Late Life/End of Life Expenses

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Barefootgirl
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Late Life/End of Life Expenses

Post by Barefootgirl » Mon Jun 10, 2019 6:48 pm

I just read a post elsewhere arguing against the 4% rule for withdrawals for one reason. The person is a physician who treats many high net worth individuals who end up going into nursing homes and burning through their assets until they finally qualify for Medicaid.

I think he's arguing for spending less in order to have an even bigger stack of money to delay the inevitable. But here's what I am thinking from a position of not being very familiar with late in life health care. If you require such an intense level of care, what's another $1M? It seems as if the healthcare system is going to burn through that anyway and you end up in the same place - in the nursing home without assets, eventually (?) So it takes Joe a year longer to consume his assets than it does Jack, but both Jack and Joe are in the same nursing home for the same time period anyway?

What am I missing? I admit to not being familiar with the nursing home issue, but I am curious about it - since I think really it's an argument for long term care insurance vs. simply saving more money?
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CascadiaSoonish
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Re: Late Life/End of Life Expenses

Post by CascadiaSoonish » Mon Jun 10, 2019 7:42 pm

That physician's sample is biased if he's just drawing it from his practice. Does this take into account the substantial portion of people who won't have any end of life expenses?

I think it's an odds game. Sure, there's the possibility that 3 - 4% is unnecessarily frugal and just means you're shoveling money into the healthcare system at end of life. But there's also the very real likelihood that (a) you may not end up needing any long-term care at all, (b) you may not need it for long, and/or (c) you might have many years of retirement expenses before the possibility of going into a home.

littlebird
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Re: Late Life/End of Life Expenses

Post by littlebird » Mon Jun 10, 2019 8:29 pm

Barefootgirl wrote:
Mon Jun 10, 2019 6:48 pm
I just read a post elsewhere arguing against the 4% rule for withdrawals for one reason. The person is a physician who treats many high net worth individuals who end up going into nursing homes and burning through their assets until they finally qualify for Medicaid.

I think he's arguing for spending less in order to have an even bigger stack of money to delay the inevitable. But here's what I am thinking from a position of not being very familiar with late in life health care. If you require such an intense level of care, what's another $1M? It seems as if the healthcare system is going to burn through that anyway and you end up in the same place - in the nursing home without assets, eventually (?) So it takes Joe a year longer to consume his assets than it does Jack, but both Jack and Joe are in the same nursing home for the same time period anyway?

What am I missing? I admit to not being familiar with the nursing home issue, but I am curious about it - since I think really it's an argument for long term care insurance vs. simply saving more money?
What you are missing is just what you said, a lack of familiarity with a very complex, almost byzantine system of independent, and assisted living homes of all types and levels of care and comfort, and nursing homes, of varying quality with none skewed toward the broke and impecunious. As with everything in life, money give you more and much better options. Not to mention the ability to see doctors of ones own choosing, accompanied by home health aides to ease your difficulties.

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Sandtrap
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Re: Late Life/End of Life Expenses

Post by Sandtrap » Mon Jun 10, 2019 8:37 pm

What is not discussed is what happens to the patients at nursing and care homes who run out of all coverage and have no more assets, and no rich relatives.

Not to mention the difference between the quality of care if one has the financial means and the non-quality of care if one doesn't.

j

SoonerD
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Re: Late Life/End of Life Expenses

Post by SoonerD » Mon Jun 10, 2019 10:00 pm

Barefootgirl wrote:
Mon Jun 10, 2019 6:48 pm
I just read a post elsewhere arguing against the 4% rule for withdrawals for one reason. The person is a physician who treats many high net worth individuals who end up going into nursing homes and burning through their assets until they finally qualify for Medicaid.

I think he's arguing for spending less in order to have an even bigger stack of money to delay the inevitable. But here's what I am thinking from a position of not being very familiar with late in life health care. If you require such an intense level of care, what's another $1M? It seems as if the healthcare system is going to burn through that anyway and you end up in the same place - in the nursing home without assets, eventually (?) So it takes Joe a year longer to consume his assets than it does Jack, but both Jack and Joe are in the same nursing home for the same time period anyway?

