LONG TERM CARE,SCAREY STUFF

[REWahoo]

Re: LTC-- the latest media hype

My spouse was telling me the other day about a combination LTC/life insurance policy offered by a company called Glock.

Looks interesting Nords. I might give it a shot.

 

[mathjak107]

well heres what we learned at the class...yes we saw the actual rates that places local to our area are charging and they were all around 130,000 a year or more,we are in new york....my dad had a stroke a decade ago in florida...we couldnt afford a home to care for him so we got a retired nurse and her husband who took 2 fellows like my father into their home and cared for them..it cost us over 1,000 a month in those days...today thats about 2,000 a month or so.......still a real hardship for the surviving spouse.........
as far as medicaid even if you do qualify they can ship you anywhere there is space..200 miles away isnt uncommon,that sucks.....its not just about nursing homes,its all care that goes beyond what medical and medicare pay.a bad fall can lay an elderly person up .....on the other hand these policies can have their rates jacked up beyond affordability after you get one....its a real delema

 

[VoyT]

When you run out of money, I believe Medicaid takes over, not Medicare...

I believe you are right. From my experience with family members, Medicare will only pay for a limited number of days in a nursing home immediately after a hospitalization.

 

[Rich_by_the_Bay]

I believe you are right. From my experience with family members, Medicare will only pay for a limited number of days in a nursing home immediately after a hospitalization.

Correct. Medicare is always "primary" and Medicaid ('title 19') is always last. If you are lucky, some carrier picks up the missing piece.

 

[2B]

From what I've seen with my parents, LTC insurance is not cost effective.  From what I've see with my in laws, it's not enough. 

My father had a 2 year policy.  He died at home after less than a month of illness attended by his children.  He paid premiums for about 15 years on the policy.  I don't know what his payments were but I wish we could split the money between me and my siblings.

My in laws are both 85.  My MIL is in a nursing home and will probably out live me.  My FIL has Alzheimer's but can call up every trick in the book to convince my wife he doesn't need to move into an assisted living facility.  Eventually, she'll pull the trigger and move him or he'll burn the house down.  Money for his long term care will be wasted.

 

[Brat]

LTC costs vary a lot by location.  Realestate and care-giver costs drive the price.  I was listening to the 'get out of debt' radio talk show the other day when an elderly husband quoted a stunning sum for care for his wife - they were in New York.  The host failed to suggest to the fellow that they consider moving to a lower cost community. 

It cost my Mom $70,000 last year for care in an intermediate level nursing home in a large west coast city.  Facilities accepting Medicaid are often no-frills affairs, but that is not to imply that the quality of care is lower.  In her metro area there is a cheaper skilled level Medicaid qualified facility with outstanding reviews, but she won't move there because she doesn't care for their food (Mom had a short stay there after breaking her hip).  She commented that there is a difference between a cook and a chief and that meals are one of the few things you can look forward to in her situation.

Husband and I are in the 7th year of a paid-up-in-10 LTC policy.  Care for an extended time for one of us would kill us financially.  A 90 day waiting period was the best buy from our insurer.  Frankly I think a 1-year waiting period policy would be great for all involved, it should be cheap because most people don't last a year after needing care and the insured would be protected against the cost of protracted frailty.

 

[macdaddy]

What rules are there to prevent transfer of all your assets to your kids? For example, why wouldn't my parents transfer all their investments, house titles, and so forth to me, and then I could pay all their bills for them (incl. a credit card for any desired expenses). Then if they needed an in-home nurse or LTC, medicare would pick up immediately?

My parents have a pension and SS which total about 50k/year so I don't know if they would qualify anyway? What happens in this situation when LTC care costs 80k/year?

 

[grumpy]

I'm not sure of the current rules because I researched all of this 10 years ago. However, there is a "look back" period during which any transfers of assets equate to an equivalent delay in eligibility for medicare coverage. I think the look back period is somewhere in the three to five year range. Further, I believe that if they conclude that the asset transfer was specifically to acheive medicare eligibility, then the individual can be permanently barred from eligibility. Others here may have more current info but I think the regs make this strategy pretty tough to succeed with.

Grumpy

 

[REWahoo]

What rules are there to prevent transfer of all your assets to your kids? For example, why wouldn't my parents transfer all their investments, house titles, and so forth to me, and then I could pay all their bills for them (incl. a credit card for any desired expenses). Then if they needed an in-home nurse or LTC, medicare would pick up immediately?

Grumpy is correct. Any asset transfer has to have occurred 3 to 5 or more years prior to Medicaid kicking in.

"The general rule is that Medicaid coverage of nursing home and certain other medical care is denied for a period of time if an applicant or his or her spouse transfers asset and fails to receive full and fair market value in return. This provision also includes transfer of the individual’s home, an asset normally excluded in determining Medicaid eligibility. The State penalizes uncompensated or inadequately compensated asset transfers occurring as far back as 36 months before a Medicaid application is filed (60 months for assets transferred into a trust)."

