How to prepare early for Nursing Home

if you have no spouse it is simple .. leave everything as is and when the money is gone its gone . but planning around a spouse and not impoverishing them is not easy. my dad was in a home for 5 years so we know all to well the effects
 

>>Most estimates I have seen of LTC costs outside of what is covered by medicare is $3-$5K per month depending on the illness. >>

We live in a high-labor cost area, specifically Northern CA. Skilled Nursing Facilities (formerly called nursing homes) are a minimum of $8K/mo and go up to $14K/mo, depending on the facility you choose.

Medicare DOES NOT cover long-term care. It covers only 100 days of skilled care nursing for convalescing. There are very stringent requirements to fulfill. For example, if you go into a hospital but your doctors keep you for observation, but never actually admit you as a patient, Medicare can deny a claim for convalescent care even if your physician recommended and sent you to the facility. It is also limited to per illness.

Medicaid is a different and separate program. Unlike Medicare it is not a federal program. It is funded 50% by the Federal government and 50% by the participating state, but it is the state's responsibility to use the funds and set up requirements for such. The Federal guidelines are mostly limited to personal asset rules; e.g., the $2000 personal net wealth total, minus certain excluded possessions.

Medicaid is the program which reimburses nursing homes for indigent patients, but because that rate is so much less what private pay facilities cost, many senior facilities will not accept people who are ailing or have insufficient financial assets. Because Medicaid is regulated by each state, you always need to keep an eye on what your state decides to fund and what it does not.

HTH and makes sense.
 
the problem insurers had was the usage stats were flawed and way understated ..
they pertained to a generation ago when more care was done at home as well as like my dad was in , many healthcare workers took people like my dad who was paralyzed from a stroke in to their homes and cared for 2 or 3 like that . it was far cheaper then a nursing home . many like my dad were healthy and were easier to care for so they basically were not in official homes and fell off the radar .

insurers were blind sided when they set rates and it took years for the actual usage to surface .

According to a 2016 report from the National Association of Insurance Commissioners

48% are expected to have no long-term care costs during their lifetimes,
15.4% will have costs of up to $50,000,
9.7% will have costs of $50,000-$100,000,
11.7% will have costs of $100,000-$250,000, and
15.2% will have costs that exceed $250,000.

the problem we have as humans is statistics mean little . we only have two outcomes ...it's us or it isn't .
 

Thanks for the statistics, they are very interesting to me.

IMO we do have some small measure of control over the outcome if we are able to literally drag our feet and delay the process of entering a SNF as long as possible. That may not be possible for someone like your dad that had a stroke or your friend with Parkinson's but for many people who are simply old and infirm it can make a huge difference in the final numbers.

Since this thread started I've been thinking about my own family and my mother was the only person in my family that died in assisted living. All of the others died at home or after a short stay in the hospital. The level of care/assistance for all of them was minimal with the exception of my stepfather who paid for round the clock home care for the final two months of his life. So in addition to my idea of self-insuring, I think I need to start thinking more like an insurance company and do everything I can to deny delay confuse and refuse for as long as possible. I know it sounds like a joke but I'm serious about doing everything I can to remain on the outside looking in for as long as possible.

I also think of Lon, remember Lon? He finally moved into an assisted living facility and found that his long term care insurance would not begin making payments until he met the insurance company's criteria of needing help with the activities of daily living for things like dressing, bathing, and using the bathroom. Who's to say that he will ever meet the insurance company's definition?

IMO about all any of us can do at this point in our lives is think it through from best case to the worst case and make plans based on our own situation with the resources we have.

Good luck everybody!!!
 
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Aunt Bea said:
"....remember Lon? He finally moved into an assisted living facility and found that his long term care insurance would not begin making payments until he met the insurance company's criteria of needing help with the activities of daily living for things like dressing, bathing, and using the bathroom. "
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It's a shame that Lon misunderstood what he was buying. But that does not in itself invalidate the need for, or usefulness of, LTCi.

It should be noted that there are a large number of ADLs - however, for the purposes of the majority of LTCi, disability insurance, and SocSec disability, the major ADLs are:

The five ADLs:
  1. Bathing: personal hygiene and grooming
  2. Dressing: dressing and undressing
  3. Transferring: movement and mobility
  4. Toileting: continence-related tasks including control and hygiene
  5. Eating: preparing food and feeding
Early on, LTCi and disability policies required a definition of being unable to perform 3 ADLs as qualifying for benefits, following the SocSec guidelines at the time. When those guidelines changed to a definition of 2 ADLs, the insurance industry followed suit.