What am I missing? I admit to not being familiar with the nursing home issue, but I am curious about it - since I think really it's an argument for long term care insurance vs. simply saving more money?
Be careful of the elitists who will claim medicaid beds are of the Devil and private pay beds are Heavenly.

Not true!

Some will share an anecdote representing a sample size of one and prejudiced by their narrow view of the great unwashed.

There are great quality homes & care of all payment schemes. If one does her respect (respect is a typo. Should have typed research) there is no need to let fear mongers lead you to save another million bucks.
Last edited by SoonerD on Tue Jun 11, 2019 12:24 pm, edited 1 time in total.

NotWhoYouThink
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Re: Late Life/End of Life Expenses

Post by NotWhoYouThink » Mon Jun 10, 2019 10:05 pm

Most of us won't need nursing home care, and few of us will need it for very long. For the unlucky few, many years in expensive nursing care will deplete resources. Which group will you be in, which group will I be in? Don't know, but don't plan to pay for 20 years a $100k/year care, indexed for inflation.

Actually, with pension, SS, and 4% (indexed for inflation) I could probably pay for many years of nursing care, but hope not to.

Katietsu
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Re: Late Life/End of Life Expenses

Post by Katietsu » Mon Jun 10, 2019 10:24 pm

I do think about later in life expenses when I read “Can I retire?” posts that plan for $40,000 a year in living expenses for a couple, for instance.

There are many degrees of being unable to live fully independently. Having funds to hire help, may allow you to stay in your home longer. You may be able to choose an assisted living facility with good food, a private room and enjoyable activities if you need the next level of care. If you can self fund at least a couple of years of care, you may be able to choose a nursing home that better meets your needs.

If you focus only the situation of being severely debilitated for an extended time leading to Medicaid eligibility, then I agree that an extra $150k is not going to matter. But many people have a different journey.

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Re: Late Life/End of Life Expenses

Post by Dottie57 » Mon Jun 10, 2019 10:48 pm

Sandtrap wrote:
Mon Jun 10, 2019 8:37 pm
What is not discussed is what happens to the patients at nursing and care homes who run out of all coverage and have no more assets, and no rich relatives.

Not to mention the difference between the quality of care if one has the financial means and the non-quality of care if one doesn't.

j
+1.

desiderium
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Re: Late Life/End of Life Expenses

Post by desiderium » Mon Jun 10, 2019 10:54 pm

As part of considering expenses for care near end of life it seems appropriate to consider your own preferences for the types of care you may or may not wish to have. This can have significant impact on both the spending rate and duration of care. This is nicely treated in Atul Gawande's book "Being Mortal". He approaches the issue from three unique perspectives: his personal experience, his professional experience as a physician, and as a journalist, interviewing elderly people. For a more provocative take on this issue, I would suggest this article by Dr. Ezekiel Emmanuel . https://www.theatlantic.com/magazine/ar ... 75/379329/. When published it generated quite a bit of controversy and offended some, but if you read it as entirely his own personal thinking about his preferences, you can take or leave it.

adamthesmythe
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Re: Late Life/End of Life Expenses

Post by adamthesmythe » Mon Jun 10, 2019 11:38 pm

If they went into a nursing home and burnt through their assets in a few years, then they did not have high net worth.

bayview
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Re: Late Life/End of Life Expenses

Post by bayview » Mon Jun 10, 2019 11:55 pm

The 2 excellent nursing homes in my area (both non-profits, which I think is important) run about $105k-$120k per year for completely self pay.

Run the numbers. Unless you get hit with early-onset Alzheimer’s, spinal trauma, MS/ALS etc., it’s not completely unreasonable to have 5 years or so in funding, as the overwhelming majority of people won’t need nearly that many years’ worth of expenses.

Unless you’re ridiculously wealthy, you just can’t cover all eventualities.
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OnTrack
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Re: Late Life/End of Life Expenses

Post by OnTrack » Tue Jun 11, 2019 12:07 am

It is a good idea to have documents in place so that an individual's healthcare choices are documented. This may include documents such as the following as appropriate:
- advanced medical directive/living will
- medical durable power of attorney
- DNR ( do not resuscitate)
- DNI (do not intubate)
- MOST (medical order for scope of treatment)

Gnirk
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Re: Late Life/End of Life Expenses

Post by Gnirk » Tue Jun 11, 2019 1:39 am

You never know what life will throw at you. Not typical, but my very healthy mom suffered from Alzheimer’s for 12 years, and 8 of those years required care. We were fortunate that she was frugal all of her life. She bought a 4 year LTC policy in her early 60’s. We found an exceptionally good adult care home that provided almost one-to-one care. Her LTC policy covered 4 years of care, and her investments covered the remaining 4 years.

