LTC - I have none. Betting on an alternative.

[youbet]

"Life Care" has been mentioned in the above posts.

For those who have not gotten into CCRC costs this is a serious subject that should be well understood, before the time comes to decide on Continuous Care Retirement Communities.

You're right on about CCRC's imoldernu. DW and I have been doing a bit of investigation into them and found that the type of contract each offers is critical in determing whether that place is right for you or not. It's easy to understand that a CCRC offers independent, assisted and NH living all co-located on the same grounds. The financial details and types of commitments are more of a challenge.

The monthly fee is set in the contract and typically increases annually to cover any increase in the cost of operations. In a CCRC, residents begin their stay in the independent living unit. If they are required to move to assisted living or skilled nursing, the monthly fee may increase due to the increased cost of care. This is not always the case. Some CCRCs charge a very high entrance fee with the promise that the monthly fee will not increase as the need for care increases. Whether the monthly fee increases as the need for care increases or not depends on the type of contract the resident signs.

In general, CCRCs offer three types of contracts:

Type A or extensive or life-care contracts that include housing, residential services and amenities — including unlimited use of healthcare services at little or no increase in the monthly fee. These contracts typically feature the highest entrance fees. The CCRC absorbs the risk that more residents than projected will need higher levels of care.
Type B or modified contracts typically offer lower entrance and monthly fees. Type B contracts limit the amount of health care services that may be accessed without any increase in the monthly fee. For example, some may offer a limited stay in the skilled-nursing facility with no increase in the monthly fee (for example, up to 30 days every four months). If the resident requires an extended stay, the monthly fee will increase but still be below the average cost of a stay in other skilled nursing facilities in the area.
Type C or fee-for-service contracts include similar housing, residential services and amenities as Type A and B contracts but require residents to pay market rates for any health-related services under an as needed arrangement. Type C contracts offer lower entrance fees and monthly fees but the risk of large long-term-care (LTC) expenses remain with the resident — the risk is not shifted to the facility.

Three Types of Contracts CCRCs Offer Prospective Residents

Since we don't have LTC insurance, we were interested in a Type A contract to provide an insurance component to our old age plans. But, very expensive. And, to our surprise, if all beds in the NH portion of the facility are full when you need one, they can send you to another facility possibly a distance away.

The CCRC we visited that offered Type B contracts gave a 20% discount off of its rack rates for Assisted Living and NH care if you started there in independent living. We haven't researched whether those discounts are legit or not. Maybe their "rack rate" is inflated to cover the discount?

We didn't see the point of a Type C contract (unless you already have LTC insurance which would make a Type A contract redundant). We have local family that would help us shop for and move to alternate assisted living or NH care if/when the time comes we need to give up independent living. So, there doesn't seem to be much advantage.

We think that CCRC's can offer some good solutions for elder care but so far we're overwhelmed by the differences between the various types, especially the financing.

CCRC's might be a good subject for a stand alone thread, especially if some of our members have already done a deep dive into the details.

 

[Bamaman]

Long Term Care Insurance is no longer affordable--simply put. And many insurance companies have cancelled future policies--arnd run for the hills.

Fortunately, assisted living and full nursing home care in our low cost of living area is substantially lower than the National averag. eWe've saved enough for our long term care if inflation doesn't go out of sight and if we're in such situations a normal amount of time.

 

[CaliKid]

I would just self-insure which is essentially what the OP said. I just won't justify it based on the autonomous car... unless I owned a big chunk of stock in such a company. Most people end up needing some amount of care and help but not everybody. Some people drop dead before that need arises.

 

[youbet]

Long Term Care Insurance is no longer affordable--simply put. And many insurance companies have cancelled future policies--arnd run for the hills.

You may be over simplifying/generalizing. I voted not to buy LTCI partially because it seemed expensive but primarily because I was struggling to understand the product. If I could have purchased a policy as straightforward as my term LI policy and with a guarantee of no rate increases, I might have. But I wasn't going to buy something that seemed expensive when I couldn't really ever completely understand it.

