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Old 03-19-2014, 01:16 PM   #21
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My plan B for expensive LTC is our home. It will be paid for by the end of the year, and the zillow estimate puts it at 62% of our investible assets. (We don't count it in our retirement assets - just the investible assets.) If one of us needs to move to LTC - we'll sell the home, by a smaller condo for the surviving spouse - and use the remaining equity to pay the LTC bills.

We've dealt up close with elder care issues. Our plan A is to hire nursing aids to help us in home - much cheaper than assisted living or nursing homes, at least in our area. Most care in nursing homes does *not* require an RN degree - it's hygiene, toileting, and supervision... Home health aids are typically paid more by the agency than nurses aids in a nursing home - so they are probably happier.
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Old 03-19-2014, 02:24 PM   #22
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We are considering living outside the U.S. for retirement. Problem solved. That leaves us with all the other countries on the planet that will have us to choose from. Health care and nursing home care wouldn't potentially bankrupt us anywhere but the U.S.

Plan B is continuing to living below our means in retirement and studying up on medicaid asset testing.

I have wondered about what Rodi said as well and just hiring in house help. Look at what live in nannies make who get room and board and care for babies. They don't make $80K a year.
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Old 03-19-2014, 03:26 PM   #23
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I 100k set aside for LTC which I do not include the value of my portfolio for retirement calculations. That should cover 15 months of care. The average stay is 7 months; if you stay longer than 7 months you tend to be there for 3 years. I'm thinking the first spouse gets the 7 months care. The second is the lifer and would use the value of the home. Including SSI the second person would be covered for 34 months. Should work.
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Old 03-19-2014, 03:29 PM   #24
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+1

One of the reason I have such a high equity allocation is I want to have enough money so that can feel comfortable spending for a Cadillac Tesla level assisted living. No overworked, underpaid, poorly trained, with minimal English skills health care aid for me. No I want an LN or RN to empty my bed pans and give me sponge baths..

Especially one who looks like my very distant cousin a recent RN...
Which one is the RN?
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Old 03-19-2014, 03:32 PM   #25
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Which one is the RN?
For you and the other woman on the forum the guy.. For the males the girl.
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Old 03-19-2014, 03:53 PM   #26
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Yes, pretty much. We paid an extra $63 this year to Medicaid on our income due to the new 0.8% adder so I am confident the program will be there for us if we need it.

edit: Oh I meant Medicare.

At our current saving rate and current high tax bracket/high cost of living area, we would need to work for 3 to 5 more years to be confident we would have enough to cover 3 to 5 years of assisted care living for the both of us. I would rather enjoy the 3 to 5 years in my 40s and just be miserable in my 80s when I probably will forget the next day how bad the previous day was.
Are you aware of the following:
- Medicare only covers nursing homes for a limited number of days (90, if I recall correctly, and then only if you go there directly from a hospital stay.) It does not cover indefinite periods of care.
- If you go on Medicaid for nursing home care, you have to exhaust your assets down to a minimal level (forget the exact numbers but it ain't much) before Medicaid payments actually kick in.
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Old 03-19-2014, 04:07 PM   #27
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Are you aware of the following:
- Medicare only covers nursing homes for a limited number of days (90, if I recall correctly, and then only if you go there directly from a hospital stay.) It does not cover indefinite periods of care.
- If you go on Medicaid for nursing home care, you have to exhaust your assets down to a minimal level (forget the exact numbers but it ain't much) before Medicaid payments actually kick in.
The Medicaid rules vary by state(you probably know this). There are other state specific laws about Medicaid. In one state mom could sign off on joint assets, and become Medicaid eligible. Where my parents moved to, for family support, she could not. So many differences, no wonder elder care attorneys are necessary, and busy.
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Old 03-19-2014, 04:12 PM   #28
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One thing that some seem to forget, I think:

