Let’s Talk Long-Term Care Insurance and/or what you think your plan is at, say, 80+

[Ginevra]

28 minutes ago, Scarlett said:

I am not being flippant but I am being realistic.  There is only so much we can do.  And sometimes we are put in the position of losing our assets to get care. And your daughter cannot be forced to care for you.  
 

I feel like you are making arguments on untrue statements.  Yes, sometimes a Medicaid or memory care bed is not available nearby and this is a hardship on family. They maybe put in a home a good distance away until a nearby bed is available.    But you aren’t forced to care for your parent because you don’t want them to lose their home.  That would be your choice.  Is it sickening? Yes.   But it is reality.  
 

If you have a plan to get unlimited money to take care of your needs so your kids don’t have to or so you don’t lose your house that is great.  Most of us do not have that option.  And we should not be sitting here feeling like crap because we aren’t wealthy.  
 

We live in a messed up society that does not value our elderly.  I can’t fix that either.  
 

Is it possible you are grieving your mother and the way she died and thus your strong feelings on this?  I am sorry.  I truly am.  But individually we do not have enough money to prevent things like that. 

What is the untrue statement I am making? 
 

I agree that I was not “forced” to care for my mother, and neither was my sister. But it’s a non-choice “choice” when it’s you. The SW meets with the family and they see 1) a loving husband, though he’s elderly too; 2) three daughters who obviously care about their mom. Those three daughters also own their own homes and none are employed FT (At the time). So the SW starts saying, “Which of you is bringing mom home?” 
 

In the first case, my dad said, “She has to go to a facility; I cannot do this any longer,” so I started the marvelous journey of trying to find a place she could go for $2,000 a month. So, as it became obvious that there was nothing in that budget but a row home in the city serving fish sticks to the residents, my dad said, “Nevermind; she can come home.” 
 

But we were back in the same exact situation a couple of weeks later and my sister volunteered as Tribute. 
 

What I resent in your argument is your assertion that having money made no difference. It seems fairly obvious to me that it made a difference to the people who actually shouldered that care. It seems quaint to me that the non-caregiver can sit on the sidelines and say, “Oh, so nice for my grandmother; she died with my aunt.” 
 

Also: of course I’m grieving the way it went with my mother! It was literally nightmarish as I would wake up in the middle of the night wishing my mom would please just die so the misery would end. But don’t we always say here, “When you know better, you do better.” My mom’s last two years were an object lesson in what to try to plan against. Of course none of us knows how this is going to go, and some diseases are very significantly more cruel than others. (Parkinson’s is up there at the top, but my mom also had Metastatic BrE@st cancer.) But you mitigate what you can so your odds are better. 
 

*I* know not everybody will have a few hundred thousand dollars that could be poached for late life care, but that doesn’t mean nobody should bother to have that if they *could*. The book that started this post is Die With Zero. The author glosses over end-of-life expenses by saying “have LTCI” or “Buy an annuity”. And then goes on to urge the reader to go on nice trips and give money to their adult kids so that there’s no “nest egg” at the end. “You probably don’t need it anyway.” I am reacting against that because I think if you have it, you should save it for the possibility of end of life care. The kids or the church can get the leftovers when you’re gone. 
 

I would happily have LTCI; that’s why I started this thread. But since many members have explained that this isn’t really a thing anymore, we’re back to the drawing board. 
 

Im sorry if my tone seems upset with you; I do feel upset by what seems like a shrug of unconcern about this topic. 

[Scarlett]

4 minutes ago, Ginevra said:

What is the untrue statement I am making? 
 

I agree that I was not “forced” to care for my mother, and neither was my sister. But it’s a non-choice “choice” when it’s you. The SW meets with the family and they see 1) a loving husband, though he’s elderly too; 2) three daughters who obviously care about their mom. Those three daughters also own their own homes and none are employed FT (At the time). So the SW starts saying, “Which of you is bringing mom home?” 
 

In the first case, my dad said, “She has to go to a facility; I cannot do this any longer,” so I started the marvelous journey of trying to find a place she could go for $2,000 a month. So, as it became obvious that there was nothing in that budget but a row home in the city serving fish sticks to the residents, my dad said, “Nevermind; she can come home.” 
 

But we were back in the same exact situation a couple of weeks later and my sister volunteered as Tribute. 
 

What I resent in your argument is your assertion that having money made no difference. It seems fairly obvious to me that it made a difference to the people who actually shouldered that care. It seems quaint to me that the non-caregiver can sit on the sidelines and say, “Oh, so nice for my grandmother; she died with my aunt.” 
 

Also: of course I’m grieving the way it went with my mother! It was literally nightmarish as I would wake up in the middle of the night wishing my mom would please just die so the misery would end. But don’t we always say here, “When you know better, you do better.” My mom’s last two years were an object lesson in what to try to plan against. Of course none of us knows how this is going to go, and some diseases are very significantly more cruel than others. (Parkinson’s is up there at the top, but my mom also had Metastatic BrE@st cancer.) But you mitigate what you can so your odds are better. 
 

*I* know not everybody will have a few hundred thousand dollars that could be poached for late life care, but that doesn’t mean nobody should bother to have that if they *could*. The book that started this post is Die With Zero. The author glosses over end-of-life expenses by saying “have LTCI” or “Buy an annuity”. And then goes on to urge the reader to go on nice trips and give money to their adult kids so that there’s no “nest egg” at the end. “You probably don’t need it anyway.” I am reacting against that because I think if you have it, you should save it for the possibility of end of life care. The kids or the church can get the leftovers when you’re gone. 
 

I would happily have LTCI; that’s why I started this thread. But since many members have explained that this isn’t really a thing anymore, we’re back to the drawing board. 
 

