Age and probability of needing long term care?

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Fremdon Ferndock
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Re: Age and probability of needing long term care?

Post by Fremdon Ferndock »

ScubaHogg wrote: Tue Jan 24, 2023 10:55 am
Fremdon Ferndock wrote: Tue Jan 24, 2023 9:32 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.
My very point is that what seems to be self-evident may not be the case. In the absence of data, we don't know for sure. As I age, it seems to be self-evident that I'll be dead; in which case I won't need LTC at all. I'm surmising there's a hump in the distribution of LTC probability that occurs in the 80s and that if you're still alive you're in a cohort that might not be as likely to need LTC or won't need it for very long. Those who require LTC in their 80s might need it for a longer time and incur much greater expense. I'd like to have some data on (a) how long I might live from my current age, and (b) how much I might have to spend on healthcare during that period. I can find (a) but don't know much about (b) because the statistics on LTC never seem to report this. We only get generalities such as "those who turn 65 have a 60% chance of needing LTC at some point, and spend an average of 1.5 years in LTC if they need it." How about "those who turn 85" or "those who turn 90"? I turned 65 a while back...
"Risk is what’s left over when you think you’ve thought of everything." ~ Morgan Housel
smitcat
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Re: Age and probability of needing long term care?

Post by smitcat »

Fremdon Ferndock wrote: Tue Jan 24, 2023 9:32 am
Sandtrap wrote: Tue Jan 24, 2023 8:35 am
Fremdon Ferndock wrote: Fri Jan 20, 2023 10:05 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.
No one can know when they might require LTC - it's not possible. It may occur earlier along a timeframe or later and there is no way to predict it.
If it is a goal to have a plan for this type of care, you can reasonably assess how long of an occurrence you would like to have covered and adjust it yearly with that goal in mind.
CloseEnough
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Re: Age and probability of needing long term care?

Post by CloseEnough »

Age 60 - probability is 0-100%
Age 65 - probability is 0-100%
Age 70 - probability is 0-100%
Age 75 - probability is 0-100%
Age 80 - probability is 0- 100%
Age 90 - probability is 0-100%
Age 95 -probability is 0-100%

The predictability on length of time needing long term care corresponds with the percentages above.

So, for financial planning, you can make some assumptions based on your own specific circumstances, knowing the likely percentages will be within the range above. If there was an answer to the question in the OP, it would maybe be useful for financial planning. It is somewhat like estimating mortality for purposes of financial planning, you just don't know.
journey
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Re: Age and probability of needing long term care?

Post by journey »

Fremdon Ferndock wrote: Tue Jan 24, 2023 10:45 am
ncbill wrote: Tue Jan 24, 2023 10:15 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.
Fremdon Ferndock: Thank you so much for this link. Even with the challenges you include (I've encountered some of them already with my parents' general care), this dementia directive is important and valuable. Very appreciated.
CloseEnough
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Re: Age and probability of needing long term care?

Post by CloseEnough »

journey wrote: Tue Jan 24, 2023 1:33 pm
Fremdon Ferndock wrote: Tue Jan 24, 2023 10:45 am
ncbill wrote: Tue Jan 24, 2023 10:15 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.
Fremdon Ferndock: Thank you so much for this link. Even with the challenges you include (I've encountered some of them already with my parents' general care), this dementia directive is important and valuable. Very appreciated.
It is beyond the scope of this forum, but my experience with an elderly person with dementia is not that the care directives won't be followed, but that even if they are the patient can live for a long time, a very long time, with low to no quality of life. So even if the instructions are clear, palliative care only, no treatment of infections etc., the patient does not have a terminal illness. Good luck and best wishes to all who are, or have, lived through this with a family member.
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Re: Age and probability of needing long term care?

Post by White Coat Investor »

Fremdon Ferndock wrote: Fri Jan 20, 2023 10:05 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?
Those who have the data you want to make this decision won't give it to you.
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Re: Age and probability of needing long term care?

Post by White Coat Investor »

CloseEnough wrote: Tue Jan 24, 2023 1:53 pmIt is beyond the scope of this forum, but my experience with an elderly person with dementia is not that the care directives won't be followed, but that even if they are the patient can live for a long time, a very long time, with low to no quality of life. So even if the instructions are clear, palliative care only, no treatment of infections etc., the patient does not have a terminal illness. Good luck and best wishes to all who are, or have, lived through this with a family member.
There might be 11 states that offer a potential solution to this issue. I'm not sure a demented patient really has capacity to make a Medically assisted suicide/euthanasia/medical aid in dying decision. I don't know if someone else can legally take you out if your valid living will specifies they should, but I doubt it. They can "withhold care" though, which I suppose can include food and water. Doesn't seem like a very nice way to go out though.
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ScubaHogg
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Re: Age and probability of needing long term care?

Post by ScubaHogg »

Fremdon Ferndock wrote: Tue Jan 24, 2023 12:49 pm
ScubaHogg wrote: Tue Jan 24, 2023 10:55 am
Fremdon Ferndock wrote: Tue Jan 24, 2023 9:32 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.
My very point is that what seems to be self-evident may not be the case. In the absence of data, we don't know for sure. As I age, it seems to be self-evident that I'll be dead; in which case I won't need LTC at all. I'm surmising there's a hump in the distribution of LTC probability that occurs in the 80s and that if you're still alive you're in a cohort that might not be as likely to need LTC or won't need it for very long. Those who require LTC in their 80s might need it for a longer time and incur much greater expense. I'd like to have some data on (a) how long I might live from my current age, and (b) how much I might have to spend on healthcare during that period. I can find (a) but don't know much about (b) because the statistics on LTC never seem to report this. We only get generalities such as "those who turn 65 have a 60% chance of needing LTC at some point, and spend an average of 1.5 years in LTC if they need it." How about "those who turn 85" or "those who turn 90"? I turned 65 a while back...
We are kinda agreeing. The interesting part isn’t whether or not you’ll need some LTC (which again, has such a wide range of meanings as to be almost useless), but what the baseline “bad” case scenario in terms of financial impact is. As you get very old you almost certainly will need some help (again, if you are 100 you almost certainly get some help), but if you start consuming the expensive type of care (memory care) starting at a very advanced age you likely won’t last very long

If there is an answer to your question I suspect it’s buried in Medicaid data, since many people who consume the expensive care for a long time end up on Medicaid
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ncbill
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Re: Age and probability of needing long term care?

Post by ncbill »

Fremdon Ferndock wrote: Tue Jan 24, 2023 10:45 am
ncbill wrote: Tue Jan 24, 2023 10:15 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.
That's why I specifically said health care POA instead of a living will, e.g. the dementia directive linked is a variation of such.