Almost all insurers now define qualification as being unable to perform 2 of the 5 ADLs. Our LTCi policies are now 20 yrs old and qualification is 2 ADLs.

The reason we felt LTCi was necessary for us is that mortality is increasing fastest in the elderly, while morbidity is worsening proportionately. IOW, people are living longer, but with a declining quality of life. Western medicine can keep you alive for a very, very long time, regardless of how much one would like to "pop off" painlessly by just not waking up in the morning.

For example, a person may have completed a DNR. But if s/he falls on a public sidewalk and 911 gets called, the EMTs will do everything possible to save his/her life, no matter what the DNR says.

Based on statistics over the last 20 yrs, what happens to the elderly is that they go in and out of convalescent (skilled nursing) care, then back in and out, in a repeating process. But the full recovery is more fragile and tentative, more easily upset - hence the repeated admissions.

This is why Asst Lvg is considered merely an interim step. Since most people wait as long as possible before going into AL, it has been shown the average stay in AL before entering SN is only two years!

LTCi is for SN care, not for AL. AL did not exist when LTCi was first introduced as a product. As pointed out, families cared for elderly at home. This is no longer true; people who are divorced, people without or who have outlived their children and other family, may still (and probably will) need some sort of assistance as they age.

What can help for AL is having a home healthcare rider on the LTCi. One could go into an Independent Senior Living facility, for example, and enjoy the social environment, transportation, meals, and no housekeeping advantages. But when one starts to need help, the home healthcare rider can assist with paying for private care assistance, putting off the day when full Skilled Nursing Care is needed.

LTCi is used to protect financial assets. Having a partnership plan ensures there will be no unpleasant IRS surprises when non-partnership benefits paid out get added to the insured's yearly income. In the U.S., costs for Skilled Care facilities vary according to COL, but the average as of 2018 for 1 year of care in a private room is slightly over $100,000.

That cost is for the facility's fees, meals, housekeeping, and basic care. It does not include medications, surgeries, or specialist care.
 
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I've had a long-term care insurance policy for the past two years. I should have gotten it years ago when the premiums were more reasonable. Also, it's difficult to qualify for as we get older because there are so many health issues that can disqualify one from being eligible for a policy.
 
No, no, I don't wanna go to a nursing home. I don't have long term care. I don't want to need it.
I want a heart attack while I am still viable and planning to live to 99 years and eleven months.
Forget the big one for now. I'm not ready yet. I'll let you know.
 
MeAgain said:
Anyone here have a Reverse Morgage? is it worth it?
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A RM was a godsend for my mother. It did NOT eat up her equity and the interest rate was reasonable. When she died we sold her home (which we would have done anyway), paid back the RM, and her heirs received the rest.

She owned her home for over 40 years and it increased dramatically in value over that time. Had it been sold before she died, the capital gains taxes would have eaten far, far more than the fees and interest incurred via the RM.

RMs are like anything else: good for some folks, not so good for others. Examine your own circumstances and research, research, research!
 
I looked into LTC insurance and found it could be complicated and costs kept increasing. Moot point though because I was declined when applying via our state retiree system's group plan. Looking at other plans' criteria I realized I would be turned down by all of them due to preexisting conditions. So I beefed up my savings/investments for over the two decades I've been in retirement (and still doing so) in hopes that if I ever need it, I'll have enough to cover costs out of pocket like my uncle did (and he was in two or more years before passing). My Medicare plan does cover three months during each benefit period which certainly helps. A benefit period starts when one has been out of the nursing home for 60 days or more. Since I'm living healthier, I hope never to need to go in, especially since N.J. has one of the highest nursing home costs in the nation.
 
This is a very informative thread.
Over the past couple of months I’ve learned a lot about retirement homes and long term care facilities ; since my mom has her stroke.

Here in Canada retirement homes are privately paid but long term care homes or nursing homes are 1/2 paid for by the government and 1/2 by the resident. If you can’t afford it the government pays it in full but they exhaust all sources first.

We also have subsidized services for the elderly.

It’s very difficult when one goes into hospital after a stroke and now needs long term care but the other one doesn’t want it.

Does the government generally take the money from their accounts once they are incapacitated? How do they find their accounts?

What if there is no POA for health?
What happens when the SDM gets incapacitated also?
Who makes the decisions then?
 