Im sorry if my tone seems upset with you; I do feel upset by what seems like a shrug of unconcern about this topic. 

I am truly sorry you went through that and your mom had to suffer.  I am NOT feeling flippant or dismissive. I am feeling like there is very little we can do.  Well, I should say very little *I* can do.  I can’t even talk my parents in to letting me drive them to far away doctors appointments so I sure don’t expect them to be reasonable and compliant when and if they need to sell their home and go to assisted living or move in with us.  
 

Also, I have no daughters.  I do not expect that any of our boys will be taking care of us end life.  We do have a family compound in AR that we would definitely be welcome at and I have 2 lovely SILs who are much younger than me and I know they would do anything for me they could to keep me out of a nursing home.  But I am fully prepared for a nursing home to be a possibility for me if I can no longer live on my own.  

And maybe it is different in different states but I have never known anyone who could not get a Medicaid bed. A few times due to special circumstances it was pretty far away, but in general there is a bed somewhere close. And this has been true in AR and OK.  
 

 

[prairiewindmomma]

Fwiw, I think Bill Perkins of Die With Zero is as deluded as Dave Ramsey. Bill Perkins is a hedge fund manager—Skylar Capital—worth about $500,000,000. His personal net worth is about $10,000,000. His money dynamics are not the average person’s.

Memory care ran about $9k month for relative. She was in a facility for close to 10 years…so over $1,000,000 for just her end of life care. Maybe that’s a non issue level of money for some folks…but most of us need to be saving quite a bit to have investments that can generate some monthly income well beyond social security. And, most people cant do that. So, find a balance of what makes you feel at peace with whatever life throws at you. 

[Scarlett]

Just now, prairiewindmomma said:

Fwiw, I think Bill Perkins of Die With Zero is as deluded as Dave Ramsey. Bill Perkins is a hedge fund manager—Skylar Capital—worth about $500,000,000. His personal net worth is about $10,000,000. His money dynamics are not the average person’s.

Memory care ran about $9k month for relative. She was in a facility for close to 10 years…so over $1,000,000 for just her end of life care. Maybe that’s a non issue level of money for some folks…but most of us need to be saving quite a bit to have investments that can generate some monthly income well beyond social security. And, most people cant do that. So, find a balance of what makes you feel at peace with whatever life throws at you. 

Yes, and this is what I was trying to convey that comes across as flippant to @Ginevra. I am a natural anxious person.  My husband calls me the financial ruiner of all fun. I am trying very hard to not let fear of the future ruin my current very nice life.  
 

And that is fear of the future for my parents and for Dh and myself.  My parents because my mom fears going to a nursing home soooooo bad but she is not an easy person at times so if she ever comes to live with us it would not be easy.  Dh and I have already discussed and we will not agree to that unless we have a mother in law apartment that is separate. But I already know that she would not like that because she would want to be in my space all the time and I am an introvert. So I do worry and I am sure others worry too, but really it is borrowing trouble because we have no clue what the future holds.  
 

This why I am trying to not worry about things I can’t control.  
 

[prairiewindmomma]

Also, medicaid estate recovery varies by state…but generally if a spouse or disabled child remains in the home, the house cannot be attached with a lien. The state can only go after the remaining assets of the deceased medicaid recipient’s estate. If there are none, then there are none. 
 

 

[SKL]

I would be OK living in a Medicaid bed.  But I wouldn't be allowed to do that until all my savings are spent down.  Meanwhile, my relatives who did not work and save the way I did will end up in the same bed as me.  Looking at it this way, who's stupider?

I think tax-funded care homes should not be limited to people who are broke.  I think it would be nice if those who paid for the homes could live in them under the same terms as those who didn't pay.  Crazy idea and it'll never happen.

[Pawz4me]

19 minutes ago, Scarlett said:

 

And maybe it is different in different states but I have never known anyone who could not get a Medicaid bed. A few times due to special circumstances it was pretty far away, but in general there is a bed somewhere close. And this has been true in AR and OK.  
 

Also true in NC. I've never heard of anyone not being able to get a Medicaid bed. There are no separate Medicaid or state facilities. Medicaid patients get beds in the same LTC facilities as private pay people. And the Medicaid people get the same level of care as the private pay people. Some facilities are better than others, of course. My understanding is that even if a Medicaid patient has to take a bed in a facility that isn't ideal (either due to it's rating or distance from family or whatever reason) that transfers can be arranged as beds become available in other facilities.

 

[Pawz4me]

2 minutes ago, SKL said:

I would be OK living in a Medicaid bed.  But I wouldn't be allowed to do that until all my savings are spent down.  Meanwhile, my relatives who did not work and save the way I did will end up in the same bed as me.  Looking at it this way, who's stupider?

 

You do realize that not all residents of LTC facilities are elderly people who had decades and decades to save and simply chose not to? There are surprising numbers of young people in LTC. I know someone who had a brain tumor and then a massively debilitating stroke at a young age. The stroke was, according to his oncologists, due to the side effects of radiation treatment for the tumor. He'd barely started his adult life, let alone had time to save enough money to cover the LTC he needed for many years. He wasn't "stupid" by any means, but he sure had terrible luck.

As for me -- I like having choices. Money gives me that, whether it's picking the LTC facility I want or choosing a continuing care retirement community long before I need end-of-life care. It's the same way I felt when our kids were picking colleges. Perhaps we were "stupid" for saving money so that they didn't qualify for any need based aid. But having money sure gave them choices. YMMV

[Ginevra]

45 minutes ago, Scarlett said:

And maybe it is different in different states but I have never known anyone who could not get a Medicaid bed. A few times due to special circumstances it was pretty far away, but in general there is a bed somewhere close. And this has been true in AR and OK.  

