Nursing Home Cost and Planning ?

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confusedinvestor
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Nursing Home Cost and Planning ?

Post by confusedinvestor » Sat May 04, 2019 5:15 pm

Folks
1. Does anyone has any real experience with cost of Nursing Home care / month ?

2. How much $/yr and for how many yours do you plan for Nursing Home care in your retirement planning projections ?

3. How do you plan on funding this ? LTC or Self Insure or Combination riders ?

FYI - I'm using this - https://itunes.apple.com/.../genworth-c ... d510413677 for cost estimation....

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cheese_breath
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Re: Nursing Home Cost and Planning ?

Post by cheese_breath » Sat May 04, 2019 5:48 pm

Where do you live? Makes a lot of difference in the cost.

Do you want a good one or just someplace to stuff your loved one until (s)he dies? Makes a lot of difference in the cost. And even the best ones leave a lot to be desired.

DW is currently in a home in TX in a private room with door to courtyard for approx 100K per year. A comparable room at the home we were previously at in MI would have been approx $130K per year. You can reduce the costs by cutting out amenities (private room, entry to courtyard, private bath, but remember this might be your loved one's home for the rest of his or her life. I'd think you'd want it to be as pleasant as possible.

These prices don't include other costs such as prescriptions or other medical services not directly provided by the NH.

Why don't you take some tours to get a better idea of the potential costs in your area ?
The surest way to know the future is when it becomes the past.

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confusedinvestor
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Re: Nursing Home Cost and Planning ?

Post by confusedinvestor » Sat May 04, 2019 5:50 pm

We live SoCAL area ...
cheese_breath wrote:
Sat May 04, 2019 5:48 pm
Where do you live? Makes a lot of difference in the cost.

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Shackleton
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Re: Nursing Home Cost and Planning ?

Post by Shackleton » Sat May 04, 2019 5:58 pm

My mother is not in a nursing home, but is in a memory care assisted living facility in Colorado. She is in a very nice one, but it's still got it's downsides such as a high turnover rate for employees. But the food is good, and it's kept clean and maintained. It costs $6995/mo, and is covered by her LTC policy for 100% of the cost. She has been there 5 years, and the LTC policy funds will run out in about 2 more years. At that point, she has enough money to cover her costs in either the memory care, or nursing home as long as needed.
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JGoneRiding
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Re: Nursing Home Cost and Planning ?

Post by JGoneRiding » Sat May 04, 2019 7:44 pm

For full NH care you run roughly 10k/mos less in the south and mid west. Remember though Medicaid will take over if you run out of funds for full NH where you get screwed is if you only need assisted living or memory care and don't qualify fo NH. Though those are less expensive they are 100% self or ltc insurance pay and highly variable

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cheese_breath
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Re: Nursing Home Cost and Planning ?

Post by cheese_breath » Sat May 04, 2019 8:05 pm

confusedinvestor wrote:
Sat May 04, 2019 5:50 pm
We live SoCAL area ...
cheese_breath wrote:
Sat May 04, 2019 5:48 pm
Where do you live? Makes a lot of difference in the cost.
This article doesn't have a date, but it might give you some ideas. Personally I would have thought SoCA would have been more...
https://www.dibbern.com/nursing_home_co ... _homes.htm

But to get the best idea I repeat my suggestion of personally visiting the homes in your area and forming your own conclusions. If you're considering Medicaid you should see an elder law attorney now for advice on how to arrange your finances to shelter as much as possible from Medicaid. If I'd stayed in MI and had been willing to give up the private room I could have sheltered almost everything. But each state has it's own rules, and I don't know if CA's are as generous as MI's
The surest way to know the future is when it becomes the past.

RetiredAL
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Re: Nursing Home Cost and Planning ?

Post by RetiredAL » Sat May 04, 2019 9:00 pm

Just going thru this with my Dad. Location: Central Valley area of Calif, near but not in SF Bay Area.