Here in the USA using your state's model form for health care POA allows you to appoint a health care agent who has the legal authority to make all medical decisions on your behalf.

Sure, others including the facility staff may try to pressure them, as I also experienced, but the agent holds ultimate legal authority, so appoint someone you trust to hold firm as to your wishes.

Mistakes do occur...mom was sent to the hospital during her final illness instead of Hospice being called, but that hospital had her instructions (well, my instructions) on file from earlier admissions and so simply kept mom comfortable until she died just a few hours later.
Last edited by ncbill on Tue Jan 24, 2023 3:14 pm, edited 1 time in total.
money2churn
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Re: Age and probability of needing long term care?

Post by money2churn »

Impossible question to answer generally IMO, way too many variables. Approached from a personal viewpoint it does become easier to do an educated guess( only that ).

I do my best at following the Jack LaLanne lifestyle to give me the best possible odds of avoiding the dreaded LTC. 8-)
journey
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Re: Age and probability of needing long term care?

Post by journey »

CloseEnough wrote: Tue Jan 24, 2023 1:53 pm
journey wrote: Tue Jan 24, 2023 1:33 pm
Fremdon Ferndock wrote: Tue Jan 24, 2023 10:45 am
ncbill wrote: Tue Jan 24, 2023 10:15 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.
Fremdon Ferndock: Thank you so much for this link. Even with the challenges you include (I've encountered some of them already with my parents' general care), this dementia directive is important and valuable. Very appreciated.
It is beyond the scope of this forum, but my experience with an elderly person with dementia is not that the care directives won't be followed, but that even if they are the patient can live for a long time, a very long time, with low to no quality of life. So even if the instructions are clear, palliative care only, no treatment of infections etc., the patient does not have a terminal illness. Good luck and best wishes to all who are, or have, lived through this with a family member.
Close Enough, I agree with your comments but it is worth noting the information on the first page of the document. It includes,

"Why it is important to express your wishes. People with advancing dementia lose the ability to make decisions for themselves. Their families need to make medical decisions for them. Giving family members guidance about what type of care you would want can help ease the burden of their decision making and help you feel more secure that you will receive the care that you would want."

Expressing our wishes, in writing, to our families and/or Health Care POAs has value in my experience. And as you said, best wishes to all ...
Mr.BB
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Re: Age and probability of needing long term care?

Post by Mr.BB »

Michael Patrick wrote: Sun Jan 22, 2023 12:27 pm
hudson wrote: Sun Jan 22, 2023 11:40 am
hppycamper wrote: Sun Jan 22, 2023 11:25 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.
We decided against LTC insurance. However I decided to start my own LTC fund(taxable acct) I figured if we hopefully don't need it for 20 years or so we should be able to save about 1-1.5 yrs of worth of LTC to offset some of the costs. Sort of splitting the difference of what insurance would of cost us and covered for us. Yeah, I know money if fungible, just a way of adding some financial structure for me.
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Allan
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Re: Age and probability of needing long term care?

Post by Allan »

hppycamper wrote: Sun Jan 22, 2023 11:25 am

I have read that LTC policies sold many years ago were good deals. But I doubt anyone can find policies like that now.
Yes, I bought a policy with John Hancock in 2001 with annual premiums of $3,000 for 10 years, then it was paid up in full. Today it would pay me $152,000 annually for LTC, and benefits increase 5% a year. In retrospect one of my better financial moves.
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Re: Age and probability of needing long term care?

Post by SmileyFace »

Didn't seem worth it when I looked at prices recently.
It seems like if you can afford to pay the crazy premiums you probably don't need it.
I could be wrong - would love to hear from anyone that has found a compelling deal recently.
WillRetire
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Re: Age and probability of needing long term care?

Post by WillRetire »

OP: Consider your parents, grandparents, elderly aunts & uncles & great-aunts & great-uncles, and how they were in their final year(s). Some may have lived with & were cared for by their adult children, which might be equivalent to assisted living or memory care as opposed to skilled nursing. LTC policies often cover assisted living & memory care as well as skilled nursing, so all 3 levels of care are forms of long-term care.

Looking at your family history & your elders' experiences may help inform you as to your odds of needing care. Even non-blood relatives gives you a rough idea.
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Fremdon Ferndock
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Re: Age and probability of needing long term care?

Post by Fremdon Ferndock »

Even though we had healthcare POA and the nursing home appointed us as custodians for all my mother's medical decisions (due to her late-stage dementia) we were still limited in what we could decide, due to the gnarly state regulations that the facility must comply with. We could not have her insulin medication stopped, we could not have feeding stopped. At one point, all her food had to be blended like baby food due to choking hazard and we could not block that decision. This was the case even though she was on hospice. Anything that remotely resembles abuse, neglect, or assistance in dying is taboo. We had no choice but to watch her suffer and die inch by inch over the period of nearly two years.

Your "medical POA" can end up being worthless, as will your "dementia directive" if you are in institutional care in most states. Your best hope is to kick off with minimal delay, but if you have a lingering debility it can be another story. Dementia is a major risk.
"Risk is what’s left over when you think you’ve thought of everything." ~ Morgan Housel
mariezzz
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Re: Age and probability of needing long term care?

Post by mariezzz »

With long-term care insurance, it seems like you are blowing out a candle and making a wish that the company/policy will actually cover you when you need the care, and that you'll actually get the amount of care you were promised. (And, with some products, premiums may skyrocket, forcing you to reconsider whether you can afford the premium, or whether it's worth it.)

Since you're less likely to be approved for a policy as you get older (and it will be more expensive), the advice is to buy such policies when you're younger ... which increases the amount of time before you're likely to need the policy, which increases the risk the company/policy will actually cover you when you need the care, and that you'll actually get the amount of care you were promised.

There have been lots of other threads about LTC insurance here, and there were many very good arguments made for self-insuring.
Last edited by mariezzz on Thu Jan 26, 2023 11:16 am, edited 1 time in total.
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Re: Age and probability of needing long term care?

Post by mariezzz »

The fact "that policies with long elimination periods are only about 10% cheaper" tells you something very important - that most people don't use expensive, labor intensive long-term care, or if they do, it's not for more than a year or two.
prd1982 wrote: Sun Jan 22, 2023 12:28 pm
hppycamper wrote: Sun Jan 22, 2023 11:25 am
frugalecon wrote: Fri Jan 20, 2023 12:28 pm
prd1982 wrote: Fri Jan 20, 2023 12:14 pm ... 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.
CloseEnough
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Re: Age and probability of needing long term care?

