visits, and medical insurance.

I know there are things you can do like exercise and challenging yourself mentally to reduce your ODDS of having to go to such a place.  But I am not sure I am willing to take the risk that I will run out of money and no longer have the option to chose where i would go.  We are only in our 30's so hopefully that time is a long way away, but what opinions do those on this board have on the topic?

Retired To Win

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Re: How to Financially Plan For Long Term Care
« Reply #1 on: June 18, 2015, 08:12:03 PM »
I have a long term care insurance policy.  Got it in my early 50s.  (You may know, the earlier you buy it, the lower the premiums are.)  Its cost to me, about $180 a month, is hardwired into my $15K a year basic living expenses.  Considering what just one month in a facility would cost, the insurance is worth the cost to me.

deborah

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Re: How to Financially Plan For Long Term Care
« Reply #2 on: June 19, 2015, 03:44:51 AM »
Recently the government here has changed all the rules about how much it costs for long term care, and they produced a paper with some interesting statistics.

Most people only last in long term care for a maximum of three years (I think it was 80% were less than 3 years). Most people start to have much higher medical costs about eight years before they die, and it takes a while after that for them to get to the stage where long term care is required (takes a while to recognize that it is needed, to agree it is needed and to get sick enough to need it).

So that $110,000 a year will probably add up to $330,000 or less. MMM seems to believe in self-insuring. When you consider that only 10% of people need this sort of care, this seems to add up to about the same amount as if your house was destroyed, and you could budget for it in retirement as either a premium or as a line item in the budget for self-insuring (depending upon how you plan to tackle it).

For those who are interested, my government (Australia) has always (well, as long as I can remember) subsidized this sort of thing, and the new rules mean that you have to pay a lot for the first three years, but not much afterward. Given this, it seems to make sense for me to self-insure. I guess their rationale is that they want your money to go to long term care rather than your heirs, but they don't want frail old people in the streets. 

CommonCents

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Re: How to Financially Plan For Long Term Care
« Reply #3 on: June 19, 2015, 10:12:54 AM »
I have a long term care insurance policy.  Got it in my early 50s.  (You may know, the earlier you buy it, the lower the premiums are.)  Its cost to me, about $180 a month, is hardwired into my $15K a year basic living expenses.  Considering what just one month in a facility would cost, the insurance is worth the cost to me.

I've heard that collecting on these policies is exceedingly difficult.  There are many carveouts

I'm in my 30s now.  I'm planning to self-insure.  If we do retire early on 4% withdrawal, we'll have the bulk of the cash then to run down for care in our final years.  DH also is very...paranoid, and subscribes to "many more years syndrome" so he would likely have us save double our withdrawal rate to insure against medical costs and changes to the tax code.

Deborah is also correct, that sadly, one does not often need long-term care as an elder for a great number of years.  There are exceptions, and should I actually run out of money, I could use Medicare (although I understand these facilities are likely on the wrong side of the acceptable equation, it's better than being on the street).

NoraLenderbee

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Re: How to Financially Plan For Long Term Care
« Reply #4 on: June 19, 2015, 02:03:03 PM »
My parents had LTC insurance and thank heavens they did. They had to go into it after Hurricane Sandy in 2012. Mom died after 2.5 years. Dad is still there.
Before the hurricane made it impossible to live independently, they had in-home aides to help my mother for several years. That's also something to think about--the possibility of living in your home but needing to pay for some assistance.
It's depressing and I don't know what the best solution is.

ltt

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Re: How to Financially Plan For Long Term Care
« Reply #5 on: June 19, 2015, 05:44:30 PM »
We are not planning on purchasing LT care insurance.  My son, a teen, told me that when I get down to my last penny and am suffering, then I can move in with him.  :)  I hope he remembers that comment years down the road.


bogart

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Re: How to Financially Plan For Long Term Care
« Reply #6 on: June 19, 2015, 08:09:27 PM »
Should I actually run out of money, I could use Medicare (although I understand these facilities are likely on the wrong side of the acceptable equation, it's better than being on the street).

Point of clarification -- Medicare, which is "old folks" insurance in the US (requires a premium but available to most people over 65) does not cover long-term care.  Medicaid, "poor folks" insurance, does.  Among other things, accessing it can be problematic for married people, depending in part on how their incomes and assets are structured, if only one needs LTC.  It's certainly great it exists, indeed, my dad is relying on it as he declines into dementia in a nursing home.  But it is not something you want to rely on if other choices are available to you -- your choice, of course, how you want to play those odds. 

We are not planning on purchasing LT care insurance.  My son, a teen, told me that when I get down to my last penny and am suffering, then I can move in with him.  :)  I hope he remembers that comment years down the road.

