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Long Term Care

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Through a series of tragic events, my dad’s sister has entered her late 70’s without any of her 5 children willing or able to take care of her (2 passed away and the other 3 for unknown reasons).   My Dad and his sis are not close  and the fact that she ended up retiring to SA after visiting here only once from the Bronx, NY (where Dad is originally from)  is still somewhat a mystery.  I met her one time prior to her moving here when I was in the 8th grade.  Without sounding harsh, I have to say that I am not particularly close to my Aunt.   I do, along with the rest of my immediate family, want her to be taken care of and in a good situation.  Over the course of the 15 years she has lived in Texas life has brought her unthinkable challenges.  The worst of these challenges was the loss of the three family members she moved to Texas with…in three consecutive Decembers.  She lost her husband, her daughter and then her son one after the other…each December for three years.  

For the next few years my elderly parents did their best to care for my aging aunt.  She was not in good health and the stress was taking its toll on my sweet parents.  My two sisters and I along with my parents then handled another few years working all together to get her what she needed and to keep her in her own home.  Ultimately we had to move her to a “senior apartment” where she lived well for about 5 years.  Then–last year–things got to the point that we knew we had to put her in a nursing home.  I hold power of attorney to handle financial and legal issues and I knew it fell to me to make this tough decision.  I say tough not because my aunt was objecting (really–she was pretty cooperative but sadly somewhat unable to fully understand) but instead because of my own mother.  At 80 years old herself the task of putting a loved one in a nursing home while facing her own physical limitations was very stressful for my mom.  We all got through it but not without a lot of tears, frustration, disagreements….etc.

Aside from the emotional impact that this had, I was ASTONISHED at the financial impact!  My aunt worked much of her life as a Registered Nurse and her husband worked for the City of New York.  Her monthly income was right around $2500 a month and as some of you know I’m sure…that won’t touch the monthly cost of a nursing home.  I was forced to do a spendown of her accounts so that she could receive assistance for her long term care.  She didn’t have a lot of money in her accounts and no longer owned property but it was SO SAD and felt just SO WRONG to have to handle it this way.  After months and months of getting everything in order things are okay now and she is well taken care of and doing much better overall.  The kids and I visit as often as possible.  I think this is both good for the kids but I also love brightening the faces of the nursing home residents!

So I am writing this post because this experience made me stop and think about long term care.  I have done no research at this point but am curious if any of you have insight on the topic of purchasing a long term care insurance policy.  I’m not going to run out and get this tomorrow but after seeing what this did to my aunt and to my parents (thankfully they DO have their long term care plans in place…as well as their funeral arrangements DONE…thank you Dad for saving your five children that stress!), I just want a timeline in my head at this point.  Feedback welcome!  🙂


13 Comments

    • Reply Claire |

      It means that we had to use the little she had to pre-purchase her funeral plan, pre-pay monthly obligations for a number of years, pay off all of her debt (although it wasn’t much) all at once so that her bottom line was $0. In Texas, this is common–I don’t know about other places. We were able to create a trust to put a small nest egg but it had to be taken out of her name and put into the name of the trust.

      • Reply Stacy |

        This is pretty common in most US states. No one can really afford to pay full price for a nursing home, and the state (Medicaid) won’t pay for medical care until the person has no assets. So the family has to pay for care until their family member is broke, which often means selling their home, car, and other assets and spending down their life savings to provide care. It’s pretty heartbreaking to watch if the person has struggled to save their entire life…

  • Reply Chantal |

    Thank you very much for sharing this painful part of your life. My MIL is approaching this stage and my husband is the only one of her 5 children who helps. It is odd how the other 4 still treat her as “mother”; asking for money, complaining about their lives, etc, to her. My goodness, she is 89 and deserves assistance and respect not constant harassing. Right now she is in assisted living but this will change and it doesn’t help that she is in Texas and we are in Delaware. We are hoping for power of attorney but she will probably give this to the daughter who lives in the same city and only turns up on her doorstep when she wants a handout. It makes us shudder but not much we can do about it. We are very fond of her and I was happy for my husband to give up his vacation 4 years ago to help her clear out and sell her home and move into where she now is.

    We are no saints and need to be thinking hard about what can be done in the near future when money for her will then become a problem for the first time. Your long email is extremely helpful in turning my thoughts to this and once again, thanks.

  • Reply Fiona |

    Wow – Claire, I don’t know anything about “long term care insurance” in the US context (I’m in Australia) but thanks for this post about financial obligations to family members.

    Many families (including ours) have financial obligations to immediate or extended family members.

    It’s something seldom written about, but an important part of financial planning. In some households, it’s also an important part of the regular family budget.

    I imagine it would have been very stressful sorting out such a complicated situation, but kudos to you for taking this on board to support an older relative.

  • Reply Stacy |

    Ideally, you’ll want to buy long-term care insurance when you’re healthy and relatively young. Once you reach the age that needing care is more likely (age 50-60+) the cost of this insurance soars. Check out prices now, and ask what the price would be if you wait 10 or 20 years. You don’t necessary need to buy insurance today, but knowing the numbers will help you make the right decision.