Post by CloseEnough »

Fremdon Ferndock wrote: Wed Jan 25, 2023 10:44 am Even though we had healthcare POA and the nursing home appointed us as custodians for all my mother's medical decisions (due to her late-stage dementia) we were still limited in what we could decide, due to the gnarly state regulations that the facility must comply with. We could not have her insulin medication stopped, we could not have feeding stopped. At one point, all her food had to be blended like baby food due to choking hazard and we could not block that decision. This was the case even though she was on hospice. Anything that remotely resembles abuse, neglect, or assistance in dying is taboo. We had no choice but to watch her suffer and die inch by inch over the period of nearly two years.

Your "medical POA" can end up being worthless, as will your "dementia directive" if you are in institutional care in most states. Your best hope is to kick off with minimal delay, but if you have a lingering debility it can be another story. Dementia is a major risk.
Sorry for the circumstances you describe. I agree with your observations, it mirrors my experience. I am hopeful that if or when I or family members of my generation reach that stage, the options will improve. Perhaps unlikely with the state of medical care.
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Lee_WSP
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Re: Age and probability of needing long term care?

Post by Lee_WSP »

To get to the answers you actually want, you need to know which questions to ask. The goal of this exercise is to presumably figure out how to plan for your final moments and how to pay for it all.

First, you need to ask what exactly the different care options are and the likelihood of needing each. Here’s a short list.

Memory care - it varies. It can be 24/7 nursing care or it can be an assisted living with a nurse on call with a focus on memory issues.

Assisted Living - A nurse will be on staff, an assistant will be on call, but you will not be checked up on. You’re basically just living life in a facility with help available at the push of a button.

Nursing Care - A nurse is there 24/7. You will be checked up on regularly. You will have an assistant 24/7. You will most likely be bedridden or close to it. It’s more or less one step away from being in the hospital.

Hospice - Basically nursing care with palliative treatment only.

As you can imagine, the cost is going to scale with the amount of labor involved. Memory care can be seen as adding a memory care component on top of the other two options. And even within assisted living, there is a range of “hands on” available. As such, the cost is going to vary.

I suggest you go and visit the facilities you are looking at and get some cost quotes. They’re pretty open about them. Assisted living is relatively affordable as you’re basically paying for an apartment and splitting an aide with ten other people.

Nursing care is going to be very expensive. I don’t know how expensive, but this is the one you’re probably worried about.

Another question you have not asked is how long you are likely to need nursing care. The answer is actually not all that long. However, it is a fat tail risk to live several decades on nursing care. So, that’s probably the risk you’re worried about. The odds of that happening are pretty low, but I do not have links to statistics. I wish I copied them down when I researched this, but I didn’t. Maybe research average length of stay at a nursing home facility. Or just ask the facility, they’ll have the statistics.
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Re: Age and probability of needing long term care?

Post by PatrickA5 »

Both my mom and MIL died at 77 with no LTC needed. My dad lived to 97 and required 2 days in a nursing home. FIL needed 3 days. I'm hoping to go out like them. Grandmother, on the other hand, lasted many years in a nursing home after a stroke, having to have both legs amputated.

I wouldn't qualify for a LTC policy even if I wanted one, so that's not something I have to be concerned with. About the only thing DW and I can do is save our money and hope for the best. I don't know that there is any way to really plan for LTC (at least for us). It's possible at some point we might look into a CCRC.
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celia
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Re: Age and probability of needing long term care?

Post by celia »

ScubaHogg wrote: Sat Jan 21, 2023 3:32 pm 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?
Not to me.

I think an over-looked factor is how much of a support system you have. If you have lots of relatives living nearby, there are others who can help in some way. But if you are one of the last remaining ones, not only will you be older, but you may not have anyone to look in on you.

For example, when my dad was 90 (having married for the third time at 79), he had 5 kids living near him with at least one of them dropping in each day to see him.

Just the fact of living with someone or seeing them every day will get you recommendations that you need to see a doctor compared to someone who lives alone and there’s no-one to notice that they should see a doctor. Earlier intervention often results in better long term health.

The support system can also do household tasks that you might not be able to do on your own. They can drive you to the doctor, food shop while they buy their own food, or walk with you to the end of the block and back. I wonder how many people go to Assisted Living just because they can’t figure out how to get help for these non-medical issues.
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Re: Age and probability of needing long term care?

Post by iim7V7IM7 »

We are age 61 and 62 and just went through this decision process (e.g., to self insure or purchase LTCI). In our case, we have no children or anticipated future support network. The challenge that we saw with self insuring was being able to actualize it when you need it (e.g., decisions on how and best to liquidate assets, tax implications etc.) vs. the insurance which is more easily turned on by one of the two of us or if one of us has past by an institution/attorney etc.

We ended up insuring to fully cover the more likely scenario of home care or assisted living vs. fully covering a worst case skilled nursing home. The later was simply too expensive when we looked into it. The plan that we were underwritten to will fully cover the former and only partially cover the later.

Plan Outline:
Carrier: NGL (only AM Best A rated company)
Max Daily Rate: $200/day
Elimination Period: 180 days
Pools: 3 x 3 year pools (1 shared) or $657,000 in 2022 dollars
Inflation Rider: 3% annually

This plan costs about $6,350/year for us. Depending on the part of the country we end up in and future LTC inflation how much this will help will obviously vary. Today, full skilled nursing care costs $300-$450/day in today's dollars so our policies $200/day covers only about 45% to 67% of those costs after the elimination period. It does cover 100% of today's assisted living and home aid costs. Having three, 3-year pools seems like it covers a long period (up to 6 years for one of us) allows you time to think through asset liquidation should we need that. The 3% inflation rider may or may not be adequate depending on where LTC costs go. Our $200/day in 10 years is $269/day, 20 years is $361/day and in 30 years is $485/day.

My Mother is fortunate to have one of the policies that is longer available (purchased back in 1990s) or underwritable under today's standards (e.g., lifetime benefit, $700/day and 90 day elimination period). She experienced three fairly significant increases in policy premiums over three decades (I believe it was like $2,000/year for both of them at the start and my father died years ago and my Mother's policy is now $5,000/year).

What I am hoping is the insurance laws that changed in States around 2007 that placed constraints on insurers writing newer policies now requires proposed increases to 1) apply to all policies written in that State and 2) it needs to come from their profits. I think that policies being underwritten today are more expensive because of this and are also based on decades of experience with these types of policies now. So I hope that the stability of policy pricing is more stable than in has historically in the past (TBD).

