Do you have long term care insurance?

[tvguy]

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.

That is exactly what happened with my Uncle. He was in an acute care hospital until an appropriate facility had an opening.

 

[mefordis]

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.

That's why the decent nursing homes are asking for $500k+ up front. They will spend that down when you are unable to pay the bills. Only after that is spent down does medicare kick in so that is several year's worth of paying full price. People are treated much better in those facilities. They by law I think have to accept medicare but they make it so most of the time they don't have to because that deposit covers enough time. (Actually, a 500k deposit might cover about 4 years and someone can be in a state of terrible health for 10+ years.)

 

[georgina]

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.

This has always made me angry. Middle class folks struggle to pay nursing home costs, while rich people hide their assets to get the government to fund theirs. We have had financial planners suggest this type of legal scam, they were immediately disqualified to work with us. Our money is there to be spent on our care, not just handed down to our kids

 

[barkley]

This has always made me angry. Middle class folks struggle to pay nursing home costs, while rich people hide their assets to get the government to fund theirs. We have had financial planners suggest this type of legal scam, they were immediately disqualified to work with us. Our money is there to be spent on our care, not just handed down to our kids

when i supervised a medicaid unit it was the policy to instruct (in basic terms) people in how to do this b/c the feds (and the state i worked in) believed it was better for a couple (of any income/asset level that might disqualify them to medicaid) to be able to acquire medicaid assistance for a spouse so that the remaining spouse (and if applicable-their minor or dependent adult children) to be able to continue to be self supporting vs. having to spend everything away and potentially end up on public assistance programs for much longer than the average ltc end of life stay. it is not a legal scam. in some states, there are laws that limit who can provide legal advice on medicaid planning, but in no states are there any laws about families engaging in medicaid planning to qualify a loved one for their state's medicaid program.

 

[CdnCarrie]

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
View attachment 712707

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.

We do have Revera homes as well but they follow the Manitoba fee guidelines.
I’m not aware of any private LTC places just private assisted living ones. Some of those may have a nursing home component.

I’m sort of in healthcare so do know the system a bit but not in depth.
And yes I know about the prescriptions but we do have pharmacare so that may help. Lots of seniors do have retirement benefits from employers that help with that. My mom does and I will.

 

[tvguy]

That's why the decent nursing homes are asking for $500k+ up front. They will spend that down when you are unable to pay the bills. Only after that is spent down does medicare kick in so that is several year's worth of paying full price. People are treated much better in those facilities. They by law I think have to accept medicare but they make it so most of the time they don't have to because that deposit covers enough time. (Actually, a 500k deposit might cover about 4 years and someone can be in a state of terrible health for 10+ years.)

I think you mean Medicaid, not Medicare. Medicare's website says they do not pay for LTC. https://www.medicare.gov/coverage/long-term-care

 

[Dan Murphy]

I think you mean Medicaid, not Medicare. Medicare's website says they do not pay for LTC. https://www.medicare.gov/coverage/long-term-care

Just what I was going to add.

 

[Colleen27]

No, and I don't plan to unless I happen into a job that offers it at a reasonable price because the policies out there right now don't provide enough coverage to justify the cost. My mom had an excellent policy - one of the perks of 40-odd years as a civil servant - that had a 30-day wait before coverage started (which is in line with what medicare will cover as a physical therapy/rehab stay after hospital discharge) and a max benefit of about 2/3 the actual cost of semi-skilled residential care. It was wonderful for her peace of mind; without it, I know she'd have fought the move to assisted living after her diagnosis, even with a "6 months to live" prognosis and enough money in the bank to cover several years' care. But the policies we've priced cost 10x what she was paying, have 60 or 90 day waiting periods, lower monthly benefit amounts, and a lifetime benefit cap that comes out to just a year or two of care. We decided we were better off upping our 401k contributions and planning to self-pay if we need residential care.

 

[RAD]

My wife and I both have it. I got it through work many years ago so my premium's are very reasonable. The wife didn't listen to me and got it when she was 58, higher premium for less coverage, as expected.

My mother had it and I was very happy that she did. She ended up with dementia and spent 5 years in a memory care unit. If it wasn't for her policy she would have had to be moved into a facility which took Medicaid after the first year because the cost would have wiped out her savings. Because of the policy she was able to say in a nice facility for 4 years, 11 months. her money ran out and we had to move her, she passed away after only 2 weeks of moving her. I'm sure that the change in her living situation and staff accelarated her passing.

 

[ronandannette]

We do have Revera homes as well but they follow the Manitoba fee guidelines.
I’m not aware of any private LTC places just private assisted living ones. Some of those may have a nursing home component.

I’m sort of in healthcare so do know the system a bit but not in depth.
And yes I know about the prescriptions but we do have pharmacare so that may help. Lots of seniors do have retirement benefits from employers that help with that. My mom does and I will.

I'm sure we're talking about the same thing. Almost all these places have "aging-in-place", which is stepped-up care for residents as needed.

 

[Pea-n-Me]

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.

The bolded is a big problem in US hospitals as well.

That's why the decent nursing homes are asking for $500k+ up front. They will spend that down when you are unable to pay the bills. Only after that is spent down does medicare Medicaid kick in so that is several year's worth of paying full price. People are treated much better in those facilities. They by law I think have to accept medicare Medicaid but they make it so most of the time they don't have to because that deposit covers enough time. (Actually, a 500k deposit might cover about 4 years and someone can be in a state of terrible health for 10+ years.)

