Long term care costs

[Runrooster]

I’ve been having a hard time at work the last few days, but it’s a newish job. I’m working on a project that my boss expects me to understand even though I told her that I am not up to speed. A contractor was supposed to teach me the ropes but decided it was too difficult and did it himself while I watched. Even if I’d done it, I’d probably be fuzzy. I started to ask my boss questions and she gave me the 3 second response that I backed off from asking more.

Unsurprisingly we had a colleague quit out of similar frustrations at about my same 6 month period. Not every project is this bad but.

But I could be retired if it wasn’t for long term care expenses. The numbers are scary-250k a year for 5+ years?  There are Medicaid run nursing homes that are supposed to be awful.

All I want, at times, is a way to kill myself when the money runs out.

I have a wealthy sister who keeps telling me she’ll take care of me when I’m old. But 1. She’s 11 years older than me and has a history of heart problems and will die before I need help. 2. She’s rich because she’s super cheap. She says she has set up money in her will for me, but I know it’s going to be some insignificant amount. 20k will buy about a month of nursing care. 3. She was visiting recently and she thought my parents were living off a $20k social security check (he’s spending closer to 100k) and that 99% of the population dies peacefully in their sleep at home. I’m 100% sure she is not leaving me anything but just dangling the possibility as a way to get me to do what she wants.

So again today was a bad day but I still thought I’d rather kill myself now than deal with this job for 17 years just so I can avoid Medicaid nursing homes.

What are other people thinking about long term care?

[jiimmy]

The numbers are scary-250k a year for 5+ years?  There are Medicaid run nursing homes that are supposed to be awful.

I’m far from an expert, but it’s my understanding that in your case you’d likely enter a nursing home with money, then once that’s spent down, you’d qualify for Medicaid. I don’t believe a home would kick you to the curb in this scenario. The vast majority of homes accept Medicaid. Of course that doesn’t mean it’s easy to BEGIN your stay with Medicaid coverage, that’s a whole other ball of wax, but it’s very common for folks to transition to Medicaid during their care.

A quick google search (take this with a grain of salt) tells me the average stay is around a year and the average cost is 8k/mo.

[iris lily]

The numbers are scary-250k a year for 5+ years?  There are Medicaid run nursing homes that are supposed to be awful.

I’m far from an expert, but it’s my understanding that in your case you’d likely enter a nursing home with money, then once that’s spent down, you’d qualify for Medicaid. I don’t believe a home would kick you to the curb in this scenario. The vast majority of homes accept Medicaid. Of course that doesn’t mean it’s easy to BEGIN your stay with Medicaid coverage, that’s a whole other ball of wax, but it’s very common for folks to transition to Medicaid during their care.

A quick google search (take this with a grain of salt) tells me the average stay is around a year and the average cost is 8k/mo.

I thought the average day was closer to seven years. I could be wrong about that.

I’m figuring $100,000 a year for a seven year stay.

[yachi]

I'm not saving anything for our long term care.  I imagine it might take all we have and we end up with Medicaid paying, and that would be just fine.  For my parent's I have the average length of stay as 835 days, so 2- 1/4 years, with 100 days paid by medicare (it's a short term stay at first).  Then I have a 33% chance that long term care is even needed in the first place.  For the cost per year, I have that as $102,200.  So I'm setting aside about $135K if they need it.  Pennsylvania is a high filial responsibility state so I'm a bit concerned that we'll end up having to pay something.

[Runrooster]

I thought the average day was closer to seven years. I could be wrong about that.

I’m figuring $100,000 a year for a seven year stay.

I imagine it depends on where you live. I’m in a HCOL state and my mom has been disabled for 14 years. In home care (40 hours a week) costs $130k per year. Nursing home is easily double that, but yeah maybe 3 years?  A lot depends on my father and I being caregivers for my Mom outside those 40 hours. I’m not married or have kids which is why I’m guessing I’ll need full time care for longer.

[former player]

My plan if I need long term care is to sell the house I live in - after all, I'm not going to need it for myself, am I?  I reckon that should give me at least 5 or 6 years in a decent place, and after that the chances are I'll be dead or past caring, at which point the state will pick up the tab for any remaining time.

That doesn't work so well if you are in a couple and the other one needs or wants to stay in the house, of course.

