How Much is Enough to Self Insure for LTC?

[youbet]

Quote:

Originally Posted by Koolau We looked at one of these on the mainland. Everything seemed fine until they took us BY the "final stage" (critical care or nursing home equivalent). It looked like a warehouse for those trapped in their worn out bodies. I'm not sure most regular nursing homes don't look like that, but that was my impression of this particular place. It was sort of a multi-bed "ward" and, near as I could see, most folks were simply sleeping and hooked up to tubes, etc. No thanks. Where's the bacon?

Unfortunately, we're fairly familiar with NH's since we shopped for one for DW's mom and Dw visited her there several days a week for over 4 years. We've also been shopping CCRC's.

We've seen a number of stand-alone NH's which didn't cut muster and gave us the impression as you described above. Those were all NH's that specialized in accommodating Medicaid clients. They're Illinois' answer to discouraging people from fiddling with their finances to get the state to pay for LTC. That was in the greater Chicago area. I'm sure it varies from place to place.

All the NH sections of the CCRC's we've looked at, while still full of old people in wheel chairs (you don't go into a NH because you're doing ok health-wise), looked reasonable given the circumstances. The place we're most interested in is all private rooms, good staff/patient ratio, modern, etc. I sure don't want to be in the NH section of a CCRC, or any NH for that matter. OTOH, if I am, I want DW to have a very easy time visiting (down the elevator, down the hall and across the lobby), and for me to be able to be wheeled back to our apartment on "good days" and that sort of thing.

No doubt, it is extremely important to really do your homework with CCRC's because the CCRC you sign up with is going to be where you'll wind up if you eventually need full nursing care.

Ain't this gettin' old and planning for the not-so-fun eventualities a pita?

[braumeister]

Quote:

Originally Posted by youbet it is extremely important to really do your homework

I couldn't agree more. Went through all this during my mom's final years. I saw places that were so horrible I couldn't imagine putting her there, and this was both at the highest end and more moderately priced. In the other direction, I saw places that were actually quite nice, and again the price point didn't seem to track very well. So you can't go by cost alone. Research is everything.

[anethum]

A few folks have expressed the thought that it's cheaper to stay in your home than move to a LTC facility. That has certainly not been the case for my parents. Beginning at age 94, my dad needed 24/7 skilled nursing care following a stroke, in order to remain at home. He lived for 8 more months and died at home. He got great care, but his home care was probably more important for my mom than my dad.

Unfortunately, my mom began developing obvious signs of dementia within months of my dad's death. I had hoped to convince my mom to move to an upscale CCRC nearby where a friend had moved years before. But once my mom's dementia began, she wouldn't have been accepted at the facility anymore.

Mom wouldn't allow any hired help in her home until she fell and fractured her pelvis and a wrist. That was about 18 months after her dementia began. Those 18 months were hellish for me, due to her "sundowning". After rehab and regaining the ability to walk, she returned home with 24/7 care. That was 5 years ago. Mom is now 100 years old. A little over a year ago, she broke her hip. She went downhill after that and was accepted for home hospice care. BTW, a nurse came to evaluate my mom and her surroundings, in order to make a decision as to whether or not she was eligible for home hospice. We spoke outside (due to Covid) afterward and she said that my mom was getting excellent care, and added "You've be running a nursing home for the past 4 years." I hadn't thought about it in those terms before, but I realized she was correct.

The upshot is that this sort of home care is not cheap, esp. for quality caregivers. Between my dad's 8 months of skilled nursing care, and my mom's 5+ years of 24/7 caregivers (but not skilled nursing), the total cost for the nurses and caregivers has now exceeded $900,000. That figure does not include all of the other household expenses such as property tax, utility bills, insurance, grass cutting, medical supplies, & food. The funds my parents accumulated in their decades of retirement thanks to a generous COLA'd pension and decreasing expenditures as they aged, is now flowing the other way. Given my mom's age and frailty, I think the remaining funds will outlive her. Probably.

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.

After 6 months of home hospice care, mom was "discharged" per Medicare rules last summer because she had improved somewhat and had supposedly gained a little weight. Hospice was very helpful, because if there were any medical issues, the caregivers & I had a 24/7 phone number to call to speak with a nurse, and there occasionally were issues. Also, hospice purchased items like my mom's diapers, mattress pads, and gloves for the caregivers. Now I have to provide all of that again. When they sprung the discharge on me, I had to hurry and find a wheelchair to replace the one hospice was taking away. The hospital bed remained, because I had obtained that myself prior to hospice care.

I know that my mom wouldn't want to live like this, and I recall a remark she made about her own mother's sad final years. But I honestly don't think I could live with myself if I shipped her off to a nursing home now. BTW, I have one sibling who also lives near mom. We are not on speaking terms anymore because he and his wife have refused to help in any way whatsoever.

[audreyh1]

Quote:

Originally Posted by marko OTOH...this thread is about LTC but there is a trend of folks 'aging at home' for a lot less. A cadre of at-home care providers (full time live-in or day-visitors) can help one dodge the nursing home until you're ready for hospice care. Even avoiding 2 or 3 years at full price can pay off. I've been researching this as my brother (and 92 y.o. mother) will require something at some point. Not for the truly sick or severe Alzheimer cases but for many it becomes a viable option money-wise. IMO, LTC can mean anything from supervised at-home all the way to hospice and everything in between.

