So how do you protect it ?

[athena53]

Quote:

Originally Posted by pb4uski When the time comes that you need nursing home services, your kids take you in and house you, feed you, wipe your drool and clean your a$$ until you are gone.... problem solved!

DS has always said he'd do this for me but, after only about 2 months of serious caregiving with DH before he died, it's not a burden I would put on anyone 24/7. What we DID discuss would be the idea of my living with them but paying the bill for home health care so they're not 100% in charge of all of the above. I hope those days don't come for many years- I'm "only" 64 now.

[imoldernu]

Quote:

Originally Posted by davef I plan for the nursing home event in the same way I planned for retirement. My initial exposure and experience came with managing my folks health options and finances. You have received good suggestions on this thread from considering long term care insurance to qualifying for Medicaid and/or see if your assets could cover you. My suggestion is to consider the various scenarios and create some options. For example qualifying for Medicaid is easy. Just turn your assets to your children/child. Realize you will lose control of your assets but the nursing home is basically free. Not for me now but maybe one day. But wait too long, and I will miss the opportunity. Perhaps you know someone you can have a conversation and/or pay for the advice of an elder attorney. Unfortunately, there is not a Firecalc for this problem that I am aware.

Caveat... two things here...
1. Transferring assets must be done prior to the 5 year look back period.

2. In Medicaid, not all nursing homes are created equal, and not all are medicaid accessible. In our CCRC, initial admission to the nursing home, is dependent on a financial review, to insure that the chances of being paid for the type of care being provided is statistically viable. In other words, the cost may be (for instance) $80K...but medicaid may only pay $25K.
... Thus, even though our nursing home is medicare approved, it will not accept a person whose only means of payment is from medicaid. That said, after being financially vetted, the patient will not be turned out. Our CCRC is not endowment secured, ie. up front costs that ensure care to end of life, (sometimes many hundreds of thousands of dollar) the vetting allows for acceptance.

The five year lookback is the key to prior planning.
.................................................. .................................................

Some random thoughts...

"Home Instead" businesses here in Peru, come at a cost of $22 hour. For a person living alone, at home, needing regular 24/7 care, annual cost would $193,000.

All nursing homes are not created equal. Visiting for an hour at a time, will not always give the true picture of care. It is only after spending time to watch how meals are handled, nighttime coverage, social interaction, staff workload, care on call and the general happiness atmosphere of the home... that one can make the decision for the patient who is likely to spend the rest of his/her life there. Easy to look at as a third person, but when love is involved, truly a very, very major decision.

[Sunset]

Quote:

Originally Posted by Ed B I don't know for certain what the issue was. he was on Medicare the whole time, but nothing about his condition changed and he had been in steady decline from August 2011 until his eventual death in Feb 2012. It was my first time to meet with a panel who decided what the medical staff could or could not do. As I said, a month later they decided it was OK to allow him to pass in their care. In this case it wasn't that they decided to refuse treatment, it was them deciding he must remain in his current state. I didn't want him to go. He was lucid and we could talk, share stories, and I could still go to him for advise on weighty family issues. But that was my selfish point of view. He felt he had lost his dignity and he truly was trapped in that facility. I have hijacked this thread far too much. I was sharing my experience with a panel that had to power to decide if my father was allowed to carry out his wishes regarding his own life and death.

I found your story to be very interesting and informative, showing us the personal conflicting issues that arise with being in care and losing control over one's own destiny.

Personally I hope if I'm ever in the same type of situation as your Father that I can request such a dignified passing away.

[Fedup]

Quote:

Originally Posted by NW-Bound Much has been talked about how the US spends more on healthcare yet has its citizens living a shorter life than in other developed nations. One can take any hospital procedure and price it out in different countries to see that it costs more in the US. But there may be other factors too, like you describe. I often wonder if we all go to be under care in another country. We may have an even shorter life, being a bunch of sick people.

I think the key is they walk more, use public transportation more, eat less, I also noticed young European men eat fish at the airport. Rare in USA. In fact my kids knew some young kids who often bragged about not eating vegs nor fruits. Maybe it's our American diet.

[Bruceski44]

Quote:

Originally Posted by bclover yes, i guess people do feel entitled to be able to get decent healthcare regardless to your economic level. silly poor people. who knew they were "gaming" the system. I'll be sure to tell my clients that. anyhoo, my hubby was from Portugal, yes much smaller than the US but there are still a number of easily transferable lessons that would go a long way to helping. Did not say, solve but definitely helping. and you stated one of the biggest problems, you and many others Don't want to listen.

I listen to facts or wisdom. To give you a headstart, why don't you answer these questions:
1. Why do people think free or low-cost healthcare is their right? Is it God-given? Is it prescribed in our Constitution?
2. Why should someone else pay for your personal responsibility?
3. Why do people in this country so frequently sue Doctors in the hopes of getting a windfall payment for minor injuries? Why does the ACA not deal with Tort Reform to contain these costs?
4. Why do health care costs in this country vary so much from region to region? Last time I checked, insurance costs in Minnesota were half those in California.
5. Why does our system not allow providers to compete across state lines?

And lastly, this country has a plan for those who cannot afford health care on their own: Medicare.
1. Why do people object to proving their level of need before being provided free healthcare?
2. Why are Medicare reimbursement levels to providers so low as to be unsustainable?

I look forward to having a discussion focused less on emotion and more on facts or objective experience.

[meierlde]

One issue is that pay for physicians in other countries is significantly lower than the US, partly because medical education is much cheaper (no 200k in loans). Also in Europe it is typically 6 years from High School to an MD, since they don't require the intermediate bachelors degree like the us (this is changing a bit). Of course my fundamental issue is that for a lot of issues Physicians in the US are over qualified and the Nurse Practitioner/Physicians Assistant level of training is all that is needed. In fact if things were done right specialists could describe what to look for and let the primary care person be sufficient if normal results are seen.
If you move to capitation i.e. the primary care group gets $x per year per patient, then things like uploading blood pressure readings etc, could be done and reimbursed, with no need for an actual appointment.

