The insane cost of elder care

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I plan to self-euthanize once I can no longer live independently. I’m not going to enrich some crooked private industry because I’ve kept myself in good health. I’d rather leave money and assets to my kids at age eighty than spend $100k a year for an additinal 10-15 years to gaze out of a window being fed cafeteria food and missing my old life.

By the time you decide to euthanize, you are too far gone to do it.

I have an end-of-life plan that I will communicate clearly to my kids as they get older (I’m in my thirties).

Estate planning attorney here. Unfortunately you can’t authorize your healthcare agent to pursue aid in dying. It is quite difficult to qualify under most states’ laws, at this time.

Not PP but I didn’t read that they meant it in such a formal way…

[Anonymous]

Anonymous wrote:Both of my DH's parents, who are divorced and 93 years old, are in an assisted living facility in Anne Arundel County that costs $4,000/month. The facility has only 12 beds, is privately run, and hasn't increased in price for 3 years. Each of his parents has a separate small bedroom with attached bathroom (with shower), and there are a couple of common areas and nice back yards (with fencing). The best thing is the meals are made family-style, in house, from real food - no Sysco sort of prepurchased junk.

Both his parents have dementia and are mostly incontinent, and both are wheelchair-bound. There is live-in staff 24/7 with nursing care and doctor visits. They're responsive and wonderful.

The only extra cost we pay is to a local pharmacy who provides supplies - this tends to be about $40-$50/month.

Having said that, both his parents are about to run out of money. I know their current place will accept Medicaid, so that might be what happens next.

For DH and myself, who are in our late fifties/early sixties, we can no longer qualify for LTC insurance because of cancer diagnoses. We'll be running through our own funds if necessary, but thankfully our grown kids are doing well on their own and don't need to rely on inheritance.

Wait they are divorced and live in the same facility that only has 12 rooms?

Of all the nursing homes in all the world…

(I’m sorry I probably shouldn’t joke about the difficult situation you’re managing but it just struck me if they were lucid how ironic it might seem. Glad you found what sounds like a great place for them)

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I plan to self-euthanize once I can no longer live independently. I’m not going to enrich some crooked private industry because I’ve kept myself in good health. I’d rather leave money and assets to my kids at age eighty than spend $100k a year for an additinal 10-15 years to gaze out of a window being fed cafeteria food and missing my old life.

By the time you decide to euthanize, you are too far gone to do it.

I have an end-of-life plan that I will communicate clearly to my kids as they get older (I’m in my thirties).

Estate planning attorney here. Unfortunately you can’t authorize your healthcare agent to pursue aid in dying. It is quite difficult to qualify under most states’ laws, at this time.

Not too hard to find some fake Percocet laced with fentanyl these days. After watching my dad suffer with cancer, this is my plan.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I plan to self-euthanize once I can no longer live independently. I’m not going to enrich some crooked private industry because I’ve kept myself in good health. I’d rather leave money and assets to my kids at age eighty than spend $100k a year for an additinal 10-15 years to gaze out of a window being fed cafeteria food and missing my old life.

By the time you decide to euthanize, you are too far gone to do it.

I have an end-of-life plan that I will communicate clearly to my kids as they get older (I’m in my thirties).

Estate planning attorney here. Unfortunately you can’t authorize your healthcare agent to pursue aid in dying. It is quite difficult to qualify under most states’ laws, at this time.

Not too hard to find some fake Percocet laced with fentanyl these days. After watching my dad suffer with cancer, this is my plan.

Once you are so obtunded, you don't have the ability to do this. You are living happily, then suddenly have a stroke on the golf course and now laying in a hospital bed, aphasic and unable to move. But you can breathe without oxygen assistance.

Best bet is to have strong Do Not Resuscitate instructions in your planning so that distraught family members don't try to put you into some rehab plan hoping you'll recover.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unless you're wealthy, it's LTC insurance or Medicaid. Get your assets out of your name 5 years before you need Medicaid LTC or the state will take it all!

Well, no. That would be unethical. Why do you think others should pay for your health care? Are you a welfare queen, too? Do you like the dole?

DP. I know you are looking for a 'discussion' but why do you think a person, few years away from death, would really care about ethics or if society foots the bill? I wouldn't? We have enough money (and hopefully a lot more in 30 years when we hit our 80s) but I think it's society's job to take care of the elderly. Shame on you for not voting out every bast*rd that is trying to move the country in the opposite direction.