Two of her aunts had Alzheimer’s, each for over 20 years.

I don’t have LTCI, so if I’m unlucky enough to also have Alzheimer’s, I will be private pay. Which is why my personal SWR is around 1%. Yes, I could live a much “higher” lifestyle now, but I don’t need to. Besides, that’s not how I was raised and I’d feel guilty blowing money on stuff I don’t need.

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Re: Late Life/End of Life Expenses

Post by carolinaman » Tue Jun 11, 2019 8:42 am

End of life expenses vary a lot. Some people spend years in a nursing home and some never stay in a nursing home. This is a real issue for some but I also think the risk is overstated as well. Christine Benz published an article with relevant statistics on this topic that might be helpful:
https://www.morningstar.com/articles/82 ... -care.html

I cannot find the statistic but people spend a disproportionate amount of money in their last year on health care. For many this is health care, not nursing homes. In that instance, Medicare and Medigap can cover a large portion of the expenses for most people over 65.

SQRT
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Re: Late Life/End of Life Expenses

Post by SQRT » Tue Jun 11, 2019 8:47 am

I guess it depends on your net worth. Our net worth is high enough that end of life expenses would not be a problem. Our current travel expenses would probably cover it. My mother is 94 soon and has lived in a nursing home for 6 years. Runs about $100k per year. Her net worth was never much over $1million and she won’t run out.

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Re: Late Life/End of Life Expenses

Post by JGoneRiding » Tue Jun 11, 2019 10:07 am

My family experience: grandpa died fast from chf and declined advanced intervention, as a result he spent 4 days in the hospital and had otherwise been at home (this cost was covered by standard Medicare insurance)

His wife has out lived him by 25 years, due to a fall and thinking she might not live longer she has spent 5+ yr in nursing care, she has now gone through all of her funds. A little stressful for the family but she doesn't know and there will be no change in a month or 2 when she moves to Medicaid care (literally nothing will change at her nursing home at all)

My other grandma was at home with some help and chf when she ended up in kidney failure too. She went into nursing care and as predicted died in 2 to 3 weeks. I believe this also was covered with normal Medicare .

So there you have it 3 data points. One has gone through all her money but it only makes a small difference to her

delamer
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Re: Late Life/End of Life Expenses

Post by delamer » Tue Jun 11, 2019 11:46 am

adamthesmythe wrote:
Mon Jun 10, 2019 11:38 pm
If they went into a nursing home and burnt through their assets in a few years, then they did not have high net worth.
I agree.

Even with a mere $1 million, you could cover over 6 years at the well-regarded skilled nursing facility where my mother spent the last several months of her life.

The net worth at 90th percentile of retirees — a reasonable proxy for high net worth — was about $2 million: https://dqydj.com/retiree-net-worth-ret ... h-america/

Godot
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Re: Late Life/End of Life Expenses

Post by Godot » Tue Jun 11, 2019 11:58 am

SoonerD wrote:
Mon Jun 10, 2019 10:00 pm
Barefootgirl wrote:
Mon Jun 10, 2019 6:48 pm


If one does her respect there is no need to let fear mongers lead you to save another million bucks.
What?
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SoonerD
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Re: Late Life/End of Life Expenses

Post by SoonerD » Tue Jun 11, 2019 12:22 pm

SoonerD wrote:
Mon Jun 10, 2019 10:00 pm
Barefootgirl wrote:
Mon Jun 10, 2019 6:48 pm
I just read a post elsewhere arguing against the 4% rule for withdrawals for one reason. The person is a physician who treats many high net worth individuals who end up going into nursing homes and burning through their assets until they finally qualify for Medicaid.