Well, I don’t know, but that could be a difference between MD vs AR and OK. There are some truly bougie care facilities here because there are a lot of very, very wealthy seniors who can pay for them. I’m not an economist, but I *think* what that means is if you want good care in a clean, pleasant suburban setting, you’re not getting that on Medicaid. They don’t need to provide that because there are self-pay people there. 

[Frances]

30 minutes ago, Pawz4me said:

19 minutes ago, Pawz4me said:

As for me -- I like having choices. Money gives me that, whether it's picking the LTC facility I want or choosing a continuing care retirement community long before I need end-of-life care. It's the same way I felt when our kids were picking colleges. Perhaps we were "stupid" for saving money so that they didn't qualify for any need based aid. But having money sure gave them choices. YMMV

 

So much this.

[Scarlett]

20 minutes ago, Ginevra said:

Well, I don’t know, but that could be a difference between MD vs AR and OK. There are some truly bougie care facilities here because there are a lot of very, very wealthy seniors who can pay for them. I’m not an economist, but I *think* what that means is if you want good care in a clean, pleasant suburban setting, you’re not getting that on Medicaid. They don’t need to provide that because there are self-pay people there. 

 

11 minutes ago, Frances said:

So much this.

Not arguing against how great it is to have money and have choices.  That would be nice.  But not everyone has that. 
 

edited to add I meant to quote @Frances and this from @Pawz4me

<<<As for me -- I like having choices. Money gives me that, whether it's picking the LTC facility I want or choosing a continuing care retirement community long before I need end-of-life care. It's the same way I felt when our kids were picking colleges. Perhaps wewere "stupid" for saving money so that they didn't qualify for anyneed based aid. But having money sure gave them choices. YMMV>>>

Edited June 21 by Scarlett

[AmandaVT]

4 hours ago, Ginevra said:

For one thing, there has to be a bed available that is a Medicaid bed. It seems to be never true that there is an indefinite-term Medicaid bed available at the time they want to release from rehabilitative care. 
 

For two, they would attach my dad’s home, which is literally the only asset he has and, to be blunt, it’s a dilapidated piece of crap. If there is ANY money, you have to surrender that first. If there are ANY assets, you have to surrender those first. 
 

For three, Medicaid facility care is extremely low quality. They won’t actively kill you. But they can’t give you attentive care. 
 

What I’m disagreeing about is just this: I feel like you’re being flippant about the care that your mother and aunt provided to your grandmother, as if it was perfectly fine because it was nice for your grandmother to be cared for by family at home. You argued that you don’t see what difference money makes and I’m saying the difference it makes is choices. The way you’re phrasing it makes me think you dont see the reason to plan for it and that family care is an acceptable option since it often becomes the only option. I’m arguing that, if it is possible to plan for paid care instead of daughter-care (or whomever), that’s what I’m doing, because, to the extent I can help it, I’m not foisting that on my daughter. 

Do some states have Medicaid and non-Medicaid facilities? Everywhere takes Medicaid here. What about Medicaid waivers for long-term care? We're working through this with my MIL right now. Her social security and pension make her ineligible for Medicaid, so she has BCBS as a secondary insurance. But she needs an assisted living facility or nursing home (she's currently in the hospital), and we applied for a long-term care waiver. Basically, when they transfer her, Medicaid will pay for the balance of the monthly fees after her SS and pension (she'll be allowed to keep about $75/month). DH and I will add her cell phone to our plan and help her out financially if things come up.

[Ginevra]

2 hours ago, prairiewindmomma said:

Fwiw, I think Bill Perkins of Die With Zero is as deluded as Dave Ramsey. Bill Perkins is a hedge fund manager—Skylar Capital—worth about $500,000,000. His personal net worth is about $10,000,000. His money dynamics are not the average person’s.

Memory care ran about $9k month for relative. She was in a facility for close to 10 years…so over $1,000,000 for just her end of life care. Maybe that’s a non issue level of money for some folks…but most of us need to be saving quite a bit to have investments that can generate some monthly income well beyond social security. And, most people cant do that. So, find a balance of what makes you feel at peace with whatever life throws at you. 

Yeah; I do not like the book and every chapter makes me madder than the previous one. 🙄

To me, this discussion reminds me a bit of sending-kids-to-college discussions I have had over the years with other parents. So, “Jane” will say, “Well, my nephew goes to XYZ University and the tuition alone is $60,000 a year…we could never afford that in a zillion years so Tyler is not going to college. We’re trying to get him into an apprenticeship with our neighbor, the elevator guy.” It’s the same all-or-nothing thinking that was part of the reason my parents did not support me going to college and I did not go until I was 38. 
 

I’m sure very few people can expect or even hope to have a million dollars to hedge against ten years of memory care at a facility. But that doesn’t mean one can’t form some type of plan before all the options disappear. Maybe the plan is to move in with your Golden Girl friends. Maybe you make a pact with your sisters-in-law and you each write one another as the beneficiary on each other’s life insurance, in exchange for the promise of a certain level of care. I mean, I’m just spit-balling here, but, in the same way as people of meager means can still get a college degree with some creative thinking and a plan, it seems like many of us can come up with some type of workable situation with whatever resources we currently have/can expect to have. 
 

In my MIL’s case, there were many assets, but they were not liquid (land, for ex.). But there was also a nice dividend check from a warehouse my ILs were partnered on in earlier years. Just to use actual numbers, that dividend check was around $5,000/month. So this was the “salary” money that was offered to the caregiver sibling. What I’m saying is, there were significant assets if the only option were for her to be in a facility as a self-pay resident, but fortunately, there was a daughter who was able - physically, mentally and financially - able to be the caregiver. But it was nice to be able to give her that “salary” and it takes some of the potential resentment away from the sibling giving most of the care. 

