Long Term Care Insurance

Horrible investment

Used to be worth it; but then the insurance companies saw long term costs eating into their margins.

Current policies are (way) overpriced and full of “gotcha” exceptions.

My mom had it and it was fantastic. I’d recommend 8k coverage a month. Don’t know when she started it so R1 maybe be right.

Medicare offers short term nursing care, depending on the particular need. With some Medigap policies, the term may be extended with partial coverage. For long term nursing care, I agree with the previous poster.

Do you really want to be in a nursing home?

I've known plenty of older people who ended up in nursing homes and not one of them liked it. They're dreary places, full of (justifiably) cranky, bitter people who do nothing but complain, again probably with justification.

Are you living in (or can you move to) a situation where you can 'age in place'? I live in a NY apartment with an elevator and a doorman. No stairs to the street. I can have anything I need delivered. No need for a car. Should I need in-home medical care, that is covered by Medicare, up to a point. Should I have a stroke or develop dementia, both my partner and doctor know my wishes. I have no intention of withering away in an old-folks home, staring out the window, looking forward to tapioca Tuesdays.

They last place I ever want to be stuck is in a nursing home, if you don't have insurance they will make sure you aren't there long.

How old are you OP?

Do you have any health conditions?

Are you able to get life insurance, with a long term care rider?

How much money do you have? If you’ve got 2-3 million, you might be better to self insure.

After the Covid fiasco in nursing home, I'll take my chances at home. If I die my cats can feast on the corpse., although they can be finicky eaters.

[quote] Should I have a stroke or develop dementia, both my partner and doctor know my wishes.

Which are to be smothered with pillows and thrown down the garbage chute?

[quote] Used to be worth it; but then the insurance companies saw long term costs eating into their margins. Current policies are (way) overpriced and full of “gotcha” exceptions.

By “eating into their margins” you mean suffering unsustainable losses that would lead to bankruptcy. Also, the “gotcha” exceptions are the policy provisions that people read and agree to when they signed their policy application. People know any insurance policy has limitations, yet feel like the contract’s terms shouldn’t apply to them even though they agreed to them and accepted the pricing that is based on both coverage and limitations.

[quote] Which are to be smothered with pillows and thrown down the garbage chute?

I was hoping for something a little more in line with the Death With Dignity Act, but as long as I don't suffer and he doesn't get caught, what the hell?

R9 is brought to you by the American Insurance Association

R11 also believes in "free" healthcare. "Why can't we just give everybody free healthcare? Why are those insurance companies so evil?"

It doesn't have to be dreary! You can be part of a margarita club, be a cheerleader, go clubbing every night, all at a place called the Villages. It's like summer camp for old people. I just saw a documentary.

Suicide is an easy way out of this life, but we must remember that if you commit suicide, you won't be allowed to enter the kingdom of heaven. Life on earth is temporary, but heaven or hell is for eternity.

Long term care insurance should be bought in your late 50’s. As was stated earlier, prices have suddenly risen astronomically.

The average stay in long term care is pretty short

I bought long term care insurance in my mid-twenties through work and pay about $150 per year. If you are already on Medicare it’s too late; you’ll be paying an astronomical amount assuming you are even eligible.

You need insurance for home health care AIDES, and it's not easy to get. If you ever have the need for an aide, and you will, better get insurance now and save up - it'll cost $60/hour by the time you need it.

[quote]Long term care insurance should be bought in your late 50’s.

No matter what age you buy, insurance companies will keep raising your premiums as you get older. I've known people who carried it for two or three decades and then just couldn't afford it any longer in their 70s.

[quote]if you commit suicide, you won't be allowed to enter the kingdom of heaven

r14 is not so concerned about the butt fucking tho

Ok, I’m discouraged. Maybe I’ll get lucky and won’t need a nursing home, but I don’t think it’s always possible to avoid it. I don’t have 2-3 million dollars and I can’t afford to pay high premiums. I’ve heard that Medicaid will cover when Medicare coverage runs out, but the facilities that will take Medicaid are generally poor quality. If I’m still capable of suicide, I agree that might be a better option.

You need to get it before you get a serious illness. If you are a cancer survivor, have high blood pressure, are HIV positive etc, no company will give you coverage,

I opted to pay long term care life insurance via my employer over ten years ago; but, effective 1/21, the insurance company stopped accepting my bi weekly premium. HR informed us all that the company will no longer offer the policy. No alternative option given.

I paid $1000s of dollars into this policy over the years, what a loss of $$! I pray I will be able to live at home in my advanced age. Good nursing homes are few and far between.

R22, I would research to make sure your rights aren’t being denied in anyway — of course I understand a company can do that, but you should still look into in-depth. I love how we all just have to keep bending over for our employers, meanwhile they have fucking *zero* accountability while we can’t afford a fucking medical crisis. Fuck the American Dream, it’s been dead since ‘93.

R20

Yes, those on Medicare can also receive Medicaid, but you have to qualify which means being low income to almost destitute (things vary by state IIRC).

Often in efforts to preserve assets of an estate children/family will attempt to move things around so their aged parent can qualify for Medicaid thus save paying for long term care and other things out of their own purse. This requires planning and possibly retaining services of a good attorney/advisor otherwise things can go wrong. In particular government can come a knocking on doors of children or estate asking (rather demanding) to get some or all of money paid out via Medicaid back.

More:

How New York State manages...

