your strategy for long term care

[Dtail]

My sincere condolences concerning the loss of your DW RetireeRobert.

I said that you seem to deem your solution "appropriate for everyone" because you push it again and again and again. We get it. We understand it. Some of us have chosen to not follow that path because it fails to fit our personal situations. Of course, we understand it fully fits yours.

You mentioned about depleting assets to qualify for Medicaid. One can go the irrevocable trust route and not deplete all their assets.

 

[youbet]

You mentioned about depleting assets to qualify for Medicaid. One can go the irrevocable trust route and not deplete all their assets.

Must depend on the state. Here in Illinois, assets removed from your control (permanently) are indeed removed permanently. You can't just create a trust transferring everything to DW and go on Medicaid.

Have you actually done this? How does it work specifically?

 

[ddoorn]

Totally agree!

Plenty of exercise and protein. A DNR order. Living in a single-level home. That's about it.

Good to see someone on my wavelength, lol!

I keep telling DW, who has a roving eye for a new house: we have everything we need on one floor, I’m not budging!

Don

 

[pb4uski]

You mentioned about depleting assets to qualify for Medicaid. One can go the irrevocable trust route and not deplete all their assets.

But you have to create and fund the irrevocable trust in advance, right?

... Remember, funding an irrevocable trust within the five years prior to applying for Medicaid (the "look-back period") may result in a period of ineligibility. The actual period of ineligibility depends on the amount transferred to the trust. ...

 

[davidfin]

Self funding 50%. Using surrender value cash from Universal Life policy to fund remaining 50%. It’s a tax free exchange until paid in amount is consumed. So basically no additional cost for the first 10 years or so. Afterwards, will pay tax on premiums from dividends used pay LTC premiums. Universal Life premiums are a sunk cost and there remains a significant death benefit.

 

[RetireeRobert]

My sincere condolences concerning the loss of your DW RetireeRobert.

I said that you seem to deem your solution "appropriate for everyone" because you push it again and again and again. We get it. We understand it. Some of us have chosen to not follow that path .....

Thank you for your condolences.

My only beef with you is you over and over and over and over say you are going to self insure. You don't trust the LTCi companies or industry and don't look forward to rate increases, or would rather have some LTCi company cover the costs "after" 3 or 4 years of self-insure.

Your self insure solution, you seem to push aggressively as the solution for everyone, forgetting that many cannot afford to self-insure. We get it, we understand it, but it is not the solution for many of us! Glad it works for you and that you are in a position which some are not to be able to self insure.

After reading so many posts about "forget LTCi, self insure" in this thread, I feel it only fair to point out the Whole life/LTC hybrid policies. As these policies solve some of the big shortcomings with LTCi others mention, and they are affordable for many who could not otherwise afford 3 or 4 years of "self insure."

 

[Sunset]

....
As a solo individual (no close family) this has me concerned: I have the finances for care, but who will run it?

This is also the concern for couples with no nearby children. Sure it's fine for the first one, assuming both don't get bad at the same time.

But then only one is left and is in the same predicament as they are now solo.

 

[Sunset]

My plan is to self fund LTC with the value of my house. It falls apart a little I guess I only one of my DW or I needs care. But still, I think the equity will cover the both of us.

It's a difficult problem, as it's highly likely it will be one of you before the other. Where will you live if she spends the house for NH care ?
Then what will you do if you need a NH ?

 

[Dtail]

But you have to create and fund the irrevocable trust in advance, right?

Yes with the 5 year lookback.

 

[Dtail]

Must depend on the state. Here in Illinois, assets removed from your control (permanently) are indeed removed permanently. You can't just create a trust transferring everything to DW and go on Medicaid.

Have you actually done this? How does it work specifically?

An irrevocable trust has been created for my parents in 2017 and funded in Jan 2018.
There will be a 5 year lookback going ahead to 2023. So currently my DF requires 24/7 home care, of which the trust has no current effect.

