your strategy for long term care

[marko]

Having seen this first-hand, here's my take:

That $100K NH cost is not in addition to your current expenses.

The sick spouse's expenses go up but the healthy one's go down.

The healthy spouse spends all of his/her time visiting the sick one. So, no more expensive dinners, exotic travel, clothing; get rid of that second car, boat and second home; etc. Your world becomes a whole lot smaller as do your previous/normal discretionary expenses.

As such, depending on your situation, your expenses could drop by $50K or so making your 'additional' NH expense half of what you think it might be.

Still not an attractive situation but a bit more palatable.

YMMV

 

[CardsFan]

Having seen this first-hand, here's my take:

That $100K NH cost is not in addition to your current expenses.

The sick spouse's expenses go up but the healthy one's go down.

The healthy spouse spends all of his/her time visiting the sick one. So, no more expensive dinners, exotic travel, clothing; get rid of that second car, boat and second home; etc. Your world becomes a whole lot smaller as do your previous/normal discretionary expenses.

As such, depending on your situation, your expenses could drop by $50K or so making your 'additional' NH expense half of what you think it might be.

Still not an attractive situation but a bit more palatable.

YMMV

That is what I have seen, and expect. So we are also "self insured".

This has been said many time here, but what I would pay for is a real "insurance" plan. 3 or 4 year elimination, but pay for rest of life.

We can easily afford the 3-4 years. The rest of life is the part we would want to insure, to preserve inheritance.

 

[SloHan]

Planning on self funding a CCRC when it’s time.

 

[FLSUnFIRE]

Self funding. Under most scenarios using a "safe" withdrawal method, the odds of having "too much" money is far more likely than running out/just making it. Most of the time there would be plenty of funds to self fund and would have to get unlucky in the health lottery as well as the market which makes the odds of a self funding failure pretty low. The opportunity cost is way too high for me to be tempted to buy (and there is a lot of risk in the policy being there when I need it as well).

 

[pb4uski]

With my mom the Ins company sent a nurses aid to assess her. She was still in her home with full time care and officially under hospice care. Terminal cancer with no more treatment only pain mgt and quality of life mgt. Insurance company (major US company) wrote back that she was denied because they didn't think she met "their" requirements of needing full time or LTC. We could appeal. We did.

This was August 2019. Thanksgiving week she was admitted full time into a private care facility. She passed December 16th.

After she had passed we received a letter to the appeal saying she was still denied. Good call, she was dead!

Plan had 90 day wait period. Discussed with attorney and decided not to pursue since at most we could push for would be two months. She paid over $80,000 into this and was so proud it would help cover her end of life and not burden us. We never told her it was denied.

Biased...big time. So wife and I have $400k set aside for LTC and I know I can access when and if needed. If we don't use it, it's earmarked for a specific charity we chose.

^^^^ One of the reasons that I am hesitant to buy traditional LTC, along with frequent demands for premium increases and/or benefit reductions.

However, these newer life insurance policies with an LTC rider seem to avoid the premium increases and while you might have a hassle getting LTC benefits when the insured passes then you get the life insurance death benefit.... so they do seem to sidestep my major concerns... still not all that interested though and plan to self-insure.

 

[almosttime]

Same for me.

Very interested in CCRC. Seems like a good balance.

 

[Car-Guy]

I don't trust the policies, the premiums, or the industry.

+1... LTC facilities are not for sissies. Cost is too much for a policy and the level of care is far too little even if you pay cash/full freight...

Just not for me....

 

[W2R]

strategy for long term care

Originally I had planned to move into a CCRC eventually and had adequate assets to self fund that option (even at the most expensive CCRC's), but the pandemic changed my mind about CCRCs. A CCRC that I had tentatively identified as my best choice got hit hard by the first wave of COVID and almost everyone there caught it. Many dozens of their residents died from it last March and April, almost singlehandedly making New Orleans a COVID "hot spot". This was an established CCRC whose residents included some of the wealthiest and most influential of New Orleanian elites, and had a long time stellar reputation so if a place like that was dangerous, then I give up.

As an avowed introvert I wouldn't move to a CCRC for socializing, but for my own health and safety. After seeing what happened in 2020, to me that no longer seems like a logical reason to choose a CCRC.

So right now, we are going with "Plan B" and planning to age in place. We can help one another to some extent (he lives next door so we can check on each other easily). If at some point I genuinely need a nursing home I can afford it but I'd rather put that off as long as is humanly possible. I am not only concerned about diseases, but even more concerned about the potential for elder abuse in any group setting. Besides, I love my Dream Home and to me the ideal would be to live here to the end.

 

[SCtransplant]

Once I priced long term care insurance, I developed an alternate plan with my spouse. Our solution is mutual agreement to smother with a pillow if LTC is needed.

