Age and probability of needing long term care?

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Fremdon Ferndock
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Age and probability of needing long term care?

Post by Fremdon Ferndock »

In terms of planning for possible future expenses, I'm wondering about the contingency between current age and the likelihood of needing long term care. For example, if I am 80 what is the likelihood I'll need LTC at some point and does this increase the older I get? It seems logical that this would be the case. I've seen articles that present the percentage of seniors that need LTC, but I don't believe I've seen data on age-based contingent LTC. Is anyone aware of such information? Does it make sense that older seniors should be basing their financial planning taking this into consideration?
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JoeRetire
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Re: Age and probability of needing long term care?

Post by JoeRetire »

Fremdon Ferndock wrote: Fri Jan 20, 2023 9:05 am In terms of planning for possible future expenses, I'm wondering about the contingency between current age and the likelihood of needing long term care. For example, if I am 80 what is the likelihood I'll need LTC at some point and does this increase the older I get? It seems logical that this would be the case. I've seen articles that present the percentage of seniors that need LTC, but I don't believe I've seen data on age-based contingent LTC. Is anyone aware of such information? Does it make sense that older seniors should be basing their financial planning taking this into consideration?
I've never seen specifically what you are looking for. Most often you find statements like "70% of people aged 65 and older will need some form of long-term care services in their lifetime." Table IX of https://www.cdc.gov/nchs/data/series/sr ... 43-508.pdf shows percent of nursing home residents by age group - not exactly what you are asking.

But I'm not sure it matters much.

Certainly the likelihood of needing LTC increases with age. But, so do LTC insurance premiums.

Most try to come up with a "sweet spot" such that their premiums are not too exorbitant, and that they aren't paying for too many years of premiums. Many settle on 60-65 as that "sweet spot".
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carolinaman
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Re: Age and probability of needing long term care?

Post by carolinaman »

I think another question is how much LTC would someone need? I believe I have read in the past that most people do not require a lot of LTC. If that is true, it could mean that the cost of LTC insurance is more than the use of limited LTC. Also, people can sometimes use home health services to avoid LTC. Of course, there are some who spend years in LTC.

This is a good Morningstar article that may help:
https://www.morningstar.com/articles/10 ... ic-edition
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JoeRetire
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Re: Age and probability of needing long term care?

Post by JoeRetire »

carolinaman wrote: Fri Jan 20, 2023 9:42 amI believe I have read in the past that most people do not require a lot of LTC.
What do you mean by "a lot" in this context?
Also, people can sometimes use home health services to avoid LTC.
Many use some home health services, at least for a while. Most often that is provided by a partner or a child. But clearly not everyone can depend on an elderly partner for the care they need. And not everyone has a child willing or able to provide free care.

So sometimes a paid home health provider is needed. Many LTC plans cover in-home care.
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Watty
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Re: Age and probability of needing long term care?

Post by Watty »

Be sure to keep in mind that most "long term care" statistics are often very misleading because they mix in different types of long term care.

For example if you hear of someone who needed five years of "long term care" that could really be four years of the much less expensive level of assisted living and one year of the more expensive skilled nursing facility.

According to this web site in my area Assisted living costs $46K a year on average which is less than my planned retirement budget so I could pay for that for a very long time without much difficulty especially if only one of use is surviving when LTC is needed. A private room runs $103K here which would be harder to pay for but if it is only needed for a year then that would not be a big problem for us.

https://www.genworth.com/aging-and-you/ ... -care.html

When you see long term care statistics you also need to be very careful since they can be very misleading. For example you may see something like;

a) 50% of 65 year olds will need some sort of LTC.
b) Average duration of LTC stay: men 2.2 years, women 3.7 years.

The problem is that half the people will not need any LTC so they are not included in that average duration so roughly 75% of people will need it for less than 2.2 years or 3.7 years or maybe not even need any.

Averages are often uses when the median stay would be a lot more useful since the few people that spend a very long time in LTC skew the statistics since a few people will have much longer stays.
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Re: Age and probability of needing long term care?

Post by bsteiner »

There's a large possibility that someone will need short-term care but a smaller possiblity that he/she will need long-term care.

As you get older, the chances of needing long-term care decrease since you may not have any many years of life remaining.
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Fremdon Ferndock
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Re: Age and probability of needing long term care?

Post by Fremdon Ferndock »

bsteiner wrote: Fri Jan 20, 2023 10:28 am There's a large possibility that someone will need short-term care but a smaller possiblity that he/she will need long-term care.

As you get older, the chances of needing long-term care decrease since you may not have any many years of life remaining.
I'd like to see the breakdown by age of (a) probability of needing LTC, (b) what type of LTC (i.e., is it expensive nursing home care?), and (c) duration of LTC (at some point, duration starts to get shorter because life expectancy is getting shorter - but where is the tipping point?).

If I'm 85 and there's an 80% chance that 85 year-olds will need LTC, and the median duration of LTC for those who need LTC is 3 years then I'll probably want to have a serious financial plan to deal with that. If the odds become 90% by the time I'm 90, then even moreso if I reach that age. But it could be the case that more long-lived folks actually are less likely to need much LTC because they are in a much healthier cohort. Just don't know.
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prd1982
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Re: Age and probability of needing long term care?

Post by prd1982 »

bsteiner wrote: Fri Jan 20, 2023 10:28 am
As you get older, the chances of needing long-term care decrease since you may not have any many years of life remaining.
I disagree. The only way to avoid needing LTC is to die.

If you start with a group of 50 yr olds, a lot will not need LTC because they will die relatively young (50 to say 80). Once you get to the group of 90+, a larger percentage of the remaining people will need LTC.

I know we talk about only a very small percentage of folks will need many years of LTC. People have said they would like a policy that kicked in after 3 years of LTC and paid for future years. That sounds reasonable. However, I have read that the LTC insurance folks say that would not significantly reduce premiums.
Fractalleaf
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Re: Age and probability of needing long term care?

Post by Fractalleaf »

Fremdon Ferndock wrote: Fri Jan 20, 2023 9:05 am In terms of planning for possible future expenses, I'm wondering about the contingency between current age and the likelihood of needing long term care. For example, if I am 80 what is the likelihood I'll need LTC at some point and does this increase the older I get? It seems logical that this would be the case. I've seen articles that present the percentage of seniors that need LTC, but I don't believe I've seen data on age-based contingent LTC. Is anyone aware of such information? Does it make sense that older seniors should be basing their financial planning taking this into consideration?
The type of LTC is what will determine costs. Someone with significant dementia will need 24/7 oversight, either at home or in a pricey assisted living facility. Someone needing help with daily tasks due to a physical impairment may be fine with a daily part-time caregiver. The published statistics lump everyone together, making them much less useful than a personal evaluation of risk.
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Re: Age and probability of needing long term care?

