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Old 02-22-2018, 11:33 PM
 
8,208 posts, read 11,929,872 times
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Quote:
Originally Posted by A1eutian View Post
True, anyone could theoretically stroke out in the next second but that's not the norm.
Not the norm? Stroke is the leading cause of disability with approximately 800,000 people suffering strokes annually.
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Old 02-23-2018, 12:03 AM
 
Location: Silicon Valley
3,621 posts, read 1,636,912 times
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Quote:
Originally Posted by A1eutian View Post
True, anyone could theoretically stroke out in the next second but that's not the norm. Euthanasia is going to be huge thing. The medical profession has been somewhat resistant in most states because it doesn't want to be accused of killing people on purpose.

Maybe it would be a good specialty for incompetent doctors to practice, if they screw up, the patient lives.

Is it really a bad thing to let someone die in a peaceful way, at the time and place of their choice? I made some bad investments and can't afford / don't want to waste away in a nursing home until the bitter end. Not going to outlive my money.
It's not that easy, especially if the patient doesn't have a clear set of instructions for their doctor and family. DNR is one thing...but kill me when the bank account goes to 0? Most States can't find doctors willing to do lethal injection on convicted killers....where will these doctors come from that are willing to say...well A1, I checked your bank account today...looks like your broke, so any last words?

Imagine the type of person that could be the caring, soothing caretaker one minute and flip the switch the next.

It's a pandora's box of things. The most important thing is that each person should decide their own path. Hopefully they've attempted to have enough financial resources together to allow that to be the case.
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Old 02-23-2018, 01:42 AM
 
Location: Tucson/Nogales
17,428 posts, read 21,272,660 times
Reputation: 24270
Quote:
Originally Posted by Aredhel View Post
That's exactly what happens. Impoverished elderly people, just like impoverished younger people, end up as wards of the state. It's sad when that happens, but that's why we pay taxes for social services: to help others who truly cannot help themselves.
At 67, I still work a few nights a week at a nursing home, and I don't see much difference in treatment for those that are private pay as opposed to those on Medicaid. They both eat the same food, no special food provisions are given to private pay patients.

Bear in mind, many of these impoverished elderly (and yes, we get previous homeless people in as well) are on so many different medications, along with pain meds, they are certainly in no physical pain. I spend an inordinate amount of time at night, answering call lights for pain meds, needed or not. And, with that Percocet, or Morphine, they're temporarily not living on this planet.

So, no, it's not as sad as it appears! I suppose many wouldn't believe it, that some of these patients are more than happy to get as far away from family as possible.
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Old 02-23-2018, 06:39 AM
 
1,738 posts, read 623,095 times
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Quote:
Originally Posted by tijlover View Post
At 67, I still work a few nights a week at a nursing home, and I don't see much difference in treatment for those that are private pay as opposed to those on Medicaid. They both eat the same food, no special food provisions are given to private pay patients.

Bear in mind, many of these impoverished elderly (and yes, we get previous homeless people in as well) are on so many different medications, along with pain meds, they are certainly in no physical pain. I spend an inordinate amount of time at night, answering call lights for pain meds, needed or not. And, with that Percocet, or Morphine, they're temporarily not living on this planet.

So, no, it's not as sad as it appears! I suppose many wouldn't believe it, that some of these patients are more than happy to get as far away from family as possible.
While I do not work at a nursing home, I do work in healthcare, so do get to meet the nursing home demographic, and what you describe is in exact agreement with my impressions, ie, Medicaid nursing homes are not significantly more miserable than the "upscale" ones - the reason why I don't worry too much about what might happen in my very old age. Again, if something should happen earlier than I am about 80, I have plans in place to get shipped to a nursing home abroad, due to the cost of nursing home being four times lower than in the US.

With aging of the US population, the enormous federal deficit, upper middle class already paying about 50% of their income in taxes in some states like California, the only place to go would be to cheaper solutions in building/maintaining services and housing for the elderly, including cheaper nursing homes (something along the lines of what I mentioned in the previous posts). There really isn't any major reason why nursing homes should be so expensive, as most of the care provided for the incapacitated elderly is by minimally skilled/ educated/ paid workers, and one wonders where all that money goes. I suspect the reason is the following: whenever you have a set price for something paid by the government (as in Medicaid nursing homes or Section 8 housing), that price tends to be much higher than what it would be if the private sector set the minimum price, and that set price that the government pays tends to drive up the price of the same product or service in the private sector as well (compare this with the discussion on some other threads, about all the rents in the Bronx being driven very high, because Section 8 subsidied housing in New York City pays very high minimum rent to the landlords). I have worked on contracts in medical field, including with both federal institutions and private groups, and the government is being drained of money mercilessly, it is incredible how much one can charge the government for minimal products or services0. You must have heard stories about the military being charged ridiculously high prices for normally cheap things like nails - well, it goes across all the areas of spending wherever the government is involved.

Anyway, this is a bit tangential to the OP's concerns. I don't think the OP should be worried, and should concentrate on spending or gifting the assets while they can still be enjoyed. The safety net for the impoverished elderly in the US is in fact very good as it is, and I don't think it would tremendously deteriorate if Medicare/Medicaid support should decrease - in fact, I think such a decrease might even drive the prices of elderly housing and elder care further down to their natural levels.
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Old 02-23-2018, 06:46 AM
 
29,812 posts, read 34,900,894 times
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Quote:
Originally Posted by tijlover View Post
At 67, I still work a few nights a week at a nursing home, and I don't see much difference in treatment for those that are private pay as opposed to those on Medicaid. They both eat the same food, no special food provisions are given to private pay patients.