Me too.  But I will note that watching my dad decline into dementia has illustrated for me that there is care that cannot be provided in the home, no matter how willing/committed the able-bodied family (unless they are truly wealthy and willing to pay for help).  Again, of course, everyone has to decide for themselves what they want to do about preparing for this possibility, if anything.

curlyfry

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Re: How to Financially Plan For Long Term Care
« Reply #7 on: June 19, 2015, 10:45:50 PM »
I used to work at long term care centres - worked at one of the nicest in town (large rooms, private TVs, cool activities like putting roses in dye & then seeing them change colour) & one of the cheapest in town  (4 people per room, some of the residents had actually been homeless beforehand, very inaccessible)  -and i must say, I don't think the happiness difference was as large as you'd think it'd be!

In the cheap place, there was always someone around!  The nursing staff would bring in their guitars & sing away.  Some of the residents did some of the chores (sweeping, calling bingo, folding, etc) which seems  & the cheap place had communal cats!   (some people would keep treats in their drawers to try to woo the cats to their rooms.. haha)

The fancy place...  the rooms were so big & spread apart, that it was hard to find any staff.  Much more socially isolating.

Anyway, just food for thought!  It's more the staff & the people that make the experience more than anything.

The Resilent Dame

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Re: How to Financially Plan For Long Term Care
« Reply #8 on: June 20, 2015, 09:12:00 AM »
We are not planning on purchasing LT care insurance.  My son, a teen, told me that when I get down to my last penny and am suffering, then I can move in with him.  :)  I hope he remembers that comment years down the road.

As someone who works in long term care, this is irresponsible and ignorant of the true dynamics of what can happen. Sadly, I've seen many of these promises turn into financial and psychological ruin for the kids involved.

SnackDog

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Re: How to Financially Plan For Long Term Care
« Reply #9 on: June 20, 2015, 10:07:04 AM »
You should account for healthcare costs in your planning scenarios and include enough for LT care.  Most LT care insurance policies seem poor value, so just ensure you have enough yourself.

lostamonkey

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Re: How to Financially Plan For Long Term Care
« Reply #10 on: June 20, 2015, 11:20:28 AM »
If you look at your FIREsim results for a successful retirement, the result is almost always a huge surplus of cash near the end of retirement. And like a previous poster mentioned, you will likely be dead within a few years of moving into those places.

Katsplaying

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Re: How to Financially Plan For Long Term Care
« Reply #11 on: June 20, 2015, 12:26:32 PM »
Both my folks died in their 60s of illnesses. Decisions about at-home v facility care weren't an issue, tho' dad did have his (retired) older sisters to care for him in his home throughout his lengthy decline. Mom was diagnosed in August 2002 and gone by xmas that year.

However, due to my better lifestyle habits I anticipate living much much longer and that is wonderful and terrifying for the LTC scenario.

My bff has been caring for her mom for the past 5 years, first in the family home (she commuted over, stayed M-Thur night, then home to hubby), then moving her in to live with bff & her husband Feb of this year. The continual drain on my bff is enormous, ongoing, and seemingly interminable. There are funds to cover a facility if necessary but bff is concerned about burning through all funds before her mom dies and ending up paying for care out of her & hubby's pockets and seeing those numbers in the OP justifies that glaring concern. Her mom is fading into dementia, is now completely incontinent, has multiple health issues but is fairly sturdy and may yet live for many more years.

My bff has put her life on hold to care for her mom. This is one of the reasons she IS my bff and I admire her and am in awe of her fortitude. I doubt I could do the same. I am even more certain MY kid could/would not.

Statistics mean nothing to the individual situation. We live longer but that often means we've extended the worse part of our lives: the longer, slower decline at the end when quality starts to suffer.

Taking LTC and end of life choices into consideration early on is smart. Assessing personal & family medical history, current life habits, making the house suitable for ageing in place, and evaluating the need for LTC coverage are constant backbeats to my FIRE goals.
« Last Edit: June 20, 2015, 12:30:55 PM by Katsplaying »

forummm

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Re: How to Financially Plan For Long Term Care
« Reply #12 on: June 20, 2015, 01:17:05 PM »
LT care is such a morass. There's no way you could really ever be fully financially prepared for it unless you have accumulated a huge amount of money. You can take some steps to be a bit more prepared, but it's just a set of overwhelmingly expensive possibilities for scenarios that could continue on for even decades. At some point, what kind of life is it if you're just stuck in a bed all day getting pressure ulcers and have no independent mobility?

I'm hopeful that both medicine, robotics, and policy will evolve around this issue to make options more reasonable and improve quality of life. In the several decades many of us have until we'll be faced with LT care being a possibility, there's a lot of time for solutions to be found.

Zamboni

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Re: How to Financially Plan For Long Term Care
« Reply #13 on: June 20, 2015, 01:59:28 PM »
I used to work at long term care centres - worked at one of the nicest in town (large rooms, private TVs, cool activities like putting roses in dye & then seeing them change colour) & one of the cheapest in town  (4 people per room, some of the residents had actually been homeless beforehand, very inaccessible)  -and i must say, I don't think the happiness difference was as large as you'd think it'd be!

