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If you or your parents are not yet 65 you’ll probably ignore what I have to say thinking this won’t apply to me. You’ll be making one of the biggest mistakes of your life.

If you or someone in your family has to go into a Skilled Nursing Facility (SNF) the current cost, in my home state, is about $72,000 yearly. I'm told it's double that in some other states. I’m going to focus on details surrounding folks who are 65 or older who qualify for Medicare. Anyone younger who needs a SNF, unless they have good Health Care Insurance that pays for some "rehab" time in a SNF, or has been smart enough to purchase Long Term Care (LTC) insurance is likely in deep financial trouble.

First, let me say I'm not an expert on this stuff...but experience is a good teacher of some basics.

Let’s assume Dad is 65+ and falls and breaks a hip.  Medicare A will pay 80% of the Medicare approved charges. Medicare B (If your parent has it) will pay for the ambulance ride and so on...but the medical billing isn't my focus. Dad will likely be released to a SNF for physical and occupational therapy (rehab). If you read the Medicare documentation it says Medicare will pay 100% for the first 20 days in a Skilled Nursing Facility (only after a 3 day hospital stay) and then all but about $135/day for up to a total of 100 days.  It might be that Dad has supplemental insurance that will cover the difference for those 80 days...and even all the costs for some additional period, and you might think... "We’re golden for xxx days."

Not so fast.....

Medicare only pays as long as the patient can be rehab’ed, and usually that’s a period of weeks. When the therapy folks say the patient is ready to go home, Medicare stops paying. You’re thinking...well, that seems OK....and it might be.  But what if Dad has a stroke while he's in rehab...and is confined to a wheelchair....and can’t benefit from more than a few days of rehab and Mom isn’t capable of taking care of him at home?

Guess what....after those few days...Dad is yours...and the bills are yours if you keep Dad at the SNF. You’ll get some "Home Health" benefits if he comes home....but not 24/7 help and not for too long.

Aha, you say...I’ve heard Medicaid will pay if my parents can’t afford the SNF.   True...but only after (unless you’ve done the proper prior planning with an "Elder Law" and Medicare/Medicaid knowledgeable attorney) taking 50% of everything your parents have (except their house and car) and limiting their income and having them sign over any life insurance in excess of $10K, annuities...and so on and so great and complete detail requiring even such things as proof of citizenship, their parents death certificates ... you name it.

(If Mom has already passed on and Dad is the surviving spouse, there's no split of the assets.  Medicaid will take everything excluding about $2000 and a burial policy and a few other things (if those things exist)...and even the house if it can't be shown he plans to return to the home.  And Dad will get to keep to keep a generous $30 a month for spending for hair cuts or a soda-pop.) say...I’ll have my parents title their home to me, give me their other assets and then they won’t have anything to give the Government.  Wrong! There is a 3 to 5 year "look back" period (varies by state) and any assets transferred during that time will be counted...and your parent(s) will be disqualified from Medicaid-paid SNF for one month for every $5000 of transferred assets. They’ll want all the bank statements and other financial records.

(BTW...Assisted Living...a place offering things like help with medications and other fairly minimal support...and usually three meals a say...with an unfurnished studio apartment...will run anywhere from $2500 monthly upwards to whatever you can afford and is never covered by Medicare or Medicaid.)

There’s a lot more to this than I’ve said... I’m trying to SCARE you and your parents into doing something NOW before you HAVE to face the reality of these circumstances.

Do your planning NOW. It's worth the cost.  Meet with an attorney who specializes in Elder Law and Medicaid Law who can help you and your parents avoid becoming impoverished.  If you or your parents can afford it, buy a long term care insurance policy.

I'm not commenting on whether all of this is morally right or wrong or if the taxpayer should or should not be saddled with public financing of custodial care.  I'm simply exposing you to some of the realities of things as they exist.

EDIT:  Thank you for putting this on the Rec list so others will have a chance to see it.  One last tip...all these financial things are sorta set in concrete the day one applies for be sure you don't apply until you have the facts.

Originally posted to Persiflage on Thu Nov 20, 2008 at 03:44 AM PST.

Also republished by CareGiving Kos.

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Comment Preferences

  •  Again..I'm not an expert...but I know enough (107+ / 0-)

    to give you ample warning to think about this and avoid the pitfalls.  I hope this helps someone.