Post by ScubaHogg »

It would be useful if these discussions and articles could be more clear in what they are talking about. Imagine if I said “50% of people will need some type of medical care in their life” but I don’t distinguish between taking an aspirin and a heart transplant

There is a world of difference between an aide coming to your house twice a week to help with laundry and living in a memory care facility for years
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Jovby
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Re: Age and probability of needing long term care?

Post by Jovby »

carolinaman wrote: Fri Jan 20, 2023 9:42 am
people can sometimes use home health services to avoid LTC. Of course, there are some who spend years in LTC.
Many LTC policies do include coverage for home health services if the conditions are met (i.e. requires assistance with 2 out of 6 activities of daily living).
frugalecon
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Re: Age and probability of needing long term care?

Post by frugalecon »

prd1982 wrote: Fri Jan 20, 2023 11:14 am
bsteiner wrote: Fri Jan 20, 2023 10:28 am
As you get older, the chances of needing long-term care decrease since you may not have any many years of life remaining.
I disagree. The only way to avoid needing LTC is to die.

If you start with a group of 50 yr olds, a lot will not need LTC because they will die relatively young (50 to say 80). Once you get to the group of 90+, a larger percentage of the remaining people will need LTC.

I know we talk about only a very small percentage of folks will need many years of LTC. People have said they would like a policy that kicked in after 3 years of LTC and paid for future years. That sounds reasonable. However, I have read that the LTC insurance folks say that would not significantly reduce premiums.
@prd1982, if you have links to anything about your last point, I would be interested. My intuition would have been that a policy with say a 3-year exclusion period would be much cheaper, unless it committed the insurer to pay a lot more in benefits conditional on getting past the exclusion period.

My dad was in a memory care facility at the end of his life, for two years. He didn’t come close to exhausting his policy’s limits, so his unused benefits were added onto my mom’s policy, which would now cover around 6 years of care.
TN_Boy
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Re: Age and probability of needing long term care?

Post by TN_Boy »

Fremdon Ferndock wrote: Fri Jan 20, 2023 11:11 am
bsteiner wrote: Fri Jan 20, 2023 10:28 am There's a large possibility that someone will need short-term care but a smaller possiblity that he/she will need long-term care.

As you get older, the chances of needing long-term care decrease since you may not have any many years of life remaining.
I'd like to see the breakdown by age of (a) probability of needing LTC, (b) what type of LTC (i.e., is it expensive nursing home care?), and (c) duration of LTC (at some point, duration starts to get shorter because life expectancy is getting shorter - but where is the tipping point?).

If I'm 85 and there's an 80% chance that 85 year-olds will need LTC, and the median duration of LTC for those who need LTC is 3 years then I'll probably want to have a serious financial plan to deal with that. If the odds become 90% by the time I'm 90, then even moreso if I reach that age. But it could be the case that more long-lived folks actually are less likely to need much LTC because they are in a much healthier cohort. Just don't know.
I don't think this is exactly what you are looking for, but it has some data and a lot of references:

https://aspe.hhs.gov/reports/long-term- ... ch-brief-0

I'll mention in passing that a lot of short term stays in nursing homes are covered by medicare, as the stays are due to rehab after surgery, accidents, etc.

But I think your question is ill-considered.

The chance that you will need some long term care in your life is non-zero. It might be 1 day. It might be three years. It might happen at age 65 (which is actually unlikely). It might happen at age 80. Regardless, since the risk is non-zero, you should have a plan for this potential need.

We have numerous threads on the LTC insurance, which delve into more details on that option, and other options (equity in the house, etc).
HomeStretch
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Re: Age and probability of needing long term care?

Post by HomeStretch »

Look around at friends and family to see what’s going on with age 80+ people. I see (and have experienced in my family) almost everyone needing some level of care and support in their 80s. The needs range from living at home with family assistance through in-facility skilled nursing with all sorts of in-between. Care, if needed, can be expensive and it can be difficult to find complete and quality care to maintain in-home living. Dementia diseases can result in staggeringly high care costs.

So I think it’s important to consider this potential need in retirement planning. Financially it can be addressed by saving extra for it, earmarking home equity for it and/or obtaining long-term care insurance.

There’s no way to precisely determine one’s potential future care costs. But for more accuracy in determining one’s likelihood of needing care (and it’s impact on retirement financial planning), that likely involves assessing one’s health, family history and perhaps genetic testing as such tests become more widely available.
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snackdog
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Re: Age and probability of needing long term care?

Post by snackdog »

Probabilities such as this apply to populations, not individuals. You will either need it or you will not.

1 in 1 billion may require it but if that one is you, then you need to be prepared to pay for it or suffer the consequences.
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Fremdon Ferndock
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Re: Age and probability of needing long term care?

Post by Fremdon Ferndock »

prd1982 wrote: Fri Jan 20, 2023 11:14 am
bsteiner wrote: Fri Jan 20, 2023 10:28 am
As you get older, the chances of needing long-term care decrease since you may not have any many years of life remaining.
I disagree. The only way to avoid needing LTC is to die.

If you start with a group of 50 yr olds, a lot will not need LTC because they will die relatively young (50 to say 80). Once you get to the group of 90+, a larger percentage of the remaining people will need LTC.

I know we talk about only a very small percentage of folks will need many years of LTC. People have said they would like a policy that kicked in after 3 years of LTC and paid for future years. That sounds reasonable. However, I have read that the LTC insurance folks say that would not significantly reduce premiums.
You would think, but is that true? People who reach the age of 90+ may be in a healthier cohort, genetically or otherwise, and in fact could be less likely to need 24/7 LTC. If I were to survey a typical nursing home, what is the median age and age range, and at what age did each person enter LTC? What we need is a life expectancy type table that shows the expectancy of needing 24/7 care and not just the chronological age expectancy. The latter shows that the longer you live, the longer you will live; but the longer you live will you necessarily need more 24/7 care? We need data and not hunches here.
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Re: Age and probability of needing long term care?

Post by Parkinglotracer »

snackdog wrote: Fri Jan 20, 2023 11:55 am Probabilities such as this apply to populations, not individuals. You will either need it or you will not.

1 in 1 billion may require it but if that one is you, then you need to be prepared to pay for it or suffer the consequences.
I am with you. That is the same reason we don’t walk around with lightening rods on our heads - we calculate the risk of an event and then decide if efforts to prevent it or insure against it are prudent.
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Re: Age and probability of needing long term care?

Post by OpenMinded1 »

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Re: Age and probability of needing long term care?