 

[macdaddy]

Great info - thanks! Seems like it pays to plan ahead (duh).

 

[mathjak107]

can anyone find out how much money holders of policies actually collect from ltc insurance companies as a group? in other what percentage of people with policys collect?

 

[lazygood4nothinbum]

mom paid about $380 per year set premiums for lifetime care of about $50k inflation-adjusted yearly (home care was good for i think 6-8 hours per day which supplemented care for mom for a year or so before we had to remove her from the house). excellent care in florida is about $50-70k for private room in alzheimer's unit. we got mom a double room to fit much of her furniture and a piano so she'd be comfortable.

needless to say, these days, my brother has been unable to find a similar policy for himself. as i've mentioned in other posts, my personal policy is underwritten by two of my buddies, smith & wesson.

 

[mathjak107]

new rules as of feburary 2006..look back is 5 years from date of medicaid application...used to be 3 years from date of transfer or 5 years from date of transfer in trust

homes are no longer protected..surviving spouse may have to reverse mortgage home...

worst part no restriction either in distance or stae as to where medicaid can send you.....200 miles away from your loved ones is not uncommon now here in new york......

medicaid homes are more like shelters than the fine looking private homes

certain transfers used to be over looked like giving education money to grand children...no longer exempt

all in all not good for someone entertaining the ole asset shift

 

[macdaddy]

and i assume a 50k a year pension excludes you also... so what is someone (ex Gov or military) supposed to do if they are broke but can't get rid of a 35k-50k annual pension?

 

[2B]

and i assume a 50k a year pension excludes you also... so what is someone (ex Gov or military) supposed to do if they are broke but can't get rid of a 35k-50k annual pension?

If you are in a medicaid facility, any social security income would go directly to medicaid. If there is a surviving spouse, trying to survive outside of a medicaid facility they would get their own SS payment. Pensions have differerent rules but are biased towards the "owner."

 

[Cattusbabe]

Very interesting discussion re. Long-term care options. It is a good idea to factor that into any early retirement plans you make before you leave the work place. Most folks just do not see it coming and think that they will stay in good health and just die quickly. Now a days that does not happen. The wonders of science can keep you around for a long time in various stages of ability/disability. Access to health care is expensive and only gets more so once care giving is added to the mix.

The Long Term Care industry is just like any other business and will charge what the market will bear and like heath care in general the more money you have the better access to services and options you have. Not fair but there it is. Money talks.

Medicare does not pay for long-term care services only for acute issues. You have about 100 days per year of benefits to use. In nursing homes Medicare will pay for skilled services like rehabilitation and the like but once you exhaust your days of are no longer making progress Medicare stops reimbursement.

Medicaid is the option of last resort to fund long-term care and will not get you much. It is a good idea to check out the following web site to find out what Medicare and Medicaid covers. www.cms.hhs.gov You will also find links to each States Department of Health web page so that you can get information about long term care facilities and services in your area. AARP is also a valuable resource.

 

[lauraf13]

I thought I would jump in and add two points.

1. If you rely on Medicaid, it can be hard to get into a nursing home. The ones around me have a couple year waiting list. Right now it appears to be better to be private pay and then transition to Medicaid.

2. The Smith & Wesson and Glock route only works if you have enough of your faculties to actually do it and do it correctly.  Timing is everything.

Unfortunately, there are no easy answers. I'm trying to decide if I need LTC myself. My Mother is currently in a nursing home (private pay) and I see how much it takes and the advantage of being private pay over Medicaid. Also, even with round the clock help, there's no way we could care for my Mother at home. The nursing home is also cheaper than having help round the clock.

Laura

 

[brewer12345]

Unfortunately, there are no easy answers. I'm trying to decide if I need LTC myself. My Mother is currently in a nursing home (private pay) and I see how much it takes and the advantage of being private pay over Medicaid. Also, even with round the clock help, there's no way we could care for my Mother at home. The nursing home is also cheaper than having help round the clock.

Laura

Let me suggest that you make the decision of what kind of LTC care you want independent of how to pay for it (LTC insurance or not). Evaluate LTC insurance strictly as a financial transaction and do not get caught up in emotional nonsense when evaluating it.

 

[REWahoo]

2. The Smith & Wesson and Glock route only works if you have enough of your faculties to actually do it and do it correctly. Timing is everything.

Very true. We refer to this option freqently here, IMO just whistling as we pass by the graveyard. Much easier said than done.

Here is an example of "Glock insurance" gone bad...

Man planned to kill himself By TANYA EISERER / The Dallas Morning News / April 27, 2006

The terminally ill man accused of killing his wife of 60 years planned to also kill himself, authorities said Wednesday.

James Roberson, 83, left a note that detailed instructions to call police, the couple's daughter and a local funeral home. It also said that he and his wife, Mary Roberson, also 83, could be found in the back of the couple's tidy brick home in west Oak Cliff.

Authorities said that after reading the note, a hospice worker discovered that Mr. Roberson had shot and killed his wife as she lay in their bed. The hospice worker then called the couple's daughter, who notified police about 10:20 a.m. Tuesday.