[Annie G]

14 minutes ago, AmandaVT said:

Do some states have Medicaid and non-Medicaid facilities? Everywhere takes Medicaid here. 

In the state I currently live in and the one I lived in previously, there were nursing homes that don’t accept Medicaid patients as new patients. They are usually facilities that have step down units- start w independent living, then assisted living, then  nursing home (they call that some other name). People enter as self pay, and have to be accepted via application that requires them to have a certain amount of assets. But once they end up in nursing care, if they exhaust their resources and go on Medicaid, they are not booted out.  So while the facility accepts Medicaid, an indigent patient cannot get a bed there unless they are already a resident.

Edited June 21 by Annie G

[Frances]

20 minutes ago, AmandaVT said:

Do some states have Medicaid and non-Medicaid facilities? Everywhere takes Medicaid here. What about Medicaid waivers for long-term care? We're working through this with my MIL right now. Her social security and pension make her ineligible for Medicaid, so she has BCBS as a secondary insurance. But she needs an assisted living facility or nursing home (she's currently in the hospital), and we applied for a long-term care waiver. Basically, when they transfer her, Medicaid will pay for the balance of the monthly fees after her SS and pension (she'll be allowed to keep about $75/month). DH and I will add her cell phone to our plan and help her out financially if things come up.

From what I understand, the majority of nursing homes (about 80 to 90%) accept Medicaid patients, but almost all prefer private pay because they get less $ from Medicaid patients. And therefore many nursing homes limit the number of Medicaid beds for financial reasons. It’s my understanding that it can be easier to get into a good home if you can start out paying and then switch to Medicaid when funds are depleted or just pay the entire time. I know the memory care facility my son worked at the summer before college was considered a very bad facility and was almost entirely Medicaid patients. Not only did most of the residents lack financial resources, he said very few ever had visitors.

And few visitors means no extra eyes on what’s happening to residents. Several years after he worked there, two residents died due to scabies infections. He was appalled by what he saw while working there and reported several things to the state, but none resulted in any action. He said the director was extremely skilled at dealing with the inspectors.

Edited June 21 by Frances

[Ginevra]

6 minutes ago, AmandaVT said:

Do some states have Medicaid and non-Medicaid facilities? Everywhere takes Medicaid here. What about Medicaid waivers for long-term care? We're working through this with my MIL right now. Her social security and pension make her ineligible for Medicaid, so she has BCBS as a secondary insurance. But she needs an assisted living facility or nursing home (she's currently in the hospital), and we applied for a long-term care waiver. Basically, when they transfer her, Medicaid will pay for the balance of the monthly fees after her SS and pension (she'll be allowed to keep about $75/month). DH and I will add her cell phone to our plan and help her out financially if things come up.

I don’t think it’s exactly that, but nicer facilités have fewer Medicaid beds, while the lower the quality, the more likely there are Medicaid beds available. 
 

Also, my experience was that the financial people at the facility do not wave Medicare/Medicaid options in front of your face and if they get any whiff that the adult kids are financially solvent, they say almost nothing about this. So - I don’t know. I feel like they keep that card up the sleeve unless the person needing care is straight-up indigent. 
 

All I remember vividly is them asking me a bunch of questions trying to find any “hidden” resources that could be used. They asked if my dad was a Veteran (no). Did my mother have a life insurance policy (no). Was there any owned real estate (yes). Did my mom have any retirement accounts (no). And so on. 
 

Im sure I don’t know what all the rules are for Medicare/medicaid. But I know what places I got referrals to when I said the budget was $2,000/month. 

[Spryte]

In my state, in my personal, lived experience caring for three elders:

(Again, I am referencing my state, yours may differ!)

There are no specific Medicaid facilities, they are not tax funded separate buildings. They are privately owned. Medicaid pays patients’ bills but didn’t build the facility. Some facilities are more expensive than others, but all have the ability to switch to Medicaid for payment when a patient runs out of funds. Because we have age in place laws, the expensive facility for which one has self paid for however long cannot boot out a patient who runs out of money, they have to convert to Medicaid, and they have a finance office and Medicaid specialist to help apply. They can vet the resources of potential patients so they can be sure the patient can pay self pay for a predetermined amount of time — that can be a big gatekeeper. But they don’t get to boot patients, according to the SW here. This means that the Medicaid patients get the same care as the self pay patients, and a self pay patient’s roommate might be on Medicaid.

Sometimes people who go to rehab at a skilled nursing facility with LTC can’t go home, and if they cannot self pay, Medicare covers the beginning of the stay then the Medicaid application starts and pays retroactively once approved.

A spouse can be on Medicaid without the healthy spouse losing their home or assets. 

Community based Medicaid is almost impossible to get though. So home help for someone aging in place at their own home — nope. Not unless one hires an attorney.

AgainC the above scenarios are my experience, in my state.

 

[AmandaVT]

2 minutes ago, Ginevra said:

I don’t think it’s exactly that, but nicer facilités have fewer Medicaid beds, while the lower the quality, the more likely there are Medicaid beds available. 
 

Also, my experience was that the financial people at the facility do not wave Medicare/Medicaid options in front of your face and if they get any whiff that the adult kids are financially solvent, they say almost nothing about this. So - I don’t know. I feel like they keep that card up the sleeve unless the person needing care is straight-up indigent. 
 

All I remember vividly is them asking me a bunch of questions trying to find any “hidden” resources that could be used. They asked if my dad was a Veteran (no). Did my mother have a life insurance policy (no). Was there any owned real estate (yes). Did my mom have any retirement accounts (no). And so on. 
 

Im sure I don’t know what all the rules are for Medicare/medicaid. But I know what places I got referrals to when I said the budget was $2,000/month. 