 

[BarbWire]

There is also a very serious issue of an elderly person stuck at home falling prey to an unscrupulous home care worker without family members nearby to keep an eye on things.

It takes some effort to properly vet people routinely coming into your home.

Does moving to a CCRC get rid of this issue? Can't a CCRC care worker "befriend" a resident the same way?


I'm thinking of a CCRC eventually (though the only one I've been exposed to via a next door neighbor whose parents were in it was a financialy and admnistrative nightmare). As a solo person with no near relatives in this country, it may be my best protection ...

 

[mickeyd]

We are self-funded for LTC.

We long ago saw LTCi as a crap shoot the favored insurance company. We have been in our CCRC for almost 2 years now and it is all that it was advertised.

If you are CCRC shopping, get onboard ASAP.

 

[harllee]

Does moving to a CCRC get rid of this issue? Can't a CCRC care worker "befriend" a resident the same way?


I'm thinking of a CCRC eventually (though the only one I've been exposed to via a next door neighbor whose parents were in it was a financialy and admnistrative nightmare). As a solo person with no near relatives in this country, it may be my best protection ...

From what I have seen at the CCRC where we are going they have a higher caliber employee-- they pay more than most places and have less turn over. They also screen and do back ground checks. It seems to me less likely for a good CCRC to have unscrupulous employees.

 

[ChrisC]

Does moving to a CCRC get rid of this issue? Can't a CCRC care worker "befriend" a resident the same way?


I'm thinking of a CCRC eventually (though the only one I've been exposed to via a next door neighbor whose parents were in it was a financialy and admnistrative nightmare). As a solo person with no near relatives in this country, it may be my best protection ...

I've noticed that many single folks are entering CCRCs as residents, which expands social networking opportunities, offers opportunities to make friends with kindred spirits, and provides more accessible home health care workers. I think a major benefit of the CCRC for those flying solo (whether they enter the CCRC as solo residents or become solo residents because a partner has left the premises) is the potential to make new caring friends or become part of an extended CCRC family.

But one has to always be careful about placing too much trust in the CCRC and its workers. Places where the elderly are captive residents and are in cognitive decline provide others with fertile grounds to scam and take advantage of the situation.

 

[audreyh1]

Does moving to a CCRC get rid of this issue? Can't a CCRC care worker "befriend" a resident the same way?


I'm thinking of a CCRC eventually (though the only one I've been exposed to via a next door neighbor whose parents were in it was a financialy and admnistrative nightmare). As a solo person with no near relatives in this country, it may be my best protection ...

There is a structure and supervision. Many people, not just one or two at home with an isolated elderly person.

I think the opportunities for foul play without getting caught are reduced.

Plus what Harllee said. You definitely want a place with long term employees and low turnover.

 

[anethum]

My parents attended an LTCi presentation many years ago and ultimately decided to self-fund, in large part due to my dad's COLA'd pension with survivor benefits. Around age 90, dad began a gradual descent due to vascular dementia. Around age 94, he had a stroke and needed 24/7 skilled nursing care. Months later, he died at home, which was probably more important for my mom.

Unfortunately, within months of dad's death, mom started showing serious signs of dementia. The next 18 months were hellish for me because she would phone me every single evening (usually multiple times) because she couldn't find my dad. It was classic "sundowning" syndrome. I'd even get texts and calls from her neighbor if she saw my mom wandering around in the dark, looking for my dad. But mom wouldn't accept any help at home until she fell and fractured her pelvis. After rehabilitation, she returned home and has had caregivers 24/7 since then. This has gone on for several years as her dementia worsened and she became more and more frail. Last fall, she fell again and fractured her hip.

After surgery to hold her hip together with a rod for the duration of her life, and after physical therapy at home, I decided it was time for home hospice. She was evaluated and approved for home hospice by a nurse who told me that my mom had been getting excellent care, and that I had basically been running a nursing home. I had never thought about it in those terms, but I realized that the nurse was correct. Home hospice, BTW, has already been of great help.

