What do you have planned for longterm care?

[iris lily]

What if you got divorced right before you or your spouse had to go into a nursing home, then the one in the nursing home would only have to exhaust half of the resources before gettin Medicaid and the still healthy spouse would not go broke. Is that a possibility?

be very careful playing this game .

it isn't easy to get what is called a medicaid divorce in many states which is usually what is done when a major health event happens .



two very powerful laws here in ny have been upheld and according to our estate attorney who is one of the biggest in ny there are very very few medicaid divorces .

all court actions are now pretty much based on right of refusal .

our two laws that pretty much killed off medicaid divorce are :

(1) Section 5-311 of the General Obligation Law which provides that except as provided in Section 236 of the Domestic Relations Law, a husband and wife cannot contract to relieve either his or her liability to support the other in such a manner that he or she will become incapable of self support, and therefore likely to become a public charge; and

(2) Family Court Act Section 415 which provides that the spouse or parent of a recipient of public assistance or care, or of a person liable to become in need thereof, or a patient in an institution in the department of mental hygiene if of sufficient ability, is responsible for the support of such a person. The Court has the discretion to require any such person to contribute a fair and reasonable sum for such support (child up to 21 years of age).

also if it is eventually determined that a divorce is to be pursued, the divorce needs to satisfy all of the requirements of the Domestic Relations Law, such as establishing one of the requisite grounds for a divorce. This may be difficult to accomplish because of the illness or disability of one spouse

I am glad to see "the Medicaid divorce" mentioned in some detail. i have never seen someone post with any knowledge  of it although I realize this is a state by state issue. Just like (as I read some years ago) the state of Michigan does not, in actuality, go after property of Medicaid funded  nursing home residents with means. That was a surprise to me! But it likely is not now true even if it was true at the time. Those who are comfortable with the 5 year "look back" period need to remember that can change in a day.

Anyway, I considered  the Medicaid divorce withiut really knowing consequences, but then I figured out that we would be able to swing nursng home care  with money we have.

[Blonde Lawyer]

This won't be popular on a blog focused on personal responsibility but I suspect by the time today's 30-somethings near retirement age, there will be another social safety net in place to provide long term care.  The number of older citizens will reach crisis proportions.  There will be government funded long term care homes, if I had to put my money on it.  Or the laws will change such that the spouse not needing the care will no longer be impoverished.  This just creates 2 wards of the state.

[mathjak107]

there is the right of refusal where a spouse refuses to pay for  the spouse in a home . it does not apply to in home care or assisted living . medicaid would just sue for recovery
ny ,florida and CT have  pretty much stopped recovery law suits .

ever since a judge in ct ruled that medicaid had to reach a suitable payment agreement with mrs jones that did not upset her lifestyle negotians have been the primary way of settling things  in these three states .

the judge in ct said he was not going to impoverish the people in his state because of a bad system and end up with 2 people on public assistance .

so our attorney said ny ,ct and florida courts have taken that stance too .

our attorney is one of the most popular in elder law and he has only negotiations now and no lawsuits for recovery .

be aware many states hold your kids liable for these payments if you can't pay . this can be a major issue .

[Exhale]

in our case we really couldn't care less about the the 3 years insurance coverage at all . we wanted the perks after the insurance runs out. to have no look back , no spending down needed, no income limitations for the stay at home spouse and no irrevocable trusts needed  and just have a special form of medicaid pick up any bills forever is priceless. but that is what our state , ny , offers on their total asset partnership plans .

But again, these "benefits" are all related to preserving one's assets.  As such, they aren't relevant for the single, childfree person who doesn't care about leaving a bequest for beneficiaries.  In my case, I don't even own a house, so I really could liquidate my entire portfolio and spend down every dollar I have if that were necessary. I think people on financial forums get a skewed view of what is necessary and possible during retirement.  There were about 8 million people insured for LTC in 2012 in a country of nearly 400 million.  The average low-income retiree living in their modest home or trailer home is ALREADY self-insuring for LTC by default, because that's the only affordable option available to them.  This concern about preserving assets in the face of needing LTC is truly a first world problem we're discussing here.