Thank you! That's really interesting - my husband is a provider in VT (therapist), and Medicaid pays either the same or better than, the commercial insurance companies like BCBS, Aetna, and Cigna. Maybe it's because we have expanded Medicaid so much here. We have Dr. Dynasaur, which, last I checked, about 50% of kids in VT have (it's Medicaid), and I think our income limit for Medicaid is 400% of the poverty level, so if places tried to limit Medicaid, they wouldn't have many patients/clients. DH's caseload is about 50% Medicaid, I believe, which is pretty typical. 

For MIL, the assisted living facility we were looking at prior to her latest hospitalization is about $7000/month. Medicaid will pay the difference between her ss and pension and the $7000, so they're not getting a discount by taking Medicaid. 

Now I'm curious - maybe it's because we're so small too. We have one hospital in central VT, and the next closest one is 45 min away in Burlington, so they kind of have to take everyone I guess. 

[Frances]

1 minute ago, AmandaVT said:

Thank you! That's really interesting - my husband is a provider in VT (therapist), and Medicaid pays either the same or better than, the commercial insurance companies like BCBS, Aetna, and Cigna. Maybe it's because we have expanded Medicaid so much here. We have Dr. Dynasaur, which, last I checked, about 50% of kids in VT have (it's Medicaid), and I think our income limit for Medicaid is 400% of the poverty level, so if places tried to limit Medicaid, they wouldn't have many patients/clients. DH's caseload is about 50% Medicaid, I believe, which is pretty typical. 

For MIL, the assisted living facility we were looking at prior to her latest hospitalization is about $7000/month. Medicaid will pay the difference between her ss and pension and the $7000, so they're not getting a discount by taking Medicaid. 

Now I'm curious - maybe it's because we're so small too. We have one hospital in central VT, and the next closest one is 45 min away in Burlington, so they kind of have to take everyone I guess. 

We also have expanded Medicaid greatly in my state and it covers a significant portion of the population, but it most definitely doesn’t pay as well as private insurance. In fact, it’s one reason so many of our hospitals are currently in financial trouble.

[Paige]

22 hours ago, Scarlett said:

 

And maybe it is different in different states but I have never known anyone who could not get a Medicaid bed. A few times due to special circumstances it was pretty far away, but in general there is a bed somewhere close. And this has been true in AR and OK.  
 

 

My family found it almost impossible to get a relative into a medicaid bed. But also, it was almost impossible to get on medicaid in the first place because his cognitive impairment meant he couldn't and wouldn't fill out the forms and absolutley wouldn't sign over POA. Also, the attorney told us that no POA would be legal because he had no capacity to make that decision. The condition was due to a sudden injury in a not so old person and not due to a progressive condition so no plans had been made. They had to get him a public guardian and declared incompetent. It was a LONG nightmare. Because of the frailty of the caregivers, they couldn't become guardians themselves and if they had, getting medicaid beds would have been even harder. Even after a guardian was assigned, it took almost 6 months to find a bed that would accept a patient with his degree of disability. Until then, he was left where he was- with 2 elderly disabled caregivers who could barely keep everyone alive. The state told us that if anything happened to his caregivers, they'd allow him to be homeless until a bed was found and he could not be compelled to enter a nursing home even if a room was found! Social worker said she already had several homeless clients. Even though he'd been declared to have the legal capacity of a 10yr old, and they were now responsible for him, they were happy to let him refuse care. He's only in a facility now instead of on the streets because of some well intended chicanery. I think some states are much worse than others. 

19 hours ago, Annie G said:

In the state I currently live in and the one I lived in previously, there were nursing homes that don’t accept Medicaid patients as new patients. They are usually facilities that have step down units- start w independent living, then assisted living, then  nursing home (they call that some other name). People enter as self pay, and have to be accepted via application that requires them to have a certain amount of assets. But once they end up in nursing care, if they exhaust their resources and go on Medicaid, they are not booted out.  So while the facility accepts Medicaid, an indigent patient cannot get a bed there unless they are already a resident.

That is how we found most homes in our area worked too. You had to private pay first. Most places had no beds available for medicaid patients- especially if you needed specialized care.

[GoVanGogh]

I haven’t read the book OP mentioned, nor read every.single.post. (Still trying to!)  But…

I remember years ago reading a financial column that said something to the effect of, “Live a long and healthy life, then die quick,” as the best possible retirement plan. I don’t remember what all the author discussed after that, but that line has stuck with me. (I know it did go on to discuss preparing for end of life care.) 

That one line stuck with me, as my grandma had just done that  she had lived a good long life, with a few medical issues here and there, then she died quickly. My grandpa, sadly, had died years prior, just a year after he retired  The contrasts of their last years has always been very sharp to me  They were both life long smokers, which is what he died from. Why did one die from smoking and the other didn’t? 
One of my spouse’s grandmas died quickly, within weeks of a massive stroke, and their spouse died many years later from a heart attack.  

None of those grandparents needed much for end of life care, nor did our other grandparents. But each generation on seems to 1.) have more chronic health issues 2.) receive life extending medical treatments that may or may not equal quality of life 4.) possibly require more memory care 5.) have possibly less wealth/savings/pensions.
 

One of my parents - very obese - always told us kids we were required to care for them in their later years  There was no way even two of us together could move them. (Requires 3-4 firemen to lift when they fell in their home.) This parent has had uncontrolled diabetes for years, multiple strokes, immobile and on and on. Currently, their spouse (stepparent) is caring for them at home, but the stepparent was recently diagnosed with early dementia. They have always refused any offers/doctor’s orders for in home nursing, skilled rehab, nursing home, etc, Over the past ten years, they have disowned all six of us kids. (My siblings and step siblings.) They have one great-niece that they speak with and we get news through. It is a huge mess, with no good endings. They have state pensions, so have some resources, but refuse to leave their house and refuse to live in a nursing home. There is  also a huge mental health component to their overall issues and none of us have been able to address or work through. It sucks, but it is what it is. 
 

