Do you have long term care insurance?

[barkley]

I know...it's quite the racket. What surprised us was that it doesn't seem to be in the nursing home's best interest as this other company is directing/guiding you to spend what's left as fast as you can. I will say this...it's already been a ton of work just getting all of the documents ready for the medicaid application people....and so now that we have all that, for $7,800, they can do the rest of the work. It's kind of smart, because they know that their fee is a part of the spend down....and the way we're looking at it now, is either he gets it or the nursing home gets it. It doesn't matter to us. And he did tell us that the nursing home will likely get about 1/3 of the money or 30K-ish....because the application takes a bit of time. And so spending 60K should take us too long with the price of everything these days. We'll upgrade his Toyota Camry....he wants a hybrid Camry, but cars are tough to find. And then a new roof. That would leave us with about 10 grand to spend on some smaller house repairs that make sense...and that'll be it.

just make sure to keep every receipt-and if they have receipts for any monetary stuff over the past 5 years grab hold of them and keep them on hand (there can be a 5 year period prior to the date of application that medicaid looks back at and wants receipts/explanations for expenditures/monetary gifts/anything that had money and assets leaving the applicant's possession).

 

[Pea-n-Me]

We have LTC policies that I got through my work. I don’t know how good they’ll be if needed. The one good thing about them is that some of the premiums can be recovered if we don’t use the policies (which may wind up going to our heirs). With two nurses here, we took care of my mother through her illness and hospice care. It was a lot and it took me a long time to recover from it. Hospice mainly helped with equipment, we provided all the other care. But that’s a whole other topic. I think Switzerland has the right idea, too. It would be good to go out with dignity when and if ready.

 

[dvcgirl67]

Don’t forget to pay for their funerals! So sad, I’m sorry you and your family have to deal with all this.


Chances are good what will be her downfall will be aspiration (due to neurological changes with swallowing). When that happens and she has frequent pneumonias and can no longer eat, it’s the time you start hospice care (or before). The facility may ask you to hire a private caregiver if she continues to yell. There are some medications and other aspects of care that can help that, too. Good luck with this.

Thanks for your kind words. Yes...the funeral is covered. They already paid for that several years back, so we can't use it as part of the spend down. I did call the funeral home to make sure that every single detail is paid for to make sure....and it is. I asked if we could set aside funds for a repast, but NJ took that expense away a few years ago. We have to spend her funds down to only $2,000 and so we could just use that money for that I suppose.

And yes, there's a good chance that aspiration pneumonia could be what ends her life. They have her on a soft diet because she's been "packing" food....not swallowing everything she chews. They also put thickener in her drinks. However, my FIL had been bringing her lots of snacks, sweets and treats that she likes. They told him to stop doing that and he told us that her mood changed and she seemed less happy. So I called and spoke with the head nurse about it....and they have made a note that he can continue bring treats. I also won't be surprised if covid or the flu ends her life this winter. She has symptomatic covid now...but seems to be rallying. They're giving her paxlovid and fluids. And she her bivalent booster recently. But the universal precautions this place are essentially non-existent. Honestly, it would be a blessing for something like this to happen....for the most part....this is no way to live.

And sorry...didn't mean to take over this thread about my MIL's issues. Hopefully our really new experience with my in-laws LTC insurance and the medicaid information will be helpful to some. It's one of those things that you don't really know about until you go through it.

 

[barkley]

I think Switzerland has the right idea, too. It would be good to go out with dignity when and if ready.

they are rethinking and tweaking their laws on this. the lack of regulation there has sadly created a high priced suicide tourism niche.

 

[dvcgirl67]

just make sure to keep every receipt-and if they have receipts for any monetary stuff over the past 5 years grab hold of them and keep them on hand (there can be a 5 year period prior to the date of application that medicaid looks back at and wants receipts/explanations for expenditures/monetary gifts/anything that had money and assets leaving the applicant's possession).