Once you go into an assisted living facility (CCRC, memory care, etc.), you're pretty much into your final phase, and the rest of the things you've been spending money on will mostly vanish.
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Old 03-19-2014, 04:24 PM   #29
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One thing that some seem to forget, I think:

Once you go into an assisted living facility (CCRC, memory care, etc.), you're pretty much into your final phase, and the rest of the things you've been spending money on will mostly vanish.
Not always true for CCRC and assisted living. For nursing home / memory care you will have added medical costs and facility assessments for things like incontinence supplies, etc (unless you have someone "on the outside" who can continue to get these things for you at "regular" prices). Really the only costs that will go away are food, housekeeping (again, not in an CCRC) and home maintenance.
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Old 03-19-2014, 04:33 PM   #30
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Are you aware of the following:
- Medicare only covers nursing homes for a limited number of days (90, if I recall correctly, and then only if you go there directly from a hospital stay.) It does not cover indefinite periods of care.
- If you go on Medicaid for nursing home care, you have to exhaust your assets down to a minimal level (forget the exact numbers but it ain't much) before Medicaid payments actually kick in.
We don't have anyone to leave money to, so spending down assets is fine. Maybe an oxygen assisted trip to Vegas and $100,000 on black.
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Old 03-19-2014, 06:14 PM   #31
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Not always true for CCRC and assisted living. For nursing home / memory care you will have added medical costs and facility assessments for things like incontinence supplies, etc (unless you have someone "on the outside" who can continue to get these things for you at "regular" prices). Really the only costs that will go away are food, housekeeping (again, not in an CCRC) and home maintenance.
And the costs for travel and cars and entertainment probably have diminished at the point of assisted living?
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Old 03-19-2014, 06:22 PM   #32
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I 100k set aside for LTC which I do not include the value of my portfolio for retirement calculations. That should cover 15 months of care. The average stay is 7 months; if you stay longer than 7 months you tend to be there for 3 years. I'm thinking the first spouse gets the 7 months care. The second is the lifer and would use the value of the home. Including SSI the second person would be covered for 34 months. Should work.
What if the first spouse lives 20-30 years needing care, and the other one just never needs it during all that time? Ouch. Don't mind me; I'm just a worrier and you are right, it might not happen that way.
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Old 03-19-2014, 06:44 PM   #33
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What if the first spouse lives 20-30 years needing care, and the other one just never needs it during all that time? Ouch. Don't mind me; I'm just a worrier and you are right, it might not happen that way.
Seriously, if that situation should develop you should consider a divorce for financial reasons.
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Old 03-19-2014, 07:20 PM   #34
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Seriously, if that situation should develop you should consider a divorce for financial reasons.
The idea of dumping the responsibility for financially supporting my spouse to the government because there are rules that allow this while I fend for myself financially is just too abhorrent to me to even consider. In sickness and in health means far more to me than any amount of money. My father lived on only Social Security and if need be so will I.

I am keeping 200K separate from my retirement funds for emergency situations, hopefully that will be enough. If not then I would sell my home and move to an apartment and use the proceeds at that point. Once I totally run out of money then we would be in the same boat, and as long as I am in that boat with my wife then whatever seas that come I will deal with at that time, even if she is lying unconscious and unknowing of the situation we are in.
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Old 03-19-2014, 10:27 PM   #35
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There are many exempt asset classes if one spouse needs to be on Medicaid long term and the other spouse would still live in a regular home or apartment. Plus if you play the odds most nursing home stays just aren't going to last 20 years. The average stay is 2 - 3 years, so personally I think if we have that time period covered in savings and use Medicaid planning as a fallback option I think that will be good enough. The Medicaid look back period to give away or convert assets is currently five years, not forever.
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Old 03-20-2014, 03:46 AM   #36
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The average stay is 2 - 3 years, so personally I think if we have that time period covered in savings and use Medicaid planning as a fallback option I think that will be good enough.
Statistics show the average stay is much shorter, one study I read and recently posted in another thread showed 79% of males who enter a nursing home die within 6 months. Women were a little lower at 72%. I have had 3 relatives enter nursing homes and none of them lasted 6 months. When visiting them it was eye opening to see the ratio of men to women in each facility, probably 1 to 15. Long stays in a nursing home are rare for men and a greater concern for a woman IMO.
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Old 03-20-2014, 07:23 AM   #37
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Old 03-21-2014, 10:38 AM   #38
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While all of the information here, and on other threads that cover Continuous Care facilities in interesting and a good basis for understanding how it works, there is nothing like seeing what it is like, and hearing from the administrator of a facility... and that means going there. Face to face, you will learn about the details of cost and care... A few hours at most for a wealth of perspective.