Post by OpenMinded1 »

Fremdon Ferndock wrote: Fri Jan 20, 2023 9:05 am In terms of planning for possible future expenses, I'm wondering about the contingency between current age and the likelihood of needing long term care. For example, if I am 80 what is the likelihood I'll need LTC at some point and does this increase the older I get? It seems logical that this would be the case. I've seen articles that present the percentage of seniors that need LTC, but I don't believe I've seen data on age-based contingent LTC. Is anyone aware of such information? Does it make sense that older seniors should be basing their financial planning taking this into consideration?
You probably already know this, but if part of your plan includes getting LTC insurance at some point, in general, it's more likely that a person will be unable to get LTC insurance as they grow older. Unlike health insurance, insurance companies can refuse LTC insurance coverage based on pre-existing conditions. In addition to requiring that applicants disclose certain existing medical conditions, insurance companies often will have a nurse administer a verbal test to determine whether the applicant has symptoms of dementia, Alzheimer's etc. Cognitive issues may result in disqualification.
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Fremdon Ferndock
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Re: Age and probability of needing long term care?

Post by Fremdon Ferndock »

The issue in retirement financial planning is not just how long one might live, but how expensive it will be due to healthcare needs. We have actuarial data regarding the former based on age-contingency, but we don't have those data regarding the latter. It would be helpful if we did. Everyone believes the former is important, but no-one seems to consider the importance of the latter.

Based on my observational impressions from nursing homes (due to my mother's care), I didn't see lots and lots of people in their 90s. Demographically, there are simply fewer people living into their 90s to be seen, but are they proportionally represented in nursing home populations? We don't know. There could be more or there could be fewer than in the general population. If there are fewer, then that would seem to violate the commonly-held assumption that the older we get, the more expensive our healthcare needs get.
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journey
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Re: Age and probability of needing long term care?

Post by journey »

Unfortunately, whether one needs home care (HC), assisted living (AL), or a nursing home (NH) can rarely be predicted. How long they might need each type of care is unpredictable.

My grandmother with Alzheimer’s moved in with us when she was 80. Moved to AL at age 82, then to a NH at age 85. Died at age 90. My parents, also with Alzheimer’s, moved to AL 2 years ago at ages 83 and 85. Now 85 and 87, they are both physically healthy enough to live another 10 years, some years possibly in a vegetative state like my grandmother. All three needed care for years before they left their homes but they refused. The length of care just can't be known.

OP, you may be in the same boat that we are which is to plan for the worst, hope for the best.

When I was young, I knew a group of octogenarians who would lovingly tell each other ‘Hope you drop dead.’ These days, my family and friends often end our conversations with ‘HYDD.' It reminds us to be prepared and to live each day to its fullest.

Very best wishes. And HYDD.
CapeLinda
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Re: Age and probability of needing long term care?

Post by CapeLinda »

Agree with Homestretch re looking at relatives, most of my relatives were in good health in early 80's. ie independent living in own home including driving, shopping. The biggest change was from 85-90 with those approaching 90 becoming increasing frail requiring more assistance and moves out of their homes. I would suggest its not just age but health and functioning - expect my generation not to live as long as my parents due to lifestyle issues, stress of working etc.

What worked for aging family was - intermittent services to maximize their functioning status ie Physiotherapy and Occupational Therapy and safety at home. Home support workers in the last year at home for several hours - several days week. OT/PT can focus on home safety and strategies to maintain independence in home including for people with cognitive deficits.

Here's an article re some of the points of the post. The latter portion of the article deals with length of stay in varying facilities. Note of interest is the diagnosis indicated of those requiring services.

https://www.cdc.gov/nchs/data/series/sr ... 43-508.pdf

Hope the link works. Not an easy stage of life!
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Fremdon Ferndock
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Re: Age and probability of needing long term care?

Post by Fremdon Ferndock »

Here's one way to get at it- look at the LTC insurance claims data:
Most long term care insurance claims begin after a person reaches age 70. According to annual studies by the American Association for Long-Term Care Insurance, 22.7% of new claims begin between ages 70-79. Just over two thirds 67.4% of all new long-term care insurance claims begin after age 80.
https://www.aaltci.org/long-term-care-i ... lator.php

Unfortunately, I don't know where to find data that breaks down claims by age to see what the relationship is to age of the claimant. Are most of the claims filed after age 80 accounted for by age 90 for example?

I just have a hunch that virtually everyone who enters LTC does so in their 70s or 80s, and that if you live longer than that your odds of needing LTC may be about nil. Having said that, my mother would be the exception since she didn't enter LTC until she was 101 and lived another 4 years.
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TN_Boy
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Re: Age and probability of needing long term care?

Post by TN_Boy »

Fremdon Ferndock wrote: Sat Jan 21, 2023 1:35 pm Here's one way to get at it- look at the LTC insurance claims data:
Most long term care insurance claims begin after a person reaches age 70. According to annual studies by the American Association for Long-Term Care Insurance, 22.7% of new claims begin between ages 70-79. Just over two thirds 67.4% of all new long-term care insurance claims begin after age 80.
https://www.aaltci.org/long-term-care-i ... lator.php

Unfortunately, I don't know where to find data that breaks down claims by age to see what the relationship is to age of the claimant. Are most of the claims filed after age 80 accounted for by age 90 for example?

I just have a hunch that virtually everyone who enters LTC does so in their 70s or 80s, and that if you live longer than that your odds of needing LTC may be about nil. Having said that, my mother would be the exception since she didn't enter LTC until she was 101 and lived another 4 years.
I think the median age to enter care facilities is something like 79. But there are a non-trivial number of people in their 60s who enter such facilities.

But I cannot understand how you would use such information. I know, right now, my financial needs for LTC will almost certainly range from $0 to $1.5M. The latter is extremely, extremely unlikely (years and years in skilled nursing). The former has a likelihood of about 50%.

But population statistics are not terribly useful. Suppose I find out that "my" chance of needing 120k worth of LTC at age 82 is 22.5%. What would I do different if that percent is 12%? Or 43%? Or if the amount reduces to 100k at age 88?

Most of us decide how much LTC we will try to handle up to some amount. And will fund that via some combination of savings, house equity, LTC insurance, etc. Since population statistics do not tell me what will happen to me, about the only number I think about much is how much LTC could we afford.

You either set aside (mentally, not necessarily in a "bucket") the resources to manage a certain amount of care or you don't.

Please help me understand how knowing the detail you are asking for would result in actionable modifications to my financial (or other) management.
ScubaHogg
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Re: Age and probability of needing long term care?

Post by ScubaHogg »

Fremdon Ferndock wrote: Sat Jan 21, 2023 1:35 pm Here's one way to get at it- look at the LTC insurance claims data:
Most long term care insurance claims begin after a person reaches age 70. According to annual studies by the American Association for Long-Term Care Insurance, 22.7% of new claims begin between ages 70-79. Just over two thirds 67.4% of all new long-term care insurance claims begin after age 80.
https://www.aaltci.org/long-term-care-i ... lator.php

Unfortunately, I don't know where to find data that breaks down claims by age to see what the relationship is to age of the claimant. Are most of the claims filed after age 80 accounted for by age 90 for example?