    The longer I live, the clearer I perceive how unmatchable a compliment one pays when he says of a man "he has the courage to utter his convictions." Mark Twain

    by Persiflage on Thu Nov 20, 2008 at 03:45:56 AM PST

    •  This is tragic and such as shame in a country (23+ / 0-)

      as well off as ours.

      Democrats should hit the ground running and fix a lot of this missing pieces in our social safety net immediately.

      Also for children.  Well, really for everyone, but since the universal health care issue will be a long controversial battle, what if we immediately said, we will let no children or elderly folks suffer without medical care, in their worst case scenarios.

      And extend Medicare to 100% after the first 100 days of deductables.

      Then ask, well what about our patriot and loyal vet, coming home with PTSD?  Should they be covered also, and include mental health?

      What about those with retardation, mental health issues, or disabilities?

      And then why are we penalizing our corporation in the international marketplace when so many of our competitors are in countries that have medical coverage for all citizens.

      But we have to do something out of basic compassion.

      This current situation is tragic.  People who think they have excellent coverage end up in bankrupcty after unexpected illnesses they could not help.

      This just isn't right.

      The means is the ends in the process of becoming. - Mahatma Gandhi

      by HoundDog on Thu Nov 20, 2008 at 05:12:36 AM PST

      [ Parent ]

    •  Yes, Persiflage, thank you (4+ / 0-)

      fortunately, I didn't have to go through that with my parents, but plenty of people do. I think it is utter bullshit that people have to sign over everything they ever worked for in order to get "help" when they are disabled.  This shit is a big problem here in WV with it's higher elderly population.

      This kind of thing is what frustrates me with so many social programs in this country - if you are a peon and need help, it is assumed you are trying to game the system and they won't help you unless you are destitute, but that by making yourself destitute to qualify it guarantees you stay destitute because the programs don't pay enough to take care of needs...meanwhile what Wall Street wants, Wall Street the tune of billions of dollars...gah!

      Floccinaucinihilipilification makes antidisestablishmentarianism look like a piker.

      by zett on Thu Nov 20, 2008 at 06:59:34 AM PST

      [ Parent ]

    •  I deal with this field (2+ / 0-)
      Recommended by:
      Joe Bob, Persiflage

      from the insurance side.  Your description of the situation is largely correct.  The only thing I will add is this: If you want to preserve your assets in retirement, you need to look at long term care insurance.  People with low assets should not consider it; truly rich people don't need it; but those with non-real estate assets between $250K and $3M should look at it.  Apply before you are 60 and it's relatively affordable.  Think of it as disability insurance for retirees.  More importantly, it gives you choice. You can have care at home if you've got a way to pay for it, and good plans emphasize the at-home care aspect.

      I see way too many families wiped out by SNF costs when a little planning would have prevented it.

      "What we have here is a failure to communicate."

      by mspicata on Thu Nov 20, 2008 at 07:42:06 AM PST

      [ Parent ]

      •  Relatively affordable (7+ / 0-)

        in my experience is a relative term. We used to fall into that group you singled out as good prospects for LTC insurance (before the stock market tanked, taking our 401Ks and IRAs with it). Hubby joined AARP a few years ago and we get LTC come-on mailings regularly. If we each bought a policy (we're both in our mid-50s), it would cost upwards of $700 a month. That's absolutely NOT affordable on our salaries, especially not now when I'm afraid I'll lose my job early next year because I work in an auto industry-related business.

        •  That's got to be gold plated coverage. (2+ / 0-)
          Recommended by:
          el dorado gal, Persiflage

          I have never sold a policy with premiums that high.  I'd be retiring right now if I could.  I just ran an illustration for a company I represent.  $170 a day coverage, with 5% compound inflation, a 120 day waiting period, a three year benefit period and a 150% home health care benefit for a married couple living in Maryland costs a little over $300 a month.  Cheap?  No; but people with less than $250,000 in non-real estate assets shouldn't be buying it anyway.  

          "What we have here is a failure to communicate."

          by mspicata on Thu Nov 20, 2008 at 08:13:32 AM PST

          [ Parent ]

          •  Missed saying (1+ / 0-)
            Recommended by:
            el dorado gal

            age 55 in that illustration.

