Not enough

[tobitonic]

5% of all 65 and over end up in a nursing home. That is 1 out of every 20. The odds are very very high and grow every year you live longer.   I think the odds are very very high.  Especially if we aren't fat bastards who die of a massive heart attack in our sleep. Healthy body with a useless brain.

http://www.agingoptions.com/2011/10/how-many-seniors-really-end-up-in-nursing-homes/

Nereo, thanks for the warm welcome. Yes, my thoughts have shifted a little thanks to the people responding here. I want to make sure myself and my wife will be taken care of, so for us, an extra $100K each is a good idea.

Here's what the AOA says:

A relatively small number (1.5 million) and percentage (3.6%) of the 65+ population in 2011 lived in
institutional settings such as nursing homes (1.3 million). However, the percentage increases dramatically
with age, ranging (in 2011) from 1% for persons 65-74 years to 3% for persons 75-84 years and 11% for
persons 85+. In addition, in 2009, approximately 2.7% of the elderly lived in senior housing with at least
one supportive service available to their residents.

The odds are still overwhelmingly in your favor for not living in a nursing home, even at 85. And statistically, the odds are very high of you being dead by 85.

[Shane]

OP here.  I believe there are some very valid points to be made particularly regarding accepting that risk. I agree with all that I would rather die a quick death than to languish for years in a nursing home. Actually my wife and I have agreed to kill the other one off if the other becomes a vegetable. I will teach my kids the same.

DH and I feel the same way. In the absence of physician-assisted suicide laws in our state, how do we accomplish this?

This organization can help. They'll send a volunteer to your house who will help you die quickly and painlessly.

[The Beacon]

Most people are highly risk averse.  So your worries are normal.  However, you would most likely over save way too much.   Most of my grand parents passed away in their nineties.  One is 99 and living with my uncle.   She was a physician too . So she knows how to take care of herself.  @99, she is more lucid than me and still can move around without any assistance.   But my uncle does not allow her to climb stairs or take a bus.  She used to when she was in her early 90s.

However, we had a neibour who died in her 70s when a heart attack occurred because she was not living with anyone.   


I think if you take care of yourself well, it is only the last couple of years of your life when things can become expensive.  But again, I'd rather die If I had Alzheimer's or anything like that. 

It is the quality of your life that matters, not the length.    One year in your prime is worth much much more than one year in your 60s, 70s......

[Shane]

Hopefully religous ideology will stop ruling over common sense and assisted suicide will be widely available by time we are old.  I am a physician and my wife is well aware that if I am unable to make my own decisions due to a lasting loss of mental capacity I am not to be artificially fed or treated for any acute life limiting illness.  Just lots of morphine and happy pills please.

+1

[pbkmaine]

Thanks, Shane!

[ETBen]

5% of all 65 and over end up in a nursing home. That is 1 out of every 20. The odds are very very high and grow every year you live longer.   I think the odds are very very high.  Especially if we aren't fat bastards who die of a massive heart attack in our sleep. Healthy body with a useless brain.

http://www.agingoptions.com/2011/10/how-many-seniors-really-end-up-in-nursing-homes/

Nereo, thanks for the warm welcome. Yes, my thoughts have shifted a little thanks to the people responding here. I want to make sure myself and my wife will be taken care of, so for us, an extra $100K each is a good idea.

Here's what the AOA says:

A relatively small number (1.5 million) and percentage (3.6%) of the 65+ population in 2011 lived in
institutional settings such as nursing homes (1.3 million). However, the percentage increases dramatically
with age, ranging (in 2011) from 1% for persons 65-74 years to 3% for persons 75-84 years and 11% for
persons 85+. In addition, in 2009, approximately 2.7% of the elderly lived in senior housing with at least
one supportive service available to their residents.

The odds are still overwhelmingly in your favor for not living in a nursing home, even at 85. And statistically, the odds are very high of you being dead by 85.

This.  There's a spectrum from 65 onward.  Also, consider that many people in some sort of facility care or residential care situation for temporary periods.  What you see in various care settings of medicine (and nursing) is vastly different.  Probably the biggest mistake we can make as providers is to think we know what it's like to be a patient until we are, in fact, that specific patient.  I think the biggest issue is how you become a burden to your family if you don't have means for private caregivers to assist. 

If something puts you at ease, then go for it.  But making data based decisions keeps us grounded too.  Especially for the non medical people.  Old age does not look how people think it is.  I would argue that $ doesn't guarantee that much more choice in setting or treatment in most cases either (again looking at the whole, not the outliers)

[Rosy]

^^^+1^^^ Absolutely - release me from this world with happy pills:) Don't keep me artificially alive when it is clearly my time to go - for physical or mental reasons.

[PhysicianOnFIRE]

Enjoyit,

I wouldn't fault you at all for continuing to work until you've doubled your assets.  At a physician's salary with your savings rate, with halfway decent market returns this may only take a few years.  If you are completely burned out and hate going to work, then it would be perfectly reasonable to retire with your current wealth.  But based on a previous post, it sounds like you've been able to improve your work environment.  Good for you.

The rationale you gave for the exta $ has been beaten down a bit, and that's fair.  But there are so many other reasons to continue to double your money before calling it a day.  Charitable aspirations.  Unforeseen changes in lifestyle (what you want in your 50s may be different than today).   Having a child with special needs.  Divorce (I know, it's not going to happen to me either, but it does happen to other people, and they can lose half their wealth).  As a physician, once you stop practicing and let certifications and licenses expire, it is extremely difficult to get back in the game, making returning to part time doctor work a less viable option compared to most other professions.

Again, if it would take 15 years to reach "double FI" I wouldn't bother.  But if you can do it in 5 years or less, years that are far easier for you than medical school and residency, no doubt, go for it.  I recently achieved FI, but I'm in a good position to double my net worth in 5 years, and that's one of my goals.  Many on this forum may wonder why i continue to work, but I would say >95% of people I know in real life would wonder why on earth I would consider retiring this early (age 40 with a 9.5 year anesthesia career).  I plan to find a happy medium that works for my family and me.

[nereo]

Again, if it would take 15 years to reach "double FI" I wouldn't bother.  But if you can do it in 5 years or less, years that are far easier for you than medical school and residency, no doubt, go for it.  I recently achieved FI, but I'm in a good position to double my net worth in 5 years, and that's one of my goals.  Many on this forum may wonder why i continue to work, but I would say >95% of people I know in real life would wonder why on earth I would consider retiring this early (age 40 with a 9.5 year anesthesia career).  I plan to find a happy medium that works for my family and me.

