Revisiting Self-funded LTC

[joesxm3]

We just managed to sell steps dads house and cleared $193,000. He has another $50,000 or so and gets $1600 social security. He recently fell and got really messed up by his hospital stay which started with two days in the ER hallway. He has been in a SNF for two weeks and is bare!y able to walk with PT helping him.

If he goes to LTC it will cost $560 per day, but at least there is a relatively c!ear process to get Medicaid to take over.

If he comes back to live with me it will stretch my ability to care for him and health aides will cost $30 per hour. Even 8 or 12 hours per day will burn through his money pretty quickly. The state plans for home care are more confusing and seem to be limited based on how much funding the state has available.

So deciding what to do is an issue. I recently did full time care for my mother for four years until she died at age 96 in August, so I have used up a lot of my energy.

But the real topic that this got me thinking about is what about me with no kids to take care of me.

I have planned to set up some sort of hired care. But the reality of the numbers is hitting me and without inflation it seems that something like this will cost $200,000 per year or more. That seems like a huge chunk of money. Who knows how the nest egg will fare, but I can see maybe only enough to fund five or six years of that level of care.

Maybe I won't live as long as them, or will die from something like a heart attack. But this seems like a major planning issue. I have been fo!lowing some of the other threads so don't want to beat a dead horse, but this was on my mind this morning.

 

[braumeister]

I recommend doing some reading in the various CCRC threads.

That is definitely in my future, and I believe very much worth at least your consideration.

 

[LateToFIRE]

Sorry to hear about your dad. Not enough info included to really address your question. But, I just want to caution that if you're looking for Medicaid to eventually provide LTC benefits to your dad, you need to be very careful what you do with the proceeds from the sale of his home and his other funds. Under no circumstances should you transfer any of it to you or siblings - because Medicaid will look-back (I think at least 5 years) to see if there have been any assets transferred and that will impact his ability to receive benefits (and they might come after you to recoup the funds).

On the topic of what about you, really depends on what your assets and recourses are. I've been thru this with parents and in-laws, what I saw was that if you have very little, Medicaid does a good job of stepping in, and if you have a lot, well, you don't have much to worry about. In both cases the real key is to have someone, whether family member or professional, who will be there for you - to make sure you get into a decent facility, to handle the mountain of paperwork, and to monitor that you get treated properly.

 

[gauss]

$560 per day sounds like it could be excessive -- unless you are talking about full Skilled Nursing Care (SKC).

For the more general assisted living we were paying about $4000/month for DMIL.

There were no grand pianos in the lobby,but the place was nice and clean and the residents seemed happy.

Also if you look into the statistics of who needs SKC for more than a year, you will find that the vast majority of them are accident victims are others with serious issues.

Old age folks don't often live for years and years in SKC failicities.

This was part of the basis for my decision to self-insure.

-gauss

 

[LateToFIRE]

$560 per day sounds like it could be excessive -- unless you are talking about full Skilled Nursing Care (SKC).

For the more general assisted living we were paying about $4000/month for DMIL.

There were no grand pianos in the lobby,but the place was nice and clean and the residents seemed happy.

Also if you look into the statistics of who needs SKC for more than a year, you will find that the vast majority of them are accident victims are others with serious issues.

Old age folks don't often live for years and years in SKC failicities.

This was part of the basis for my decision to self-insure.

-gauss

+1, vast majority of skilled nursing stays for elderly are under 2 years, though early onset Alzheimers can be the exception to the rule.

 

[flyingaway]

We just managed to sell steps dads house and cleared $193,000. He has another $50,000 or so and gets $1600 social security. He recently fell and got really messed up by his hospital stay which started with two days in the ER hallway. He has been in a SNF for two weeks and is bare!y able to walk with PT helping him.

If he goes to LTC it will cost $560 per day, but at least there is a relatively c!ear process to get Medicaid to take over.

If he comes back to live with me it will stretch my ability to care for him and health aides will cost $30 per hour. Even 8 or 12 hours per day will burn through his money pretty quickly. The state plans for home care are more confusing and seem to be limited based on how much funding the state has available.

So deciding what to do is an issue. I recently did full time care for my mother for four years until she died at age 96 in August, so I have used up a lot of my energy.

But the real topic that this got me thinking about is what about me with no kids to take care of me.

I have planned to set up some sort of hired care. But the reality of the numbers is hitting me and without inflation it seems that something like this will cost $200,000 per year or more. That seems like a huge chunk of money. Who knows how the nest egg will fare, but I can see maybe only enough to fund five or six years of that level of care.

Maybe I won't live as long as them, or will die from something like a heart attack. But this seems like a major planning issue. I have been fo!lowing some of the other threads so don't want to beat a dead horse, but this was on my mind this morning.

I am really confused about the LTC cost of $560 a day, or $204,400 a year. Would that amount of money (salary) is enough to hire a CEO of LTC company?