Nerd Wallet says....

Unlike many other countries in Europe and elsewhere that offer what would be considered LTC services in various forms as part of wide social service net United States does not. While this isn't surprising the latest effort by Obama administration (CLASS Act) was shot down as well, thing was deemed "unworkable".

While highly ever likely to happen, USA needs to address this huge issue as wave of Boomers move though senior citizen and old age. Worse many will do so single (never married, divorced, surviving spouse), and thus may not have family to rely upon.

Of course large issue would be same as when Social Security was created; those who paid least to nothing into scheme (those already requiring LTC services) would receive largest benefits upfront. This while those currently working would be paying into scheme for years or decades before being eligible.

OP, it might be worth it to consult with a financial advisor who has no ties to any insurance company. The cost will depend on your age, pre-existing conditions, etc.

I started LTCI several years ago and the price went up once, I think (i.e., the price did not go up every year).

You might not even qualify for anything reasonably-priced, but at least you found out.

When I purchased my policy, premium increases were exceedingly rare. I now experience double-digit increases each year and if I walk away, I lose what is over $20k in premiums.

Thank you, R23, I will research. I didn’t even think I may have a chance to recoup. I appreciate your information.

Thanks R27. That was helpful.

Boomers fucked themselves and their kids by not sorting out single payer universal healthcare. Their life savings will be vaporized by end of life medical care costs.

Instead of the impossible Medicare-for-all, people should demand that Medicare for the elderly (who are the ones who actually need it) be expanded to provide no cap LTC.

If you have no dependents & are not so concerned with leaving an estate, is long-term insurance that necessary?

I was looking at this today and I was seeing lifetime limits of $250,000. If the monthly cost of a nursing home increases to $10,000 by the time we need it, the benefit would run out after a little over two years. It might be better just to save $250,000 out of your retirement funds and self-fund nursing care until you deplete all your assets and are eligible for Medicaid.

For the that aren't concerned about entering heaven, suicide is always a cheap and readily available option.

^^^ Thank you for your helpful suggestion.

Trust me, you don't want to be in one. I'd kill myself first. Even the nice ones reek of urine.

Health insurance and Medicare only cover up to 100 days for nursing home stays, after that, nursing homes basically try to get at your assets, that means any savings, your home, your pension and your SS check. Whatever is deemed an asset, it's there for these thieves to take.

An elderly man in my co-op lost all his family's life savings, then, the nursing home tried to go after the co-op where his elderly cancer survivor 90+ year old wife was still living in. If the man hadn't died in the nursing home, I wonder how far these disgusting unscrupulous nursing home bastards would have gone.

Tell me why the government doesn't intervene and try to stop this ongoing scam. Nursing homes, which are mostly privately owned, are a billion dollar industry. They can literally bankrupt the elderly and their families. Why have be accepted this as the norm?

The idea to avoid a nursing homes grifting, is to move yours or your parents assets into a trust, get the assets down to nothing and the nursing home will be happy with the government paying them via Medicaid, accepting the pension and the SS check.

Many of my friends with elderly parents have done this. Their parents have been in nursing homes for years.

The biggest joke, the people who claim to want "less government interference" in their lives are always the first ones moving their parents money into trusts and they gladly accept the government paying for their parents Medicaid which keep their parents in a nursing home.. Fucking hypocrites.

Nursing homes don't seize assets per se, rather it is tied to Medicaid and a patient being "indigent" enough to qualify for coverage.

However there are ways around and or to lessen impact.

How France does LTC and what is different compared to USA.

Important take away before even reading link is to understand how France like many other European nations wrap LTCI into their universal health coverage schemes. One compliments the other so both work in tandem.

Since United States does not have a true universal health, you can see where problems start...

Medicare for all isn't a great solution either because you're enlarging a pool of beneficiaries who will draw benefits for decades without any corresponding increase in revenue (taxes).

Ideally as with Social Security workers would begin paying into any universal LTCI while young and not yet in need. Revenue can either be invested for future returns, or as with SS pay out current benefits with any excess above a certain amount invested. SS surpluses are "invested" as government borrows from fund but must pay back with interest IIRC. Any idea of allowing SS trust funds to be invested in open markets is always shot down.

As with French healthcare system private LTCI insurance can be used to top off state issued benefits, much like various Medicare "advantage" plans make up for what that scheme does not cover.

If you need LTC you can use your own money and assets then when you run out the state kicks in. Don't buy insurance unless you plan to use it to stay at home.

My mom bought a policy from MetLife in early 2000s. I don’t think they offer iit anymore. It pays a little over $8k a month and has been a godsend as her care at a facility is around $10k a month. This facility is in no way fancy. I don’t know what I’d do if she didn’t have this.

I’ve considered getting a policy but I know I do not want to live in a facility. I would rather take my own life than end up in a place like that.

I had an elderly friend who went broke and then couldn't walk, he ended up in a nursing home for 8 years under Medicaid. It wasn't a bad place, but he hated it. It ran close to $100,000/year, though I don't know what Medicaid paid. I went out every week on 2 buses to see that he was ok, and it was a chore, but I miss it now. He was quite a character. I put some of his drawings online, he was always drawing.

[quote]Nursing homes don't seize assets per se, rather it is tied to Medicaid and a patient being "indigent" enough to qualify for coverage. However there are ways around and or to lessen impact.