Clarification: My concern isn't about preserving assets for kids/spouse or getting perks. My concern, as a single child free person, is to do what I can to get decent care should I need need it due to illness, age, injury (old age isn't the only thing that can make us need care). Of course, I can't guarantee anything 100%, but I do want to want to set things up as best as possible (via savings, LTC insurance or whatever else I decide is the best fit for me).

[Exhale]

My plan is to set myself up before hand to be as physically able to care for myself and be as independent as possible. Be in housing and in a local that can support that. Like a no stairs apt that is easy care in a city or town with access to everything I need without a car.

Yes, this is absolutely a part of my plan. There is so much that can be addressed with thoughtful planning.

[iris lily]

there is the right of refusal where a spouse refuses to pay for  the spouse in a home . it does not apply to in home care or assisted living . medicaid would just sue for recovery
ny ,florida and CT have  pretty much stopped recovery law suits .

ever since a judge in ct ruled that medicaid had to reach a suitable payment agreement with mrs jones that did not upset her lifestyle negotians have been the primary way of settling things  in these three states .

the judge in ct said he was not going to impoverish the people in his state because of a bad system and end up with 2 people on public assistance .

so our attorney said ny ,ct and florida courts have taken that stance too .

our attorney is one of the most popular in elder law and he has only negotiations now and no lawsuits for recovery .

be aware many states hold your kids liable for these payments if you can't pay . this can be a major issue .

This is all very interesting.
And whatbis this  about children being held liable dor payment of nursing hme fees? Please gve more detail or context. That is new to me.

[mathjak107]

it is easier to google it and see what your states can do . but here is a little bit about it . more than 1/2 the states have filial laws regarding this. many have not enforced them but that does not mean they are not enforced from time to time .

"A Rare Case
Although, in practice, these laws rarely cause children have to pay for their parents’ bills, a 2012 Pennsylvania appeals court ruled that an adult son of a nursing home resident would have to pay his mother’s $93,000 nursing home bill based on the Pennsylvania filial responsibility law. This is a rare case because 1) the mother made just enough money through a pension not to qualify for Medicaid, and 2) the court allowed a private institution to sue the son, whereas filial responsibility laws are generally designed to empower the state to recover payments to reduce the burden on welfare. While this is an unusual case, some practitioners wonder if rising care costs will cause more cases like this to surface.

http://www.nolo.com/legal-encyclopedia/your-obligation-pay-parents-nursing-home-bill.html

[Lake161]

We used to have a LTC policy, but decided as we FIREd to drop it. The cost would have been a big part of our budget, and given our long retirement time frame, it seemed risky to trust the company to be there with the kind of policy we needed at a reasonable rate over so many years.

We should have enough assets to pay our own expenses, as we are using a very conservative 3.5% withdrawal rate.

Also, we would seriously look at going back overseas for better and cheaper care. This article has a nice analysis of the options: http://retireearlylifestyle.com/aaa/spending_your_money.htm.

[iris lily]

it is easier to google it and see what your states can do . but here is a little bit about it . more than 1/2 the states have filial laws regarding this. many have not enforced them but that does not mean they are not enforced from time to time .

"A Rare Case
Although, in practice, these laws rarely cause children have to pay for their parents’ bills, a 2012 Pennsylvania appeals court ruled that an adult son of a nursing home resident would have to pay his mother’s $93,000 nursing home bill based on the Pennsylvania filial responsibility law. This is a rare case because 1) the mother made just enough money through a pension not to qualify for Medicaid, and 2) the court allowed a private institution to sue the son, whereas filial responsibility laws are generally designed to empower the state to recover payments to reduce the burden on welfare. While this is an unusual case, some practitioners wonder if rising care costs will cause more cases like this to surface.

http://www.nolo.com/legal-encyclopedia/your-obligation-pay-parents-nursing-home-bill.html

Ok ,thanks, that Nolo press summary was fine.

