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Old 02-24-2018, 09:43 AM
 
Location: Paranoid State
13,047 posts, read 10,460,401 times
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Quote:
Originally Posted by artillery77 View Post
Imagine the type of person that could be the caring, soothing caretaker one minute and flip the switch the next.
Doesn't that describe veterinarians? They take care of pets, livestock, large animals, small animals... yet if the Fluffy or Fido is in pain with cancer, they will counsel their human clients and, if desired, euthanize the pet.

Actually, among cats and dogs, the leading cause of the decision to euthanize the animal is incontinence. When Fluffy stops using her litter box for whatever reason (chronic UTIs, cancer, senility) her days are numbered.
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Old 02-24-2018, 09:56 AM
 
Location: Paranoid State
13,047 posts, read 10,460,401 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.
I'd say not probable rather than not possible, but regardless, many families won't have the savings.

What do you suggest they do?
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Old 02-24-2018, 09:59 AM
 
Location: Paranoid State
13,047 posts, read 10,460,401 times
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Quote:
Originally Posted by matisse12 View Post
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'?
Well, you certainly can plan for the future now while you are able to make decisions. And, of course, it is your decision to stay where you are even if the SNF sux. It's your life, and your death.

Where do you want to die?
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Old 02-24-2018, 10:06 AM
 
Location: Paranoid State
13,047 posts, read 10,460,401 times
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Quote:
Originally Posted by TNSLPPTSO13 View Post
Why even try?
It's called Delayed Gratification. See for example the Stanford Marshmallow Experiment.

The Stanford marshmallow experiment was a series of studies on delayed gratification in the late 1960s and early 1970s led by psychologist Walter Mischel, then a professor at Stanford University. In these studies, a child was offered a choice between one small reward provided immediately or two small rewards (i.e., a larger later reward) if they waited for a short period, approximately 15 minutes, during which the tester left the room and then returned. (The reward was sometimes a marshmallow, but often a cookie or a pretzel.) In follow-up studies, the researchers found that children who were able to wait longer for the preferred rewards tended to have better life outcomes, as measured by SAT scores, educational attainment, body mass index (BMI), and other life measures.
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Old 02-24-2018, 10:12 AM
 
1,738 posts, read 623,095 times
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Quote:
Originally Posted by SportyandMisty View Post
The gist of your argument is economies of scale -- that is, spreading fix costs over lots of incremental units. Unfortunately, there is no evidence to support the idea that current facilities are now inefficient because they are too small.

Attempts to employ economies of scale in public housing, for example, have been disasters. Pruitt-Igoe in St. Louis, Queensbridge Houses in Queens, Robert Taylor Homes in Chicago, Jordan Downs in Watts (L.A.), Magnolia Projects in New Orleans, Marcy Projects in Brooklyn, Cabrini Green in Chicago -- all of these are generally regarded as failures.

Economies of scale in the VA hospital system have similarly been unsuccessful. Originally built many decades ago, large VA hospitals were designed for a WWII-style war with many hundreds of thousands of casualties. The data are unreliable, but at least 670,000 US servicemen & servicewomen were injured in that war (ignoring deaths). However, that doesn't describe the wars we've had since then. The hospitals are uneconomic unless occupied at near capacity -- huge, giant laundry facilities and kitchens and insfrastructure designed for 500 or more occupied hospital beds. The VA has attempted to close some of the worst of these, to be replaced by modern facilities designed for far fewer patients, but elected politicians representing those districts fight vigorously to prevent closure, as those facilities represent actual jobs in their local communities.
Sporty, large-scale senior living facilities I envisioned would differ from large housing projects and VA hospitals in some very important ways: (1) public housing has been a disaster because of the criminal and negligent population that tends to inhabit such housing (you give people free housing - they tear it down and infest it with crime. This outcome is certainly not related to the charitable initiative, taxpayers funds or generally VERY solid architecture of public housing projects). Old people are generally too old for major crime and vandalism, as it is obvious from the existing housing projects restricted to the elderly, and same would hold for very large housing projects restricted to the 65+ age group without criminal record; (2) unlike the VAs, large elderly housing projects WOULD be occupied to the maximum. Waiting lists for the existing elderly housing (private and public) are getting longer and longer.