PhysicianOnFire - sorry to jump in here, but I had a question for you.  My father is a recently retired physician (internal medicine) and worked for a private practice.  One of the things he lamented was that he couldn't ever work 'half-time' because of the way billing was set up; essentially his costs remained the same but his billable hours would be cut in half, meaning all the work he'd do would result in little or no pay unless he kept up a full schedule.  Ultimately for him it was a minor inconvienence, since he wanted (enjoyed!) working the hours up until the last two years of his career.

so my question to you is - are there other/better options for physicians who might want to work a half-time schedule?    Can you practice medicine and keep licenses and certifications current while just putting in 20-25 hours/week?

[AZDude]

So in the mind of the OP, it is better to work a decade longer to cover *every* eventuality, than to retire and enjoy life knowing that there is a small possibility of death associated with having a limited income stream.

This is a little too risk averse. By the same logic one should never leave the house. Seriously, statistically speaking, you are much more likely to die driving to work than any of the scenarios you discussed.

[going2ER]

If you were to become ill and need some assistance I would think that initially your wife would step in to offer care? Possibly your children as well? Then only part time care may be needed to assist with some things. Becoming ill in old age does not necessarily mean being put in a nursing home.

You can never predict what will happen in the future. I have 4 kids and 2 have unrelated, non-genitic rare diseases. Thankfully we live in Canada. The chances of that happening are pretty slim, as you probably know. In fact other than people we have met at the hospital I don't know anyone else with a rare disease.

We can't predict every eventuality, but you have to be comfortable with your decisions. In 2 years you may decide that you have had enough of work and enough saved, although it may be 5 years, maybe once a baby is born. I think it is important to prepare for the future, but not for every possible thing that could happen.

[PhysicianOnFIRE]

Again, if it would take 15 years to reach "double FI" I wouldn't bother.  But if you can do it in 5 years or less, years that are far easier for you than medical school and residency, no doubt, go for it.  I recently achieved FI, but I'm in a good position to double my net worth in 5 years, and that's one of my goals.  Many on this forum may wonder why i continue to work, but I would say >95% of people I know in real life would wonder why on earth I would consider retiring this early (age 40 with a 9.5 year anesthesia career).  I plan to find a happy medium that works for my family and me.

PhysicianOnFire - sorry to jump in here, but I had a question for you.  My father is a recently retired physician (internal medicine) and worked for a private practice.  One of the things he lamented was that he couldn't ever work 'half-time' because of the way billing was set up; essentially his costs remained the same but his billable hours would be cut in half, meaning all the work he'd do would result in little or no pay unless he kept up a full schedule.  Ultimately for him it was a minor inconvienence, since he wanted (enjoyed!) working the hours up until the last two years of his career.

so my question to you is - are there other/better options for physicians who might want to work a half-time schedule?    Can you practice medicine and keep licenses and certifications current while just putting in 20-25 hours/week?

The quick answer is Yes, other options exist but may require leaving your current practice.  It depends on many factors, but your specialty and employment / contract are chief among them.  It sounds like your father was in a private practice group in IM.  What you say about the overhead, etc... is true.  In an arrangement like that, you might work half the year to break even, then the rest of your billing is all profit.  Half time work for no income is no good.

But, there are opportunities out there.  Locum tenens work is temporary work where you are paid by the hour / day for a facility that may be short staffed or require vacation coverage.  I have done a lot of locums work (in anesthesia,but I know internists who do this)  Some specialties are better suited for part time work, such as those that do not require you to build up a roster of patients.  Emergency Medicine, Radiology, Pathology, Anesthesiology, Dermatology...  In IM, your father would be qualified to be a hospitalist doing shift work, but he may have been more comfortable in the clinic.  Being an employee or part of a large, multispecialty group may give you more options for part time work.  The small, private practice is going to be the one with the least flexibility. 

[EnjoyIt]

Ok, so what does your FI picture look like now?  You mentioned you are considering having kids, and possibly retiring in your 40s, so you are.... around 30?  If you can save 60%+ of your post-tax income that gives you an enormous ability to generate a large 'stach very quickly.

I think it's sensible to plan for end-of-life care, but that can be dealt with easily enough if you have 30+ years of compounding.  $100k now sounds sensible.  Also, you still have lots of control once you do FI/RE.  Simply controlling your budget and/or picking up a side gig can ensure that your savings grow over hte next several decades, leaving you with far more money than you had when you officially retire.

I'm actually 40 years old, and having a hard time deciding between going part time now and letting the stack grow on its own, or sticking it out for a few more years just to be safe.  In all honesty, if it was completely up to me, I would probably sell all my possessions except my laptop some clothes and travel the world.  Travel for 6 months then come back to the states to do locums work for 3 months and repeat.  Unfortunately I have a wife who is not interested in that.  Therefor I can only do my traveling in short bursts when she can go as well. Her reasons are hers and I will not bring them up here.   In another 4 years she will have the same flexibility as me, but by then we will want to start having kids and I am concerned that traveling as I want may be too difficult with an infant/toddler.

Hopefully religous ideology will stop ruling over common sense and assisted suicide will be widely available by time we are old.  I am a physician and my wife is well aware that if I am unable to make my own decisions due to a lasting loss of mental capacity I am not to be artificially fed or treated for any acute life limiting illness.  Just lots of morphine and happy pills please.

No kidding.  This country is so weird regarding end of life.  My wife and I have agreements to kill the other one off if we become mentally incapacitated to enjoy living. 

The odds are still overwhelmingly in your favor for not living in a nursing home, even at 85. And statistically, the odds are very high of you being dead by 85.

This isn't just about nursing homes. I would rather live in my own home with a little assistance than being stuck in a nursing home.  That need for some kind of assistance in our old age is almost garuanteed.  Having assistance may even prolong the quality of your life and I think it is worth saving for.  As I wrote in another post in this thread, for most it may take an extra 1-2 years of savings to be able to make that happen.  This extra cash could be something as simple as an extra 6 months of rehab to build back strength after an injury.  Or hiring someone to drive you around when you are too high a risk of getting into an accident> it could be not relying on others to get you groceries or to be able to leave the house and catch some live music.