Everyone's situation is different and LTCI may or may not make sense.
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Re: Age and probability of needing long term care?

Post by ScubaHogg »

celia wrote: Thu Jan 26, 2023 12:17 pm
ScubaHogg wrote: Sat Jan 21, 2023 3:32 pm 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?
Not to me.

I think an over-looked factor is how much of a support system you have. If you have lots of relatives living nearby, there are others who can help in some way. But if you are one of the last remaining ones, not only will you be older, but you may not have anyone to look in on you.

For example, when my dad was 90 (having married for the third time at 79), he had 5 kids living near him with at least one of them dropping in each day to see him.

Just the fact of living with someone or seeing them every day will get you recommendations that you need to see a doctor compared to someone who lives alone and there’s no-one to notice that they should see a doctor. Earlier intervention often results in better long term health.

The support system can also do household tasks that you might not be able to do on your own. They can drive you to the doctor, food shop while they buy their own food, or walk with you to the end of the block and back. I wonder how many people go to Assisted Living just because they can’t figure out how to get help for these non-medical issues.
I mean, this is LTC, just not the kind you pay for. So the point remains. At 90, 95, 100 you almost certainly aren't doing it all by yourself.

And to be clear, Assisted Living isn't really what I'm talking about. The big, scary numbers don't come from assisted living. They come from nursing homes/memory care
“… 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
HomeStretch
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Re: Age and probability of needing long term care?

Post by HomeStretch »

A dementia diagnosis seems to me to be the big game changer in LTC financial needs. As dementia progresses, the person’s needs may become too great for a family caretaker to continue to manage at home. In-facility memory or skilled nursing care is costly.

As genetic testing becomes more available for more dementia types, one’s planning could include being tested early (even before showing signs of dementia) to both consider starting whatever therapies are available at the time to slow progression as well as to revisit the financial resources available/needed to address future care. Detected/treated early enough, one might reduce the cost of future care, be able to increase savings rate for care costs and/or make estate changes to benefit a spouse/minor children prior to the start of any Medicaid LTC benefits look-back period.
mhalley
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Re: Age and probability of needing long term care?

Post by mhalley »

The reason that most won’t need many years (>5) of ltc is that they mostly die within a few years of being admitted to the nursing home. Lots will need som3 short term ltc, like say rehab after a hip replacement. I think the average is 2,5 years for females and 1,5 for men.
Here are a lot of ltc statistics
https://www.morningstar.com/articles/95 ... 19-edition
TN_Boy
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Re: Age and probability of needing long term care?

Post by TN_Boy »

HomeStretch wrote: Thu Jan 26, 2023 1:19 pm A dementia diagnosis seems to me to be the big game changer in LTC financial needs. As dementia progresses, the person’s needs may become too great for a family caretaker to continue to manage at home. In-facility memory or skilled nursing care is costly.

As genetic testing becomes more available for more dementia types, one’s planning could include being tested early (even before showing signs of dementia) to both consider starting whatever therapies are available at the time to slow progression as well as to revisit the financial resources available/needed to address future care. Detected/treated early enough, one might reduce the cost of future care, be able to increase savings rate for care costs and/or make estate changes to benefit a spouse/minor children prior to the start of any Medicaid LTC benefits look-back period.
Lots of people having spouses with dementia start by taking care of them, avow they will never put them in a facility .. then reality sets in and they have to. Memory care is more expensive than "regular" assisted living but in my area still a lot cheaper than skilled nursing.

Genetic testing is a not a bad idea, I suppose, but from my experience helping relatives I'm not sure how useful the information would be. If you knew at age 60 you'd have dementia at age 80 you could consider lots of savings, but actually you still would not know at age 60 how much care you would need. You might die at 75 of something else. You might quickly decline at 80, or regrettfully linger on for a decade with dementia. There are no useful therapies for the progressive dementias at this time so mostly what you learn is that your future is not bright. And, if you have an unfortunate genetic test result, I suspect that would immediately disqualify you from being able to get LTC insurance, if that was part of your plan to help with such costs.
ColoradoRick
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Re: Age and probability of needing long term care?

Post by ColoradoRick »

Fremdon Ferndock wrote: Fri Jan 20, 2023 10:05 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?
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I'm too lazy to look it up for you, but AARP has a great page on probabilities, ages and costs of LTC. However, there is no way to customize the inputs. I and two couples we are friends with struggled with this. I never paid LTC premiums and they did. They eventually came around to same conclusion I did.

If you have $1.3 to 2.0 million we felt it better to self-insure. I had read several articles that talked about all the insurance companies that rushed to sell this in the 1990's. However they ran into 2 things: 1) there were no tables like mortality tables so they just guessed and 2) life spans kept expanding.

With the success against most forms of cancer I don't see anything to change #2. Companies keep raising premiums and many say I'm not cancelling, they've got too much of my money. But after 50-100% increases over 10 years, both couples threw in the towel. I thought of our family and only my grandmother spent years in a facility. All other relatives either were in a nursing home for 6 months or never went in. Nursing homes here cost ~ $100,000 yr.

I only looked at both pages quickly and didn't see AARP referenced, but if I missed it - apologies.
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Re: Age and probability of needing long term care?

Post by ScubaHogg »

TN_Boy wrote: Fri Jan 27, 2023 11:30 am Memory care is more expensive than "regular" assisted living but in my area still a lot cheaper than skilled nursing.
Really? In our area, depending on the level, memory care is either the equivalent price or quite a bit more than skilled nursing. Which makes sense since it basically is skilled nursing with dementia thrown in for good measure.
“… 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
TN_Boy
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Re: Age and probability of needing long term care?

Post by TN_Boy »

ScubaHogg wrote: Sun Jan 29, 2023 10:24 am
TN_Boy wrote: Fri Jan 27, 2023 11:30 am Memory care is more expensive than "regular" assisted living but in my area still a lot cheaper than skilled nursing.
Really? In our area, depending on the level, memory care is either the equivalent price or quite a bit more than skilled nursing. Which makes sense since it basically is skilled nursing with dementia thrown in for good measure.
My experience is completely different from your comment.

Many dementia patients do not need skilled nursing services; their physical health is not much different than a typical assisted living patient. What they need is, frankly, a locked facility and hopefully a bit higher staff to patient ratio than regular assisted living, as the residents may need more, well, supervision.

My experience is helping relatives who were in, at various times, in assisted living, memory care and skilled nursing, across two different states. A dedicated memory care facility (or often, wing of a larger assisted living facility) was always quite a bit cheaper than a true skilled nursing facility. Because many dementia patients do not need skilled nursing care, which requires a higher staff/patient ratio, perhaps a nurse onsite 24x7, etc.