Large size of these things would make it very economical to run. You could have just small private cubicles for people to sleep and keep personal effects, with everything else shared - ie, shared bathrooms, large common restaurants, common facilities. All of that could be run super cheaply, like a large hostel. Turn this over from Medicaid to the private sector (with some incentives, like maybe tax abatement to somebody willing to undertake such projects), and I think this would totally thrive. There are hundreds of miles of desert in Nevada and Utah where one could construct and run these things - be it a housing for impoverished seniors, or hospices for the severely incapacitated of any age. If you want to go into this venture, count me a partner :-). Want to write a proposal to the federal government?
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Old 02-24-2018, 10:41 AM
 
Location: Boise
610 posts, read 583,436 times
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If you own a home and have it mostly paid off, investigate Reverse Mortgages from a local trusted source. The loan has two liens, the banks and hud's lien.. this effectively takes home equity out of reach of medicaid or any other liens if one eventually has to go into a nursing home.

The home equity can be accessed, tax free via a line of credit and its not considered income for medicaid purposes.

Many seniors, 62 and up to qualify, use it to pay LTCI premiums, home healthcare, or simply the lawn guy, etc...

It's a great way to age in place. More and more financial advisers are recommending it to clients. I will be getting mine when I hit 62.

Its possible for 4 people to be on the loan if all are 62 plus. This technique is often used by children caring for aging parents.

Not selling, just educating......be well, Op.
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Old 02-24-2018, 11:35 AM
 
3,100 posts, read 827,905 times
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[/b]
Quote:
Originally Posted by elnrgby View Post
About CCRCs and a potential situation you describe with your daughter... is it actually allowed to buy into a CCRC, and then rent your CCRC share to someone else until you are ready to move in there yourself? I looked superficially into CCRCs, but I kind of don't want to be paying the hefty monthly fees for something I wouldn't be using at all until some unspecified later time.
Agreed. Even though ...

The risk of future LTC is included in that fee. If you subtract the cost of current LTCi (for a new policy for a 65 yo, single, female) from the fee, the costs go down quite a bit. There's a variable meal plan so that could help further reduce expenditures. Then add on the value obtained from participating fully in the community (social, continuous access to the facilities) plus having a second home leaving DD more independent and it becomes potentially more attractive.

But for me not now financially feasible - although I may well get onto the waiting list. One, I can't afford to support two homes from current income. Two, most fund the entry fees from "new money," the sale of the current home. I need not do that but unfortunately the bond component of my investments are in a tax-advantaged account. My marginal tax rate is higher than the capital gains rate.

So there will be no frivolous purchase from that money. Another consideration is buying the next-door 1 bedroom condo. My DD's future career plans center around geriatrics, perhaps occupational therapy and that's her favorite option for my someday little-old-lady home. A plus in some ways - much cheaper carrying costs with resale value - but then no 24-hour intense LTC component. DD would be fine helping out with some basic assistance, if needed, or I could pay for some care but neither of us would want to have her take on caregiving.

Planning is complicated by the wide age-gap (43 years) between DD and myself although a couple of the pieces may be in place. She's completely committed to remaining in this area as is her long-term boyfriend - and would she says value community and familial ties more than a specific job opportunity. Still ... the area is economically vital, where we are located makes commutes to a variety of areas quite possible.

Her mindset is a mixture of the frugality in which I was raised added to that of the new-immigrant community. It's simply a different world - certainly compared to the expectations that my brothers' children had and how he (grudgingly) and my SIL (initially with more enthusiasm) poured money into every wish. Want to switch colleges to experience Manhattan? New colleges - and a duplex, granted in Spanish Harlem but still - appear.

DD is Asian (adopted) and many of her friends are second-generation Asian immigrants. No way was I paying for anything other than a state-college. She upped me one and like her friends decided to live at home and commute to community college. I think a total of $800 has been withdrawn from her 529. (Turns out, I actually qualified for a benefit - the AOTC and so it made financial sense to cover the low tuition directly from my income.)

She (and they) are now transferring to the university portion of their educations - again either staying local (we're surrounded by universities) or utilizing the local satellite-campus for the consortium programs. Does she want a new car for that commute? No, too much money she thinks. There's a bus, says DD. We do have excellent public transportation.