I just have a hunch that virtually everyone who enters LTC does so in their 70s or 80s, and that if you live longer than that your odds of needing LTC may be about nil. Having said that, my mother would be the exception since she didn't enter LTC until she was 101 and lived another 4 years.
It’s pretty self-evident that if you are 90 there is a higher chance you’ll need LTC over the next year than if you are 70.

If you are 100 there is almost a 100% chance that you are receiving some type of LTC

Is that helpful?
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VanGar+Goyle
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Re: Age and probability of needing long term care?

Post by VanGar+Goyle »

carolinaman wrote: Fri Jan 20, 2023 9:42 amI believe I have read in the past that most people do not require a lot of LTC.
Long-term care involves a variety of services designed to meet a person's health or personal care needs during a short or long period of time. https://www.nia.nih.gov/health/what-long-term-care

A lot of long term care insurance policies have a 90 consecutive day elimination period, which is never exceeded, so the LTC insurance policy provides no benefit. If you are one of the above average people who need more than 2 years, a LTC insurance policy would help.
hudson
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Re: Age and probability of needing long term care?

Post by hudson »

Fremdon Ferndock wrote: Fri Jan 20, 2023 9:05 am In terms of planning for possible future expenses, I'm wondering about the contingency between current age and the likelihood of needing long term care. For example, if I am 80 what is the likelihood I'll need LTC at some point and does this increase the older I get? It seems logical that this would be the case. I've seen articles that present the percentage of seniors that need LTC, but I don't believe I've seen data on age-based contingent LTC. Is anyone aware of such information? Does it make sense that older seniors should be basing their financial planning taking this into consideration?
Need long term care (LTC) after 80? As you said, it seems logical; I vote probable. Both of my parents needed it off and on during their lives.

Should seniors take this into consideration? Yes, if they can afford it.

Long term care insurance (LTCI)? I'm 75. When I passed the sweet spot for buying LTCI, I couldn't afford it. None of the deals that I saw made sense for me anyway. I had other priorities like getting kids out of college and getting debt free.

What's my plan? To wing it; take one day at a time; survive in place as long as possible, use family resources within reason. I would try to keep enough money available in case LTC is needed.
humblecoder
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Re: Age and probability of needing long term care?

Post by humblecoder »

Tough love time. Honestly, I think people are looking at this the wrong way.

There is one only data point that matters.... YOU!


The purpose of any type of insurance is to protect you from risks that may have low probability, but high financial cost if that risk comes to pass. LTC insurance in no different.

What does it matter if 95% of the population doesn't need LTC if you happen to be in the 5% group that does need it (I just made those numbers up but you get the point)?

Nobody says "well, since 95% of people aged 30 live to age 60 so I don't need life insurance to protect my family". If you have a family who are dependent upon your future salary, then of course you need it, since you might be one of the unlucky 5%. So why shouldn't one have the same thinking when it comes to LTC insurance?

Personally, I am not letting the age and probability of needing long term care drive my decision as to whether to buy LTC insurance. I am not one of the lucky few who can set aside money to cover this risk, so I am going to buy it (I already have, in fact).

But if others feel comfortable rolling the dice and hoping, then all the best to you.

PS: The reason for the tough love is that my father is currently in the memory care center for his dementia. It costs around $12K/month. This is on top of a home health aid that lived with him and my mom until they were unable to care for him in the home. If it weren't for my father's LTC policy, I am not sure what we would have done. I'm sure we would have figured out a way financially to make it all work, but with this policy, that is one less thing my mom has to worry about.

I certainly pray that the OP doesn't face similar issues. Maybe the odds are in their favor. Maybe they are hoping that they are in the lucky group that doesn't need care. But make no mistake, hope is NOT a strategy
Nowizard
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Re: Age and probability of needing long term care?

Post by Nowizard »

We have no LTC insurance though we are elderly, one in 80's, other in late 70's. LTC insurance would probably be very expensive at this point. A friend of similar age was recently rejected for it, for example. Our approach is that we will eventually move to a Lifecare facility in all probability. Those communities offer a continuum of care based on entry payments that are substantial (But largely tax deductible). As you enter independent living, should you move to assisted care, memory care or nursing care (Typically called skilled nursing), your charges are what they would have been if you remained in independent living. In that sense it is an insurance policy that can aid in planning. We are currently considering possible locations, as there is often a waiting list and advantage in signing up before entering the community. That also allows planning for things such as downsizing a home, its contents, etc. rather than moving at a time when it may be more challenging for various reasons, including an illness that would require entry to, for example, assisted care or memory care rather than independent living.

Tim
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Re: Age and probability of needing long term care?

Post by J295 »

humblecoder wrote: Sun Jan 22, 2023 9:02 am Tough love time. Honestly, I think people are looking at this the wrong way.

There is one only data point that matters.... YOU!


The purpose of any type of insurance is to protect you from risks that may have low probability, but high financial cost if that risk comes to pass. LTC insurance in no different.

What does it matter if 95% of the population doesn't need LTC if you happen to be in the 5% group that does need it (I just made those numbers up but you get the point)?

Nobody says "well, since 95% of people aged 30 live to age 60 so I don't need life insurance to protect my family". If you have a family who are dependent upon your future salary, then of course you need it, since you might be one of the unlucky 5%. So why shouldn't one have the same thinking when it comes to LTC insurance?

Personally, I am not letting the age and probability of needing long term care drive my decision as to whether to buy LTC insurance. I am not one of the lucky few who can set aside money to cover this risk, so I am going to buy it (I already have, in fact).

But if others feel comfortable rolling the dice and hoping, then all the best to you.

PS: The reason for the tough love is that my father is currently in the memory care center for his dementia. It costs around $12K/month. This is on top of a home health aid that lived with him and my mom until they were unable to care for him in the home. If it weren't for my father's LTC policy, I am not sure what we would have done. I'm sure we would have figured out a way financially to make it all work, but with this policy, that is one less thing my mom has to worry about.

I certainly pray that the OP doesn't face similar issues. Maybe the odds are in their favor. Maybe they are hoping that they are in the lucky group that doesn't need care. But make no mistake, hope is NOT a strategy
Tough situation. Good luck to all.

What are the daily and lifetime maximums on his policy, and the annual premium?

My mom has an older policy with daily max around $215 and lifetime around $350k for about $3200 annual premium as one data point. 90 day elimination period and no HHC.
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Re: Age and probability of needing long term care?

Post by humblecoder »

J295 wrote: Sun Jan 22, 2023 9:15 am
humblecoder wrote: Sun Jan 22, 2023 9:02 am Tough love time. Honestly, I think people are looking at this the wrong way.

There is one only data point that matters.... YOU!