The thing is, many on these programs are not necessarily 'indigent', they are simply savvy enough to have put their money in a trust. They are no technically poor, yet on Medicaid, because they moved their assets years before they needed to be in a nursing home.

When a nursing home requires a person to "spend down", it means exactly that. You spend down your assets, afterwards, you are broke. The nursing home are then more than happy to take your pension (if you have one ) and your SS check. Medicaid then kicks in and pays the rest. It's that simple.

If a person wasn't savvy enough to move their assets before needing to go into a nursing home, they are screwed. The 'look back ' period to move assets is five years. Think it might be longer now.

Cuomo has recently changed the look back period for Medicaid covering at-home aides. If a person wants to remain at home, the look back period for moving assets, was one month, now its 30 months. The catch with this type of Medicaid program, the person needing the home aide doesn't get more than eight hours a day.

If you need 24 hour home care, forget it. You must pay out of pocket. It also won't help if you've moved you assets into a trust, the look back for a nursing home is still five years. A person wouldn't even be able to go into a nursing home full time unless they are willing to spend down the assets they put in the trust in order to be eligible for the at-home care. It's all so convoluted and basically a scam.

R41, your link is not relevant for NY state. There is law on the books called Spousal Refusal of Support, it's legal in NY. So much in that link has nothing to do with NY state laws.

One spouse can have their assets transferred to their wife, husband or legal partner. The nursing home then puts the other spouse on Medicaid. Asset transfers are also legal in NY state. The look back is five years.

In NY state there are literal millionaires on Medicaid in nursing homes. Of course, technically they are no longer millionaires because their assets were moved. Millionaires are usually are the types of people who seem to know all about the loopholes.

[quote] “gotcha” exceptions are the policy provisions that people read and agree to when they signed their policy application. People know any insurance policy has limitations, yet feel like the contract’s terms shouldn’t apply to them even though they agreed to them and accepted the pricing that is based on both coverage and limitations.

R9 is a vile fucking waste of flesh and bone. May he fall through the cracks of an insurance policy and die in a pile of his own waste.

Even if one's specialty were Contract Law, spotting the gaps in one of these policies doesn't open a path to a selecting another policy that does guard against what you might wish for as a potential client -- and certainly not what the insurance industry suggests that its Long-Term Care policies cover.

For some reason, Long Term Care Insurance popped into my mind today. Reading this has depressed me.

NFW.

When I get to that point it's helium balloons.

First, while it's too detailed to discuss here, when you look at the fine print long-term care insurance just doesn't pan out. Though yes it sounds like a good idea.

Second, and speaking of vultures, if you're saving up to fund your own care, put in place someone to step in if you ever get to the point where you can't handle your own finances. Nursing homes will jump at the chance to have a "professional" receiver etc appointed for you and once that happens your money will disappear. This is especially a concern for those of us ageing without families.

My mother has been paying for this type of insurance for years. But after the Covid disaster in nursing homes, she will never go into one. That was money well spent!

R51. Yes this is my concern ... I expect my partner to go before me and Im not sure I trust anyone in his family to do right by me w/o him around. And, Ive no close blood-relation family of my own. Do I hire my own Trust Officer?

Do you have a lawyer you can trust?

The problem is, in many states the appointment of receivers is nothing but a racket run by the courts for a favored few, who know how to strip assets out while staying within the law. It's a serious issue that gets little attention when single guys plan their end-stage finances.

I’ve heard nursing homes are fun again.

R16 many life insurance policies won't pay if person dies from suicide.

This movie was a real eye opener, because there’s really evil fucking people out there abusing the elder .

^oops didn’t attach^

R58 Yes! That's exactly the problem. But the whole guardianship/receiver system operates so under the radar you don't understand how powerful and dangerous it is until you or a family member gets caught up in it. And then it's too late.

My mother was in renal failure about 3 years ago. She was on dialysis for about 6 months and then one day I got a call that she was going to the hospital, and then another later that day that I had better drop everything and fly across the country because things weren't looking good. I was able to help get her issues settled (or so I thought) and she stabilized and began to improve, so I left after a week. The day after I got home I got a call from my aunt that they had moved her to a rehab facility. This had never been discussed with me or even mentioned as an option. While I had been in the hospital with my mom, I got her to sign both medical and legal powers of attorney, which the hospital had notarized copies of, but again, no one bothered to tell me.

In the "rehab facility" (which was really a nursing home), my mother began to decline again, and was experiencing sudden and acute dementia. I had to come out two more times to handle things and was pretty much told that should she need to stay in the facility past a certain date (which was looming) she was going to have to either pay privately or qualify for Medicaid.

My mother had no assets outside of a couple small pensions and her social security. She owned a small house in a retirement community that was totally under water. She lived with a long-term partner who was not on the deed and who I insisted at the time of her purchasing the house that she do a rental agreement with so he would be her tenant and not be able to lay claim to the house in case they split up.

In going through all of her papers during one stay there to try and get her monthly bills in order since her boyfriend was completely useless ( and hoping to find some evidence of LTC insurance), I found general life insurance policies, and (I shit you not) TEN accidental death ONLY insurance policies, all of which she was currently paying on, and none of which were going to amount to a hill of beans. It drove me insane because she barely left her house at that point so the odds of her dying in an accident were slim to none and I felt she could have been using that money to pay for a LTC policy. This is a woman who had sketchy health issues for 20 years and should have realized it would likely come to that.