At least at the skilled nursing facility I'm most familiar with, I don't think there was any sort of "upcharge" for patients with dementia.
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Fremdon Ferndock
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Re: Age and probability of needing long term care?

Post by Fremdon Ferndock »

TN_Boy wrote: Sun Jan 29, 2023 10:39 am
ScubaHogg wrote: Sun Jan 29, 2023 10:24 am
TN_Boy wrote: Fri Jan 27, 2023 11:30 am Memory care is more expensive than "regular" assisted living but in my area still a lot cheaper than skilled nursing.
Really? In our area, depending on the level, memory care is either the equivalent price or quite a bit more than skilled nursing. Which makes sense since it basically is skilled nursing with dementia thrown in for good measure.
My experience is completely different from your comment.

Many dementia patients do not need skilled nursing services; their physical health is not much different than a typical assisted living patient. What they need is, frankly, a locked facility and hopefully a bit higher staff to patient ratio than regular assisted living, as the residents may need more, well, supervision.

My experience is helping relatives who were in, at various times, in assisted living, memory care and skilled nursing, across two different states. A dedicated memory care facility (or often, wing of a larger assisted living facility) was always quite a bit cheaper than a true skilled nursing facility. Because many dementia patients do not need skilled nursing care, which requires a higher staff/patient ratio, perhaps a nurse onsite 24x7, etc.

At least at the skilled nursing facility I'm most familiar with, I don't think there was any sort of "upcharge" for patients with dementia.
My experience with memory care vs. skilled nursing for my mother is basically the same. Memory care was a bit cheaper but not by a lot. The difference was that memory care is often a wing of an assisted living facility, but can be a dedicated memory care facility. These are usually private pay (Medicaid does not pay for memory care) and, as a result, the facilities I saw were much nicer than nursing home facilities. Rooms were single occupant; whereas skilled nursing is often shared rooms. Staff ratio usually much better. You get what you pay for. However, in memory care your fellow residents are people with dementia/alzheimer's which isn't that pleasant unless you are also in that condition.
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Lee_WSP
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Re: Age and probability of needing long term care?

Post by Lee_WSP »

ScubaHogg wrote: Sun Jan 29, 2023 10:24 am
TN_Boy wrote: Fri Jan 27, 2023 11:30 am Memory care is more expensive than "regular" assisted living but in my area still a lot cheaper than skilled nursing.
Really? In our area, depending on the level, memory care is either the equivalent price or quite a bit more than skilled nursing. Which makes sense since it basically is skilled nursing with dementia thrown in for good measure.
I think there’s some confusion. As I said earlier, memory care is more or less an added service on top of whatever basic care the person is receiving. Whether that is assisted living or skilled nursing, memory care can be added to each.

It’s just that facilities won’t be able to just “add on” that service. The facility has to offer memory care to every patient for it to make economic sense unless they’ve got dedicated wings.
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WoodSpinner
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Re: Age and probability of needing long term care?

Post by WoodSpinner »

celia wrote: Thu Jan 26, 2023 12:17 pm
ScubaHogg wrote: Sat Jan 21, 2023 3:32 pm 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?
Not to me.

I think an over-looked factor is how much of a support system you have. If you have lots of relatives living nearby, there are others who can help in some way. But if you are one of the last remaining ones, not only will you be older, but you may not have anyone to look in on you.

For example, when my dad was 90 (having married for the third time at 79), he had 5 kids living near him with at least one of them dropping in each day to see him.

Just the fact of living with someone or seeing them every day will get you recommendations that you need to see a doctor compared to someone who lives alone and there’s no-one to notice that they should see a doctor. Earlier intervention often results in better long term health.

The support system can also do household tasks that you might not be able to do on your own. They can drive you to the doctor, food shop while they buy their own food, or walk with you to the end of the block and back. I wonder how many people go to Assisted Living just because they can’t figure out how to get help for these non-medical issues.
Celia,

I think you have a very important point….

Living through this right now, my MIL is slowly dying of Pancreatic Cancer — a tough way to go. The only bright side is the network of family and friends she has built who are all working together to help as best they can. It’s a very humbling experience to be part of.

Considering my own mortality and who will step up to help me is becoming a key question to grapple with. Fortunately my financial house is in order and I have time and resources to reinforce my network.

I would like to add another point that isn’t often mentioned — planning for Aging Assistance. Essentially, it’s a budget item and plan for help around the house, shopping, laundry, maintenance, repair etc. that you can no longer tackle. It can make a big difference in your need to shift to an Assisted Living accommodation.

WoodSpinner
TN_Boy
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Re: Age and probability of needing long term care?

Post by TN_Boy »

Lee_WSP wrote: Sun Jan 29, 2023 11:23 am
ScubaHogg wrote: Sun Jan 29, 2023 10:24 am
TN_Boy wrote: Fri Jan 27, 2023 11:30 am Memory care is more expensive than "regular" assisted living but in my area still a lot cheaper than skilled nursing.
Really? In our area, depending on the level, memory care is either the equivalent price or quite a bit more than skilled nursing. Which makes sense since it basically is skilled nursing with dementia thrown in for good measure.
I think there’s some confusion. As I said earlier, memory care is more or less an added service on top of whatever basic care the person is receiving. Whether that is assisted living or skilled nursing, memory care can be added to each.

It’s just that facilities won’t be able to just “add on” that service. The facility has to offer memory care to every patient for it to make economic sense unless they’ve got dedicated wings.
May be not understanding part of your comment. Often you cannot offer memory care as just another service in assisted living. Because one unfortunate common problem with dementia is wandering, at which point you need a locked down building or wing, with memory care residents largely separate from "regular" assisted living residents. I will also note that assisted living and "independent living with help" residents are often not that happy about having dementia patients mixed in with them, even if the dementia patients are not unduly disruptive.

That said, many assisted living facilities have some residents with dementia, but if the resident is not wandering or disruptive, they can deal with that. But once wandering starts, it's a different ballgame (this is often when families have give up on home care, as the dementia patient may be wandering at any time of day or night and the spouse/family can literally get no sleep).
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Re: Age and probability of needing long term care?

Post by GreenLawn »

celia wrote: Thu Jan 26, 2023 12:17 pm
ScubaHogg wrote: Sat Jan 21, 2023 3:32 pm 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?
Not to me.

I think an over-looked factor is how much of a support system you have. If you have lots of relatives living nearby, there are others who can help in some way. But if you are one of the last remaining ones, not only will you be older, but you may not have anyone to look in on you.

