Author Topic: Nursing homes/long term care for FIRE community  (Read 2445 times)

FireAnt

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Nursing homes/long term care for FIRE community
« on: June 25, 2019, 07:12:50 PM »
https://www.bloomberg.com/news/articles/2019-06-25/u-s-nursing-home-costs-may-get-worse-thanks-to-a-labor-shortage?srnd=premium

Someone posted this article on Reddit and asked what is everyone's plans for this extremely high cost of care. For those who plan to live on a leaner FI, it doesn't equate to the costs of these facilities. For example, our FI # is 1 million, but 40k/year is not going to cover it. Based on the responses on the thread, it doesn't appear to be many viable options other than rely on Medicaid or hope their children take care of them. It's somewhat anxiety provoking when you think about it. Maybe things will change in 40-50 years. Do you have a plan for long term care? If so, what is it?




Classical_Liberal

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Re: Nursing homes/long term care for FIRE community
« Reply #1 on: June 26, 2019, 04:16:27 AM »
I work in the medical field and have considered this often.  First off, no one wants to go to long term care, so the question shouldn't be only "how can I afford this?", it should be "how can I avoid it for as long as possible".  Secondly, the average length of LT care is not as long as you might think, that goes doubly so if one is realistic about outcomes and chooses to avoid many of the life extending (read extend life at all costs, even if quality of life is sacrificed) medical treatments available.  I believe our medical abilities have far exceeded our ethics and morality wrt end of life care.

Considering my first point, I plan to use funds to purchase a multiunit building designed for the elderly.  Then, I plan to rent out (at considerable discounts to assisted living) units to other couples who hope to avoid LT care.  The synergy of multiple households working together towards the end goal of avoiding LT care will work wonders towards meeting that goal.  Cost sharing of any needed in home services, friends living together can rally around each other if one person suffers an injury or illness, etc.  Maybe pie in the sky, but I haven't really heard of it being tried, and my highly qualified opinion is that it will be effective.  Considering my second point, I think it behooves everyone to seriously consider their personal beliefs about life and it's end, reconcile this with reality, and take whatever legal measures needed (living will, etc) to ensure life is not extended past their personal quantity vs quality measure.


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Re: Nursing homes/long term care for FIRE community
« Reply #3 on: June 26, 2019, 05:21:53 AM »
https://www.bloomberg.com/news/articles/2019-06-25/u-s-nursing-home-costs-may-get-worse-thanks-to-a-labor-shortage?srnd=premium

Someone posted this article on Reddit and asked what is everyone's plans for this extremely high cost of care. For those who plan to live on a leaner FI, it doesn't equate to the costs of these facilities. For example, our FI # is 1 million, but 40k/year is not going to cover it. Based on the responses on the thread, it doesn't appear to be many viable options other than rely on Medicaid or hope their children take care of them. It's somewhat anxiety provoking when you think about it. Maybe things will change in 40-50 years. Do you have a plan for long term care? If so, what is it?

Thing is, this isn't a problem for the individual, it's a problem for society.  From an individual's point of view, if you need long term care in a nursing home you are no longer living on income but on capital.  Your house is sold, your investments are sold, and when there is nothing left the state steps in because a rich and civilised society does not throw its old and disabled out onto the streets to die in terrible circumstances.  And frankly, by the time you reach that stage you are probably not in a position to know or care who is paying for you.

What can an individual do?  You can't do anything about the money on an individual basis.  You can do other things.  Firstly, live a reasonably healthy lifestyle, avoiding obvious risk factors such as obesity and smoking and keeping mind and body active.  Secondly, set up the necessary documentation for someone you trust to look after your finances and make medical decisions if you are unable to do so yourself.  And thirdly, future-proof your living conditions so that independent living will be feasible for as long as possible.  That doesn't just mean a home that is small and easily cleaned and maintained, it also means living somewhere you don't need to drive a car for daily necessities and to maintain connections with other people.

As to dealing with the money on a government level, it's about getting involved in the politics to help direct future policy.  Or if that is not for you, it is at least about making decisions when you vote which will direct government towards a financially sustainable and humanitarian response to the issues.

