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Long Term Care

Hawk_4shur

HR Legend
Jan 2, 2009
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My wife (no pics) and I, both 67, have put away a very nice chunk of money for retirement. We have a nice home and a vacation home - we drive nice cars and can give money to our kids. Our only debt is a very manageable mortgage on the vacation home that I could pay off, but it's only 2.625% interest. We are financial set ..... except for long term care.

Since I turned 50, I have looked at long term care insurance every few years, but it just didn't seem like a good deal. Now, skilled care facilities are crazy expensive and the LTC Insurance plans I have seen are nothing but glorified savings accounts - you give $300,000 to an insurance company today and it will pay you $360,000, IF you go into a skilled care facility AND you qualify for the benefit.

My father was stayed in perhaps the nicest and best skilled care facility in the area in 2020 and it was $8,000 a month. My mother-in-law stayed is a "nice" facility (but not the best) in 2022 and it was $9,000/mo. I doesn't take an actuary or economist to see where this is going.

I know there are a lot of "experienced" (old) HROT'ers out there. What have you done, or are planning to do, about a possible future in a nursing home? 🤷‍♀️

You "young" whippersnappers- go ahead and make your jokes! ;)
 
I am a former nursing home administrator and am now a CPA. I have had this discussion many times with my clients. When I started in long term care the average stay of a patient was 85 days, it is now around 45 days I believe. Essentially people are living in their homes longer with assisted living and possibly transition to assisted living or living in a retirement community before going to the nursing home much sicker than before. In general I would tell you the whether the husband or wife were to get sick, in general they can stay home while the other cares for them unless it gets to become too much. The new policies don’t want to lose any money on any policy because several of the old policies paid out much more than was ever paid on them. invest in cds or bonds and create your own LTC insurance funds with the premiums you would pay in. the First days in a nursing home are generally covered under skilled care In which you pay nothing or little and the end days are generally covered under hospice.
 
My wife (no pics) and I, both 67, have put away a very nice chunk of money for retirement. We have a nice home and a vacation home - we drive nice cars and can give money to our kids. Our only debt is a very manageable mortgage on the vacation home that I could pay off, but it's only 2.625% interest. We are financial set ..... except for long term care.

Since I turned 50, I have looked at long term care insurance every few years, but it just didn't seem like a good deal. Now, skilled care facilities are crazy expensive and the LTC Insurance plans I have seen are nothing but glorified savings accounts - you give $300,000 to an insurance company today and it will pay you $360,000, IF you go into a skilled care facility AND you qualify for the benefit.

My father was stayed in perhaps the nicest and best skilled care facility in the area in 2020 and it was $8,000 a month. My mother-in-law stayed is a "nice" facility (but not the best) in 2022 and it was $9,000/mo. I doesn't take an actuary or economist to see where this is going.

I know there are a lot of "experienced" (old) HROT'ers out there. What have you done, or are planning to do, about a possible future in a nursing home? 🤷‍♀️

You "young" whippersnappers- go ahead and make your jokes! ;)
Sounds like you don’t need the insurance. Use a CFP to help plan for it by ear marking certain assets.
 
This may not be the answer you're looking for but I'd stop life extending treatment after age 70.

Most Americans want to live forever but quality of life is usually very bad after age 80. Alzheimer's disease, physical disabilities, etc. explode after age 80. I just had a neighbor die from dementia. She was 88 and had dementia for 13 years.

This article makes a lot of sense, IMO.

 
I am a former nursing home administrator and am now a CPA. I have had this discussion many times with my clients. When I started in long term care the average stay of a patient was 85 days, it is now around 45 days I believe. Essentially people are living in their homes longer with assisted living and possibly transition to assisted living or living in a retirement community before going to the nursing home much sicker than before. In general I would tell you the whether the husband or wife were to get sick, in general they can stay home while the other cares for them unless it gets to become too much. The new policies don’t want to lose any money on any policy because several of the old policies paid out much more than was ever paid on them. invest in cds or bonds and create your own LTC insurance funds with the premiums you would pay in. the First days in a nursing home are generally covered under skilled care In which you pay nothing or little and the end days are generally covered under hospice.
Awesome. That's a great answer from an excellent source. Thanks.

