LONG TERM CARE,SCAREY STUFF

[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]

Originally Posted by lauraf13

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]

Originally Posted by lauraf13

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]

Originally Posted by brewer12345

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]

Originally Posted by REWahoo!

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]

Originally Posted by lauraf13

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.

Originally Posted by Nords

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]

Originally Posted by 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.*

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.

[Cattusbabe]

Originally Posted by lazygood4nothinbum

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.

Don't be too hard on yourself. This is not an easy situation to have to go through. I know. Dh and I are/were in the business and it was still difficult caring for his parents. You do the best you can. Just know that your mother was safe, clean and well cared for. She was not left to wander the streets dirty and sick or removed from a filthy house that was falling down around her. That stuff does happen. In all my years as a nurse in long term care I have jet to see anyone move in happy. The first six months are doozies but then things settle in...most of the time.

[Brat]

I have come to conclude that late in life cancer can be a blessing, at least you can move to Oregon and have options,

[samclem]

I'm still on the fence regarding purchase of LTCI for my wife and I.

- I did a little more research concerning the insurance offered to government employees--if you don't buy the "level premium" policy, then the rates shoot up viciously as you get older (the rates don't just go up with inflation as I'd thought--they go up as though you are buyiong more coverage each year as you get older. Addtional purchases of LTCI for an 80 year old are >>expensive<<)

- My wife and I can get three years of coverage each (just $100 payment per day--the other aprox $50 per day would come out of pocket) for a level premium of approx $100 per month at our age ($50 per month for each of us). I did an alternate case of investing the premiums and made assumptions of 5% inflation for LTC costs and ROI of 7%: At the end of 40 years we'd be able to afford a total of 357 days of care. Of course, if we both die suddenly, then this money ($240K) would be a nice bundle for our child or to a charity. All in all, based on what I've seen and heard, I'm thinking the purchase of LTC insurance might just make some sense. The three years of payments might give the "non-LTC" spouse time to protect enough assets to stay independent and avoid the "look-back" provisions of medicaid in the worst case. Still, $100 per month forever would pay for a lot of nights on the town, vacations, and living.

Like I said, I'm still on the fence.

[lazygood4nothinbum]

Don't be too hard on yourself. This is not an easy situation to have to go through. I know.

thanx cattusbabe, but nothing i can't handle.

point being that just as we need to prepare financially for long term care that makes life better, it is equally important to prepare for long term so-called care which only makes life worse

[Ed_The_Gypsy]

Brat said:

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.

Brat,

I have read that there are two LTC facilities in the Lake Chapala area of Mexico with an intended market of old gringos. At least one was well spoken of by a daughter of a resident. In Mazatlan, there is a relatively newly renovated building called the Mellville that started out trying to be a LTC facility, but may have scaled back to being just a retirement home.

This kind of care is said to be unusual in Latin America, because families take care of their own. Others use inexpensive home care. I see this in my wife's and my future.

Be wary. My mother worked in LTC facilities in her last 15 or so working years so had an expert's knowledge when she and my father retired to one. I remember Marvin Zindler on Houston TV who had a private crusade against bad nursing homes.

My most agonizing searches to date when I hit a new town are
a) a new car repairman, and
b) a new dentist.
LTC is a whole new dimension of anxiety.

Be well.

Old age ain't for sissies. [from All in the Family].

Ed the Third-age Gypsy

[Brat]

I don't disagree. What has me concerned is the % of the population that hasn't thought through what will happen when they are unable to care for themselves. There are good and bad care situations of all types.. from home care to skilled nursing facilities. Those who are trying to assist a person who needs care has more options when there are economic resources to fund the care.

There is a direct association between the number of visits a care recipient receives and the quality of care. There is less chance of neglect that goes un-noticed. For this reason, imho, the frail elderly should be cared for near a family member who will see them regularly.

My comment about LTC in Mexico was a bit tongue-in-cheek, although the number of Gringos moving there is stunning (DH and I just returned from Loreto, over half the Gringos I met were from the NW).

[lazygood4nothinbum]

Originally Posted by Brat

There is a direct association between the number of visits a care recipient receives and the quality of care.* There is less chance of neglect that goes un-noticed.* For this reason, imho, the frail elderly should be cared for near a family member who will see them regularly.

i sort of agree with this but just want to comment that even with excellent care, even with family living 10 minutes away from the nursing home and even with regular visits, ya just don't know. sometimes you just have to put your faith in the system.

dealing with the alzheimer's of a mom who was always quite the babe (in college people used to ask "who's the chic in the picture"--back off, that's my mom), even a bit of a babe into old age, how do i know she is safe from rape when i'm not there?

she can't talk now and even when she could she couldn't remember. how could she tell me? how would i know?

what kind of person signs up to work hospice? a deeply caring person? someone who likes to help people die? a murderer? what kind of person signs up to change my mother's diaper, to wipe her ass, to clean her breasts?

think about that the next time you go to the podiatrist or better yet, the proctologist. and ask yourself should we be thankful for fetish or scared? now put yourself in a nursing home.