Beyond E-R

[Guamaniac]

I can think of a couple of ways to make my exit relatively easy. Without being graphic, I offer the CIA spy method of a poison pill. I also saw this example on the recent Vikings Valhalla series. One of the characters knew she was dying a painful death and created a poison pill with plant materials she knew were fatal.

I didn’t mean to make this a focus of my post. I’m really trying to get suggestions or advice on making the older, older years easier.

After witnessing DM's dementia and eventual death in 2019 and now moving DD to AL and then memory care for his dementia I have looked into LTC insurance but just couldn't stomach the premiums for something I may not use. And the premiums keep moving higher. I've also read about people having trouble collecting from the insurance companies at times.

DD's memory care is about $75k/yr for a good facility for our area. A top notch place runs about $120k/yr. I plugged these numbers into firecalc starting at age 84 and was good with the lower amount but came close to a failure with the higher number. My assumption is that the first person to have problems would be cared for by the other and it would be the surviving spouse that would need AL at some point.
If that were the case, our home would no longer be needed and would be sold.
Once I added the home value into firecalc the numbers looked much better.

Just a few days ago I went to the federal LTC insurance sight to look at rates again and got a message that said they had suspended applications to "thoroughly assess benefit offerings and establish sustainable premium rates that reasonably and equitably reflect the cost of the benefits provided".

I think the costs are just getting way out of hand.

 

[Act2]

As my parents aged, their world grew smaller because they were no longer comfortable traveling or even getting out much. Their friends were having similar issues, so there was little socialization. They lived hours away from any family member because Dad wanted to stay in the home. Eventually they moved into a CCRC very near me. It was like my Mom immediately rejoined the living - she now had new friends and frequent social interaction but they could just go into their own apartment if they didn’t want to socialize. I saw them frequently, we shopped together each week as long as they wanted to and could, and basically their lives were better all around. I believe that in their fantasy I would have bought a big house and we would have moved in together, I would have quit my job and been 100% dedicated to their care with no life of my own. That didn’t happen. I am so grateful it didn’t. I spent a lot of time with them and was very glad to be able to do so. But I admit that sharing a home and being a 24/7 caregiver was beyond my abilities. I was quite burned out during that era before they passed away, even as it was. And I have no doubt the care staff at their CCRC, including rehab/skilled nursing, Assisted Living, and Memory Care, all of which we used after Independent Living wasn’t enough, was better than I could have done myself.

I have two supportive brothers but they live hours away. It was mostly just me - single, no kids, but I was always on call or at their CCRC.

Every family and every situation is different. I think this worked best overall for our family, balancing everyone’s needs and abilities as best we could. They truly enjoyed their CCRC, Mom immediately and Dad starting a couple weeks later after his initial uncertainty about it all. Dad outlived Mom by several years. His caregivers there cared for him and he liked them. I interacted with them often, and could see the affection between them and my Dad.

I think wanting to live in one’s longtime home is understandable but sometimes it is not realistic. And sometimes ‘independent’ is not an honest description of how one is living when a family member has morphed into a full-time caregiver. My parents were more able to live happy, social lives when they moved into the CCRC than when they had a home to take care of, meals to prepare, and only themselves to get them to places they needed to go.

 

[Dtail]

My DF needed part time then full time in home care for his last 4 years until passing this year at 92.
My DM assisted, but could tell she was somewhat relieved at his passing. Despite having a LTC plan, the OOP expenses were over 100k in the last year when the care was full time.
My DM will be 90 this year and has no issues of note and a 3 year LTC plan with suspended premiums.
2 of my siblings live close by. I handle all the finances.

 

[Rianne]

I’m encouraged by the responses of caring responsible families helping each other to the best of their abilities. Since we don’t have children but do have immediate family, nieces/nephews and siblings, our plan is to focus on CCRC care. Hopefully, family will check in every so often. We will not burden any family members with our aging health concerns. I don’t want to fear getting older or make it a taboo subject. We’re all going there one way or another. My DB is 7 years older than me, lives independently but is showing signs of decline. He has a good pension and SS, plus health insurance + Medicare in the state of Florida. He’s lucky. We can only hope for the best and plan for the worst.

 

[street]

The experience I have had with LTC was a blessing for my parents. They both spent about 5 years apiece in a nursing home facility. They had a small policy but was a huge help and because of each long stay they had to spend all what they had worked so long for.

My wife and I both have LTC insurance and the cost for an unlimited time of stay with a ~6000$ a month payout. The plan for both of us is just under 140$ a month. For me I felt it was worth the investment to protect a lot of our portfolio. LTC can happen at an early age with an accident etc. just not at old age. If I pay those premiums for 30 years those premiums only cost us ~50K and that wouldn't even be one year stay in a nursing home.

