Do you have long term care insurance?

[dvcgirl67]

Look at the rate of college failings it’s like 2%. Look at every other industry which is in 20s.

Yup...government money.

 

[piccolopat]

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.

As for the confusion and yelling, have someone check to see if she has a UTI. When my MIL was in the nursing home after her stroke, she started getting delusional and it turned out to be a UTI. Once they treated that, she settled down.

 

[RAD]

Really no different that home owners/renters/auto insurance/flood/earthquake/medical insurance. If you have the financial ability to cover any potential expenses, you don't need it.
I'm 65 and between homeowners and auto insurance I have submitted claims in my lifetime totaling less than one year's premiums for both. But one major incident, and I could be wiped out financially. I don't want to think about how much I have paid out in premiums over my lifetime.

I think of insurance as another form of legalized gambling, you're betting that you're going to have some big claim in the future and the companies are betting you aren't.

 

[Cogswel_Cogs]

As for the confusion and yelling, have someone check to see if she has a UTI. When my MIL was in the nursing home after her stroke, she started getting delusional and it turned out to be a UTI. Once they treated that, she settled down.

UTI's are often the cause of delusional behavior in elderly. With kidney issues and otehr reasons its also often hard to get a positive uncontaminated result so they can't go on antibiotic. So they just stay there as conditions worsens make sure you push them to test till they get a result.

 

[tvguy]

I think of insurance as another form of legalized gambling, you're betting that you're going to have some big claim in the future and the companies are betting you aren't.

Not a bad way to put it.

 

[tvguy]

That last sentence is very false in my state. My husband worked as environmental services supervisor in a state of the art facility that had a number of Medicaid beds. There are a certain number the state will pay for and the various ltc facilities fight over them. It’s guaranteed money. The people caring for residents have no idea who is private pay and who is Medicaid.

My only experience with Medicaid was in Illinois in the late 1990's. The options were limited for Medicaid beds. My wife's Grandparents ended up in a non-profit facility owned by a church. The home took the Medicaid money, and all their Social Security money, except for a small allowance each month they had for incidental expenses like toothpaste and clothing.

 

[dvcgirl67]

UTI's are often the cause of delusional behavior in elderly. With kidney issues and otehr reasons its also often hard to get a positive result so they can go on antibiotic. So they just stay there as conditions worsens make sure you push them to test till they get a result.

Thanks to you and the other poster for suggesting this…I’ll check in with the head nurse today to see if that’s been investigated.

 

[dvcgirl67]

My only experience with Medicaid was in Illinois in the late 1990's. The options were limited for Medicaid beds. My wife's Grandparents ended up in a non-profit facility owned by a church. The home took the Medicaid money, and all their Social Security money, except for a small allowance each month they had for incidental expenses like toothpaste and clothing.

Well, I'm not sure what the exact numbers were back then, currently about 1/3 of all LTC facilities are non-profits....there were likely more non-profits back then as the trend has been to overwhelming move towards for-profit facilities. Again, because there's just a ton of money to be made in these places. Also, "non-profit" does not mean that a business doesn't make money. And some of the biggest and best hospital systems in this country are non-profit....Mayo Clinic, Clevland Clinic, Mass General, Johns Hopkins are all non-profit.

The last six month job that I took as a nurse after getting burned out in critical care was at a non-profit sub-acute/LTC facility that was a part of a large community non-profit system in NJ. I worked on the sub-acute side....and it was a pretty awful job and the end of my nursing career. And...that place also gets a 5 star rating on the medicare website. It's been awhile, but I don't remember it seeming like a five star kind of place. Maybe they have a secret star system for the super high-end places. Because...around here, apparently you can charge 13K a month, have staffing issues, serve hot dogs for dinner....etc....and be a five star facility in medicare's eyes.

The situation you describe for your wife's grandparents sounds like they weren't homeowners, likely had to do the "spend-down" to get their checking down accounts to $2,000 or so like my MIL....and then I believe she gets to keep $50 a month from her SS....for incidentals like "beauty parlor"....snacks, etc.