This has certainly taken a toll on me. For several years, I've had to buy mom's food, medicine, household items, make medical decisions, deal with issues with her house, her finances, taxes, and deal with the caregivers. My one sibling also lives just 10 minutes from mom. But mom never called him when she couldn't find dad, and he has refused to help out in any way. As a result, we are no longer on speaking terms.

My parents always had an LBYM lifestyle. Their assets started to grow as they aged and were spending less and less. Now the spigot is flowing out the other way. In an HCOL area, between my dad's skilled nursing care and my mom's home care, the cost has been nearly $750,000. That's just for the care. Given my mom's age (99) and state of health, I'm pretty sure the money will outlast her. A reverse mortgage would be the last resort.

As for me, I'm in the same situation described by BarbWire. I'm self-funding, but I hope that if I get to the situation my dad knew he was getting into at the early stages of dementia, that I have the courage and the means to end things peacefully on my own.

 

[harllee]

Wow, anethum, you have really had a hard time with your parents. There should be a special place in heaven for a dedicated child like you. Your brother, on the other hand---

 

[MrsHaloFIRE]

im hearing this from friends and also on the board about people declining to have help at home. Is this because they dont have the awareness to KNOW they need help? Or they think its the end of independence (which if they need help, that ship as kind of already sailed)? Or a friend's parent didnt want "strangers in the house at night." Any insight? Is it just a part of the mental decline? Or do some people with all of their mental faculties just flat out refuse and would lather lie in a pool of their own waste with the expectation they will personally handle it or their children will indeed handle it? This feels uncool.

 

[meleana]

im hearing this from friends and also on the board about people declining to have help at home. Is this because they dont have the awareness to KNOW they need help? Or they think its the end of independence (which if they need help, that ship as kind of already sailed)? Or a friend's parent didnt want "strangers in the house at night." Any insight? Is it just a part of the mental decline? Or do some people with all of their mental faculties just flat out refuse and would lather lie in a pool of their own waste with the expectation they will personally handle it or their children will indeed handle it? This feels uncool.

All of this.


I worked in home health care for most of my life and went through it with my own parents.



Honestly, good, dependable and honest home care help is hard to find. It seems it would be ideal, but the reality is it often times is not- far from it. Almost like child care, the best help is that from your family, but that is also not realistic and puts a big burden on them.


I know when my time comes I don't like either of the choices- home or facility. Do not have Long Term Care Insurance either.



Has anyone else read the controversial book Final Exit?

 

[audreyh1]

im hearing this from friends and also on the board about people declining to have help at home. Is this because they dont have the awareness to KNOW they need help? Or they think its the end of independence (which if they need help, that ship as kind of already sailed)? Or a friend's parent didnt want "strangers in the house at night." Any insight? Is it just a part of the mental decline? Or do some people with all of their mental faculties just flat out refuse and would lather lie in a pool of their own waste with the expectation they will personally handle it or their children will indeed handle it? This feels uncool.

I agree - it’s all of that.

It is very uncool.

 

[ncbill]

An irrevocable trust has been created for my parents in 2017 and funded in Jan 2018.
There will be a 5 year lookback going ahead to 2023. So currently my DF requires 24/7 home care, of which the trust has no current effect.

A 5 year look-back isn't the only concern.

When I was on a high-traffic Alzheimer's email list years ago one attorney posted that her state had passed a law allowing the state to "bust" open Medicaid irrevocable trusts...even after the look-back (only 3 years back then) to get access to the principal.

So you might have to domicile any irrevocable trust setup to preserve assets from attachment by Medicaid out-of-state as well.

 

[ncbill]

Self funding 50%. Using surrender value cash from Universal Life policy to fund remaining 50%. It’s a tax free exchange until paid in amount is consumed. So basically no additional cost for the first 10 years or so. Afterwards, will pay tax on premiums from dividends used pay LTC premiums. Universal Life premiums are a sunk cost and there remains a significant death benefit.