            "What we have here is a failure to communicate."

            by mspicata on Thu Nov 20, 2008 at 08:21:29 AM PST

            [ Parent ]

          •  If I could find a policy like that (0+ / 0-)

            we'd seriously consider it.

            •  Check your state's Department of Insurance (2+ / 0-)
              Recommended by:
              el dorado gal, Persiflage

              website for a list of companies offering LTC insurance in your state.  Steer clear of any company with inordinately low premiums; ask the consumer hotline at the DOI if any companies have unusual volumes of complaints, or have increased the premiums on existing policyholders.  Avoid bells and whistles like cash benefits and paid up policy options unless they are truly beneficial to you.  It helps greatly if you know what waiting periods and benefit periods you want before you talk with an agent.  If your state has a Partnership Plan (and the DOI will know if you do), take a look at it.

              "What we have here is a failure to communicate."

              by mspicata on Thu Nov 20, 2008 at 08:34:06 AM PST

              [ Parent ]

            •  Try GE Financial.... (1+ / 0-)
              Recommended by:
              el dorado gal

              My wife and I have a joint policy...covers up to around $150K total over 4 years.  Still leaves us with a gap..but the policy is affordable and makes a difference for us. .

              The longer I live, the clearer I perceive how unmatchable a compliment one pays when he says of a man "he has the courage to utter his convictions." Mark Twain

              by Persiflage on Thu Nov 20, 2008 at 12:10:47 PM PST

              [ Parent ]

          •  Thanks for being so specific in your information. (1+ / 0-)
            Recommended by:
            yoduuuh do or do not

            I've been feeling like I can't afford LTD but that I was being irresponsible not to get it...  It's nice to have a professional's opinion, because I'm no where near $250K non-real-estate assets. Guess my feeling that I can't afford it is pretty reality-based after all.

        •  In the 80s they wanted 15,000 a year for this (0+ / 0-)

          for my husband who was sixty.  In California we have a lot of companies that will not pay or have collapsed.  This is an issue going to court here now.

          The case that made the newspapers was a woman who sold the insurance and bought one of the policies she sold was denied.  Took six years of going to court for her to get justice.  But in the interm she lost everything but her lawyer who soldiered on based on internal rage.  Thank god for him.

  •  Thanks. (10+ / 0-)

    As is often the case the devil is in the details.  So thanks for the many details which I did not know.  Do you have some links to good unbiased information sources on this kind of issue?  If so, please insert links in the diary.

  •  The only real assumption that can be made.,,, (14+ / 0-)

    about any type of insurance is that if there is any possible way an insurance company can avoid paying a claim they will find it.

    CHRISTIAN, n. One who believes that the New Testament is a divinely inspired book admirably suited to the spiritual needs of his neighbor. A. Bierce

    by irate on Thu Nov 20, 2008 at 04:26:43 AM PST

    •  Well, this really isn't about insurance... (14+ / 0-)

      It's about the RULES covering Medicare/Medicaid funding for Skilled Nursing.

      The longer I live, the clearer I perceive how unmatchable a compliment one pays when he says of a man "he has the courage to utter his convictions." Mark Twain

      by Persiflage on Thu Nov 20, 2008 at 04:28:40 AM PST

      [ Parent ]

      •  Yes, but long-term care insurance is often (3+ / 0-)

        a scam as well, as it's very expensive and has all sorts of limitations in the fine print.  The only real solution that I can see is nationalized health and mental health care for all, regardless of need or age.

        •  Beg to disagree (1+ / 0-)
          Recommended by:

          There are few limitations in current long term care policies, because premiums are potentially tax deductible if they meet federal government standards; virtually all plans today meet those standards, and the coverage is comprehensive.  The real reason LTC policies are expensive is that not enough people buy them.

          "What we have here is a failure to communicate."

          by mspicata on Thu Nov 20, 2008 at 07:46:32 AM PST

          [ Parent ]

          •  No. The real reason LTC policies are expensive (3+ / 0-)

            is because insurance companies exist to make money.  I've looked into LTC insurance, and the exceptions and fine print are inordinate and, often, inscrutible.

            •  All LTC policies being sold today (1+ / 0-)
              Recommended by:

              are required -- if they are to be tax qualified -- to declare an insured eligible if they meet one of two tests: either they fail 2 of 6 Activities of Daily Living (bathing, continence, dressing, eating, toileting, transferring) or they are certified by a physician as suffering from a permanent cognitive impairment.

