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Old 12-27-2015, 07:12 AM
 
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my dad needed 6 years of nursing home care in florida .

we ended up getting him taken in by a retired nurse and her husband . he was totally paralyzed from a stroke and needed 24/7 care .

they took one other person in and cared for them both . the care was very good and a fraction of the price of a home at that time
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Old 12-27-2015, 08:18 AM
 
Location: Ponte Vedra Beach FL
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Quote:
Originally Posted by mathjak107 View Post
the idea is to save enough of your assets to get in to the home of your choice and pay a year or 2 . . once you are in , most homes will keep you once medicaid takes over payments .

while the nicer one's may not take you on medicaid day one they generally will keep you when you switch .

that is why we wanted the 3 years insurance . there isn't a place around here that wouldn't drool over 3 years payments at a very high rate compared to what medicaid pays
I would do a reality check on the bolded sentence. When we moved my late FIL into a SNF - we were given a long financial questionnaire to complete. We were able to avoid filling out the questionnaire by submitting my FIL's net worth statement - and ours. And signing a letter that stated that if my FIL ran out of money - we guaranteed payment. And that was that.

Note that my FIL never ran out of money - or anything close to it. And he died after 2 1/2 years - which is about how long reasonably sick people wind up living in SNFs on average.

That was 10 years ago - and someone in his/her 60's today is probably talking about a need 20 years in the future. Who knows what things will look like then? What facilities will look like/be available in our areas? Which will have even some Medicaid beds - much less many? What their policies will be in terms of assets? Whether we'll even need SNF care - as opposed to lesser levels of care in senior independent living facilities or ALFs - many/most of which don't deal with Medicaid in any way/shape/form?

BTW - my FIL (who wasn't Jewish) was in the "Jewish" SNF here - one of the best in the whole state. Religious non-profits like this one - which often get substantial private support from members of the community - are often the better/best facilities in an area. Ours gives Medicaid bed preference to poorer members of the Jewish community here. And has - over the last decade - implemented a set of rules that discriminate against people who have tried to "game the system" to make themselves "poor" (there is ample need/demand from people who are really poor).

Better/best facilities may also include the SNF portions of high end CCRCs - some of which are open to members of the public. Unlike the religious non-profits - which may feel an obligation to serve poor members of their communities - the CCRCs - at least the couple we explored here - didn't have any Medicaid beds at all.

When it comes to the large for-profit operators - like Brookdale - which probably operate most of the facilities in the US - their facilities may be better or worse - depending on one's geographical area - and may vary within geographical areas. Also - various facilities in various areas may have different rules about Medicaid beds/admissions.

Overall - I wouldn't assume - without checking - that all facilities - especially the better/best ones - would necessarily admit a resident who can pay for 2-3 years of private care - but not more. Either today - or down the road. Especially if it seemed like the prospective resident might easily live another decade. I also wouldn't assume that a large public for-profit corporation wouldn't ever try to evict a paying resident who went on Medicaid - especially if it had paying residents waiting to move in (although various state laws might offer some protections and the result might depend on whether the facility has Medicaid beds). Robyn
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Old 12-27-2015, 08:39 AM
 
Location: Ponte Vedra Beach FL
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A few misc. points. Not all estate planning and similar attorneys will get involved in this "Medicaid planning". The ones I have used over the years won't.

Irrevocable trusts are separate legal entities that require separate accounting - tax returns - etc. They can be an expensive PITA to administer IMO.

The level of care in a SNF is correlated with the amount of money the SNF has available to spend. The more Medicaid beds - the less money available to spend. If the operator is "for profit" - profits will come off the top and there will be less money available to spend. If the SNF is a non-profit - it may - like our local one - get substantial cash charitable contributions - so there is more money available to spend. A non-profit may also get substantial non-cash contributions in the form of volunteer hours and the like. Overall - the SNF my late FIL lived in had about 15-20% more money to spend than a typical "for-profit" SNF. Even with Medicaid beds (the number of which it has been reducing over the years). That 15-20% can make a big difference in terms of quality of care. Robyn
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Old 12-27-2015, 08:55 AM
 
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as expensive as our LTC INSURANCE is i rather pay it then get involved with the headaches of having irrevocable trusts . i would rather not cut each other off from our own assets .

besides the trusts don't alleviate the restrictions on income for the stay at home spouse so in that respect they would be horrible here .


my grandfather was in a real dive on medicaid and it was the only place we could get him in .

I WAS A KID AT THE TIME AND THAT HOME IS BURNED IN MY MEMORY FOREVER IT WAS SO AWFUL .

but our family was poor and we couldn't help him .


we made a few calls ourselves before we took the policy to see just what the nicer homes in our area did once the insurance ran out . that was important to us .

they said they offer a limited number of beds for medicaid but if you are there a few years privately , no problem assigning medicaid .