My father and mother had LTC insurance. My mother didn't use it, but my Dad did and the ROI was incredible. I understand why insurance companies backed off on what they were doing a couple of decades ago.

I'm also a CPA. Your answer is EXACTLY what I have been planning. My Wealth Mgt advisor has said the same thing.

But, as a CPA, I worry a lot about the unknown ......
 
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This may not be the answer you're looking for but I'd stop life extending treatment after age 70.

Most Americans want to live forever but quality of life is usually bad after age 80.

This article makes a lot of sense, IMO.

70? o_O
 
My grandfather bought "nursing home" insurance in the 60s or 70s. He passed before they got there, buy grandma ended up in one. It cut the monthly cost in half until she passed. Crazy expensive, but sometimes there are no other options
 
Maybe bump it up a few years. :)

I would rather die at 70 than 95.

Dying at 95 practically guarantees years of disabilities, mental and/or physical.

(I've had several relatives live past 90.)

My grandpa died of lung cancer at 74. Went quick. Grandma lived 10-15 years but deteriorated mentally for the last 2-3. It was hard to lose my grandpa but watching my grandma not know who I was killed me. Just take me before I don't know my own kids/grandkids
 
My grandpa died of lung cancer at 74. Went quick. Grandma lived 10-15 years but deteriorated mentally for the last 2-3. It was hard to lose my grandpa but watching my grandma not know who I was killed me. Just take me before I don't know my own kids/grandkids

I don't recommend suicide but would stop treatment myself.

I went to visit my 92 year old Aunt at her assisted living a few weeks ago and there was another resident walking around the dining area with his pants and underwear off. (No pics)

He's probably 85. He used to be a neurologist...
 
My mother (fortunately) only spent 1 month in a nursing home. My father moved into assisted living at age 89 and lived there a few years, which were pretty good. Then pneumonia and skilled care at the end of his life - it was hard to watch him decline.

End of life can really suck.
 
I don't recommend suicide but would stop treatment myself.

I went to visit my 92 year old Aunt at her assisted living a few weeks ago and there was another resident walking around the dining area with his pants and underwear off. (No pics)

He's probably 85. He used to be a neurologist...

Yeah, two grandparents still alive and both are 80+

Grandma on that side is starting to show signs of mental deterioration. Grandpa is good buy is slowing way down. I hate to say this but I could certainly see my grandpa eating a bullet before going to a nursing home. I'm not sure he wouldn't shoot her too (as a humane gesture of not going into one of those god awful facilities)
 
Yeah, two grandparents still alive and both are 80+

Grandma on that side is starting to show signs of mental deterioration. Grandpa is good buy is slowing way down. I hate to say this but I could certainly see my grandpa eating a bullet before going to a nursing home. I'm not sure he wouldn't shoot her too (as a humane gesture of not going into one of those god awful facilities)

He could just stop treatment instead of suicide.

No more blood pressure meds, vaccines, doctors visits, etc.
 
We are having talks with my grandparents on a daily basis about going to, not a nursing home, but assisted living. My grandma is starting to be confused all the time, had an eye removed a couple months ago, isn’t mobile. My grandpa is 87 and takes care of her like it’s a badge of honor, but it’s killing him. I put him in PT for his balance, but he’s still a fall away from my grandma being stuck in a chair, not being able to get help. He refuses to leave his home and pay for an assisted living situation, he feels like that is him failing and giving away everything he ever worked for. I’m so proud of how he loves her, but it’s literally the shittiest situation
 
Awesome. That's a great answer from an excellent source. Thanks.

My father and mother had LTC insurance. My mother didn't use it, but my Dad did and the ROI was incredible. I understand why insurance companies backed off on what they were doing a couple of decades ago.

I'm also a CPA. Your answer is EXACTLY what I have been planning. My Wealth Mgt advisor has said the same thing.

But, as a CPA, I worry a lot about the unknown ......
Hawk4shur, look into trusts. I don’t claim to know all the ins and outs, I know one set up has where only 50% of the assets can be used for either the husband or spouse. There is a firm in Des Moines that somehow sets it up as 33% for husband, spouse, and then the trust.

