The insane cost of elder care

[Anonymous]

Anonymous wrote:My plan for when I hit retirement is to buy a small unit with lifetime continuing care in a retirement complex and a second house or condo somewhere either for winters (six months in Florida) or coastal New England (five months in spring to fall). When the time comes, I can sell the second property and upgrade the unit to a bigger 2-bedroom and live there full time. But I will have a foot in the door so they can't kick me out if I suddenly start declining, physically or cognitively. I am single, will always be single so no spouse to help take care of me. I want the guarantee of lifetime care no matter what happens. Yes, expensive, but I can make it happen. This plan is based on what good friends of my parents have done.

CCRCs are the way to go---good goal to be able to get in. If you can afford one, it's the best way to know you will be well taken care of. Paid entry fee to get my parents in (they have enough to qualify minus the entry fee). Best thing we ever did. They are a distance from us and refused to move closer. This way they are well taken care of and should they need more than independent living, it will seamlessly happen, and will not cost them (or us) a penny more---that's what the huge entry fee is for. Best part is, even if they "run out of money", the CCRC will still continue service---you are guaranteed to live your life there and they do NOT touch your monthly SS. Most who have run out of money are women over 95---there are 4 of them currently living there who pay nothing each month, husbands have long since died. 2 are still in independent living, the other 2 are in assisted living.

If you plan well it can happen---my parents are not wealthy. But made it happen.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Sorry, Medicaid is meant for the poor, not middle class people with assets who want their kids to inherit those assets instead of paying for their own care. It is out and out fraud to “structure” assets to take advantage of benefits meant for the poor.

If the benefits truly were meant for everyone, there would be no need to hide… er, I mean “structure” assets in order to appear eligible for the program.

Complying with the law is fraud? Because it offends your ignorant and judgmental sensibilities? You don’t have the slightest idea what you are talking about.

Yes, “complying with the law” in a way that allows the older person’s assets to be assigned to another family member is essentially a sneaky way to make a person look poor enough to be eligible for Medicaid benefits.

If these benefits were meant for everyone, then people would be able to access them without having to appear to be poor enough to meet an eligibility standard.

Lol, the government is using its power to go after churches and pro-life families standing outside abortion clinics. Spare me the ethical nonsense. I am going to continue to pay as little as legally possible into this corrupt system.

[Anonymous]

My spouse has aging parents, 82&86. His mom is declining, but they both live in their own home not too far from us. Our own kids will be done with college in four years. We can't help out much financially until then. Or I could quit my job and care for them during the day. Yeah, that costs money, too. But I adore his mom and if I could help it, I don't want her going to assisted living.

But the 100k a year help is something only the very wealthy can afford. Most of us will be doing the caretaking ourselves.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My plan for when I hit retirement is to buy a small unit with lifetime continuing care in a retirement complex and a second house or condo somewhere either for winters (six months in Florida) or coastal New England (five months in spring to fall). When the time comes, I can sell the second property and upgrade the unit to a bigger 2-bedroom and live there full time. But I will have a foot in the door so they can't kick me out if I suddenly start declining, physically or cognitively. I am single, will always be single so no spouse to help take care of me. I want the guarantee of lifetime care no matter what happens. Yes, expensive, but I can make it happen. This plan is based on what good friends of my parents have done.

CCRCs are the way to go---good goal to be able to get in. If you can afford one, it's the best way to know you will be well taken care of. Paid entry fee to get my parents in (they have enough to qualify minus the entry fee). Best thing we ever did. They are a distance from us and refused to move closer. This way they are well taken care of and should they need more than independent living, it will seamlessly happen, and will not cost them (or us) a penny more---that's what the huge entry fee is for. Best part is, even if they "run out of money", the CCRC will still continue service---you are guaranteed to live your life there and they do NOT touch your monthly SS. Most who have run out of money are women over 95---there are 4 of them currently living there who pay nothing each month, husbands have long since died. 2 are still in independent living, the other 2 are in assisted living.

If you plan well it can happen---my parents are not wealthy. But made it happen.

