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Old 02-23-2018, 02:07 PM
 
Location: Southwest Washington State
22,117 posts, read 14,534,664 times
Reputation: 31266

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Quote:
Originally Posted by Mircea View Post
Medicare will pay for nursing home care up to 28 days.

Long-term care is provide through Medicaid for the vast majority.



When the time comes, you'll go into long-term nursing home care, courtesy of Medicaid.
It is my understanding that Medicare will pay for nursing home care as a part of rehab. Once the patient stops imoroving, nursing home payment will stop. And, after 28 days, no matter the need, payment will stop.

You are correct about Medicaid. I was replying to what sounded like a reference to Medicaid with the incorrect term, Medicare. People who have not had to deal with this issue often get the two terms confused.
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Old 02-23-2018, 02:45 PM
 
2,571 posts, read 1,041,873 times
Reputation: 2017
Quote:
Originally Posted by SunGrins View Post
I have two LTC policies I bought when I was relatively young so they are affordable now and I keep them updated every couple of years. If I spend seven years in a nursing home as my mom did I suspect that my modest nest egg will be spent helping to pay added expenses. What would I use it for otherwise except to pass it along as an inheritance. There is a good chance I'll be run over by a bus tomorrow and all that money spent on LTC will be for nothing. Okay...but I might fool everyone and live to be 100. I live off my retirement income and seldom touch my savings and I'm able to add a little each month. I forego extravagance and live a simple life and things are hunky-dory financially if I stay healthy and the economy holds up.

Hiring a live-in health attendant was what we tried to do with my parents rather than use a nursing home. They were happy living at home but the level of care was minimal at best. That was an expensive mistake because the attendant stole thousands of dollars from them and eventually landed in prison. Be very cautious if you decide to go that route.
If you have the resources, high quality home health care is definitely an option. Just ask the Reagans.
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Old 02-23-2018, 05:00 PM
 
29,912 posts, read 34,981,661 times
Reputation: 11812
Quote:
Originally Posted by EveryLady View Post
mathjak ... I'm not trying to put you on the spot for I appreciate your C-D contributions. Plus, these discussions help me get off my comfortable spot and get moving. But I've never understood what you expect to get out of Medicaid. Maybe you're trying to cover the risk-subset that affected your Dad. Stroke that resulted in immediate SNF-based care.

Or perhaps the special program (available only in NY and Illinois/Indiana ?) you are in offers some guarantees - and, if so, that's great. Just like those who purchased lower-cost LTCi years ago from companies that have not been raising rates.

But it's not a track that all can follow.



Sure ... and this was one of my concerns. To begin, Medicaid did not cover the *type* of facilities that would be most appealing forcing the patient to shift at some point to a facility that covers Medicaid as their funds draw down to enter as a private-pay patient.

For example, the new memory care units seem to be located in ALFs. (Not talking here about the SNF lock-down wings.) No Medicaid.

Now I've NO personal experience in seeing how Medicaid worked for a patient (neither parent needed any form of LTC, siblings are healthy, and a set of grandparents easily paid for minimal care at home) ... but I've been reading.

It's a state-based system that no doubt will change over time.

How will this work in the future?
1. Our state recently changed the rules for hospitalizations. Medicaid no longer pays to hold the bed. My guess is that the family can chip in to again private-pay to allow the patient to return "home" to that facility? For now?

2. Already in some states, once in Medicaid it is Medicaid (per doctor-determined assessments) that determines the level of care needed not patient preference. And that may not be a SNF or a facility located anywhere near your loved ones. Now I'm assuming this is for patients who never were in or somehow fell out of "private-pay" status.

3. In our state, Medicaid is an entitlement but the new Medicaid programs to provide in-home care are not. Long waiting lists.