Metalcat

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Re: Nursing homes/long term care for FIRE community
« Reply #4 on: June 26, 2019, 05:35:10 AM »
It's impossible to predict what the labour market will be years down the road. Throw in automation, and it's really anyone's guess. Also, as the boomers age, senior care is going to explode as a major social issue, so you can pretty much bank on this being solved for you.

Don't base any decisions now on completely unpredictable future outcomes. Make reasonable decisions now that allow for some flexibility.

First, in end of life, you don't need a WR that's calculated to make your 'stache last indefinitely.

Second, if you have any fat in your FIRE budget, then your 'stache is likely to get stupid huge by the end of your life.

Third, will you have a paid off home? We treat our home as a healthcare fund, which will help pay for our care when we have to sell it.

Fourth, if you really want some insurance, get some literal insurance. A life insurance policy will refill the coffers if one spouse needs significant care before the other.

Overall, unless you are planning a very lean-FIRE on a very small budget, with absolutely no plan or capacity to make more money in retirement, then it's probably a non-issue, and definitely not worth drastically changing your FIRE plans out of fear.

Linea_Norway

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Re: Nursing homes/long term care for FIRE community
« Reply #5 on: June 26, 2019, 05:37:51 AM »
Considering my first point, I plan to use funds to purchase a multiunit building designed for the elderly.  Then, I plan to rent out (at considerable discounts to assisted living) units to other couples who hope to avoid LT care.  The synergy of multiple households working together towards the end goal of avoiding LT care will work wonders towards meeting that goal.  Cost sharing of any needed in home services, friends living together can rally around each other if one person suffers an injury or illness, etc.  Maybe pie in the sky, but I haven't really heard of it being tried, and my highly qualified opinion is that it will be effective.  Considering my second point, I think it behooves everyone to seriously consider their personal beliefs about life and it's end, reconcile this with reality, and take whatever legal measures needed (living will, etc) to ensure life is not extended past their personal quantity vs quality measure.

Isn't this done already? I know someone who lives in such a place (in the Netherlands). This building was also built as a private initiative from some people who became older. It is called senior housing, but without all the entertainment circus like some complexes in the US have. Everyone owns his/her own unit. The idea in her complex is that the neighbours take a some care of each other. A different one of them is responsible for providing coffee in the cafetaria every week. I think you need a very diverse number of ages there, because you can expect the eldest to need the most help from the youngest. But of course, one could also hire nurses/handyman to help several people in the complex. That is probably cheaper than hiring them individually.

Linea_Norway

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Re: Nursing homes/long term care for FIRE community
« Reply #6 on: June 26, 2019, 05:40:57 AM »
Still, most people who FIRE with a big stash will be better off than the masses with low pensions. Maybe you could keep living in your own home, but give free housing and a salary to a care giver who lives with you.

use2betrix

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Re: Nursing homes/long term care for FIRE community
« Reply #7 on: June 26, 2019, 08:51:45 AM »
As long as SS is still in place (which is a whole other conversation) A lot of long term facilities will accept the fixed income social security to be turned over for an adjusted cost.

I spent many years working in long term care facilities and became very close with many residents. Some residents are very angered that they saved and sacrificed their whole lives, to have it eaten away at at $10k/mo, while their neighbor in a similar room never saved a dollar in their life and is getting the same lifestyle.

I have seen married couples get divorced to protect some of their assets as well. If only one family member is in the facility it will eat their savings away very fast, while the other spouse still has to support a life outside the facility.

Dancin'Dog

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Re: Nursing homes/long term care for FIRE community
« Reply #8 on: June 26, 2019, 09:22:50 AM »
It is a concern & hard to plan for because nobody knows how much they'll actually need. 


My dad was lucky in that he only lived in a nursing home for a year before passing away.  Although it was a very nice place he was angry about being trapped there.  He'd tried to escape in his wheelchair the week before he died.  I'd cared for him until his physical needs were beyond my abilities.  He had plenty of money for home care, but he was too mean, demanding, & bossy for at home nurses to work.  He'd have fired them all, until I finally assumed the health care PoA. 

FireAnt

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Re: Nursing homes/long term care for FIRE community
« Reply #9 on: June 26, 2019, 03:01:24 PM »
It is a concern & hard to plan for because nobody knows how much they'll actually need. 