Society DOES take care of the elderly. What you are suggesting is that the elderly should be able to keep all their assets at the same time. That’s fine, if you raise the money for their care elsewhere (ie tax the rich or a consumption tax or whatever) but we don’t do that. Advocating FRAUD and sheltering assets to duck the cost of care under the current system is disgusting and unethical. Freeloaders suck.

Your ignorance is showing.. please come back when you have learned the difference between between tax planning and tax fraud.

Estate planning attorney here. “Medicaid planning” is impoverishing yourself on paper to qualify for gov’t benefits that are intended for the poor. Plain and simple. I agree the cost of long-term care is a terrible shame. But it doesn’t follow that I shouldn’t have to pay it because damnit I worked hard and I want my kids to get my money.

“Impoverishing yourself on paper” is a nasty, derogatory, calumny, used perjoratively to describe seeking and following expert legal advice to structure assets to obtain maximum benefits from a public benefit plan according to its legislative and regulatory terms. It is akin to prudent tax planning, including (yes) estate planning. Whatever someone else may think, these provisions are part of the law. Congress and the regulators know they are there. The envy, hatred and condescension toward people in need in US society is appalling. One would think that the detractors were being dragged to open their own checkbook for someone else.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unless you're wealthy, it's LTC insurance or Medicaid. Get your assets out of your name 5 years before you need Medicaid LTC or the state will take it all!

Well, no. That would be unethical. Why do you think others should pay for your health care? Are you a welfare queen, too? Do you like the dole?

DP. I know you are looking for a 'discussion' but why do you think a person, few years away from death, would really care about ethics or if society foots the bill? I wouldn't? We have enough money (and hopefully a lot more in 30 years when we hit our 80s) but I think it's society's job to take care of the elderly. Shame on you for not voting out every bast*rd that is trying to move the country in the opposite direction.

Society DOES take care of the elderly. What you are suggesting is that the elderly should be able to keep all their assets at the same time. That’s fine, if you raise the money for their care elsewhere (ie tax the rich or a consumption tax or whatever) but we don’t do that. Advocating FRAUD and sheltering assets to duck the cost of care under the current system is disgusting and unethical. Freeloaders suck.

Your ignorance is showing.. please come back when you have learned the difference between between tax planning and tax fraud.

This. There is nothing fraudulent about Medicaid planning. And in many cases, the planning preserves assets in the near term but leaves them subject to levy (absent an exception) after the beneficiary’s death.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unless you're wealthy, it's LTC insurance or Medicaid. Get your assets out of your name 5 years before you need Medicaid LTC or the state will take it all!

Well, no. That would be unethical. Why do you think others should pay for your health care? Are you a welfare queen, too? Do you like the dole?

DP. I know you are looking for a 'discussion' but why do you think a person, few years away from death, would really care about ethics or if society foots the bill? I wouldn't? We have enough money (and hopefully a lot more in 30 years when we hit our 80s) but I think it's society's job to take care of the elderly. Shame on you for not voting out every bast*rd that is trying to move the country in the opposite direction.

Society DOES take care of the elderly. What you are suggesting is that the elderly should be able to keep all their assets at the same time. That’s fine, if you raise the money for their care elsewhere (ie tax the rich or a consumption tax or whatever) but we don’t do that. Advocating FRAUD and sheltering assets to duck the cost of care under the current system is disgusting and unethical. Freeloaders suck.

Your ignorance is showing.. please come back when you have learned the difference between between tax planning and tax fraud.

Estate planning attorney here. “Medicaid planning” is impoverishing yourself on paper to qualify for gov’t benefits that are intended for the poor. Plain and simple. I agree the cost of long-term care is a terrible shame. But it doesn’t follow that I shouldn’t have to pay it because damnit I worked hard and I want my kids to get my money.

“Impoverishing yourself on paper” is a nasty, derogatory, calumny, used perjoratively to describe seeking and following expert legal advice to structure assets to obtain maximum benefits from a public benefit plan according to its legislative and regulatory terms. It is akin to prudent tax planning, including (yes) estate planning. Whatever someone else may think, these provisions are part of the law. Congress and the regulators know they are there. The envy, hatred and condescension toward people in need in US society is appalling. One would think that the detractors were being dragged to open their own checkbook for someone else.

