Is long term Care a smart decision?

Liberty said:
Both of the cases I've been familiar with lately HAD to get lawyers because they were turned down. I know of the physical issues with both of these people. One had worked for our company for years and than was my housekeeper for many more years. As far as I know, it was about the proper form explanations regarding the doctor interfaces and so forth. The lawyers seem to know how to do that...the legitimate ones, too. As far as I know there are only a couple lawyers - good ones - specializing in this around the area.
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Very true. The process has gotten so long and intricately complicated that just about everyone who applies without a lawyer is turned down, even my friend who has a debilitating (and probably fatal in the future) heart condition, complications of diabetes, and who is legally blind was turned down the first time. She hired an attorney experienced in the field and finally was approved, but it took two and a half years.

And of course, SSDI stops when you reach fra (full retirement age).
 

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A friend in another state has his mother in law in a facility. No LTC policy, upper middle class with no way to qualify for Medicaid.

He met with the facility told them the situation. Give me a fair price and I’ll pay you a check monthly. They came to a fairly reasonable price for him. Told him that they fight daily with insurance companies over ever single itemized bill. Then the bill is delayed payment while they argue and negotiate. Payments are always 69-90 days behind with tons of paperwork.

He is happy and so are they.
 
Floridatennisplayer said:
A friend in another state has his mother in law in a facility. No LTC policy, upper middle class with no way to qualify for Medicaid.

He met with the facility told them the situation. Give me a fair price and I’ll pay you a check monthly. They came to a fairly reasonable price for him. Told him that they fight daily with insurance companies over ever single itemized bill. Then the bill is delayed payment while they argue and negotiate. Payments are always 69-90 days behind with tons of paperwork.

He is happy and so are they.
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His MIL still has enough assets that Medicaid won't kick in?

Good to know about the possibility of negotiating with nursing homes.
 

Floridatennisplayer said:
oh yes, way beyond Medicaid to qualify.
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Got it. Glad that her SIL stepped in to negotiate this.

On a side note, although I've heard many, many "hate your mother-in-law" jokes and comments in this lifetime, the people I know (hubby and myself included) became as close or closer to our in-laws than to our own parents. Loved, cared and watched out for them, and they for us.
 
StarSong said:
Got it. Glad that her SIL stepped in to negotiate this.

On a side note, although I've heard many, many "hate your mother-in-law" jokes and comments in this lifetime, the people I know (hubby and myself included) became as close or closer to our in-laws than to our own parents. Loved, cared and watched out for them, and they for us.
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Me too. I loved my MIL.. Passed away in 2018. What a wonderful woman.
 
Keesha said:
What????😧
Oh goodness. Basic accommodation here is about $1,890 a month. Private I think is $2400
It includes room cleaned daily, laundry done once a week, name sewed in all garments, 3 meals a day, 2 snacks, 2 baths or showers per week, help with medication, help with mobility, help with toiletries, entertainment, daily activities, crafts etc.

The only thing it doesn’t cover is nail care and hair cutting & styling. Some cover physiotherapy and some dont

I wish you the best
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$1890 sounds ideal... I could definitely handle that.. Room cleaned, laundry done, 3 meals, 2 snacks.. of course I will have my own snacks in my room but OH YES!!!
 
When I was researching LTC policies, some features of the plans, as well as pricing, which could continue to rise, were off putting. Wound up being a moot point because I was denied coverage from our retiree group plan and a private plan due to certain health conditions. The older you are, the more policies cost. If I could get a policy it would have to be a company that is large and well established
 
OneEyedDiva said:
When I was researching LTC policies, some features of the plans, as well as pricing, which could continue to rise, were off putting. Wound up being a moot point because I was denied coverage from our retiree group plan and a private plan due to certain health conditions. The older you are, the more policies cost. If I could get a policy it would have to be a company that is large and well established
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Yes, and also heard there are quite a bit of complaints from some of them also. That's what I want to do...pay for it for years and then when you want it get a "gee, no you don't meet the requirements - lol.
 
Liberty said:
Yes, and also heard there are quite a bit of complaints from some of them also. That's what I want to do...pay for it for years and then when you want it get a "gee, no you don't meet the requirements - lol.
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i hope to never qualify .... i just want to pay premiums like i would term life or health insurance ..i don't want to use it or qualify for it
 
>>...insurance? Its a money pit any way you look at it. >>

So is a car. So are your clothes.

Insurance is for risk mitigation. Most people vastly underestimate how much risk they take on with their financial decisions as they go through life.

Get injured by an uninsured driver and decide how much of a "money pit" health and auto insurance is to you.

Not everyone needs LTCi. If you can genuinely self-insure - not just "hoping nothing bad happens" - excellent! If you can assure me you'll die a week before you suffer a debilitating stroke or fall in the bathtub and break your pelvis in three places - that's even better.

Unfortunately for my life and my spouse's, our crystal ball just ain't working right now. Gotta get it fixed ASAP, lol.

We've visited the Medicaid nursing facilities in our area. Worth it to us to make sure we NEVER have to risk one of us - let alone both! - ever having to use one of them. Nearby are two top-rated convalescent facilities which handle both short- and long-term patients. Neither one takes Medicaid patients.
 
