How Much is Enough to Self Insure for LTC?

[FIREHAPPY]

My inlaw's LTC policy met its payout cap late last year. I wonder how often that happens. I believe the cap was about $250k. The insurance firm made the payments each month like clockwork.

I didn't initially realize that policy holders have to meet specific conditions to be eligible to begin receiving payments. Inability to drive or take care of the house are not qualifying events. Read the policy carefully before you sign.

My wife and I will self insure.

 

[athena53]

I live 10 minutes away. I buy her food, prepare dinners to put in her freezer, do yard work other than mowing the lawn, shovel snow, pay and prepare the tax documents for the caregivers, do my mom's taxes, arrange for doctor's appointments and took her to them before Covid. There have been HVAC, electrical, & plumbing issues, which I have to resolve. I had to replace several appliances. It's been one thing after another.

You are a saint. This is exactly why I plan on entering LTC when I need it. I don't want DS and DDIL to give up normal lives so that I can stay in my house.

 

[mickeyd]

For those of you without LTC insurance, what reserve are you holding to fund LTC for a couple?

No LTCI here. We do not have a specially noted fund to cover possible LTC needs. However, what we do have is residency in our CCRC which includes assisted living, memory care and nursing medical care on campus. Should we ever (eventually?) need any of these services they are ready to accept us. Part of our monthly fee is used to support these other services. Like HO insurance, we hope to never need it but...

 

[Koolau]

I dunno.

Ma lasted about 6 months bouncing from hospital to home and back to hospital.

Pops got pneumonia a lot and went to hospital then to rehab at home and then back here with me when he could walk w/o falling over. After about 5 of these trips (you never get it all back, a little weaker and a little older) he died at the home about 3 months in.

So again not worried.

I think my dad lasted 6 months in memory care, IIRC. While his dementia was debilitating, he had a lot of good days too. His death was actually unexpected. They called it "old age" rather than his underlying dementia. It was actually a quite merciful passing.

Mom went years later to memory care and lasted about 3 years. She actually died of COPD. I believe she would have lived much longer had she not smoked from age 17 to 57. I never smoked!

So, we rolled the dice and opted for LTCi. I pray often that I have wasted ALL the money we have spent on it. Few bigger BTD categories than LTC - but not something I WANT to spend for. YMMV

 

[ncbill]

Do people not understand the meaning of words like "median"? The median means half spend less than that time and half spend more. It doesn't mean "the max", or even "most". The only reason the median has gone down is because people are spending lots of money before that on in-home care for a few years. It's cheaper than full-blown nursing home care but it ain't cheap.

Feels like people are pretty confident they'll die fast and easy. Not that I hope people experience it in their families but perceptions change quickly when you see what a couple older relatives go through. Very few people die in their sleep from a massive heart attack or stroke these days. There are many "middling" conditions where you're not dead, and not even on life support (so you can't be "assisted" in dying) but you clearly will need a lot of help to continue living.

Yep, and this is why the burden is on every individual to complete a health care POA where you spell out your wishes.

After seeing mom live for the better part of a decade once the progress of her dementia had rendered her bed-ridden, unable to communicate in any way (there were never any "good days") I have written an extremely restrictive health care POA.

Mine says in the event of any terminal illness, including dementia, palliative care only...hopefully Hospice if I qualify.

The human body isn't meant to live in bed & when it does you get all sorts of life-threatening infections.

The only reason mom survived with such a poor quality of life for so long was the regular use of increasingly powerful antibiotics.

In hindsight, all the above did was force mom to live with her terminal illness for nearly another decade.

So once diagnosed I'm content to let my first infection be my last.

 

[Scuba]

In United States there are no legal options. Switzerland does have legal options.

I’m hoping the US will progress on this point over the next few decades. As the population ages and medical advances are able to keep people alive much longer, but not necessarily cognitively functional, I’m hoping US will become more like Switzerland in this area.

 

[Scuba]

Yeah, me too. Most people don't last 6 months in "the home"

The average length of stay in skilled nursing is about 2 years, I believe. The scary part is that people can often live for 10-20 years in assisted living/Memory Care. Assisted living may not be so bad if you just need assistance with a few things but still have reasonable cognitive ability. Memory Care would be horrible though. I can’t imagine having to live in an Alzheimer’s unit for many years.

 

[Scuba]

Yep, and this is why the burden is on every individual to complete a health care POA where you spell out your wishes.

After seeing mom live for the better part of a decade once the progress of her dementia had rendered her bed-ridden, unable to communicate in any way (there were never any "good days") I have written an extremely restrictive health care POA.

Mine says in the event of any terminal illness, including dementia, palliative care only...hopefully Hospice if I qualify.

The human body isn't meant to live in bed & when it does you get all sorts of life-threatening infections.

The only reason mom survived with such a poor quality of life for so long was the regular use of increasingly powerful antibiotics.

In hindsight, all the above did was force mom to live with her terminal illness for nearly another decade.

So once diagnosed I'm content to let my first infection be my last.

I agree with you 100%. I’m wondering how you see that working practically. If you got dementia and had to move into a memory care facility, would a “palliative care only” POA allow the facility to let you die from infected bedsores? I’m surprised they could legally do that, despite such a POA.

 

[ncbill]

I agree with you 100%. I’m wondering how you see that working practically. If you got dementia and had to move into a memory care facility, would a “palliative care only” POA allow the facility to let you die from infected bedsores? I’m surprised they could legally do that, despite such a POA.

You really do need to appoint a health care agent in your health care POA who you are sure will stand firm on your wishes...yes, they can refuse antibiotics for infected bed sores even if that kills you...but at that point I'd think you'd qualify for Hospice.

 

[Bryan Barnfellow]

In United States there are no legal options. Switzerland does have legal options.

You can become a member of Dignitas (dignitas.ch), which is a nonprofit based in Switzerland, and arrange to travel there (with family and friends if desired) when you are prepared and have their approval. Swiss law requires, along with extensive health records, letters from two doctor confirming your illness and that you are beyond help.

Dignitas pulls out all the stops *not* to have you commit suicide if there is any doubt about your condition; but in the end will enable you to carry out your wishes. They only assist you, providing a place in Zurich and preparing the liquid you will drink; but you have to drink it yourself. If that is not possible (you are too weak, etc.) they will provide a machine that, when you press the button, will automatically hold the glass for you. After you are gone--which is in minutes--they call the police to report the suicide.

This 2009 Guardian newspaper article provides a good summary of the process. https://www.theguardian.com/society/2009/nov/18/assisted-suicide-dignitas-house

About four years ago a neighbor in our small apartment building committed suicide with the assistance of Dignitas. It was a shock; we had no idea that she was ill.

-BB

 

[Bryan Barnfellow]

In Switzerland, there aren't vehicles for long term care insurance as in the US. So, my wife and I have reserved an IRA portfolio of investments to pay for end of life care.

You can go to a skilled nursing home or have at home care. There are also very nice private facilities with a lot of amenities. Your compulsory health insurance, which you pay for yourself all your life, provides the medical-related payments that supplement your own cash. It can cost anywhere between $10,000 to $20,000 per person per month for long term care. If you run out of assets, your canton of residence (which is responsible for long term care programs) will pay the balance on your behalf. There appears to be a marked preference here for home-based care.

-BB