Fortunately, assisted living and full nursing home care in our low cost of living area is substantially lower than the National averag. .

Fortunately, LTC in less expensive geographical areas is available to everyone as long as you're willing to be there. DW's cousin in Ct had her mom in a NH in Mo for just that reason. She paid the Mo NH home + an elder care manager to visit her mom regularly far less than what the NH alone would have been in Ct.

 

[medved]

For me, whether to buy LTCI was one of the toughest financial calls I have made -- and I think, in retrospect, I probably got it wrong. I bought a policy, but probably should have self-insured.

The policy I bought is unusually good, and I don't think its terms are widely available any more (maybe not available at all any more). The main advantage is that it is an indemnity policy. In other words, if I meet the coverage standards (which are standard among qualified LTCI policies: needing substantial hands-on or standby assistance with two or more ADLs, or requiring memory care), I get the monthly benefit. Full stop. I do not have to get my provider approved. I do not have to be living in any type of facility. I do not have even have to be paying for care. If my wife is taking care of me, or we hire someone, or I get care from a dog or a robot, we get the benefit. (If we are in an AL or SNF, the benefit is about 25% higher). Also the benefit level increases 5% compounded per year, regardless of the actual rate of inflation. The coverage period is 6 years. (I could have paid more for a policy that becomes fully paid up -- no more premiums -- at age 65; probably should have done that but the premium was much higher so i did not)

The biggest problem with these policies is the premium rates can increase, repeatedly, with state regulatory approval. And they have increased, in many cases very substantially, because the insurers underestimated claim rates and claim durations, underestimated life-spans, overestimated lapse rates, and overstimated interest rates (the yield the insurers get on their bond investments). So they have taken a bath on these policies, and they pass the cost of their mistakes along to insureds. Many state regulators have allowed this -- probably hoping it would avoid insurer insolvencies which could leave the state on the hook (at least to some extent). Our state has been relatively pro consumer, but there have still been increases, and there's ever-present risk of more increases.

I could have, and should have, self insured. But now that I have the policy and have been paying for some years, it does not pay to let it lapse. And, as I said, it is a good policy, as these things go.

 

[Teacher Terry]

We did not buy LTC. It's a crap shoot because you have no way of knowing how you will age. Both my Mom and my Aunt cared for sick dh's at home until they died. My Aunt is 92 and still lives alone with no supports. My Mom died at 89 and went to hospice a week before she died. I had a rich Grandma and a poor one and they both ended up in the same good nursing home. I have good friends where he got cancer and was dying and she had Alzheimer's both in early 60's. He went to stay with son until he died and she had to go to a home. Who would have predicted that happening so young.

 

[audreyh1]

We decided to forgo LTC insurance long ago, deciding we could self insure, and this is still true.

Now I'm thinking that the funds I have mentally set aside for LTC will go to funding a CCRC, which is just fine with us. I don't think we'll move to one until DH is 75 at least which is 14 years away. This totally depends on our on our health, of course - if it gets worse sooner, we'll have to make arrangements sooner.

 

[aja8888]

The OP needs to look into Medicare Part G:

http://www.early-retirement.org/forums/f52/medicare-part-g-86083.html#post1858989

 

[meierlde]

Note depending on where you live you you may not need to go grocery shopping, as more and more stores will put your order together and combine it with uber to deliver and you get the fresh food you need. That is until Amazon starts same day delivery of food. Note that for non perishables you can get them on Amazon right now. Amazon is soon to beat Macy's as the largest clothing seller in the country, plus of course many many other web sites selling clothes. If you are homebound and have a cluster mail box I understand you can apply to the post office to have mail delivered to the door also.

 

[Out of Steam]

To me, the problem with long term care insurance is that it is a prepayment plan, rather than an insurance policy. What I'd be interested in is something that has only a 10 or 20% chance of paying out, to take away the largest financial risk.