Not saying it is a good trade off or not it all depends on how life goes to see if it was the right thing to do.

 

[Teacher Terry]

Doing 24-7 caregiving is brutal and very different than short stints to overcome an illness or injury. I was very happy to help my parents stay independent but couldn’t have done 24-7 because I had my kids, college and then my career. Plus it’s not fair to expect kids to sacrifice themselves.

I have told my kids that I would accept help similar to what I did for my parents but not full time. I only said this after my youngest has said that he will be there for me. My best friend’s mom still lives alone at 88 and keeps her house clean and hires help for the outside.

Even spouses need to be careful because they can end up dying before the patient from the stress, etc. I have been the guardian for a friend in a nursing home with dementia and one in assisted living with Parkinson’s and both were still a lot of work. The responsibility of the friend in AL was shared with another friend but I lived a few minutes away so was the on call person. I don’t regret doing either.

 

[Sojourner]

I believe that in their fantasy I would have bought a big house and we would have moved in together, I would have quit my job and been 100% dedicated to their care with no life of my own. That didn’t happen. I am so grateful it didn’t. I spent a lot of time with them and was very glad to be able to do so. But I admit that sharing a home and being a 24/7 caregiver was beyond my abilities. I was quite burned out during that era before they passed away, even as it was.

This really resonates with me. My elderly DF is suffering from mid/late stage dementia but it still living in his home with his longtime companion and caregiver, who is thankfully quite a bit younger and in good health. I know that when the time comes where she can no longer care for him adequately, he will be very upset and dismayed at the thought of going to live in a memory care facility. Unfortunately, this is likely to happen within the next 6-12 months, and I dread that day. I'm certain he will ask why he has to go and why he can't just come and live with me or my siblings. It will be heartbreaking. But, just as in your case, DW and I are simply not cut out for being 24/7 caregivers and neither are my siblings. I expect that within 12 months, DF will no longer be able to walk, feed himself, or take care of his personal hygiene at all (i.e., bathing, toilet, etc.). As much as we love him and want him to be as happy and comfortable as possible, there is just no way that any of us can realistically take care of someone in that condition. And I know that, despite what he might say at the time, he wouldn't want to be that kind of burden on us. It's going to be a challenging and gut-wrenching 2023 for our family, that's for sure. It really helps to read about others' experiences and perspectives, so thanks for sharing yours.

 

[Sunset]

The experience I have had with LTC was a blessing for my parents. They both spent about 5 years apiece in a nursing home facility. They had a small policy but was a huge help and because of each long stay they had to spend all what they had worked so long for.

My wife and I both have LTC insurance and the cost for an unlimited time of stay with a ~6000$ a month payout. The plan for both of us is just under 140$ a month. For me I felt it was worth the investment to protect a lot of our portfolio. LTC can happen at an early age with an accident etc. just not at old age. If I pay those premiums for 30 years those premiums only cost us ~50K and that wouldn't even be one year stay in a nursing home.

Not saying it is a good trade off or not it all depends on how life goes to see if it was the right thing to do.

I'm amazed that you haven't had giant increases in the premium for your LTC policy. It seems many others have, to the extent that it priced them out of reach or into a reduction of benefits.

 

[Sunset]

This is frequently stated as the 'final solution' to declining health and increased need for care. Unfortunately, by the time you reach that point it is highly unlikely that you will have the resources and/or the mental capacity to act.

IOW, it's not a viable plan.

+1

Frankly, everyone deep down wants to live. History if full of people in horribly terrible situations that didn't end their own life as they hoped for an improvement.

My DM in the hospital, who had always said DNR , at the last minute, told the Doctor that she wanted to live. She died anyway, and the Doctor told me it's seen very often that people want to live even if previously they claimed not too.

 

[Souschef]

My mom lived in FL, and my sis in NY. I live in CA. My mom lived to 102, and had 24/7 care in her home. My sis and BIL (bless them) would fly down every so often to be with her. I would fly over on my birthday every year.

Shortly before she died, sis was finally able to move her to a nursing home.

 

[audreyh1]

I just don’t see how anyone could expect their children to give them 24/7 care. Supervise perhaps, provided they live not too far away. But even the supervision and oversight takes a lot of work. I managed my Dad’s property and finances when he moved into an AL type facility for almost 4 years, plus another 2.5 years so far as executor. This was still a lot of work. I didn’t have to worry about supervising care until he entered hospice about a year before he died. Then it really was hands on and we essentially relocated for almost a year.

You can’t be independent if someone else has to take care of you. That is not being independent! Or independence in such a situation is an illusion.

 

[braumeister]

Or independence in such a situation is an illusion.

Exactly why a CCRC (Type A contract) is such a good idea for many people, including me.