I think he's arguing for spending less in order to have an even bigger stack of money to delay the inevitable. But here's what I am thinking from a position of not being very familiar with late in life health care. If you require such an intense level of care, what's another $1M? It seems as if the healthcare system is going to burn through that anyway and you end up in the same place - in the nursing home without assets, eventually (?) So it takes Joe a year longer to consume his assets than it does Jack, but both Jack and Joe are in the same nursing home for the same time period anyway?

What am I missing? I admit to not being familiar with the nursing home issue, but I am curious about it - since I think really it's an argument for long term care insurance vs. simply saving more money?
Be careful of the elitists who will claim medicaid beds are of the Devil and private pay beds are Heavenly.

Not true!

Some will share an anecdote representing a sample size of one and prejudiced by their narrow view of the great unwashed.

There are great quality homes & care of all payment schemes. If one does her respect (Typo, respect should have been research) there is no need to let fear mongers lead you to save another million bucks.

SoonerD
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Re: Late Life/End of Life Expenses

Post by SoonerD » Tue Jun 11, 2019 12:26 pm

Godot wrote:
Tue Jun 11, 2019 11:58 am
SoonerD wrote:
Mon Jun 10, 2019 10:00 pm
Barefootgirl wrote:
Mon Jun 10, 2019 6:48 pm


If one does her respect there is no need to let fear mongers lead you to save another million bucks.
What?
Sorry, that was a typo. I meant to write “does her research...”, not “respect”.

LongHauler
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Re: Late Life/End of Life Expenses

Post by LongHauler » Tue Jun 11, 2019 1:39 pm

The OP's "Jack and Joe" example is only possible if the nursing home has Medicaid beds and, moreover, has a Medicaid bed available at the precise time that Jack runs out of money, waits 30 days for the Medicaid approval, and (hopefully) gets approved. And what if he gets rejected because he did things he shouldn't have during the five-year lookback?

Some nursing homes don't have Medicaid beds at all, so if you're planning to ask the government to keep caring for you, you better make sure you're in the correct place first.

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Earl Lemongrab
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Re: Late Life/End of Life Expenses

Post by Earl Lemongrab » Wed Jun 12, 2019 6:22 pm

It varies by person too. Single people have the advantage that if they go into extended full-time care most other expenses stop. You don't need a car, a house or apartment, utilities, food, etc. It's more complicated for married people, if one spouse is not in care, as the expenses there will remain.

I have a significant pad built into my savings to account for this. I don't see many scenarios that would come close to depleting that.
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fourwheelcycle
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Re: Late Life/End of Life Expenses

Post by fourwheelcycle » Wed Jun 12, 2019 8:39 pm

My father is 97. He lives in an independent living unit at a very excellent retirement facility. His total annual expenses exceed his pension, social security, and 1099 DIV income by an amount which represents a 3% draw on his savings. If he ever needs to move to assisted living or a nursing home his annual draw would increase to a maximum 6% annual draw on his savings.

He is very worried that his expenses now exceed his income, but I, and my siblings, have told him not to worry - he will make it!

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Re: Late Life/End of Life Expenses

Post by willthrill81 » Wed Jun 12, 2019 9:11 pm

The objective facts of the matter are approximately this. There is about a 50% likelihood that an individual will need some kind of Federally-defined "long-term care" at some point in their life. Typically, this level of care is provided by a family member, but if not, then help must be hired to do it or the afflicted person must enter a LTC facility. In our area, a nursing home costs about $100k annually; I urge you to search for costs in your area. About 75% of those who enter a LTC facility will be there for under three years.

Consequently, it seems that the likelihood that you will spend more than around $500k on LTC is very low. For most on this forum, that's not a problem, especially if they are single. If you're married, you need to determine whether such a hit would leave your spouse (or you if they need LTC) with adequate funds.

In general, my take on the issue is that those with $2 million in their portfolio or more do not need LTC insurance. Those with under $500k are unlikely to benefit from buying LTC insurance due to their relatively modest assets. Those in between these levels might benefit from LTC insurance.

