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Old 03-10-2020, 07:37 PM   #41
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You are a good man. My dad was in much the same place with my mom. My wife and I have a dear friend in the same situation we help out. My suggestion is retire, but also hire help for at least two or three days a week. Full time caregiving will kill you. All our prayers, friend.
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Old 03-10-2020, 08:52 PM   #42
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So sorry to learn about your wife. You can find on-line help at www.alz.org. Many tips and information as well as forums dedicated to husbands and wives dealing with this disease. It provides a safe place to vent with people who understand.
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Old 03-11-2020, 05:25 AM   #43
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My suggestion is retire, but also hire help for at least two or three days a week. Full time caregiving will kill you. All our prayers, friend.
You may be right. I went to a support group Sunday for caregivers of people with this illness. Three gentlemen are regular attendees. Their wives passed away years ago but they still attend to help others along the journey. They are saints.

One point they asked me to write down was "when the time comes", which means, there will come a time when I have to make a change. Retiring, or at least scaling back is one change. Getting a paid caregiver to help is another step. For some people, finding a care facility is another step but I honestly don't see us needing that step in our case because I plan to do the job. Still, I have to be prepared for anything.

A big part of early retirement seems to be planning for expenses, and matching those expense to retirement savings. We've done a pretty good job of that, but the expense of assisted living or nursing home care is NOT in the plan (at least until we are past the retirement stage in life and don't need money for anything else - would self-fund the end-of-life care, and if we go broke at that point then Medicaid steps in and pays. Not that we are ever planning to go broke, no way, but many people do and they end up just fine.) There is long term care insurance out there but less than 5% of people have it due to the extremely high cost...

A dementia care facility could run $80 K - $100 K a year and if funding from a pretax IRA, we would need to withdraw even more for taxes.

Of course, if the ill spouse is being cared for 24/7 in a facility I could continue to work and there would not be any retirement expenses for me, but I still have the mortgage, etc. and would be going in the hole financially paying for a facility. So less and less retirement funds over time, rather than more. Since she's pretty young and strong, she probably has many more years ahead and I'd rather not be on the hook for an indefinite stay in a facility. It's hard to fathom that financially.

Let me tell you what though, care facilities are big business. They advertise like crazy. They know people have retirement savings, and they want it!!

So we've pretty much excluded a full time care facility from the list of options, at least at this point. I've read about dementia patients who live out the remainder of their lives at home, and that sounds like the best option for everyone. I will be ready "when the time comes" to hire some help around the house.
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Old 03-11-2020, 05:48 AM   #44
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I know many on this site are against it, but perhaps set up an irrevocable trust with some monies in it, which after 5 years, these monies would be protected from being extracted by a LTC facility and Medicaid would step in.
Just another thought, if taking care of her full time becomes a bit much.
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Old 03-11-2020, 06:22 AM   #45
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I know many on this site are against it, but perhaps set up an irrevocable trust with some monies in it, which after 5 years, these monies would be protected from being extracted by a LTC facility and Medicaid would step in.
Just another thought, if taking care of her full time becomes a bit much.
I don't know why anyone would be against Medicaid planning, any more than they would be against Tax planning. The law is there for all of us, so use it where you can!

I talked EXTENSIVELY with several elder law attorneys. First, each state has its own flavor of the law, and I am in NC, so your mileage may vary.

The irrevocable trust route has two drawbacks:
1) You have to use a trustee, typically a trusted child, who then has the burden of managing the assets

2) The trust can NEVER disburse principal money back to you, under any possible circumstance. It can disburse income, which is counted, but the principal is not counted because you don't control it and can never get at it. If the trust could disburse principal to you, the assets are countable for Medicaid. This means the trustee can withdraw funds for themselves (they own it and can do whatever they want with it) and one of the things they can do is "gift" it back to you. That just puts too much burden on the kids, in my opinion.

This is a fine way to pass along money to your heirs that you never want to see again, and you don't want Medicaid to touch. We do not have such an estate.

There is another trust, which is created after a spouse dies, called a Testamentary Trust. This type of trust CAN disburse principal and income money back to you, and only the money you receive is counted as income, but again, the kids have the burden of managing and disbursing the money. You have no say in how it is invested, how much if any is disbursed, etc. The kids have all the control over your money. This is not for us.

