long term care insurance--going naked

[q-school]

discuss pros and cons of abandoning long term care insurance

let's start with the assumption you can afford the insurance--and that if you live to an age where you would reasonably be needing to access the insurance, you have reasonable assets, and are liquid enough to afford the NH payments.  of course it means you will leave a smaller estate to your heirs, unless the money you invested by not paying the premiums over the years was >> than the NH payments.  i'm trying to decide for me if and when i should consider this.

by way of background, my dad passed recently.  he paid long term care insurance for twenty years.  went to NH for one month.  long term care insurance paid a total of $0 out in his lifetime.   mom looked carefully at all the nursing homes and decided they all sucked.  she wants to stop paying for long term care insurance.   it appears that right now, based on bills from dad, NH is about $10k per month.  i'm sure it will continue to increase in the future.  she sees no benefit from going to a fancy nursing home.  if she could, she would rather just stop receiving food and water to ensure she would pass quickly if NH becomes the best option.  she would rather have her assets drained then keep paying the bills for long term care.  i always tell her to do whatever she wants, but i wonder if there is any statistical information about when and where it might be stopped.  i'm pretty sure if she gives it up, they won't offer an 80 year old person another policy.  however, interestingly, there is no shortage of offers for life insurance for 80 year old people.

as a society i can't walk a block without getting asked to insure something.  someone wanted me to insure a watch battery.  insure my kids toys.  insure iPad.  insure health.  insure disability.  insure house.  insure car.  insure life.  insure death.   supplemental insure life.  supplemental insure funeral expenses.   i'm sure insurance serves a function but i no longer no exactly what that function is.

thanks!

[VagabondMD]

Remember that LTC can also insure home care, which your mother might prefer over a nursing home. I agree, nursing home life sounds dreadful, and the thought of squandering whatever I have socked away to warehouse my decrepit, mindless body for months to years until I pass makes me sick.

[childay]

Are you asking for yourself or your mother?

I would agree with your mother in some ways, at least in my area the nursing homes are all similar, the "fancy" ones don't necessarily provide better care.

In your case, you hopefully will be able eventually to self-insure to a degree.  In-home care is extremely expensive but so are the nursing homes.

The other real concern is whether LTC insurance companies will even be around when you need it.  I am just guessing you are in your 50s so you may not need LTC until 30 years from now..

[childay]

I am curious though how many people on the forum actually have LTC insurance

[Hatton]

I do not have it.  I consider that I have self insured.  From my readings folks that retire poor rely on Medicaid.  Those with assets 3-4 million or above self insure. Others might need it say 500k-3mill.  I am kind of making these numbers up but I have read about this but do not have the reference handy.  The only doc I know with a policy does not have the money to retire at 62.

[Hatton]

This is why you delay ss until 70.

[G]

I had to look up Joe Stack.  WTF, Crixus?

q-school, I'm prepared to self insure.  As a middle-aged guy, I can't imagine myself being stuck in a nursing home for 40 years.  Regardless, I would think that my inability to work would trigger my disability insurance, which would cover the cost.  Thinking ahead 20-30 years, I anticipate having enough spun off in dividends/SS each month to cover it without getting into the principal.

[CordMcNally]

Like many other healthy people, the thought of a nursing home makes me cringe. I'm hoping to self insure. If my quality of life deteriorates enough to need a prolonged nursing home stay, I would rather call it quits as I feel like my heirs/charities would get better use of the money than I would be getting.

[PhysicianOnFIRE]

I'll take my chances self-insuring. Build up enough of a nest egg to be able to afford that $10,000 a month ($3 Million at a 4% SWR) and you're good to go.

[q-school]

I'm asking for myself but my mother was the one who triggered the discussion.

yes home care can be provided with long term insurance but if we estimate at around 10k/ mo we can go a pretty long time.

It depends on if you get sick and are lucky enough to pass relatively quickly or if you have a chronic debilitating disease at relatively young age and the health insurance doesn't cover stuff you want but disease not enough to kill you. At least that's what I think. That's one reason we opted for spia in our retirement plans.

Thanks for thoughts

[MrsIMDoc]

I am a nursing home medical director, so I have a few thoughts. If you have LTC coverage be sure you know some basic definitions/realities of nursing homes.

Nursing homes have two types of patients:

1. SUB-ACUTE REHAB - This is covered by Medicare A after a hospitalization

Many people say, "I will never go to a nursing home" or "I would never send mom to a nursing home" but if grandma breaks a hip many times they will spend some time in sub-acute rehab. Sub-acute rehab patients bring more money into the nursing home and are often prioritized.

2. LONG TERM CARE - These patients require 24/7 care with assistance with ADLS. This includes bathing, toileting, feeding (not just making meals but hand feeding). Now, compared to 20 years ago, long term care patients are VERY dependent.  Most of the patients that were living in nursing homes 20 years ago are now living in ASSISTED LIVING.

Most older adults do NOT need long term care in a nursing home but might need assisted living.  Assisted living can range from providing meals only to very high levels of care similar to a nursing facility.