I may also contemplate assisted suicide, if it comes to that.  I don't have a lot of imagination but I can imagine being in a condition that's worse than death.  I've had a good run already and more to come as far as I know, so not too many regrets if it becomes necessary in the end.

[Omy]

We fatFIREd with the intention of having plenty of money if either or both of us end up in that situation.

We didn't buy long term care insurance, but we did buy an annuity that has a long term care rider. If either of us can't perform 2 of the 5 activities of daily living, the annuity payout doubles for up to 5 years.

Fortunately our parents (so far) and grandparents did not have illnesses that required long term care, so we're hoping we are as lucky. I'm also not averse to assisted suicide if my quality of life stinks and can't be improved by throwing money at the problem.

[wenchsenior]

There's only so much trade off one can reasonably make between accumulating enough and working forever.

We bought LTC insurance for my husband (I didn't qualify at any reasonable rate) and I'm planning on accumulating 250-300K for this purpose for myself. Beyond that, broadly, we will spend down our estate until it's gone and then hopefully qualify for Medicaid.

In terms of actual variables, there are so many possible complicating factors that it's hard to plan much beyond that. Some of the crucial ones are e.g., when and whether to buy into a continuing care community, which state we end up in (Medicaid rules vary by state and there are big differences in how states 'fill in' care gaps left in their Medicaid systems), and (most vitally) whether one of us needs long term care for an extended period of time when the other does not (since the cost of care of the sick spouse can quickly and completely bankrupt the nonsick spouse; in this case, we would likely try to divorce to protect assets of non-sick  spouse.

But yeah, it can be ruinously expensive. My dad refused to get LTC insurance and was certain he would die suddenly and not need care (and he repeatedly emphasized that he absolutely under no circumstances wanted to go to a nursing home, that he'd rather go to a state that allowed euthanasia). This all seemed fine in the abstract even 15 years ago, when he and his wife had an estate worth about 2.5 million.

Then they separated, he spent a mass of money on professional rehab, used a bunch of his cash to buy additional property (an emotional desire that I understand but is biting him in the ass now), and developed dementia and needs 24 hour care (at home), which completely aside from the incredible difficulty of finding the reliable help, is costing about 15K per MONTH (he has regular bills on top of that). So he will be totally out of cash in a little over a year, though he could easily live another 5 years at least.  So, despite his lifelong repeatedly emphasized wishes, he missed the window to do euthanasia and he's likely going to a nursing home in a year or so. ETA: And his (ex)wife had to legally divorce him instead of just the legal separation, to protect herself from financial ruin.

It's not fun, and these kind of situations are common (esp in my family, where the people who have lived to be old enough to go to a nursing home at all mostly have ended up living in them for >3 years...considerably longer in some cases).

[GilesMM]

Neither of us is interested in long term care, paid or otherwise. It’s no way to live.

[okits]

I still thought I’d rather kill myself now than deal with this job for 17 years just so I can avoid Medicaid nursing homes.

Whatever you decide about LTC, surely you can find a less unpleasant job right now.

[swashbucklinstache]

Before I worked 17 additional years to pay for LTC I'd do some research on how long average stays are and what they cost. It also depends how old you are now, how much you have now, how much you spend now, and how much you save each year. For instance, if you are 33 now an additional 10k could grow to 295k real at 83 at 7% returns.

The big troubles were as mentioned above

That doesn't work so well if you are in a couple.

or if you have a reason to need an extended period long term care, especially if you need it unexpectedly early and for a long time.

I'm not sure either of those, if you're overall goal is to live the best life, are best met by working an additional 17 years.

Don't forget that LTC spending is likely to be instead of your current spending, so it is only the marginal increase that matters. But also don't forget that you might have new non-insurable expenses too, like getting to the grocery store or extra help an insurance company doesn't want to cover.

[snic]

The numbers are scary-250k a year for 5+ years?

Where do you get this number from? My mother was recently in a nursing home and the cost was $500 per day - or $182k/year. (Fortunately she was there for only a month and medicare + LTC insurance paid for it.) This was in a HCOL area so there are probably cheaper options in, I dunno, Kentucky.