At home: 24x7 assistance would have been $20K a month.We tried just 15hrs x 7, but that forced me to be their every night.
Nursing Home: $330/day double, $370/day single. 2 stints there, medicare has paid most of that.
Assisted Living: $4500/month base + additional care levels, total of $5300/month. This is his current placement
and is right for his current needs.
Memory Care: Was somewhat higher than Assisted, around $5800 base as I remember.
Costs in the SF Bay Area: 40 to 50% higher.

We ( I and him ) are fortunate. He has a LTC policy that will pay up to $6000/month, up to a max of $292,000 in total. His readily available savings exceeds that amount. Additionally his income alone is such that it will cover the current level of costs forever, if most of his non-care expenditures were curtailed. I will be able prune those non-care expenditures some, but at this point I do not intend to sell his home, so some can't go away.

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confusedinvestor
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Re: Nursing Home Cost and Planning ?

Post by confusedinvestor » Sat May 04, 2019 9:24 pm

Thanks!

This is very helpful, yes, thanks for 2 great advises 1. tours few NHs 2. Talk to a elder care attorney to shelter assets for Medicaid …(interesting)...

cheese_breath wrote:
Sat May 04, 2019 8:05 pm
This article doesn't have a date, but it might give you some ideas. Personally I would have thought SoCA would have been more...
https://www.dibbern.com/nursing_home_co ... _homes.htm

But to get the best idea I repeat my suggestion of personally visiting the homes in your area and forming your own conclusions. If you're considering Medicaid you should see an elder law attorney now for advice on how to arrange your finances to shelter as much as possible from Medicaid. If I'd stayed in MI and had been willing to give up the private room I could have sheltered almost everything. But each state has it's own rules, and I don't know if CA's are as generous as MI's

Topic Author
confusedinvestor
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Re: Nursing Home Cost and Planning ?

Post by confusedinvestor » Sat May 04, 2019 9:27 pm

Good to hear your story, thanks for sharing.

Do you know if Medicare will cover some of Assisted Living should LTC policy max is met ?

RetiredAL wrote:
Sat May 04, 2019 9:00 pm
Just going thru this with my Dad. Location: Central Valley area of Calif, near but not in SF Bay Area.

At home: 24x7 assistance would have been $20K a month.We tried just 15hrs x 7, but that forced me to be their every night.
Nursing Home: $330/day double, $370/day single. 2 stints there, medicare has paid most of that.
Assisted Living: $4500/month base + additional care levels, total of $5300/month. This is his current placement
and is right for his current needs.
Memory Care: Was somewhat higher than Assisted, around $5800 base as I remember.
Costs in the SF Bay Area: 40 to 50% higher.

We ( I and him ) are fortunate. He has a LTC policy that will pay up to $6000/month, up to a max of $292,000 in total. His readily available savings exceeds that amount. Additionally his income alone is such that it will cover the current level of costs forever, if most of his non-care expenditures were curtailed. I will be able prune those non-care expenditures some, but at this point I do not intend to sell his home, so some can't go away.

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Watty
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Re: Nursing Home Cost and Planning ?

Post by Watty » Sat May 04, 2019 9:40 pm

confusedinvestor wrote:
Sat May 04, 2019 5:15 pm
3. How do you plan on funding this ? LTC or Self Insure or Combination riders ?
One thing to remember is that if you are single, or only one spouse of a couple is surviving when LTC is needed that most of your other expenses will stop. Mainly you will just need to worry about the gap between your normal budget and your LTC costs.

We live in a moderate cost of living area so the LTC costs for one person are not dramatically higher than our normal retirement budget. For us that gap can be covered for many years by the home equity in our paid off house.

That of course only works if only one spouse is surviving when LTC is needed. If we are both surviving when LTC is needed we could handle that for a few years and the majority of people don't use LTC for more than a few years.