It's one thing for a facility to agree to accept lower Medicaid reimbursement (which most SNF do) ... another to be dependent on what Medicaid will in the end pay for.
Folks need do some research on the quality of SNF in their area. The federal gov't ranks them with the top being five stars. My observation is that most five star facilities are connected with CCRC's and that is the path to getting and and Medciaid is not a path to get in the CCRC. We affiliated with a high end CCRC a couple of years ago at age 68 for use down the road. We get to go to some of their plush annual events during the summer and at Xmas. How high their SNF will be rated is to be determined as it is only a couple of years new. It is a monthly fee structure with no buy in. Thus the monthly cost are high. No Medicaid and if you run out of money, bye bye!
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Old 02-23-2018, 06:13 PM
 
6,833 posts, read 3,818,947 times
Reputation: 13956
Quote:
Originally Posted by Chaofan View Post
The point of saving for retirement is not to "save" $500k or whatever goal one sets. The point is to "save" a goal amount with each chunk of income (weekly, monthly, whatever works) and let the miracle of compounding do its magic. Make the money do as much of the work as possible.


Once that is on autopilot, then the goal should be learning about creating other streams of income, preferably something that doesn't require the application of one's own labor. For many people, that takes the form of some type of investment.


If one manages to avoid succumbing to greed or the blandishments of the get-rich-quick con artists, it is, indeed, possible to achieve that seemingly impossible goal of sufficient funds to provide care in one's old age.
It's really not possible for an average family to save that kind of money, on top of the other money that will be needed for the other years of one's senior years.

The average family of 4 grosses about $53k a year. After all the expenses & costs, esp with kids, and if you even dream of helping with college (who can afford student loans at the tuition prices these day?), there's little left to save. So those that do save, save a paltry sum, which will get merged with Social Security to form a living income for some years. But not the sort of income that would pay for a nursing home.

The good news is that most people don't ever end up in nursing homes, and of those that do, the average stay is about two years, I read.
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Old 02-23-2018, 06:24 PM
 
2,571 posts, read 1,041,873 times
Reputation: 2017
Quote:
Originally Posted by TuborgP View Post
Folks need do some research on the quality of SNF in their area. The federal gov't ranks them with the top being five stars. My observation is that most five star facilities are connected with CCRC's and that is the path to getting and and Medciaid is not a path to get in the CCRC. We affiliated with a high end CCRC a couple of years ago at age 68 for use down the road. We get to go to some of their plush annual events during the summer and at Xmas. How high their SNF will be rated is to be determined as it is only a couple of years new. It is a monthly fee structure with no buy in. Thus the monthly cost are high. No Medicaid and if you run out of money, bye bye!
That's exactly our plan. When we're near 80 (if we live that long), will move into CCRC in Asheville.
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Old 02-23-2018, 06:29 PM
 
2,571 posts, read 1,041,873 times
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Quote:
Originally Posted by bpollen View Post
It's really not possible for an average family to save that kind of money, on top of the other money that will be needed for the other years of one's senior years.

The average family of 4 grosses about $53k a year. After all the expenses & costs, esp with kids, and if you even dream of helping with college (who can afford student loans at the tuition prices these day?), there's little left to save. So those that do save, save a paltry sum, which will get merged with Social Security to form a living income for some years. But not the sort of income that would pay for a nursing home.

The good news is that most people don't ever end up in nursing homes, and of those that do, the average stay is about two years, I read.
People make choices. Granted we have both worked and have good incomes. Our daughter, who has a master's degree in the health care field and could make very good money, has decided she doesn't want to work. She says daycare is too expensive. Interestingly, they would have much more income, even after daycare, if she worked. Bottomline, she doesn't want to work. And while her husband makes a decent income, they will pay a huge price in later life for this decision. So, some people do have a choice.
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Old 02-23-2018, 06:43 PM
 
5,433 posts, read 3,478,515 times
Reputation: 13714
Quote:
Originally Posted by TuborgP View Post

Folks need do some research on the quality of SNF in their area. The federal gov't ranks them with the top being five stars. My observation is that most five star facilities are connected with CCRC's and that is the path to getting and and Medciaid is not a path to get in the CCRC.
You say "Folks need do some research on the quality of SNF in their area."

This doesn't seem like a likely action or a likely occurrence unless one is monied and interested in CCRC's.