There are other options as well which can protect your assets and/or the 'well' spouse's income from being consumed before you reach Medicaid eligibility. Two of the most common are irrevocable trusts and Medicaid-compliant annuities. You can search for prior discussions of these strategies on this forum.
“It's a dangerous business, Frodo, going out your door. You step onto the road, and if you don't keep your feet, there's no knowing where you might be swept off to.” J.R.R. Tolkien,The Lord of the Rings

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willthrill81
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Re: Late Life/End of Life Expenses

Post by willthrill81 » Wed Jun 12, 2019 9:15 pm

fourwheelcycle wrote:
Wed Jun 12, 2019 8:39 pm
My father is 97. He lives in an independent living unit at a very excellent retirement facility. His total annual expenses exceed his pension, social security, and 1099 DIV income by an amount which represents a 3% draw on his savings. If he ever needs to move to assisted living or a nursing home his annual draw would increase to a maximum 6% annual draw on his savings.

He is very worried that his expenses now exceed his income, but I, and my siblings, have told him not to worry - he will make it!
Yes, given his age, it sounds like he is in excellent shape. He could withstand a 6% withdrawal rate, assuming no portfolio growth, for 17 years. And the likelihood of him living that long is essentially zero.
“It's a dangerous business, Frodo, going out your door. You step onto the road, and if you don't keep your feet, there's no knowing where you might be swept off to.” J.R.R. Tolkien,The Lord of the Rings

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Re: Late Life/End of Life Expenses

Post by Shallowpockets » Thu Jun 13, 2019 7:08 am

The end of life could come sooner than your less than 4% withdrawal rate. You could die suddenly, or within a year. End of life always seems to be thought of as long years of care in a setting of good food, activities, and quality of life. Your mileage may vary. This means that while you have good food, activities you will be unable or have no desire to participate. You will be in your fine nursing home, waiting.
It seems the better health you are now the quicker you will go. Maybe not so for Alzheimer's. If you already have a chronic condition, your chance of lingering longer is better. Medicine is good at keeping the machine going when it rusts slowly.
The takeaway from this is that if you are healthy, don't worry about the end of life, spend without huge considerations about the impact of 4% vs 1%. If you have a chronic unfixable condition, then you know your end of life journey has already begun. It just has not culminated in the classic scenario yet. Make your plans accordingly.

3-20Characters
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Re: Late Life/End of Life Expenses

Post by 3-20Characters » Thu Jun 13, 2019 7:17 am

Given real life examples, unless one is extremely high net worth or has insurance (need to be high net worth to afford), extended end of life at nursing home will burn through all savings. The key is to have an amount to get into a good facility (pension and SS help). Once accepted, the homes figure you won’t last long but if you do, they accept Medicaid plus your SS income and care continues as usual. It helps for some relative to tip aides and such for extra good care.

This assumes system remains in place. Any further comment requires politics.

ncbill
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Re: Late Life/End of Life Expenses

Post by ncbill » Thu Jun 13, 2019 11:17 am

I'm doing my best to limit potential end-of-life expenses.

Those of us in the U.S. can specify what end-of-life treatments we don't want in a legally-binding health care POA.

Personally, since I watched a parent with dementia (diagnosed ~age 50) spend the better part of a decade bed-bound, unable to communicate, requiring total care my health care POA is very restrictive.

In the event of dementia or any other terminal illness nothing more than palliative care for me...NO antibiotics...I'm content to let my first infection be the last.

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Re: Late Life/End of Life Expenses

Post by likegarden » Thu Jun 13, 2019 12:11 pm

A friend once mentioned at our lunch group that he just visited his mother in a nursing home for which his mother paid, and next to her was a lady who got her stay paid by Medicaid. That was same care except that one person paid herself, and Medicaid paid for the other.

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dm200
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Re: Late Life/End of Life Expenses

Post by dm200 » Thu Jun 13, 2019 12:23 pm

likegarden wrote:
Thu Jun 13, 2019 12:11 pm
A friend once mentioned at our lunch group that he just visited his mother in a nursing home for which his mother paid, and next to her was a lady who got her stay paid by Medicaid. That was same care except that one person paid herself, and Medicaid paid for the other.
Yes - so far, at least. Who knows what will (or might) happen as these costs will skyrocket in future years as we elderly folks increase a lot.

