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The Boomers will completely overwhelm the long term care infrastructure of the US.
Home care will have to become the main way to cope.
The whole paradigm needs to change. Many LTC plans cover home care / assistants.
Of course it is catastrophic and meant to protect a shared nest egg if one spouse needs that nest egg to survive after the earlier declining spouse has an extreme situation lasting more than 90 days. It is geared toward upper middle class and lower upper class people who are too wealthy and have too much at stake to wait for Medicaid to kick in and are too poor to self insure.
As you note at one time LTC was an important discussion point as part of legal estate planning. A discussion point to be evaluated on a personal basis. It also was discussed when evaluating fixed combined income streams like pensions and SS etc.
One of the reasons NH care may wind-up being so short-term is the often prohibitive costs of ALF/NH care for folks with no financial preparations (as you likely know, Medicare covers neither - and one must spend-down their entire financial estate to qualify for Medicaid ALF/NH assistance). In addition to the financial implications, extended home-care wreaks a huge toll on the surviving spouse or caregiver. Long Term Healtcare today is only the 'tip of the iceberg' facing the ever-growing 'boomer retiree population.'
Good news if you live in CA, at least. State Medicaid (called Medi-Cal on CA) allows the non-LTC spuose to retain a nice chunck of change, while hubby is relaxing in a local facility. Check to see if your State has a similar law on the books.
"California law allows the community spouse to retain a certain amount of otherwise countable resources available to the couple at the time of application. This is called Community Spouse Resource Allowance (CSRA) and it increases every year according to the Consumer Price Index. The current (2010) CSRA is $109,560."
I beg to disagree with your optimistic view of the community spouse being able to retain $109,000.
What kind of a cushion is that in todays world where a loaf of bread costs $3? My car is 19 years old and I will have to replace it soon because it is no longer reliable and in constant need of repair.
My husband has been in a health and rehab facility for more than 3 months. I am now down to the bare bones and have applied for medicaid. I am told that I will have to contribute (as our share) all but $35 of his monthly SS check. That leaves me with my SS check of about $1100 per month to live on. Out of that I am expected to pay for food, shelter, clothing, utilities, insurance, taxes, gasoline, home and auto repair/maintenance and anything else that comes up on a daily basis.
Do the math and you will find it is not possible. Therefore that generous resource allowance will quickly dwindle. On top of all that, my accountant tells me I still have to pay the minimum federal income tax.
As far as your comment about hubby relaxing in a local facility, you have obviously not been close to
anyone in such a situation. I used to go visit him every day. Now I have cut back to twice a week. First off - I can not afford the gas to get me there. But more important is his attitude. He is definitely not 'relaxing' and argues each time I see him or speak to him on the phone and he wants OUT and come home. He accuses me of keeping him in jail and not wanting him around. It is a very depressing state of mind for myself. We have no family to lend moral or any other support. I feel very much useless and inadequate to help him or myself.
He can not walk or otherwise take care of himself. He has a heart condition, diabetes, high blood pressure and restricted arteries. Needs assistance to get dressed, go to the bathroom - take a bath - etc. Even though he has lost a lot of weight, he is still around 190 pounds and prone to frequent falls. I am 5'3", 115 pounds and pushing 70 years old myself. Aside from the fact that the home is reluctant to release him, I can not let him come home because I can not take care of him.
What the insurance people would like you to believe:
Today, three out of four people over the age of 65 will need long-term care at some point in their lives. The reality is, the longer you live, the greater the likelihood that you may require long-term care. The costs associated with needing long-term care are significant. While it can take decades to accumulate the assets you’ll need to retire comfortably, just a few years of paying for long-term care may threaten a lifetime of savings.
According to the U.S. Bureau of the Census, slightly over 5 percent of the 65+ population occupy nursing homes, congregate care, assisted living, and board-and-care homes, and about 4.2 percent are in nursing homes at any given time. The rate of nursing home use increases with age from 1.4 percent of the young-old to 24.5 percent of the oldest-old. Almost 50 percent of those 95 and older live in nursing homes.
As some of you may know I work in Social Services and see how it is. I can assure you that 75% of our folks over 65 are not in long tem care. There simply isn't enough bed space to accomidate 75% of people over 65 in our county. None of my friends, who are over 65 reside in a nurseing home. If you want to buy LTC insurance that is fine. Just know the facts.
Like they say - there are lies - dam* lies - and statistics. The thing about X% of people over age Y being in a SNF at any given time is totally irrelevant. The first question is what a person's chances of ever winding up in a SNF for long term care are. The most common figure I've seen is about 50% - and that seems to be the norm:
Less than 5% of elderly Americans reside in a nursing home at any one time, but 43% of all people eventually spend some time in a long-term care facility.