@mathjak107
We each have our own way of looking at this. You choose to rent your home. Like many here, my husband and I decided to buy.

Between the value of our fully shielded house and other assets not countable by Medicaid, the surviving spouse would not be wiped out.

It's good that you're comfortable with your plan. Please respect that others have also thought this through and made decisions that work for their specific circumstances.
 
Amazing how many people try to hide, bend, fake, lie, spend down, jump through hoops to try to qualify for Medicaid, which is designed and designated for poverty level people, so they can be put in a nasty sub standard Medicaid accepting facility In a nasty area of town you wouldn’t think of driving through normally.
 
Liberty said:
Yeah, when do you ever win with insurance? Its a money pit any way you look at it.
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the problem is as humans unlike insurers where statistics matter , we can only have two outcomes to things . it is us it happened to , or it isn't ..

since all the things we insure against have a very low risk of happening to us we cherry pick what we feel would be a disaster if it was us it happened to . it has to happen to many on the wrong side of the statistic so it can just as easily be us .
 
Floridatennisplayer said:
Amazing how many people try to hide, bend, fake, lie, spend down, jump through hoops to try to qualify for Medicaid, which is designed and designated for poverty level people, so they can be put in a nasty sub standard Medicaid accepting facility In a nasty area of town you wouldn’t think of driving through normally.
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most places have no specific medicaid homes ... there are a certain number of beds in private facilities .
here in new york and ,long island we have mostly private homes if not all private ones . ... that is why the partnership plans here are wonderful .

if you are a paying customer for three years and have a partnership plan , then you stay right where your and a special version of medicaid called mec takes over the payments . that is why the plans cost so much .
 
StarSong said:
@mathjak107
We each have our own way of looking at this. You choose to rent your home. Like many here, my husband and I decided to buy.

Between the value of our fully shielded house and other assets not countable by Medicaid, the surviving spouse would not be wiped out.

It's good that you're comfortable with your plan. Please respect that others have also thought this through and made decisions that work for their specific circumstances.
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my comments do not have a thing to do with anyone's individual choice ... they merely point out what is going on , what the pitfalls are of taking certain routes and what the options are other then "words" like oh , i am self insuring .

nothing throws fear in to a stay at home spouse , as much as realizing they can easily be impoverished when it happens ...

our estate attorney is one of the most well known in the tristate area and he sees the lions share of cases .... most are all the self insurers with no real plan other than a cross of the fingers and hoping they have enough .. but now when bad things happen they panic as they realize at 120k a year they can easily be impoverished since they do not segrate the self insuring money from the income generation money .... it ends up killing the goose laying the golden eggs as it diminishes for that stay at home spouse , possibly with decades to live ....

that is not to say some can't self insure , but it does mean for most , there really is no plan to do so other than to say that is what we do . .
 
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Floridatennisplayer said:
Amazing how many people try to hide, bend, fake, lie, spend down, jump through hoops to try to qualify for Medicaid, which is designed and designated for poverty level people, so they can be put in a nasty sub standard Medicaid accepting facility In a nasty area of town you wouldn’t think of driving through normally.
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As @mathjak107 said, in CA there are not "Medicaid" homes, only payment assistance through Medicaid. Not looking to dodge paying for care, just trying to ensure that the surviving spouse isn't left completely impoverished.

US policies force long-term nursing care, even when there's zero hope of recovery from severe vascular dementia or Alzheimer's. Our laws demand that people are kept alive with expensive medical support, despite disastrous diagnoses, prognoses, family wishes or person's specified advanced directives.

I understand the complexities of enacting legislation that can address all of these issues, but what we've got now isn't working well.

My BIL suffered a brain aneurysm a month ago. He's now four surgeries into them trying to help him, and he's almost never conscious. Can barely respond to the simplest requests by the neurological testing team. His family is equally terrified about what might happen if he doesn't survive as they are about if he does. We are praying that a lot of his cognitive ability will come back, but there are no guarantees.

The possible nightmare of him living semi-consciously in a nursing home for years on end has crossed the minds of all of us. His wife is being very careful about what kinds of supportive devices to allow (surgically installed feeding tubes, for instance) because once done, they're difficult to legally undo.
 
Lethe200 said:
>>...insurance? Its a money pit any way you look at it. >>

So is a car. So are your clothes.

Insurance is for risk mitigation. Most people vastly underestimate how much risk they take on with their financial decisions as they go through life.

Get injured by an uninsured driver and decide how much of a "money pit" health and auto insurance is to you.

Not everyone needs LTCi. If you can genuinely self-insure - not just "hoping nothing bad happens" - excellent! If you can assure me you'll die a week before you suffer a debilitating stroke or fall in the bathtub and break your pelvis in three places - that's even better.

Unfortunately for my life and my spouse's, our crystal ball just ain't working right now. Gotta get it fixed ASAP, lol.