[athena53]

Quote:

Originally Posted by imoldernu Caveat... two things here... 1. Transferring assets must be done prior to the 5 year look back period. 2. In Medicaid, not all nursing homes are created equal, and not all are medicaid accessible. In our CCRC, initial admission to the nursing home, is dependent on a financial review, to insure that the chances of being paid for the type of care being provided is statistically viable. In other words, the cost may be (for instance) $80K...but medicaid may only pay $25K. ... Thus, even though our nursing home is medicare approved, it will not accept a person whose only means of payment is from medicaid. That said, after being financially vetted, the patient will not be turned out. Our CCRC is not endowment secured, ie. up front costs that ensure care to end of life, (sometimes many hundreds of thousands of dollar) the vetting allows for acceptance. The five year lookback is the key to prior planning. .................................................. ................................................. Some random thoughts... "Home Instead" businesses here in Peru, come at a cost of $22 hour. For a person living alone, at home, needing regular 24/7 care, annual cost would $193,000.

I would have expected it to be less in Peru- that's what I was paying in the KC area when DH got to the point where I was afraid to leave him alone.

I'm hoping I won't need years of that level of care and if I need it 24/7 maybe it would be time for a nursing home. If I'm OK at night but need someone to help me bathe and get dressed, keep me company while the rest of the family goes out, etc. it won't be 24/7. Too early to get into that level of detail. At least DS knows I'd rather be in a nursing home than have them burn out, and the money is there.

[NW-Bound]

Quote:

Originally Posted by Ed B ...I have hijacked this thread far too much. I was sharing my experience with a panel that had to power to decide if my father was allowed to carry out his wishes regarding his own life and death.

I for one appreciate you sharing your experience. We will all have to deal with this for our loved ones, or for ourselves. It's not too early to think about this, as most people here are no youngsters.

[Fedup]

Quote:

Originally Posted by meierlde One issue is that pay for physicians in other countries is significantly lower than the US, partly because medical education is much cheaper (no 200k in loans). Also in Europe it is typically 6 years from High School to an MD, since they don't require the intermediate bachelors degree like the us (this is changing a bit). Of course my fundamental issue is that for a lot of issues Physicians in the US are over qualified and the Nurse Practitioner/Physicians Assistant level of training is all that is needed. In fact if things were done right specialists could describe what to look for and let the primary care person be sufficient if normal results are seen. If you move to capitation i.e. the primary care group gets $x per year per patient, then things like uploading blood pressure readings etc, could be done and reimbursed, with no need for an actual appointment.

Exactly. My niece in UK makes about GBP 60,000 or lower, my nephew in USA makes about $200K but he has $400k loan. My niece has no loan, she said once she turned 24, she was considered independent.

[athena53]

Quote:

Originally Posted by Bruceski44 And lastly, this country has a plan for those who cannot afford health care on their own: Medicare. 1. Why do people object to proving their level of need before being provided free healthcare? 2. Why are Medicare reimbursement levels to providers so low as to be unsustainable?

I believe you're referring to Medicaid.

[meierlde]

Quote:

Originally Posted by Fedup Exactly. My niece in UK makes about GBP 60,000 or lower, my nephew in USA makes about $200K but he has $400k loan. My niece has no loan, she said once she turned 24, she was considered independent.

Note with the 6 year plan typically at 24 one would be starting residencies also. Not 26 like in the US.

[Nature Lover]

In our family, there is a strong desire to lessen (avoid, if possible) spending on LTC. All legal paperwork (estate planning, directives etc.) focus on actions/care that preserves "quality of life" rather than "living at all costs". The laws governing the medical profession, of course, limit the effectiveness of these; but we think it prudent to have them in place nonetheless.

Beyond medicare coverage for medical needs, we keep adequate assets to self-insure the use of use of such facilities where it is expected a stay is not a "final stay" ---but should the need to stay become custodial and likely final, we wouldn't push for continued treatment. Instead we've opted for whatever best and legal approach allows for a more dignified exit. In the last two cases, that has meant opting for hospice ---and declining medical care other than to "keep comfortable".

As for protecting assets for the family/others, our belief is that annual gifting while we're able is the best way. We follow a long-standing "lifetime of giving" program. $14k/yr/person to each, to the extent possible and financially comfortable.

NL

[Ed B]

Quote:

Originally Posted by Nature Lover ...... As for protecting assets for the family/others, our belief is that annual gifting while we're able is the best way. We follow a long-standing "lifetime of giving" program. $14k/yr/person to each, to the extent possible and financially comfortable. NL

I like this approach. My wife and I wouldn't be able to give as much as you do but I hope we can give some part of our heirs inheritance to them while we are with them.

[pb4uski]

OP is MIA... probably a troll.

[KevinC]

Troll I'm not

[pb4uski]

Wow... that was quick.

[KevinC]

I learn while I "lurk" !

[Bruceski44]

Quote:

Originally Posted by athena53 I believe you're referring to Medicaid.

Yes, you are right.

thanks,
b

[COcheesehead]

This is why I bought whole life with a LTC rider. But nobody here likes to talk about the advantages of whole life. Carry on.

[marko]

Quote:

Originally Posted by bclover please forgive me because I know this question sounds snarky and it's not meant to be. Why do we (very general use of the word) expect anyone else to pay for our care

Because in states like mine (Mass), almost everyone does it.

If everyone is managing their assets such that the state picks up the tab, why should I be the one paying?

Similar to the ACA subsidy game in a way.