The purpose of any type of insurance is to protect you from risks that may have low probability, but high financial cost if that risk comes to pass. LTC insurance in no different.

What does it matter if 95% of the population doesn't need LTC if you happen to be in the 5% group that does need it (I just made those numbers up but you get the point)?

Nobody says "well, since 95% of people aged 30 live to age 60 so I don't need life insurance to protect my family". If you have a family who are dependent upon your future salary, then of course you need it, since you might be one of the unlucky 5%. So why shouldn't one have the same thinking when it comes to LTC insurance?

Personally, I am not letting the age and probability of needing long term care drive my decision as to whether to buy LTC insurance. I am not one of the lucky few who can set aside money to cover this risk, so I am going to buy it (I already have, in fact).

But if others feel comfortable rolling the dice and hoping, then all the best to you.

PS: The reason for the tough love is that my father is currently in the memory care center for his dementia. It costs around $12K/month. This is on top of a home health aid that lived with him and my mom until they were unable to care for him in the home. If it weren't for my father's LTC policy, I am not sure what we would have done. I'm sure we would have figured out a way financially to make it all work, but with this policy, that is one less thing my mom has to worry about.

I certainly pray that the OP doesn't face similar issues. Maybe the odds are in their favor. Maybe they are hoping that they are in the lucky group that doesn't need care. But make no mistake, hope is NOT a strategy
Tough situation. Good luck to all.

What are the daily and lifetime maximums on his policy, and the annual premium?

My mom has an older policy with daily max around $215 and lifetime around $350k for about $3200 annual premium as one data point. 90 day elimination period and no HHC.
Thank you. To be honest, I don't know all the policy details.
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Re: Age and probability of needing long term care?

Post by JoMoney »

This Christina Benz article on Morningstar.com has a lot of interesting (I think) statistics on Long Term Care
https://www.morningstar.com/articles/82 ... -term-care

There is a big distinction between "Long Term Care" and "assisted living", personally I don't worry about LTC, if I'm at that stage I'm not even sure it's something I would want. FWIW, one stat from the above article,
0.88 years: Average duration of nursing-home stay for men.
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Re: Age and probability of needing long term care?

Post by hppycamper »

frugalecon wrote: Fri Jan 20, 2023 11:28 am
prd1982 wrote: Fri Jan 20, 2023 11:14 am
bsteiner wrote: Fri Jan 20, 2023 10:28 am
As you get older, the chances of needing long-term care decrease since you may not have any many years of life remaining.
I disagree. The only way to avoid needing LTC is to die.

If you start with a group of 50 yr olds, a lot will not need LTC because they will die relatively young (50 to say 80). Once you get to the group of 90+, a larger percentage of the remaining people will need LTC.

I know we talk about only a very small percentage of folks will need many years of LTC. People have said they would like a policy that kicked in after 3 years of LTC and paid for future years. That sounds reasonable. However, I have read that the LTC insurance folks say that would not significantly reduce premiums.
@prd1982, if you have links to anything about your last point, I would be interested. My intuition would have been that a policy with say a 3-year exclusion period would be much cheaper, unless it committed the insurer to pay a lot more in benefits conditional on getting past the exclusion period.

My dad was in a memory care facility at the end of his life, for two years. He didn’t come close to exhausting his policy’s limits, so his unused benefits were added onto my mom’s policy, which would now cover around 6 years of care.
About 10 years ago, I looked for a LTC policy that would function like any other insurance products as @prd1982 described. And I talked to a couple of insurance agents who specialized in LTC insurance products. When I asked about such a policy point blank, they told me that there were no product like that on the market, period. In fact all the LTC policies I looked at basically have a life-time max benefit amount and only covers the first few years of LTC needs. Without going into the details, my conclusion was (and still is) that if I were to set the LTC insurance premiums aside and invest them, I would be able to self-cover the LTC needs if I need any. And if I don't need LTC, I keep the $. In either case, I would be on my own if the LTC needs last for many years, with medicaid as the safety net.

I have read that LTC policies sold many years ago were good deals. But I doubt anyone can find policies like that now.
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Re: Age and probability of needing long term care?

Post by jebmke »

JoMoney wrote: Sun Jan 22, 2023 9:46 am This Christina Benz article on Morningstar.com has a lot of interesting (I think) statistics on Long Term Care
https://www.morningstar.com/articles/82 ... -term-care

There is a big distinction between "Long Term Care" and "assisted living", personally I don't worry about LTC, if I'm at that stage I'm not even sure it's something I would want. FWIW, one stat from the above article,
0.88 years: Average duration of nursing-home stay for men.
Same; also, it isn't even clear that it will be available given staffing and other issues that seem to be hitting the industry. Even in-home care is probably at risk.
When you discover that you are riding a dead horse, the best strategy is to dismount.
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Re: Age and probability of needing long term care?

Post by hudson »

hppycamper wrote: Sun Jan 22, 2023 10:25 am Without going into the details, my conclusion was (and still is) that if I were to set the LTC insurance premiums aside and invest them, I would be able to self-cover the LTC needs if I need any.
My personal research has come up with the same conclusion for my situation.
I've never seen an attractive LTC insurance deal.
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Re: Age and probability of needing long term care?

Post by smitcat »

J295 wrote: Sun Jan 22, 2023 9:15 am
humblecoder wrote: Sun Jan 22, 2023 9:02 am Tough love time. Honestly, I think people are looking at this the wrong way.

There is one only data point that matters.... YOU!


The purpose of any type of insurance is to protect you from risks that may have low probability, but high financial cost if that risk comes to pass. LTC insurance in no different.

What does it matter if 95% of the population doesn't need LTC if you happen to be in the 5% group that does need it (I just made those numbers up but you get the point)?

Nobody says "well, since 95% of people aged 30 live to age 60 so I don't need life insurance to protect my family". If you have a family who are dependent upon your future salary, then of course you need it, since you might be one of the unlucky 5%. So why shouldn't one have the same thinking when it comes to LTC insurance?

Personally, I am not letting the age and probability of needing long term care drive my decision as to whether to buy LTC insurance. I am not one of the lucky few who can set aside money to cover this risk, so I am going to buy it (I already have, in fact).

But if others feel comfortable rolling the dice and hoping, then all the best to you.

PS: The reason for the tough love is that my father is currently in the memory care center for his dementia. It costs around $12K/month. This is on top of a home health aid that lived with him and my mom until they were unable to care for him in the home. If it weren't for my father's LTC policy, I am not sure what we would have done. I'm sure we would have figured out a way financially to make it all work, but with this policy, that is one less thing my mom has to worry about.

I certainly pray that the OP doesn't face similar issues. Maybe the odds are in their favor. Maybe they are hoping that they are in the lucky group that doesn't need care. But make no mistake, hope is NOT a strategy
Tough situation. Good luck to all.