I think you mean Medicaid, not Medicare. Medicare's website says they do not pay for LTC. https://www.medicare.gov/coverage/long-term-care

Just what I was going to add.

What is the difference between Medicare and Medicaid?

Medicare is a medical insurance program for people over 65 and younger disabled people and dialysis patients.

Medicaid is an assistance program for low-income patients' medical expenses.

 

[robinb]

Nope. Our financial advisor convinced me that we should self-insure.

 

[Cogswel_Cogs]

This has always made me angry. Middle class folks struggle to pay nursing home costs, while rich people hide their assets to get the government to fund theirs. We have had financial planners suggest this type of legal scam, they were immediately disqualified to work with us. Our money is there to be spent on our care, not just handed down to our kids

Quite a good part of middle class do this.
And Medicare/caid does not pay anywhere near the same amount that you pay which is another reason to do it.
To me that's the part that pisses me off. Why someone has to pay more than payments for someone else in facility seems like a crime. Especially when it's the person without insurance/coverage who pays the most.

I think many of the work insurances are capped(say $80K), and of course only available when you are at company or part of retirement plan.
80K will get you through three months if you something that puts you in a facility especially if that is someone who has a debilitating stroke sickness while at work. At least that's what mine is capped at and similar my prior company as well.
Certain states have right to refuse for spouses. So I believe this in a way at least makes it a widow problem more than in other states.
But Things are still easier if money is in spouses name again somewhat earlier than the action is required.

 

[soccerdad72]

No, we do not. Not sure if we ever plan to get it.

 

[dvcgirl67]

This has always made me angry. Middle class folks struggle to pay nursing home costs, while rich people hide their assets to get the government to fund theirs. We have had financial planners suggest this type of legal scam, they were immediately disqualified to work with us. Our money is there to be spent on our care, not just handed down to our kids

I hear what you're saying, but I'm not sure "scam" is the right word. But we were totally surprised by the "spend down" part of this whole thing....meaning that my MIL's half of the estate can be used to make repairs, upgrade car...etc, for the benefit of her spouse, my FIL, who is still in the community. In this case, it's not our money, it's our parents' money and we feel obliged to spend it to benefit them both. And like I said...this whole thing is apparently so common, and so expected by the nursing home....that they are ones who referred the company to help us with the spend down. In other words....everyone is in on it. Our family member who works in admissions at the facility where my MIL is told me last night that the nursing home that in my MIL's case...between the $3,500 they'll get from her SS and LTC policy....and what medicaid pays....they're "whole" as far as they're concerned. They don't care where the money is coming from as long as they get paid.

We found out yesterday as well that there is a 15K co-pay for the 100 days that medicare is covering for the first few months of her care....so that goes to them, and is part of that spend down. And we were advised to leave a 20K buffer in her account early on until it all settles out, in case we need to pay for up to two months of private pay. I guess our outlook on all of this is that we're not going to fall on our sword and advise our parents to spend 1/2 of their remaining assets on nursing home care, when we can legally use about 65K for the benefit of one of them. And....it's not only legal, it's 100% what my MIL would want for her spouse. Also, I think we'd feel more outraged paying full price out of pocket for the care....because it's ridiculous overpriced.

What we've learned in the overall process of LTC facilities in general....is that there are very pricey high end LTC facilities which very few can afford, and then all the rest of (and that's the grand majority of these places). Thankfully my FIL is able to not only spend 4-5 hours a day with her, but he also bring home cooked food, etc to improve the experience for her. That and having a family member work in the building helps us all cope with the whole thing.

 

[HopperFan]

Medicare is a medical insurance program for people over 65 and younger disabled people and dialysis patients.

Medicaid is an assistance program for low-income patients' medical expenses.

My disabled young adult person is on MEDICAID medical insurance. For now he still qualifies under his Dad's insurance so the Medicaid is only used for surgeries & specialists (rarely used) because they accept it.

It is all a complicated process and sadly most do not understand it. It is underused by some and abused by others.

 

[disykat]

We evaluated based on what the long term plans we were looking at would have paid out for each of our parent's situations. Since it was pretty much zero, we chose to concentrate on asset building to cover the costs. We are unfortunately aware of EXACTLY what the costs are from experience with our parents over the last 6 years and felt it best.

We are, however, encouraging dh's sister to get it. It really depends on assets/ income stream in retirement, etc. Owning a home you're willing to sell makes a huge difference, for example.

 

[MillauFr]

Nope. Our financial advisor convinced me that we should self-insure.

Ditto. The currently policies for sale are expensive and have very little benefit.

 

[mefordis]

My disabled young adult person is on MEDICAID medical insurance. For now he still qualifies under his Dad's insurance so the Medicaid is only used for surgeries & specialists (rarely used) because they accept it.

It is all a complicated process and sadly most do not understand it. It is underused by some and abused by others.

I think a lot of people don't realize that medicare does not pay for LTC or nursing homes, and that you have to pay out of pocket for them, spending everything you have and keeping your house and car only. Once you are low income yourself you apply for Medicaid.

 

[HopperFan]

I think a lot of people don't realize that medicare does not pay for LTC or nursing homes, and that you have to pay out of pocket for them, spending everything you have and keeping your house and car only. Once you are low income yourself you apply for Medicaid.

Yeah, it's complicated.

Why I responded to poster was because they said that young disabled people are put on Medicare. That is not the case in our situation. They were put on Medicaid.

And sadly some people do know that you can scam Medicare by getting a "service" industry "provider" to apply with "non-facts" and get some services they should not. This happened in DH family and it was very disturbing to me.