If something puts you at ease, then go for it.  But making data based decisions keeps us grounded too.  Especially for the non medical people.  Old age does not look how people think it is.  I would argue that $ doesn't guarantee that much more choice in setting or treatment in most cases either (again looking at the whole, not the outliers)

Thanks ETBen, I completely agree that preparing a little for some contingencies is probably a good idea.  It is why people buy insurance.  Although the likelihood of my roof blowing away from a tornado is low, I would rather spend a little extra money to protect myself financially from that event. I think for myself and maybe others saving for an extra 1-1.5 years to provide yourself a little extra security and assistance in old age may be a good idea.  I have read quite a few posts on here regarding the thoughts of this community pertaining to medical care.  I think there is a little misinformation being passed around.  Nothing dangerous, but it may make things difficult for some in old age or when they get sick.  It makes a big difference if your FIRE spending is $25K a year vs someone retiring on $75K.

Enjoyit,

I wouldn't fault you at all for continuing to work until you've doubled your assets.  At a physician's salary with your savings rate, with halfway decent market returns this may only take a few years.  If you are completely burned out and hate going to work, then it would be perfectly reasonable to retire with your current wealth.  But based on a previous post, it sounds like you've been able to improve your work environment.  Good for you.

PhysicianOnFIRE, thanks for your insight.  I went and read some of your blog posts prior to replying here.  I enjoyed them a bunch.  In all honesty, I am not ready to FIRE just yet.  You are correct, my work environment has improved drastically recently and am amazed that someone went back to research my previous thoughts. My career like yours has been rather short thus far, and I would prefer not to call it quits. Actually I still enjoy the medicine especially when not overworked. As you know, whenever a physician stops seeing patients for a period of time, their skill and knowledge will decrease to a point where they will not be fit to practice medicine any more. I am not quite ready to give up everything I have learned.  Not to mention, I have aging parents and in laws that will require my help in the future.  Since I can't travel like I would like, the next best thing is to not get burned out and work part time. Luckily like you, I can work as much or as little as I want. 

Again, if it would take 15 years to reach "double FI" I wouldn't bother.  But if you can do it in 5 years or less, years that are far easier for you than medical school and residency, no doubt, go for it.  I recently achieved FI, but I'm in a good position to double my net worth in 5 years, and that's one of my goals.  Many on this forum may wonder why i continue to work, but I would say >95% of people I know in real life would wonder why on earth I would consider retiring this early (age 40 with a 9.5 year anesthesia career).  I plan to find a happy medium that works for my family and me.

Although I completely understand where you are coming from, what exactly is your goal with the extra money?  What are you looking to purchase with it?

We can't predict every eventuality, but you have to be comfortable with your decisions. In 2 years you may decide that you have had enough of work and enough saved, although it may be 5 years, maybe once a baby is born. I think it is important to prepare for the future, but not for every possible thing that could happen.

I completely agree with you.  I think educating ourselves on possibilities and their likelihood is not a bad idea. If with a little effort you can prepare for them, then why not. Just in case we store a few gallons of extra water and some canned goods in the house. We may never need them, but the price was not that high to be prepared.  Equally we purchased a few hundred rounds of ammunition.  Again, the odds of ever needing them is very low.  But the cost was not high to be able to protect ourselves in that rare circumstance.

[PhysicianOnFIRE]

Enjoyit,

I wouldn't fault you at all for continuing to work until you've doubled your assets.  At a physician's salary with your savings rate, with halfway decent market returns this may only take a few years.  If you are completely burned out and hate going to work, then it would be perfectly reasonable to retire with your current wealth.  But based on a previous post, it sounds like you've been able to improve your work environment.  Good for you.

PhysicianOnFIRE, thanks for your insight.  I went and read some of your blog posts prior to replying here.  I enjoyed them a bunch.  In all honesty, I am not ready to FIRE just yet.  You are correct, my work environment has improved drastically recently and am amazed that someone went back to research my previous thoughts. My career like yours has been rather short thus far, and I would prefer not to call it quits. Actually I still enjoy the medicine especially when not overworked. As you know, whenever a physician stops seeing patients for a period of time, their skill and knowledge will decrease to a point where they will not be fit to practice medicine any more. I am not quite ready to give up everything I have learned.  Not to mention, I have aging parents and in laws that will require my help in the future.  Since I can't travel like I would like, the next best thing is to not get burned out and work part time. Luckily like you, I can work as much or as little as I want. 

Again, if it would take 15 years to reach "double FI" I wouldn't bother.  But if you can do it in 5 years or less, years that are far easier for you than medical school and residency, no doubt, go for it.  I recently achieved FI, but I'm in a good position to double my net worth in 5 years, and that's one of my goals.  Many on this forum may wonder why i continue to work, but I would say >95% of people I know in real life would wonder why on earth I would consider retiring this early (age 40 with a 9.5 year anesthesia career).  I plan to find a happy medium that works for my family and me.

Although I completely understand where you are coming from, what exactly is your goal with the extra money?  What are you looking to purchase with it?
-------------------------------------------------------------------------------------------------------------------------------
I don't have any concrete plans for the extra 25x.  I really like the idea of having a cushion, though.  I realize the 4% SWR takes into account worst case scenarios based on historical data, but I would be doing a lot of second guessing if I retired with exactly 25x expenses just before a 20% to 50% market decline, and I find myself with less than 20x in the nest egg.  Also, I can't imagine retiring when my working career is shorter than the 12 years of education and training I put myself through to have this career.  I've also got 2 boys in KG and preschool.  Retiring now wouldn't give us that much freedom.

When I contemplate part time, I think it will just prolong the time it takes to reach my retirement goals.  But if I were feeling overworked, I would welcome the idea.  I'm not putting in the 60 to 80 hours a week that some physicians are. 

Also, I'm glad you found my blog posts and enjoyed them.  I'll keep 'em coming. 

[partgypsy]

5% of all 65 and over end up in a nursing home. That is 1 out of every 20. The odds are very very high and grow every year you live longer.   I think the odds are very very high.  Especially if we aren't fat bastards who die of a massive heart attack in our sleep. Healthy body with a useless brain.

http://www.agingoptions.com/2011/10/how-many-seniors-really-end-up-in-nursing-homes/

Nereo, thanks for the warm welcome. Yes, my thoughts have shifted a little thanks to the people responding here. I want to make sure myself and my wife will be taken care of, so for us, an extra $100K each is a good idea.