This.

I think the difficulty of planning makes it anxiety provoking. You just can't with the exception of minor things like save more or eat healthy. And yes I would like to avoid going this route as much as possible (and hopefully entirely avoid it). I like the conversation happening here though- very creative ideas. I will read past threads that were posted too.
« Last Edit: June 26, 2019, 07:40:37 PM by FireAnt »

bogart

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Re: Nursing homes/long term care for FIRE community
« Reply #10 on: June 26, 2019, 04:04:22 PM »
As long as SS is still in place (which is a whole other conversation) A lot of long term facilities will accept the fixed income social security to be turned over for an adjusted cost.

I spent many years working in long term care facilities and became very close with many residents. Some residents are very angered that they saved and sacrificed their whole lives, to have it eaten away at at $10k/mo, while their neighbor in a similar room never saved a dollar in their life and is getting the same lifestyle.


This has not at all been my experience -- my dad lived in a nursing home for many years as he declined into dementia and while it's true that the cost was covered by a combination of his pension/SS and Medicaid, there were very few options in our area of facilities willing to accept Medicaid.  We did get him into one (obviously) but it was relatively bottom-of-the-barrel relative to other options in our area.  Not having other choices also made it difficult to negotiate with the facility when problems arose -- it wasn't like we could threaten to move to another facility. 

Medicaid varies state-by-state, and is generally more generous in the northeast and west coast states; I live in the south, so that probably affected my experience.

Classical_Liberal

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Re: Nursing homes/long term care for FIRE community
« Reply #11 on: June 26, 2019, 11:16:45 PM »
This has not at all been my experience -- my dad lived in a nursing home for many years as he declined into dementia and while it's true that the cost was covered by a combination of his pension/SS and Medicaid, there were very few options in our area of facilities willing to accept Medicaid.  We did get him into one (obviously) but it was relatively bottom-of-the-barrel relative to other options in our area.  Not having other choices also made it difficult to negotiate with the facility when problems arose -- it wasn't like we could threaten to move to another facility. 

Insider hint.  Many upper end facilities accept Medicaid, but may only have a few Medicaid beds, while most remain private pay.  If someone is placed as private pay, then private funds run out down the road, the faculty can not transfer them simply because all of the Medicaid beds are filled.   So all someone really needs is a year or so of private pay ability (sell your house) to get into a nice private place.  Then apply for Medicaid later.

rosarugosa

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Re: Nursing homes/long term care for FIRE community
« Reply #12 on: June 27, 2019, 07:50:00 AM »
Yes, I think this is where my SIL went wrong by letting my MIL go into a crummy facility initially.  Now that she is considered maintenance care instead of rehab, and Medicaid is funding her care, she is stuck there.

totoro

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Re: Nursing homes/long term care for FIRE community
« Reply #13 on: July 14, 2019, 12:14:20 PM »
We bought a multi-family home.  Our plan is to hire caregivers if needed, have them live in one unit, and stay at home as long as possible. In Canada you can hire trained nurses from overseas (Phillipines being most common due to English skills) full-time for approximately $25k per year, plus processing/travel fees.  After two years they can apply to become permanent residents and bring their families so if you provide a good place for them (they are allowed to change employers anyway) it is a win:win.

Cassie

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Re: Nursing homes/long term care for FIRE community
« Reply #14 on: July 14, 2019, 12:22:46 PM »
My plan is to stop taking my BP and heart medications. I won’t last a month without them. I am never going into a home.

Parizade

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Re: Nursing homes/long term care for FIRE community
« Reply #15 on: July 14, 2019, 01:14:06 PM »
Still, most people who FIRE with a big stash will be better off than the masses with low pensions. Maybe you could keep living in your own home, but give free housing and a salary to a care giver who lives with you.

In Minnesota we have programs to match up people who need in home care with people willing to provide it in exchange for housing, as discussed in this thread:
Mustachian Housing Opportunity in Minnesota

I personally plan to check out care homes in Mexico while I'm snowbirding there. I suspect long term care is far more affordable there.
« Last Edit: July 14, 2019, 01:15:44 PM by Parizade »

 

Wow, a phone plan for fifteen bucks!