In the cheap place, there was always someone around!  The nursing staff would bring in their guitars & sing away.  Some of the residents did some of the chores (sweeping, calling bingo, folding, etc) which seems  & the cheap place had communal cats!   (some people would keep treats in their drawers to try to woo the cats to their rooms.. haha)

The fancy place...  the rooms were so big & spread apart, that it was hard to find any staff.  Much more socially isolating.

Anyway, just food for thought!  It's more the staff & the people that make the experience more than anything.

This is an important point, and thank you for sharing this perspective!

Since one aspect of the MMM philosophy might be summarized that "in terms of happiness and life satisfaction, bigger and more expensive is not always better, it is often worse," we all ought to really interview the residents and spend quite a bit of time at each center (perhaps by volunteering at a couple of different places on several occasions) before we make decisions based upon sparkle and glossy brochures.

ltt

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Re: How to Financially Plan For Long Term Care
« Reply #14 on: June 20, 2015, 02:16:24 PM »
We are not planning on purchasing LT care insurance.  My son, a teen, told me that when I get down to my last penny and am suffering, then I can move in with him.  :)  I hope he remembers that comment years down the road.

As someone who works in long term care, this is irresponsible and ignorant of the true dynamics of what can happen. Sadly, I've seen many of these promises turn into financial and psychological ruin for the kids involved.

It's not irresponsible; it's being realistic.  We have taken our elders and basically put them out of sight in very sterile, "cold" environments, where people have to spend all of their assets and die broke, rather than having family members try to do their best to take care of them.  The insurance industry is a racket.  It's very difficult to afford long-term care for the majority of Americans.  Most people can't afford the premiums or deductibles for Obamacare, much less throw long-term care insurance into the mix.  We tried to help our elderly parents--my husband handled his mother's care, and I handled my parents care.  My father made the decision to place my mother in a care facility, even though I offered to bring her to my house.  And the first thing a care facility wants is all your financial information. 

bogart

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Re: How to Financially Plan For Long Term Care
« Reply #15 on: June 20, 2015, 05:44:15 PM »

It's not irresponsible; it's being realistic.  We have taken our elders and basically put them out of sight in very sterile, "cold" environments, where people have to spend all of their assets and die broke, rather than having family members try to do their best to take care of them.


I won't argue against the point that there are systemic problems that need to be addressed.

But since 2009, my dad -- besides progressing dementia -- has been wheelchair-bound, unable to transfer himself to/from a bed to his wheelchair, give himself a bath, use a toilet (2009 was the year he broke a hip when he slipped trying to get into his wheelchair and failed to regain the ability to stand or walk after that; the dementia explains not relearning but is otherwise largely distinct from his physical problems.  In many ways, his immobility has been a blessing as I no longer have to worry that he might get behind the wheel of a car, or wander off).  There is absolutely no way my family could care for him in our homes.  None.  Should my husband find himself similarly situated in the future, the same will be true for him.  I'd have a marginally better chance, given the difference in our sizes and strengths (both my husband and dad are 200# 6' tall men), but -- only marginally, given the many other issues.

Obviously, my dad's case is -- his case.  Most of us won't be so unlucky.  But all the same.

My dad's in a pretty low-end place, and my experience has not been the same as @curlyfry's.  Putting two older men, one or both with dementia, who rely on wheelchairs in a shared room the size of a small dorm room is not a recipe for friendship or joy.  My dad has been moved (or his roommate has been moved) on several occasions after fist-fights erupted between him and his roommate -- and certainly he has been part of the problem.  But it's not like you can tell someone with dementia that they need to get their act together.

Pigeon

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Re: How to Financially Plan For Long Term Care
« Reply #16 on: June 20, 2015, 05:49:25 PM »
I'm dealing with this right now with my parents and my MIL. I would not lightly assume you can move in with your kids. In our case, even though my dad had 6 kids, we are all working and raising our own kids. I can't afford to stay home with him. Having help full time is very expensive, too. He also is unable to transfer to a wheelchair, has a catheter and neither I or his 89 yo wife could care for him.

You can live a healthy lifestyle. That is no guarantee of anything. Dad did, but most 90 year olds are going to have issues. In my family, health history would predict Dad would have died decades ago, but mom would live to 100. He is 92 and she died at 64.

From what I've seen the quality of everything really is better at the more expensive facilities. The cheaper ones cut corners and have higher turnover.

We are getting LTC policies this summer.

The whole situation is dreadful. I'm very glad Dad, step mother and my MIL planned ahead because if you don't, you're screwed.
« Last Edit: June 20, 2015, 05:55:04 PM by Pigeon »

Lyssa

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Re: How to Financially Plan For Long Term Care
« Reply #17 on: June 21, 2015, 07:22:01 AM »
We are not planning on purchasing LT care insurance.  My son, a teen, told me that when I get down to my last penny and am suffering, then I can move in with him.  :)  I hope he remembers that comment years down the road.