The challenge I face as a geriatrician is that I have had patients in assisted living and their long term care insurance would not pay. I may write an extensively detailed letter explaining how a patient is dependent in so many ADLS and the LTC insurance would not pay because the patient was in an assisted living but not a nursing home.

So for me, I am choosing not to get LTC insurance because I have seen it not cover people when it should have.  I have also seen it run out and then family members are scrambling.

 

[MrsIMDoc]

if she could, she would rather just stop receiving food and water to ensure she would pass quickly if NH becomes the best option.

 

As a nursing home medical director, I recommend your mom fill out advance directive paperwork to organize her thoughts regarding this.  Remember that if a patient is a nursing facility we are obligated to offer food by mouth and a patient can refuse to eat but we cannot just stop giving food. I have had a patient's family ask that...

Regarding home care, be sure you live in a area with an agency that can provide 24/7 care.  I had a patient build a beautiful home in a rural area 45 minutes away from the already rural area that I live. He was quite wealthy and developed a neurodegenerative disease. He had plenty of money to pay for 24/7 care but there was not an agency that serviced his fancy home in the rural mountains.  He and his wife could not find consistent caretakers despite having the funds to pay for it. That was how he ended up in the nursing facility that I work at.

[q-school]

MrsIMDoc wrote:

if she could, she would rather just stop receiving food and water to ensure she would pass quickly if NH becomes the best option.

 

As a nursing home medical director, I recommend your mom fill out advance directive paperwork to organize her thoughts regarding this.  Remember that if a patient is a nursing facility we are obligated to offer food by mouth and a patient can refuse to eat but we cannot just stop giving food. I have had a patient’s family ask that…

Regarding home care, be sure you live in a area with an agency that can provide 24/7 care.  I had a patient build a beautiful home in a rural area 45 minutes away from the already rural area that I live. He was quite wealthy and developed a neurodegenerative disease. He had plenty of money to pay for 24/7 care but there was not an agency that serviced his fancy home in the rural mountains.  He and his wife could not find consistent caretakers despite having the funds to pay for it. That was how he ended up in the nursing facility that I work at.

Click to expand...

Thanks.  We were quite dismayed at how hard the process was when dad got sick.  It's like everything has to be a little harder than it should be.  Amazingly even though they had advanced directives arranged, apparently they were too old and some laws had changed and blah blah blah.Thankfully mom and dad has discussed everything and we were pretty much still able to follow his wishes.

 

Mom's met with an attorney to draft carefully and legally all her advance directives, poa, property poa, and a whole bunch of other documents.   i would never have thought of it, but we have the documents stored in our safe deposit box along with keys.   we are lucky they didn't both go together if only because we never would have found their legal documents in their home.

luckily dad's computer is still logged in to his email otherwise we wouldn't even know some of the bills he was paying, and lots of companies, including utilities, are really not set up to allow for sudden death.  shocking how hard it was to get them to talk without knowing the password.  however, if you have the cellphone and the email account open, you can figure something out.

i'm just afraid to turn off his computer because i don't know if the email will permanently log out.

[ITEngineer]

q-school wrote:

i’m just afraid to turn off his computer because i don’t know if the email will permanently log out.

Click to expand...

Finally - a topic I might be more qualified than all of you doctors to address Thank you all for letting me be part of this forum.

Keepass - Everyone should use Keepass (or some other similar program) to generate unique passwords for each account and keep all your passwords in one encrypted file. The master password to this encrypted file should be put in a safe deposit box with all your legal documents so when you pass (or become disabled) your family (or whomever has POA) can:

1. Have access to all your accounts.

2. Know the password for all your accounts.

Keepass has plugins for IOS and Android so you can use it on your mobile devices too.

As for the email password, I would try to reset it if possible and if not, update all the accounts to send email notices to an account that you can access. And reset their passwords now while you have access to that email account. Good luck.

[q-school]

ITEngineer wrote:

q-school wrote:

i’m just afraid to turn off his computer because i don’t know if the email will permanently log out.

Click to expand…

Finally – a topic I might be more qualified than all of you doctors to address Thank you all for letting me be part of this forum.

Keepass – Everyone should use Keepass (or some other similar program) to generate unique passwords for each account and keep all your passwords in one encrypted file. The master password to this encrypted file should be put in a safe deposit box with all your legal documents so when you pass (or become disabled) your family (or whomever has POA) can:

1. Have access to all your accounts.

2. Know the password for all your accounts.

Keepass has plugins for IOS and Android so you can use it on your mobile devices too.

As for the email password, I would try to reset it if possible and if not, update all the accounts to send email notices to an account that you can access. And reset their passwords now while you have access to that email account. Good luck.

Click to expand...

tried to reset gmail but it wouldn't let me.  i was able to reset a lot of other accounts using the gmail account and the cellphone.

 

thanks for participating!  

will look into this keepass.   i can't figure out if it is kee-pass or keep-****************** however