Here's what the AOA says:

A relatively small number (1.5 million) and percentage (3.6%) of the 65+ population in 2011 lived in
institutional settings such as nursing homes (1.3 million). However, the percentage increases dramatically
with age, ranging (in 2011) from 1% for persons 65-74 years to 3% for persons 75-84 years and 11% for
persons 85+. In addition, in 2009, approximately 2.7% of the elderly lived in senior housing with at least
one supportive service available to their residents.

The odds are still overwhelmingly in your favor for not living in a nursing home, even at 85. And statistically, the odds are very high of you being dead by 85.

I agree. Those numbers do not sound that high to me. I work in a hospital, latest study I am working on is palliative care so I was speaking to a lot of sick people and their family members. The vast majority of them were living at home. The expensive aspect was multiple hospitalizations and intervention/surgeries in last few years of life. A surprising number of the patients died at home.
It's all about how you value your time. If you value that security over the time you are spending when young and healthy to earn that money, do it. I'm more like my Dad, about quality of life. Do what you can to eliminate, reduce chronic diseases, and live your life! None of us have a crystal ball. If you have kids do you want your kids to remember you were never around, too busy working to accumulate an additional million for private care when you are aged? It's up to you.

[KayakMom]

Hopefully religous ideology will stop ruling over common sense and assisted suicide will be widely available by time we are old.  I am a physician and my wife is well aware that if I am unable to make my own decisions due to a lasting loss of mental capacity I am not to be artificially fed or treated for any acute life limiting illness.  Just lots of morphine and happy pills please.

+1

I'm also a physician and I believe sometimes as a society we are kinder to our golden retrievers than our grandmothers.

[partgypsy]

My Dad would probably be for assisted suicide if it was legal. He jokes that in the old country when the old people were getting too old to be of any use, the old person would take a walk in the mountains, and not return. He thought that sounded like a pretty good way to go. My father has already drawn up an advance directive of no life-prolonging treatments of any kind if he has a terminal type illness or incapacitation. Us kids weren't too happy when he first informed us, but that's his decision.

[golden1]

It does seem crazy to work an extra 5,10 years only to give it all to a nursing home when you get older.  It just seems like a massive waste.

Personally, I hope to be like my great Aunt Anna, who was healthy and travelled well into her 90's.  She went to Antarctica at age 91 because she had a life goal of putting her feet on all 7 continents.  She finally died at age 100, when she finally moved from assisted living to a nursing home.   She got sick and developed a UTI that was not treated properly.  She didn't linger though and died relatively peacefully. 

My husband jokes but is semi-serious about "taking the long walk" if he finds out he has a terminal illness or cognitive decline past the age of 65-70 and I'm inclined to agree.   I don't want to be a burden on my family, and I'd rather leave any money to my kids or charity then let it be wasted taking care of me or trying to treat me when I am declining. 

[StockBeard]

I constantly see patients requiring certain medical care that just isn't covered by insurance.

Your profession obviously brings a bias, you must feel everyone on Earth has a huge medical issue, when in reality the number is pretty low.

Independently of that, money will not protect you from fate. You can postpone your ER date, prepare for the worst all your life, double your investments before you retire, decide to work until 60 instead of 50, and that will still not prevent you from being hit by a truck at 59, one year before your target date.
Or you could retire now with 1.25 million

[MandalayVA]

When he was 80, my father-in-law was diagnosed with a leaky aorta.  He got it replaced, but an infection developed, so surgeons ended up cracking open his 80-year-old sternum not once, but twice.  He never fully recovered and died last year at the age of 82. 

A few years ago Michael Wolff wrote a fantastic article for The Atlantic about the realities of long-term elder illness and care.

And yet, I will tell you, what I feel most intensely when I sit by my mother’s bed is a crushing sense of guilt for keeping her alive. Who can accept such suffering—who can so conscientiously facilitate it?
 
“Why do we want to cure cancer? Why do we want everybody to stop smoking? For this?” wailed a friend of mine with two long-ailing and yet tenacious in-laws.

http://nymag.com/news/features/parent-health-care-2012-5/

[lizzie]

http://nymag.com/news/features/parent-health-care-2012-5/

wow, thank you for sharing that article. My mother died unexpectedly last summer just after turning 72 after a short but intense period of illness.  After she had been in the ER for twelve days, my brothers and I had to decide whether to continue other treatments or begin hospice care. We chose hospice.

Of the many, many things that swirl through my head on a daily basis still, months after this devastating loss, is the thought that at least we did right by her; we gave her a good, peaceful death. This article just hammered that home more.

[EnjoyIt]

It does seem crazy to work an extra 5,10 years only to give it all to a nursing home when you get older.  It just seems like a massive waste.

It does seam crazy to save another 5-10 years.  Luckily if you save today and need it 30 years from now it will only cost you 1-2 years thanks to compound interest.  This price will hire assistance so that maybe you don't have to live in a nursing home and enjoy your life a bit more.  I think it is an investment worth saving for.  Needing help in old age is guaranteed.   

[Geekenstein]

Individual aversion to risk, be it life or investment, is just that - individual.  Spend some time on some of the forums dedicated to early retirement and you will find that most folks don't share the concerns you have, but then their assessment of the risk isn't based on the experiences you have. 

Just as deciding an asset allocation is an exercise in risk matching, so is deciding what your "number" is.  You can use tools like FIRECalc, analyze your spending, and get all sorts of input but if in the end you aren't comfortable, it's useless information. 

Do what makes you comfortable, so you can enjoy the decision.

[detroit_johnny]

To each their own.  You need to decide when to leave the rat race for yourself.  Even with Goooogles of money, it will not save you in the end. 

Michael Jackson
David Bowie
Glenn Frey

They all died before the "average" age of death for males in America.  And all of them had lots of money.  A lot more than any of us will ever have!  As some have said, this is the reason we look for early retirement, at least from the corporate world.  We can be free from that and do what we want and be more fulfilled no matter what happens.  The key is to still be on the left side of the bell curve of the average age of death and not on the right side!

[ptgearguy]

We all have to die somehow. I would bet the stress of dealing with your working life will more likely kill you than crap care down the road. I would focus on maintaining fantastic health (physically and mentally) before what your stressing about. I work as a physiotherapist and see all sorts as well. People die, including you. Enjoy life and if you want to work more, go for it. I love my job and find it very rewarding helping people overcome injury and returning to the things I love. I don't make close to what a physician makes but i much prefer the path I decided on (I had originally wanted to be a radiologist--thank goodness I let this one go).