That is far from bullet proof but there are a lot of ways that it could work out OK with some combination of;

1) LTC is never needed.
2) Only one of use is surviving when LTC is needed.
3) LTC is only needed for a limited time.
4) Our investments perform better than planned on and we have lots of money.
5) We qualify for Medicaid to pay for LTC

Our Social Security will be a higher than average and we are delaying staring it to get a larger check. Since we live in a moderate cost of living area it will be enough to cover our core expenses. It would not be pretty but if we had to we could more or less get by on just Social Security if we needed to.

chessknt
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Re: Nursing Home Cost and Planning ?

Post by chessknt » Sat May 04, 2019 9:45 pm

If you aren't local one tip I would give is that paying a surrogate (usually a lawyer or an employee from a legal office) to visit your loved one at random times 2-3x per week will let you get away with a lower priced facility and still get excellent care.
The unfortunate reality of these places is that patients with frequent visitors (especially with legal or medical knowledge) get far more attention than those who dont.

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ResearchMed
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Re: Nursing Home Cost and Planning ?

Post by ResearchMed » Sat May 04, 2019 9:56 pm

confusedinvestor wrote:
Sat May 04, 2019 9:27 pm
Good to hear your story, thanks for sharing.

Do you know if Medicare will cover some of Assisted Living should LTC policy max is met ?

RetiredAL wrote:
Sat May 04, 2019 9:00 pm
Just going thru this with my Dad. Location: Central Valley area of Calif, near but not in SF Bay Area.

At home: 24x7 assistance would have been $20K a month.We tried just 15hrs x 7, but that forced me to be their every night.
Nursing Home: $330/day double, $370/day single. 2 stints there, medicare has paid most of that.
Assisted Living: $4500/month base + additional care levels, total of $5300/month. This is his current placement
and is right for his current needs.
Memory Care: Was somewhat higher than Assisted, around $5800 base as I remember.
Costs in the SF Bay Area: 40 to 50% higher.

We ( I and him ) are fortunate. He has a LTC policy that will pay up to $6000/month, up to a max of $292,000 in total. His readily available savings exceeds that amount. Additionally his income alone is such that it will cover the current level of costs forever, if most of his non-care expenditures were curtailed. I will be able prune those non-care expenditures some, but at this point I do not intend to sell his home, so some can't go away.
Our understanding from working with MIL is that Medicaid will *not* cover Assisted Living Facilities.
It will cover skilled nursing care/etc., IF someone cannot do 2 (or 3?) of the normal activities of daily living, such as bathing, dressing, etc.

In MIL's case, at her advanced age (98+), IF she runs out of money (another couple of years), she'll be moved to the skilled nursing area of her complex and be put on Medicaid. She'd been extremely healthy until just recently (except for needing a walker, finally), but she recently developed some sort of heart problem, and seems to be fading a bit... She would almost definitely qualify for skilled nursing now, but she prefers to be with her friends in the ALF, where she still enjoys bridge every day.

She also has a LTC policy with an unusual feature. If it's used, but then not used for a certain time interval, it starts over with full $$ coverage. She's needed it twice in the past, but doesn't qualify now, as it also requires a need for substantial individual care.
So this would be an additional financial buffer if/when she moves to skilled nursing.

But for someone who is not yet even "borderline" needing the skilled care, at least in our state, Medicaid would be of no use for ALF care. However, there are some other state programs for ALF residents in need of some extra services.

It's all very tricky, and can be extremely expensive.

RM
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RetiredAL
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Re: Nursing Home Cost and Planning ?

Post by RetiredAL » Sat May 04, 2019 10:52 pm

confusedinvestor wrote:
Sat May 04, 2019 9:27 pm
Good to hear your story, thanks for sharing.

Do you know if Medicare will cover some of Assisted Living should LTC policy max is met ?

RetiredAL wrote:
Sat May 04, 2019 9:00 pm
Just going thru this with my Dad. Location: Central Valley area of Calif, near but not in SF Bay Area.