Perhaps it is a good suggestion for those in the market for buying into a CCRC, but for the rest of us - are we supposed to move if SNF is not rated particularly high in 'our area'?

Last edited by matisse12; 02-23-2018 at 07:44 PM..
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Old 02-23-2018, 07:11 PM
 
Location: Sugarland
13,782 posts, read 12,795,770 times
Reputation: 16646
Quote:
Originally Posted by TNSLPPTSO13 View Post
When one reads about how much it costs to end up in a nursing home($50-$60k/year unless it's a really
bad one that looks like something out of a horror movie)...it must be obvious that there is no way most of us will be able to save enough to cover those kind of costs.
How much can one possibly save?.. .Is it really realistic that we would have saved $500K or even $300K to be able to stay in a nursing home for 5-10 years? and unfortunately you don't die.... Especially if you have no family to help you at that point in your life ... And then when the money runs out they will jump on any leftover assets you may still own and dry those up...what happens next??? Why even try??
Long term insurance seems very expensive,and probably not enough for a long term stay
Early death,whether natural or on purpose seems more and more like the best retirement plan.
Agreed. I donít see any point in living past the age where youíre properly able to care for yourself.
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Old 02-23-2018, 08:06 PM
 
3,115 posts, read 836,291 times
Reputation: 1781
I was surprised at the affordability of the CCRC in this high-cost metro area that's been recommended by friends. Absolutely beautiful, indoor pools etc. No need to transfer from your unit within the community for assisted living. Short-term rehab available (that would probably bill Medicare). A longer-term stay at the SNF or memory care or the new hospice unit are separate. Covered by the level monthly residential fee for the traditional plan A but at that point you'd move from your original unit.

Most who sold the average home *anywhere* in the US could easily afford the buy-in. The monthly LEVEL residential fee *would* exceed the average social security check but folks really need to depend on more than social security.

So it's doable - BUT only after pre-planning, for the waitlist is 10 years for one of the (larger) apartment types. It's a non-profit church affiliated facility around about 50 years.

If I had the money, I'd buy a studio there and use it to pop in for the community and athletic facilities then live here "at home" all the while knowing that the monthly fee was covering future LTC if ever needed. Best of both worlds!

If my daughter really does want the condo once she graduates and starts working (and paying its bills), I may well do that if she stays single. Privacy for her ... a community for me. It's an unconventional way of living, but why not?

Preplanning sometimes leads to future choice and those two with a dash of good fortunate can go a long way.

Me? I've got pages of notes on various LTC options and funding alternatives and only now would I consider consulting an attorney or financial analyst.
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Old 02-24-2018, 12:55 AM
 
Location: Northern California
107 posts, read 57,601 times
Reputation: 222
To save more than 100K (adding 2k a yr = 8% inflation) seems extreme

Summing it up-
https://pocketsense.com/the-average-...-12386771.html
43% of people will end up in Skilled Nursing
78% of Nursing Home stays are 3 months or less.
Average cost for a nursing home in Calif is $250 per day
At slightly higher cost...$275 per day,=about 25K for 3 months aka the average length of stay
-------------------------------------
25K = 78% coverage of 3 months stay
100K= 95% coverage for average length of stay (60 months or less)

This is because out of a hundred people, 43 will go into Skilled Nursing.
Out of 43 people, 10 will stay longer than 3 months.
For those remaining 10 out of a 100 people, the average length of stay is 2.5 years.
So 6 people remaiing out of 100 will stay for up to 2.5 years.
The other 4 people out of 100 people will stay longer than 2.5 years.

What is the likelihood you'll be that unlucky 4 people out of 100 people? it is 4%.


Delay SS to plan to increase the check by $166 more per mo along w/ your saved 100K and you'll be doing WONDERFUL
You'll be covered for 95% of the skilled nursing scenarios


To save more than 100K on the chance you could be that unlucky 4%...feels excessive. JMHO



And if you are of Medicare age, then the above will be even better since Medicare will cover some of the costs.


.

Last edited by BushyEyeBrows; 02-24-2018 at 01:04 AM..
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