Sure, you might be in a nursing home for 5+ years, but it's more likely that if you need long-term care, you can get away with an assisted living facility or even a few hours of in-home help every day. Those options are considerably less expensive (again, depending on where you live). If I were you I'd look into a long-term care insurance policy or a creative life insurance policy or annuity as someone mentioned above, with LTC option should you need it. That way you can work until you can afford the premium of a few thousand dollars per year, rather than until you can afford to pay the full cost of a long stint in a nursing home.

Finally, re the assisted suicide option - all good and fine, but the reality is that the in many cases the mind goes before the body. When your cognition is impaired it's going to be very difficult to go that route, and it's very unlikely that anyone will help you to do it.

[Runrooster]

I still thought I’d rather kill myself now than deal with this job for 17 years just so I can avoid Medicaid nursing homes.

Whatever you decide about LTC, surely you can find a less unpleasant job right now.

Not at all. I’ve been out of my profession for over 10 years as a caregiver and I got lucky with the job market to land this job. I could go back to minimum wage, but again I’d rather plan on euthanasia.  I did it for 4 years, I could do it again I guess.  My boss is not always condescending or dismissive. I was already at the end of my day so I just didn’t feel like staying late and dealing with the attitude.But both coworkers were off today so I spent the day spinning my wheels.  I’ve certainly had worse bosses. Just a really steep learning curve but others say it gets better at the year mark. I figure I have to put in 2-3 years minimum before I look to job hop. And the job market already looks worse than 6 months ago.

I think it’s just the family stuff - I need to move out of the caregiving situation, my 3 siblings irritate me - piling on the job stuff. Most days are not this bad.

[Runrooster]

Just some basic background: I’m 53 and planning to work til 70, when social security will give me about 40k. I don’t know my expenses because I’m still caregiving and rent etc are covered. I think I could live on my current salary minus 401k, but housing is expensive here, so I may have to pull more from savings.  So I could save $37k a year on top of the million I have in savings. I did a retirement analysis a couple years ago and that landed me at 2-3 million at retirement which sounds like enough to cover long term care needs ( again assuming neither my parents nor wealthy sister leave me anything). I think I’ll need more than others because I’ll be living alone.

The alternative that I was considering while working minimum wage, was to get low income housing and retire on a million. Social security would be about half, so 20k at age 70. If I could live off the 4% then I could use down the million for long term care issues. I spend almost nothing right now, but I know 40k doesn’t go as far as it used to.

ETA: I pulled out the retirement analysis, it was at age 51 assuming 67 retirement, and my starting balance looks about the same as todays. It did land at 3.3 million at retirement but all the numbers seem to be inflation adjusted.

[Dave1442397]

I've seen that it's often housing issues (stairs, maintenance and repairs, etc) as well as distance from needed amenities like doctors and stores and easy safe transportation when you can't drive anymore, that seem to cause many problems as people age.

Also the Smith and Wesson route if possible.

Yes, infrastructure is important. My 93-year-old mother-in-law lives alone in a condo. She's on the 4th floor, has an elevator, and the staff are great at keeping an eye on things. They have a maintenance guy who can do whatever she (or we) can't. She can walk to the casino next door, and the hospital is a short cab ride away when she has appointments. That covers all her needs.

Meals on Wheels delivers food to her, but she says "it's white-people food" and doesn't eat much of it. That doesn't stop her stockpiling the little milk cartons in her freezer, though. Come the apocalypse, there will be milk!

It's a race to see whether she'll spend all her money at the casino before the grim reaper strikes, or she needs assisted living.

[Catbert]

If assisted suicide is really part of your long term plan, I suggest you read "In Love: A Memoir of Love and Loss" by Amy Bloom.  It's the story of her husband's early onset Alzheimer's and legal assisted suicide in Switzerland.  Switzerland is the only country that allows legal assisted suicide of non-terminal people.  It's not easy to get approved since you have to demonstrate that you are of sound mind and not depressed.  This is something I would consider if my husband predeceases me and I was facing a long and  ugly residence in a care home.

A paid off house you can sell will fund LTC expenses for a long while - depending. 

[iris lily]

If assisted suicide is really part of your long term plan, I suggest you read "In Love: A Memoir of Love and Loss" by Amy Bloom.  It's the story of her husband's early onset Alzheimer's and legal assisted suicide in Switzerland.  Switzerland is the only country that allows legal assisted suicide of non-terminal people.  It's not easy to get approved since you have to demonstrate that you are of sound mind and not depressed.  This is something I would consider if my husband predeceases me and I was facing a long and  ugly residence in a care home.

