your strategy for long term care

[frayne]

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

Ditto !

 

[BarbWire]

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.

Exactly. In the last two years of my parents' lives I was their full time healthcare coordinator / financial manager / advocate. DM went to a memory care unit, and I had to be her "person" and visited at least weekly to monitor the situation. DF died at home, and though we had lots of caregivers over two years, I still had to orchestrate, interview, and even be the caregiver if the CNA was a no-show. And basically run his household with grocery shopping, etc. And manage their finances (though DF had 95% of his marbles until the last few weeks).


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

 

[MrsHaloFIRE]

Amen. If you do it privately not through an agency you are running your own staffing and payroll service. Finding coverage for late and missed shifts. Buying the groceries, managing the drs office calls and meds. Its a full time job to keep private help in your home. The infirm cannot do it and the family member running payroll/staffing/pharm/logistics is working a fulltime job. Imagine running a rest home with no help. Thats what youve got on your hands 24/7. And its not for a customer so youre entirely emotionally involved with your sole patient with evolving needs almost daily. Diff bandages. Diff diets. Horrific laundry!!! Bonus points if they are grumpy or senile and treat you like sh#t or curse out the hired help. This is no easy way to ease into the inevitable.

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.

 

[RetireeRobert]

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

You and others have indicated sharp skepticism about LTCi and instead say you will self-insure.

But I wonder how many like you for years buy home owners insurance without any thought as to insurers denying claims?

People trust home insurance companies and buy the product, they trust auto insurance companies and buy the product, they trust umbrella insurance companies and buy the product.

But Long term Care insurance, no they don't trust the insurance companies contractual promises (which by the way are regulated by State Insurance regulatory agencies just as home insurance, auto insurance, umbrella insurance, and other types of consumer insurance are regulated), and they say "I will self-insure".

I think a lot of the claims complaints relating to LTCi relate to people not understanding the contractual promises. Usually they revolve around two ADL's (activities of daily living) being compromised to the extent the insured cannot perform for themselves two ADLs. And of course, the inability to perform two ADLs must be assessed by a professional as spelled out in the policy, and people do not get those assessments (such as by the person's doctor, or other professional as agreed in the policy). Also most LTCi policies have a "waiting" period of two or three months, but people are often thinking after one week "Mom's in the nursing home-why isn't her LTCi paying"?

I think a lot of the claims complaints arise from misunderstandings such as this, and failure to "use" the LTCi "when" and "how" the contract specifies. As well, even in the case of real hassles, people do not follow through with available resources to help them resolve claims (State Insurer regulatory authorities).

 

[CardsFan]

You and others have indicated sharp skepticism about LTCi and instead say you will self-insure.

But I wonder how many like you for years buy home owners insurance without any thought as to insurers denying claims?

People trust home insurance companies and buy the product, they trust auto insurance companies and buy the product, they trust umbrella insurance companies and buy the product.

But Long term Care insurance, no they don't trust the insurance companies contractual promises (which by the way are regulated by State Insurance regulatory agencies just as home insurance, auto insurance, umbrella insurance, and other types of consumer insurance are regulated), and they say "I will self-insure".

I think a lot of the claims complaints relating to LTCi relate to people not understanding the contractual promises. Usually they revolve around two ADL's (activities of daily living) being compromised to the extent the insured cannot perform for themselves two ADLs. And of course, the inability to perform two ADLs must be assessed by a professional as spelled out in the policy, and people do not get those assessments (such as by the person's doctor, or other professional as agreed in the policy). Also most LTCi policies have a "waiting" period of two or three months, but people are often thinking after one week "Mom's in the nursing home-why isn't her LTCi paying"?

I think a lot of the claims complaints arise from misunderstandings such as this, and failure to "use" the LTCi "when" and "how" the contract specifies. As well, even in the case of real hassles, people do not follow through with available resources to help them resolve claims (State Insurer regulatory authorities).

I have said this before, but the problem with any LTCI policy you can buy now is the limit.

Insurance is there to cover what we cannot afford to pay out of pocket. 3-4 years (each), no problem. 20 years each, problem.

I wait for the policy with a 3 or 4 YEAR elimination, then pays for rest of life. THAT would be insurance.

 

[harllee]

Regarding LTDI claims versus Homeowners Insurance claims. I can research homeowners insurance and find out the best company to handle claims--I did this and it is Amica so that is the company I insure my house and car with. If Amica changes and gets bad ratings for claims I can easily change to another homeowners insurance company. Not so for LTCI. It is almost impossible to research and determine if a LTCI is good with claims. If I do find out my LTCI is not good with claims I will probably not qualify to go with a different company and even if I could that premiums would be much greater. LTCI and homeowners insurance are no way comparable.

 

[martyp]

I canceled my LTC this week. I bought my policy 25 years ago. When I logged into pay my quarterly premium they had a notice that they were not enrolling new customers. That their long term investments were not performing well. That they were increasing premiums 50% in July and 25% more the following year. They were offering lower benefits in exchange for lower rates. They did a similar rate increase 10 years before and I accepted a reduction of lifetime benefits to 10 years. At this point now I can’t see accepting two more benefit reductions or the rate increases since I moved to Thailand 4 years ago. The company is not looking like it will survive much longer anyway.