Best of luck!

[lukebuz]

Well, my mom is a nurse.  She is a hypochondriac.  What you are exposed to becomes your life, no matter how unusual.   She has every type of cancer ever.  Me too, each time I have a headache.

[MrsPete]

I am afraid that a lot of this is bad luck. No amount of money to buy private care would guarantee that you don't fall and hit your head or develop some kind of infection.

No, but if you're unfortunate enough to have this bad luck, having money to pay for the best care can make you more comfortable while you're healing and can give you a better chance of not continuing down the bad luck path.  No, you can't erase your risks, but you can improve your odds. 

The real question is, How much is right for your needs?

[tobitonic]

To each their own.  You need to decide when to leave the rat race for yourself.  Even with Goooogles of money, it will not save you in the end. 

Michael Jackson
David Bowie
Glenn Frey

They all died before the "average" age of death for males in America.  And all of them had lots of money.  A lot more than any of us will ever have!  As some have said, this is the reason we look for early retirement, at least from the corporate world.  We can be free from that and do what we want and be more fulfilled no matter what happens.  The key is to still be on the left side of the bell curve of the average age of death and not on the right side!

Add Steve Jobs to the list...

[nereo]

To each their own.  You need to decide when to leave the rat race for yourself.  Even with Goooogles of money, it will not save you in the end. 

Michael Jackson
David Bowie
Glenn Frey

They all died before the "average" age of death for males in America.  And all of them had lots of money.  A lot more than any of us will ever have!  As some have said, this is the reason we look for early retirement, at least from the corporate world.  We can be free from that and do what we want and be more fulfilled no matter what happens.  The key is to still be on the left side of the bell curve of the average age of death and not on the right side!

Add Steve Jobs to the list...

On a similar thread... Practically every day I read of some wealthy/powerful person who died years before my projected median life expectancy of ~78.  It is just a reminder that even almost unlimited money to spend on health care is no guarantee that I'll live as long as I think I will.  So I stay fit, eat well and try to make good use of whatever time I've got left.  Maybe it's the 4+ decades I think it will be, maybe it'll be far less.

All the reason to be FI faster.

[ulrichw]

[...]

Here's what the AOA says:

A relatively small number (1.5 million) and percentage (3.6%) of the 65+ population in 2011 lived in
institutional settings such as nursing homes (1.3 million). However, the percentage increases dramatically
with age, ranging (in 2011) from 1% for persons 65-74 years to 3% for persons 75-84 years and 11% for
persons 85+. In addition, in 2009, approximately 2.7% of the elderly lived in senior housing with at least
one supportive service available to their residents.

The odds are still overwhelmingly in your favor for not living in a nursing home, even at 85. And statistically, the odds are very high of you being dead by 85.

These statistics are misleadingly low.

They're not stating the percentage of people who end up in nursing homes - they're stating the percentage people who are living in nursing homes *right now*.

Let me give you an artificial example to show how the math works out:
- Assume you have a population of people who will all die at 85
- Furthermore, assume that 100% of the population will spend their last year in a nursing home
- Randomize the ages of the people

If you look at the population between 65 and 85 years old, because they're randomized 5% will be between the ages of 84-85 (the year they spend in the nursing home) at any given time.
However 100% of them are spending a year in the nursing home.

Real life is not quite like that, since the age at death is randomized, too. The math, however, works out similarly - the percentage of people who spend some time in a nursing home is higher than the percentage of people who are in a nursing home right now.

I unfortunately could not find a good source of statistics to get this number, but the National Hospice and Palliative Care Organization has some stats that hint that the number is higher than those given above.
(source: http://www.nhpco.org/sites/default/files/public/Statistics_Research/2012_Facts_Figures.pdf)

Specifically, they state that 44.6% of the deaths in the US in 2012 were under Hospice care, and of those deaths, 18% were in a Nursing Home.

This puts a floor on the percentage of people who died in Nursing Homes at 44.6% of 18%, which is 8%.

This doesn't count the following people, however:
- The people who left a Nursing Home to die in a different location (at home, dedicated hospice facility)
- The people who died in a Nursing Home while not under Hospice Care

Therefore the actual number is likely to be considerably higher.

[ltt]

I see your point, but I don't necessarily think the solution is money. You can pay someone to watch over you 24/7, but a more robust solution is to build yourself a secure social network. Make friends, and be sure to make them across the generations.

If your friend ends up in a skilled care facility, be the person watching out for their sudden confusion, or worsening wound status. And have young people who will do the same for you.

Bingo!  Having one's own family look after them in their old age or through an illness, surgery, etc. is so much better than someone who is "paid" to look after many people.  I think the reason my daughter does so well after her surgeries is that she has me.  I'm with her from beginning to end.  I bring her home from the hospital and make her comfortable.  We make her favorite foods, give her medicine when needed and she has always recovered quite well.  I can't imagine having an elderly person go to rehab where they probably don't know anyone.  Our "system" here is based on payment-----sad.

[franklin w. dixon]

Instead of treating disease, accept it as divine punishment for sin; instead of fearing death, welcome it as a mercy. Instant savings!

[Exflyboy]

5% of all 65 and over end up in a nursing home. That is 1 out of every 20. The odds are very very high and grow every year you live longer.   I think the odds are very very high.  Especially if we aren't fat bastards who die of a massive heart attack in our sleep. Healthy body with a useless brain.

http://www.agingoptions.com/2011/10/how-many-seniors-really-end-up-in-nursing-homes/

Nereo, thanks for the warm welcome. Yes, my thoughts have shifted a little thanks to the people responding here. I want to make sure myself and my wife will be taken care of, so for us, an extra $100K each is a good idea.

Hey OP, you sound awfully like a good friend of mine who is also a Physician.. He has a massive school loan debt that (assuming he stays employed and healthy) won't take too long.

I like you you have a similar healthy disrespect I totally admire..:)

Anyway, a couple of others mentioned the fact that if you run Cfiresim, most of the scenarios end up with a boatload of money at the end of the period.. Whcih one will assume will be close to the end of life.

The other point is you didn't mention how old you are?.. If your say in your mid 40's and you feel the risks of retiring are too great.. well then keep working for a while. If we go through another significant market pullback like we did in 2008 (and you keep buying) you will have a LOT more money than you have today.