Anyway, to try and wrap this story up, she had a moment of clarity and decided she no longer wanted to continue dialysis, so she was put on hospice care, which bought us a little time because the insurance got reset to zero. I was of the understanding that hospice care was 6 months, and then they re-evaluate if for some odd reason you're still alive. Not in NJ. We basically had three weeks and then they wanted her to qualify for Medicaid. Again, she had no huge estate, but they required us to put her house up for sale, even though it wouldn't net any money, and they wanted us to sell one of the two insurance policies. Her boyfriend was living in the house and would have been out on the street (he was useless, but a decent guy). It was incredibly stressful and nearly impossible to deal with and I was put in the position of hoping my mother would die so that I wouldn't have to throw someone out of their home. (And I certainly don't mean that literally, but you start thinking- man, it would be so much easier if she just... went. She's got no quality of life, she's in full blown dementia, etc. This is someone I love with all my heart.)

She died with something like five days to spare, and the whole thing left a really bad taste in my mouth, so I agree with those who advocate the suicide route. I wouldn't qualify for LTC insurance because I had cancer in my 40s, and I have no family now, so I'm definitely a candidate for the nursing home when the time comes, and I'd rather be dead.

R9 That's why medical insurance shouldn't be a thing. In what other insurance segment does the customer pay mountains for nothing in return? You can't even call it gambling because you get Nothing. I pay for home insurance. I pay for car insurance. It's there when I need it. I don't lose my job and file for bankruptcy after a claim. Life insurance - where you are virtually guaranteed to die and require a payout still can be profitable. So the idea that health insurance can't is bullshit. It is All. A Scam.

OP you're unlikely to need long term care anyway. Have you ever looked at a assisted living facility or nursing home? Almost all the inmates are WOMEN, hardly a man to be found. You will just likely kick it relatively fast and not hang on like women do for years. It's not called a place for mom for nothing, that's because dad croaks fast.

The benefits of a long term care policy can used for in-home care. If you want to avoid a nursing home you should get it. In-home care is costly.

R63 is right, get a policy with good in-home care provisions.

I also recommend watching Dirty Money on Netflix which is a great series and has an episode on abuse of the guardianship system. My limited experience with the Guardianship system has been of the thank goodness the courts have set this up this important mechanism so people who will never achieve adult level decision making aren’t scammed and homeless. One person I know under the system is a multi millionaire and the other is on Social Security Disability and they both have responsible, loving family member guardians. But wow, that episode opened my eyes. I plan to annuatize (sp clearly wrong sorry) my retirement funds. If my wife dies before me I’ll sell our apartment and buy an additional annuity with the funds. It’s not smart financially, but I figure it makes you les of a mark if there is nothing to liquidate.

Does anyone know how the Money Follows the Person provision works with the Administration for Community Living now?

I am disabled, no medicare. I just want burial. Colonial Penn or whatever it is called is my only option, but no coverage for two years. They claim to never increase the price, but I do not really know the fine print. There is always fine print. Ugh! Does anyone here have burial from them?

Colonial Penn is rather puny on total benefits (only about $50k), and as you might imagine they do rack up a fair amount of complaints.

However if you do due diligence, and can live with the max payouts then CP might work.

It helps to have some idea of average funeral, burial and or cremation costs are in your area. That will give a rough idea of how much coverage you will need for "final arrangements" so not to burden family or friends with expenses.

More on CP

It looks like there is flexibility in how States administer it R65. What state are you in?

When someone goes into a nursing home they must either have long term care insurance to pay the bills or pay out of pocket. If they have no insurance they must pay out of pocket until they become impoverished (in most states that's when they have less than $2000.00 in the bank). Then the nursing home will apply for what is called 'nursing home medicaid'. Once approved their state's Medicaid will begin paying the remainder of the monthly bill after whatever income monthly (social security, etc) the resident receives is turned over to the nursing home, minus whatever stipend their state medicaid allows the patient to keep (most often around $50.00/mo.).

Insurance to cover $8000.00/mo may be enough now, but nursing home charges are soaring on a yearly basis. Who knows what the average nursing home will charge 10 years or more from now. I can see it easily going over $15000.00/mo. Even crappy nursing homes these days charge over $6500.00/mo. I don't know if Medicaid & nursing homes have the same payment setup that Medicare has with doctors & hospitals or not. Medicare pays a set amount for each charge and if the provider accepts Medicare that's all they can get, other than the patient's co-pay. But I suspect they may. I can't fathom state Medicaid programs being able to pay $5000-$6000/mo or more for the vast majority of patients in nursing homes without going bankrupt.

If nursing home medicaid was done away with most nursing homes would close.

I'm in my 50s and taking the long view of what's ahead. I plan to live in my home until I die.

Georgia. Thank you. I thought they were not paying out for two years because of my MS. Very grateful to you.

To everyone questioning “nursing home care” that term can be used for home care. My mom had Medicare and state funded care and the state covered nursing home care. She had to qualify to get it, but since she had a stroke the state considered her eligible for nursing home care. With that being said, she was at home and I took care of her. She had x amount of hours a worker would come in per week. I was still considered her main caregiver though. Again, I don’t know how it is from state to state, but where I am they even had a provision where you could privately hire someone who wasn’t in the family to be your secondary caregiver.