 

[HI Bill]

After seeing my mom in a memory care unit, my LTC plan has a 9mm diameter. Seriously, I have no intent or desire for LTC, and plan to avoid it at all costs. I just pray I don't have a stroke or anything before I end up on one.

 

[daylatedollarshort]

We plan to self fund. The look back period for Medicaid in California is 30 months for assets and 5 years for real estate. If we still have our marbles and need care beyond that amount of time, maybe we will give our assets to our kids and go on Medicaid after the look back period is up.

 

[RetireeRobert]

I canceled my LTC this week. I bought my policy 25 years ago. ......... That they were increasing premiums 50% in July and 25% more the following year. They were offering lower benefits in exchange for lower rates. They did a similar rate increase 10 years before and I accepted a reduction of lifetime benefits to 10 years. ...........

This is typical of others' complaint about LTCi, premium increase and/or coverage reductions over the years. The other typical complaint is "what if I never use the coverage, then all the premiums I pay were wasted".

I had exactly those two problems myself. I solved it with whole life insurance LTC hybrid.

For my single premium upfront, I got leveraged coverage to provide what I deemed adequate LTC coverage for what I deemed an adequate period of 3 years. For that same single upfront premium I also got leveraged amount of life insurance that goes to my heirs if I never used (or never used all) of the LTC benefits. The One America/State Life policy also covered both my wife and I under one policy with LTC benefits available for either or both of us.

Some seem to want an "umbrella" type LTC policy for catastrophe coverage of paying "after" 3 or 4 years of self-insured LTC need for the rest of one's life. Yes, that would be a catastrophe, and such coverage would be prohibitively expensive. But people already have catastrophe coverage of going on medicaid after depleting their assets.

The "by far most likely" peril is what I worry about, the one "most likely" to occur, 3 or 4 years of LTC need. The whole life/LTC hybrid nicely solves that problem for me---at a price I can afford---to preserve assets for my heirs. And in fact "guarantees" an increase in assets--the life insurance--to give to my heirs if I never need the LTC.

 

[Gumby]

To the CCRC crowd.......

As in many areas over the years I have been on this board, I expect the young wife and I will follow your example.

 

[ncbill]

I have said this before, but the problem with any LTCI policy you can buy now is the limit.

Insurance is there to cover what we cannot afford to pay out of pocket. 3-4 years (each), no problem. 20 years each, problem.

I wait for the policy with a 3 or 4 YEAR elimination, then pays for rest of life. THAT would be insurance.

They exist but premiums are not cheaper enough to make financial sense.

IIRC, the LTC broker over on bogleheads pointed out a $400/day policy with 4-year wait doesn't catch up to a $200/day policy with a 90 day wait until sometime in year 8...very few who need LTC would survive that long.

 

[ncbill]

After seeing my mom in a memory care unit, my LTC plan has a 9mm diameter. Seriously, I have no intent or desire for LTC, and plan to avoid it at all costs. I just pray I don't have a stroke or anything before I end up on one.

I don't think one needs to be that dramatic.

There's a professor out there who advocates nothing more than palliative care past a certain age (70 or 75)...quality of life over quantity, based on what he's seen with the elderly population he's studied.

On a personal note, by the time my mom became bed-bound as a result of the progression of her dementia she could no longer perform any ADLs or even communicate with any of us, nor did we think she even knew we were there anymore.

But after become bed-bound she began suffering repeated UTIs which I had treated with oral antibiotics (her health care POA prohibited IV antibiotics)...that went on for years, until the last UTI, which resulted in a fatal sepsis.

In hindsight, I feel like all I ended up doing was prolonging the course of her terminal illness...for nearly a decade.

So for me, I choose only palliative care if diagnosed with a terminal illness, even one as slow as dementia...no antibiotics, even oral ones.

 

[Lewis Clark]

My dad had a LTC policy and it paid as promised until he died. No issues with them.

My mom still has her LTC policy. Every year or two, she (and dad while he was still alive) gets a letter from the insurance company offering her either a large premium increase for the same coverage, or a significant decrease in coverage for the same premium.

When I consider what they have paid in premiums, and what the limit of covrage is, in my view the policies were never worth the money.

I looked into LTC insurance for myself around age 50. Would like to have LTC insurance, but it is not worth the premiums for me.

 

[pb4uski]

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....

This reminds me of a elderly great uncle who had plenty of money but his abilities declined to apoint where he could no longer live on his own and he refused to go to a nursing home because it "cost too much". He ended up living in his own feces and squalor because we was too cheap to pay for proper care.

But his greedy heirs appreciated his sacrifice.

 

[youbet]

Some seem to want an "umbrella" type LTC policy for catastrophe coverage of paying "after" 3 or 4 years of self-insured LTC need for the rest of one's life. Yes, that would be a catastrophe, and such coverage would be prohibitively expensive.

