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Old 01-19-2016, 04:29 PM
 
Location: Sierra Nevada Land, CA
8,410 posts, read 9,157,087 times
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Quote:
Originally Posted by Suevee View Post
I am curious. I hear and read so much about financially preparing for these living arrangements. In my family and in my husband's family no one has used these options. All of them have lived in their homes or with family until death. All were comfortable up to the end surrounded by family. Some combined resources with other family members, some stayed independent in their own homes with family near by for support. It seems if we survive our sixties, we stick around until our mid-eighties and some beyond that.

Are we an anomaly? Or is this more common than reported?
Nope, you are the rule. The insurance companies want you to believe otherwise. I have posted these things before, but am too lazy to cite links. Only 50% of people over 90 die in a nursing home. My most famous example was Merle. A fellow of whom I was the Public guardian thereof. He fell and broke his hip. He was transferred from the hospital to a nursing home and died there after 11 days.

The fact is that for people over 65 you have a 15% chance of spending any real time in a nursing home.

Further, the FEDS have a Medicaid program that lets the at home spouse keep most of their income and nice property reserve while the LTC spouse's care is covered.
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Old 01-19-2016, 04:44 PM
 
Location: Ponte Vedra Beach FL
14,628 posts, read 17,947,745 times
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Quote:
Originally Posted by selhars View Post
As for length of nursing home stay, as was stated that can vary because of the quality of care in the institution.

Look at the number of people who (I'm told) do down hill once in a SNF.
They've been at home doing relatively fine, but for whatever reason go to a SNF….and do down hill. WHERE AS, IF they'd been able to stay, or go back home after an incident, would NOT deteriorate any where near as immediately after.

So when I look at "length of stay' -- I look at what the person had (condition or illness) -- AND what kind of care did they get in the SNF. Did they start getting UTIs, did they no longer have CARING attendants? etc.

My understand is that the "average length of stay is about two years. IF you don't count dementia patients who could live longer than most other patients and skew the length of stay UPWARD…..I'd think the length of stay is definitely two years or less. (We can debate a margin of error.)
Why would you go to a SNF if you're "doing fine"? Usually - most long term stays that I've seen are the result of significant health events. Like - for example - the bad stroke my late FIL had when he was about 82. Or dementia that gets past the "tipping point" - which the SNF CEO I mentioned above said is usually fecal incontinence. I've also seen people with things like advanced Parkinson's disease (not pretty). Or people with severe heart problems - like advanced congestive heart failure - who need very close medical and dietary care that is difficult for an old frail person to manage in a home environment.

I think my late FIL was probably somewhat typical. After 6 months of rehab after his stroke - he was perhaps almost ready to leave his SNF and perhaps go to ALF care. Then he got a recurrence of his bladder cancer - and he got a new cancer too - an angiosarcoma - a horrible skin cancer - on his head. Which required a couple of radical surgeries. Also - in the background - he had bad CHF. For the last year of his life - he was bouncing back and forth between hospitalizations - ER visits - time in the SNF - and - at the end - he was in hospice care at the SNF. End of life doesn't usually come wrapped in a nice pretty package best I've seen.

When it comes to UTIs and women - well I've only had 1. About 20 years ago. And my PCP at the time said the best way for women to prevent them is to use one wad of toilet paper at the front - and wipe forward. And another wad at the back and wipe to the back. The technique does use more toilet paper - but I always buy TP on sale at Costco . Hope that if I lose 99% of what's inside my head - I still remember to do this - it works ! Note that I don't have a clue about guys. My husband hasn't had a UTI since I met him almost 50 years ago. Robyn
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Old 01-19-2016, 05:11 PM
 
Location: Ponte Vedra Beach FL
14,628 posts, read 17,947,745 times
Reputation: 6717
Quote:
Originally Posted by Mr5150 View Post
Nope, you are the rule. The insurance companies want you to believe otherwise. I have posted these things before, but am too lazy to cite links. Only 50% of people over 90 die in a nursing home. My most famous example was Merle. A fellow of whom I was the Public guardian thereof. He fell and broke his hip. He was transferred from the hospital to a nursing home and died there after 11 days.

The fact is that for people over 65 you have a 15% chance of spending any real time in a nursing home.

Further, the FEDS have a Medicaid program that lets the at home spouse keep most of their income and nice property reserve while the LTC spouse's care is covered.
There are 2 ways of looking at this. The first is "what are my odds" - or my spouse's. And the second is what do I need to do if anything to insure against those odds. Although my husband and I have had a fair amount of experience with family members needing LTC - no one in our families has had LTC insurance. And things have worked out fine for the most part - mostly because family members have had relatively "deep pockets" and not huge needs. Things didn't work out so fine for the 2 of my aunts/uncles with very limited resources who wound up in lousy places at the ends of their lives. Things didn't work out at all for a neighbor whose husband wound up needing expensive care. After his dementia caused him to make a lot of super lousy investment decisions - she wound up mowing neighbor's lawns to pay the bills (and we live in a neighborhood of $600k or so houses). It was pitiful.