Mrs. Roberson had been dependent on her husband after she suffered a series of strokes that left her right side partially paralyzed. Police say Mr. Roberson, who has brain and lung cancer, killed his wife because he feared she would wind up in a nursing home upon his death.

But when he tried to shoot himself, "for some reason, he couldn't pull the trigger," said Sgt. Gene Reyes, a homicide supervisor. "It's hard to say why. It could have been that the gun malfunctioned."

The frail Mr. Roberson, with two sheriff's jailers on either side helping him walk, shuffled out of the Dallas County Jail shortly before 2 p.m. Wednesday after being released on $2,500 bail on a murder charge. He was on suicide watch in jail, authorities said.

 

[lauraf13]

Evaluate LTC insurance strictly as a financial transaction and do not get caught up in emotional nonsense when evaluating it.

I'm not sure what "emotional nonsense" you got out of my post, but I think I am looking at it as a financial decision. I see that I just said "LTC" instead of "LTC insurance" in my first sentence, but it's also probably true that I will need some form of LTC. My Mother and Grandmother have needed it, but you never know. My thought now is that I would like to keep from relying on Medicaid. You lose your control once the government pays for it.

Then the question is, How do you pay for it? I can self insure or buy LTC insurance and let that help. It sure would be nice to have some financial help paying for in home care and nursing homes, but how reliable is the insurance company and what is the overall cost? I think that right now, the LTC insurance business is too young to judge the cost/value issue, but I'm at the age to either buy now or forget.

I find this area to be very difficult to make an informed decision. I think that things in this area could change drastically in the next 10-20 years as the first wave of baby boomers hit the nursing homes.  

I think I can make a good case for buying and one for not buying LTC insurance, thus by default I haven't bought because it's the easiest thing to do.

Laura

 

[Brat]

In my former profession I met a lot of nice folks who speak Spanish and are working at the minimum wage, or less.  I often thought that a smart LTC provider should build nice care facilities near our southern border, train a lot of aids and teach them English [outscource LTC].  Two needs met!

Locate them around Cabo, PV or other resort areas and the family will visit regularly.

 

[Nords]

But when he tried to shoot himself, "for some reason, he couldn't pull the trigger," said Sgt. Gene Reyes, a homicide supervisor. "It's hard to say why. It could have been that the gun malfunctioned."

Amateur. Probably not the type of long-term care he had in mind, either.

Admiral Nimitz Jr. & spouse suicide

 

[lazygood4nothinbum]

Right now it appears to be better to be private pay and then transition to Medicaid....2. The Smith & Wesson and Glock route only works if you have enough of your faculties to actually do it and do it correctly.  Timing is everything.

i agree to point 1. however, if i've lost the ability to properly point the instrument of point 2, please just drop some rat poison near me. i'll find my way to it.

i think i could handle a physical disability and for that i should have enough cash as there's no spouse depending on me. but having watched mom lose her mental abilities over the years and to wind up how she is now, no thank you. that is neither the life nor death for me.

as you mention, timing is key. it might mean giving up a few years of good life to avoid many years of a bad one. and in that the assumption would be no hope of recovery or cure in those last good years.

we should be able to stipulate in living wills an option for opting out, so that if we miss that window of opportunity, we might have another chance for peace. but i don't see this society going for such policy. it would be too compassionate and too out of line with that complicated billing procedure we call dieing.

Amateur. Probably not the type of long-term care he had in mind, either.

that's funny. though i fail to see how you'd ever get enough practice to go pro.

 

[Brat]

I had an interesting conversation with a LTC Administrator a few years ago. They had a male resident who insisted on having his pistol. Not knowing what he would (could) do with it they instituted a policy whereby no guns, or other potential weapons, are permitted.

 

[lazygood4nothinbum]

I had an interesting conversation with a LTC Administrator a few years ago.  They had a male resident who insisted on having his pistol.  Not knowing what he would (could) do with it they instituted a policy whereby no guns, or other potential weapons, are permitted. 

for years mom was aware of her condition, that her brain was dieing, but as it worsened we worked very hard to create the illusion for her that her life was normal.

later we had to remove mom from her house because safety became an issue. hygiene was a huge problem (alzheimer's victims often become afraid of water) and she kept kicking the nurse's aid out of her house. we hated doing it but we had no choice.

so that the transition would not be horrible, we tricked her into the new facility by telling her she was going there just for testing. but when she saw all her furniture in her room she freaked. it was a terrible scene. she threatened to kill herself but, of course, we had already removed any possibility of that.

just last week mom's secretaries came to visit with us. one said how she and mom used to joke about keeping a batch of sleeping pills so they'd never wind up mindlessly drooling in a wheelchair.

though i did everything according to today's standards and norms and accepted behavior--i did everything proper--every day i wonder if i didn't steal my mother's window of opportunity.

hopefully, if such will be my fate, i will have the wherewithal to not let them catch me.