Please reconsider and 'release' your son from this promise. I'm currently witnessing the fourth and fifth LTC case in my family. Sometimes the burden gets unbearable. Sometimes people feed and diaper a body without any spirit left in it for years. Sometimes dementia eats the good part of a personality first and children need to hear their mother shouting and cursing all day long. If they're really unlucky all night long as well.

'You can move in with me, mom!' does not even begin to cover all of those risks.

GuitarStv

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Re: How to Financially Plan For Long Term Care
« Reply #18 on: June 21, 2015, 07:45:41 AM »
I plan to kill myself before requiring long term care (aiming to check out between 75-80).  I've been to several of these LTC places and seen the shells of people who inhabit them.  Dementia runs in my family.  Just because you can keep people alive at this point in their life doesn't mean it's morally right to do so.  Death is far preferable to the pseudo-life I'll be looking forward to.

wenchsenior

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Re: How to Financially Plan For Long Term Care
« Reply #19 on: June 21, 2015, 08:34:26 AM »
We are not planning on purchasing LT care insurance.  My son, a teen, told me that when I get down to my last penny and am suffering, then I can move in with him.  :)  I hope he remembers that comment years down the road.

Please reconsider and 'release' your son from this promise. I'm currently witnessing the fourth and fifth LTC case in my family. Sometimes the burden gets unbearable. Sometimes people feed and diaper a body without any spirit left in it for years. Sometimes dementia eats the good part of a personality first and children need to hear their mother shouting and cursing all day long. If they're really unlucky all night long as well.

'You can move in with me, mom!' does not even begin to cover all of those risks.

I'm just adding the chorus of people who would strongly encourage moving in with/expecting kids to deliver care if needed to view that as the very last option to be considered only in emergency. This is an issue that tends to absolutely destroy inter-family relationships (and that assumes the relationships are good to begin with). Even in large families, the bulk of the burden tends to fall on only one main caregiver, which can more or less consume up to a decade of their life...resulting in strain on relationships with kids/partners, resentment of siblings/parents, huge financial drain, and often inability to leave the person in decline, even for a few days' vacation.

Don't anticipate your son to have considered this in his offer. And I would assume you would not voluntarily inflict it on him.

And for all those people who talk about how 'we used to care for our elderly at home blah blah', that's totally true, BUT most of the women did not work back in the day, families were much larger and often more closely geographically located so the burden could be spread out, and most people died MUCH younger, so the period of required care was shorter.

Katsplaying

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Re: How to Financially Plan For Long Term Care
« Reply #20 on: June 21, 2015, 09:30:52 AM »
I plan to kill myself before requiring long term care (aiming to check out between 75-80).  I've been to several of these LTC places and seen the shells of people who inhabit them.

This is why I am so glad to see more states passing right to die legislation. We cannot make that decision for anyone but ourselves but having that choice is crucial. After my mom died, I determined that if/when I get the never-get-over diagnosis, I will take steps to make sure that I don't become that crushing burden to my loved ones. That was at least one good thing about mom's death; we all started talking to each other about end of life care and choices. These conversations are awful and upsetting but valuable.

wenchsenior

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Re: How to Financially Plan For Long Term Care
« Reply #21 on: June 21, 2015, 09:48:55 AM »
I plan to kill myself before requiring long term care (aiming to check out between 75-80).  I've been to several of these LTC places and seen the shells of people who inhabit them.  Dementia runs in my family.  Just because you can keep people alive at this point in their life doesn't mean it's morally right to do so.  Death is far preferable to the pseudo-life I'll be looking forward to.

This is something I need to start thinking through as well. If I live long, I will likely end up alone or nearly so in terms of family...no kids, siblings near my age with no kids, no extended family, older spouse. And if I did have those things, I still might seriously consider suicide to prevent the horror show of inflicting myself on younger relatives to care for anyway.

Exhale

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Re: How to Financially Plan For Long Term Care
« Reply #22 on: June 21, 2015, 10:03:36 AM »
Is anyone considering senior co-housing and/or assisted living scenarios? I understand there may come a time when one needs more intensive care, but one thought I've had is to find a place I can age into for as long as possible. I've only begun this line of thinking so don't have any examples yet. However, as a soloist (single person), I want to be especially sure to have a plan and back-up in place.

Kris

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Re: How to Financially Plan For Long Term Care
« Reply #23 on: June 21, 2015, 10:05:40 AM »
I plan to kill myself before requiring long term care (aiming to check out between 75-80).  I've been to several of these LTC places and seen the shells of people who inhabit them.  Dementia runs in my family.  Just because you can keep people alive at this point in their life doesn't mean it's morally right to do so.  Death is far preferable to the pseudo-life I'll be looking forward to.