I thnk it is safe to say that in nly rare cases children might have to,pick up a tab for a parent ina nursing hme.

Certainly laws could chamge to make thatbmore common, but I really really dou t that will happen.

[HenryDavid]

Holy crap the idea of long term "care" freaks me out.
I've had a great life for 54 years already. No kids.
If I get to the point of needing long term care I hope to have just enough independence left to find a beautiful northern river, glacier fed. Walk into that thing naked on a sunny cold winter day. Look at the beautiful world one last time and just let it all go.
Of course it's say to say this now . . . ..
Still, "Care" as a purchased commodity just doesn't sound that promising to me.

[stoaX]

My plan is to self insure until impoverished and then go on Medicaid.  But that's a worse-case scenario.  My fear about long term care is paying lots of premium dollars only to have the following happen:

-  the insurance company finding BS reasons not to pay when I finally need it.
- the insurance company going out of the long term care business and cancelling my policy just after I develop a medical condition that prevents me from getting it anywhere else (that's what happened to my mother).

These reasons might qualify as irrational fears, but that's where I'm at.

[jim555]

I am wondering if going to a lower priced state / country would be an option.  I think in my area it is $14,000 a month for a nursing home.

[mathjak107]

with all our kids and grand kids in the tristate area it would never be a thought if that was us .

[SachaFiscal]

This site has a table of the minimum, median, and maximum cost per day of nursing homes by state. From 2015. In Cali looks like the median is $285 :-(

http://www.seniorhomes.com/p/nursing-home-cost/

[Lake161]

I am wondering if going to a lower priced state / country would be an option.  I think in my area it is $14,000 a month for a nursing home.

The article I cited above suggests that $15k a year would cover you in Mexico, Thailand, or Guatemala. But it could be tougher overseas if you want family to be able to visit and provide emotional support.

[jodelino]

Darrow Kirkpatrick analyzes the current market for long term care insurance in two good posts on his blog:

http://www.caniretireyet.com/long-term-care-insurance-beyond-the-sales-pitch/

http://www.caniretireyet.com/long-term-care-insurance-why-we-arent-buying-it/

My husband & I bought LTC policies 20 years ago, when they were much cheaper and better, and they give us peace of mind. Not sure if we would buy in today's market.

[okits]

Holy crap the idea of long term "care" freaks me out.
I've had a great life for 54 years already. No kids.
If I get to the point of needing long term care I hope to have just enough independence left to find a beautiful northern river, glacier fed. Walk into that thing naked on a sunny cold winter day. Look at the beautiful world one last time and just let it all go.
Of course it's say to say this now . . . ..
Still, "Care" as a purchased commodity just doesn't sound that promising to me.

Your comment made me think of a post in a previous thread:

I've noticed a lot of comments in the thread where the poster takes the position that they would take their own life.  I've thought the same thing.  But there's a catch.  As I've grown to the age where people of my parents' generation are facing difficult end of life choices, none have taken the Oregon Option.  This has included a number of people who for much of their lives made the same confident pronouncement -- when it comes time, I will end it myself.  My (anecdotal) experience is that people hold on to life instead, for whatever diverse set of reasons.  Please accept from me that the folks in my example are  people of firm conviction, courage and principles.  What I took from this observation is that "middle aged me" cannot meaningfully speak for "disabled/dying/dementia me."  Life is too complicated for that degree of foresight about that massive an undertaking.  So yeah, I've opted for LTC insurance.   

HD, I relate very much to your recoiling from the idea of being in care, nevermind its sale and purchase as a commodity, but a Plan B is always a good idea.

[Exhale]

Darrow Kirkpatrick analyzes the current market for long term care insurance in two good posts on his blog:
http://www.caniretireyet.com/long-term-care-insurance-beyond-the-sales-pitch/
http://www.caniretireyet.com/long-term-care-insurance-why-we-arent-buying-it/

My husband & I bought LTC policies 20 years ago, when they were much cheaper and better, and they give us peace of mind. Not sure if we would buy in today's market.