What are the daily and lifetime maximums on his policy, and the annual premium?

My mom has an older policy with daily max around $215 and lifetime around $350k for about $3200 annual premium as one data point. 90 day elimination period and no HHC.
After dealing with care for our parents we bought LTC insurance so our daughter would not have to go thru similar situations. While we hope we don't need it the fact that we have it allows all of our other funds to be invested exactly how we want to.
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Re: Age and probability of needing long term care?

Post by Michael Patrick »

hudson wrote: Sun Jan 22, 2023 10:40 am
hppycamper wrote: Sun Jan 22, 2023 10:25 am Without going into the details, my conclusion was (and still is) that if I were to set the LTC insurance premiums aside and invest them, I would be able to self-cover the LTC needs if I need any.
My personal research has come up with the same conclusion for my situation.
I've never seen an attractive LTC insurance deal.
I came to essentially the same conclusion. Also, I'll still be collecting my pension and social security, so it's not like the entire amount would be coming out of savings. Some portion of the cost would be able to be covered by ongoing income.
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Re: Age and probability of needing long term care?

Post by prd1982 »

hppycamper wrote: Sun Jan 22, 2023 10:25 am
frugalecon wrote: Fri Jan 20, 2023 11:28 am
prd1982 wrote: Fri Jan 20, 2023 11:14 am ... However, I have read that the LTC insurance folks say that would not significantly reduce premiums.
@prd1982, if you have links to anything about your last point, I would be interested. My intuition would have been that a policy with say a 3-year exclusion period would be much cheaper, unless it committed the insurer to pay a lot more in benefits conditional on getting past the exclusion period.
Without going into the details, my conclusion was (and still is) that if I were to set the LTC insurance premiums aside and invest them, I would be able to self-cover the LTC needs if I need any.
I did some searching on Bogleheads, and found 2 threads with comments by WoW2012, who is a LTC insurance person.

Thread viewtopic.php?t=364049 talks about LTC policies with long elimination periods being available in 42 states. However, there is no mention of the states or examples. So, it appears I'm wrong. I would love to hear of someone with a multi-year elimination period.

In thread viewtopic.php?t=245157 Wow2012 mentions that policies with long elimination periods are only about 10% cheaper.

I also wanted to comment on investing the LTC insurance premiums. My wife & I have LTC policies with no max years, and a 5% yearly inflation rate. So the policies are relatively expensive, I think. We got the policies in 2004. I looked how big a pot we would have if we had invested the premiums in VTSAX (US stocks) or VBIAX (Balanced). Through 2022, our pot would only cover 3 years for 1 person. Now, the premiums have really started to increase since 2018, and I expect the rates to continue to rise. I would suggest you look get a price for a policy, assume you invested the premium starting in 2004, and see how big the pot would be in 2023. Like all insurance products, it is assumed that most people will lose money, but a small number of people would "win". My wife and I are hoping to lose big.
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Re: Age and probability of needing long term care?

Post by hppycamper »

prd1982 wrote: Sun Jan 22, 2023 11:28 am
hppycamper wrote: Sun Jan 22, 2023 10:25 am
frugalecon wrote: Fri Jan 20, 2023 11:28 am
prd1982 wrote: Fri Jan 20, 2023 11:14 am ... However, I have read that the LTC insurance folks say that would not significantly reduce premiums.
@prd1982, if you have links to anything about your last point, I would be interested. My intuition would have been that a policy with say a 3-year exclusion period would be much cheaper, unless it committed the insurer to pay a lot more in benefits conditional on getting past the exclusion period.
Without going into the details, my conclusion was (and still is) that if I were to set the LTC insurance premiums aside and invest them, I would be able to self-cover the LTC needs if I need any.
I did some searching on Bogleheads, and found 2 threads with comments by WoW2012, who is a LTC insurance person.

Thread viewtopic.php?t=364049 talks about LTC policies with long elimination periods being available in 42 states. However, there is no mention of the states or examples. So, it appears I'm wrong. I would love to hear of someone with a multi-year elimination period.

In thread viewtopic.php?t=245157 Wow2012 mentions that policies with long elimination periods are only about 10% cheaper.

I also wanted to comment on investing the LTC insurance premiums. My wife & I have LTC policies with no max years, and a 5% yearly inflation rate. So the policies are relatively expensive, I think. We got the policies in 2004. I looked how big a pot we would have if we had invested the premiums in VTSAX (US stocks) or VBIAX (Balanced). Through 2022, our pot would only cover 3 years for 1 person. Now, the premiums have really started to increase since 2018, and I expect the rates to continue to rise. I would suggest you look get a price for a policy, assume you invested the premium starting in 2004, and see how big the pot would be in 2023. Like all insurance products, it is assumed that most people will lose money, but a small number of people would "win". My wife and I are hoping to lose big.
Thanks for the info. You're lucky to have a policy with no max years. I wasn't able to find one when I researched it. I was also asking for elimination periods longer than 1 year, such as 3 years and 5 years, because I wanted to do price comparisons.
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Re: Age and probability of needing long term care?

Post by frugalecon »

Michael Patrick wrote: Sun Jan 22, 2023 11:27 am
hudson wrote: Sun Jan 22, 2023 10:40 am
hppycamper wrote: Sun Jan 22, 2023 10:25 am Without going into the details, my conclusion was (and still is) that if I were to set the LTC insurance premiums aside and invest them, I would be able to self-cover the LTC needs if I need any.
My personal research has come up with the same conclusion for my situation.
I've never seen an attractive LTC insurance deal.
I came to essentially the same conclusion. Also, I'll still be collecting my pension and social security, so it's not like the entire amount would be coming out of savings. Some portion of the cost would be able to be covered by ongoing income.
Perhaps one option would be to invest the equivalent of the LTCI premium for some years, and then eventually (as the date of when it might be necessary to have LTC gets sufficiently close) use the pot of money to purchase a SPIA. That way you would benefit from the mortality credit.
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Re: Age and probability of needing long term care?

Post by CletusCaddy »

snackdog wrote: Fri Jan 20, 2023 11:55 am Probabilities such as this apply to populations, not individuals. You will either need it or you will not.

1 in 1 billion may require it but if that one is you, then you need to be prepared to pay for it or suffer the consequences.
And if the odds are truly 1 in a billion then is it rational for you to insure?
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Re: Age and probability of needing long term care?

Post by smitcat »

CletusCaddy wrote: Sun Jan 22, 2023 8:50 pm
snackdog wrote: Fri Jan 20, 2023 11:55 am Probabilities such as this apply to populations, not individuals. You will either need it or you will not.

1 in 1 billion may require it but if that one is you, then you need to be prepared to pay for it or suffer the consequences.
And if the odds are truly 1 in a billion then is it rational for you to insure?
And if the odds are truly 1 in a billion then the LTC insurance companies must be making 90+% margins.
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Re: Age and probability of needing long term care?