This is something I need to start thinking through as well. If I live long, I will likely end up alone or nearly so in terms of family...no kids, siblings near my age with no kids, no extended family, older spouse. And if I did have those things, I still might seriously consider suicide to prevent the horror show of inflicting myself on younger relatives to care for anyway.

I have heard and seen so many people say things like this recently...  I wonder if we will start to see an "epidemic" of people choosing to kill themselves in countries that don't have decent, affordable ways for the aging to live their last years in dignity.  And to clarify, I am one of those people, myself.  I will likely outlive my husband, don't have siblings or children, and would never want to inflict myself on my stepkids. So this is the choice I will likely make at some point.

Pigeon

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Re: How to Financially Plan For Long Term Care
« Reply #24 on: June 21, 2015, 10:59:11 AM »
Is anyone considering senior co-housing and/or assisted living scenarios? I understand there may come a time when one needs more intensive care, but one thought I've had is to find a place I can age into for as long as possible. I've only begun this line of thinking so don't have any examples yet. However, as a soloist (single person), I want to be especially sure to have a plan and back-up in place.

I have explored senior housing and assisted living for our elderly family members. My step mother ( and until recently Dad) is in a senior apartment complex. It is nice and offers some services and activities, but no medical help other than a shuttle to medical facilities. You are expected to be able to live independently.  It costs appreciably more than a similar regular apartment. Assisted living offers more options if you need medical help but aren't so bad you need a nursing home. The ones I looked at were around $7K per month for one person, more for a couple even if you are in one apartment. If you need additional help,  it is more.

Some of the places were really nice. The cheaper ones, not so much.

wenchsenior

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Re: How to Financially Plan For Long Term Care
« Reply #25 on: June 21, 2015, 11:09:27 AM »
One good thing is that with the Boomers aging, this is likely to become a HUGE issue in the United States over then next 20 years, and I suspect quite a bit of creative thinking and development will occur to increase housing opportunities for the ever burgeoning single-person households, and households without kids.

On a side note, here is a really interesting book on the rise of single-person households across the developed world, and the sociological implications, especially in terms of the aging of the populations.

http://www.amazon.com/Going-Solo-Extraordinary-Surprising-Appeal/dp/0143122770

forummm

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Re: How to Financially Plan For Long Term Care
« Reply #26 on: June 21, 2015, 11:27:28 AM »
For those of you looking "check out" instead of LT care, check into a living will and advanced care directives. And do it while you are still independent and of sound mind. Otherwise your personal wishes may not be honored when the time comes. These documents should be revisited periodically and discussed with family members and physicians. If no one knows about them, medical staff will not adhere to your wishes.

deborah

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Re: How to Financially Plan For Long Term Care
« Reply #27 on: June 21, 2015, 03:08:29 PM »
Is anyone considering senior co-housing and/or assisted living scenarios? I understand there may come a time when one needs more intensive care, but one thought I've had is to find a place I can age into for as long as possible. I've only begun this line of thinking so don't have any examples yet. However, as a soloist (single person), I want to be especially sure to have a plan and back-up in place.

I have explored senior housing and assisted living for our elderly family members. My step mother ( and until recently Dad) is in a senior apartment complex. It is nice and offers some services and activities, but no medical help other than a shuttle to medical facilities. You are expected to be able to live independently.  It costs appreciably more than a similar regular apartment. Assisted living offers more options if you need medical help but aren't so bad you need a nursing home. The ones I looked at were around $7K per month for one person, more for a couple even if you are in one apartment. If you need additional help,  it is more.

Some of the places were really nice. The cheaper ones, not so much.
One problem with the places that not only have senior living, but also higher care facilities, is that you are not guaranteed that the higher care facility is available when you need it (there may be too many people in it already). An aunt and uncle decided on a particular senior living place because it had long term facilities as part of the complex, but now she needs it, the facility isn't available.

Pigeon

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Re: How to Financially Plan For Long Term Care
« Reply #28 on: June 21, 2015, 04:09:59 PM »
The thing with physician assisted suicide is that few will qualify even if you live in an enlighted state. The doctor has to certify that you have a terminal condition and only have 6 months to live, for example. You have to also be of sound mind. So it isn't like you can put in your medical directive that you want to check out when things get miserable.

My Dad had a fall and shattered his shoulder but it can't be repaired. He is 92 and in misery. He screams that he just wants to die. He has early Alzheimer's. He hates being in a facility but has too many medical issues to be cared for at home. Even if our state had assisted suicide, he wouldn't be a candidate. It just sucks.

GuitarStv

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Re: How to Financially Plan For Long Term Care
« Reply #29 on: June 21, 2015, 06:26:50 PM »
Fortunately you don't need a physician to commit suicide, just a car and a length of hose.