The second issue is the "normal" length of stay (most people agree it's about 2 1/2 years).
And the third - but most important issue - is what particular people in varying circumstances should do in light of the statistics.
Now I know we have folks here who are always saying they'll put a gun to their heads and pull the trigger before they'd go to a SNF. But I doubt anyone is saying that from the POV of: 1) I need SNF help; or 2) I have to pull the trigger. Talk is cheap. How can someone who is 65 and relatively healthy know how they'll feel when they're 85 or 90 and infirm? I know that I don't know the answer to that question for myself.
The financial thing is tricky for most people in the middle (if you have a lot of money - you don't have to worry about insurance - if you have no money - you don't have to worry because you can't afford insurance). And - so as not to reinvent the wheel and have everyone repeat themselves - I'd suggest that people in the middle read the recent thread in this forum about long term care insurance that mathjak started recently. Robyn
You can buy lifetime coverage, at a price, but they've yet to define a "lifetime" other than to say you die at the end of one.
The REAL story might just explain why and how some of our many really (?) elderly (mid-70s to 90s) neighbors are managing just fine in their own homes. Besides, it's nice to read an OP that doesn't send me outside to check on the sky.
The "neighbors" thing isn't to be trusted IMO. Because when your neighbors have "issues" - they tend to disappear (frequently having to move to be near their children or other family members). I'm sure my late FIL's neighbors thought he was doing "great" in his 80's. Until he had a stroke - and we had to move him to a SNF near us where he spent the last years of his life. Robyn
The number one reason family puts old folks in nursing homes...is...incontinence. changing Dad's diapers and changing bed sheets becomes a task most people prefer not to deal with. I took care of my Grandmother at home for years. But after her last fall, she broke her hip and needed full time care and advanced chronic pain management, it was too much.
I see things changing. ..long term care is really becoming more like "short term" care...seems to me folks are being assessed, and only last 6 to 9 months at a nursing home. Otherwise, after a stroke or something they send you to 30-90 day rehab and back home if you are doing okay.
You nailed it. And - specifically - fecal incontinence (we became friends with the CEO of my late FIL's SNF and talked a fair amount about this stuff during our visits/lunches there).
Also - you may be mixing 2 of the things that most skilled nursing facilities do. One being long term care. The other being rehab. Medicare pays for a limited amount of post-hospitalization rehab. Once Medicare rehab is finished - either because the patient has reached maximum medical improvement through rehab (even if the patient is still in miserable shape) or Medicare benefits are exhausted - the patient has 2 choices. Either go home - or become a traditional long term care patient. With traditional long term care - you have to pay for it. Through personal resources - insurance - or Medicaid (if you qualify for Medicaid).
I've honestly seen so many permutations of these scenarios that it's hard for me to generalize about anyone or anything. My 90+ year old aunt went into rehab twice after 2 knee replacements at ages 88 and 90 IIRC. She worked hard in rehab - and is now living in an independent senior living facility. A friend's mother (age 80) just broke her hip - had a hip replacement - and refuses to do anything in terms of the rehab necessary to reach maximum medical improvement and walk unassisted again. With her current attitude - I don't think her prognosis is very good. She's living with my friend now - and perhaps will be a burden on my friend for the rest of her life. It's the old - you can lead a horse to water...
...well, ever try putting on the call light because you need to "pee?'...
I can't address your specific medical conditions. But often - after various surgeries- it's not advisable to be up and about - to do anything - for a variety of reasons. So you'll wind up with a catheter - or a bed pan.
If your biggest complaint about your surgery was you couldn't pee like you're used to doing at home without surgery for a while - consider yourself lucky (the patient who can bit** is the patient who is getting better fast ). Robyn
I beg to disagree with your optimistic view of the community spouse being able to retain $109,000.
What kind of a cushion is that in todays world where a loaf of bread costs $3? My car is 19 years old and I will have to replace it soon because it is no longer reliable and in constant need of repair.
My husband has been in a health and rehab facility for more than 3 months. I am now down to the bare bones and have applied for medicaid. I am told that I will have to contribute (as our share) all but $35 of his monthly SS check. That leaves me with my SS check of about $1100 per month to live on. Out of that I am expected to pay for food, shelter, clothing, utilities, insurance, taxes, gasoline, home and auto repair/maintenance and anything else that comes up on a daily basis.
Do the math and you will find it is not possible. Therefore that generous resource allowance will quickly dwindle. On top of all that, my accountant tells me I still have to pay the minimum federal income tax.