The other thing is being open minded to of hiring someone to help take care at the house. I had one client that hired a full time caretaker for 40,000 a year. They essentially lived with the client. That individual didn’t have much resources so it was easy to just move into a spare bedroom. Had another that would come over at 6 am in the morning would get them up shower clothes on and go to the restroom. Set them up in their chair at around 8. Would come over at noon take them to the restroom and feed them lunch. Come over at 6 do the same. Put them to bed at 9. In general they are there about 2 hours a day. No different than a nursing aid at a nursing home. They paid around 20-25k for that. It can get difficult if someone flakes out. Dependability is key, they offered 4 weeks off for the caretaker with each child being responsible for 1 week a year and of course Christmas time was the easiest one which worked for all Parties.
 
Not if you have a living will that says not to, I think.

Maybe, but I doubt most facilities aren't going to let you stay there to die. They're going to try to give you the best quality of life. That would include prescription drugs to keep you comfortable/alive
 
Maybe, but I doubt most facilities aren't going to let you stay there to die. They're going to try to give you the best quality of life. That would include prescription drugs to keep you comfortable/alive

If there's a living will stating otherwise, they can't force care, I think.
 
Also be willing to sign DNR’s Depending on your age. Both my wife and I have living wills signed with specifics instructions on what life saving measures we want.
 
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If there's a living will stating otherwise, they can't force care, I think.
If you don’t have a DNR signed the home is required to do everything they can to keep you alive requiring them to do CPR. . If you don’t have a living will stating what you want done or an IPost as IAtipper mentions below a home is required to put in interventions ensure you are not declining in your ADLs or else they will get a tag for not providing quality care and possibly a fine if DIA deems they caused harm by lack of care.
 
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Also be willing to sign DNR’s. Both my wife and I have DNR signed with specifics instructions ina living will what care CPR ect we are willing to have and to not be on a vent for longer than a specified amount of time.

In Iowa, family can override your plans.

Get a house that will allow you to transition into old age (hallways, doorways, showers that can accommodate wheelchairs, everything on one floor, etc). Hire an RN for part time or full time care.
 
My wife (no pics) and I, both 67, have put away a very nice chunk of money for retirement. We have a nice home and a vacation home - we drive nice cars and can give money to our kids. Our only debt is a very manageable mortgage on the vacation home that I could pay off, but it's only 2.625% interest. We are financial set ..... except for long term care.

Since I turned 50, I have looked at long term care insurance every few years, but it just didn't seem like a good deal. Now, skilled care facilities are crazy expensive and the LTC Insurance plans I have seen are nothing but glorified savings accounts - you give $300,000 to an insurance company today and it will pay you $360,000, IF you go into a skilled care facility AND you qualify for the benefit.

My father was stayed in perhaps the nicest and best skilled care facility in the area in 2020 and it was $8,000 a month. My mother-in-law stayed is a "nice" facility (but not the best) in 2022 and it was $9,000/mo. I doesn't take an actuary or economist to see where this is going.

I know there are a lot of "experienced" (old) HROT'ers out there. What have you done, or are planning to do, about a possible future in a nursing home? 🤷‍♀️

You "young" whippersnappers- go ahead and make your jokes! ;)
Well, good topic.

I am 70 and my wife is 68. She wanted a long term care policy 10 years ago , so we have one. Back then it wasn't much money really and our premiums have never been raised. We are healthy.
She wants to continue with the policy and I do not want to argue.
 
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I work as a VP for an assisted living company, and can tell you the average stay is around 2 years, not 45 days. Costs are around $6,000 a month, and there are a number of options to pay for care, but LTC insurance is the best bet if you are financially set.

If you'd like to really talk about long term care, the options, what to look for or look out for, let me know. I've connect with a few on here about LTC, even met a few @jasonrann. Message me here or email rayhonsandrew at gmail.com.
 
In Iowa, family can override your plans.