Last edited by mathjak107; 12-27-2015 at 09:10 AM..
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Old 12-27-2015, 08:56 AM
 
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Originally Posted by Harpaint View Post
There are going to be SO MANY Boomers with no assets and therefore dependent on Medicaid, that I am very skeptical that they will receive quality care. Medicaid already pays so little that many facilities and physicians won't accept these clients.
This captures the long-term trend. Something like 2/3 of late-boomers and Gen-X'ers are going to die poor. The wealthier states are on the hook for 50% of Medicaid. It is crushing them with the burden. It's not sustainable and Medicaid is inevitably going to be dialed back considerably. Nobody is going to build Medicaid-oriented long term care facilities because there is no money in it. If your financial planning strategy is that Medicaid is going to deal with you, you're likely to live some pretty miserable last years of your life. Ward-style long term care facilities staffed with $12.00/hour CNA-level employees and one RN to oversee them.
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Old 12-27-2015, 09:06 AM
 
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the flip side as the judge in ct brought up . if you impoverish all the stay at home spouse's then it will not only cost the state the medicaid money but it will cost them in other ways when the spouse is broke too .

everything from defaults on homes , taxes paid , loans , and money available to be spent supporting business in the state would end up suffering .

it was better he felt to contain the effect to just medicaid .

like i say , 3 states support that view now as policy and many more are coming on board with it . they are forcing medicaid in to negotiating a price with the stay aat home spouse that does not leave them eventually broke .
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Old 12-27-2015, 09:46 AM
 
Location: Close to an earthquake
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Honestly, look around and count all the elderly people you have known and how they lived the tail end of their lives. How many ended up in assisted living or skilled nursing facilities? I'll tell you that for me, it's a pretty low percentage.

Some of the fear people harbor about this and wanting to protect against it is like the boogeyman who doesn't exist in real life.

It's hard for me to imagine a person having wealth even of modest means wanting to become impoverished by giving away their "little farm". We do live in a society where a safety net exists for those who are destitute and truly need to land in this safety need, and anyone who has the need for late-in-life care provided by a facility of some type (rather than family members) will receive it. It may not be like the Ritz-Carlton but it will give you a bed and meals.
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Old 12-27-2015, 10:57 AM
 
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Borninsac makes a good point IMO. None of my family members has ended up in a care facility of any sort, and they have all lived for 84-102 years.
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Old 12-27-2015, 11:00 AM
 
71,651 posts, read 71,777,271 times
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Originally Posted by borninsac View Post
Honestly, look around and count all the elderly people you have known and how they lived the tail end of their lives. How many ended up in assisted living or skilled nursing facilities? I'll tell you that for me, it's a pretty low percentage.

Some of the fear people harbor about this and wanting to protect against it is like the boogeyman who doesn't exist in real life.

It's hard for me to imagine a person having wealth even of modest means wanting to become impoverished by giving away their "little farm". We do live in a society where a safety net exists for those who are destitute and truly need to land in this safety need, and anyone who has the need for late-in-life care provided by a facility of some type (rather than family members) will receive it. It may not be like the Ritz-Carlton but it will give you a bed and meals.
my grand father and my father . so i ain't taking chances .

but statistics mean little with this stuff . there are only two outcomes . things either work out as planned or they don't . it is more like a coin toss where how many you know really is irrelevant . it is only if it is you or not .

think about the fact everything we insure against or protect against is against the remote flyers that can be devastating if you are the recipient . what are the odds of dying young ? yet most of us had life insurance raising a family . what are the odds of your house burning down ? likely less then even dying young .

it is the stuff we don't think will happen to us that gets the insurance an planning .

as i said , there are tools in place that you can utilize to mitigate great financial damage . they were put there to utilize .

you can certainly choose not to and to pay more then your share and we all thank you for it . perhaps one of those smart bombs can even have your name imprinted on it .

Last edited by mathjak107; 12-27-2015 at 11:11 AM..
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Old 12-27-2015, 11:28 AM
 
Location: Close to an earthquake
890 posts, read 677,754 times
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Quote:
Originally Posted by mathjak107 View Post
my grand father and my father . so i ain't taking chances .

but statistics mean little with this stuff . there are only two outcomes . things either work out as planned or they don't . it is more like a coin toss where how many you know really is irrelevant . it is only if it is you or not .

think about the fact everything we insure against or protect against is against the remote flyers that can be devastating if you are the recipient . what are the odds of dying young ? yet most of us had life insurance raising a family . what are the odds of your house burning down ? likely less then even dying young .

it is the stuff we don't think will happen to us that gets the insurance an planning .

as i said , there are tools in place that you can utilize to mitigate great financial damage . they were put there to utilize .

you can certainly choose not to and to pay more then your share and we all thank you for it . perhaps one of those smart bombs can even have your name imprinted on it .
Well it seems your boogeyman is real rather than imaginary with some family history to support it so I can understand your decision. Emotional decision making always seems to strike closest to home.

I recently attended a continuing education seminar and learned a little clever expression about insurance. It goes like this: "If you can't afford to replace the item or it would kill you to write the check, then you need insurance!"

When you look at a young person with a young family, buying life insurance makes sense. Ditto for disability insurance in the case of a higher-earning person (self-employed professional as an example) at the peak of his/her earnings with many years to go. Long-term care insurance, for the person who has amassed some wealth and who does not have any family history of concern, then I'm not sure. But if emotions run high keeping you from sleeping at night and it would kill you to write the check, then buy your long-term care policy and have your peace. And I'll write my check if and when that day comes and have my peace too.

Some people buy extended warranty policies when purchasing major appliances and others don't. Some people think a glass of water is half empty while others believe it's half full. We're all different and that's the way it should be.
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