For my spouse and I… We are late 50’s, have a nice retirement fund. Our one story house is paid off and perfect for aging in. Kid through college and paid for. I have Parkinson’s and my spouse has been very stressed about what my medical care/expenses will be like in the future. I have been very much YOLO since my diagnosis. I want to enjoy life NOW. I already struggle to travel much because of my health so I want to go and do things while I still can. My spouse is the opposite. Must save every penny. They were diagnosed with an aggressive form of cancer last year and are now even more of a penny pincher, can’t enjoy life, must save. I know they are now even more worried about my medical needs if they are to die first. One of my siblings-in-law and I have already decided we will live together, if it ever comes to that. I did recently read an article on the Washington post about more and more non-relative multi generational families living together because of housing costs. I think that is fabulous and can be beneficial to everyone. 
 

 

[SKL]

I do think having as many people share a home as practical can help ... hopefully there could be some economies of scale that would make home help more affordable. 

But there again, there are so many possibilities that are hard to predict.

I've been thinking a lot about what house modifications would help us all to age in place.  Of course that assumes that the house is still standing and serviceable, first of all.  Then, it obviously requires that we have a few bucks to make modifications.  Though, sharing the home is a built-in savings scheme since it lowers the overall cost of living.  We're also thinking about sharing a car, which should not be difficult if we aren't all working regularly outside the home.

I'll have to research my state's rules about property vs. being able to utilize tax-funded elder resources.  Like, if I want any of my life's work to benefit my kids, when should I make asset transfers?  And, if one of us unrelated house owners needs to go into care, how does that impact the house or other shared assets?

[Clarita]

On 6/20/2024 at 6:46 PM, Ginevra said:

Yeah; I do not like the book and every chapter makes me madder than the previous one. 🙄

You should just put that book through the shredder. 

[Ginevra]

13 minutes ago, Clarita said:

You should just put that book through the shredder. 

Well, it’s an audiobook, so, not really recommended! 😂 

But I hear you. 

[Scarlett]

2 hours ago, SKL said:

I do think having as many people share a home as practical can help ... hopefully there could be some economies of scale that would make home help more affordable. 

But there again, there are so many possibilities that are hard to predict.

I've been thinking a lot about what house modifications would help us all to age in place.  Of course that assumes that the house is still standing and serviceable, first of all.  Then, it obviously requires that we have a few bucks to make modifications.  Though, sharing the home is a built-in savings scheme since it lowers the overall cost of living.  We're also thinking about sharing a car, which should not be difficult if we aren't all working regularly outside the home.

I'll have to research my state's rules about property vs. being able to utilize tax-funded elder resources.  Like, if I want any of my life's work to benefit my kids, when should I make asset transfers?  And, if one of us unrelated house owners needs to go into care, how does that impact the house or other shared assets?

I think I have mentioned before that the one or two people in my life that I think would care for me in my old age are my sisters in-laws who are younger than me by 15 and seven years.

Dh and I were talking about our old age today. We are only 57 and 59 but very much feeling our age. 

Edited June 23 by Scarlett

[GoVanGogh]

19 hours ago, Scarlett said:

I think I have mentioned before that the one or two people in my life that I think would care for me in my old age are my sisters in-laws who are younger than me by 15 and seven years.

Dh and I were talking about our old age today. We are only 57 and 59 but very much feeling our age. 

I keep wanting to start a post on healthy aging. My partner and I are around your ages and - it is just grim anymore. We do know some older people that are going strong at 75+ but more and more it is the opposite. 
I have two friends whose spouses have terminal cancer. One of the spouses is in their mid 40s. Another friend’s spouse had a major stroke and is now wheelchair bound, unable to speak, take care of themselves, much less work. They had just turned 60. It just seems like everyone I turn, I think, What is going on?!? Many of these people were seemingly healthy, one ran marathons, never overweight. It is unnerving. Is this common with hitting this stage of life? 

[Laura Corin]

13 minutes ago, GoVanGogh said:

I keep wanting to start a post on healthy aging. My partner and I are around your ages and - it is just grim anymore. We do know some older people that are going strong at 75+ but more and more it is the opposite. 
I have two friends whose spouses have terminal cancer. One of the spouses is in their mid 40s. Another friend’s spouse had a major stroke and is now wheelchair bound, unable to speak, take care of themselves, much less work. They had just turned 60. It just seems like everyone I turn, I think, What is going on?!? Many of these people were seemingly healthy, one ran marathons, never overweight. It is unnerving. Is this common with hitting this stage of life? 

The biggest risk factor for cancer is increasing age. There are lifestyle factors that can increase that risk, but age remains key. Blood pressure and stroke risk also rise with age, and many people have undiagnosed high blood pressure. 

 

[TexasProud]

11 minutes ago, GoVanGogh said:

I keep wanting to start a post on healthy aging. My partner and I are around your ages and - it is just grim anymore. We do know some older people that are going strong at 75+ but more and more it is the opposite. 
I have two friends whose spouses have terminal cancer. One of the spouses is in their mid 40s. Another friend’s spouse had a major stroke and is now wheelchair bound, unable to speak, take care of themselves, much less work. They had just turned 60. It just seems like everyone I turn, I think, What is going on?!? Many of these people were seemingly healthy, one ran marathons, never overweight. It is unnerving. Is this common with hitting this stage of life? 