 

[tvguy]

Well, I'm not sure what the exact numbers were back then, currently about 1/3 of all LTC facilities are non-profits....there were likely more non-profits back then as the trend has been to overwhelming move towards for-profit facilities. Again, because there's just a ton of money to be made in these places. Also, "non-profit" does not mean that a business doesn't make money. And some of the biggest and best hospital systems in this country are non-profit....Mayo Clinic, Clevland Clinic, Mass General, Johns Hopkins are all non-profit.

The last six month job that I took as a nurse after getting burned out in critical care was at a non-profit sub-acute/LTC facility that was a part of a large community non-profit system in NJ. I worked on the sub-acute side....and it was a pretty awful job and the end of my nursing career. And...that place also gets a 5 star rating on the medicare website. It's been awhile, but I don't remember it seeming like a five star kind of place. Maybe they have a secret star system for the super high-end places. Because...around here, apparently you can charge 13K a month, have staffing issues, serve hot dogs for dinner....etc....and be a five star facility in medicare's eyes.

The situation you describe for your wife's grandparents sounds like they weren't homeowners, likely had to do the "spend-down" to get their checking down accounts to $2,000 or so like my MIL....and then I believe she gets to keep $50 a month from her SS....for incidentals like "beauty parlor"....snacks, etc.

My wife's Grandparents were homeowners and had to sell their home for no less than the appraised value set by the Medicaid appraiser. That money all went to the nursing home, along with their Social Security....less the incidental allowance, and money from Medicaid.
Non-profits have to file annual reports showing that any money they have in bank accounts is earmarked for specific projects. I have been on the boards of several non-profits. This is not to be confused with "not for profit" which most hospitals are registered as.
I live in a community with probably more care homes than any other zip code in our county. And they run the spectrum from decades old minimum feature facilities to a huge nearly 1,000 resident community that offers everything from Senior Apartments, rehab, Assisted living, Memory care , hospice etc. That facility is one where residents "buy in"....(around $300,000) ...no Medicaid or LTC coverage, and the facility will provide all the care you need for the rest of your life.

 

[dvcgirl67]

My wife's Grandparents were homeowners and had to sell their home for no less than the appraised value set by the Medicaid appraiser. That money all went to the nursing home, along with their Social Security....less the incidental allowance, and money from Medicaid.
Non-profits have to file annual reports showing that any money they have in bank accounts is earmarked for specific projects. I have been on the boards of several non-profits. This is not to be confused with "not for profit" which most hospitals are registered as.
I live in a community with probably more care homes than any other zip code in our county. And they run the spectrum from decades old minimum feature facilities to a huge nearly 1,000 resident community that offers everything from Senior Apartments, rehab, Assisted living, Memory care , hospice etc. That facility is one where residents "buy in"....(around $300,000) ...no Medicaid or LTC coverage, and the facility will provide all the care you need for the rest of your life.

Right...I meant "not for profit".

And I know about the type of facility you're talking about....they used to them "continuing care communities". Now they call them Life Plan communities. It was a similar buy in....a bit over 300K, but in most cases, then there's a pretty significant rent that you pay for your apartment, and more for meal service. This place said that 90% of the buy-in was refundable to the estate upon the death of the resident. They offer "in home" care...which is someone coming to assist with ADLs in your apartment, but that's separate. And the nursing home side...was also more money. So the "buy in" for the Life Plan communities that I know of in our area...that 300-600K gives you an apartment that you rent...extras you can pay for like a meal plan....and *access* to healthcare services like home care, rehab and nursing home care...etc. But those services/costs are extra.

It sounds like you're saying if a resident pays 300k (presumably 600K for a couple), moves into the senior apartment....and then rent, rehab, assisted living and nursing home care is completely covered? Because if that's the case....that sounds like a steal of a deal. I've never heard of anything like that around here.

 

[tvguy]

Right...I meant "not for profit".

And I know about the type of facility you're talking about....they used to them "continuing care communities". Now they call them Life Plan communities. It was a similar buy in....a bit over 300K, but in most cases, then there's a pretty significant rent that you pay for your apartment, and more for meal service. This place said that 90% of the buy-in was refundable to the estate upon the death of the resident. They offer "in home" care...which is someone coming to assist with ADLs in your apartment, but that's separate. And the nursing home side...was also more money. So the "buy in" for the Life Plan communities that I know of in our area...that 300-600K gives you an apartment that you rent...extras you can pay for like a meal plan....and *access* to healthcare services like home care, rehab and nursing home care...etc. But those services/costs are extra.