What I wonder about in the situation of medicaid paying for the same quality care is whether it makes any difference how the medicaid recipient got into this position. In other words, would (or might) someone who starts as a paying patient - then ends up on medicaid get the better care than someone going on Medicaid from the beginning? . My guess is that it can make a big difference - but I don't know.

Compared with previous generations, there does not seem to be the once-common "stigma" of public assistance for such care. In my rural hometown, for example, lots of folks (including some of my relatives) spend their last days (or years) in a County facility - some paying and some on medicaid (do not know all details, though). This facility (or perhaps its predecessor) opened in about 1960 - so it was soon after that the 'stigma" of public assistance seemed to begin going away. I saw a recent online article about this facility opening about 1960. It replaced an aging (and not very good) place called the County "Poor House" or "Almshouse" or "County House".

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Re: Late Life/End of Life Expenses

Post by Bobby206 » Thu Jun 13, 2019 12:26 pm

Barefootgirl wrote:
Mon Jun 10, 2019 6:48 pm
I just read a post elsewhere arguing against the 4% rule for withdrawals for one reason. The person is a physician who treats many high net worth individuals who end up going into nursing homes and burning through their assets until they finally qualify for Medicaid.

....
I'd be curious what his definition of "high net worth" is because a true "high net worth" person will rarely spend all their money on nursing homes. Someone with modest worth of a mil or two MIGHT spend it all but someone with 5 or 10 mil or very unlikely to spend it all. VERY. Anybody over 10, which is to me where "high" starts, will not run out of money on nursing homes.

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Re: Late Life/End of Life Expenses

Post by Broken Man 1999 » Thu Jun 13, 2019 12:26 pm

likegarden wrote:
Thu Jun 13, 2019 12:11 pm
A friend once mentioned at our lunch group that he just visited his mother in a nursing home for which his mother paid, and next to her was a lady who got her stay paid by Medicaid. That was same care except that one person paid herself, and Medicaid paid for the other.
I sometimes wonder about the difference in charges for a self-pay client and a Medicaid client. Has anyone ever attempted to negotiate down the self-pay charges? I would hope the government could get good rates, but who knows?

I am referring to strictly nursing home charges, nothing like CCRC setups.

Hopefully those on Medicaid get the same level of care.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven than I shall not go. " -Mark Twain

FI4LIFE
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Re: Late Life/End of Life Expenses

Post by FI4LIFE » Thu Jun 13, 2019 12:34 pm

I have recently acquired a deep interest in end of life decision making... perhaps it is a mid-life crisis.

I am always curious when an elderly person decides to undergo intense life-saving surgery for cancer or some other ailment. I don't have an exact age where I feel this is foolish, but it's somewhere in the 85yo+ range. I often wonder how I will feel when that time comes for me. Will I be desperate for that last taste of life or will I be desperate for it to end? How do finances play into these decisions? What control will I actually have over my care through advance directives etc?

I am in nursing homes quite a bit for my job and I would say the nurse who is assigned to you is probably the biggest predictor of the quality of care you will receive. The state-funded facilities have nurses who tend to be less knowledgeable but just as friendly as those in the high price-tag facilities. It is very important to get references from others who have had family members in facilities as pretty carpeting doesn't always equate to better care.

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Re: Late Life/End of Life Expenses

Post by NotWhoYouThink » Thu Jun 13, 2019 12:51 pm

likegarden wrote:
Thu Jun 13, 2019 12:11 pm
A friend once mentioned at our lunch group that he just visited his mother in a nursing home for which his mother paid, and next to her was a lady who got her stay paid by Medicaid. That was same care except that one person paid herself, and Medicaid paid for the other.
There is a lot of anecdata out there. But you'll probably find that that home does not admit patients who can't pay for at least a couple of years, because most don't last longer than that. If you do live longer and revert to Medicaid the care may or may not be the same, it depends on the facility. But finding a place that will take a direct placement of a Medicaid patient will likely be more difficult and depressing.

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dm200
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Re: Late Life/End of Life Expenses

Post by dm200 » Thu Jun 13, 2019 12:53 pm

Someone we knew for many decades recently died. She had just turned 100 - and, until she fell and broker her hip - she was still driving, living on her own and doing an exercise class three times a week. She as doing well (physically and mentally) after the fall, but went downhill quickly after surgery to fix the hip.