Post by smitcat »

frugalecon wrote: Sun Jan 22, 2023 8:35 pm
Michael Patrick wrote: Sun Jan 22, 2023 11:27 am
hudson wrote: Sun Jan 22, 2023 10:40 am
hppycamper wrote: Sun Jan 22, 2023 10:25 am Without going into the details, my conclusion was (and still is) that if I were to set the LTC insurance premiums aside and invest them, I would be able to self-cover the LTC needs if I need any.
My personal research has come up with the same conclusion for my situation.
I've never seen an attractive LTC insurance deal.
I came to essentially the same conclusion. Also, I'll still be collecting my pension and social security, so it's not like the entire amount would be coming out of savings. Some portion of the cost would be able to be covered by ongoing income.
Perhaps one option would be to invest the equivalent of the LTCI premium for some years, and then eventually (as the date of when it might be necessary to have LTC gets sufficiently close) use the pot of money to purchase a SPIA. That way you would benefit from the mortality credit.
What is the 'cost' of keeping those potential LTC funds available over these timeframes?
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Re: Age and probability of needing long term care?

Post by dcabler »

carolinaman wrote: Fri Jan 20, 2023 9:42 am I think another question is how much LTC would someone need? I believe I have read in the past that most people do not require a lot of LTC. If that is true, it could mean that the cost of LTC insurance is more than the use of limited LTC. Also, people can sometimes use home health services to avoid LTC. Of course, there are some who spend years in LTC.

This is a good Morningstar article that may help:
https://www.morningstar.com/articles/10 ... ic-edition
This might be another case of looking at averages and realizing that while everybody when taken together is average, few individuals are. Case in point is that my MIL was something of an outlier in that she lived nearly a decade after the Alzheimer's diagnoses. 2 years at home, then 7 years in a memory care unit, then a year in standard nursing home before passing. And my FIL had cancelled their LTCi 2 years before the diagnoses.

Her twin sister, brother, and Aunt also all succumbed to this horrible disease. So, yeah, we purchased LTCi for my wife and I. 2 rate increases since we purchased, but the last increase, which was substantial, also included a "no more increases" rider.

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Re: Age and probability of needing long term care?

Post by Sandtrap »

Fremdon Ferndock wrote: Fri Jan 20, 2023 9:05 am In terms of planning for possible future expenses, I'm wondering about the contingency between current age and the likelihood of needing long term care.
1
For example, if I am 80 what is the likelihood I'll need LTC at some point and does this increase the older I get?
2
It seems logical that this would be the case.
3
I've seen articles that present the percentage of seniors that need LTC, but I don't believe I've seen data on age-based contingent LTC. Is anyone aware of such information?
4
Does it make sense that older seniors should be basing their financial planning taking this into consideration?
To OP:
Notes and questions for you:
1
While exceptions do not make for the greater bell curve, and anyone can always and do always quote an exception with confidence, there's no way of knowing when one will need LTC. For example, perhaps a minor surgery at age 50 results in a debilitating stroke that then requires LTC. See?
2
Define logical in the perspective of LTC needs per age?
3
Can you please provide some links to online articles that you've read/seen?
4
IMHO: anyone of any age and stage of life, whether single or with a family, etc, should always consider the possibility of needing to be cared for by others and the expenses and lifestyle strategies, etc, that might involve. To not do so would range from; denial (aka: Da Nile), to ambivalence, to etc.
Much like a classic "boglehead financial portfolio" is prepared for extreme downturns at any time. . see?
5
**Actionably:
As life does not fit on a spreadsheet or flight plan, the inevitable "financial and life "black swans" and "perfect storms" should be prepared for regardless of age and stage of life, etc.

To OP:
I hope this is helpful for you.
j
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Fremdon Ferndock
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Re: Age and probability of needing long term care?

Post by Fremdon Ferndock »

Sandtrap wrote: Tue Jan 24, 2023 7:35 am
Fremdon Ferndock wrote: Fri Jan 20, 2023 9:05 am In terms of planning for possible future expenses, I'm wondering about the contingency between current age and the likelihood of needing long term care.
1
For example, if I am 80 what is the likelihood I'll need LTC at some point and does this increase the older I get?
2
It seems logical that this would be the case.
3
I've seen articles that present the percentage of seniors that need LTC, but I don't believe I've seen data on age-based contingent LTC. Is anyone aware of such information?
4
Does it make sense that older seniors should be basing their financial planning taking this into consideration?
To OP:
Notes and questions for you:
1
While exceptions do not make for the greater bell curve, and anyone can always and do always quote an exception with confidence, there's no way of knowing when one will need LTC. For example, perhaps a minor surgery at age 50 results in a debilitating stroke that then requires LTC. See?
2
Define logical in the perspective of LTC needs per age?
3
Can you please provide some links to online articles that you've read/seen?
4
IMHO: anyone of any age and stage of life, whether single or with a family, etc, should always consider the possibility of needing to be cared for by others and the expenses and lifestyle strategies, etc, that might involve. To not do so would range from; denial (aka: Da Nile), to ambivalence, to etc.
Much like a classic "boglehead financial portfolio" is prepared for extreme downturns at any time. . see?
5
**Actionably:
As life does not fit on a spreadsheet or flight plan, the inevitable "financial and life "black swans" and "perfect storms" should be prepared for regardless of age and stage of life, etc.

To OP:
I hope this is helpful for you.
j
I started with the fact that actuarially the older I get, the older I will get. To illustrate: an 80 year old might have a median longevity of 10 years to age 90, but if that person lives to 85 their expected longevity becomes, say, 93 years. There is an increasing curvilinear function of longevity with current age. Consequently, we are advised to adjust our retirement spending plan accordingly. The plan we have at age 80 should be reviewed and modified at age 85 in light of the change in one's expected longevity.

However, what's missing here is one of the largest expenses that might be incurred. If it becomes more likely that I'll need LTC the older I get, then I should account for that as I review and adjust my retirement spending plan. For example, I might want to shift more assets to the fixed-income side than I might otherwise do at age 85, 90, etc., or I might decide that I need to spend even less on living expenses the older I get. But if it actually becomes more and more unlikely I'll need LTC the older I get, then the plan I had at 80 might not need to be adjusted as I get older.

Longevity data (life-expectancy) means relatively little for planning or spending purposes without corresponding health care data, since that is probably the major expense that could be incurred. I personally feel that information would be informative, but I haven't seen it.
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Re: Age and probability of needing long term care?

Post by ncbill »

I watched mom slowly die over a ~15 year period due to a rarer form of dementia normally diagnosed mid-40s to mid-50s.

Bedridden, completely unresponsive for the better part of a decade before she died.

So my spouse & I plan on buying LTC so the other spouse doesn't end up ruining their remaining health on caregiving.