So, pretty much the term “nursing home care” is just Medicaid/insurance jargon for when you become unable to care for yourself and qualify for that care. It doesn’t necessarily mean staying in a nursing home.

After my mom had to go to a nursing home for a few weeks after breaking her leg I wouldn’t put anyone in one of those godforsaken places.

Another thing, before you sign up for any kind of insurance GET A WILL AND DURABLE POWER OF ATTORNEY. Don’t ever think you’re too young for that shit.

The problem for a lot of people ageing here is that there's nobody around to accept a power of attorney. That's the real dilemma.

Hate to be the bearer of bad news but read that fine print.

I used to perform private disability chart reviews (by federal law- ERISA- the policy holder is allowed to appeal and get a board certified MD to review the case). I did a few long term care reviews (for cognitive changes, I am a psychiatrist). None of the cases were supportable based on the fine print - that is, the level of disability did not meet the criteria for need for assisted living. One must be essentially a basket case. not eating or bathing, and at risk for starting fires, etc.

To be fair, you can buy different policies that trigger at different care levels. But again, it's all a morass once you try to use it. Insurance companies of all types make their money saying "No."

Watch "I Care a Lot" on Netflix, with Rosamund Pike playing a professional guardian/ scammer. She's perfect in the role (many would say, because she doesn't have to act), and that film -- apart from being darkly funny -- though fictional, is a real eye-opener on what can happen with guardianship, care homes and flat-out theft.

R72 this is the site I found.

R78- Thank you.

Until Covid, elder care lawyers Connors and Sullivan in New York gave free seminars. The laws are very complicated. Connors gave the example of a woman who thought adding her children to the mortgage was transferring the house to them. Not only wasn't true, it took away her Senior tax exemption on the property,

I have it, with a $100K life-insurance policy with an LTC rider, meaning: Should I need a nursing home for any reason---broken limb/hip; dementia; etc.---my insurance pays the first $100 K, and should I require a longer stay, the company kicks in up to another $100K.

After all that is as exhausted as I, then would go my investments, then house. Then the government can take care of me.

R13, Better love Trump, then. They're quite nuts in The Villages.

That sounds like a good compromise, r81. Can I ask how old you were when you purchased the life insurance policy? I'm assuming it's not term. Is it whole or universal?

R81 here. Yes, I know Medicare pays for the first 100 days!

Also, because I purchased the policy at about age 68, I had to pay the total $100,000 premium up front. But at least it's drawing interest! Just an FYI.

R83, About age 68. I don't know about "whole" or "universal"; I just know it's good until I need it!

[quote]The benefits of a long term care policy can used for in-home care. If you want to avoid a nursing home you should get it. In-home care is costly.

But less expensive than nursing home care. The industry is moving, albeit glacially, to more at-home care. I work with some local nursing homes that have expanded into home healthcare the last five years and that segment has been growing much faster than their traditional model.

It may vary by region but here in NYC area aging in place has been almost standard for two decades or so. Only time elders end up in nursing homes around here it seems is when they suffer some sort of major illness that requires skilled nursing care, and that care cannot be provided at home.

For those without family and or friends to arrange city gets involved, assigns a social worker or someone coordinates things like an aid to come in, meals on wheels, and everything else so a person can remain in their apartment.

Many nursing homes around this area have or are planning to become in whole or part rehabilitation centers. People not ill enough to remain in hospital, but need some care as they heal or whatever before going home go to these rehab places. So much so that nursing schools send students to rehab centers for things like med-surg I or II because that is where stable populations of patients can be found nowadays.

Scores of rent stabilized or controlled apartments are full of seniors or the elderly who are aging in place.

Few years back NYT did an excellent series of the "oldest of the old"; New Yorkers 85 years old and up. Most were aging in place, a few had trips into hospitals or rehab, but finally ended up back home again.

John Sorensen, an elder gay who lived on UWS of Manhattan just off Central Park in a wonderful apartment he shared with his partner of 60 years was one of the "oldest of the old" covered.

Mr. Sorensen more or less chose to age in place because he didn't want to leave the apartment he and his late partner spent a lifetime together.

That NYT piece highlighted something most of us already know, and those that do not had better learn, majority of elder/senior care as they age in place is provided by family members. Children, grandchildren, nieces, nephews, brothers, sisters, etc... or maybe close friends.

Mr. Sorensen had his late brother's niece as is caretaker. That poor woman was juggling aging in care for three (IIRC) members of her family including her late uncle's partner.

I live in flyoverstan. My grandparents nursing home was something outrageous like $10,000 a month for some shit one bedroom hole. They were required to be able to care for themselves (ADLs) and medical care/medication was not included in that $10,000 fee. What an outrageous scam. For that price, I’m moving to a NYC, living in a flat, get myself food delivery and a social worker. Fuck it.