 

[friar1610]

Just a few days ago I went to the federal LTC insurance sight to look at rates again and got a message that said they had suspended applications to "thoroughly assess benefit offerings and establish sustainable premium rates that reasonably and equitably reflect the cost of the benefits provided".

I think the costs are just getting way out of hand.

As a military retiree, I became eligible for the Fed LTC program shortly after I retired when the field of potential beneficiaries was expanded. My wife and I enrolled and we’ve been having premiums deducted from my military pension ever since. There have been several premium increases over the years (when the contact with OPM is renewed) and we’ve bitten the bullet and stuck with it. (Each time we are offered the opportunity to receive a refund of all premiums paid if we drop it.) Recently we received a letter whose message was along the lines of what you summarized above and that there would be a premium increase in May although it didn’t give any idea how much it would be. I shudder to think how much the increase will be. I’d hate to have to give up the plan at this stage (mid-late 70s) as the chances of really needing the insurance is increasing as we age.

 

[audreyh1]

Exactly why a CCRC (Type A contract) is such a good idea for many people, including me.

Exactly!

That’s a graceful way of dealing with self-care abilities that inevitably decline.

 

[explanade]

I feel so sorry for those of you having to single handedly take care of an aging parent. You are having to pay an awful price for the decisions made by your parents. I am so grateful my mother moved to a nice CCRC at age 80 and now at 90 is doing well with help there. I am her POA and still spend quite a bit of time on her finances, I could not handle 24/7 caregiving. My husband and I are on a waiting list for a nice CCRC and hope to move there some time this year.

Did she pay based on whatever the CCRC was charging when she moved in or had she contracted years earlier?

 

[street]

I'm amazed that you haven't had giant increases in the premium for your LTC policy. It seems many others have, to the extent that it priced them out of reach or into a reduction of benefits.

I have mine with AFLAC and took it when we were about 52 years. I had some insurance with them, and the agent told me if I waited another year those premiums would have been more to start out with. So, we got the policies and within the next few years they stopped selling the LTC policies.

No cost change yet and we have had them about 12 or so years now. My parents had their policies with them also and were very easy to work with and the checks came right to me after they were in nursing home. I than paid their monthly bill from that money.

 

[KarenF]

My Mom was self insured but could afford care. She fought assisted living even when she really needed it. I was still working and it really wore me down working full time and visiting her in the evenings and doing all her laundry, preparing meds, and spending time with her on the weekends. I did not mind spending time with her, but those evening trips I made because I was worried were exhausting. I will not do that to my kids. We have a reasonably good LTC policy and I have put into my long term memory that I will do whatever my kids want me (or us) to do. I have told my kids this and they think I have overreacted but they did not go through what I did. Our LTC policy covers both in home care and facility care.

 

[Montecfo]

We self insure. LTC is too expensive for the benefit, for which there is often no or very little payoff.

I think first-to-die paid up life insurance is a better buy. Use it to replenish funds or build them. It always pays off.

I am saddened for and in awe of folks who have cared for loved ones for years. Praise God for these angels! My parents passed at young ages and never required care, perhaps a weak homage to a quick or sudden decline. I am glad I am not forced to recall them as bedridden. My wife's folks enjoyed long lives but no LTC payout due to elimination periods.

No one in assisted living or LTC planned to be there. But we have to prepare for that eventuality.

One key issue in our plans is mental decline. My 80 year old self just might cancel that expensive LTC policy. Or might forget where I put that super secret poison recipe.

We must plan for mental decline before it grips us.

 

[harllee]

Did she pay based on whatever the CCRC was charging when she moved in or had she contracted years earlier?

My mother had to pay a fairy large entrance fee when she moved into the CCRC at age 80. It was the fee the CCRC was charging at that time. Mother was lucky that she was in good health and able to qualify to move into the CCRC at age 80. My husband and I are not going to wait that long to move into a CCRC, I am afraid we will not qualify health wise if we wait too long.

 

[NoEZmoney]

To LTC or Not LTC?

I've heard many folks stand by their decision to pony up the cash for LTC premiums. And good for them as they feel the cost helps them sleep at night knowing that when (and if ) they need LTC , it will be there.
But I had an aunt and uncle (they were siblings and didn't live together) who paid a lot of $$$ for LTC premiums for years. We're talking serious cash that if they did the same and invested it in the S&P index over the same period they would've likely been covered. The aunt used less than 2 years of LTC benefit before she died. My uncle used less than a year. I did some basic research and learned that when most people need that type of skilled care, they are (on average) about <2 yrs. Reason is they had a catastrophic medical event (stroke, heart attack, pulmonary issue, etc.) and they were slowly on the spiral downward.

Now I know others who have had one family member wind up lasting a few years so there's that. Luck of the draw. But I also know people saving the would-be premiums and putting them in an interest-bearing account or saving up for an annuity. And these folks also established a trust to avoid Medicaid tapping into their savings should they need care.