Also I plan to modify my health care POA to be extremely restrictive...only palliative care if diagnosed with any terminal illness, including dementia.

Mom only lived so long bedridden because every infection was aggressively treated with antibiotics.

But after watching what mom had to go through I'm content once I meet the above criteria to let my first infection be my last.

That won't eliminate LTC needs but should shorten their duration.
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Re: Age and probability of needing long term care?

Post by TN_Boy »

Fremdon Ferndock wrote: Tue Jan 24, 2023 8:32 am
Stuff deleted

I started with the fact that actuarially the older I get, the older I will get. To illustrate: an 80 year old might have a median longevity of 10 years to age 90, but if that person lives to 85 their expected longevity becomes, say, 93 years. There is an increasing curvilinear function of longevity with current age. Consequently, we are advised to adjust our retirement spending plan accordingly. The plan we have at age 80 should be reviewed and modified at age 85 in light of the change in one's expected longevity.

However, what's missing here is one of the largest expenses that might be incurred. If it becomes more likely that I'll need LTC the older I get, then I should account for that as I review and adjust my retirement spending plan. For example, I might want to shift more assets to the fixed-income side than I might otherwise do at age 85, 90, etc., or I might decide that I need to spend even less on living expenses the older I get. But if it actually becomes more and more unlikely I'll need LTC the older I get, then the plan I had at 80 might not need to be adjusted as I get older.

Longevity data (life-expectancy) means relatively little for planning or spending purposes without corresponding health care data, since that is probably the major expense that could be incurred. I personally feel that information would be informative, but I haven't seen it.
It's interesting how different people view this question.

I find LTC planning to be quite vexing, though I understand why .. in general you really have no idea what the needs of you and your spouse will be.

For example, you believe detailed stats on LTC as you age would be helpful, whereas I don't think data other than the big picture is useful for planning. Because as Sandtrap and others have noted, it doesn't much matter what the stats are. At age 80 for example, in your later life you will need between 0 and a lot of LTC.

It's possible you will know from your own health status at a given point in time that you are destined for a lot of care (concrete diagnosis of a degenerative condition for example), but the converse, alas, is not true. Regardless of your health status you are one unfortunate event (stroke, a fall, etc) from needing a lot of LTC, even if the day before you finished a brisk 10 mile run.

Thus I believe financial planning requires assuming a large potential expense beginning pretty much any time for LTC as you age. This is my strong belief based on dealing with relatives needing LTC care and reading a fair bit about it. The stats will definitely show that the likelihood of need increases through at least age 80 I believe. So if you think you might need a somewhat conservative asset allocation to handle LTC you would need to be pondering that as you leave your 60s. But you would also be doing things like thinking "the equity in my paid off house would handle four years of skilled nursing." And maybe buying LTC insurance at age 60.

Should ones pile of money continue to grow as one gets older and health remains excellent, that might convince me to do things like start giving away money to heirs early*, on the grounds that I am in almost no danger of burning through it. But that decision should, in my view, be based upon how much money one has, not any guesses of how much care one is likely to need.

I'd still be interested in you giving a more concrete example of how you would use the requested data, though it sounds like shifting to a less aggressive asset allocation is one step.

Incidentally, I"m not sure that I will be adjusting spending much based on estimated life expectancy. Usually people do tend to spend less on non-health issues as they hit later years, as their energy level decreases, but I'm not going to say "I'm 86 and have only 2.5 years left" and go on a spending spree. Or decide at the same age I have ten more good years and cut way back. I'll spend based on how the portfolio is doing, being aware of potential needs like several years in LTC. Just like I would at age 60 or 65.

* assuming of course that I had/have a plan for managing multiple years in LTC
Topic Author
Fremdon Ferndock
Posts: 1023
Joined: Fri Dec 24, 2021 11:26 am

Re: Age and probability of needing long term care?

Post by Fremdon Ferndock »

ncbill wrote: Tue Jan 24, 2023 9:15 am I watched mom slowly die over a ~15 year period due to a rarer form of dementia normally diagnosed mid-40s to mid-50s.

Bedridden, completely unresponsive for the better part of a decade before she died.

So my spouse & I plan on buying LTC so the other spouse doesn't end up ruining their remaining health on caregiving.

Also I plan to modify my health care POA to be extremely restrictive...only palliative care if diagnosed with any terminal illness, including dementia.

Mom only lived so long bedridden because every infection was aggressively treated with antibiotics.

But after watching what mom had to go through I'm content once I meet the above criteria to let my first infection be my last.

That won't eliminate LTC needs but should shorten their duration.
What you describe is awful. My mother's last couple of years in LTC were somewhat like what you describe and it was so distressing to see her that way, so I can only imagine. We placed her on hospice for most of that period, and understood that she would only receive palliative care; no antibiotics for infections, etc. But we did decide to have the Covid vaccine for her because we couldn't bear having her go through that in the nursing home where it was raging. But we were required to watch her slowly die, suffering, losing weight until she was a skeleton.

I've thought about your plan to modify the POA; you can include a "dementia directive" as part of that.

https://dementia-directive.org/

However, there can be a real problem if you're in a long term care facility. Staff are not bound by your directives and probably won't follow them because they conflict with their practices and/or state laws. You might like them to withhold treatment, but they won't comply. And you might not be eligible for hospice if you have dementia, which requires a 6-month terminal diagnosis. Your family would have to remove you from the facility to follow your wishes, and they have to be wary of being reported to state authorities for abuse. It's tricky business -- I have some knowledge of this and recommend studying the issue thoroughly. State laws and customary LTC practices need to be modified in this country.
"Risk is what’s left over when you think you’ve thought of everything." ~ Morgan Housel
ScubaHogg
Posts: 1978
Joined: Sun Nov 06, 2011 2:02 pm

Re: Age and probability of needing long term care?

Post by ScubaHogg »

Fremdon Ferndock wrote: Tue Jan 24, 2023 8:32 am But if it actually becomes more and more unlikely I'll need LTC the older I get, then the plan I had at 80 might not need to be adjusted as I get older.
It’s pretty self-evident that the older you get, the more likely you’ll need some LTC.

What’s not obvious is if the older you get, the total cost of the LTC you might (probably) need will be higher or lower than it could have been at a younger age.

That’s worded awkwardly. Basically, if you’ve made it to 99 without any LTC your worst case LTC case is better than when you were walking around at 75. At age 99 if you go into a memory care facility you longest reasonable life expectancy isn’t very long. But same thing at 75? Could be years and years

So, as age increases probability of some LTC undoubtedly goes up. But does the worst case (defined by total spend) LTC go up or down? Unclear.
“… the fact remains that buying a nominal bond ladder to defease future living expenses can prove disastrous.” - Bill Bernstein | | “…something unusual happens—usually.” - Nassim Taleb
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