Get a house that will allow you to transition into old age (hallways, doorways, showers that can accommodate wheelchairs, everything on one floor, etc). Hire an RN for part time or full time care.
1. I have never seen it occur. Remember you would likely have a social worker in each home advocating for the patients right. There are multiple steps this could go though from patients advocate system in Iowa, DIA or even going to the court system.
2. there is a huge difference in having someone’s wishes in writing. There is little room for interpretation or disagreement among family members.
3. regularly update and discuss the reasons of why you want what you want. When a potential power of attorney is on the same page as you it minimizes any change. If a difference of opinion comes up in these conversations you may want to chose a different person to be your power of attorney. M
4. Issues arise when no planning has been done prior. It can also get costly. If no power of attorney has been signed then a guardianship or conservatership by the courts.
 
If you don’t have a DNR signed the home is required to do everything they can to keep your weight up, including possibly a feeding tube, and doing all they can to ensure you are not declining in your ADLs or else they will get a tag for not providing quality care and possibly a fine if DIA deems they caused harm by lack of care.
Absolutely incorrect. Potentially dangerously incorrect. A DNR means, at least in most circumstances, you won’t get CPR, you won’t get defibrillated, and you will be allowed to pass in an emergency situation. A living will, which has been discussed in this thread is an entirely different beast. It is a contract with your physician/hospital spelling out the care you want and don’t want, in most cases it doesn’t mention CPR.

So a typical DNR does not cover feeding tubes at all, and may require a facility to place one, although family has input. A living will typically doesn’t cover sudden out of hospital death.

What you need in Iowa is called an Ipost. It gives guidance for exactly what treatment you want and is binding on all healthcare providers. It includes instructions on resuscitation and feeding tubes

 
I work as a VP for an assisted living company, and can tell you the average stay is around 2 years, not 45 days. Costs are around $6,000 a month, and there are a number of options to pay for care, but LTC insurance is the best bet if you are financially set.

If you'd like to really talk about long term care, the options, what to look for or look out for, let me know. I've connect with a few on here about LTC, even met a few @jasonrann. Message me here or email rayhonsandrew at gmail.com.
Nursing homes and assisted living home are much different. There is a significant difference between the median and mean stay. The average is brought down immensely by those who are there less than 30 days and you would be surprised how many are less than a week. Now some of this is encouraged. Up to 20% of residents at any one time are on skilled care to rehab and get back home significantly bringing down the average stay. The Assisted living has become what nursing homes were 20-30 years ago. In some aspects they are providing care beyond what an asissisted living was original intended to but that is a different conversation.
 
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In Iowa, family can override your plans.
That’s a tough call. It depends. The Iowa DNR says that someone has to be a “valid surrogate" for a DNR to be overridden. A healthcare power of attorney can. A spouse can. Could a child? Maybe? Its hard to be in that spot. What if one child says resuscitate and one child says no and the patient has a DNR?
 
My grandpa died of lung cancer at 74. Went quick. Grandma lived 10-15 years but deteriorated mentally for the last 2-3. It was hard to lose my grandpa but watching my grandma not know who I was killed me. Just take me before I don't know my own kids/grandkids
Flip side is that you're probably not suffering with dementia. Also probably aren't who you used to be. The burden is on other people.
 
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That’s a tough call. It depends. The Iowa DNR says that someone has to be a “valid surrogate" for a DNR to be overridden. A healthcare power of attorney can. A spouse can. Could a child? Maybe? Its hard to be in that spot. What if one child says resuscitate and one child says no and the patient has a DNR?

I can't go into detail, obviously, but I've seen it happen.
 
I work as a VP for an assisted living company, and can tell you the average stay is around 2 years, not 45 days. Costs are around $6,000 a month, and there are a number of options to pay for care, but LTC insurance is the best bet if you are financially set.

If you'd like to really talk about long term care, the options, what to look for or look out for, let me know. I've connect with a few on here about LTC, even met a few @jasonrann. Message me here or email rayhonsandrew at gmail.com.
We bought ltc insurance in our early 50s and still have it. My wife chafes at the annual premiums, but every financial advisor we have consulted about it reinforces my thinking that it is valuable and wothwhile. In addition to paying some of the cost at the time, it also allows the spouse to keep financial assets equal to the benefits paid yet qualify for the Medicaid spend down if needed. Like most ltc plans, ours also pays for in home care.
 
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