Honestly, it feels like a crap shoot.  I remember back in 2002 I sang in the one year anniversary of 9/11 in our town and came home and my husband sat me down, "I have something to tell you."  I thought of all of these relatives: my grandmother in a nursing home, my dad a lifelong heavy smoker, an unhealthy uncle etc.  No, it was my mom's husband.  He was 52 or 53 at the time, ate very healthy, a runner and he had a stroke. He has never been the same since.  His complete cognitive faculties didn't come back ( he was a brilliant engineer) and he can get around but can't use his right arm and wears a brace on his leg.  He can care for himself to a certain extent.  He and my mom were a symbiotic pair.  Now that she is gone, he is in an assisted living type place and it is working really well.

Anyway, if I had listed an order of relatives I thought would have a major health event, he would have been very last on the list.   But yes, at this point, I feel like every day is a gift. I could go out at any time or be very disabled as could my husband. It is part of the reason we are traveling now. We aren't guaranteed tomorrow. 

[SKL]

35 minutes ago, TexasProud said:

But yes, at this point, I feel like every day is a gift.

Yes, and for me, that includes every day with my parents, who are still alive, and with my siblings and my friends who are my age or older.

I've lost a series of friends, who were older, but not always that much older (some younger than I now am).  Most of them were smokers, but I don't know that all were.  One friend, who had two young daughters, dropped dead in the raquetball court.  Turns out he had some undiagnosed heart issue.

So clearly I need to "prioritize" my health.  But it feels strange to focus on my health when my folks and various friends and siblings are struggling where I'm not.

And sometimes, planning for a "senior lifestyle" requires the cooperation of others who aren't ready to think that way.  😛

[GoVanGogh]

3 hours ago, TexasProud said:

Honestly, it feels like a crap shoot.  I remember back in 2002 I sang in the one year anniversary of 9/11 in our town and came home and my husband sat me down, "I have something to tell you."  I thought of all of these relatives: my grandmother in a nursing home, my dad a lifelong heavy smoker, an unhealthy uncle etc.  No, it was my mom's husband.  He was 52 or 53 at the time, ate very healthy, a runner and he had a stroke. He has never been the same since.  His complete cognitive faculties didn't come back ( he was a brilliant engineer) and he can get around but can't use his right arm and wears a brace on his leg.  He can care for himself to a certain extent.  He and my mom were a symbiotic pair.  Now that she is gone, he is in an assisted living type place and it is working really well.

Anyway, if I had listed an order of relatives I thought would have a major health event, he would have been very last on the list.   But yes, at this point, I feel like every day is a gift. I could go out at any time or be very disabled as could my husband. It is part of the reason we are traveling now. We aren't guaranteed tomorrow. 

It does totally feel like a crap shot. 
I have a parent (I mentioned them up thread) that is very obese, uncontrolled diabetes, just one major health crisis after another. It is like they are a cat with nine lives. Survival rate for anyone with a blood clot that goes to their lungs is extremely low. Yet, they survived that. And so much more. Then on the flip, I know 45 year old healthy people with terminal cancer. My spouse and I have always been very healthy and active, yet we both have major health issues, issues that normally don’t hit until a decade or two past when we were diagnosed. 

[freesia]

4 hours ago, TexasProud said:

Honestly, it feels like a crap shoot.  I remember back in 2002 I sang in the one year anniversary of 9/11 in our town and came home and my husband sat me down, "I have something to tell you."  I thought of all of these relatives: my grandmother in a nursing home, my dad a lifelong heavy smoker, an unhealthy uncle etc.  No, it was my mom's husband.  He was 52 or 53 at the time, ate very healthy, a runner and he had a stroke. He has never been the same since.  His complete cognitive faculties didn't come back ( he was a brilliant engineer) and he can get around but can't use his right arm and wears a brace on his leg.  He can care for himself to a certain extent.  He and my mom were a symbiotic pair.  Now that she is gone, he is in an assisted living type place and it is working really well.

Anyway, if I had listed an order of relatives I thought would have a major health event, he would have been very last on the list.   But yes, at this point, I feel like every day is a gift. I could go out at any time or be very disabled as could my husband. It is part of the reason we are traveling now. We aren't guaranteed tomorrow. 

Yes. In 2007 my FIL passed away at 60. He was the healthiest grandparent. And ate extremely healthfully. He died of cancer 4 months after diagnosis. 5 months later my slim healthy 57 year old aunt died of lung cancer ( she was not a smoker). It was all a shock. 

[Toocrazy!!]

Some of it really does seem like a crap shoot, especially cancer. A lot of that does seem random. But a lot of health issues we do have some control over. 
I went on a health makeover about 2 1/2 years ago and definitely have healthier markers than when I started. I’m 54 and feel better than I did in my 40’s going through perimenopause for sure. I play pickleball every day with people close to 70 and they are GOOD, and in great shape.  It’s motivational to see them doing the same thing I’m doing, but 15 years on. 
I’m hoping all of it leads to a longer healthspan- what they’re calling living a healthy long life instead of just a longer lifespan. But for now I really do FEEL better everyday and that’s important too. 
also- there’s more to good health than being slim and eating well- sleep and especially stress really affect your body, and that’s something you just don’t really know about someone looking on from the outside. 
Heart issue, diabetes, COPD are all top killers and in many instances can be improved through lifestyle choices, early detection, aggressive treating, etc. Looking at the big picture, and not the scary anecdotes of outliers, most of us are probably not doing all we can to be as healthy as possible going into older age. 

[MagistraKennedy]

On 6/18/2024 at 9:26 PM, Shelydon said:

Assisted living apartments or better quality nursing care centers are around $5500 a month here. People definitely do not save enough to cover that. 

Can I ask what part of the country? 

In our area, it's around $7K

[City Mouse]

2 hours ago, MagistraKennedy said:

Can I ask what part of the country? 