She had no children and her husband had died 30-40 years ago.

Not everyone incurs these long and high cost end of life expenses. While no guarantee, I believe good lifestyle decisions (proper diet, exercise, maintaining good body weight, etc.) can make a big difference.

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Earl Lemongrab
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Re: Late Life/End of Life Expenses

Post by Earl Lemongrab » Thu Jun 13, 2019 1:13 pm

"High net worth" is going to vary some by circumstance. I live a modest life in a low-cost area. A top care facility isn't going to be all that expensive. A million bucks goes further in most ways here than other locations. I don't want it to be a question about getting into the place I want, so I have extra built into my savings. If it's not needed, so what? It goes to my family, and I like them
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delamer
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Re: Late Life/End of Life Expenses

Post by delamer » Thu Jun 13, 2019 2:57 pm

likegarden wrote:
Thu Jun 13, 2019 12:11 pm
A friend once mentioned at our lunch group that he just visited his mother in a nursing home for which his mother paid, and next to her was a lady who got her stay paid by Medicaid. That was same care except that one person paid herself, and Medicaid paid for the other.
A friend’s elderly family member is currently able to afford the cost of a small apartment in her assisted living/nursing facility. Basically, a bedroom, a sitting room, and a bathroom. All meals are taken in the communal dining room.

If she runs out of funds and ends up on Medicaid, she’ll move within the facility and share one room (and a bath) with another resident. In other words, no privacy.

So while the quality of her food and healthcare probably won’t decline if she moves to Medicaid, her overall quality-of-life certainly will.

And, as someone else noted, there are many facilities that will not take you if you can’t afford to self-pay for at least a few years.

As with virtually every other purchase that people make, more money means more options.

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willthrill81
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Re: Late Life/End of Life Expenses

Post by willthrill81 » Thu Jun 13, 2019 3:33 pm

NotWhoYouThink wrote:
Thu Jun 13, 2019 12:51 pm
likegarden wrote:
Thu Jun 13, 2019 12:11 pm
A friend once mentioned at our lunch group that he just visited his mother in a nursing home for which his mother paid, and next to her was a lady who got her stay paid by Medicaid. That was same care except that one person paid herself, and Medicaid paid for the other.
There is a lot of anecdata out there. But you'll probably find that that home does not admit patients who can't pay for at least a couple of years, because most don't last longer than that. If you do live longer and revert to Medicaid the care may or may not be the same, it depends on the facility. But finding a place that will take a direct placement of a Medicaid patient will likely be more difficult and depressing.
If you don't have the funds to cover at least a year at a LTC facility right now, then you may have bigger problems than paying for LTC. Sadly, most retirees are more or less in this position.
“It's a dangerous business, Frodo, going out your door. You step onto the road, and if you don't keep your feet, there's no knowing where you might be swept off to.” J.R.R. Tolkien,The Lord of the Rings

Swimmer
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Re: Late Life/End of Life Expenses

Post by Swimmer » Sat Jun 15, 2019 10:21 am

NotWhoYouThink wrote:
Thu Jun 13, 2019 12:51 pm
likegarden wrote:
Thu Jun 13, 2019 12:11 pm
A friend once mentioned at our lunch group that he just visited his mother in a nursing home for which his mother paid, and next to her was a lady who got her stay paid by Medicaid. That was same care except that one person paid herself, and Medicaid paid for the other.
There is a lot of anecdata out there. But you'll probably find that that home does not admit patients who can't pay for at least a couple of years, because most don't last longer than that. If you do live longer and revert to Medicaid the care may or may not be the same, it depends on the facility. But finding a place that will take a direct placement of a Medicaid patient will likely be more difficult and depressing.

Based on my own experience, I think it depends on the state administering Medicaid. When I dealt with this five years ago in Pennsylvania, nursing homes had “quotas” (my term) for Medicaid beds. My relative, who had spent 90% on her life savings on Assisted Living, wound up in the highest rated excellent facility in the area. Her remaining savings covered two months in the nursing home. She then was flawlessly transferred to Medicaid. She remained there for four years.

While I have not had direct experience with nursing homes in Florida, I get the sense that Medicaid recipients do not have the same quality nursing homes as private pay.

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