We've visited the Medicaid nursing facilities in our area. Worth it to us to make sure we NEVER have to risk one of us - let alone both! - ever having to use one of them. Nearby are two top-rated convalescent facilities which handle both short- and long-term patients. Neither one takes Medicaid patients.
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Think states and regional areas are different where nursing home facilities are concerned. I learned a lot when a friend of mine's mother went into a facility for a few months. In areas around here and where she went in out of state there are many nice nursing homes and SNF that accept medicare and medicaid patients. Learned a lot. As my husband says, you still usually never win with insurance although of course you do need to have it. By the way, we have a car right now that's been appreciating...lol. Have a friend that only buys cars that he knows will greatly appreciate in value. Then he sells them and restocks!
 
Liberty said:
.... By the way, we have a car right now that's been appreciating...lol. Have a friend that only buys cars that he knows will greatly appreciate in value. Then he sells them and restocks!
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That is very nice for you and your friend. However, I think you will acknowledge that is NOT the normal for 99.9% of autos ever built or bought.

An item is worth only what it is to someone who wants it. No different than a house, or a Le Creuset stock pot.

If I don't want it, it's worth nothing to me. Smash your car up in an accident, and who's going to buy it? Smash yourself up with it, and who pays for the 24/7 care?

You are absolutely correct that there are differences in facilities depending on where one lives. I'm glad for you that you live somewhere where you can count on county or state facilities. That's a rare thing in America, so you're very fortunate.

I love where I live, but Medicaid (Medicare has nothing to do with nursing home costs) facilities are not good where we are. Thus, it's worth the cost for us to protect our assets, because although we live very comfortably, we would be risking too much to be solely dependent upon only those assets.

Therefore, we "spread the risk" because the expenditure in premiums is minor compared to the cost if one or both of us needs SCN - or home healthcare and Asst. Living, if we choose it.

I like having options. That's a worthwhile safety net in my mind.
 
Lethe200 said:
That is very nice for you and your friend. However, I think you will acknowledge that is NOT the normal for 99.9% of autos ever built or bought.

An item is worth only what it is to someone who wants it. No different than a house, or a Le Creuset stock pot.

If I don't want it, it's worth nothing to me. Smash your car up in an accident, and who's going to buy it? Smash yourself up with it, and who pays for the 24/7 care?

You are absolutely correct that there are differences in facilities depending on where one lives. I'm glad for you that you live somewhere where you can count on county or state facilities. That's a rare thing in America, so you're very fortunate.

I love where I live, but Medicaid (Medicare has nothing to do with nursing home costs) facilities are not good where we are. Thus, it's worth the cost for us to protect our assets, because although we live very comfortably, we would be risking too much to be solely dependent upon only those assets.

Therefore, we "spread the risk" because the expenditure in premiums is minor compared to the cost if one or both of us needs SCN - or home healthcare and Asst. Living, if we choose it.

I like having options. That's a worthwhile safety net in my mind.
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Medicare did pay for my friend's mom's very nice SNH for 3 months. She lives in another state and is thankfully back home now. She sure got "value received".
 
keep in mind most states make Medicaid divorces near impossible .

two very powerful laws here in ny have been upheld and according to our estate attorney who is one of the biggest in ny there are very very few medicaid divorces .

all court actions are now pretty much based on right of refusal .

our two laws that pretty much killed off medicaid divorce are :

(1) Section 5-311 of the General Obligation Law which provides that except as provided in Section 236 of the Domestic Relations Law, a husband and wife cannot contract to relieve either his or her liability to support the other in such a manner that he or she will become incapable of self support, and therefore likely to become a public charge; and

(2) Family Court Act Section 415 which provides that the spouse or parent of a recipient of public assistance or care, or of a person liable to become in need thereof, or a patient in an institution in the department of mental hygiene if of sufficient ability, is responsible for the support of such a person. The Court has the discretion to require any such person to contribute a fair and reasonable sum for such support (child up to 21 years of age).

also if it is eventually determined that a divorce is to be pursued, the divorce needs to satisfy all of the requirements of the Domestic Relations Law, such as establishing one of the requisite grounds for a divorce. This may be difficult to accomplish because of the illness or disability of one spouse
 
Liberty said:
Medicare did pay for my friend's mom's very nice SNH for 3 months. She lives in another state and is thankfully back home now. She sure got "value received".
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Yes, 120 days is the MAXIMUM Medicare allows, and there are strict rules:
  • You must have stayed at least 3 days ("observation only" stays do not count) in the hospital.
  • You require a "skilled" level of care in the nursing facility that cannot be provided at home or on an outpatient basis, on the order of a doctor
Also, as soon as the nursing facility determines that a patient is no longer receiving a skilled level of care, the Medicare coverage ends. And, beginning on day 21 of the nursing home stay, there is a significant copayment equal to one-eighth of the initial hospital deductible ($176 a day in 2020). This copayment will usually be covered by a Medigap insurance policy, provided the patient has one.

On the good side the restrictions are per incident. If you were discharged and have not used SCN for at least 60 days, a recurrence will qualify for another 120-day admittance. The copay still applies.

Full article: Medicare's Limited Nursing Home Coverage
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Nobody gets a "free ride".
 
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