If you're looking at a family history where there is a lot of dementia in your family tree - or your spouse's - or histories of early onset debilitating diseases - and you'd wind up being impoverished/in the dog house if your spouse was a veggie at age 80 - then I think it is reasonable to look into LTC insurance. And to consider the costs/benefits. The trade-off. This definitely isn't a one size fits all thing IMO. Robyn

P.S. You are uninformed about Medicaid. At least here in Florida - you have to be a pauper in many ways to qualify. And who wants a Medicaid bed in most SNFs that cater to Medicaid patients? Not me.
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Old 01-19-2016, 09:04 PM
 
Location: Sierra Nevada Land, CA
8,410 posts, read 9,157,087 times
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Quote:
Originally Posted by Robyn55 View Post
Th
P.S. You are uninformed about Medicaid. At least here in Florida - you have to be a pauper in many ways to qualify. And who wants a Medicaid bed in most SNFs that cater to Medicaid patients? Not me.
Perhaps FL is not as generous CA. Too bad. One does not need to be a pauper. Plus the same SNFs who charge $15,000 a month to private pay folk in CA also offer beds for Medicade folk. Just how it is. Enjoy your low tax state.

Last edited by Mr5150; 01-19-2016 at 09:13 PM..
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Old 01-20-2016, 05:52 AM
 
29,809 posts, read 34,894,042 times
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Quote:
Originally Posted by Mr5150 View Post
Perhaps FL is not as generous CA. Too bad. One does not need to be a pauper. Plus the same SNFs who charge $15,000 a month to private pay folk in CA also offer beds for Medicade folk. Just how it is. Enjoy your low tax state.
You do realize that Cover California and other state funded medical programs are facing significant funding issues and are perhaps one recession away from a melt down? When the choice is between providing for you at age 80 or the 3 year old impoverished. Latino who do you think will get the service?
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Old 01-20-2016, 05:55 AM
 
29,809 posts, read 34,894,042 times
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Quote:
Originally Posted by Mr5150 View Post
Perhaps FL is not as generous CA. Too bad. One does not need to be a pauper. Plus the same SNFs who charge $15,000 a month to private pay folk in CA also offer beds for Medicade folk. Just how it is. Enjoy your low tax state.
Will you get one of those beds or one at a more Medicaid focused lower tier facility. Will there be a lottery for those beds or will they go to those who could afford the 15k a month for a year and were not kicked out when they went on Medicaid. Big difference between staying and getting in.
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Old 01-20-2016, 06:15 AM
 
29,809 posts, read 34,894,042 times
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Very interesting twist and new trend on the topic:
Retirement housing becoming a family affair - Baltimore Sun

Quote:
Pat, 68; John, 67; and Rose, 88, share the physical and mental space of a two-bedroom apartment at the Charlestown retirement community in Catonsville, where they moved more than two years ago in hopes of adapting an easier lifestyle.

Living with mom or dad again — or the in-laws — after years of independence isn't for everyone, but such living arrangements are becoming more common as the U.S. population ages and Americans live longer. While there appear to be no studies showing how frequently it occurs, many retirement communities in Maryland and elsewhere are seeing older children move into the same communities as their parents, sometimes even the same units.
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Old 01-20-2016, 07:27 AM
 
Location: Ponte Vedra Beach FL
14,628 posts, read 17,947,745 times
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Quote:
Originally Posted by Mr5150 View Post
Perhaps FL is not as generous CA. Too bad. One does not need to be a pauper. Plus the same SNFs who charge $15,000 a month to private pay folk in CA also offer beds for Medicade folk. Just how it is. Enjoy your low tax state.
A house - a car - no more than $3000 in assets - and income no more than about $1500/month:

Medi-Cal (for People with Medicare) | California Health Advocates

Doesn't sound very generous to me. In fact - although I am not an expert - the Florida Medicaid asset rules for spouses seem more generous than those in California:

Medicaid Elegibility, Inc.

Note that I have an aunt and a late uncle in California who are/were hardly wealthy people. They owned a modest townhouse (by California standards) - worth about $180,000. An old beat up car. No pension plan. They lived on Social Security and had a bit of income from assets (CDs worth about $75,000). That's it. My uncle had dementia for years and never qualified for a Medi-Cal/Medicaid SNF bed. After my uncle died - my aunt had to sell the townhouse and move into a small apartment. Because she hasn't totally exhausted/spent the proceeds of the house sale - she still - at age 91 - doesn't qualify for Medi-Cal/Medicaid SNF care should she need it (she doesn't need it now).

So I will take my *no* income tax state. Where people can save and invest the taxes they would have paid for the "privilege" of living in California and wind up with a nest egg for their old age (if you save $5k a year starting at age 25 and invest it at 3% - you'll have $377k at age 65). Robyn
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Old 01-20-2016, 08:20 AM
 
29,809 posts, read 34,894,042 times
Reputation: 11730
One of the big questions in all of this is do we as individuals want to strive to build our own ability to fund and pay for are future needs or do we want to be dependent on wealth transfer via taxation from a wide range of people with earnings being taxed. We can try and if things didn't work out, we tried and can with heads up high say we tried to do it ourselves.
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Old 01-20-2016, 09:00 AM
 
Location: Columbia SC
9,002 posts, read 7,766,040 times
Reputation: 12231
This chat is very interesting but I caution everyone to be sure that other's experiences fit their model. As an example in another chat, one poster said that her and her husband told their father's that they would be more than willing to help them but they had to move close to them, which the Fathers did. While this sounds good there is no way in he!! I would move to where my children live so I have to make plans to take care of myself where I am.

Along these same lines many will tell of their experiences/plans but do those plans fit you? As an example. I am a widower thus for long range planning, I do not have anyone else (a spouse) to consider.What I need/do could be quite different than what a couple needs to do.

Bottom line is take all advice with a grain of salt as much may not fit you.
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