A paid off house you can sell will fund LTC expenses for a long while - depending.

Was she the woman who did a podcast on NPR, maybe this American life? Yeah, this whole assisted suicide thing is not nearly as easy as people think it is. If this is the one, do you have to be able to administer the legal drug yourself to yourself. Then of course, eliminates paralyzed persons.

[Runrooster]

I’ll put in a few words about ltc policies based on my parents federal policy. My dad bought in early, and my mom went into pay in 2010, so she’s approaching her 14th year of full benefits. Around 2014, my Dads policy doubled their premium and cut the benefits. Now there’s a lifetime max. Don’t quote me but the lifetime max is around 3 years worth of benefits. Or closer to 1-1.5 years of nursing care.

Of course, paying $2500 a year for 30-40 years is still worth it if you need that year of nursing home care.

[wenchsenior]

I’ll put in a few words about ltc policies based on my parents federal policy. My dad bought in early, and my mom went into pay in 2010, so she’s approaching her 14th year of full benefits. Around 2014, my Dads policy doubled their premium and cut the benefits. Now there’s a lifetime max. Don’t quote me but the lifetime max is around 3 years worth of benefits. Or closer to 1-1.5 years of nursing care.

Of course, paying $2500 a year for 30-40 years is still worth it if you need that year of nursing home care.

Yes, this has been a typical thing in the past decade or so. Increasing premiums, decreasing coverage. My husband's policy hasn't increased premiums so far but we specifically bought a policy that has a max similar to what you stated. So far, his policy is about 10 years old and no changes but I anticipate it will increase for the same coverage at some point (or decrease coverage).

[wenchsenior]

If assisted suicide is really part of your long term plan, I suggest you read "In Love: A Memoir of Love and Loss" by Amy Bloom.  It's the story of her husband's early onset Alzheimer's and legal assisted suicide in Switzerland.  Switzerland is the only country that allows legal assisted suicide of non-terminal people.  It's not easy to get approved since you have to demonstrate that you are of sound mind and not depressed.  This is something I would consider if my husband predeceases me and I was facing a long and  ugly residence in a care home.

A paid off house you can sell will fund LTC expenses for a long while - depending.

Was she the woman who did a podcast on NPR, maybe this American life? Yeah, this whole assisted suicide thing is not nearly as easy as people think it is. If this is the one, do you have to be able to administer the legal drug yourself to yourself. Then of course, eliminates paralyzed persons.

I think a whole lot of people fool themselves that they will be able to do this when the hypothetical time comes. Not only is it logistically very hard, but the will to live just one more day is incredibly strong, even when people are completely miserable. My father was actively suicidal for at least 5 or 6 years (and previous to that he was absolutely adamant that he would never allow himself to suffer the perceived indignities of long term care, that he absolutely would shoot himself and end it). But in the end, even though he was suicidal and completely miserable and convinced that there was nothing to live for, and had 24-7 access to firearms with no one watching him, he refused to take that final step. And now, here he is, in 24-hour per day care and shortly to be broke, and in a state where he is incapable of taking that step even if he wanted.

[Runrooster]

I’ll put in a few words about ltc policies based on my parents federal policy. My dad bought in early, and my mom went into pay in 2010, so she’s approaching her 14th year of full benefits. Around 2014, my Dads policy doubled their premium and cut the benefits. Now there’s a lifetime max. Don’t quote me but the lifetime max is around 3 years worth of benefits. Or closer to 1-1.5 years of nursing care.

Of course, paying $2500 a year for 30-40 years is still worth it if you need that year of nursing home care.

Yes, this has been a typical thing in the past decade or so. Increasing premiums, decreasing coverage. My husband's policy hasn't increased premiums so far but we specifically bought a policy that has a max similar to what you stated. So far, his policy is about 10 years old and no changes but I anticipate it will increase for the same coverage at some point (or decrease coverage).

My point was that current ltci plans will only cover a fraction of ltc needs. You can use it for the part time in home care for a few years, but pay out of pocket for nursing home. Or you can pay out of pocket for the various in home needs, like instacart, home repairs, taxi to the doctor, plus day to day care, and then have some left for nursing care which will still probably run out to Medicaid paid nursing home.