For example, when my dad was 90 (having married for the third time at 79), he had 5 kids living near him with at least one of them dropping in each day to see him.

Just the fact of living with someone or seeing them every day will get you recommendations that you need to see a doctor compared to someone who lives alone and there’s no-one to notice that they should see a doctor. Earlier intervention often results in better long term health.

The support system can also do household tasks that you might not be able to do on your own. They can drive you to the doctor, food shop while they buy their own food, or walk with you to the end of the block and back. I wonder how many people go to Assisted Living just because they can’t figure out how to get help for these non-medical issues.
That's awesome to have that support network!

I thought my not having children was the way to go, now I see the flip side of that decision. I suppose I could try to fit in a few more marriages with stepchildren, though time is running short for that. Guess I'm stuck with saving money and hoping for the best.
TN_Boy
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Re: Age and probability of needing long term care?

Post by TN_Boy »

GreenLawn wrote: Sun Jan 29, 2023 11:43 am
celia wrote: Thu Jan 26, 2023 12:17 pm
ScubaHogg wrote: Sat Jan 21, 2023 3:32 pm 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?
Not to me.

I think an over-looked factor is how much of a support system you have. If you have lots of relatives living nearby, there are others who can help in some way. But if you are one of the last remaining ones, not only will you be older, but you may not have anyone to look in on you.

For example, when my dad was 90 (having married for the third time at 79), he had 5 kids living near him with at least one of them dropping in each day to see him.

Just the fact of living with someone or seeing them every day will get you recommendations that you need to see a doctor compared to someone who lives alone and there’s no-one to notice that they should see a doctor. Earlier intervention often results in better long term health.

The support system can also do household tasks that you might not be able to do on your own. They can drive you to the doctor, food shop while they buy their own food, or walk with you to the end of the block and back. I wonder how many people go to Assisted Living just because they can’t figure out how to get help for these non-medical issues.
That's awesome to have that support network!

I thought my not having children was the way to go, now I see the flip side of that decision. I suppose I could try to fit in a few more marriages with stepchildren, though time is running short for that. Guess I'm stuck with saving money and hoping for the best.
Even with a lot of support, many people with living spouses wind up a facility because taking care of that person is an arduous 24x7 job. I mentioned dementia and that is absolutely a situation where a facility is often the only way to keep the "healthy" spouse in good health. I personally would not want my family to spend all their time taking care of me. Helping a lot, sure. But 24x7 running themselves ragged ... I'd rather not put them through that.

A lot of the care situations we are talking about are beyond what family and friends dropping in every day can handle. If you cannot toilet yourself for example, somebody has to be available 24x7. Mom getting frail and needing help with shopping and medical appointments? Sure, family and friends can probably pick that up. Mom needing help going to the bathroom and getting clothes on? Hmm, that's a lot of help that might be needed multiple times a day, every day, any hour of the day.
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Fremdon Ferndock
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Re: Age and probability of needing long term care?

Post by Fremdon Ferndock »

TN_Boy wrote: Sun Jan 29, 2023 11:38 am
Lee_WSP wrote: Sun Jan 29, 2023 11:23 am
ScubaHogg wrote: Sun Jan 29, 2023 10:24 am
TN_Boy wrote: Fri Jan 27, 2023 11:30 am Memory care is more expensive than "regular" assisted living but in my area still a lot cheaper than skilled nursing.
Really? In our area, depending on the level, memory care is either the equivalent price or quite a bit more than skilled nursing. Which makes sense since it basically is skilled nursing with dementia thrown in for good measure.
I think there’s some confusion. As I said earlier, memory care is more or less an added service on top of whatever basic care the person is receiving. Whether that is assisted living or skilled nursing, memory care can be added to each.

It’s just that facilities won’t be able to just “add on” that service. The facility has to offer memory care to every patient for it to make economic sense unless they’ve got dedicated wings.
May be not understanding part of your comment. Often you cannot offer memory care as just another service in assisted living. Because one unfortunate common problem with dementia is wandering, at which point you need a locked down building or wing, with memory care residents largely separate from "regular" assisted living residents. I will also note that assisted living and "independent living with help" residents are often not that happy about having dementia patients mixed in with them, even if the dementia patients are not unduly disruptive.

That said, many assisted living facilities have some residents with dementia, but if the resident is not wandering or disruptive, they can deal with that. But once wandering starts, it's a different ballgame (this is often when families have give up on home care, as the dementia patient may be wandering at any time of day or night and the spouse/family can literally get no sleep).
This is correct. "Memory Care" is a term used to refer to both the type of quarters in which the individual resides and the care they are receiving, which is a dedicated facility or a unit of an assisted living or long term care facility with locked access where the residents all have dementia/alzheimer's. Many residents of standard assisted living or long term care facilities are afflicted with dementia/alzheimer's that has not progressed to the stage that requires segregation in a locked facility. They are not receiving the same level of care as is typically provided in a memory care unit.
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smitcat
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Re: Age and probability of needing long term care?

Post by smitcat »

TN_Boy wrote: Sun Jan 29, 2023 1:20 pm
GreenLawn wrote: Sun Jan 29, 2023 11:43 am
celia wrote: Thu Jan 26, 2023 12:17 pm
ScubaHogg wrote: Sat Jan 21, 2023 3:32 pm 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?
Not to me.

I think an over-looked factor is how much of a support system you have. If you have lots of relatives living nearby, there are others who can help in some way. But if you are one of the last remaining ones, not only will you be older, but you may not have anyone to look in on you.

For example, when my dad was 90 (having married for the third time at 79), he had 5 kids living near him with at least one of them dropping in each day to see him.

Just the fact of living with someone or seeing them every day will get you recommendations that you need to see a doctor compared to someone who lives alone and there’s no-one to notice that they should see a doctor. Earlier intervention often results in better long term health.

The support system can also do household tasks that you might not be able to do on your own. They can drive you to the doctor, food shop while they buy their own food, or walk with you to the end of the block and back. I wonder how many people go to Assisted Living just because they can’t figure out how to get help for these non-medical issues.
That's awesome to have that support network!

I thought my not having children was the way to go, now I see the flip side of that decision. I suppose I could try to fit in a few more marriages with stepchildren, though time is running short for that. Guess I'm stuck with saving money and hoping for the best.
Even with a lot of support, many people with living spouses wind up a facility because taking care of that person is an arduous 24x7 job. I mentioned dementia and that is absolutely a situation where a facility is often the only way to keep the "healthy" spouse in good health. I personally would not want my family to spend all their time taking care of me. Helping a lot, sure. But 24x7 running themselves ragged ... I'd rather not put them through that.