PLUS - in order for an asset to be in a trust it has to come out of your IRA or 401K... which means you pay taxes everything you withdraw and there is no more tax shelter.
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Old 03-11-2020, 06:33 AM   #46
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.... A dementia care facility could run $80 K - $100 K a year and if funding from a pretax IRA, we would need to withdraw even more for taxes....
While it only helps a little, I believe that the cost is tax deductible to the extent that it exceeds 10% of AGI.
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Old 03-11-2020, 06:43 AM   #47
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... I don't know why anyone would be against Medicaid planning, any more than they would be against Tax planning. ....
There are some of us who object to millionaires and multi-millionaire couples structuring their finances to pass their millions onto their kids while sticking taxpayers with a $65k+ a year bill for their long-term care in a nursing home. We think that a couples resources should be used for their care rather than shouldering taxpayers with that burden to the benefit of their heirs. There is a difference from tax planning in that tax planning reduces tax that the taxpayer would otherswise owe whereas Medicaid planning robs money from other taxpayers. Finally, the magnitude of the amounts for Medicaid planning is much more egregious/objectionable that the amounts that tax planners benefit from.
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Old 03-11-2020, 06:55 AM   #48
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It’s probably best to avoid the Medicaid discussion. It’s really off topic, the OP said it’s not an issue or objective, and it risks derailing the thread.
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Old 03-11-2020, 07:16 AM   #49
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Agreed... I just wanted to provide the OP with a snippet of the other side since he wrote that he didn't know why anyone would be against Medicaid planning.
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Old 03-11-2020, 09:26 AM   #50
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I would suggest going through the Medicaid planning process so you understand how it works in your state. In my friend's case, his wife could no longer physically care for him and a facility became the only option. In Colorado a spouse can have about $126k in assets and the car and house are not included as long as the house value is under about $500k. If your wife is placed under Medicaid, you are provided a monthly income and the rest of the income is used to pay for her care with Medicaid paying the rest. Knowing these figures and how it works including Medicaid application forms and income trusts (sometimes referred to as Miller trust) for your state would, in my estimation, be good planning for an unlikely but possible eventuality.
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Old 03-11-2020, 06:01 PM   #51
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Wishing you the best with your situation. You are certainly handling it well and planning for all options. Good luck.


If you decide to go the path of being her primary caretaker you might look into whether you can receive payment from the state for this role. My close friend took care of his mom for years until she passed. He got certified as some kind of caregiver and was paid around $800 a month via a state agency to provide her primary care. It took a lot of work (training, paperwork, etc) to get it done but it helped him out financially a lot during those years. She didn't suffer from dementia which made it easier.


Incidentally, he is now trying to re-enter the workforce at 60 and finding it very challenging.



Good luck to you sir!
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Old 03-11-2020, 08:04 PM   #52
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Agreed... I just wanted to provide the OP with a snippet of the other side since he wrote that he didn't know why anyone would be against Medicaid planning.
Noted! I won't discuss it again and already said everything I know about it.
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Old 03-11-2020, 08:22 PM   #53
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If you decide to go the path of being her primary caretaker you might look into whether you can receive payment from the state for this role. My close friend took care of his mom for years until she passed. He got certified as some kind of caregiver and was paid around $800 a month via a state agency to provide her primary care. It took a lot of work (training, paperwork, etc) to get it done but it helped him out financially a lot during those years. She didn't suffer from dementia which made it easier.
I think there is something like that available here. I have not heard about any cash payment option but there are County home health care services out there. I don't have a lot of details but it is supposed to prioritise those in greatest need, and there are not any income limits to qualify.

I expect I will learn all the possibilities over time.

I went to a caregiver support group Sunday. Two other people were there and caring for someone with the same illness as my wife. One lady was caring for her mom, who seems about two years more advanced than my wife. She had been full time caregiver but needed to return to work and was trying to find the right person to hire to sit with her mom during the day. Another older gentleman was caring for his wife who seemed nearer to the end, as he has just engaged hospice. He just said life was hell for him. It was hard to listen to their words but important to hear.

I visited a fantastic adult memory day care facility today and it looks like it may be a great fit to allow me to keep working, plus it will expand my wife's world greatly to have things to do during the day other than watch me shoo her away when I am on a business call or concentrating on work. They have food, music, art, and other activities that do not require speech or too much comprehension. It is a bit expensive but if it allow me to keep working and is good for her then it is worth it!
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Old 03-11-2020, 08:43 PM   #54
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I have a friend that used the PACE program for help with her mother that was suffering from dementia.
It is a support program that tries to help to keep the family member at home if that is what is preferred.
Here is a link to info on the program.
https://www.npaonline.org/pace-you
There might be resources to help you, if it is operating in your area.
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