As for me and DW, we're actually looking at overseas residency where we can use geographic arbitrage for cost-of-living and get excellent care. So there are options. We don't have kids to rely on and our relatives (nieces and nephews) don't instill confidence in us to ask to be our advocates when we get too old to deal with things ourselves.

Anyways...my2cents... as always each one's mileage will vary.

 

[BarbWire]

Exactly why a CCRC (Type A contract) is such a good idea for many people, including me.

But you've got to have someone -- anyone -- who is willing to be the "responsible party" who is contacted by the CCRC for medical and other needs.

My folks went to a CCRC for 9 months (and left because they rightly hated it). I had to be named as the "contact person" and each time there was a "reportable incident" (eg. my father with severe arthritis would sometimes fall -- "rather well" as he said -- no injury as it was more of a crumple when his knees buckled. I was called each time).

If the person has to be transported by ambulance to a hospital, or admitted to the nursing home, the responsible party takes over: the resident is just put in the ambulance with a packet of information and a wave goodbye.

The CCRC is not "in loco parentis."

So for people who are truly flying solo -- no near family or younger friends in North America -- a US CCRC isn't an option.

I worry about this ... a lot.

 

[BarbWire]

I just don’t see how anyone could expect their children to give them 24/7 care. Supervise perhaps, provided they live not too far away. But even the supervision and oversight takes a lot of work. I managed my Dad’s property and finances when he moved into an AL type facility for almost 4 years, plus another 2.5 years so far as executor. This was still a lot of work. I didn’t have to worry about supervising care until he entered hospice about a year before he died. Then it really was hands on and we essentially relocated for almost a year.

You can’t be independent if someone else has to take care of you. That is not being independent! Or independence in such a situation is an illusion.

Precisely. People who dismissively waive a hand and say "we have plenty of money" don't grasp that supervision and oversight -- finances, finding and hiring 24/7 staff, dealing with medical -- is a massive undertaking that SOMEONE has to do.

I did that, single handed, for both parents for three years, and for the final year of DF's life, DM was in residential dementia care but DF was in their home and I was the solo 24/7 caretaker with hired help....when it showed up. DM outlived DF by 11 months, but I was still on call for the dementia facility while working on his estate probate. To settle first his estate and then hers took nearly 2 years. It would have taken much longer had I not managed their finances for the final 5 years.

Early when they needed care I was able to move to their town and telecommute. Then I had to quit my job -- end my career -- to take care of them. Forced ER? There was no other option that would allow me to look in the mirror each morning and know I had done the best I could for them.


I have an excellent LTC policy. I have ample resources. I do not have children, nor nieces or nephews within reasonable distance (NZ). I don't know what the heck I'm going to do for my last decade. My fear is somehow becoming a ward of the state or a predatory eldercare guardian.

 

[BarbWire]

As for me and DW, we're actually looking at overseas residency where we can use geographic arbitrage for cost-of-living and get excellent care. So there are options. We don't have kids to rely on and our relatives (nieces and nephews) don't instill confidence in us to ask to be our advocates when we get too old to deal with things ourselves.

But no matter where you are -- low COL, excellent care (Malaysia and Philippines come to mind), who will be your advocate when you get old?

That is the bottom line, no matter where you are: someone to be your advocate and guardian angel when you are alive, and someone to "mop up" after you have died.

 

[street]

Kind of like home insurance do I really need it. I have paid a lot on 40 year of premiums and haven't got anything in return. It is all a gamble and many people through the years lost the farm to pay for their long years of life.

 

[harllee]

But you've got to have someone -- anyone -- who is willing to be the "responsible party" who is contacted by the CCRC for medical and other needs.

My folks went to a CCRC for 9 months (and left because they rightly hated it). I had to be named as the "contact person" and each time there was a "reportable incident" (eg. my father with severe arthritis would sometimes fall -- "rather well" as he said -- no injury as it was more of a crumple when his knees buckled. I was called each time).

If the person has to be transported by ambulance to a hospital, or admitted to the nursing home, the responsible party takes over: the resident is just put in the ambulance with a packet of information and a wave goodbye.

The CCRC is not "in loco parentis."

So for people who are truly flying solo -- no near family or younger friends in North America -- a US CCRC isn't an option.

I worry about this ... a lot.

The CCRC where my mother is required that she have a POA and a HCPOA when she moved in. She has fallen twice and we have been called. When we decided she needed more help (aides for 2 hours in the morning and 2 hours in the evening) all I had to do was call the CCRC and tell them what we wanted and they arranged for the aides and they started in a couple of days. Most of the aides have been excellent and they always show up. I don't have to worry about the aides, a real benefit of the CCRC.