A lot of the care situations we are talking about are beyond what family and friends dropping in every day can handle. If you cannot toilet yourself for example, somebody has to be available 24x7. Mom getting frail and needing help with shopping and medical appointments? Sure, family and friends can probably pick that up. Mom needing help going to the bathroom and getting clothes on? Hmm, that's a lot of help that might be needed multiple times a day, every day, any hour of the day.
"I personally would not want my family to spend all their time taking care of me. Helping a lot, sure. But 24x7 running themselves ragged ... I'd rather not put them through that."
Agreed 100% - I do not think most folks think this through and know what amounts of 'life' are drained in these situations. I have seen it up close and personal and agree with you 100%.
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Kickstart1967
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Re: Age and probability of needing long term care?

Post by Kickstart1967 »

When my Dad went into a care home (age 88) we were told by his doctor that the average life expectancy in a home at his age was 18 months and also that he would probably improve initially as his medication and care needs would be better provided than when he lived with his partner
All of this proved to be accurate
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Fremdon Ferndock
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Re: Age and probability of needing long term care?

Post by Fremdon Ferndock »

Once an individual requires the level of care provided in a SNF, the likelihood that dementia is involved is very high. Sure, there are some folks there who are cognitively intact but require 24/7 care for strictly physical reasons, but that's not the typical situation. Commonly, it's both physical and cognitive issues. Another factor is financial -- you need to be in a Medicaid qualified facility to receive financial support and that's almost exclusively a SNF. Folks in SNFs that are there for non-cognitive care are often folks without financial resources; otherwise, they could be in an ALF instead. You don't have to leave an ALF unless you can't transfer to a wheelchair without being picked up, you develop a level of cognitive impairment that requires 24/7 care, or you run out of money.
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Re: Age and probability of needing long term care?

Post by GreenLawn »

TN_Boy wrote: Sun Jan 29, 2023 1:20 pm
GreenLawn wrote: Sun Jan 29, 2023 11:43 am
celia wrote: Thu Jan 26, 2023 12:17 pm
ScubaHogg wrote: Sat Jan 21, 2023 3:32 pm
Even with a lot of support, many people with living spouses wind up a facility because taking care of that person is an arduous 24x7 job. I mentioned dementia and that is absolutely a situation where a facility is often the only way to keep the "healthy" spouse in good health. I personally would not want my family to spend all their time taking care of me. Helping a lot, sure. But 24x7 running themselves ragged ... I'd rather not put them through that.

A lot of the care situations we are talking about are beyond what family and friends dropping in every day can handle. If you cannot toilet yourself for example, somebody has to be available 24x7. Mom getting frail and needing help with shopping and medical appointments? Sure, family and friends can probably pick that up. Mom needing help going to the bathroom and getting clothes on? Hmm, that's a lot of help that might be needed multiple times a day, every day, any hour of the day.
Agreed. My sister is a kind and generous woman who offered to care for me if necessary, but I've already been informed that back end care will not be available from her :?
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Re: Age and probability of needing long term care?

Post by Katietsu »

Fremdon Ferndock wrote: Wed Jan 25, 2023 10:44 am
Your "medical POA" can end up being worthless, as will your "dementia directive" if you are in institutional care in most states. Your best hope is to kick off with minimal delay, but if you have a lingering debility it can be another story. Dementia is a major risk.
I am very sorry you experienced this. I have had enough experience with elderly relatives to understand your concerns and empathize.

But if how would it change if the person was not in institutional care? I do not think my parent would have wanted me to go to jail for hastening their death in a way that would be illegal. For the most part, the type of care that must be provided and that can be withheld would be the similar in an institution or at home.
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Lee_WSP
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Re: Age and probability of needing long term care?

Post by Lee_WSP »

TN_Boy wrote: Sun Jan 29, 2023 11:38 am
Lee_WSP wrote: Sun Jan 29, 2023 11:23 am
ScubaHogg wrote: Sun Jan 29, 2023 10:24 am
TN_Boy wrote: Fri Jan 27, 2023 11:30 am Memory care is more expensive than "regular" assisted living but in my area still a lot cheaper than skilled nursing.
Really? In our area, depending on the level, memory care is either the equivalent price or quite a bit more than skilled nursing. Which makes sense since it basically is skilled nursing with dementia thrown in for good measure.
I think there’s some confusion. As I said earlier, memory care is more or less an added service on top of whatever basic care the person is receiving. Whether that is assisted living or skilled nursing, memory care can be added to each.

It’s just that facilities won’t be able to just “add on” that service. The facility has to offer memory care to every patient for it to make economic sense unless they’ve got dedicated wings.
May be not understanding part of your comment. Often you cannot offer memory care as just another service in assisted living. Because one unfortunate common problem with dementia is wandering, at which point you need a locked down building or wing, with memory care residents largely separate from "regular" assisted living residents. I will also note that assisted living and "independent living with help" residents are often not that happy about having dementia patients mixed in with them, even if the dementia patients are not unduly disruptive.

That said, many assisted living facilities have some residents with dementia, but if the resident is not wandering or disruptive, they can deal with that. But once wandering starts, it's a different ballgame (this is often when families have give up on home care, as the dementia patient may be wandering at any time of day or night and the spouse/family can literally get no sleep).
You can’t just add memory care to an existing facility, it needs to be built around it.

But within memory care options, there are differing levels of care, same as non memory care facilities.
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Re: Age and probability of needing long term care?

Post by JPM »

How can one estimate one's own or one's mate's personal risk of needing LTC for the long term?
Does population data interpretation help make the decision for an individual? To a degree
Does family history help make the decision? To a degree
Does one's own and one's mate's current health help make the decision? To a degree
Does one's means help make the decision? To a large degree
Does one's desire to leave one's surviving mate a good option for LTC after one has passed? To a degree.
Does one's perception of value affect the decision? To a large degree.
Are enough of one's own caring children nearby and available to provide or at least supervise in-home care? To a large degree.
Are there other considerations that did not affect my and DW's own decision? Probably so.

As one ages, one becomes more susceptible to the disabling neurodegenerative diseases. While dementias, Parkinson, Lou Gehrig's disease, and similars occur at younger ages, these are predominantly the diseases of advancing age. As many people survive their cardiac events with stents, bypasses, pacemakers, etc. and many more survive cancers now as compared to a few decades ago, they can more often live on into the ages where neurodegenerative diseases become more prevalent.