Very helpful - thank you for sharing these links. I was especially struck by:

- "Your LTCI premium is not guaranteed!...The insurance company could raise your premium at any time in the future....For me, this is a deal-killer. Scott Burns concurs: 'The insurance company raises your premium after you have paid in for many years…. I believe it happens too often to make LTC insurance a reliable solution to the problem of long-term care.'"

- "The other gaping hole in LTCI, in my view, is that it is difficult to insure against the worst case. Lifetime policies are no longer generally available. Agents typically recommend policies covering 3-4 years of long-term care as the best value. But that’s not enough to protect against the worst scenarios..."

- "In most areas, you can call a nearby firm and have a competent home health aide at your house a day or two later. They can assist with any activities of daily living, and perform light house chores. Costs can average around $20/hour, or $80 for a half-day of care. That’s about $30K/year, less than half the cost of a typical nursing home."

- "Doug Nordman at The Military Guide, has dealt with an Alzheimer’s-afflicted parent for more than seven years. He writes, 'I’ve learned that health tech is a better use of my money than LTC insurance. I think that safety sensors, health monitors, assistive equipment, and perhaps even robots will reduce caregiver stress. Insurance companies are not reducing caregiver stress.'"

[jodelino]

Glad you found them useful. I think Kirkpatrick is very good at clearly analyzing the risks inherent in early (or any) retirement and helping you think through how you want to handle those risks.

The LTC policy that I was able to buy in the '90s (when I was in my 40's) has an unlimited term (so useful in Kirkpatrick's worst case scenario). But those policies don't seem to be available any more at an affordable premium, if at all. Nowadays, when it seems you can only buy LTC insurance for a limited term, self-insurance may well be the way to go.

[mathjak107]

in our case with the partnership plan we only need to get in to a nice facility by paying using the insurance   and make sure they take medicaid assignment in 3 years when the insurance runs out .

most in our area do . so that is it . we have no assets to shift or income to protect and all assets are secure . we couldn't care less about the 3 years coverage . we want all the protections we get after the insurance runs out

in 20 years time we may pay in what amounts to a years worth of benefits via our premiums but  the perks are well worth it .

as we get older ,more and more we like the idea of mitigating certain risks more and more since we already seen how statistics don't apply when it is you on the opposite side of the statistic.

eventually for the benefit of my spouse we may head more and more in to an integrated strategy .

spia for a base income , our own investing and a single premium life policy for beautiful tax free  money with no rmd's and no taxes ever ..


that combo has beaten buy term and invest the rest in 2/3's of 10,000 scenario's run . it beat it by having a higher draw rate  100% of the time since insurance money has no sequence risk and no powder to keep dry for worst case scenario's and over just normal life expectancy a bigger balance for heirs left as well  .

if i were to buy a joint annuity my wife would be taxed  and the spia would pay out less . it can be a better deal to take a single annuity and use a single premium life policy instead for the spouse as it is 100% tax free .

so between the partnership plan and the guarantee's of blending in insurance products the whims of markets ,rates and outcomes become reduced by quite a bit .

my wife was a widow once already . she had a pile of investments dumped in her lap  she knew little about , trusted her broker at the bank and lost 1/2 her money in the dot com crash .

so to her a good solid stable comprehensive  plan with at least some  guaranteed income and not having open ended risk in long term care costs  is important .

[Blonde Lawyer]

You also might want to look into retirement care communities that are regulated by your state's AG.  There are 3 very nice ones around me.  They have independent living houses, assisted living houses and a nursing home on site.  There is a "buy in" amount around $50,000 or $100,000.  Most people sell their home to "buy in."  Then you pay a reasonable rent for as long as you have the assets to support it.  As long as you meet the reasonable minimum income requirement and the buy in, you have a home there for life.  You stay in the location you can handle at that time.  You also must be fully independent when you buy in.  So, for example, you buy in at 55 in a nice, single story home.  Enjoy the country club like property, activities, pool.  Pay your monthly rent.  As you get older or infirm, you move up to assisted living and finally into the nursing home.  You won't have any assets left when you die but you will be very well cared for until the day you die.