DP: But aren't you talking about a way where people with means hide their means so that they can get resources that are meant as a last resource for the poor? Not people who are "in need"? The people who are likely to have access and knowledge to do this sort of advance planning of their resources, and who have the resources, are likely to have significant resources. This seems more like something the UMC does to protect inheritances, whereas MC and LMC just genuinely become poor.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Both of my DH's parents, who are divorced and 93 years old, are in an assisted living facility in Anne Arundel County that costs $4,000/month. The facility has only 12 beds, is privately run, and hasn't increased in price for 3 years. Each of his parents has a separate small bedroom with attached bathroom (with shower), and there are a couple of common areas and nice back yards (with fencing). The best thing is the meals are made family-style, in house, from real food - no Sysco sort of prepurchased junk.

Both his parents have dementia and are mostly incontinent, and both are wheelchair-bound. There is live-in staff 24/7 with nursing care and doctor visits. They're responsive and wonderful.

The only extra cost we pay is to a local pharmacy who provides supplies - this tends to be about $40-$50/month.

Having said that, both his parents are about to run out of money. I know their current place will accept Medicaid, so that might be what happens next.

For DH and myself, who are in our late fifties/early sixties, we can no longer qualify for LTC insurance because of cancer diagnoses. We'll be running through our own funds if necessary, but thankfully our grown kids are doing well on their own and don't need to rely on inheritance.

Wait they are divorced and live in the same facility that only has 12 rooms?

Of all the nursing homes in all the world…

(I’m sorry I probably shouldn’t joke about the difficult situation you’re managing but it just struck me if they were lucid how ironic it might seem. Glad you found what sounds like a great place for them)

Yes, I know, it is strange! But they don't recognize each other, and it's the easiest and most efficient way for us (and DH's siblings) to visit and care for them.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unless you're wealthy, it's LTC insurance or Medicaid. Get your assets out of your name 5 years before you need Medicaid LTC or the state will take it all!

Well, no. That would be unethical. Why do you think others should pay for your health care? Are you a welfare queen, too? Do you like the dole?

DP. I know you are looking for a 'discussion' but why do you think a person, few years away from death, would really care about ethics or if society foots the bill? I wouldn't? We have enough money (and hopefully a lot more in 30 years when we hit our 80s) but I think it's society's job to take care of the elderly. Shame on you for not voting out every bast*rd that is trying to move the country in the opposite direction.

Society DOES take care of the elderly. What you are suggesting is that the elderly should be able to keep all their assets at the same time. That’s fine, if you raise the money for their care elsewhere (ie tax the rich or a consumption tax or whatever) but we don’t do that. Advocating FRAUD and sheltering assets to duck the cost of care under the current system is disgusting and unethical. Freeloaders suck.

Your ignorance is showing.. please come back when you have learned the difference between between tax planning and tax fraud.

Estate planning attorney here. “Medicaid planning” is impoverishing yourself on paper to qualify for gov’t benefits that are intended for the poor. Plain and simple. I agree the cost of long-term care is a terrible shame. But it doesn’t follow that I shouldn’t have to pay it because damnit I worked hard and I want my kids to get my money.

“Impoverishing yourself on paper” is a nasty, derogatory, calumny, used perjoratively to describe seeking and following expert legal advice to structure assets to obtain maximum benefits from a public benefit plan according to its legislative and regulatory terms. It is akin to prudent tax planning, including (yes) estate planning. Whatever someone else may think, these provisions are part of the law. Congress and the regulators know they are there. The envy, hatred and condescension toward people in need in US society is appalling. One would think that the detractors were being dragged to open their own checkbook for someone else.

DP: But aren't you talking about a way where people with means hide their means so that they can get resources that are meant as a last resource for the poor? Not people who are "in need"? The people who are likely to have access and knowledge to do this sort of advance planning of their resources, and who have the resources, are likely to have significant resources. This seems more like something the UMC does to protect inheritances, whereas MC and LMC just genuinely become poor.