Thats what I did.. When I did "retire" 2 years ago I found a new love of work, so I now work part time and its great! I have roughly about $2M and we spend $30k a year. The part time work means we are still saving.

We won't do this forever but my Wife still works full time because she loves her job, but when she quits well then I probably will too. Heck we might even be moving to a country with true affordable HC while we're at it..:)

Oh BTW.. here in the PNW they say we are at 37% risk of a mag 9.0+ earthquake in the next 50 years... Like 1 in 2.5 or so... I don't see meny people moving out of State though..

Save a few more bucks, if your at $1,25M it really won't take that long to get to say 1.5 or 2.0 from here... Assuming your not totally burned out of course.

[tobitonic]

[...]

Here's what the AOA says:

A relatively small number (1.5 million) and percentage (3.6%) of the 65+ population in 2011 lived in
institutional settings such as nursing homes (1.3 million). However, the percentage increases dramatically
with age, ranging (in 2011) from 1% for persons 65-74 years to 3% for persons 75-84 years and 11% for
persons 85+. In addition, in 2009, approximately 2.7% of the elderly lived in senior housing with at least
one supportive service available to their residents.

The odds are still overwhelmingly in your favor for not living in a nursing home, even at 85. And statistically, the odds are very high of you being dead by 85.

These statistics are misleadingly low.

They're not stating the percentage of people who end up in nursing homes - they're stating the percentage people who are living in nursing homes *right now*.

Meh. In the absence of solid figures stating otherwise, I'm going to stick with the figures presented by the Administration on Aging, which is also backed up by census data:

According to the U.S. Bureau of the Census, slightly over 5 percent of the 65+ population occupy nursing homes, congregate care, assisted living, and board-and-care homes, and about 4.2 percent are in nursing homes at any given time. The rate of nursing home use increases with age from 1.4 percent of the young-old to 24.5 percent of the oldest-old. Almost 50 percent of those 95 and older live in nursing homes.

The fact is that the vast majority of seniors in the US aren't living in institutionalized care unless they manage to live way, way beyond the average US life expectancy (which is 76 for men, or a decade short of 85 and 2 decades short of 95) and the OP's fear of ending up in such a situation is statistically unfounded. The odds are much greater that he'll develop heart disease, cancer, or dementia (and statistically speaking, he'll still not die in an institution).

[tobitonic]

I see your point, but I don't necessarily think the solution is money. You can pay someone to watch over you 24/7, but a more robust solution is to build yourself a secure social network. Make friends, and be sure to make them across the generations.

If your friend ends up in a skilled care facility, be the person watching out for their sudden confusion, or worsening wound status. And have young people who will do the same for you.

Bingo!  Having one's own family look after them in their old age or through an illness, surgery, etc. is so much better than someone who is "paid" to look after many people.  I think the reason my daughter does so well after her surgeries is that she has me.  I'm with her from beginning to end.  I bring her home from the hospital and make her comfortable.  We make her favorite foods, give her medicine when needed and she has always recovered quite well.  I can't imagine having an elderly person go to rehab where they probably don't know anyone.  Our "system" here is based on payment-----sad.

Once again, yes. The safest path isn't money, although that can work as a poor substitute if you're lucky. The safest path is to cultivate a network of people who care about you independently of your money. For most people around the world, that's family, but it can also be friends. It pretty much needs to be one or the other, though.

[BPA]

I am willing to accept that risk.

My work life was so stressful that it was harming my health.  I feel so much better now.  I would much rather have many healthy years (maybe even decades) and then live out the hell of not great nursing home care for a few years.  I totally support euthanasia too, so if that is an option for me, I would take it.

My greatest concern is  that my son carries the gene for Alzheimer's and that somehow, if no cure is found, he will hit early onset as I am starting to fail in health.  I worry about how he might get help if I can't advocate for him. 

[Exflyboy]

I am willing to accept that risk.

My work life was so stressful that it was harming my health.  I feel so much better now.  I would much rather have many healthy years (maybe even decades) and then live out the hell of not great nursing home care for a few years.  I totally support euthanasia too, so if that is an option for me, I would take it.

My greatest concern is  that my son carries the gene for Alzheimer's and that somehow, if no cure is found, he will hit early onset as I am starting to fail in health.  I worry about how he might get help if I can't advocate for him.

Sorry to hear that BPA.. Tell me, does carrying the gene = 100% chance of developing the disease?

I must admit I didnt know there was a genetic test of Alzheimers available..

[EnjoyIt]

My work life was so stressful that it was harming my health.  I feel so much better now.  I would much rather have many healthy years (maybe even decades) and then live out the hell of not great nursing home care for a few years.

In your scenario, I could not agree more to retire ASAP to have a healthier longer life.

I still enjoy my work, so working an extra year to fund assistance when I am old to keep me out of the nursing homes seems like a wise decision.  Remember working 1 more year not only allows me to save money, but also allows my stash to grow without withdrawing living expenses.  It doesn't take that long to save some extra cash that will compound over 30 years and provide what you may need.

[EnjoyIt]

Once again, yes. The safest path isn't money, although that can work as a poor substitute if you're lucky. The safest path is to cultivate a network of people who care about you independently of your money. For most people around the world, that's family, but it can also be friends. It pretty much needs to be one or the other, though.

Most people don't want to be a drain on their loved ones.  Sure family will help, but how much of their lives do you want them to devote to your sickly ass?

[BPA]

I am willing to accept that risk.

My work life was so stressful that it was harming my health.  I feel so much better now.  I would much rather have many healthy years (maybe even decades) and then live out the hell of not great nursing home care for a few years.  I totally support euthanasia too, so if that is an option for me, I would take it.

My greatest concern is  that my son carries the gene for Alzheimer's and that somehow, if no cure is found, he will hit early onset as I am starting to fail in health.  I worry about how he might get help if I can't advocate for him.

Sorry to hear that BPA.. Tell me, does carrying the gene = 100% chance of developing the disease?

I must admit I didnt know there was a genetic test of Alzheimers available..

IIRC, the stat is 60%-80% likelihood.  I had genetic testing done because I wanted to see how likely I was to succumb to what got my father and grandfather. I wasn't thinking about Alzheimer's for me or my son.  No one in either side of his family had it.  So, when I got the results back and they had "locked" three genetic conditions: breast cancer, Parkinson's, and Alzheimer's, I unlocked them because I wanted to see if my son carried the breast cancer gene.  There is some breast cancer history on his dad's side. I guess the chances of developing those conditions is so high if you have the genes that cause them, the genetic analysis company decided to allow people to not know if they carried them.  I understand that. 