    Also remember that long-term care insurance can keep people OUT of nursing homes. In a good way, of course. 🙂 Many elderly need just a little bit of help to stay living in their own homes, but Medicare won’t pay for anything less than a nursing home. Long-term care insurance can help you to afford less-expensive care while keeping you in your home longer.

  • Reply adam |

    hopefully i’m some years away from this, but there’s a dave ramsey lesson about this too. he says age 60 is the magic number, and he says it’s a must at that point, but not before.

    i watched this same thing play out in my family. my dad worked in a nursing home, and he warned my mother (even though they were divorced) for several years that she needed to start doing estate planning and protecting my grandmother’s assets, and they never did. my grandparents worked hard and saved a quarter million dollars by the time my grandfather died. 8 years later, it’s all gone and now that my grandmother passed, the only asset left is their modest home, which may end up being sold at a tax sale because the family can’t agree on what to do with it and my grandmother didn’t have anything left to pay property tax.

    at the same time, i think it’s unfortunate that people think they shouldn’t have to pay for their nursing home expenses. it appears to be pretty prevalent, but to me, it seems like if you use the services, you should pay for them if you have the means. i strongly advocate that families take care of their own. but my time to care my aging parents hasn’t come yet, so I’ll see if I keep this mindset when it does.

  • Reply Dream Mom |

    We just spent the last year moving my Mom around from a few different nursing homes. She entered nursing home #1 after a bout with plantar fasciitis and was unable to care for herself. She caught a flu bug in the nursing home and through their mismanagement and lack of medical care, she went downhill. I met with the Administrator and addressed these. Unfortunately, when she went there from the hospital, the only nursing homes with vacancies are the poorly rated ones since the best ones have no vacancies. Assisted living atarts at $6k (more like $10k average in our area) a month so that option was out. We transferred her to a second nursing home after those mishaps and because the Medicare was running out (for therapy). I found a four star nursing home in my area for her that had great medical care (I have a severely disabled son who lives at home with me so I know what to look for in these places.). Nursing home number 2 messed up too and she nearly died and luckily we were able to get her into nursing home #3, the one I liked from the start (we were on a waiting list) and it’s been a big difference. She had an income similar to your aunt’s and now the nursing home takes all of it except for $30.

    The biggest factor in finding a nursing home is the medical care. Most nursing homes have one doctor on staff (he holds his main job elsewhere) and shows up “maybe” once a week if that so if you have a pressing issue, it’s virtually impossible to see the doc. At her new nursing home, there is a staff of 5 doctors who have been on staff from 15-25 years, plus a psych doc and psychologist. They have a doc that rounds every day and the medical care has been night and day. Each of the 5 primary docs has specialities that are appropriate for senior medical issues.

    The other thing to do when you are young, is to take care of yourself. Seniors lose their dentures, so having your own teeth and taking care of them is good; taking care of your health and getting any necessary surgeries when you are young is helpful too instead of waiting until you are in your 70’s and 80’s when it’s a higher risk.

  • Reply Brian |

    Claire,

    it sounds like you got her approved for Medicaid base don the “spend down”. That’s good. Provided she has adequate Rx coverage then she should have no worries.

    As for the Long Term Care policy, I went through this recently wiht my own mother in law. She had Banker’s Life and Casualty and when we transferred her into an assisted living facility. The policy paid the bill for the first year but realize there is a maximum payout and then the policy is done. They even told us we could apply for an extension but when we did so and were later approved, we found out she only had 7K left to use which would have covered two and a half months. My mother paid religiously on this policy for many year. Was it worth it in the end? I suppose so. It gave us a whole year to figure out how to proceed with her savings. But my mother was a PLANNER and everything had insurance (she even bought the extended warranties — rip off that they are). So.. that’s my two cents.

  • Reply Sissy |

    This topic hits very close to home. We just went through something similar with my father-in-law. He planned and planned for his future, but didn’t plan on falling in his rehab and suffering injuries too great to overcome. He too had Banker’s Life which would have covered his expenses for about 3 years at an assisted living. Although he never had the opportunity to use this policy, it brought him a great peace knowing he had this and felt he wouldn’t be a burden to his family. I think it is a wise investment at a certain age.

    • Reply Brian |

      I am sorry for your loss Sissy. Your father in law sounds like my mother in law. The frustrating part with Bankers is that they intentionally made it hard to apply for an extension, which is typical of any insurance company. They WANT you to go through the hoops. It made me angry when I thought about the fact she had diligently paid for that policy for so many years only to be hassled. Insurance is the only business in this country where they are allowed to collect money from you without actually providing a service and the level of service they do provide is at their discretion. It boggles the mind.

  • Reply Chantal |

    Before entering into any long term care agreements first read up on the subject. Consumer Reports has a very thorough analysis of what to look for and what to avoid. It is an area full of companies out for your money with very little in return so watch out.

  • Reply Honey |

    I have long-term care insurance (I am 32). It is a company that partnered with my workplace (over 10,000 employees at my company) so I feel confident it is good insurance. Also because of the deal struck with my employer, I didn’t have to provide a medical history, which is important to me because my mother died of a dominantly inherited degenerative neurological condition. This means I also have short- and long-term care insurance (both what is provided through my employer and also supplemental through another company). I didn’t end up getting what I considered the “best” plan, but the one I could afford – I think that if the time comes I’ll be grateful for whatever I can get.

So, what do you think ?