At home: 24x7 assistance would have been $20K a month.We tried just 15hrs x 7, but that forced me to be their every night.
Nursing Home: $330/day double, $370/day single. 2 stints there, medicare has paid most of that.
Assisted Living: $4500/month base + additional care levels, total of $5300/month. This is his current placement
and is right for his current needs.
Memory Care: Was somewhat higher than Assisted, around $5800 base as I remember.
Costs in the SF Bay Area: 40 to 50% higher.

We ( I and him ) are fortunate. He has a LTC policy that will pay up to $6000/month, up to a max of $292,000 in total. His readily available savings exceeds that amount. Additionally his income alone is such that it will cover the current level of costs forever, if most of his non-care expenditures were curtailed. I will be able prune those non-care expenditures some, but at this point I do not intend to sell his home, so some can't go away.
Medicare only covers nursing/rehab for up a certain number of days after a qualifying hospital stay. Admission to a hospital for observation IS NOT a qualifying hospital stay. Hospital level treatment is required. The hospital's and nursing's management plan agreements with medicare can be a hindrance. Be careful to not get caught in these traps.

His first round was Sepsis due to bladder issues. This really knocked him down. For Sepsis, the medicare management plan said two weeks in nursing/rehab. No exceptions, even for a 94 year old man. When I took him home, having paid out of pocket for extra nights, he struggled using a walker from his bedroom to the tv room, needing someone to be with him to prevent a fall. So the first 2 weeks at home was mostly in a wheel chair. Medicare provide in-home Physical Therapy which got him to up to walker competent around the house at about week 5. He remains such that he requires assistance with several of his daily activities.

The second incident was some kind of seizure. He did not physically decline for this. He went straight from Nursing/rehab to assisted living. As a plus, he got weeks more of therapy thus he can now stand balanced for short periods of time. He will always require a walker to get around.

Dad knew before the second incident that assisted living was needed/coming so there was no kicking and screaming when I moved him across the street, literally, from nursing to assisted. The complex has independent living apts, assisted living apts, memory care apts, and skilled nursing.

My biggest hassle now is he expects me to be continually around and I need to wean him off that. This weekend is the just the 2nd time since before Xmas I've be able to spend multiple nights in my own bed, as I live 90 miles away from him. Luckily, I'm retired.

In our case, I've managed his financial affairs since Mom passed 6 years ago, so I did not have to learn that on the fly. As I've posted here, I did have quite a spat with Wells Fargo Advisors over Power of Attorney rights to his IRA's. His advisor, who has accepted my instructions for years, left the network and the replacement group in St Louis said "well the computer does not say so", thus they froze everything including the monthly RMD's. This started before my father got ill and took 120 days for me to resolve. I went to Schwab and had them suck one IRA over to them and that was much easier and quicker than dealing with Wells Fargo.

Confused, I know this is more than you asked for, but the whole journey so far has had many facets.

Chris K Jones
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Re: Nursing Home Cost and Planning ?

Post by Chris K Jones » Sat May 04, 2019 11:01 pm

I am currently paying for $5800 per month for a nursing home for a family member. This is in one of the lowest cost areas for nursing home in the country. I am pretty sure that their rate is frozen and doesn't go up until the patient leaves or dies. She has been there for several years so current rate for new admits is probably somewhat higher.

As for me, I plan to pay for any long term care needs for myself out of pocket.

Best wishes.

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confusedinvestor
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Re: Nursing Home Cost and Planning ?

Post by confusedinvestor » Sat May 04, 2019 11:25 pm

You and your Dad's story is touching. Glad you were able to take care of your dad and manage such events.

At this point Medicare/Medicaid is funded, but, when we age and need such programs to pay for our situations such as your dad's, I'm unsure the program's solvency and thus we need to plan for such expenses and not impact our kids on this.

thanks for such a detailed response on this, thanks RetiredAL.
RetiredAL wrote:
Sat May 04, 2019 10:52 pm

Confused, I know this is more than you asked for, but the whole journey so far has had many facets.

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