In our area, it's around $7K

In a small town in East Texas in 2023

The very nice Assisted Living place where my parents lived had a base rate of $3500 for the smallest studio. I think my parents 1 bedroom apartment was $4500 base rate, $1000 extra per month for the second person. Then my dad also paid $450 per month for Medication Management. They did not pay for any extra services from the AL. Included in the base rate was all meals, weekly cleaning, and weekly laundry and scheduled  transportation in the facility bus or car. Everything else was extra. Then my mother paid her private care giver another $15 per hours for usually 20-30 hours per week. The care giver did my mom’s personal laundry, assisted with bathing and dressing my mom, and drove them to dr appointments. My mom could have had AL provide those services but she didn’t want to. Other AL in same town had similar base rate but different structure for paying for extra services.
Memory care (locked unit) at same AL was just under $5000 per month for 1 person and included all services that AL could provide - medication assistance, bathing and dressing, and bathroom assistance.

Decent but not fancy nursing home in same town was about $175 per day (private room) for a private room. We continued to pay mom’s private caregiver approximately 12 hrs per week to basically just be a companion and do mom’s laundry. The facility would have done laundry but mom preferred it this way. When I say “decent” - The facility and residents never smelled bad. It was always clean. Someone came in to my mom’s room at least once an hour or so and would always ask if she needed anything. Residents who were mobile, either walking or scooting, were frequently moving around the hallways. Food was decent but some days better than other. There was always snacks and drinks available in a central location, and snacks were brought to bed bound patients twice per day or more if requested. 

State Veterans Home (skilled nursing) in Tyler Texas about 1 1/2 away was around $7500 per month for full price private pay which only applies to spouses. Veterans paid less based on income, service disability, etc. with the VA stipend, which goes directly to the facility, my dad’s daily rate was $129. Staffing ratios were much higher than the  “decent” facility. They had one RN for every 20 residents, and 2 CNAs for every 10 residents.  This place was amazing. It was constructed as 10 separate houses, and each house had 10 residents. Each house had its own cook and one big dining table where all the residents who could sat together to eat. The biggest downside is the long waiting list to get in.

Edited June 25 by City Mouse

[Terabith]

In all honesty, my plan is to kill myself when I get a diagnosis that means I will not be able to care for myself or support myself.  Dementia, terminal cancer, all sorts of things.  It seems like the only way to insure my loved ones won’t be killing themselves trying to care for me and to keep myself from using up too much money.  I know it’s tricky because you can lose the capacity to do it if you wait too long. I’m not sure how to deal with that.  I just hope I’m brave enough to do it.  It seems like the best thing for everyone.  

[Corraleno]

1 hour ago, Terabith said:

In all honesty, my plan is to kill myself when I get a diagnosis that means I will not be able to care for myself or support myself.  Dementia, terminal cancer, all sorts of things.  It seems like the only way to insure my loved ones won’t be killing themselves trying to care for me and to keep myself from using up too much money.  I know it’s tricky because you can lose the capacity to do it if you wait too long. I’m not sure how to deal with that.  I just hope I’m brave enough to do it.  It seems like the best thing for everyone.  

I have the same plan, and getting the timing right also concerns me. I'd much rather be diagnosed with terminal cancer than dementia or Alzheimer's, because at least that qualifies for the Death with Dignity Act and I think it's easier to decide on a time. My greatest fear is dementia. My mother was diagnosed with early stage dementia at 86, then a few months later she was diagnosed with terminal pancreatic cancer, which I think was ultimately a blessing, because she had enough time to get her affairs in order while still competent, and only really started losing it in the last week or so before she died.

[GoVanGogh]

On 6/23/2024 at 3:16 PM, Laura Corin said:

The biggest risk factor for cancer is increasing age. There are lifestyle factors that can increase that risk, but age remains key. Blood pressure and stroke risk also rise with age, and many people have undiagnosed high blood pressure. 

 

One of my siblings kids had a heart attack earlier this year at age 39. And now a friend of mine had a heart attack over the weekend. They had just turned 40. It just seems like both heart disease and cancer are getting younger and younger people. I know our diets and lifestyle are big contributors, but many of these people are extremely healthy, based on outward appearances. 

[Spryte]

1 hour ago, GoVanGogh said:

One of my siblings kids had a heart attack earlier this year at age 39. And now a friend of mine had a heart attack over the weekend. They had just turned 40. It just seems like both heart disease and cancer are getting younger and younger people. I know our diets and lifestyle are big contributors, but many of these people are extremely healthy, based on outward appearances. 

I’m sorry for your family’s loss, and for your friend. So young!

We lost two long-term friends to heart issues last year —  49 and 51. Both had had Covid in the months before their deaths, and we thought it was likely due to post-Covid issues. We also lost my FIL last year to a clot due to Covid, but he was in poor health prior to Covid and elderly.

I suspect multiple Covid infections are driving those types of events up, along with lifestyle and diet.

Edited June 27 by Spryte

[Shelydon]

On 6/20/2024 at 6:31 PM, Pawz4me said:

Also true in NC. I've never heard of anyone not being able to get a Medicaid bed. There are no separate Medicaid or state facilities. Medicaid patients get beds in the same LTC facilities as private pay people. And the Medicaid people get the same level of care as the private pay people. Some facilities are better than others, of course. My understanding is that even if a Medicaid patient has to take a bed in a facility that isn't ideal (either due to it's rating or distance from family or whatever reason) that transfers can be arranged as beds become available in other facilities.

 

Wanted to address this-- in a few states and there are Medicaid only nursing homes. They are vastly inferior to private pay places. Medicare part A rehab is serviced in both private pay and Medicaid homes.