 

[corn18]

Don't believe you can age in place and die a peaceful death in your home. My last memories of my FIL, who I loved dearly, was carrying him to the bathroom and wiping his arse. He could afford any care imaginable, but he was too stubborn and proud to do it. So we got to do it. His plan was to gracefully die in place. Cancer doesn't work that way. My MIL's best friend had the same plan. Her family is now carrying her around the house and wiping her arse. Again, plenty of money to get care, but she was bound and determined to die in her house. Nice plan, but she got cancer and could not care for herself. So for those who have that as their plan, please don't. It won't turn out that way.

For us, we are going to self insure LTC. My MIL's CCRC had a $500k buy in and she lives in a house for $4,800 a month. And it is a really nice CCRC. Since she is in a house, she never had to deal with the COVID spreading in the apartments, although they only had 2 deaths that she knows of out of 400 residents. And we are more than willing to carry her around and wipe her arse, we don't have to worry about that because she was gracious enough to move into the CCRC. She didn't want to, and she always brings up how we made her move, but she has no worries other than her poor health. They take care of everything. I thank her for that.

 

[marko]

Don't believe you can age in place and die a peaceful death in your home. My last memories of my FIL, who I loved dearly, was carrying him to the bathroom and wiping his arse. He could afford any care imaginable, but he was too stubborn and proud to do it. So we got to do it. His plan was to gracefully die in place. Cancer doesn't work that way. My MIL's best friend had the same plan. Her family is now carrying her around the house and wiping her arse. Again, plenty of money to get care, but she was bound and determined to die in her house. Nice plan, but she got cancer and could not care for herself.

FWIW, if money is not a real issue, you can get 24/7 care in your own house and die there if that's what you want to do. Lots of outfits out there that specialize in such things.

My brother has a housekeeper and someone else who comes in every other day to help with his showers/bathing. He could get someone to wipe him if he needed that too or whatever else a SNF does.

 

[corn18]

FWIW, if money is not a real issue, you can get 24/7 care in your own house and die there if that's what you want to do. Lots of outfits out there that specialize in such things.

My brother has a housekeeper and someone else who comes in every other day to help with his showers/bathing. He could get someone to wipe him if he needed that too or whatever else a SNF does.

I wish my FIL would have done that. He would not allow any outside help until hospice showed up. That was 2 weeks before he died.

 

[sheehs1]

FWIW, if money is not a real issue, you can get 24/7 care in your own house and die there if that's what you want to do. Lots of outfits out there that specialize in such things.

My brother has a housekeeper and someone else who comes in every other day to help with his showers/bathing. He could get someone to wipe him if he needed that too or whatever else a SNF does.

Both of my parents wanted to die at home and this is what we did. We organized and scheduled their care, drove them to doctors appts when needed and until it wasn't needed anymore as things were eminent, etc.

I plan to self pay as well. The only thing I might do is move closer to DD and family such that if she has to handle things, I am closer. It's also a much larger city with more potential resources to draw from than the little city I am in currently.
Plan B would be to move to a Senior facility down the street from where she lives.

 

[youbet]

To the CCRC crowd.......

DW and I are also interested in entering a Plan A (Life Care) CCRC at some point. When that point occurs can be tough to figure out and does add a bit of risk to the decision.

We're in our early 70's and enjoying reasonably good health and still camp, canoe, fish, hike, etc. DW is a cancer survivor (on continued remission according to the oncologist) and I have persistent, long term AFIB. Neither of those things would keep us from qualifying for a Plan A contract.

As of today (we visited yet another CCRC this morning), we don't feel ready to sell our home and move there yet. Although we could still participate in off-site activities and the apartments and common areas were very nice and upscale, I'm just not ready to leave my home with its workshop, storage for our outdoor toys, my ham radio antennas, DW's quilting area and all that.

The risk in waiting is that if either of our health suffers some setback that would keep us from being fully independent, it's difficult or impossible to find a top notch CCRC that will take you on a Plan A basis. You have to find the right window of time to enter these places. Late enough in life that your passion for an out-and-about life style and being with younger people is not hindered but soon enough that you're still fully independent. Wait until you've suffered a stroke or until dementia hints that you'll be a quick resident of their memory care unit, and you won't get in. At least not with a Plan A contract.

The path we're leaning toward is setting things up so that the "buy-in" money we've set aside for the CCRC would also be appropriately invested and available to be "self-pay" money if we wind up missing the CCRC window.

So........

First choice - buy into a top notch, Plan A CCRC when we feel ready to settle down and are still fully capable of independent living (and therefore qualify).