So, to me it was better to know if he carried the breast cancer gene to alert people in my ex's family.  At least there are ways to mitigate breast cancer as Angelina Jolie has demonstrated.  I wasn't expecting Alzheimer's.  About a year later, my son's paternal grandfather was diagnosed and now I feel awful, because my ex, who just turned 50, realizes he is likely next.  He said to our son, "There will probably be a cure for you, bud, but I don't think there will be one in time for me." 

I'm hopeful my son will dodge it or there will be a cure.  He is only 17. 

Anyway, I'm rambling.  If I know my ex, he will take this knowledge and not put off things until his own retirement, but will enjoy his life now.  But I do worry about how my son will fare if he develops it while I am an old lady. 

And because I do not have the markers for the genetic conditions that killed my father and grandfather at fairly young ages, I may have a long life. 

My work life was so stressful that it was harming my health.  I feel so much better now.  I would much rather have many healthy years (maybe even decades) and then live out the hell of not great nursing home care for a few years.

In your scenario, I could not agree more to retire ASAP to have a healthier longer life.

I still enjoy my work, so working an extra year to fund assistance when I am old to keep me out of the nursing homes seems like a wise decision.  Remember working 1 more year not only allows me to save money, but also allows my stash to grow without withdrawing living expenses.  It doesn't take that long to save some extra cash that will compound over 30 years and provide what you may need.

That makes sense.  I think it's important that everyone make the choice that is best for them. 

[Exflyboy]

To each their own.  You need to decide when to leave the rat race for yourself.  Even with Goooogles of money, it will not save you in the end. 

Michael Jackson
David Bowie
Glenn Frey

They all died before the "average" age of death for males in America.  And all of them had lots of money.  A lot more than any of us will ever have!  As some have said, this is the reason we look for early retirement, at least from the corporate world.  We can be free from that and do what we want and be more fulfilled no matter what happens.  The key is to still be on the left side of the bell curve of the average age of death and not on the right side!

Of course MJ was using Propofol to sleep, not EXACTLY what its supposed to be used for!... I guess the one benefit is he wouldn't actually remember dying.. They don't call it "Milk of amnesia" for nothing...:)

[Exflyboy]

I am willing to accept that risk.

My work life was so stressful that it was harming my health.  I feel so much better now.  I would much rather have many healthy years (maybe even decades) and then live out the hell of not great nursing home care for a few years.  I totally support euthanasia too, so if that is an option for me, I would take it.

My greatest concern is  that my son carries the gene for Alzheimer's and that somehow, if no cure is found, he will hit early onset as I am starting to fail in health.  I worry about how he might get help if I can't advocate for him.

Sorry to hear that BPA.. Tell me, does carrying the gene = 100% chance of developing the disease?

I must admit I didnt know there was a genetic test of Alzheimers available..

IIRC, the stat is 60%-80% likelihood.  I had genetic testing done because I wanted to see how likely I was to succumb to what got my father and grandfather. I wasn't thinking about Alzheimer's for me or my son.  No one in either side of his family had it.  So, when I got the results back and they had "locked" three genetic conditions: breast cancer, Parkinson's, and Alzheimer's, I unlocked them because I wanted to see if my son carried the breast cancer gene.  There is some breast cancer history on his dad's side. I guess the chances of developing those conditions is so high if you have the genes that cause them, the genetic analysis company decided to allow people to not know if they carried them.  I understand that. 

So, to me it was better to know if he carried the breast cancer gene to alert people in my ex's family.  At least there are ways to mitigate breast cancer as Angelina Jolie has demonstrated.  I wasn't expecting Alzheimer's.  About a year later, my son's paternal grandfather was diagnosed and now I feel awful, because my ex, who just turned 50, realizes he is likely next.  He said to our son, "There will probably be a cure for you, bud, but I don't think there will be one in time for me." 

I'm hopeful my son will dodge it or there will be a cure.  He is only 17. 

Anyway, I'm rambling.  If I know my ex, he will take this knowledge and not put off things until his own retirement, but will enjoy his life now.  But I do worry about how my son will fare if he develops it while I am an old lady. 

And because I do not have the markers for the genetic conditions that killed my father and grandfather at fairly young ages, I may have a long life. 

My work life was so stressful that it was harming my health.  I feel so much better now.  I would much rather have many healthy years (maybe even decades) and then live out the hell of not great nursing home care for a few years.

In your scenario, I could not agree more to retire ASAP to have a healthier longer life.

I still enjoy my work, so working an extra year to fund assistance when I am old to keep me out of the nursing homes seems like a wise decision.  Remember working 1 more year not only allows me to save money, but also allows my stash to grow without withdrawing living expenses.  It doesn't take that long to save some extra cash that will compound over 30 years and provide what you may need.

That makes sense.  I think it's important that everyone make the choice that is best for them.

I think your reply effectively reminds us the value of "quality time".. We are not all born with equal amounts.

Your Son being 17 means there could be 50 years before he gets the disease and thats IF he gets it. There is a lot of research going on right now. Its only been 5 years or so since we could actually scan the brain to detect Alzheimers prior to death, so the rate at which discoveries will be made will grow exponentially from here.

Thankfully we believe that alzheimers as far as we know is only a single disease, unlike "cancer" which (according to the radio show I heard in 1996) is 287 seperate diseases, eech with a number of different stages, each sensitive to particular treatment... A humungous problem.

I think there is a lot of hope for your Son.

Disclaimer.. I am not a medical professional, just an interested amature.

[Exflyboy]

Enjoyit,

I wouldn't fault you at all for continuing to work until you've doubled your assets.  At a physician's salary with your savings rate, with halfway decent market returns this may only take a few years.  If you are completely burned out and hate going to work, then it would be perfectly reasonable to retire with your current wealth.  But based on a previous post, it sounds like you've been able to improve your work environment.  Good for you.

The rationale you gave for the exta $ has been beaten down a bit, and that's fair.  But there are so many other reasons to continue to double your money before calling it a day.  Charitable aspirations.  Unforeseen changes in lifestyle (what you want in your 50s may be different than today).   Having a child with special needs.  Divorce (I know, it's not going to happen to me either, but it does happen to other people, and they can lose half their wealth).  As a physician, once you stop practicing and let certifications and licenses expire, it is extremely difficult to get back in the game, making returning to part time doctor work a less viable option compared to most other professions.