We can probably afford $150,000 in combined long term care out of pocket, which probably has a 30 or 40% chance of happening. What I'd like to insure against is the unlikely, but devastating, possibility of $10,000 a month in care for 5-10 years.

 

[brewer12345]

You really think you have any inkling what things will be like in 25 years? I am impressed. Personally I equally weight the probability of a zombie apocalypse and the appearance of benevolent (besides the probing) alien saviors and leave all the other possible outcomes to the almighty.


If I were 70 now, I would hope for a swift end. I watched my FIL die a lingering death from Parkinsons over the last several years and I am not going that way. In his position I would manufacture the swift end if necessary. Otherwise, if I don't know what is going on hook me up to some good dope and I will not care.

 

[W2R]

Note depending on where you live you you may not need to go grocery shopping, as more and more stores will put your order together and combine it with uber to deliver and you get the fresh food you need. That is until Amazon starts same day delivery of food. Note that for non perishables you can get them on Amazon right now.

I am getting my non-perishables from Amazon Pantry now, and it is GREAT. They just put the box on my front porch, and I don't have to lug all those heavy groceries around so much. I have a nice cart that I use for putting them away.

How wonderful it will be when a local grocery store or Amazon will deliver fresh perishable foods to my door as well. We don't have that quite yet, from any established and reputable source that I know of, although I have a hunch that it is coming soon. Meanwhile, when I go to the grocery store I don't need to buy and carry nearly as much if it is only perishables.

Edited to add - - - WAIT!!! HOLD THE PRESSES! I just Googled again and found out that we now do have a reputable local grocery store that will shop (for $10) and deliver groceries to your door ($20 more). Hallelujah! Expensive, but gee, I need to explore this option.

 

[COcheesehead]

Everybody that knows me here already knows what I am going to post, but I fund a whole life policy with a long term care rider. The LTC comes off the death benefit so I can use the funds in my end days or my heirs get the cash or I can use the cash value for my retirement, if I choose.
I bought it because I have personally witnessed the end days of loved ones and saw first hand how "self financed" care looks. Assets go like wildfire. I also didn't want to pay every year into an LTC policy and have the cash evaporate, so I bought the hybrid life.
Proceed to beat me up as always.

 

[samclem]

To me, the problem with long term care insurance is that it is a prepayment plan, rather than an insurance policy. What I'd be interested in is something that has only a 10 or 20% chance of paying out, to take away the largest financial risk.

We can probably afford $150,000 in combined long term care out of pocket, which probably has a 30 or 40% chance of happening. What I'd like to insure against is the unlikely, but devastating, possibility of $10,000 a month in care for 5-10 years.

That's been a theme here for quite some time. Many of us would be interested in a LTCi policy with a 24 month-or-so waiting period, or even some sort of deductible (prove that you've paid $100K for LTC after you give them notice, and the benefits begin). And, for DW and I, we really only need coverage while we are both still alive (as soon as one of us dies, the pension, SS, savings, and house equity should cover LTC for the remaining one). Such a policy should be relatively cheap since the payout likelihood is low (i.e. it is real insurance), but nobody seems to sell such a thing.

 

[meierlde]

I am getting my non-perishables from Amazon Pantry now, and it is GREAT. They just put the box on my front porch, and I don't have to lug all those heavy groceries around so much. I have a nice cart that I use for putting them away.

How wonderful it will be when a local grocery store or Amazon will deliver fresh perishable foods to my door as well. We don't have that quite yet, from any established and reputable source that I know of, although I have a hunch that it is coming soon. Meanwhile, when I go to the grocery store I don't need to buy and carry nearly as much if it is only perishables.

Edited to add - - - WAIT!!! HOLD THE PRESSES! I just Googled again and found out that we now do have a reputable local grocery store that will shop (for $10) and deliver groceries to your door ($20 more). Hallelujah! Expensive, but gee, I need to explore this option.