You will not likely find --- online... information about costs. Most webpages require signing up for information. Even the few facilities that DO show information about costs, are often not fully forthcoming... ie. up front costs, entrance fees, moneys to be returned at death where upfront charges for membership/ownership have been assessed.

If you are sincerely interested in building your retirement plans to include care for the later years, I'd suggest that going to a facility... While that's going to be scary for people who don't have relatives who live in a facility,( ie. for people who have never been there except to look in at the reception area), it's a reality trip that will make a dent in those plans for world-wide travel, or tending your backyard garden, when you are 85. NOT that it's bad... it's just coming face to face with thinking about the later years. At 50, 60, or 70, most healthy people subconsciously avoid thinking about ever being physically or mentally impaired.

For married retired persons.. the chance of both dying by falling off an elephant while touring India at age 85... It ain't gonna happen. I mention that because there are ways to ease into the later years, without a soul shattering disruption. Let me explain, by talking about our own situation.

The house/apartment/assisted living/nursing home/Alzheimers unit combination that we live in...
In the Villas... 65 Regular homes
About 20 homes occupied by widows only, 35 homes occupied by couples, and the other 10 homes, by a husband or wife who has a spouse in one of the other facilities.
In the Apartments, a similar ratio.

So what's the big deal about this? It means that in the later retirement years, a married couple can stay together or close enough to avoid the agony of being far apart, and only being able to visit after an occasional trip from a one person home. If this thought doesn't stir emotions, it probably won't matter where you live or what you do.

The very best part of this kind of arrangement is that there is no shock to the social life of either spouse, as the years of living in the greater community allow both spouses to be with friends and neighbors.

Yesterday, we played bridge in the library of our CCRC... Two Widows from the Apartments, one lady from assisted living (husband lives inthe apartments), a man whose wife is in the nursing home (he lives in a villa), another widower (from the apartments), and a husband and wife who live in the villas DW and me.
Some of the other regulars were elsewhere... 2 ladies at the gambling casino, one out shopping, and a husband and wife on a trip to Branson.

There is a reality out there for older persons, but it doesn't have to be unpleasant.

For us, the decision was made earlier... and we're very happy. For others, it may seem like hell.
A matter of playing the odds.
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Old 03-21-2014, 11:11 AM   #39
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thank you Imoldernu for a very informative response. I have a couple of very basic questions. 1. What is the youngest age you would move into a continues care facility as you describe in your note. 2. What would be the approximate entry cost, monthly cost as you enter and what would be the approximate higher cost when you move into assistant living or need nursing care. 3. what type of net worth do they require before you move in so that they are assured you can pay when you need additional help? 4. Is there any type of government assistance if you run out of money as you age and need the most care? 5. Are there non profits that run these facilities that are possibly a bit kinder to old folks as they age? 6. Rate your satisfaction with your lifestyle on a 1 to 10 basis, 1 being you're unhappy, 10 being your satisfied that you made a good decision.

Thanks, again, for all the info, I really appreciate it.
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Old 03-21-2014, 11:16 AM   #40
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For married retired persons.. the chance of both dying by falling off an elephant while touring India at age 85... It ain't gonna happen.
Well there goes that plan.

What about a camel with a bad knee?
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