Right, I've read that about the five years. We have a meeting with the owner of the medicaid application company tomorrow at my FIL's house to begin the process. Oh...one other big thing that we didn't think about until all of this happened....is that we are also having to hire a Title Company to quickly change the deed to the home so that it's not in both of their names....and just my FIL. He's in amazing shape, but he is 91...and anything can happen at that age. If he was to predecease my MIL...the house is up for grabs. Another thing we hadn't thought about.

 

[dvcgirl67]

And that is the main problem with these plans. My dad lives in a medium to low cost of living place and they are charging $10k per month. No one is going to sell you a policy that will pay $10k per month for several years. Those policies are simply unavailable.

That's what we've learned in this process. And it's why we've decided to self-insure for ourselves. I would say my MIL is in a similar facility to your Father. But the other thing I believe about the "higher end" facilities...is that they may be a bit shinier....look fancier, etc. But the employees are about the same in most of these places. We've seen an occasional rock star...but for the most part it's just so-so on that front.

 

[mefordis]

1000% agree. The way that many of us die in this country is a sin.

We're going through all of this right now. My MIL is almost 88....had a couple of strokes a couple of years back and has gone through a slow decline in the years since. The frequency of hospitalizations increased and then about two months ago she went in after a fall at home and was transferred to a rehab facility to regain her mobility two weeks later. Well that was six weeks ago and it's been determined that she will not regain the ability to stand/walk...and so the decision has been made to admit her permanently as a resident of the long term care facility....same place, just other side of the building. My husband and I looked into bringing her home with private care, but the price is astronomical. The only other option would have been to find someone "off the books", and by the time we began looking into that my MIL started to get increasingly confused and yelling out. And so we had to look out for both of them and made the decision to admit her permanently.

And so my in-laws do have a LTC policy, and in their circumstance, it's not going to help them at all. They took it out over 30 years ago....no idea what their premiums were. But in their case....it was money wasted. It will help the nursing home out a bit, but not much. I don't know what they paid for the policy, but they took out the policy in their early to mid-60s. It pays $80 a day, or $2400 a month for about 6 years. The cost of the nursing home (in NJ) is over $13,000 a month....and it's not what I'd consider to be a very good one....it's mediocre. It was chosen by my FIL because we have a family member there who works in admissions....and that made him feel better....and so we wanted to support his decision. The really nice ones around here are a part of Life Care facilities....where you plunk down hundreds of thousands of dollars and start out in an apartment....the assisted living facility and long term care facility are on site at those places....presumably for when you need them.

Now we're in the process of learning about the "Medicaid Spend Down"....which is a world we had no idea about. Basically, my in-laws own their home outright (about 350K) and have about 180K left (in a savings account and IRA), and social security. They were amazing savers but very, very conservative investors throughout their working lives....and they retired in 1998, and got aggressive based on the advice of a "financial advisor".....well, we many of us know what the market did in 2000-2001....went down over 50%....and that's when they panicked, and pulled their money out. I'm honestly amazed they still have 180K left as the money hasn't been invested in over twenty years. They were able to enjoy their retirement though....took a number of trips on their own dime, with us funding a few in their later years.

So now...with my FIL an incredibly healthy 91 (could easily live another 10 years+), is called a "spouse in the community".....and since the house is under the medicaid threshold....he gets to keep the house. The other 180K now gets split in half, he keeps 90K and his social security. The other 90K and my MIL's Social Security goes to the nursing home.....but, then we learned about the "spend down". And while it kind of feels shady....this is apparently what everyone does.....you quickly buy approved items/repairs....to "spend down" my MIL's side....essentially as fast as you can... before the nursing home gets it. It's really a terrible plan, and has to be a big part of the reason that LTC is sooooo expensive, and that over 60% of all LTC residents are fully on medicaid. The wild part is that the nursing home referred us to a "Medicaid Application Agency"....to *help* us with the application, but also the spend down. Also...conveniently for this company....their $7,800 fee is considered a part of the spend down. So...now we're looking to upgrade my FIL's car, get him a new roof and other large expenditures. It's just nuts.

As for my husband and I....we're not getting LTC insurance. We're in a position to afford home care and/or a LTC facility and pay out of pocket. We're both extremely adamant that we don't want to die in a place like that....but understand that it sometimes happens and is out of one's control.