Are the benefits guaranteed?

Normally universal life policies recalculate the insurance premium annually.

It starts out cheap but down the road the insurance premium rises to the point that it more than drains any built-up cash value & so the policy "blows up" without substantial additional cash infusions.

So it's important to review the guaranteed, not the projected, illustration.

I had one agent who wanted me to trade in my plain-vanilla whole life for a policy with LTC benefits, but the new policy was UL rather than WL so under the guarantee it would have blown up in my 60s, likely well before I needed LTC.

 

[ERObjd]

Being that I am over 80% disable war veteran I have the option of veterans ran nursing homes. Not free they would take 50% of military retirement and 100% of VA disability and most of SS retirement every month. Now if my wife needs it we can not afford to self fund and do not have long term insurance. Sadly we might likely end up with a medical divorce to qualify for nursing home. Wemake too much in retirement to qualify for medicaid but not wealthy enough to pay out of pocket. Sadly medical divorce would be an option. I dont like it but it is very common today as millions of couples end up resorting to medical divorce as an optio. A pastor i know had to go to nurse home due to failing health. They were not wealthy but
in order to protect some assets so his wife could at least have some income and assets to live, on a medical divorce was what they had to resort to. I am told it is not uncommon.

 

[syd03]

Purchased single premium LTC policies through Nat'l Guardian four years ago with inflation rider. In the event they're needed, would pay 50% of costs for three years and we'll fund the rest.

 

[MrLoco]

I have a couple of comments.
I feel some have vastly underestimated the future cost of LTC. I saw one post mention self funding at $400,000 for a couple. In my state, in 20 years, when one might need LTC, the cost of a private room in a nursing home will run about $20,000/month. That comes to close to $250,000 for the year for one spouse. And that is just an estimate. The concern we had was not the average time one might spend in a nursing home , but what if we are one of the outliers and "last" more than 2 or 3 years. We planned for legacy and do want to leave assets to our adult children. The LTC Policy lets us do that. We have a policy that covers both of us for 2 years and a shared pool for 2 years that either spouse can draw from. So a max of 6 years. One spouse could use 4 years and the other 2 years. Each spouse always retains their 2 years.

One aspect that attracted us was that the policy qualifies as a "Partnership Plan." What this means is that we can set aside whatever the policy might pay out in the future for MEdicaid purposes. For example, if we both use the max allowed with our policy, we estimate the policy will pay out $750,000 in future dollars. This amount is set aside and not included in total assets when one or both applies for MEdicaid. This assures the $750k passes on to heirs and is not considered for MEdicaid purposes. Plus, the policy is portable to 48 states. It is a reciprocal agreement between 48 states. ( I believe CA and one another state do not honor the policy....so obviously don't move to CA).

Another reason we liked the policy was for tax purposes. We have a huge amount in a TRad. IRA from my previous employer. I have been converting some every year but it just keeps growing and I will never be able to convert all of it (neither do I want to). Assuming the IRS will still allow a Medical deduction ( Sch. A if one itemizes)....we could draw from the Trad. IRA in future years to offset most of the LTC costs and minmize any or all taxes due on the TRad IRA withdrawal. My Mother was able to do this when my FAther was in an Alzheimer facility for 7 years.

Another issue for me is that I had 2 parents with Alzheimers. One can last a lot longer in an Alzheimer facility than a nursing home and the cost is almost identical.

Finally, for those on the fence pertaining to a LTC policy....I was told by my insurer that less than 50% of applicants are even accepted! So you might apply and not even get a chance at a policy. The sweet spot to apply is between 58-63 before any chronic issues arise. I was told that if there is a history or current issue with cancer, diabetes....don't even bother.

My wife and I were lucky in that we both received the Ultra rates which are given only to 15% of applicants who are excepted. If rates rise too much we can always cancel. And those premiums are not "wasted." You can have a disease , episode where you need LTC in your 60's. It does happen.