Without a close trusted family member to oversee it, managing at home care providers can easily overwhelm the ones being cared for.

[FANOFJESUS]

Quote:

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

Right Robbie it is not long. I think most people are gone in 2-3 years. I think I heard that on Clark Howard.

[audreyh1]

Quote:

Originally Posted by jkern I believe that a large portion of LTC expenses will be tax deductible, thus cancelling a portion of that IRA tax bill.

Yep!

[REWahoo]

I've posted this a number of times, but it seems appropriate to post again.

[Markola]

Thanks Wahoo. Is that sample of decedents 1,000 people who went to a nursing home and died there? Something else?

[bobbyr]

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Originally Posted by rodi We look out our paid off home as more than enough.

We have a rental that I view in the same light...although I suspect we would sell it way before we would need LTC (knock on wood, cross fingers).

Managing the rental is not a huge effort, but it is just enough that I wouldn't want to be saddled with that by age 75-80 (63 now).

[homestead]

Quote:

Originally Posted by REWahoo I've posted this a number of times, but it seems appropriate to post again.

Good graph. From the article with the graph.

Quote:

What they found was that out of the 8,433 study participants who died between 1992 and 2006, 27.3% of resided in a nursing home prior to their death. Most of these patients (70%) actually died in the nursing home without being transferred to another setting like a hospital.

[REWahoo]

Sorry, I failed to include a link to the source article when I posted the graph above: https://geripal.org/length-of-stay-i...-homes-at-end/

[RobbieB]

The chart explains why I'm not worried.

[aja8888]

Quote:

Originally Posted by RobbieB The chart explains why I'm not worried.

Where do you think you will be on the chart, Robbie? (or on it at all?)

[RobbieB]

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.

[youbet]

Quote:

Originally Posted by RobbieB The chart explains why I'm not worried.

+1

I guess the perfect storm for us would be:

DW is in decent health and I go into a NH due to a stroke and live many years giving her a part time job visiting and advocating for me. She just finished this duty for her mom and, I tell ya, it's a crappy job.

Our financial situation turns out to be the lowest portfolio value we see in our FireCalc planning. That is, we know the residual value of our FIRE portfolio could be anywhere from near zero to many millions and can't really predict that outcome with any accuracy.

I live a long time in the NH. Unlikely, but hard to predict.

So DW has an ugly, part time job for years. Our portfolio has performed at the bottom limits of our 100% FireCalc testing range and my LTC expenses are high because I have encountered the low probably outcome of needing LTC for a long time. When I croak DW is exhausted and low on funds....... Exactly what I'd like to avoid.

Type A CCRC's solve those issues for the most part (if you don't pick a loser and get unexpected results) but I'm not so keen on living in one while I can still walk and chew gum simultaneously.

Makes it hard to figure out. So maybe, like you, just don't worry about it? I can see the odds of both needing very long term LTC and having the portfolio perform at the bottom of the range both occur are low. And if I was only fretting about myself, no problem....... But I really don't want to put long enduring DW into any sort of predicament, even if the odds are super low. So, I'm noodling it.

[RobbieB]

That's my plan. Not going to buy LTC insurance, not shopping CCRC's either.

I'll do what needs to be done when it happens.

[aja8888]

Quote:

Originally Posted by RobbieB That's my plan. Not going to buy LTC insurance, not shopping CCRC's either. I'll do what needs to be done when it happens.

My dad was living at home when his liver started to go (too much fun). He went in the hospital and died within a few days. Mom lived with my sister for several years fully mobile and with a slight case of dementia. She felt sick at 84 and went to the hospital and had failing kidneys and was gone in a couple of days.

I'm with you on this in the same fashion.

[youbet]

Quote:

Originally Posted by RobbieB That's my plan. Not going to buy LTC insurance, not shopping CCRC's either. I'll do what needs to be done when it happens.

I admire your outlook! For reasons I can't explain, lately I've been spending too much time thinking about the only risk we face in regard to LTC: simultaneously our FIRE portfolio performs at the bottom of expectations and LTC expenses are at the top of possibilities due to very, very extended needs. Off the top of my head, very low odds of that happening. But what would life be without a little fretting?

[RunningBum]

Well, my Mom entered memory care at age 84, not in very good health with arthritis and weight greatly limiting her mobility, which just spirals into worse health. Her mind was to the point where she only recognized my Dad, and that didn't last long. She probably should have been there months earlier. 16 months later she's still going. She could catch something next month and go quickly, or she could last a lot longer. That's one story, as a counter to these other stories where parents went much more quickly. You just don't know.

ETA: Even based with this, I'm self-insuring. I don't want to commit to a CCRC early, and I don't think know that LTCI would work out any better than self-insuring, unless I'm certain I'll use it. Which I'm not.

[Teacher Terry]

Unless I get dementia or have a big stroke and can’t care for myself I will stay home like most people in my family. Luckily my family values independence over safety.