This opens up money for travel from current income and we travel a lot, again very cheaply without paying for airline tickets. Not having a large house (taxes, utilities, maintenance) helps make that possible. DD really did not NEED a private yard - although we do have two completely separate living spaces and entrances, sharing only a kitchen and laundry.

Sometimes the "American" way is just plumb expensive. How we live mirrors exactly how our friends in Europe do. This keys into the recent posts on the societal expense of overlaying support services onto the current system instead of developing a more cost-efficient secondary track. And then look at the outcry over possible death panels. The Dutch and Swiss are, again, much more realistic here.

Last edited by EveryLady; 02-24-2018 at 11:45 AM..
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Old 02-24-2018, 12:13 PM
 
3,100 posts, read 827,905 times
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Quote:
Originally Posted by mathjak107 View Post
as the insurers found out those statistics were way off base .
[/b] ...
many also were using care for far more than 2.50 years . my dad was 5 years and the other person was still going strong .
True. Back when researching LTCi last fall, I put together a data file that included a variety of statistics, one of which was usage by age grouping and sex. Yesterday, I put my head under the pillow and deleted it with some of the other LTCi files - or I'd attach a link or two. What surprised me was the longevity risk - not so much for the elderly, although there is that - but of the young-old (particularly women) who have a life-changing event.

This remains my area of risk until DD is financially independent. The main concern is that she hold onto the condo. If I spend down the assets, in our state Medicaid allows her to remain in the condo as long as the Medical Application indicates that I plan on returning home. There is no medical requirement that I ever be likely to do so, as in some states.

I'm guessing that I'd be allowed to keep supporting the condo (her college funds will be transferred to her name) during the 5-year look back period which probably for me would turn out to be much longer depending on the actual SNF cost. Those devilish details?

Then my plan is to take out a renewable term life insurance policy that would then allow her to pay off any Medicaid lien on the condo. I'm healthy with a family history that let me qualify for an excellent rate the first time around (a 20 year policy at age 43 that I did not renew.)

I'll be consulting an attorney but this sure sounds like a better option than a life-estate deed without powers, although I'll probably sign an expanded Durable Power of Attorney to cover all bases.

Quote:
Originally Posted by mathjak107 View Post

people who have insurance tend to use the insurance as well as 77% of us will need some form of in home care

insurers went by those statistics and got crushed
This is why (in part) I found LTCi so frustrating. For me, there is a lot of community support and possible familial support plus I can certainly private-pay for basic care levels making my own choices. But once folks HAVE the insurance then course it makes sense to USE it - raising overall costs. To me, that's not frugal.
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Old 02-24-2018, 02:52 PM
 
2,081 posts, read 874,674 times
Reputation: 5112
You are not saving for a nursing home. You are saving for your retirement. There are 40 million people over 65 in the US. Only 1.5 million are in nursing homes. Most people don't go to a nursing home. They die at home or in hospitals. If you have savings you are able to stay in your own home and get home care if needed. I wouldn't want long term insurance, because I wouldn't want to use it.
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Old 02-24-2018, 04:06 PM
 
71,811 posts, read 71,896,917 times
Reputation: 49370
Quote:
Originally Posted by mortgageboss View Post
If you own a home and have it mostly paid off, investigate Reverse Mortgages from a local trusted source. The loan has two liens, the banks and hud's lien.. this effectively takes home equity out of reach of medicaid or any other liens if one eventually has to go into a nursing home.

The home equity can be accessed, tax free via a line of credit and its not considered income for medicaid purposes.

Many seniors, 62 and up to qualify, use it to pay LTCI premiums, home healthcare, or simply the lawn guy, etc...

It's a great way to age in place. More and more financial advisers are recommending it to clients. I will be getting mine when I hit 62.

Its possible for 4 people to be on the loan if all are 62 plus. This technique is often used by children caring for aging parents.

Not selling, just educating......be well, Op.
A home held in personal name is a protected asset up to I think 750k in equity . Don' t quote me on the exact number . A home does not count for purposes of Medicaid spend down and can't be taken as long as a spouse or family member is in it or if you claim you will one day hope to go back
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