Second choice - Self-insure for LTC including setting aside the funds and some planning regarding where the at-home spouse will live, how he/she will cover expenses, etc.

Financially, we're ok either way. Our preference for the Plan A CCRC is that we've seen the importance of having an advocate/visitor when you're a NH resident. DW spent five years visiting her DM several times a week, about a half hour's drive each way. It was brutal, especially in winter. If one of us needs NH care, we want the other to be living where visiting means easily walking over yet the independent living accommodations are definitely upscale and as pleasant as possible for the healthy spouse.

 

[ncbill]

My wife and I bought a single pay, combined insured, hybrid life policy with LTC benefits from One America/State Life company four years ago. It is a "two insureds" policy which provides the LTC benefits to either one, or the other, or both of us until the policy limits are reached. It also has a 3% inflation rider which we pay annually, and can quit paying for that at anytime if we feel we are adequately covered for our life expectancies. The policy pays up to $7000 a month LTC benefits, and will cover home care as well. It has a 60-day elimination period. The life insurance pays upon second to die, and amount is reduced by any LTC benefits paid. Policy was issued based on "combined age" (i.e., wife was 62 and I was 69 at issue, so premium based on combined age 64. Paid $121,000 up front, life insurance amount is $233,000. So, if LTC benefit is never used, our kids get the $233,000! So, I figured for peace of the LTC coverage and "refund" feature to our family via life benefits, the insurance company gets to use/invest our upfront premium. Fair deal!!

But what is the current annual cost for the "3% inflation" rider?

 

[audreyh1]

FWIW, if money is not a real issue, you can get 24/7 care in your own house and die there if that's what you want to do. Lots of outfits out there that specialize in such things.

My brother has a housekeeper and someone else who comes in every other day to help with his showers/bathing. He could get someone to wipe him if he needed that too or whatever else a SNF does.

Someone has to manage and pay for that care. At some point the elderly person really can't manage it. It can work well if good family willing to supervise lives nearby. But otherwise I don't see how to make it work. There is no way DF could have done it.

 

[ncbill]

FWIW, if money is not a real issue, you can get 24/7 care in your own house and die there if that's what you want to do. Lots of outfits out there that specialize in such things.

My brother has a housekeeper and someone else who comes in every other day to help with his showers/bathing. He could get someone to wipe him if he needed that too or whatever else a SNF does.

You don't need a SNF for that.

After she was unexpectedly diagnosed with terminal cancer while in hospital for surgery (never took place) my aunt went into a SNF near the hospital.

She had loved that SNF when on the Medicare rehab side but hated the custodial care side (only semiprivate rooms), though we were able to start Hospice for her there.

So after only a few weeks I arranged for her to be moved to a private room in an ALF near me.

Even though she was completely bed-bound by then (from the progression of the cancer) they had no trouble taking care of her...at a cost of less than half that of the SNF.

 

[harllee]

For "youbet" and others who want to go into a CCRC but are not ready to leave their house yet, I know of some folks who have bought into the CCRC , paid the money, have their apartment and are paying the monthly fees but kept their house and are still living in the house for the time being. Costs a lot of $$ but it can be done.

On the issue of the effect of Covid on CCRCs--the one where I am on the waiting list has done a great job of keeping their residents safe from Covid, they have had very few cases and no deaths. They can afford better testing, better paid and more stable employees, etc. Also they were able to work with the local health department and got their residents vaccinated among the first.

 

[youbet]

For "youbet" and others who want to go into a CCRC but are not ready to leave their house yet, I know of some folks who have bought into the CCRC , paid the money, have their apartment and are paying the monthly fees but kept their house and are still living in the house for the time being. Costs a lot of $$ but it can be done.

On the issue of the effect of Covid on CCRCs--the one where I am on the waiting list has done a great job of keeping their residents safe from Covid, they have had very few cases and no deaths. They can afford better testing, better paid and more stable employees, etc. Also they were able to work with the local health department and got their residents vaccinated among the first.

Yep, that's true Harlee. It would be quite expensive, but I'm sure the CCRC would think it's fine if you buy-in, pay the monthly fee but only stop by from time to time.

From time to time, we have seen opportunities where a CCRC will take a deposit (substantial) and charge you a partial monthly fee to cover the insurance component of the Part A contract and let that go on until the type of unit you want is available. If you need NH care prior to your move-in, you're covered. We're looking at that option at one place we like.

 

[nwsteve]

On the issue of the effect of Covid on CCRCs--the one where I am on the waiting list has done a great job of keeping their residents safe from Covid, they have had very few cases and no deaths. They can afford better testing, better paid and more stable employees, etc. Also they were able to work with the local health department and got their residents vaccinated among the first.