Again, if it would take 15 years to reach "double FI" I wouldn't bother.  But if you can do it in 5 years or less, years that are far easier for you than medical school and residency, no doubt, go for it.  I recently achieved FI, but I'm in a good position to double my net worth in 5 years, and that's one of my goals.  Many on this forum may wonder why i continue to work, but I would say >95% of people I know in real life would wonder why on earth I would consider retiring this early (age 40 with a 9.5 year anesthesia career).  I plan to find a happy medium that works for my family and me.

Exactly!.. We are in theory about 3 times FI and (because we are both healthy) don't regret the extra time working one bit... I also really enjoyed my career, my Wife still works and I have a part time "hobby job".. I will quit when she does I'm sure.

Adding a little extra stuffing is perfectly fine with a high stash rate whcih means low misery, or no misery at all if you love what you do.

[Cassie]

Unfortunately, you can develop early onset Alzheimer's in your 40's. I know a few people that did. Also in regard to taking care of family or friends to keep them out of a nursing home you can only do that for so long and it takes a big toll. WE did that for some good friends for about a year and then they had to go to homes. we are older ourselves and don't know how much time we have left. I helped my Mom with my DAd for 14 very long years but the majority of the burden fell on her.  I will never be a burden to my kids. If I get that bad I will go to a home.  I expect that very few people will do that for friends and if they do it won't be for long.

[BPA]

I am willing to accept that risk.

My work life was so stressful that it was harming my health.  I feel so much better now.  I would much rather have many healthy years (maybe even decades) and then live out the hell of not great nursing home care for a few years.  I totally support euthanasia too, so if that is an option for me, I would take it.

My greatest concern is  that my son carries the gene for Alzheimer's and that somehow, if no cure is found, he will hit early onset as I am starting to fail in health.  I worry about how he might get help if I can't advocate for him.

Sorry to hear that BPA.. Tell me, does carrying the gene = 100% chance of developing the disease?

I must admit I didnt know there was a genetic test of Alzheimers available..

IIRC, the stat is 60%-80% likelihood.  I had genetic testing done because I wanted to see how likely I was to succumb to what got my father and grandfather. I wasn't thinking about Alzheimer's for me or my son.  No one in either side of his family had it.  So, when I got the results back and they had "locked" three genetic conditions: breast cancer, Parkinson's, and Alzheimer's, I unlocked them because I wanted to see if my son carried the breast cancer gene.  There is some breast cancer history on his dad's side. I guess the chances of developing those conditions is so high if you have the genes that cause them, the genetic analysis company decided to allow people to not know if they carried them.  I understand that. 

So, to me it was better to know if he carried the breast cancer gene to alert people in my ex's family.  At least there are ways to mitigate breast cancer as Angelina Jolie has demonstrated.  I wasn't expecting Alzheimer's.  About a year later, my son's paternal grandfather was diagnosed and now I feel awful, because my ex, who just turned 50, realizes he is likely next.  He said to our son, "There will probably be a cure for you, bud, but I don't think there will be one in time for me." 

I'm hopeful my son will dodge it or there will be a cure.  He is only 17. 

Anyway, I'm rambling.  If I know my ex, he will take this knowledge and not put off things until his own retirement, but will enjoy his life now.  But I do worry about how my son will fare if he develops it while I am an old lady. 

And because I do not have the markers for the genetic conditions that killed my father and grandfather at fairly young ages, I may have a long life. 

My work life was so stressful that it was harming my health.  I feel so much better now.  I would much rather have many healthy years (maybe even decades) and then live out the hell of not great nursing home care for a few years.

In your scenario, I could not agree more to retire ASAP to have a healthier longer life.

I still enjoy my work, so working an extra year to fund assistance when I am old to keep me out of the nursing homes seems like a wise decision.  Remember working 1 more year not only allows me to save money, but also allows my stash to grow without withdrawing living expenses.  It doesn't take that long to save some extra cash that will compound over 30 years and provide what you may need.

That makes sense.  I think it's important that everyone make the choice that is best for them.

I think your reply effectively reminds us the value of "quality time".. We are not all born with equal amounts.

Your Son being 17 means there could be 50 years before he gets the disease and thats IF he gets it. There is a lot of research going on right now. Its only been 5 years or so since we could actually scan the brain to detect Alzheimers prior to death, so the rate at which discoveries will be made will grow exponentially from here.

Thankfully we believe that alzheimers as far as we know is only a single disease, unlike "cancer" which (according to the radio show I heard in 1996) is 287 seperate diseases, eech with a number of different stages, each sensitive to particular treatment... A humungous problem.

I think there is a lot of hope for your Son.

Disclaimer.. I am not a medical professional, just an interested amature.

That's what I'm hoping for too.  And there is a good chance that it will turn out that way.  My worst case scenario is that one though and nothing about my own health or outliving my stash or anything like that.  I don't think a lot about it, but it does concern me more than long term care.  As my grandmother used to say, "Just knock me over the head when I get like that."  ;)  She was charming.  lol

[BPA]

Unfortunately, you can develop early onset Alzheimer's in your 40's. I know a few people that did. Also in regard to taking care of family or friends to keep them out of a nursing home you can only do that for so long and it takes a big toll. WE did that for some good friends for about a year and then they had to go to homes. we are older ourselves and don't know how much time we have left. I helped my Mom with my DAd for 14 very long years but the majority of the burden fell on her.  I will never be a burden to my kids. If I get that bad I will go to a home.  I expect that very few people will do that for friends and if they do it won't be for long.

Fortunately my son's paternal grandfather was in his late 60's when he was diagnosed.  I have no idea for how long he was showing symptoms, but he was in his fifties when we were together and was as sharp as the proverbially tack. 

My ex is a good person.  I so hope he either doesn't get it or he is much older than he is now before it starts affecting him.

I agree.  I don't want to be a burden to my kids.  <cue my grandmother's solution>

[EnjoyIt]

I see a number of people saying that in old age we need social ties to assist us.  Just as many say they don't want to be a burden on their loved ones in old age. Well, we can't have both. Therefor if someone can save an extra $100K prior to retiring and let it compound for the next 30 years. They will likely be much less of a burden in old age. Plus be able to enjoy more of your life in your own home instead of a nursing facility.