[mathjak107]

they are well beyond budget in our area . they are more in the luxury end right now

[Exhale]

You also might want to look into retirement care communities that are regulated by your state's AG.  There are 3 very nice ones around me.  They have independent living houses, assisted living houses and a nursing home on site.  There is a "buy in" amount around $50,000 or $100,000.  Most people sell their home to "buy in."  Then you pay a reasonable rent for as long as you have the assets to support it.  As long as you meet the reasonable minimum income requirement and the buy in, you have a home there for life.  You stay in the location you can handle at that time.  You also must be fully independent when you buy in.  So, for example, you buy in at 55 in a nice, single story home.  Enjoy the country club like property, activities, pool.  Pay your monthly rent.  As you get older or infirm, you move up to assisted living and finally into the nursing home.  You won't have any assets left when you die but you will be very well cared for until the day you die.

Thank you for this suggestion. Will check to see what's available in my state.

[HenryDavid]

Holy crap the idea of long term "care" freaks me out.
I've had a great life for 54 years already. No kids.
If I get to the point of needing long term care I hope to have just enough independence left to find a beautiful northern river, glacier fed. Walk into that thing naked on a sunny cold winter day. Look at the beautiful world one last time and just let it all go.
Of course it's say to say this now . . . ..
Still, "Care" as a purchased commodity just doesn't sound that promising to me.

Your comment made me think of a post in a previous thread:

I've noticed a lot of comments in the thread where the poster takes the position that they would take their own life.  I've thought the same thing.  But there's a catch.  As I've grown to the age where people of my parents' generation are facing difficult end of life choices, none have taken the Oregon Option.  This has included a number of people who for much of their lives made the same confident pronouncement -- when it comes time, I will end it myself.  My (anecdotal) experience is that people hold on to life instead, for whatever diverse set of reasons.  Please accept from me that the folks in my example are  people of firm conviction, courage and principles.  What I took from this observation is that "middle aged me" cannot meaningfully speak for "disabled/dying/dementia me."  Life is too complicated for that degree of foresight about that massive an undertaking.  So yeah, I've opted for LTC insurance.   

HD, I relate very much to your recoiling from the idea of being in care, nevermind its sale and purchase as a commodity, but a Plan B is always a good idea.

I notice this too. But the emotional response still stands! Aaaggghhh.
In France the whole LTC concept gets shifted into "aging in place," so they support people staying in their home until the very last minute. Caregivers visit weekly, daily, help with shopping, laundry, medications etc. Costs the elderly nothing, costs taxpayers something, but waaaay less than warehousing people in buildings where their friends and neighbours never see them.

[stoaX]

Holy crap the idea of long term "care" freaks me out.
I've had a great life for 54 years already. No kids.
If I get to the point of needing long term care I hope to have just enough independence left to find a beautiful northern river, glacier fed. Walk into that thing naked on a sunny cold winter day. Look at the beautiful world one last time and just let it all go.
Of course it's say to say this now . . . ..
Still, "Care" as a purchased commodity just doesn't sound that promising to me.

Your comment made me think of a post in a previous thread:

I've noticed a lot of comments in the thread where the poster takes the position that they would take their own life.  I've thought the same thing.  But there's a catch.  As I've grown to the age where people of my parents' generation are facing difficult end of life choices, none have taken the Oregon Option.  This has included a number of people who for much of their lives made the same confident pronouncement -- when it comes time, I will end it myself.  My (anecdotal) experience is that people hold on to life instead, for whatever diverse set of reasons.  Please accept from me that the folks in my example are  people of firm conviction, courage and principles.  What I took from this observation is that "middle aged me" cannot meaningfully speak for "disabled/dying/dementia me."  Life is too complicated for that degree of foresight about that massive an undertaking.  So yeah, I've opted for LTC insurance.   