My husband's grandmother ended up in one of the nice ltc facilities. She had her own apartment and lived there for about 15 years before her health declined and they moved her to the other side of the facility. They treated them unbelievably good. She had to put down I think $450k and they kept the interest and the family got it back when she passed away. Her monthly rent and expenses were reasonable, too. She entered that place about 17 yrs ago when it was much more reasonable. Now these places require way more down, and they keep a big chunk of it if not all. The monthly is about 6-10k now, too. It's in NJ.

We have the money to pay for our care so no LTC insurance for us, either. My in laws also have the money to pay for their own care. My mother - a whole other issue.

 

[Dan Murphy]

Yes, we both have LTC policies. We took them out 29 years ago when I was 49 and Marie was 47. As a career financial planner (now retired) and with LTC policies just becoming available pretty much then (late 80's, early 90's) they became a part of possible recommendations to many of my clients' portfolios.

When we acquired ours, Marie asked, 'what do we need these for NOW, we don't need these NOW!' My response was, 'exactly, we don't these NOW, which is why we can get them NOW. If we NEED them some day, we won't be able to purchase them THEN.' 3 years later, Marie had Stage III breast cancer (now a 24 year survivor ). Acquiring a policy subsequent to that would not have been impossible for her, but it would have been tougher to get, higher cost and not as high a level of benefits.

At the time we acquired the policies, the daily benefit was $100 per day. That was about $20 a day higher than the then current private room skilled nursing home. The waiting period is -0- days, benefit period is unlimited and the yearly inflation increase is 5% compounded. Today, the monthly benefit is almost $13,000 a month. Private rooms at higher end skilled nursing facilities are about $12,000 a month here in our area. Our yearly premiums are each just under $1,000 a year.

Both Marie and I have each made a claim once already. When I had my knee replaced 8 years ago, I went to a skilled nursing rehab for 15 days. Marie had her hip replaced 6 years ago. Same nursing facility, 13 days

I don't think these benefits could be purchased at any price today.

 

[CdnCarrie]

We have LTC policies that I got through my work. I don’t know how good they’ll be if needed. The one good thing about them is that some of the premiums can be recovered if we don’t use the policies (which may wind up going to our heirs). With two nurses here, we took care of my mother through her illness and hospice care. It was a lot and it took me a long time to recover from it. Hospice mainly helped with equipment, we provided all the other care. But that’s a whole other topic. I think Switzerland has the right idea, too. It would be good to go out with dignity when and if ready.

Does USA not have medically assisted suicide?

Canada does now.
And are American LTC facilities subsidized by the government there and based on income?

I just checked and the maximum per month for a LTC facility is around $3000 based on income/marital status. Minimum around $1200 Of course there would be some additional fees for personal expenses on top of that.

 

[Pea-n-Me]

Does USA not have medically assisted suicide?

Canada does now.
And are American LTC facilities subsidized by the government there and based on income?

Very few of the 50 states do. Mine does not.

https://euthanasia.procon.org/states-with-legal-physician-assisted-suicide/

I’m sure there’s someone more qualified to answer your second question than me, but it’s complicated.

If one qualifies for Medicaid (state assisted health care coverage), then they cover skilled care. Income and asset guidelines are very strict, though. (@dvcgirl67 was saying that they are “spending down” her FIL’s money so he can qualify.)

People who can afford to, pay out of pocket.

Medicare (federal health care plan for people over age 65) does not cover nursing home care. They do cover rehab for a short period of time.

I’m sure more can chime in with additional information.

https://www.elderneedslaw.com/how-t...-assisted-living-facility-or-home-health-care

Many people plan it out early with estate-planning attorneys so their money is put into trusts and such and so they can qualify for Medicaid if needed. There is a five year “look back” period where Medicaid officials can look back to see where the money has gone.

 

[antmaril]

Yes, I have long term care insurance. It was offered through my employer when I was about 40 (more than 30 years ago). I didn’t even know what it was, but I asked the attorneys I worked for if this was something I should have and they all said ”Yes, and never cancel it.”. It was very, very inexpensive at the time. Of course, it has gone up over the years, but it is still very affordable. I hope I never need it, but it will be there if I do.

