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Old 01-09-2015, 11:48 AM   #61
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So what happens to someone when they cannot pay to stay in the LT care facility and there is no family (or no family money) to pay or take them in and benefits under Medicare/Medicaid is used up? Can they dump someone at their house (if they have one) that cannot take care of themselves?
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Once they spend down all their assets Medicaid will pay for the nursing home.
They will pay for a nursing home.

The home you are in may not take medicaid. In the case you describe, they'll call up the state of which you are now a ward, and ask the state to take you to a medicaid assigned home.

There, you will get very spartan service.

Of course, if you are in a home that accepts medicaid, then you stay. I'm giving the example of someone who lived in a non-medicaid place first.

I'll just say that many (but not all, but you may have to look really hard) medicaid homes are pretty spare in accommodations and service. There are hybrids where you pay an a lot each month -- more than you would at another nice place that doesn't accept medicated -- and then when you run out of cash, they'll take you. Those can work for some people.

But I don't mean to be harsh, but the pure medicaid places I've been to have been pretty hellish.

All this stuff gets really complicated and depends on state laws, so your mileage may vary.
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Old 01-09-2015, 11:52 AM   #62
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Okay, so it is the EU or Louisiana then for lower nursing home care costs.
I don't really know the details, but from what people here tell me, Louisiana nursing homes are pretty awful compared with those in other states. Apparently some of the worst things that Edwin Edwards* did for Louisiana is what he did to nursing home regulation here. Or so I'm told. I wasn't here then, so all I can do is report what I have been consistently told.

Anyway, one of the reasons I have been wanting to move out of state, is the nursing home situation here. I'd advise looking someplace else. Looks like nursing homes are pretty cheap in Missouri.


* (Edwin Edwards is a charming but very corrupt former Louisiana governor who was incarcerated for 8+ years for racketeering)
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Old 01-09-2015, 11:53 AM   #63
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Is prison better than the horrible conditions at a Medicaid LTC facility? I could always wheel myself into a bank...

Would that protect a spouse's assets?
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Old 01-09-2015, 12:01 PM   #64
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One of the arguments I read on M* for LTC insurance was how difficult it might be to manage your money and cash flow to pay for your care if self-insured. And all I could think of was that sounded way easier than riding herd on the LTC insurance company to pay claims.
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Old 01-09-2015, 12:24 PM   #65
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Data point, but my LTC with Genworth is $129/mo, covers up to $4500/mo until $270k is exhausted, i.e. five years, and has a 3% inflation adjustment.

Mostly worried about a catastrophic illness or accident. I hope someone puts me out of my misery long before I've spent five years in a nursing home...

Just crank up that morphine drip!
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Old 01-09-2015, 12:45 PM   #66
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Who cares about assets if you are in LTC for more than 5 years and have to go on Medicaid. What % of people come out of LTC and go back to taking cruises or mowing their home lawn after 5+ years? Less than 0.01%?
The spouse of the person in care who doesn't want to be impoverished.
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Old 01-09-2015, 12:54 PM   #67
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There are a lot of loopholes in getting Medicaid to pay for LTC beore the healthy spouse becomes impoverished and currently a 5 year limit on the look back period.

My LTC insurance is having enough saved and kept in reserve for 5 years or so of LTC plus my books on all the loopholes and, when the time comes, a good elder care attorney.
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Old 01-09-2015, 01:01 PM   #68
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After years and years of paying through the nose on her premiums, when she was in her mid 90's the time came for her to make a claim. She had a number of very upsetting phone conversations with them. She couldn't get a dime out of them until she had her grandson (a forceful and high powered NYC attorney) contact them. According to him and my brother, the grandson/attorney said the exact same things she had been saying, but they paid attention to him, not her.
Jim Cramer on CNBC lost his father just before Thanksgiving. He did NOT have nice things to say about the LTC insurer (which, unfortunately, he did not name). After years of paying the premiums and suffering a stroke in his 90s, he was denied nursing home benefits because they didn't think he was disabled enough. Cramer took them to court but said most of what they were able to collect went to attorney fees.
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Old 01-09-2015, 01:59 PM   #69
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There are a lot of (I hope) jokes in this threadabout assisted suicide via smothering, morphine, and other things I never heard of (nitrogen?). Are certain people seriously expecting a family member to perform this "service"? What protects the family member from being prosecuted for murder?