Walmart will do the picking at most stores, so the only issue is will uber/lyft do this, or perhaps the local taxi company do the delivery.

 

[meierlde]

That's been a theme here for quite some time. Many of us would be interested in a LTCi policy with a 24 month-or-so waiting period, or even some sort of deductible (prove that you've paid $100K for LTC after you give them notice, and the benefits begin). And, for DW and I, we really only need coverage while we are both still alive (as soon as one of us dies, the pension, SS, savings, and house equity should cover LTC for the remaining one). Such a policy should be relatively cheap since the payout likelihood is low (i.e. it is real insurance), but nobody seems to sell such a thing.

Of course it is reputed that for the right premium LLyods will insure anything, so perhaps you need to find an agent that deals with LLyods. Given that the average stay in a nursing home is 835 days, a 3 year elimination period would likley result in reasonably low premiums.

 

[Souschef]

My uncle died last fall at age 86 after suffering from Alzheimer's for about 8 years. My aunt didn't want to put him in a home, so slowly increased the amount of home care he had, until it was 24/7. It cost about $70K a year in the last 3 years. The money came out of savings. For me, that is part of what I am saving money for when I retire....

I agree. My mom died in 2015 at 102. In he last years she needed 24 hr care that was about 5K a month. She spent down her savings, sold the stock earmarked for the grandchildren, and was moved into a facility.
We plan to self insure for that type of care.

 

[meierlde]

Note depending on where you live you you may not need to go grocery shopping, as more and more stores will put your order together and combine it with uber to deliver and you get the fresh food you need. That is until Amazon starts same day delivery of food. Note that for non perishables you can get them on Amazon right now. Amazon is soon to beat Macy's as the largest clothing seller in the country, plus of course many many other web sites selling clothes. If you are homebound and have a cluster mail box I understand you can apply to the post office to have mail delivered to the door also.

I just checked and HEB in Houston now delivers groceries (HEB is a big Tx grocery chain) So it is happening all be it in big cities first.

 

[audreyh1]

The thing is, even if you can get groceries delivered, you have to be willing to prepare your own meals. Dad stopped doing that about a year before he quit driving, so he went out to eat twice a day. When he decided to stop driving, it was time to move to assisted living. We were very lucky that he had a reliable person that had come by to clean house once or twice a month, otherwise he might have needed to move sooner. He managed to keep the yard mowed, having purchased a nice zero-turn mower that didn't require much physical exertion, but DH and I spent a lot of time catching up with house maintenance when we visited the last few years.

It does not appeal to me to have to do my own housekeeping or prepare my own meals or deal with hiring people to take care of me and my property once I reach a certain age, so I intend to move somewhere that has those options available to me already, well before it's an absolute must have.

 

[Dash man]

We were fortunate to get a LTC policy for each of us through a group plan offered through my former employer back around 2002. We can increase for inflation every three years and the prices have remained stable for us, costing only $3,258 for both of us this year. The policy pays $465/day for me and $395:day for DW up to a maximum dollar amount that would last about five years. Home care daily amounts are about half of the rate of in a facility, we could probably self insure, but this policy is worth keeping. Getting it young and through an employer group plan really helps control the rates. Sadly, they don't offer it anymore, but as long as we pay our premiums we get to keep it.

 

[misanman]

I'm a volunteer driver for Meals on Wheels. We deliver a hot meal (plus a cold lunch at the clients option/cost) Monday through Friday to folks who aren't up to preparing their own meals. The costs are very reasonable. My understanding is that a doctor's recommendation is needed to sign up.

On occasion I've delivered to a client that IMO shouldn't be living alone though.

One of the "family" benefits is that they have someone visiting the home each day. If we spot a problem or if there is no response we call the MOW director and he/she contacts the family.

 

[Amethyst]

May I ask what you specifically don't like about Aunt Ant's situation? I realize you prefer your home by the lake - everybody would rather be in their own home than any facility - but are there specific things about her facility that turn you off (other than the mere fact that it is a retirement community)? Is the facility "institutional" or depressing somehow, is Aunt a virtual prisoner, things like that?