 

[ronandannette]

they are rethinking and tweaking their laws on this. the lack of regulation there has sadly created a high priced suicide tourism niche.

With recent changes to Canadian legislation, there is no longer any requirement to have a terminal diagnosis, and as of March, 2023, persistent mental illness (with or without suicidal ideation) will be considered "grievous and irremediable". The wording on the Bill is rather vague in how it applies to non-residents, using the term "generally" not eligible. How that actually plays out is probably rather hard to verify.

Here's a snippet from the Government of Canada Health Ministry website: https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html

Does USA not have medically assisted suicide?

Canada does now.
And are American LTC facilities subsidized by the government there and based on income?

I just checked and the maximum per month for a LTC facility is around $3000 based on income/marital status. Minimum around $1200 Of course there would be some additional fees for personal expenses on top of that.

Unless Manitoba prohibits them for some reason, if you look around there will also be private facilities that cost much, much more, but the costs are for more luxurious accommodations and lifestyle amenities. The basic medical care components are subsidized at all facilities. In the public ones you're quoting the monthly cost is for lodging and board and some other things that are considered discretionary and residents (or their family members) still have to provide their own meds, either through provincial Blue Cross or OOP.

This discussion about the realities of the costs of LTC in the US is something I've never thought of before. It's sobering to think of having to account for it in one's long-term financial planning.

 

[dvcgirl67]

My husband's grandmother ended up in one of the nice ltc facilities. She had her own apartment and lived there for about 15 years before her health declined and they moved her to the other side of the facility. They treated them unbelievably good. She had to put down I think $450k and they kept the interest and the family got it back when she passed away. Her monthly rent and expenses were reasonable, too. She entered that place about 17 yrs ago when it was much more reasonable. Now these places require way more down, and they keep a big chunk of it if not all. The monthly is about 6-10k now, too. It's in NJ.

We have the money to pay for our care so no LTC insurance for us, either. My in laws also have the money to pay for their own care. My mother - a whole other issue.

Yes, we have a few of those high end Life Care places around here. The one in our town was 600K for the buy in a few years back. There's a lot of big money investing into the higher end places like this....some of them resemble five star resorts.

My FIL looked at a place down by them that had a buy in around 325K to start. He said it was nice enough, but it meant that they had to go all in....sell the house....etc. And the monthly rent plus meal plan wasn't cheap. However, it was becoming clear that my MIL was likely to end up on the nursing home side, and that's a whole separate fee. My husband and I then discouraged the whole idea because he would be moving from a community that he loves and be sitting in an apartment by himself....while his wife was in a bed on the nursing home side. If he wasn't able to drive that may have been an idea to contemplate, but he can drive...and visits her daily.

Watching all of this unfold the key to not ending up in a place like this....is to be lucky enough to retain your memory/wits....and to remain mobile.

 

[dvcgirl67]

Does USA not have medically assisted suicide?

Canada does now.
And are American LTC facilities subsidized by the government there and based on income?

I just checked and the maximum per month for a LTC facility is around $3000 based on income/marital status. Minimum around $1200 Of course there would be some additional fees for personal expenses on top of that.

Well, our system is ridiculous. The LTC facilities do what every other part of our healthcare system does....inflates the price of care to astronomical levels.....so that they can cover their costs and turn a profit with what Medicare/Medicaid and Insurers actually pay them. My MIL started this whole last cycle with a 10 day hospital stay. She was always on a regular floor and didn't receive any specialized care. The bill for the stay was $92,000. It's literally insane.

And yes, 60% of our LTC is paid for by Medicaid...a separate entity from Medicare, which is the healthcare insurance that all seniors over 65 carry. In our circumstances, with the 1/2 of the countable assets being 90K, that would be enough to carry my MIL through 9 months of care along with her monthly Social Security and the $2,400 per month from the LTC policy. But....then we learned that we can essentially spend all of that money on allowable things that my FIL needs. And so this is why our system is so crazy expensive. My FIL told us that he always wondered why people in his community seemed to get new cars and roofs when their spouse went into the nursing home.....and now we know why. They are quickly spending down assets, to keep the nursing home from getting it.