No one is “hiding” anything. Nobody gets Medicaid without an in-depth financial examination. And since when are public benefit programs a “last resource” for “the poor?” A person who can’t afford reasonable (and many Medicare places barely meet that standard) care without leaving their surviving spouse, caretaking child, or disabled child homeless and penniless in fact is “poor.” And absent competent advice, there are people who will put themselves and their survivors in that state because they don’t know any better or they feel guilty “taking charity.”

Again, this is not lying, smurfing money around, trying to hide assets in other people’s names, burying them in the yard, etc. It is structuring assets and transactions in conformity with the law.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unless you're wealthy, it's LTC insurance or Medicaid. Get your assets out of your name 5 years before you need Medicaid LTC or the state will take it all!

Well, no. That would be unethical. Why do you think others should pay for your health care? Are you a welfare queen, too? Do you like the dole?

DP. I know you are looking for a 'discussion' but why do you think a person, few years away from death, would really care about ethics or if society foots the bill? I wouldn't? We have enough money (and hopefully a lot more in 30 years when we hit our 80s) but I think it's society's job to take care of the elderly. Shame on you for not voting out every bast*rd that is trying to move the country in the opposite direction.

Society DOES take care of the elderly. What you are suggesting is that the elderly should be able to keep all their assets at the same time. That’s fine, if you raise the money for their care elsewhere (ie tax the rich or a consumption tax or whatever) but we don’t do that. Advocating FRAUD and sheltering assets to duck the cost of care under the current system is disgusting and unethical. Freeloaders suck.

Your ignorance is showing.. please come back when you have learned the difference between between tax planning and tax fraud.

Estate planning attorney here. “Medicaid planning” is impoverishing yourself on paper to qualify for gov’t benefits that are intended for the poor. Plain and simple. I agree the cost of long-term care is a terrible shame. But it doesn’t follow that I shouldn’t have to pay it because damnit I worked hard and I want my kids to get my money.

“Impoverishing yourself on paper” is a nasty, derogatory, calumny, used perjoratively to describe seeking and following expert legal advice to structure assets to obtain maximum benefits from a public benefit plan according to its legislative and regulatory terms. It is akin to prudent tax planning, including (yes) estate planning. Whatever someone else may think, these provisions are part of the law. Congress and the regulators know they are there. The envy, hatred and condescension toward people in need in US society is appalling. One would think that the detractors were being dragged to open their own checkbook for someone else.

My parents went through this. Mom in perfect health was dad's caretaker until it became too much to handle. She didnt want to move, and was of modest means net worth under 500K. So Dad was placed in a state run Medicare facilty its nothing fancy and the care he needed put his tab at 14-15k a month. Mom had to pay month 1. If she would have been faced with paying it every month in no time flat she would have been flat broke. Her and my siblings and I would have been rooting for dad to pass away to spare mom's lifetime savings. We got legal advice and set her up on a Medicare Annuity which was basically a transfer of retirement funds into an immediate annuity (payout to her) and in 5-6 weeks she had the levels of her total net worth at a point where the "snapshot" showed she was broke enough to qualify for Medicaid. She used other personal savings to "rollover" her retirement on a 60 day rollover to avoid a big tax hit. She also no longer receives dads SS There was no 5 year look back my siblings and I helped arrange this with her legal team after Dad went to the home.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unless you're wealthy, it's LTC insurance or Medicaid. Get your assets out of your name 5 years before you need Medicaid LTC or the state will take it all!

Well, no. That would be unethical. Why do you think others should pay for your health care? Are you a welfare queen, too? Do you like the dole?

DP. I know you are looking for a 'discussion' but why do you think a person, few years away from death, would really care about ethics or if society foots the bill? I wouldn't? We have enough money (and hopefully a lot more in 30 years when we hit our 80s) but I think it's society's job to take care of the elderly. Shame on you for not voting out every bast*rd that is trying to move the country in the opposite direction.

Society DOES take care of the elderly. What you are suggesting is that the elderly should be able to keep all their assets at the same time. That’s fine, if you raise the money for their care elsewhere (ie tax the rich or a consumption tax or whatever) but we don’t do that. Advocating FRAUD and sheltering assets to duck the cost of care under the current system is disgusting and unethical. Freeloaders suck.

Your ignorance is showing.. please come back when you have learned the difference between between tax planning and tax fraud.