Paul der Krake

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Re: How to Financially Plan For Long Term Care
« Reply #30 on: June 21, 2015, 06:44:43 PM »
I'm with GuitarStv on this one. My great-grandmother was in a nursing home for over 10 years, and we watched her slowly lose her memory and mental sharpness. She barely recognized any of us in the last 5 years, had no concept of time.

Cost considerations aside, that is no way to live. The day my age makes it impossible for me to take care of myself is the day I'll start making plans to peace out.

forummm

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Re: How to Financially Plan For Long Term Care
« Reply #31 on: June 21, 2015, 07:20:29 PM »
Fortunately you don't need a physician to commit suicide, just a car and a length of hose.

My car's electric.

Erica/NWEdible

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Re: How to Financially Plan For Long Term Care
« Reply #32 on: June 21, 2015, 07:22:39 PM »
Yup. Count me in with the "black capsule" crowd.

I used to live next door to a woman in her late 50s. Very healthy, she was an avid kayaker. Her plan was to kayak out into the sunset with no plans to return.

frugalecon

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Re: How to Financially Plan For Long Term Care
« Reply #33 on: June 21, 2015, 07:24:17 PM »
My father has been in dementia care for about four months, and in theory he has now satisfied the 100 day elimination period of his LTC policy. I am hopeful that the insurance company will start paying soon, because it costs about $7000/ month, which is rapidly depleting the assets available to mom and dad. Mom and dad both said that they would never go into a facility, or put the other one there, but then dad began to sundown every night, up wandering around, putting on all of his clothes, looking for car keys and matches. And he started peeing in the hall and on the bedroom carpet, and he forgot how to handle bowel movements. And once he forgot, there was no way to reteach him. And he can't really express himself intelligibly, so it is hard to know what he needs. Mom could take about a week of no sleep before she was at the breaking point. The choice really was the facility or full time care at home, because mom simply could not handle the physical task of handling dad's toileting, which is doubly miserable because of chronic diarrhea due to colon cancer surgery. All along mom told me that she would never put him in a facility, and I told her that was the hope, but we needed to be prepared. No preparations were made, so it was a fire drill when the breaking point was reached. It is definitely a contingency to prepare for.

deborah

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Re: How to Financially Plan For Long Term Care
« Reply #34 on: June 21, 2015, 07:25:55 PM »
My great-grandmother was in a nursing home for over 10 years, and we watched her slowly lose her memory and mental sharpness. She barely recognized any of us in the last 5 years, had no concept of time.
Be thankful it wasn't worse. I remember the day my grandmother ate the flowers we brought her, well after she had stopped recognizing even her son who visited her every day, but before the downhill stretch of the last five years.

frugalecon

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Re: How to Financially Plan For Long Term Care
« Reply #35 on: June 21, 2015, 07:26:31 PM »
My father has been in dementia care for about four months, and in theory he has now satisfied the 100 day elimination period of his LTC policy. I am hopeful that the insurance company will start paying soon, because it costs about $7000/ month, which is rapidly depleting the assets available to mom and dad. Mom and dad both said that they would never go into a facility, or put the other one there, but then dad began to sundown every night, up wandering around, putting on all of his clothes, looking for car keys and matches. And he started peeing in the hall and on the bedroom carpet, and he forgot how to handle bowel movements. And once he forgot, there was no way to reteach him. And he can't really express himself intelligibly, so it is hard to know what he needs. Mom could take about a week of no sleep before she was at the breaking point. The choice really was the facility or full time care at home, because mom simply could not handle the physical task of handling dad's toileting, which is doubly miserable because of chronic diarrhea due to colon cancer surgery. All along mom told me that she would never put him in a facility, and I told her that was the hope, but we needed to be prepared. No preparations were made, so it was a fire drill when the breaking point was reached. It is definitely a contingency to prepare for.

Btw, I always thought that dad would have committed suicide if he could have foreseen how it would have turned out, but he was in denial about his own illness. It is easy to say that one will commit suicide, but one might not be in a position to carry out that plan when the time comes.

forummm

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Re: How to Financially Plan For Long Term Care
« Reply #36 on: June 21, 2015, 07:30:16 PM »
I think I'm in the camp where I'll be ready to check out when I'm ready to check out. But I have heard interviews with people where they say you feel differently when you're in that state. But obviously some people still continue to be ready to pass on. So we'll see what happens.

Maybe I'll be saved by the Singularity and live forever and this whole conversation will be unnecessary.

Exhale

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Re: How to Financially Plan For Long Term Care
« Reply #37 on: June 21, 2015, 07:54:29 PM »
One problem with the places that not only have senior living, but also higher care facilities, is that you are not guaranteed that the higher care facility is available when you need it (there may be too many people in it already). An aunt and uncle decided on a particular senior living place because it had long term facilities as part of the complex, but now she needs it, the facility isn't available.