I know that some nursing homes won't take you unless you are private pay....but they are few and far between. Most can't survive without some medicaid beds. And while some of them may be resort like with huge buy-ins...etc, the pay for most of the employees is similar. They are overworked and underpaid at facilities at every price level.

 

[ronandannette]

...I know that some nursing homes won't take you unless you are private pay....but they are few and far between. Most can't survive without some medicaid beds. And while some of them may be resort like with huge buy-ins...etc, the pay for most of the employees is similar. They are overworked and underpaid at facilities at every price level.

This situation is exactly the same here too - the swanky places are certainly nicer from a lifestyle-amenities perspective, but every sector of health care is devolving into chaos due to staffing shortages. It's particularly critical in elder-care and there are often reports of horrific instances of neglect and/or even abuse in all kinds of facilities.

 

[dvcgirl67]

Yes, we both have LTC policies. We took them out 29 years ago when I was 49 and Marie was 47. As a career financial planner (now retired) and with LTC policies just becoming available pretty much then (late 80's, early 90's) they became a part of possible recommendations to many of my clients' portfolios.

When we acquired ours, Marie asked, 'what do we need these for NOW, we don't need these NOW!' My response was, 'exactly, we don't these NOW, which is why we can get them NOW. If we NEED them some day, we won't be able to purchase them THEN.' 3 years later, Marie had Stage III breast cancer (now a 24 year survivor ). Acquiring a policy subsequent to that would not have been impossible for her, but it would have been tougher to get, higher cost and not as high a level of benefits.

At the time we acquired the policies, the daily benefit was $100 per day. That was about $20 a day higher than the then current private room skilled nursing home. The waiting period is -0- days, benefit period is unlimited and the yearly inflation increase is 5% compounded. Today, the monthly benefit is almost $13,000 a month. Private rooms at higher end skilled nursing facilities are about $12,000 a month here in our area. Our yearly premiums are each just under $1,000 a year.

Both Marie and I have each made a claim once already. When I had my knee replaced 8 years ago, I went to a skilled nursing rehab for 15 days. Marie had her hip replaced 6 years ago. Same nursing facility, 13 days

I don't think these benefits could be purchased at any price today.

Wow Dan...that's an incredible policy. I can't imagine what that policy would cost...or like you say, if someone would even write it. I also have concerns about these policies because quite a few of insurers went belly up after the Great Recession and those policy holders were out of luck. So, we're just going to self-insure.....and as far as saving/investing, one little silver lining of late is that the Feds increased the 401K contribution by quite a lot for next year (thanks inflation...lol). Next year is $22,500....up two grand. And the catch-up for those of us over 50 is up one grand....to $7,500. So we can sock away 60K just in the 401ks (a bit more as my husband gets a nice match and I have a solo 401K so can do profit sharing contribution above that).

 

[_19disnA]

Have some elderly relatives and the experience some others have mentioned is similar to what we have also seen. You stay in the hospital the absolute minimum number of days for the specific issue you have. Assume there is some table they refer to since insurance will only pay for as few days as possible and also seems unrelated to your age or other existing medical issues. Someone who is 25 vs. 85 will have significantly different recovery times, but that doesn't seem to matter. Then they push you out the door to rehab. Rehab is also only covered by insurance for the specified minimum based on your issue. After rehab you are basically on your own and hopefully well enough to be able to function at home.

It is nearly impossible to find a doctor who can speak holistically about the overall condition/status of your elderly relative since everyone seems to be a specialist now. They bounce you from one doctor to the next if the person doesn't have a condition related to their exact specialty. Most also talk in medical mumbo/jumbo and don't seem to grasp that everyone is not a medical professional. Baffles me how such highly trained medical professionals do such a poor job of communication with patients/relatives.