It should not be "prohibitively expensive." Very, very few people would use it according to current NH usage statistics. When lots of people are paying into a class of insurance and very few are collecting, that tends to drive premiums down.

But people already have catastrophe coverage of going on medicaid after depleting their assets.

I think this is wrong on two counts. First, in some states (like Illinois where I live) most Medicaid funded NH care is poor. If you're both fortunate to be in a quality home that will keep you on Medicaid and you have clever and hard working advocates, you might avoid inferior Medicaid funded care. But, it's a crap shoot. Been there and done that. Second, you must have little concern for your spouse. If you deplete your assets to go on Medicaid, that means your spouse is left with little to live on. That eventuality is what most of us are trying to avoid.

The "by far most likely" peril is what I worry about, the one "most likely" to occur, 3 or 4 years of LTC need.

This is a personal situation for each of us. In my case, paying for 3 or 4 years of NH care would be fundable without impoverishing my spouse. It's the long stay costing perhaps a million bux or more that would be troublesome. Obviously your finances are different so you're doing what you have to do. That's what we should all do...... the thing that is best for our own personal circumstances. My beef with you is that you're so aggressively pushing a solution you deem appropriate for you as being appropriate for everyone.

Having said that...... I am looking at LTCi via a Type A CCRC contract and have been visiting places in this area for the last couple of years.

 

[youbet]

They exist but premiums are not cheaper enough to make financial sense.

IIRC, the LTC broker over on bogleheads pointed out a $400/day policy with 4-year wait doesn't catch up to a $200/day policy with a 90 day wait until sometime in year 8...very few who need LTC would survive that long.

Please help with this by sharing where we can find them! I've looked on the Internet, talked to agents, etc., and so far have come up empty. Anyplace other than the broker on bogleheads talking.... ?

I'd like to understand why the broker compared a $200/day policy to a $400/day policy and why the premiums wouldn't be cheaper considering the fact that folks collecting would be down in the low single digit percentages.

 

[RetireeRobert]

......Second, you must have little concern for your spouse. If you deplete your assets to go on Medicaid, that means your spouse is left with little to live on.

........ My beef with you is that you're so aggressively pushing a solution you deem appropriate for you as being appropriate for everyone..........

As to my DW, she died over a year ago, so you are quite wrong about your judgement of my level of concern for her.

Furthermore, you say you have a beef with me for so aggressively pushing a solution "I deem appropriate for everyone." I never, not once, said I deem Whole Life/LTC hybrids appropriate for everyone. I did point out their existence and advantages for many who "so aggressively" seemed to keep deriding LTCi at all and saying "self insure" instead. Indeed self insure solution is not only not appropriate for everyone, it is not possible for everyone.

 

[Dtail]

My father has an LTC policy and still they will pay out around 100k for unreimbursed 24/7 home care costs this year.

 

[CoolChange]

Personal Advocate/Manager

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.

This is my major concern, serious decline in my [already slowly diminishing?] faculties with no one to take over day to day household management.

I am still seeking a reasonable solution and keep reading these threads hoping someone will share something that I have completely missed.

 

[audreyh1]

This is my major concern, serious decline in my [already slowly diminishing?] faculties with no one to take over day to day household management.

I am still seeking a reasonable solution and keep reading these threads hoping someone will share something that I have completely missed.

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.

 

[bookman51]

We are self-funding for long-term care. By the time we looked into it, at ages in our late 40s, it was cost prohibitive for us.

I would agree. My wife and I looked into it even later in life. As I recall 20 years ago there were several companies involved. Most bailed out and there are just a few now. Given the cost and time span, I am not sure I would enroll now even if I were in my 20s or 30s. There is a good chance a company might not be around by the time one might need it. I do not know how well they are regulated.

 

[JJpop]

MIL is with Genworth. But I think you will find similar stories from many on the forum who have had similar experiences. The basic problem with LTC plans are twofold:

1) They get to decide if you meet the criteria for being eligible, and the criteria is hard to pin down. There is a lot of wiggle room for them to decide you are not eligible.

2) They get to decide how much the plan is going to increase each year. In theory there is some formula based on prior year’s losses, but at the end of the day they calculate what it is and send you a bill. You either pay the increase each year, reduce your coverage, or cancel the policy and lose everything you put into it.

So they have all the power in the contract and you have the choice to pay the premiums and hope it will be there for you or back out and lose what you put into it. It’s so one sided that it’s just a bad deal for most people.

I am pretty sure any increases have to be approved by the state insurance board.
My brother had a Genworth policy and it paid out about 350,000 until he passed with no problems in California.

 

[couch]

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.

 

[youbet]

As to my DW, she died over a year ago, so you are quite wrong about your judgement of my level of concern for her.

Furthermore, you say you have a beef with me for so aggressively pushing a solution "I deem appropriate for everyone." I never, not once, said I deem Whole Life/LTC hybrids appropriate for everyone. I did point out their existence and advantages for many who "so aggressively" seemed to keep deriding LTCi at all and saying "self insure" instead. Indeed self insure solution is not only not appropriate for everyone, it is not possible for everyone.

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.