For myself, I did not expect to live as long as I have and expected to (and still may) predecease DW. Her mother needed 12 years of institutional care due to dementia with otherwise good health. Lots of dementia in the family. I wanted DW to be able to afford the best NH in the area if I were no longer alive or healthy enough to care for her if and when the need arises. So I got a high-payout policy with no lifetime limit that combined with her pension and SS would be able to pay for the best nearby NH where her local kid and grandkids could still visit her there if they are so inclined. The benefit and the premium rise with inflation, and that still cracks the nut. I have a professional trustee to supervise it. I am OK with that so far and flat-fee FA says the policy is a bargain now.
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Re: Age and probability of needing long term care?

Post by ScubaHogg »

Lee_WSP wrote: Sun Jan 29, 2023 11:23 am
ScubaHogg wrote: Sun Jan 29, 2023 10:24 am
TN_Boy wrote: Fri Jan 27, 2023 11:30 am Memory care is more expensive than "regular" assisted living but in my area still a lot cheaper than skilled nursing.
Really? In our area, depending on the level, memory care is either the equivalent price or quite a bit more than skilled nursing. Which makes sense since it basically is skilled nursing with dementia thrown in for good measure.
I think there’s some confusion. As I said earlier, memory care is more or less an added service on top of whatever basic care the person is receiving. Whether that is assisted living or skilled nursing, memory care can be added to each.

It’s just that facilities won’t be able to just “add on” that service. The facility has to offer memory care to every patient for it to make economic sense unless they’ve got dedicated wings.
Well, I'm not sure where you live, but I can say with confidence none of the 4 states we've lived in offered "memory care" as an add-on service in a non-memory care facility. I don't even know how that could work. By convention they are dedicated, locked units/wings. If someone is telling you that's what they do I'm guessing they are going to try and sell you the brooklyn bridge as well

I can say that with confidence because giving therapy to people with dementia in facilities is what my wife does for a living. It's a big country so who knows what one-offs are offered where, but it's not the norm for sure
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ScubaHogg
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Re: Age and probability of needing long term care?

Post by ScubaHogg »

TN_Boy wrote: Sun Jan 29, 2023 10:39 am
My experience is helping relatives who were in, at various times, in assisted living, memory care and skilled nursing, across two different states. A dedicated memory care facility (or often, wing of a larger assisted living facility) was always quite a bit cheaper than a true skilled nursing facility. Because many dementia patients do not need skilled nursing care, which requires a higher staff/patient ratio, perhaps a nurse onsite 24x7, etc.

At least at the skilled nursing facility I'm most familiar with, I don't think there was any sort of "upcharge" for patients with dementia.
In Arkansas by law memory care facilities have a higher staff/patient ratio than assisted living facilities, and similar to skilled nursing. If anything memory care tends to have more staff per patient than skilled nursing. Like I said, maybe your area is different, but around here memory care facilities alternate between a similar price to skilled nursing to quite a bit more, depending on the care level of the required patient. We've both done this for family members and my wife provides therapy to patients with dementia in a bunch of these facilities for her job. Take that FWIW.
“… 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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Lee_WSP
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Re: Age and probability of needing long term care?

Post by Lee_WSP »

ScubaHogg wrote: Sun Jan 29, 2023 3:52 pm
Lee_WSP wrote: Sun Jan 29, 2023 11:23 am
ScubaHogg wrote: Sun Jan 29, 2023 10:24 am
TN_Boy wrote: Fri Jan 27, 2023 11:30 am Memory care is more expensive than "regular" assisted living but in my area still a lot cheaper than skilled nursing.
Really? In our area, depending on the level, memory care is either the equivalent price or quite a bit more than skilled nursing. Which makes sense since it basically is skilled nursing with dementia thrown in for good measure.
I think there’s some confusion. As I said earlier, memory care is more or less an added service on top of whatever basic care the person is receiving. Whether that is assisted living or skilled nursing, memory care can be added to each.

It’s just that facilities won’t be able to just “add on” that service. The facility has to offer memory care to every patient for it to make economic sense unless they’ve got dedicated wings.
Well, I'm not sure where you live, but I can say with confidence none of the 4 states we've lived in offered "memory care" as an add-on service in a non-memory care facility. I don't even know how that could work. By convention they are dedicated, locked units/wings. If someone is telling you that's what they do I'm guessing they are going to try and sell you the brooklyn bridge as well

I can say that with confidence because giving therapy to people with dementia in facilities is what my wife does for a living. It's a big country so who knows what one-offs are offered where, but it's not the norm for sure
I’m clearly using the wrong language to describe it. I give up.
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celia
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Re: Age and probability of needing long term care?

Post by celia »

Lee_WSP wrote: Sun Jan 29, 2023 4:01 pm
ScubaHogg wrote: Sun Jan 29, 2023 3:52 pm
Lee_WSP wrote: Sun Jan 29, 2023 11:23 am I think there’s some confusion. As I said earlier, memory care is more or less an added service on top of whatever basic care the person is receiving. Whether that is assisted living or skilled nursing, memory care can be added to each.

It’s just that facilities won’t be able to just “add on” that service. The facility has to offer memory care to every patient for it to make economic sense unless they’ve got dedicated wings.
Well, I'm not sure where you live, but I can say with confidence none of the 4 states we've lived in offered "memory care" as an add-on service in a non-memory care facility. I don't even know how that could work. By convention they are dedicated, locked units/wings. If someone is telling you that's what they do I'm guessing they are going to try and sell you the brooklyn bridge as well

I can say that with confidence because giving therapy to people with dementia in facilities is what my wife does for a living. It's a big country so who knows what one-offs are offered where, but it's not the norm for sure
I’m clearly using the wrong language to describe it. I give up.
Lee, I’m with you on this. I’ve had 4 relatives with memory issues (one case had memory loss due to a Rx that was needed) who lived in Assisted Living. Around here, most of the places I know about are in “group homes” that can house 6 people. Therefore, they are nicknamed “6-packs”.

Each patient can have different needs than the others. Maybe only one client has memory issues. But it is easy to care for them with bells on the exterior doors and “alarmed” floor matts on the side of their bed. A caregiver is always awake and can tell where everyone is. Sometimes they are helping one client when another one wants to use the restroom. Since they may not be able to help the restroom person, they all wear adult diapers.

I like the family atmosphere in these Assisted Living homes. You feel like you live in a regular neighborhood, except for a wheelchair ramp to the front door.


I’ll bet ScubaHogg’s wife has always worked in larger facilities since there isn’t a need for her services as much in a group home. And she would spend half of her time in driving from home to home.
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