How long will your savings last and does it account for Assisted Living?

[friar1610]

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.

 

[MRG]

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.
MRG

 

[braumeister]

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.

 

[Live And Learn]

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.

 

[Fermion]

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.

 

[Bestwifeever]

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?

 

[W2R]

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.

 

[shotgunner]

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.

 

[Running_Man]

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.

 

[daylatedollarshort]

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.

 

[shotgunner]

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.

 

[OAG]

Longer than I will & Yes.

 

[imoldernu]

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.

 

[jerome len]

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.

 

[Fermion]

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?

 

[tmm99]

Is there a website or something that tells us which state looks at joint assets and which state doesn't for figuring out medicaid eligibility?

 

[Walt34]

This is one of the reasons we're looking very hard, and probably will, move to a CCRC by the time I'm 70, give or take a bit. Understand a CCRC does not mean assisted living or a nursing home. It only means that those services are available if needed.

Many won't even accept you (except on a space-available basis) if you aren't capable of independent living at the time of moving in. What we want is a SF house and other than some downsizing don't expect or want our lifestyle to change. Maintenance issues go away - the rent covers that. For DW, that is very, very good.

My mother, then 73 moved to an independent living setting in a CCRC for 11 years and was very happy with it and wished she had made the move sooner. Six months with assisted living was okay. She never moved to the nursing section but it was good to know it was available.

FIL did not want to face the reality that he would not be able to live on his own. Only by being very lucky with timing were we able to get him into a very good care facility. I will not count on being that lucky again.

We're not concerned with leaving an inheritance so basically swapping the house equity for the entrance fee gets us into a position that is financially sustainable even if the worst happens and one is in full nursing care for years. With the low rent even if resources were exhausted for nursing care the amount available to the "able" spouse by Medicaid would allow them a comfortable, albeit not luxurious, standard of living.

All part of "hope for the best, prepare for the worst".

 

[imoldernu]

thank you Imoldernu for a very informative response. I have a couple of very basic questions.

Good questions... will do my best, but can't guarantee the answers.

1. What is the youngest age you would move into a continues care facility as you describe in your note.

I won't give advice or suggest,... depends on circumstances. We did it at age 67, (regular home... Villa) but were still Florida snowbirds. The reason we bought was to have some substantial equity in a home that we could keep, if one partner had to go into a nursing home and that exhausted our assets... the remaining spouse could stay in the home and use it as an asset if the nursing home partner passed away... simple as that. Our Florida residence was worth about $25... the CCRC villa, closer to $200K.

For us, apartment..2BR,2BA. w/all utilities, 2 meals a day, free transportation as needed annual $24K, with second person, $30K
Assisted living about $44K plus needed extras.
Nursing Home $75 to $85K double or single...


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.

This varies all over the lot. In our community, no entry cost. In the Apartments a $1500 refundable fee, plus ability to live independently. Other communities (not ours) as much as $250K or more... with a refund at death of resident, based on # of years of residence.
Our Assisted Living and Nursing Home also has no upfront large fee, though they do an asset review to insure that the "can't kick out the indigent" rules are being followed. (It's medicare iapproved) The $$$ number is one of the reasons that it it so important to actually visit a facility and talk to a representative. I know of no website or central info service that provides this info.

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?

comment above applies... I don't know. Not stated in our community.

4. Is there any type of government assistance if you run out of money as you age and need the most care?

Most important is medicare/medicaid approved. Not all communities are.

5. Are there non profits that run these facilities that are possibly a bit kinder to old folks as they age?

Can't answer that. DW worked in one of these, years ago, and it was a great home, but they have closed due to costs. I know of none, except for a few religious communities and in particular a Salvation Army community in Florida for retired officers. A neighbor was a Catholic nun, and up until this year they had a retirement complex in Indiana, but as of this year it is in the process of closing to new residents.

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.

It was good for us... Yeah, a 10... except for the medicaid protection part, a little sooner than we planned, but since we still have other alternatives... Florida and our campground in Illinois, we are not totally rooted here.

I understand that as long as I have no vested interests in the communities we live in, that I can post the websites...

FWIW...
http://www.simplythefinest.net/

http://woodhavenassociation.com/

http://www.lakegriffinharborfla.com/
read the newsletter to get a feel for the activities in an active over 55 community.

and more details on this forum, here:
http://www.early-retirement.org/forums/f27/sharing-23-years-of-frugal-retirement-62251.html#post1214041

 

[seraphim]

Since we have pensions and draw very little from investments ( actually need withdraw none, were we more frugal), FireCalc suggests our nest egg might grow - on average - about 3x it's current value during our expected lifetime. So rather than start paying about $700 a month for LTC for 30 or so years, we chose to self insure. That's $8400 less a year for us to withdraw and build value.

MIL went into an apartment that had assisted and nursing card - an Alzheimer's unit. She went in to unassisted living, and prepaid $60k into a fund at the center. That guaranteed she could never be kicked out should her income fail. After two years in her apartment, she went to the Alzheimer's unit for about a year and a half. The AZ unit was about $6k a month. She passed away two years ago at the age of 85.

One thing to take into account, IMO, is family history. My father lived to 72. The women in DWs family lived as long as 104. I don't expect to use LTC. DW assuredly will.