I’m not particularly sold on ltci policies. I think for people with decent assets it makes more sense to self insure.

[Villanelle]

Mentions of "killing yourself now" are not okay.  Either you need some counseling ASAP, or you maybe need to take a moment to understand how suicide affects people and that it's really not something to be casually tossed about.  To be clear, I'm not referring to thinking that assisted (or not assisted) suicide when you are old and feeble might be preferable.  I'm talking about the mention of killing yourself *now* because your job is awful.  If your job is that bad, find an alternative, even if it means working longer.  If it isn't but you still feel that way, seek counseling immediately.  If you don't actually feel that way, don't say that shit. 

I agree with the suggestion that you should look for another job.  You just dismiss it when suggested, but keep looking.  The only way to guarantee you'll never find anything is to not loo,.

[snic]

Mentions of "killing yourself now" are not okay.  Either you need some counseling ASAP, or you maybe need to take a moment to understand how suicide affects people and that it's really not something to be casually tossed about.  To be clear, I'm not referring to thinking that assisted (or not assisted) suicide when you are old and feeble might be preferable.  I'm talking about the mention of killing yourself *now* because your job is awful.  If your job is that bad, find an alternative, even if it means working longer.  If it isn't but you still feel that way, seek counseling immediately.  If you don't actually feel that way, don't say that shit. 

I agree with the suggestion that you should look for another job.  You just dismiss it when suggested, but keep looking.  The only way to guarantee you'll never find anything is to not loo,.

OP said they want a way to kill themself "when the money runs out," which is not now. So let's hope the OP is not so depressed by their job that they would consider that as an option.

Re LTC insurance costs: Here is one example. My mother paid for a policy for about 20 years (since about age 70). The premium went up from I think around $1500 to $2500 per year a few years ago. It pays a lifetime max of $215,000, and the monthly amount is determined by the kind of care she receives ($6000/mo for nursing home, $4200 for assisted living, $3000 for in-home care; there is a 90 day waiting period before benefits begin). Her assisted living facility costs more than 3x the LTC benefit, but this is in a HCOL area and people on this board have described considerably less expensive options in LCOL areas.

She is likely to receive far more in benefits from the LTC policy than the $30-50k she paid in premiums. I have no idea what LTC policies cost now, but one that pays something close to the current cost of LTC services for more than a few months would be quite expensive - and even more expensive if it has an unlimited inflation rider, if such a thing even exists anymore. However, a policy that pays a portion of LTC costs, so that you cover the rest with social security, sale of assets like retirement funds and house, etc, would extend the amount of time before you'd have to resort to Medicaid.

[Villanelle]

Mentions of "killing yourself now" are not okay.  Either you need some counseling ASAP, or you maybe need to take a moment to understand how suicide affects people and that it's really not something to be casually tossed about.  To be clear, I'm not referring to thinking that assisted (or not assisted) suicide when you are old and feeble might be preferable.  I'm talking about the mention of killing yourself *now* because your job is awful.  If your job is that bad, find an alternative, even if it means working longer.  If it isn't but you still feel that way, seek counseling immediately.  If you don't actually feel that way, don't say that shit. 

I agree with the suggestion that you should look for another job.  You just dismiss it when suggested, but keep looking.  The only way to guarantee you'll never find anything is to not loo,.

OP said they want a way to kill themself "when the money runs out," which is not now. So let's hope the OP is not so depressed by their job that they would consider that as an option.

Re LTC insurance costs: Here is one example. My mother paid for a policy for about 20 years (since about age 70). The premium went up from I think around $1500 to $2500 per year a few years ago. It pays a lifetime max of $215,000, and the monthly amount is determined by the kind of care she receives ($6000/mo for nursing home, $4200 for assisted living, $3000 for in-home care; there is a 90 day waiting period before benefits begin). Her assisted living facility costs more than 3x the LTC benefit, but this is in a HCOL area and people on this board have described considerably less expensive options in LCOL areas.

She is likely to receive far more in benefits from the LTC policy than the $30-50k she paid in premiums. I have no idea what LTC policies cost now, but one that pays something close to the current cost of LTC services for more than a few months would be quite expensive - and even more expensive if it has an unlimited inflation rider, if such a thing even exists anymore. However, a policy that pays a portion of LTC costs, so that you cover the rest with social security, sale of assets like retirement funds and house, etc, would extend the amount of time before you'd have to resort to Medicaid.