Ditto for our CCRC. We got both our Covid shots done before first week in Feb--well before most of seniors in the state. Walgreens sent a team and inoculated from 8-5, including staff. We had no infections in Independent Living but did have some in the SNF which appears to have come in from the community. As a fairly new property, it still accepts community SNF & AL for short stay (think joint replacement). In two more years, that will not happen.
Harlee comment regarding better staff and less turnover is key as every turnover comes a risk of an outside infection coming on campus. All staff are still be tested weekly. We were told on a new parttime hire in AL that was feeling "bad", immediately tested and sent home. Later came back positive but it appears no infection on campus--vaccine works!

 

[RobbieB]

Self funded home care.

 

[ChrisC]

LTCi and CCRC (on the waitlist). Our initial plan was to age-in-place in our home, in which we could bring in home health care if necessary, leverging the LTCi and self-fund any shortage. Then, we had to care for MIL and BIL in our house on an emergency medical basis. And wiping a 97 year old's ass and caring for MS challenged 62 year old for several months made us re-assess our plan. We don't want any of our children to be in a situation of having to carefully monitor our LTC, which would likely be the case if we stayed at home and needed skilled nursing care. Besides, finding suitable home care would be challenging, as our experience with my MIL and BIL demonstrated.

So, we started visiting CCRCs in our community and placed a waitlist deposit on an expensive Type C-CCRC, in which you purchase your residential unit and have equity ownership in the unit. This CCRC has villas/condos in multi-family housing and separate single family homes, and a skilled nursing facility with 60 beds. We're not completely sure the social aspect of the CCRC (more like a country club environment) is a good fit for us, but the life-cycle program and SNF would work exceptionally well with our LTCi.

We've been tracking the Covid-19 report our state puts out. And the data has disclosed outbreaks in a number of facilities. The report, which disclosed outbreaks in the skilled nursing wing of the CCRC we've waitlisted, has caused us to re-assess our preference for units at the CCRC, which initially was for a villa/condo. I might add that there has been no reported outbreaks in the independent living quarters of this CCRC. One thing I have noticed in the reports is that the outbreaks seem to be the result of Covid-19 spreading among the staff. Moreover, I thought I heard on some podcast that the biggest driver of high infection rates in nursing homes is staff turnover.

We're 67 and 69 and perhaps still 4-6 years away from moving into our CCRC, assuming we maintain our good health.

 

[marko]

Someone has to manage and pay for that care. At some point the elderly person really can't manage it. It can work well if good family willing to supervise lives nearby. But otherwise I don't see how to make it work. There is no way DF could have done it.

Right. I was responding to the poster who was on-site physically and had to do a number of unpleasant support tasks. The poster sort of implied there was no other way (assuming money was not an issue).

Given the choice between 'wiping' someone and managing their money/writing checks for them, I think most folks would choose the latter.

 

[corn18]

LTCi and CCRC (on the waitlist). Our initial plan was to age-in-place in our home, in which we could bring in home health care if necessary, leverging the LTCi and self-fund any shortage. Then, we had to care for MIL and BIL in our house on an emergency medical basis. And wiping a 97 year old's ass and caring for MS challenged 62 year old for several months made us re-assess our plan. We don't want any of our children to be in a situation of having to carefully monitor our LTC, which would likely be the case if we stayed at home and needed skilled nursing care. Besides, finding suitable home care would be challenging, as our experience with my MIL and BIL demonstrated.

So, we started visiting CCRCs in our community and placed a waitlist deposit on an expensive Type C-CCRC, in which you purchase your residential unit and have equity ownership in the unit. This CCRC has villas/condos in multi-family housing and separate single family homes, and a skilled nursing facility with 60 beds. We're not completely sure the social aspect of the CCRC (more like a country club environment) is a good fit for us, but the life-cycle program and SNF would work exceptionally well with our LTCi.

We've been tracking the Covid-19 report our state puts out. And the data has disclosed outbreaks in a number of facilities. The report, which disclosed outbreaks in the skilled nursing wing of the CCRC we've waitlisted, has caused us to re-assess our preference for units at the CCRC, which initially was for a villa/condo. I might add that there has been no reported outbreaks in the independent living quarters of this CCRC. One thing I have noticed in the reports is that the outbreaks seem to be the result of Covid-19 spreading among the staff. Moreover, I thought I heard on some podcast that the biggest driver of high infection rates in nursing homes is staff turnover.

We're 67 and 69 and perhaps still 4-6 years away from moving into our CCRC, assuming we maintain our good health.

I love you. What a great approach.

 

[youbet]

I love you. What a great approach.

The catch being that this requires you to be able to self-insure or that you have LTCi since it's a Type C contract. Since ChrisC does have LTCi, sounds like a winner.