OneEyedDiva said:
I looked into LTC insurance and found it could be complicated and costs kept increasing. Moot point though because I was declined when applying via our state retiree system's group plan. Looking at other plans' criteria I realized I would be turned down by all of them due to preexisting conditions. So I beefed up my savings/investments for over the two decades I've been in retirement (and still doing so) in hopes that if I ever need it, I'll have enough to cover costs out of pocket like my uncle did (and he was in two or more years before passing). My Medicare plan does cover three months during each benefit period which certainly helps. A benefit period starts when one has been out of the nursing home for 60 days or more. Since I'm living healthier, I hope never to need to go in, especially since N.J. has one of the highest nursing home costs in the nation.
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however in order for medicare to cover it for those 3 months you have to meet certain conditions as far as being hospitalized first .
 
Keesha said:
This is a very informative thread.
Over the past couple of months I’ve learned a lot about retirement homes and long term care facilities ; since my mom has her stroke.

Here in Canada retirement homes are privately paid but long term care homes or nursing homes are 1/2 paid for by the government and 1/2 by the resident. If you can’t afford it the government pays it in full but they exhaust all sources first.

We also have subsidized services for the elderly.

It’s very difficult when one goes into hospital after a stroke and now needs long term care but the other one doesn’t want it.

Does the government generally take the money from their accounts once they are incapacitated? How do they find their accounts?

What if there is no POA for health?
What happens when the SDM gets incapacitated also?
Who makes the decisions then?
Click to expand...
I don't know anything about the Canadian medical system. Wish I could be of help... :(
 
A friend once suggested I turn my assets over to my son and let Medicaid pay for a nursing home. I told him that makes no sense. Why would I let Medicaid be the deciding factor in a substandard home for me (because they certainly wouldn't pay for the best) when my healthcare quality, comfort and sanity are at stake? I want to have access to the best SNF possible.
 
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mathjak107 said:
however in order for medicare to cover it for those 3 months you have to meet certain conditions as far as being hospitalized first .
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Oh believe me, I'm well aware MJ. Went through the nursing home process with my mother and have kept up with it's rules and regulations ever since. In fact the benefit period I spoke of previously depends on discharge from the nursing home, then readmission to the hospital before another nursing home stay is required and it has to be more than 60 days after being discharged from the home.
 
mathjak107 said:
however in order for medicare to cover it for those 3 months you have to meet certain conditions as far as being hospitalized first .
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Have you or any of your family members ever been admitted to a nursing home? Besides my mom, several cousins, my godmother and an uncle spent from months to years there. A couple of my cousins were my age range at the time (60's).
 
OneEyedDiva said:
Besides my mom, several cousins, my godmother and an uncle spent from months to years there.
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Wow! That's a very long time to be in a SNF. My mother, MIL and FIL spent some time in them, but none of their stints was longer than a few weeks. Even the best of these places would be unpleasant after a while, not to mention extraordinarily expensive once Medicare stops picking up the tab.
 
StarSong said:
Wow! That's a very long time to be in a SNF. My mother, MIL and FIL spent some time in them, but none of their stints was longer than a few weeks. Even the best of these places would be unpleasant after a while, not to mention extraordinarily expensive once Medicare stops picking up the tab.
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My uncle's granddaughter said he paid out of pocket and he was there more than a year. My mother paid out of pocket for the first few months then had to go on Medicaid. The head of the accounts department schooled me on exactly what to do. I was so glad she was able to stay in that facility. It was clean, had pleasant decor and they literally loved my mother, so took very good care of her. My godmother was in a less pleasant one for more than a year (I moved my mother from that one). I imagine she was also on medicaid. I'm in N.J. where nursing homes are among the most expensive in the country. So I'm continuing to save and invest so if I have to go in I'll have the funds to do so. I would never want Medicaid to choose what home I can go into. o_O
 
mathjak107 said:
very risky move , there is a 5 year look back ... the kids can be sued if creditors come after them for something , as well as divorce between the kids can be a problem .

trusts are a whole other problem for the stay at home spouse .. plus what does a spouse do when you put all their money in your kids name ?
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I think it's longer than 5 years now...in NYS
 
treeguy64 said:
Yeah, I can't see concerning myself with how to prepare, financially, for going into some facility that smells like Death's waiting room, where I'll sleep away the rest of my life, drooling on myself in a wheelchair in front of a TV tuned to who knows what channel, not that it'll make a difference. I'll take the alternative, no second thoughts needed.
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I agree but.....when do we know it is time to take the 'alternative' ? I mean, if one has a sudden medical emergency , they can well wind up in a home, by no choice of their own . They can holler & shout all they want, if med folks have them on the stretcher , their going in that home.......period.

If a person is deemed unable to be on their own/take care of themselves......that person goes where someone else decides.

LOL.......think I'll finish my coffee, and shoot myself......it's about the only way to "play it safe"........ :rolleyes:
 
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