Don’t rely on Medicare to pay for a full 100 days. Skilled care (PT/OT/skilled nursing for things like daily IVs, certain wound care) is covered under Med A for as long as deemed “medically necessary” by Medicare standards. This means 100 days for a very small percentage of cases. More like a few weeks for the average person, and if you have a managed Medicare plan you’ll be lucky if you get 10 days before your insurance company cuts your coverage. Nursing homes are audited all the time and must pay back beaucoup bucks to Medicare if the stringent guidelines for skilled care are deemed unmet. You need steady, consistent progress for PT/OT to continue to cover your stay under Medicare. Everything in a Medicare/Medicaid facility is an aggravation, as they are rightfully the most insanely regulated industry in the country. Nursing homes don’t “seize” assets as some assert here, but they do charge for a service provided. If people need LTC after their insurance-covered stay and are not immediately eligible for Medicaid (another major pain in the ass process for nursing home social workers or business office) you need to pay privately from your own assets until you meet Medicaid eligibility. In most states, mine included, facilities house private-pay and Medicaid residents together, and the same level of care is provided to all. Of course that care varies depending on the facility, but the dreaded “Medicaid nursing home” is a myth. LTC insurance is great if you have major assets to pay the premium prior to nursing home need, and other levels of care like assisted living (not covered by Medicaid in many states) and private duty home care could be covered by that policy as well. But once you’re looking at long-term care, only the very wealthy would benefit from that insurance, drawing from the policy rather than their own assets to pay for care. Most just pay privately for a few months until Medicaid eligible, and i wouldn’t say what they would have paid for LTC insurance was worth it. Nursing home care is astronomical, but needed for many. Medicaid is such an important program to cover those costs. It’s great if you have money to pay for a good policy that would cover the full cost of care, but there’s also the risk of the policy denying full coverage.

If you get long-term care insurance, [bold]MAKE SURE TO SET UP SOME AUTO-PAY SYSTEM for the premiums[/bold]

An elderly uncle started showing signs of dementia so we went over his bills and records and to make arrangements to get him into a "home." Due to the dementia, he'd been hit-or-miss on bills for months. One of the bills he'd been "miss" on was long-term care insurance. He'd been paying the premium for years (maybe decades) but hadn't payed in a few months. I contacted them about paying any back-owed amount and they said they'd cancelled the policy for non payment, I asked if I could start anew and they said no, he no longer qualified. So they got all their premium money and never had to pay a dime even though he needed it - and the reason he needed it is the reason he skipped paying.

He was now screwed and only had his social security amount to cover care costs. The place we found him wasn't terrible, sort of like a group home and he was mentally out of it so it didn't matter to him, but there really wasn't much dignity there in the end.

A few years back an old friend of mine had emergency surgery to correct a strangulated hernia that almost killed him. It left him with an unclosed surgical wound you could easily have dropped a baseball into on his lower abdomen. After he was out of the hospital he was sent to a nursing home that had a certified rehab program. He needed to set up a power of attorney for someone very quickly as all his family was dead and gone. He chose me. On his first day in the nursing home they provided him with a huge binder with everything one would need too know about short term, long term, and rehab facility care. I took the binder home and spent the next few days reading it from start to finish. My God what a horror story of red tape and cruel treatment by the government people have to go through when they're at their weakest point. At that point we didn't know if his nursing home stay would last beyond the rehab or not. I learned from the binder info that Medicare would only pay for 20 days in the rehab facility. Most of the real nurses in the home were quite nice and caring. But the CNAs (Certified Nursing Assistants) for the most part were horrors, many of which needed to be locked up in jail. I learned from one of the few CNAs who was nice that they were paid just barely above minimum wage. She had given her notice and filled me in on what goes on in those places. During my friend's time there CNAs were fired on a daily basis for abusing residents, but only after being given multiple chances to correct their behavior. They allowed people who they knew were abusing people to stay on for weeks until they had no other alternative because CNAs were hard to come by due to the shitty pay and working conditions. I don't know of too many people who'd want to spend their days wiping 90 year old soiled butts and bathing the bed ridden for just above minimum wage. And unfortunately too many of them took their anger out on the residents there.

After a couple days as he regained some semblance of mental acuity I point blank told him "you need to do everything in your power to get well enough to go home within 20 days because if you have to stay longer they're going to bleed you dry financially". At that time a semi private room in that nursing home was $6600.00/mo, which would come out of his pocket after 20 days until he was reduced to less than $2000.00 in his bank account. The only good thing about him being there for rehab was that they put rehab patients in private rooms. If they stayed after 20 days they would be moved to a regular semi private room with only a shared toilet (no shower or tub) between each 2 rooms.

Luckily he paid attention and was able to go home on day 18. Then a nurse would come to his house twice a week to repack the gaping wound (a procedure I hope to never witness again). It took months for that wound to fully seal.

I forgot one thing. I decided during those 18 days he was in the nursing home that if anyone ever told me I would have to go to one of those places for the rest of my life, and I still had enough sense left in me to know what was going on, I'd end my own life before I'd let anyone take me. Spending the rest of your life in a nursing home, unable to take care of yourself, is a fate far worse than death in my opinion.

You should've thought of that when you were 20. It's too late now. Do what Brian the dog does.

My mother bought it in 2004 and it pays out $6500 each month. The bill from the assisted living is around $10,000.00. The people looking after the residents are paid under $20/hour. You don’t get much for your $10,000.00: Lousy food, urine smelling building, indifferent staff. I wouldn’t buy the insurance, I’d rather kill myself than live in a place like that.

Although maybe in other states they are actually decent. My mother’s is in NY.

Monthly bill is $10,000 a month, I mean.