Costs of health insurance are high for a number of reasons and neither political party will be able to solve this by passing some new laws. With something like car insurance, you may drive you entire life and NEVER have a claim. Money you pay for car insurance is pooled with everyone else and used to pay the small % of people who do have serious accidents. Health insurance is nothing like that and likely as you get older EVERYONE will need various often increasingly expensive types of medical care. Medical science has advanced over the years where people now live longer and thing that used to be fatal in the past can be resolved and the person lives longer. However, living longer also mean that the more serious medical issues you will likely develop are VERY expensive to deal with. Unfortunately, there are no easy answers to this.

 

[dvcgirl67]

Have some elderly relatives and the experience some others have mentioned is similar to what we have also seen. You stay in the hospital the absolute minimum number of days for the specific issue you have. Assume there is some table they refer to since insurance will only pay for as few days as possible and also seems unrelated to your age or other existing medical issues. Someone who is 25 vs. 85 will have significantly different recovery times, but that doesn't seem to matter. Then they push you out the door to rehab. Rehab is also only covered by insurance for the specified minimum based on your issue. After rehab you are basically on your own and hopefully well enough to be able to function at home.

It is nearly impossible to find a doctor who can speak holistically about the overall condition/status of your elderly relative since everyone seems to be a specialist now. They bounce you from one doctor to the next if the person doesn't have a condition related to their exact specialty. Most also talk in medical mumbo/jumbo and don't seem to grasp that everyone is not a medical professional. Baffles me how such highly trained medical professionals do such a poor job of communication with patients/relatives.

Costs of health insurance are high for a number of reasons and neither political party will be able to solve this by passing some new laws. With something like car insurance, you may drive you entire life and NEVER have a claim. Money you pay for car insurance is pooled with everyone else and used to pay the small % of people who do have serious accidents. Health insurance is nothing like that and likely as you get older EVERYONE will need various often increasingly expensive types of medical care. Medical science has advanced over the years where people now live longer and thing that used to be fatal in the past can be resolved and the person lives longer. However, living longer also mean that the more serious medical issues you will likely develop are VERY expensive to deal with. Unfortunately, there are no easy answer to this.

I totally agree with you on the lack of continuity of care. My FIL has been a tireless advocate for my MIL and still there has been several times when one hand doesn't know what the other is doing. Most of the time this is because they aren't given the proper amount of time with patients. It's all a numbers game...."x" number of patients need to be seen every hour...etc.

Someone else mentioned that staffing is an issue and we *definitely* see that at the nursing home, particularly because we can only visit on weekends. It's like pulling teeth to get an aide to help and quite often the dinners on the weekends are cold sandwiches, which I think is unacceptable. Once we learned that my FIL began to bring her hot meals on those evenings, something he shouldn't have to do. My sister in law visits during the week after work a couple of days a week and told me that she's seen them serve hot dogs for dinner at least three times. Hot dogs? And mind you....this place is over 13K a month. On what planet is a hot dog considered a nutritious meal? I do know what it is though....cheap, and a child can prepare it. I'm guessing on the weekend they have very few in the kitchen and they cut out early....so sandwiches it is.

 

[tvguy]

Unless Manitoba prohibits them for some reason, if you look around there will also be private facilities that cost much, much more, but the costs are for more luxurious accommodations and lifestyle amenities. The basic medical care components are subsidized at all facilities. In the public ones you're quoting the monthly cost is for lodging and board and some other things that are considered discretionary and residents (or their family members) still have to provide their own meds, either through provincial Blue Cross or OOP.

This discussion about the realities of the costs of LTC in the US is something I've never thought of before. It's sobering to think of having to account for it in one's long-term financial planning.

My cousins in Ottawa struggled with LTC for this dad. There was a wait list for a facility of about two years.

 

[ronandannette]

My cousins in Ottawa struggled with LTC for this dad. There was a wait list for a facility of about two years.

Yes, that can happen in some locales, especially if a patient/family wants a choice of where to go. It's very common for elders to be offered a bed in a facility that isn't anywhere near their home or the homes of their support people, just based on availability. And there are countless (tens of thousands, probably, nation-wide) elders being maintained in acute-care hospital beds because an appropriate LTC situation isn't available in a timely manner. This is crisis-level and has been impacting Canadian health-care resources for many years.