Sheesh, that's sounds awful. I hope that wenchsenior is right about the Boomers changing the landsape for the better on this issue.

deborah

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Re: How to Financially Plan For Long Term Care
« Reply #38 on: June 21, 2015, 08:07:35 PM »
One problem with the places that not only have senior living, but also higher care facilities, is that you are not guaranteed that the higher care facility is available when you need it (there may be too many people in it already). An aunt and uncle decided on a particular senior living place because it had long term facilities as part of the complex, but now she needs it, the facility isn't available.

Sheesh, that's sounds awful.
It was - the complex was one of the more expensive around. She has alzheimers and he has a bad hip, so has little ability to walk around.

WildHare

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Re: How to Financially Plan For Long Term Care
« Reply #39 on: June 21, 2015, 10:31:55 PM »
My mom has lived with us for the past several years.  She is 87 and we are in our mid/late 50's.   She has her own suite of rooms.  My mom has dementia and needs some help bathing, dressing,etc. 
What  works for us is using outside caregivers.  Agencies are very expensive, I hired a lady through care.com, set up my mom as employer, use a payroll service, got work comp on my homeowner policy.  This runs around $110 per day .  The lady is very flexible, she gets perks such as taking my mom on all kinds of outings, lunches, flexible hours, etc.
I do not have 24 hr care unless I am gone. 
I have to say that this works really well for us.  I believe it has helped keep my Mom alive and she has a good quality of life.  I manage my Mom's life, but I don't do the actual caregiving.
I use an agency for the two days my other caregiver has off.  It is a good idea to maintain a relationship with an agency because they can always get you a caregiver, even on short notice.
My husband and I have talked and we would use this kind of set up for ourselves, ( having someone live in and one of our kids handling our finances,)as long as possible. 
My mom's cost runs about 40,000 a year.


GuitarStv

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Re: How to Financially Plan For Long Term Care
« Reply #40 on: June 22, 2015, 07:36:34 AM »
Fortunately you don't need a physician to commit suicide, just a car and a length of hose.

My car's electric.

Thanks, Obama.

forummm

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Re: How to Financially Plan For Long Term Care
« Reply #41 on: June 22, 2015, 07:53:23 AM »
Fortunately you don't need a physician to commit suicide, just a car and a length of hose.

My car's electric.

Thanks, Obama.

The original tax credit bill was actually signed by Bush in 2008.

Pigeon

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Re: How to Financially Plan For Long Term Care
« Reply #42 on: June 22, 2015, 11:22:33 AM »
I really wish the physician assisted suicide wasn't tied to having a terminal diagnosis.  Not only am I going through this with my Dad now, I went through it with FIL a couple of years ago, and MIL is heading down the same road.

The problem is that the elderly in my family have been pretty happy right up to a sudden event (falls for both FIL and Dad).  They both had mild dementia, but were enjoying life.  I think it's easy to say that you would just get a car and a hose and do the deed while everything was still OK, but human nature is such that you think things will continue to be OK for at least a while longer.  And suddenly it isn't and it's too late to take matters into your own hands.

And having to commit suicide on your own is much riskier (that it won't work and you'll be stuck alive in much worse shape than you already are) and much harder on your loved ones.  Dad's wife would be able to handle him asking the doctors for a nice, easy overdose much better than she would if he were able to fling himself out of the fourth story window, which is about the only option he could even attempt right now.

GuitarStv

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Re: How to Financially Plan For Long Term Care
« Reply #43 on: June 22, 2015, 11:34:48 AM »
Fortunately you don't need a physician to commit suicide, just a car and a length of hose.

My car's electric.

Thanks, Obama.

The original tax credit bill was actually signed by Bush in 2008.

Since when have facts got in the way of blaming Obama?

curlyfry

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Re: How to Financially Plan For Long Term Care
« Reply #44 on: June 22, 2015, 01:25:13 PM »
I guess the more I think about it, the more happiness just really depends on the person. 

 And a little bit of luck depending on health (obviously the guy who still climbs stairs & goes for a mile walk every day is happier than the person slowly losing their ability to move.)   But some people have significant issues & still a good outlook. It's also easier to make friends when you have your own mobility.  (There were a few gangs of ladies in walkers who would pick each other up from their rooms that would make me smile.) 

I'm thinking women usually do better than men because by nature they tend to be more social.

Food for thought- Did treat a lady who was 104 years old & never had children. When it was her birthday, her room was FULL OF CARDS! She said "as most of my contemporaries are no longer around, good thing I always made the intention to make friends with younger people." 

In summary, save money, get moving, make friends, and continue working on the ability to be happy.

I actually asked hundreds of people in long term care "what their secret was"  (the ones that were doing well) & basically everyone answered some variation of: hard work.   ie. Had a farm, 8 kids, the YMCA, etc.    One 94 year old lady credited, "Well.. I ate a lot of sugar AND a lot of butter." Haha!    The 104 year old lady with no kids credited the fact that she walked 30 minutes to the grocery store twice a week.