1. Medicare is the same nationwide as it is a federal only program. If you have traditional Medicare with a supplement, you can choose any Medicare provider in the country. Medicare, which was developed starting in the 30s (but did not become law until 1965) was needed to provide the post-employed access to the health system. The issue at the time was a need to provide coverage for treatment of acute illness. It was never designed to handle chronic illness and the disabilities of aging. In fact, Medicare treats chronic illness as acute illness happening over and over and over again. After the Medicare Modernization Act of 2002, what had been Medicare HMOs got standardized as Medicare Advantage Plans. These plans cover all typical Medicare A (inpatient) and B (outpatient) benefits but are not administered by the Federal Government and CMS, they are administered by private insurance companies. If you select one of these, your Medicare dollars are transferred from the Feds to the insurance company to manage. The insurance company gets you to choose them through slick advertising and a few bells and whistles (cheap benefits generally not covered under Medicare) but then is allowed to limit your choices and you may only receive services from providers in their contract network. (As private companies, they have 20-30% overheads including paying their stockholders compared to Medicare's 2% overhead - gotta save money somewhere.) This acute care focus of Medicare (finally tempered slightly through some provisions of PPACA in 2010) is one of the reasons health care in this country is so ridiculously expensive. We pay for things only after the disaster has happened rather than by trying to keep the disaster from happening in the first place.

2. Medicaid, which provides services to the impoverished is a joint federal/state program with significant state dollars involved. It is an enormous cost to state budgets. As long term care in a nursing home cannot be defined in acute terms, publicly funded long term care falls under Medicaid programs and the rules and regulations are different in every state. In some states, only nursing home care is paid for. In other states, there are Medicaid funds available for supportive care at home or for assisted living. The difference between a nursing home and assisted living is that a nursing home offers 'skilled care', things that must by law be overseen by a nurse such as medication management, dealing with catheters, feeding tubes etc. Assisted living offers non skilled care - assistance with bathing, dressing, preparation of meals, housekeeping. How assisted living deals with medications is different from state to state. Nursing homes, as they receive federal dollars are required to adhere to a byzantine array of federal regulations. Assisted living, as they do not, are usually only subject to state regulation which tends to be much lighter.

3. Following an acute illness that requires hospitalization, if you are a Medicare beneficiary and you are hospitalized for a minimum of three days (defined as three midnights in the hospital), Medicare A (hospital insurance) opens up a benefit for rehabilitaion in a nursing facility that is covered by Medicare. In general, it is for 20 days (but can be extended up to 100 days if Medicare considers you to be making progress in your recovery and you are willing to take on additional copays). This particular payor source is quite lucrative to the nursing home industry so most nursing homes have built 'therapy units' for these patients and there is a push to get patients out of the hospital and into rehab sooner rather than later as it is cheaper for Medicare in the long run. Many therapy units do a good job at restoring function. Some are nothing more than financial scams.

4. Long Term Care insurance is a private product and insurance companies can set any rules, riders, and regulations they choose as it is a contract that individuals sign, presumably with their eyes open. Long Term Care insurance which has decent open ended benefits for thousands of dollars of care a month generally is not sold any more as the product has proven actuarially unsound. Older policies which have been paid on for years are still out there. Some policies have set premiums. Some have adjustable. What the policy will pay for and how and what the conditions are that allow the policy to come into force are entirely up to the language of the contract. If there is suspicion of fraud, contact the state insurance commissioner's office. 5. You are, of course, free to live your life as you choose at home as you age under your own rules. However, most individuals do not take in the realities of aging. Dementia is inevitable if one lives long enough. You are likely to have more and more trouble walking and balancing so stairs become an issue. The everyday business of cooking, cleaning, laundry and the like may become too much. The skills needed to drive safely are often gone by the mid 80s. If you can't do these things for yourself, someone else must be able to do them for you. If you have family and friends who can do them, great. If you don't and must rely on hired caregivers, most areas have reputable agencies (expect to pay a minimum of $20-25 an hour. You can of course, privately hire a companion to live with you but finding someone trustworthy who is willing to give up their life for you is difficult.

5. If you cannot manage on your own and feel like you must live in congregate senior living, there are lots of options. The majority of nice ones cater to those with money. Independent senior living (condo/apartment with dining and housekeeping services etc) will run $4000-10000 a month depending on the location and level of amenities. Assisted living or dementia living will cost a good deal more. Skilled nursing living (often the only option for those on Medicaid) generally starts around $6500 a month. If you do not have this kind of money, you will be forced into a 'spend down' of assests until you meet the level of poverty Medicaid in your state requires for qualification. Most of these levels are very low as the laws haven't been updated for fifty years. Then you will be placed in a facility that will accept Medicaid in your state. As the payments are poor, they tend not to be nicest.

6. All of this is about to crack and fall apart under the weight of the baby boom. The classic boomers (born 1946 to mid 1950s) are now in their late 60s and early 70s. This remains a relatively healthy cohort in American society and few need significant health services or long term care. Fast forward ten years when they are in their late 70s and early 80s. This cohort is far less health with a significant burden of dysfunction and dementia. Mind you this will be happening in a generation that a) wants everything and wants it NOW and b) refuses to admit that they ever change or are anything other than young. The 2030s and 2040s are going to be very interesting in terms of health care because of this phenomenon.

7. In 2030, roughly 85% of the initial boomer cohort will still be living and the entire cohort will be over the age of 65 (this is the year of peak age). 40% of boomers will die in the 2030s and another 40% will die in the 2040s and their stranglehold on political / social / economic power will end. There will still be a few boomers left after 2050. In fact, the very last one won't die until about 2080.

[quote] Nursing homes don’t “seize” assets as some assert here, but they do charge for a service provided.