Do you have any numbers to share? Which CCRCs are you talking about? What's the entrance fee? monthly cost? etc.

[Anonymous]

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.

Thankfully at 80 my parents are still independent and relatively healthy, and I know things can change quickly, but when you or your loved ones get there it actually doesn’t seem as old as it once did.

[Anonymous]

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.

Serious question: what does this look like in reality, shooting yourself in the head? Do you not think that would be traumatic for your family?

[Anonymous]

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.

Serious question: what does this look like in reality, shooting yourself in the head? Do you not think that would be traumatic for your family?

You can’t possibly be serious. You’ve never heard of assisted suicide?

[Anonymous]

Anonymous wrote:+1 to strong family bonds. In my family / immigrant community it's very common to have a family member move in and/or hire live-in helpers from the community to handle these end of life situations with dignity and grace. Usually the care and loving connection provided far exceeds what one would receive at a facility.

It's lovely to see when it is possible. But is it bonds or necessity though? Can they afford this expensive care elsewhere? And what does that really look like when the loved one has serious dementia (which is when most people actually look for LTC)? What price to the stress and lifestyle of a young family trying to care for dementia patient at home? It's actually dangerous.

[Anonymous]

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.

Serious question: what does this look like in reality, shooting yourself in the head? Do you not think that would be traumatic for your family?

You can’t possibly be serious. You’ve never heard of assisted suicide?

Yes, I thought it wasn't legal in the US?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Sorry, Medicaid is meant for the poor, not middle class people with assets who want their kids to inherit those assets instead of paying for their own care. It is out and out fraud to “structure” assets to take advantage of benefits meant for the poor.

If the benefits truly were meant for everyone, there would be no need to hide… er, I mean “structure” assets in order to appear eligible for the program.

Complying with the law is fraud? Because it offends your ignorant and judgmental sensibilities? You don’t have the slightest idea what you are talking about.

Yes, “complying with the law” in a way that allows the older person’s assets to be assigned to another family member is essentially a sneaky way to make a person look poor enough to be eligible for Medicaid benefits.

If these benefits were meant for everyone, then people would be able to access them without having to appear to be poor enough to meet an eligibility standard.

Lol, the government is using its power to go after churches and pro-life families standing outside abortion clinics. Spare me the ethical nonsense. I am going to continue to pay as little as legally possible into this corrupt system.

at last, honesty. that I respect. - estate planning attorney

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My parents thought they had planned carefully but had no comprehension of elder care costs in the 21st century (neither did us kids). They were an accountant and administrative assistant with modest pensions and <$1 million in other savings. It's all gone after years of those $10k/month bills. My Dad passed at 86 and my 88-year old Mom is moving to a Medicaid facility this summer.

Sometimes that's how it goes when you get old. I have no better suggestion other than to not be sick for very long at the end.

Precisely what happened to us. My dad went to level 4 LTC at Hebrew Home in Rockville at 15K/month. Previously he'd had 24-hour private nurses at his home at ca. 30k/month. We burned through his savings, and his house sale proceeds, like a match through dry grass.

Now that he has passed, I'm wondering what to do in my own old age. "Not being sick for very long at the end" is the only solution in the US, unless you are very wealthy indeed.

+1. Unless you/your family has recenlty had to deal with elder care, you just don't get it. Unless you are independently wealthy, you can never save enough. And this is why more and more parents are moving in with their children - the money starts to run out.

You don't have to be "independently wealthy" to buy LTC. People just don't choose to spend their money that way. My in-laws did. And we will too. My father is broke enough that we will just spend down his assets and use Medicaid.

This is just not true, this insurance is ridiculously expensive. My parents had two policies (that did not kick in for 180 days so you're stuck with the cost early on) and the lovely state of Md decided that it was okay for the premiums to increase even though their policy was sold as a lifetime locked premium. This from a very reputable insurance company. As soon as MD passed the law the insurance company doubled their monthly premiums and that was in their fifties. They had to let it go by the time they retired because the premium cost over time out weighed their possible redeeming any usage. It was not inexpensive and I hate when people throw it around as if you are a total loser for not having it. LTC is for the WEALTHY but it will become insolvent with all the wealthy boomers who purchased it once they start cashing in, there just aren't enough policy holders to support that coming disaster.