But I do wonder what my generation will be like in Long term care, as we are a very different crowd (ie. not used to just the simple things) - Will we be in yoga pants?   "My ipad 7 isn't working!!!"     


TrMama

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Re: How to Financially Plan For Long Term Care
« Reply #45 on: June 22, 2015, 03:31:14 PM »
Oiy, my family is in the thick of this right now. I'm with the others who say that self insuring is the way to go.

My grandma is self-insured and has rapidly moved from her own home (widowed years ago) into the nicest assisted living place in town and this week is moving again into the nicest nursing home my parents could find for her. In fact, she's even moving across the province because her home town only has horrible nursing homes (and hospital) and the town we live in has an abundance of nice places, staffed with professionals who actually give a damn.

Watching this unfold has taught me that you don't just need cash, you also need a caring, tireless person to coordinate all this for you. My mom has been that person for my grandma and it's been incredibly hard on her, even without having to do any of the physical care. Plus, you need for the right place to be available to you when and where you need it.

As for me, I also want to be able to check myself out when the time comes. However, I've never known anyone to actually do that. Can anyone cite some examples?

As others have pointed out, the new legislation is seriously limited and for anyone wanting to go this route, they'll likely need to take matters into their own hands anyway. Based on how few people actually do this, I'm not super optimistic about my odds.

I read an interesting article a while ago by a doctor who not only planned to end his own life, but also planned to stop seeking medical care at all after about age 75. His plan was no more medications, no flu shot, nada. I think he might be on to something.


Kris

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Re: How to Financially Plan For Long Term Care
« Reply #46 on: June 22, 2015, 04:21:39 PM »
Fortunately you don't need a physician to commit suicide, just a car and a length of hose.

My car's electric.

Thanks, Obama.

I saw this pic on a right-winger's FB page today.  I guess it's supposed to be an insult? ...

« Last Edit: June 22, 2015, 04:40:52 PM by Kris »

Lyssa

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Re: How to Financially Plan For Long Term Care
« Reply #47 on: June 23, 2015, 09:11:02 AM »
Oiy, my family is in the thick of this right now. I'm with the others who say that self insuring is the way to go.

My grandma is self-insured and has rapidly moved from her own home (widowed years ago) into the nicest assisted living place in town and this week is moving again into the nicest nursing home my parents could find for her. In fact, she's even moving across the province because her home town only has horrible nursing homes (and hospital) and the town we live in has an abundance of nice places, staffed with professionals who actually give a damn.

Watching this unfold has taught me that you don't just need cash, you also need a caring, tireless person to coordinate all this for you. My mom has been that person for my grandma and it's been incredibly hard on her, even without having to do any of the physical care. Plus, you need for the right place to be available to you when and where you need it.

As for me, I also want to be able to check myself out when the time comes. However, I've never known anyone to actually do that. Can anyone cite some examples?

As others have pointed out, the new legislation is seriously limited and for anyone wanting to go this route, they'll likely need to take matters into their own hands anyway. Based on how few people actually do this, I'm not super optimistic about my odds.

I read an interesting article a while ago by a doctor who not only planned to end his own life, but also planned to stop seeking medical care at all after about age 75. His plan was no more medications, no flu shot, nada. I think he might be on to something.

A few hundred Germans have already travelled to Switzerland and got assisted suicide there, including a few in the early stages of dementia (still capable of making that decision, thus surrendering a quite a few good months in order not having to go through the bad ones). One prominent case was Gunter Sachs (one of the heirs of the Opel family) who shot himself because of a declined that he selfdiagnosed as Alzheimers, another recent one Udo Reiter, a disabled journalist who fought for "right to die" legislation for years and shot himself a day after one of his numerous appearances advocating this cause. I think there is a steady trickle of such cases but most of them fly under the radar both because people want to keep it private and because media are reluctant to report for fear of "inspiring" others. Both Sachs and Reiter were figures of public interest and too bold about their motivation to be ignored or written of as "depressed and not thinking clearly".

Given the ever increasing lifespan and the growing awareness of how ones last years could look I assume that that trickle is going to turn into quite a wave over the next two decades.

GuitarStv

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Re: How to Financially Plan For Long Term Care
« Reply #48 on: June 23, 2015, 09:24:54 AM »
It's quite unfortunate that lifespan is easy to measure, but quality of life is difficult.  That's made science and modern medicine aim for the former, too often ignoring the latter.

mateoSF

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Re: How to Financially Plan For Long Term Care
« Reply #49 on: June 23, 2015, 04:06:21 PM »
Besides savings, I am planning on delaying Social Security until age 70 to maximize its payments and to lessen the financial burden of any long-term care.  Also, delaying would provide my wife a larger survivor benefit if I pre-decease her.

Plans subject to change as always.