 

[Jerry1]

I am really confused about the LTC cost of $560 a day, or $204,400 a year. Would that amount of money (salary) is enough to hire a CEO of LTC company?

It does seem high but there is a very wide range in pricing depending on the level of care that is needed and the perceived quality of the facility. MIL is in memory care for about $300 per day which is about $110K per year. There’s a “nicer” place around here that is about $460 per day (about $170K). Not sure if the difference in actual care is better enough to justify the cost, but that’s a local example.

Now, add onto that a higher level of care and the cost can get even higher.

 

[joesxm3]

I am familiar with the Medicaid look back since I did it for my mother. But thanks. Good to make sure I knew.

The place he is in is a SNF rehab section. I will have to check but LTC price is probably close.

This is definitely one of the more expensive facilities, but it got five stars from the Medicare rating and we live in a very high cost of living southern new England state. When my mother was in there four years ago some residents that moved in from other places said it was better. Although better is subjective given the overloaded staffing issues.

He is 92 and has Parkinson like symptoms and early stage demenia. That seems not likely to kill him, so he will probably live for a while unless the health care system makes a mistake.

He would not be suitable for assisted living.

As far as my situation, I agree that even if I have the resources to pay for care I will be in deep trouble without a reliable advocate. I don't have any young friends close enough to do that and really only one younger second cousin that I see only every year or two. I will definitely have to work on that.

One thing I was wondering is if I would hold off long enough for there to be health care robots that would drive costs down. But, like the magic medical advances, I think at 67 I might be 10 years too early to really benefit from that sort of stuff.

 

[Surewhitey]

DW moved MIL to a shared home (she has a private room) that is <$4k/mo. SIL took care of her until 6 months ago for 5+ years. Last time I saw her, she was visibly more frail @84 w/dementia. I'd be surprised if she makes another year or two...

The daughters feel she's getting sufficient care (now with hospice a couple times per week. Her SS & pension is taking care of 75% of expenses and we're taking care of the remaining, split 3 ways. Probably can't do much better than this in our situation.

$200k sounds excessive...

 

[LateToFIRE]

I am familiar with the Medicaid look back since I did it for my mother. But thanks. Good to make sure I knew.

The place he is in is a SNF rehab section. I will have to check but LTC price is probably close.

This is definitely one of the more expensive facilities, but it got five stars from the Medicare rating and we live in a very high cost of living southern new England state. When my mother was in there four years ago some residents that moved in from other places said it was better. Although better is subjective given the overloaded staffing issues.

He is 92 and has Parkinson like symptoms and early stage demenia. That seems not likely to kill him, so he will probably live for a while unless the health care system makes a mistake.

He would not be suitable for assisted living.

As far as my situation, I agree that even if I have the resources to pay for care I will be in deep trouble without a reliable advocate. I don't have any young friends close enough to do that and really only one younger second cousin that I see only every year or two. I will definitely have to work on that.

One thing I was wondering is if I would hold off long enough for there to be health care robots that would drive costs down. But, like the magic medical advances, I think at 67 I might be 10 years too early to really benefit from that sort of stuff.

FYI, 92 would not be "early stage dementia," at least not in my non-medical opinion. I meant like someone in their 60's getting dementia and needing LTC for 20 more years. By the way, dementia can and often does shorten life - its not only about memory loss, can affect multiple brain/body functions.

 

[joesxm3]

I think you mean early onset dementia.

What I mean by early stage dementia is that he basically knows what is going on but mixes up or substitutes words going out, takes time to process incoming thoughts, performs poorly planning tasks and fails the three word memory test. My mom also used to ask the same question over and over but he does not do that yet.

When under stress in the ER hallway he rapidly degraded to figiting movements and hallucinations.

 

[Rianne]

We've seen a wide range of personal experiences with this topic and it is scary to think about, especially if you're not somewhat prepared.
-My mom with dementia lived with us for about 5 months and we had an in-home LPN 8 hours/day until that could no longer be managed. She went into a nursing home and passed away within 2 weeks.
-A close neighbor who lives alone with no reliable family had major back surgery and is in a rehab facility as I write this. She will need full-time care for a while and she's a senior. We assume she will sell or do a reverse mortgage to stay in her house.
-My SIL refuses to go to a facility with a long-term debilitating disease and her DH, my brother takes care of her. She is very frail.
-A local retired professor lived into his 90s and could afford a full-time live-in nurse. I believe that cost him approx. $100K/year. He refused a nursing facility. A tenured professor can afford that kind of care.

All these scenarios help us understand the unfortunate fate for us, one way or another. We do not have children but a large local extended family. I would not put this burden on anyone. We think of these friends and family often and discuss our options.

 

[joesxm3]

I was wrong about the pricing. Single room rehab is $560. Double room LTC is $430.