OP also said, "I’d rather kill myself now than deal with this job for 17 years".  That's the part that was concerning to me. 

[rosarugosa]

This is anecdotal of course, but my MIL spent her last 3 years in what I would describe as a pretty crappy, run-down nursing home.  She did frequently ask to go home, but most of the time she thought she was in a hotel.  She said everyone there was very nice to her and the food was good.  She spent her days reading in bed.
I think it's hard, if not downright impossible, not to assess nursing home life though the eyes of someone who is relatively young, fit and healthy.  In other words, we think how much we, at our current age, health and abilities, would hate being in that nursing home bed.  This is as true for me as anyone else, and I fear ending up in that very nursing home, which is quite local.
I've often pondered the fact that with long-term care, there are princes and paupers, but nothing in between.  As functioning adults in our prime, there are many, many living options in the middle range; it's not just either mud huts or palaces.  With long term care facilities, it seems one must be fantastically wealthy or Medicaid eligible, and there are no reasonable mid-range options.

[iris lily]

This is anecdotal of course, but my MIL spent her last 3 years in what I would describe as a pretty crappy, run-down nursing home.  She did frequently ask to go home, but most of the time she thought she was in a hotel.  She said everyone there was very nice to her and the food was good.  She spent her days reading in bed.
I think it's hard, if not downright impossible, not to assess nursing home life though the eyes of someone who is relatively young, fit and healthy.  In other words, we think how much we, at our current age, health and abilities, would hate being in that nursing home bed.  This is as true for me as anyone else, and I fear ending up in that very nursing home, which is quite local.
I've often pondered the fact that with long-term care, there are princes and paupers, but nothing in between.  As functioning adults in our prime, there are many, many living options in the middle range; it's not just either mud huts or palaces.  With long term care facilities, it seems one must be fantastically wealthy or Medicaid eligible, and there are no reasonable mid-range options.

Rosa, I wouldn’t say that. My mom‘s nursing home seemed decent to me and she was private pay. And I know for a fact there were several people in there that were not private pay  but were Medicare patients. Same facility. The only difference is that she got a private room and they did not.

It does seem to depend on the facility though. I’ve heard that some facilities have “Medicare floors “that are quite different from the private pay floors.

But my mom’s nursing home was all one floor.

[Runrooster]

I’m trying not to feed the troll, and I don’t think my psychological issues are helpful to discuss in this forum. But I will say that I don’t live under a rock, I’m aware of medications and therapy, have used both. My passing (as I said in my first post and since) frustration was a lot worse before this job, and there are personal, familial factors that are much larger. 

It’s easy for an outsider to assume a new job or therapy or whatever are panaceas. They’re not.  This thread has reminded me that I can probably make compromises to increase my standard of living while still funding enough long term care.

[stoaX]

Your comment about making some changes to improve life today is a good idea.

You might not need assisted living or nursing home care untill 30 or more years from now. You might not ever need it at all.  Who knows how things will have changed by then or what the options will be. 

[NextTime]

The numbers are scary-250k a year for 5+ years?  There are Medicaid run nursing homes that are supposed to be awful.

I’m far from an expert, but it’s my understanding that in your case you’d likely enter a nursing home with money, then once that’s spent down, you’d qualify for Medicaid. I don’t believe a home would kick you to the curb in this scenario. The vast majority of homes accept Medicaid. Of course that doesn’t mean it’s easy to BEGIN your stay with Medicaid coverage, that’s a whole other ball of wax, but it’s very common for folks to transition to Medicaid during their care.

A quick google search (take this with a grain of salt) tells me the average stay is around a year and the average cost is 8k/mo.

A few weeks ago, my sister and I went around and checked out several long term care facilities, none of which take Medicaid. All of them implied, without actually saying it, that they would be kicked out once you go on Medicaid. My mother brings in over $6k/month in pensions and SS, and with her investments, she would never have to go on Medicaid, but it was definitely disheartening to hear.

I live in a LCOL city, so $8k/month was on the high end of the places I checked out. So it's definitely location dependent. The best place for her (dementia) is a memory care facility that was a little over $6k/month. Just being in that place was depressing. I'll try to keep her at home as long as I can.