My in-laws paid $50k each upfront for their policies. No ongoing premiums.

LTC insurance is well-recognized to be in dire straits--either they offer a reasonable deal and the company goes under and doesn't pay out as expected or they are increasingly unaffordable. Your in-laws better check the fine print. They may be okay or they may not be. There are so many think tanks working on how to solve this problem.

You should also check to see if there is a cap on benefits offered or term. I would be shocked if there isn't. Those gold plated policies no longer exist.

[Anonymous]

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.

Serious question: what does this look like in reality, shooting yourself in the head? Do you not think that would be traumatic for your family?

You can’t possibly be serious. You’ve never heard of assisted suicide?

The problem is you have to have very strict end of life instructions in place before the dementia or medical catastrophe happens. One of my parents died relatively young of a prolonged and ugly cancer and the other, watching this, decided in no way did they want to be demented, stuck in a facility that is leeching their money and time. They put it strict instructions in their will and medical directives that if the person is unable to feed, clothe, or bathe themself, then they wanted to essentially not have any medical care given or even food. The estate attorney was, like, are you sure about this? It needed to be documented in multiple ways. This has been communicated to all of the kids. I don't know how this will play out when it actually happens though in terms of what the hospitals/medical facilities will do though.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My parents thought they had planned carefully but had no comprehension of elder care costs in the 21st century (neither did us kids). They were an accountant and administrative assistant with modest pensions and <$1 million in other savings. It's all gone after years of those $10k/month bills. My Dad passed at 86 and my 88-year old Mom is moving to a Medicaid facility this summer.

Sometimes that's how it goes when you get old. I have no better suggestion other than to not be sick for very long at the end.

Precisely what happened to us. My dad went to level 4 LTC at Hebrew Home in Rockville at 15K/month. Previously he'd had 24-hour private nurses at his home at ca. 30k/month. We burned through his savings, and his house sale proceeds, like a match through dry grass.

Now that he has passed, I'm wondering what to do in my own old age. "Not being sick for very long at the end" is the only solution in the US, unless you are very wealthy indeed.

+1. Unless you/your family has recenlty had to deal with elder care, you just don't get it. Unless you are independently wealthy, you can never save enough. And this is why more and more parents are moving in with their children - the money starts to run out.

Nope. There are plenty of places that are $3-5k a month.

They may start you out at that rate... but 6 mos later, that place is bought out by XXX company, and the price goes up to $6500/mo. Then another 6 mos later, they do an assessment and decide the needs have increased (although it's mostly the same as it was in the beginning) and the price goes up to $8000/mo. By this point, your parent is familiar with the routines/people at this place, so you don't want to move him/her b/c it will likely cause agitation and even more confusion.... and besides that, there are waiting lists for the other places (that are cheaper). So, you figure it can't be THAT long before they don't need any care at all. And time goes on...

The "retirement savings" of $250,000 are dwindling down month by month (after using all the parent's SS and military pension first, and then drawing the remaining balance from the retirement savings). The parent who is fully healthy stays in the marital home, but honestly, is going to be a lot better off financially when the dementia parent dies b/c she will get the use of the spousal portion of the military pension and the widow portion of the SS. For people in the midwest who stopped working 20+ yrs ago (now in their 80's) -- whose salaries were never comparable to what people earn today (and on the coasts), $250k was a very respectable retirement nestegg. But, when you start drawing down several thousand per month, and that goes on for years... it shows you where the gaps are in our care system.

I don't think it's correct to suggest that there are places for people with dementia at $3-5k/mo. That's more of a way to get people into the facility... and it assumes they are low-needs/high-functioning. That's just not the case for most people who are progressing through dementia -- they need full care.

You’re doing such a disservice making this claim. It’s why people pay $12k per month for care and drain accounts. They don’t know any better.