WTF do you think "spending down" means? It means exactly that, slowly seizing your assets!

Of course, these disgusting nursing homes don't take everything from you at once, however, once you are past the "up to 100 days allowed on your health insurance" bullshit (usually a combo of Medicare and your private healthcare plan) and you must remain, they start charging whatever their monthly rate is. The place my mom was in a few years ago, charged $13,500 a month! They tried to make her an invalid. She went in walking with a cane and went home in a wheelchair!

For long term care, if you are not on Medicaid, a nursing facility takes a combo of payment from Medicare, your private insurance, your pension (if you have one) and your assets. Mostly your assets!

If the person needing long term care was smart enough to move their home(s), investments and other money into a trust long before they need long term care, the facility will put you on Medicaid. Over the course of the two months my mom was in a nursing home, I met and spoke to several old women. All had several properties, one owned several apartment buildings and another had a third home in Europe. All these women had moved their assets years before they needed nursing home care.

One woman was only there a month, for actual physical rehab, yet she was on Medicaid. Ironically, all these women were foreigners with money and many properties. Seems they all knew how to get on Medicaid, lots of Americans sure don't know, or seem to care, about what will happen to them if the are no longer mobile and healthy.

Gay geriatrician is right. Currently NYS spends 1/3 (about $70 billion) of its state budget on Medicaid, with a huge chunk of that going to long term care. As the boomers age, they will use up a greater chunk of state budgets as well as bankrupting Medicare.

My cousin is a Medicaid fraud. She is perfectly healthy, able bodied and has no problem living off of someone’s else’s hard work.

R102, what is her "Medicaid fraud"? Full Medicaid? Is everything covered? Does she live in Section 8 or NYCHA housing, gets 'free' healthcare and a food stamp card? How about a free cell phone? Meanwhile, let me guess, she's walking around in $300 designer sneakers? Working off the books too?

Your cousin isn't the only one, lots of people are now perpetuating some type of Medicaid scam, especially in NYC.

How to do you feel about non-US residents currently getting the Covid vaccine while they are visiting family in the US? I know a few who already got the vaccine. They are in the US on 6 month visas.

People will always find a way to scam the system.

NYS is a Medicaid fraud.

I (r84) have no one, r89. No siblings, hence no nieces or nephews. No children, hence no grandchildren. Four friends only, all in their 60s and 70s, three of them childless also!

The fourth one, thank God, can take me to out-patient procedures and lives in my close vicinity. But her adult son lives 60 miles away and I've never met him!

Thus and therefore, I opted for my LTC policy!

Now, I did experience the negative, to wit: For years, my husband and I paid thousands into an LTC policy for him. But I wasn't paying much attention, and when we needed it (nursing home for dementia plus hospitalizations), I learned that the policy kicked in only after 30 days post-Medicare. Because he died on Day 31, it was money thrown away. But one never knows, does one?

[quote] How to do you feel about non-US residents currently getting the Covid vaccine while they are visiting family in the US?

I'd rather them get the vaccine than go around infecting people while they're here, or running up huge hospital bills if they get sick and have to be hospitalized. Bills that will never be paid once they go back to their home countries.

R101

Whoa there little buddy!

NYS's spending on education and Medicaid is huge for many reasons, much of it due to this place being a welfare state, and run by unions. Democrats and some republicans just don't have the belly to fight against teachers, and healthcare unions. And it would be a colossal battle to make sort of changes required to reduce education and Medicaid costs in NYS.

As long as health care is an industry that the top people want to get into in order to get rich nothing is going to change in this country. There's a reason why Russia and Cuba have 2 of the best health care systems on earth. Doctors don't become rich off their profession, and hospitals don't run on huge profit margins.

Something that I’ve have to sit down with my mom and sister and figure out some long term plans. Sounds depressing but got to do it.

It takes a lot of work and energy to keep yourself at Medicaid levels.

Try doing it.

R103 she’s actually not into designer sneakers/clothes. She dresses like a virginal teenager in old clothes. Part of her, “look at me! I’m a victim!” act is to dress shabbily. She has no remorse about scamming. She really thinks “rich” people are evil and “poor” people are good and that the poor are incapable of scamming. All scamming is done by the wealthy. Who are the “rich” in her eyes? Anyone with a job. I am not kidding.

[quote][R103] she’s actually not into designer sneakers/clothes. She dresses like a virginal teenager in old clothes. Part of her, “look at me! I’m a victim!” act is to dress shabbily. She has no remorse about scamming. She really thinks “rich” people are evil and “poor” people are good and that the poor are incapable of scamming. All scamming is done by the wealthy. Who are the “rich” in her eyes? Anyone with a job. I am not kidding.

You are not stating how she does the scamming. Does she have money stashed somewhere? How does she hide it? Does she work off the books? That's how so many scam the welfare system, most have off the books jobs. If these scammers don't work off the books, you do have to wonder how they can afford HD smart TVs, iPhones, the biggest Macs, expensive clothing and everything else so many scammers seem to have.

You cannot sell food stamps anymore, as the recipients now get a food stamp card. Many easy ways of scamming no longer exist.

How has she ben able to perpetuate her scamming? Anyone on Medicaid has to be reviewed yearly, even the elderly on Medicaid for their home aides, everything needs to be verified yearly.

Is she on disability, which is very difficult to get on, at least in my state I'm in.