Bear in mind, many of these impoverished elderly (and yes, we get previous homeless people in as well) are on so many different medications, along with pain meds, they are certainly in no physical pain. I spend an inordinate amount of time at night, answering call lights for pain meds, needed or not. And, with that Percocet, or Morphine, they're temporarily not living on this planet.

So, no, it's not as sad as it appears! I suppose many wouldn't believe it, that some of these patients are more than happy to get as far away from family as possible.
Once in the facility care may be the same but getting into the best facilities is often not a Medicaid option.
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Old 02-23-2018, 07:26 AM
 
71,797 posts, read 71,896,917 times
Reputation: 49350
when we looked at our long term care options we reviewed all our choices .

we could do nothing and roll the dice and keep our fingers crossed potentially impoverishing our spouse . .

we could plan around trusts and loans to legally protect assets but the restrictions on the stay at home spouse including income restrictions and trust restrictions sucked .

we could have bought a hybrid life /ltc policy but once you looked under the hood they were a poor way of getting coverage and were the most expensive option costing far more than the premiums we would have paid on a full ltc policy because of the way these hybrids work despite they promise you a return of money as a life insurance policy . the costs were insane because of what you don't see them take ..

we could have self insured properly . but that would have meant taking hundreds of thousands of dollars and investing it very conservatively . not a great idea or efficient use of so much money ..

or we could just buy 3 years insurance and have total asset protection , income protection and the option of just letting medicaid pick up all bills after the insurance was up with the states blessing and no look back , recovery or restrictions . .

so the policy was really a no brainier in our case. we could just leave our money in the risk pool and with just a tiny part of the gains pay the premium without tying up any large sums of money at ridiculously low returns . .

Last edited by mathjak107; 02-23-2018 at 07:49 AM..
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Old 02-23-2018, 08:40 AM
 
2,565 posts, read 1,028,922 times
Reputation: 2004
Quote:
Originally Posted by mathjak107 View Post
when we looked at our long term care options we reviewed all our choices .

we could do nothing and roll the dice and keep our fingers crossed potentially impoverishing our spouse . .

we could plan around trusts and loans to legally protect assets but the restrictions on the stay at home spouse including income restrictions and trust restrictions sucked .

we could have bought a hybrid life /ltc policy but once you looked under the hood they were a poor way of getting coverage and were the most expensive option costing far more than the premiums we would have paid on a full ltc policy because of the way these hybrids work despite they promise you a return of money as a life insurance policy . the costs were insane because of what you don't see them take ..

we could have self insured properly . but that would have meant taking hundreds of thousands of dollars and investing it very conservatively . not a great idea or efficient use of so much money ..

or we could just buy 3 years insurance and have total asset protection , income protection and the option of just letting medicaid pick up all bills after the insurance was up with the states blessing and no look back , recovery or restrictions . .

so the policy was really a no brainier in our case. we could just leave our money in the risk pool and with just a tiny part of the gains pay the premium without tying up any large sums of money at ridiculously low returns . .

Self-insurance would have been an option for you. With many years left to invest, the money could have been invested moderately aggressively and annuitized when you needed it. No LTC limits, no cap, no worrying about company solvency, etc..
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Old 02-23-2018, 08:45 AM
 
71,797 posts, read 71,896,917 times
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we weighed that and after discussing it with the team of pro's at money magazine when we did the article it was not the best choice . we don't have to be conservative with those hundreds of thousands it would take and we can pay the premium and pocket a profit most years doing it this way and investing normally . in fact we do not even need to segregate that money pulling it out of the income generation loop . . i am not worried at all about the company solvency . .

self insuring still offered no benefit if that sum ran out and it required the same back up planning as no insurance which we wanted to avoid in the first place . in these parts to self insure you need many millions to make it a worthwhile option rather than the great partnership plans our state offers .. it is not about the 3 years coverage as much as the choices and perks after the 3 years insurance is up .

so all in all , self insuring would have been a poor choice in comparison so i changed my view on self insuring and i agreed with them .

with my dad having a stroke around 67 i want things in place ready to go .

Last edited by mathjak107; 02-23-2018 at 08:57 AM..
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Old 02-23-2018, 09:00 AM
 
2,565 posts, read 1,028,922 times
Reputation: 2004
Quote:
Originally Posted by mathjak107 View Post
we weighed that and after discussing it with the team of pro's at money magazine when we did the article it was not the best choice . we don't have to be conservative with those hundreds of thousands it would take and we can pay the premium and pocket a profit most years doing it this way and investing normally . in fact we do not even need to segregate that money pulling it out of the income generation loop . . i am not worried at all about the company solvency . .

self insuring still offered no benefit if that sum ran out and it required the same back up planning as no insurance which we wanted to avoid in the first place . in these parts to self insure you need many millions to make it a worthwhile option rather than the great partnership plans our state offers ..

so all in all , self insuring would have been a poor choice so i changed my view on self insuring and i agreed with them .

with my dad having a stroke around 67 i want things in place ready to go .
Depends on how much you self-insure (how much annuity and when you annuitize) with. In our case, our annuityz will very likely provide what we need for care. We also have a sizeable Roth IRA which we can draw from, if needed.
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Old 02-23-2018, 09:22 AM
 
71,797 posts, read 71,896,917 times
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we need 140k a year in today's dollars in these parts . not counting what the spouse at home would need and that goes up each year by about 5%. by the time we are in the sweet spot we need 2x that or more . it is a crazy amount to segregate
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