your strategy for long term care

[Gumby]

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Originally Posted by youbet 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]

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Originally Posted by CardsFan 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]

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Originally Posted by 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.

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]

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Originally Posted by 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....

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]

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Originally Posted by RetireeRobert 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.

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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.

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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]

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Originally Posted by ncbill 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]

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Originally Posted by youbet ......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]

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Originally Posted by audreyh1 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]

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Originally Posted by CoolChange 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]

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Originally Posted by Lewis Clark 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]

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Originally Posted by Ready 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]

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Originally Posted by RetireeRobert 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.

[Dtail]

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Originally Posted by youbet 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]

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Originally Posted by Dtail 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]

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Originally Posted by twaddle 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]

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Originally Posted by Dtail 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?

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... 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.