Estate planning attorney here. “Medicaid planning” is impoverishing yourself on paper to qualify for gov’t benefits that are intended for the poor. Plain and simple. I agree the cost of long-term care is a terrible shame. But it doesn’t follow that I shouldn’t have to pay it because damnit I worked hard and I want my kids to get my money.

“Impoverishing yourself on paper” is a nasty, derogatory, calumny, used perjoratively to describe seeking and following expert legal advice to structure assets to obtain maximum benefits from a public benefit plan according to its legislative and regulatory terms. It is akin to prudent tax planning, including (yes) estate planning. Whatever someone else may think, these provisions are part of the law. Congress and the regulators know they are there. The envy, hatred and condescension toward people in need in US society is appalling. One would think that the detractors were being dragged to open their own checkbook for someone else.

My parents went through this. Mom in perfect health was dad's caretaker until it became too much to handle. She didnt want to move, and was of modest means net worth under 500K. So Dad was placed in a state run Medicare facilty its nothing fancy and the care he needed put his tab at 14-15k a month. Mom had to pay month 1. If she would have been faced with paying it every month in no time flat she would have been flat broke. Her and my siblings and I would have been rooting for dad to pass away to spare mom's lifetime savings. We got legal advice and set her up on a Medicare Annuity which was basically a transfer of retirement funds into an immediate annuity (payout to her) and in 5-6 weeks she had the levels of her total net worth at a point where the "snapshot" showed she was broke enough to qualify for Medicaid. She used other personal savings to "rollover" her retirement on a 60 day rollover to avoid a big tax hit. She also no longer receives dads SS There was no 5 year look back my siblings and I helped arrange this with her legal team after Dad went to the home.

This is following the law and is reasonable. I think the estate planning lawyer is talking about the many more circuitous means that more well-off people are being advised to take to protect their children's inheritances, not a living spouse.

[Anonymous]

Anonymous wrote:Lifelong planning and savings. Also LTC insurance.

Yo soy Latina y una immigrants. Me pagaron poco los gringos y no me alcanza Para retiramlento. Nadie fue mi mentor o nada Para Saber esto. Que puedo hacer de vieja?

I'm Latina and an immigrants. The gringos paid me little for my work and I don't have enough for retirement. Nobody was my mentor or nothing to know this. What can I do now that I'm old?

[Anonymous]

My BIL and his wife, who as recently as 3 years ago asked to borrow $5k to cover a home repair (and do not have any non-liquid assets of significant value), who make $100k/year are now talking about "retiring early" in their 50s. They say they "live cheaply" but have not thought about this *at all*. I can't imagine they have even looked up what health insurance will cost you pre-medicare when you are in your 50s, as that alone would blow their so called cheap living budget.

I am really hoping that DH doesn't want to delay our retirement to help them when they run out of assets at the first sign of a health problem and have to live on medicaid.

I love them but their lack of planning seems really frustrating when we work constantly and they are fully capable (both highly educated and qualified, just don't lie to work).

I do wish elder care were cheaper and society invested more in making QOL better for our real life cycle now. But I also wish people understood *how much* you need not to enjoy life on big vacations, but to actually make sure you can get to the bathroom safely and not burn your own house down if anything but the rosiest scenario happens, and if not, what it costs even for end of life care with a minor extent of dignity in many cases. Ugly stuff.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Lifelong planning and savings. Also LTC insurance.

Yo soy Latina y una immigrants. Me pagaron poco los gringos y no me alcanza Para retiramlento. Nadie fue mi mentor o nada Para Saber esto. Que puedo hacer de vieja?

I'm Latina and an immigrants. The gringos paid me little for my work and I don't have enough for retirement. Nobody was my mentor or nothing to know this. What can I do now that I'm old?

Your family takes care of you.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Lifelong planning and savings. Also LTC insurance.

Yo soy Latina y una immigrants. Me pagaron poco los gringos y no me alcanza Para retiramlento. Nadie fue mi mentor o nada Para Saber esto. Que puedo hacer de vieja?

I'm Latina and an immigrants. The gringos paid me little for my work and I don't have enough for retirement. Nobody was my mentor or nothing to know this. What can I do now that I'm old?

Your family takes care of you.

In general, Hispanic families are far better prepared for elder care because of a culture of intergenerational living and care despite fewer on paper resources.