It sounds like you're saying if a resident pays 300k (presumably 600K for a couple), moves into the senior apartment....and then rent, rehab, assisted living and nursing home care is completely covered? Because if that's the case....that sounds like a steal of a deal. I've never heard of anything like that around here.

They may have changed their business model, but it was opened as a one price gets you everything for life situation. And it lines up pretty much with the caps on LTC insurance payments.

 

[Marrila]

They may have changed their business model, but it was opened as a one price gets you everything for life situation. And it lines up pretty much with the caps on LTC insurance payments.

A fair number of those facilities are pretty restrictive on pre-existing conditions.
They aren't available to everyone, even if a senior can pay all the fees.

 

[tvguy]

A fair number of those facilities are pretty restrictive on pre-existing conditions.
They aren't available to everyone, even if a senior can pay all the fees.

No idea. But there is a wait list.

 

[dvcgirl67]

They may have changed their business model, but it was opened as a one price gets you everything for life situation. And it lines up pretty much with the caps on LTC insurance payments.

Ahhh, ok. I only know that when we briefly considered the Life Plan community for my in-laws that we never got so far as to determine if the "all in" price which in this case (and all other facilities like it I've seen)....simply gives you the opportunity to rent an apartment and access to the healthcare you'll need down the road, and that 90% of that fee was refundable to the estate (but the rest of the rent/care/meal plans...is on the resident). We knew, that in my in-laws situation the only way it would have worked for them is if the "buy in" at least covered potential nursing care when they both needed it. We never got that far because, as I said, my FIL got cold feet when he realized that he'd be sitting in a apartment by himself while his wife was over in the nursing home unit.

Honestly, I'm glad in their case we didn't go down that road because we would have sold the house....and then there would have been no going back. We can still provide whatever financial support he needs with what Medicaid will allow him to keep in addition to the house. And we're effectively preserving the 350K house for his nursing home stay if indeed that is required down the road.

The company we hired to help with the medicaid application for my MIL suggested that we could switch the deed to the house from my FIL into my husband and my names...once she is accepted to the program. My FIL is in very good health and it's quite possible that he will live beyond the five year look back period and effectively protect the house from a future nursing home getting it if he requires care. However, we won't do that. I really do think that the spend down makes sense....it's allowing my FIL to use some of their remaining assets to update his car and make some larger repairs....to effectively see him through to the end of his life. But....we won't save the house for us to inherit, because we don't think that's fair. If my FIL needs to go into a home....we'll sell his house and use those funds to pay the bill.

So, we're fine with doing this medicaid spend down to help the two of them....but we won't try to shield assets to benefit us. We don't need the money, and it's not the right thing to do in my opinion.

 

[Marrila]

No idea. But there is a wait list.

I'd doubt they start the actual qualification process until space is available. People can have health changes while waiting.
I've wondered how the business models will handle folks with long covid.

 

[dvcgirl67]

A fair number of those facilities are pretty restrictive on pre-existing conditions.
They aren't available to everyone, even if a senior can pay all the fees.

ahh...interesting, hadn't even considered that. But, do a lot of people really move into those facilities without pre-existing conditions? We have a high-end place in my town and it's just really old people...I'd bet the median age is in the 80s for sure.

 

[Marrila]

ahh...interesting, hadn't even considered that. But, do a lot of people really move into those facilities without pre-existing conditions? We have a high-end place in my town and it's just really old people...I'd bet the median age is in the 80s for sure.

The facilities generally known as CCRC's are the ones that can be harder to qualify for.

 

[tvguy]

ahh...interesting, hadn't even considered that. But, do a lot of people really move into those facilities without pre-existing conditions? We have a high-end place in my town and it's just really old people...I'd bet the median age is in the 80s for sure.

Oh yes, I was amazed at the advanced age in the Residential Care Facility for the Elderly my mom was in. She lived there a year and at 89/90 was the youngest person of the 6 residents. And many had no family left. One lady was 98 and the owner of the Care Home said her two children had both died of old age.