Please STOP with suggesting people who pay more then $3-5K are just being fleeced and stupid for "not knowing any better." My SIL actually RAN an assisted living facility in the same area where my FIL is getting care (not the same facility). SIL has been very involved in finding a place for him (where he has been for nearing 3 yrs). There IS a cheaper place -- it's the VA facility -- but FIL is #51 on the waiting list! No, there are not better options than paying $8000+ for high needs dementia care. This is in smaller town WI, not some big metro area.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My plan for when I hit retirement is to buy a small unit with lifetime continuing care in a retirement complex and a second house or condo somewhere either for winters (six months in Florida) or coastal New England (five months in spring to fall). When the time comes, I can sell the second property and upgrade the unit to a bigger 2-bedroom and live there full time. But I will have a foot in the door so they can't kick me out if I suddenly start declining, physically or cognitively. I am single, will always be single so no spouse to help take care of me. I want the guarantee of lifetime care no matter what happens. Yes, expensive, but I can make it happen. This plan is based on what good friends of my parents have done.

CCRCs are the way to go---good goal to be able to get in. If you can afford one, it's the best way to know you will be well taken care of. Paid entry fee to get my parents in (they have enough to qualify minus the entry fee). Best thing we ever did. They are a distance from us and refused to move closer. This way they are well taken care of and should they need more than independent living, it will seamlessly happen, and will not cost them (or us) a penny more---that's what the huge entry fee is for. Best part is, even if they "run out of money", the CCRC will still continue service---you are guaranteed to live your life there and they do NOT touch your monthly SS. Most who have run out of money are women over 95---there are 4 of them currently living there who pay nothing each month, husbands have long since died. 2 are still in independent living, the other 2 are in assisted living.

If you plan well it can happen---my parents are not wealthy. But made it happen.

Do you have any numbers to share? Which CCRCs are you talking about? What's the entrance fee? monthly cost? etc.

I'm not the PP you quoted, but I posted earlier, naming Collington in Bowie and Riderwood in Silver Spring.

There's a chart on this page with some sample pricing for Collington: https://collington.kendal.org/living-options/pricing-information/

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My plan for when I hit retirement is to buy a small unit with lifetime continuing care in a retirement complex and a second house or condo somewhere either for winters (six months in Florida) or coastal New England (five months in spring to fall). When the time comes, I can sell the second property and upgrade the unit to a bigger 2-bedroom and live there full time. But I will have a foot in the door so they can't kick me out if I suddenly start declining, physically or cognitively. I am single, will always be single so no spouse to help take care of me. I want the guarantee of lifetime care no matter what happens. Yes, expensive, but I can make it happen. This plan is based on what good friends of my parents have done.

CCRCs are the way to go---good goal to be able to get in. If you can afford one, it's the best way to know you will be well taken care of. Paid entry fee to get my parents in (they have enough to qualify minus the entry fee). Best thing we ever did. They are a distance from us and refused to move closer. This way they are well taken care of and should they need more than independent living, it will seamlessly happen, and will not cost them (or us) a penny more---that's what the huge entry fee is for. Best part is, even if they "run out of money", the CCRC will still continue service---you are guaranteed to live your life there and they do NOT touch your monthly SS. Most who have run out of money are women over 95---there are 4 of them currently living there who pay nothing each month, husbands have long since died. 2 are still in independent living, the other 2 are in assisted living.

If you plan well it can happen---my parents are not wealthy. But made it happen.

Do you have any numbers to share? Which CCRCs are you talking about? What's the entrance fee? monthly cost? etc.

I'm not the PP you quoted, but I posted earlier, naming Collington in Bowie and Riderwood in Silver Spring.

There's a chart on this page with some sample pricing for Collington: https://collington.kendal.org/living-options/pricing-information/

They don't detail the "entrance fee." And you don't get all of that back. So, the monthly fee looks low because it isn't including a portion for the entrance fee.

Also, I noticed that the service level for "memory care" does not include assistance for daily grooming and toileting. That doesn't count as an amenity until you are in long term nursing care. The details on the website are lacking and of course they want you to think it's a good deal...to get you in the door.

If it diunds too good to be true, it probably is.