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Old 01-09-2015, 02:02 PM   #70
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Shoot, I think some of them are dead serious - but many will choke if hung with the responsibility.
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Old 01-09-2015, 02:17 PM   #71
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My mother had dementia, she could not talk, eat, go to the bathroom on her own. She would try to take walks on her own, she was a danger to herself and had to be watched 24/7. The few places that took dementia patients were horrible. It is bad enough to need a regular nursing home, but dementia units are the worst. Literally a ward of zombies, who can get violent for no reason. The experience was horrible for all involved.
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Old 01-09-2015, 02:21 PM   #72
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Just to add an example where LTC insurance worked out pretty well.

My Grandma had LTC insurance and it made a big difference for her during her last few years.

She always lived frugally, especially after my Grandfather died (30 years ago). She had a modest set of assets including a small house. As she got older she moved to a condo so she didn't have to keep up the yard.

At some point, the condo was too much for her so she sold that and she moved into assisted living. Her LTC insurance kicked in after 6 months and paid for, I believe it was, three years.

She lived there for about 3 years, with one stint in the associated nursing care facility when she had pneumonia.

The coverage of the assisting living was just about right. It would have run out a few months after she died. Her assets would have run out soon thereafter. (A few of us grandkids had agreed we'd step in and pay for her care if need be, but it never came to that - she was pleased she had provided for herself right up until the end)
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Old 01-09-2015, 02:38 PM   #73
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Oh, also meant to mention that while we had LTC insurance before FI through work, we dropped it and now self insure.
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Old 01-09-2015, 02:49 PM   #74
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Are certain people seriously expecting a family member to perform this "service"? What protects the family member from being prosecuted for murder?

Amethyst
Well, this accomplishes two birds with one stone.

Spouse A takes out spouse B, then Spouse A gets LTC coverage at a state prison. Children get max inheritance as the state can't go after assets to recoup prison costs. Everybody wins!

No need for paying those nasty premiums!
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Old 01-09-2015, 02:52 PM   #75
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Old 01-09-2015, 03:28 PM   #76
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Our plan right now (in our 30's) is to self insure. The genworth link posted by REW says we can expect between $40-80k per year costs in North Carolina. A 10 year stay at some combo of those places would still leave a partially intact portfolio for a surviving spouse. That plus the surviving spouse's SS will probably be "enough" to live comfortably.

Maybe we will change our minds once we approach our 50's and 60's. Although by then, we'll probably either have way more than enough to self insure, or our portfolio will have dwindled to the point that we'll be relying on SS.
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Old 01-09-2015, 04:01 PM   #77
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Well IMO, if my heirs want to protect their inheritance they should feel free to pay my LTC premiums.
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Old 01-09-2015, 04:11 PM   #78
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So, isn't this really just a limited term 'self-insurance' strategy?

If LTCI pays out a limited benefit, then couldn't one determine a self-insurance 'term' (aka the exclusion) and how much in LTCI benefits to cover a given situation, which would result in a lower premium, but lower benefit because of the self-imposed/self-insured period?
Yes, if you bought 3 years of benefits, you could decide to either:
1) use them first
2) make the decision, by yourself, to pay for your own care for a few years and then let the insurance start paying.

The insurance company will charge you the same premium for that 3 years of benefits whether you decide to take them immediately or if you choose to pay you own way for a few years and then start using the benefits (they don't have any guarantee that you'll pay your own way for the first few years. If were a formal agreement it would be called an "exclusion period" and spelled out in the policy. Nobody sells a polciy like that).

Given these factors, no sane person would decide to self-fund the first few years before filing a claim. They'd file a claim as soon as they could, since they could die before using up all the insurance benefit and thereby pass a lot more of their own money to heirs, a spouse, etc.

The reason some people want to be able to buy a LTCI policy with a long >official< exclusion period (e.g. 2 years) is that:
1) They have the means to cover the first 24 months with their own assets
2) Most people who go into nursing homes are dead within 2-3 years. So, buying insurance to cover just the period beyond 2 years should be a lot less expensive (the insurance company is far less likely to need to pay out anything=lower premiums). People want to pay less and get the true insurance they really need.

The Kitces article cited by Audrey does a good job of explaining the concept.
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Old 01-09-2015, 04:52 PM   #79
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Anyway, one of the reasons I have been wanting to move out of state, is the nursing home situation here. I'd advise looking someplace else. Looks like nursing homes are pretty cheap in Missouri.
Well, let us know what you find out. I've only been to Missouri once on vacation but I did think when I was there that it would be a nice place to live.
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Old 01-09-2015, 05:05 PM   #80
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Well, let us know what you find out. I've only been to Missouri once on vacation but I did think when I was there that it would be a nice place to live.
I am not sure about Missouri. I think you would have to show me.
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