Just wondering, since I'd think people of means would have the desire, and the ability, to purchase residence options that almost anybody would like.

I



I have two aunts. Let's call them Aunt Ant and Ant grasshopper.

Aunt Ant: married, stayed married, worked, and invested for retirement. Husband long gone, she lives in a high-cotton retirement community. One bedroom apartment that has all kinds of social programs and well trained personnel available at her beckon call. To give you an idea of the place, her neighbors are an ex-governor and several other prominent citizens in Florida. But, its still a retirement home/community. Its just dressed up nicely and is quiet and peaceful. She has a LTC policy that will last 5 years and allow her to spend her final years in this nice facility with excellent care.

BTW, I didn't make up this story. I really do have two aunts that lived polar opposite lives. I've visited both numerous times and don't like either one's situation.

 

[bingybear]

Of course it is reputed that for the right premium LLyods will insure anything, so perhaps you need to find an agent that deals with LLyods. Given that the average stay in a nursing home is 835 days, a 3 year elimination period would likley result in reasonably low premiums.

If this really resulted in low enough premiums, this is something I might be interested in. I would want an open ended coverage. It is more reasonable to plan for covering 3 years of LTC than 25 years.

I asked one LTC sales guy about long elimination policies. He did not think they offered them.

In my mind it would have to be really cheap

 

[donheff]

Just a caution about CCRCs - you might want to give some consideration to looking into communities operated by religious organizations or other non-profits that truly put their members well being first. The reality is that life care contracts have an out for the provider -- if you prove to be a hassle they can and will toss you. DW's father was in the very early stages of Alzheimers when he and his wife (DW's step-mother) entered a highly regarded CCRC, one that many members love and I was very impressed with. Unfortunately, when he had to move from his independent living unit to a memory unit the staff wasn't up to their task. He was pestered by a female member who would enter his room and lay down naked in his bed. Step mom (who was an idiot) gave him hell because she was jealous which caused him to become fearful that she might leave him. The staff couldn't or wouldn't police the situation and DW's father became agitated and yelled at staff and finally banged some chairs in frustration. The administrators very nicely told us we needed to move him briefly to a psychiatric hospital so they could get an evaluation showing that he wouldn't present a danger. They assured us this was a routine "requirement" and we could rest assured he would be back in a couple of weeks. But once he was out they simply wouldn't approve his return. Since he was "voluntarily" out they could avoid the removal process they would normally have to follow to eject a member. That enabled them to avoid the requirement to refund the deposit for members they eject. Catch 22 - he wasn't ejected, he just couldn't come back because he might prove a risk. It became clear to us that the need to get an evaluation was a ruse - they just wanted to get us to move him out so they could bypass their ejection procedure. DW ultimately got action from the state ombudsman who ruled the facility had in effect improperly tossed him out. DW got the deposit refunded but in the meantime her father had spent almost a year dying in a dedicated AZ facility.

In retrospect, we should simply have refused to take him out the door once the facility started their oh, so concerned recommendations and BS promises of quick return. Had we done so they probably would have moved the woman who was pestering him to their other memory unit (this was a big place) which would likely have solved the problem. But most of us are not expecting such cynical behavior and want to go along with the counselors. Caveat emptor with for profit CCRCs.

 

[marko]

who is going to get you out of your bed and/or clean your bedpan and feed you?

Currently dealing with this for my brother who's had a stroke and lives alone. There are a whole suite of services available: VNA, home health aides (bathing, dressing), home therapists, house cleaners, cooks, transportation etc etc that do this. Even 24 hour supervision at home if needed. Health aides usually come AM and PM for an hour to get you in/out of bed, dressed etc.

It can be paid by yourself and some through Medicaid. Usually the costs are much less than a nursing home.

Wintering in Florida, almost everyday we see some old man/lady being tended to at the pool/beach by an attendant/nurse/aide