HD, I relate very much to your recoiling from the idea of being in care, nevermind its sale and purchase as a commodity, but a Plan B is always a good idea.

I notice this too. But the emotional response still stands! Aaaggghhh.
In France the whole LTC concept gets shifted into "aging in place," so they support people staying in their home until the very last minute. Caregivers visit weekly, daily, help with shopping, laundry, medications etc. Costs the elderly nothing, costs taxpayers something, but waaaay less than warehousing people in buildings where their friends and neighbours never see them.

I agree - aging in place is quite often better for all concerned.  Amongst my mother's friends, all but one are aging in place using support services like you describe. They are in their 80's and 4 are in their 90's!  So it seems quite possible and popular here in SoCal.

[iris lily]

But if "aging in place" means that granny stays in her 2700 sq ft house, how it that "better?" Better for who in her family who has to see that the lawn is mowed, the gutters cleaned, the entire thing kept up?And then, there is her cost of heating and cooling a space 2x to 3x what she needs and uses.

Ive seen too many granny houses here in my neighborhood of 2500-4000 sq ft Victorians that need constant care. They go downhill fast when the seniors become too feeble to keep on top of upkeep.

I think it is best to look at each situation objectively. There is no one size fits all.

[seattlecyclone]

But if "aging in place" means that granny stays in her 2700 sq ft house, how it that "better?" Better for who in her family who has to see that the lawn is mowed, the gutters cleaned, the entire thing kept up?And then, there is her cost of heating and cooling a space 2x to 3x what she needs and uses.

Ive seen too many granny houses here in my neighborhood of 2500-4000 sq ft Victorians that need constant care. They go downhill fast when the seniors become too feeble to keep on top of upkeep.

I think it is best to look at each situation objectively. There is no one size fits all.

Yes. Aging in place can be good, but perhaps a home that worked well for a mobile middle-aged couple with three kids in the house is not ideal for an aging couple who can't get around so well anymore. Seniors who wish to age in place should really consider switching their "place" to something more manageable years before they actually need to hire help.

[Larsg]

About the time at which you need that last three years, is the time I hope I live in a "right to die" state and have said my last good byes to those I love. That is no way to live...for what, for who? We need a more "natural model," in the same way we try to be as humane as possible for our pets. I hope I have it locked down to the point that my loved ones will have the courage to see this through with me as I will for them.

[iris lily]

About the time at which you need that last three years, is the time I hope I live in a "right to die" state and have said my last good byes to those I love. That is no way to live...for what, for who? We need a more "natural model," in the same way we try to be as humane as possible for our pets. I hope I have it locked down to the point that my loved ones will have the courage to see this through with me as I will for them.

i think you are dismissing the last three years of life as having any quality at all.
My mother, addle brained  with dementia and in a nursing hime, had decent quality if life until the last, oh, 4-6 months. Granted her life was very small, VERY small,but she had occasional moments of fun and joy, and she was not in pain.

[Bicycle_B]

About the time at which you need that last three years, is the time I hope I live in a "right to die" state and have said my last good byes to those I love. That is no way to live...for what, for who? We need a more "natural model," in the same way we try to be as humane as possible for our pets. I hope I have it locked down to the point that my loved ones will have the courage to see this through with me as I will for them.

i think you are dismissing the last three years of life as having any quality at all.
My mother, addle brained  with dementia and in a nursing hime, had decent quality if life until the last, oh, 4-6 months. Granted her life was very small, VERY small,but she had occasional moments of fun and joy, and she was not in pain.

Well put. 

I had a similar experience with my Dad.  It made me change my perspective on what quality of life is.  That changes with age.  The changes are hard to grasp emotionally ahead of time but they're real.