As far as your comment about hubby relaxing in a local facility, you have obviously not been close to
anyone in such a situation. I used to go visit him every day. Now I have cut back to twice a week. First off - I can not afford the gas to get me there. But more important is his attitude. He is definitely not 'relaxing' and argues each time I see him or speak to him on the phone and he wants OUT and come home. He accuses me of keeping him in jail and not wanting him around. It is a very depressing state of mind for myself. We have no family to lend moral or any other support. I feel very much useless and inadequate to help him or myself.
He can not walk or otherwise take care of himself. He has a heart condition, diabetes, high blood pressure and restricted arteries. Needs assistance to get dressed, go to the bathroom - take a bath - etc. Even though he has lost a lot of weight, he is still around 190 pounds and prone to frequent falls. I am 5'3", 115 pounds and pushing 70 years old myself. Aside from the fact that the home is reluctant to release him, I can not let him come home because I can not take care of him.
Sorry about the rant - it just had to be said.
You don't have to apologize for your "rant" at all. You actually remind me of some people in my family. My aunt X and my late uncle Y in California. Although you're younger - too young to have to go through what you're going through IMO. This aunt and uncle of mine have 2 kids - but the kids were/are more interested in any potential inheritances than helping their folks. I'm glad I live 3000 miles away - because - if I lived any closer to my cousins - I'd be mad at them perpetually. Apart from the old car - I suspect you're driving on close to bald tires too.
I also agree that the comment about one's spouse "relaxing" in a local facility is really obnoxious. Also agree about the observation about handling people who basically have limited/no mobility. My late FIL was tall and thin. About 155 pounds. But if you ever try handling a 155 pound sack of potatoes - well it's impossible for most people. My husband developed horrible back problems when he had to deal with his late father in the year before he died (even just doing things like getting him into and out of the car for various reasons). In a SNF or similar - someone of your husband's weight - or even my late FIL's weight - will need 2 people to help in terms of doing many things.
I will say in all honesty that I have never walked in your shoes (and hope I never do). And - therefore - I don't have a lot in the way of suggestions for you. But I would like to hear from you. What changes would *you* like to see in terms of how things are handled that you think would improve things on your part? Big things - little things - whatever.
I know I have a reputation here as a conservative curmudgeon. And I reckon I am. But - to me - because we in this country can't pay for everything we want - it's first things first IMO. Elder care goes ahead of 9 bazillion copies of 50 Shades of Gray in public libraries. And I think I should be paying more for my Medicare (because I can afford to pay more - as can many seniors). You take care, Robyn
Maybe that whole African Pygmy culture...when you can't keep up with the clan any longer, they would leave you under a tree with a gourd of water...there is something to be said for the dignity and simplicity of an end of life choice like that.
Sorry...I spend a lot of time with people who would probably embrace a choice like that....instead of scrambling,, trying to find assisted living, medical foster care, group foster care homes, adult day care...figuring out the cost...it is crazy.
Like they say - there are lies - dam* lies - and statistics. The thing about X% of people over age Y being in a SNF at any given time is totally irrelevant. The first question is what a person's chances of ever winding up in a SNF for long term care are. The most common figure I've seen is about 50% - and that seems to be the norm:
Less than 5% of elderly Americans reside in a nursing home at any one time, but 43% of all people eventually spend some time in a long-term care facility.
The second issue is the "normal" length of stay (most people agree it's about 2 1/2 years).
And the third - but most important issue - is what particular people in varying circumstances should do in light of the statistics.
Now I know we have folks here who are always saying they'll put a gun to their heads and pull the trigger before they'd go to a SNF. But I doubt anyone is saying that from the POV of: 1) I need SNF help; or 2) I have to pull the trigger. Talk is cheap. How can someone who is 65 and relatively healthy know how they'll feel when they're 85 or 90 and infirm? I know that I don't know the answer to that question for myself.
The financial thing is tricky for most people in the middle (if you have a lot of money - you don't have to worry about insurance - if you have no money - you don't have to worry because you can't afford insurance). And - so as not to reinvent the wheel and have everyone repeat themselves - I'd suggest that people in the middle read the recent thread in this forum about long term care insurance that mathjak started recently. Robyn
Just curious if you sell insurance. How is it true that if 7% of folks over age 75 (see my links) live in nursing homes you say that 43% of us are going to spend 2.5 years in LTC? Folk I work with...Those who do rehab in LTC (90-95%) spend a month or two in LTC, which is under the 120 day limit for Medicare.
So what does your company charge for LTC insurance?
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). Robyn