              All insurance policies by definition have exclusions and exceptions.  They are inscrutable to the layperson, just as mortgage agreements and mutual fund prospectuses are; a good advisor makes the difference.

              "What we have here is a failure to communicate."

              by mspicata on Thu Nov 20, 2008 at 08:20:35 AM PST

              [ Parent ]

              •  And the need for an advisor is exactly part of (1+ / 0-)
                Recommended by:

                the problem.  Everything should be transparent.  A system where one has to be of a certain SES to both afford the insurance and to afford the translator of the insurance is not one set up for the betterment of the health and mental health and care of the US population.

                •  Do you take a mortgage (1+ / 0-)
                  Recommended by:

                  without an advisor?  Buy a mutual fund?  Do you go to court without a lawyer?  I'd love a world simple enough that I could understand everything without an intermediary; but I accept that there are some areas where an expert helps me make better decisions.  OTOH, it's certainly possible to obtain the knowledge to read and understand an insurance policy, just as it's possible to represent oneself in court.

                  "What we have here is a failure to communicate."

                  by mspicata on Thu Nov 20, 2008 at 08:59:19 AM PST

                  [ Parent ]

                  •  And if health and mental health care (1+ / 0-)
                    Recommended by:

                    was nationalized, none of this would be necessary.  It say something about how this country values life.

                    •  It would still be necessary. (0+ / 0-)

                      Ask anyone navigating through Medicare and Medicaid, which are after all insurance programs.  There are multitudes of social services agencies assisting clients with health and mental care paid for by the government.  I know lawyers who make a good living representing clients in Social Security and Workers' Compansation cases.

                      "What we have here is a failure to communicate."

                      by mspicata on Thu Nov 20, 2008 at 09:37:04 AM PST

                      [ Parent ]

  •  No, I don't have links but you could (11+ / 0-)

    google (including your state) such things as Medicaid Look Back, Medicaid Deficit Reduction Act and so find out how your state looks at things.  

    But...your BEST bet is to talk with a knowledgable attorney who deals in this stuff.  Sometimes they're happy to give you a free consultation.

    And, your situation and everyone else's will be different...  

    The longer I live, the clearer I perceive how unmatchable a compliment one pays when he says of a man "he has the courage to utter his convictions." Mark Twain

    by Persiflage on Thu Nov 20, 2008 at 04:27:12 AM PST

  •  I know details are different for each state (33+ / 0-)

    but my parents both had to go to an assisted care facility, while my mother recuperated.  My mom takes care of my dad.

    It was a jaw dropping experience to count out on fingers (each one being a year) how many years my parents could stay their with their assets.

    I always thought my parents were very comfortable. Now I know they are on the edge of a cliff.  And I too am on that cliff's edge because I have accumulated far less than they have.

    I could go on about my experience... If you don't know about this issue, you are going to be shocked some time.  Tipped and Recommended for thinking ahead.

    I think. Therefore I O'Bama.

    by MarkMarvin on Thu Nov 20, 2008 at 04:34:42 AM PST

  •  What are our parents saving money for? (7+ / 0-)

    I'm not commenting on whether all of this is morally right or wrong or if the taxpayer should or should not be saddled with public financing of custodial care.

    Why would persons who have saved all of their lives and is now living out their days in long term care need tax dollars to finance their custodial care?

    In order to fund people sheltering their savings from facilities they rely on to maintain their lives, should our tax rolls contain a "long term care" tax?  Where will this funding come from to support the lives in long term care?

    I am just not sure why the person needing long term care should also need sheltered funds.  What are they being sheltered for if not for the late life needs?

    Are they being sheltered so the children of the elderly can inherit money while society pays the care cost of their parents?

    I just don't get it.

    •  Assume your parents own their home, a 10 year old (18+ / 0-)

      car and each has a $25K life policy, have $50K saved, and are each collecting social security and one parent has a pension.  Say their total yearly income is $30K.  Say you are their only child and that you're not inclined to see them homeless or otherwise destitute.

      So, after all their assets are gone...which would likely be in less than a year or so...and the non-SNF parents icome has been cut in half...I guess you'll take over and pay their bills?  

      I said I'm not making judgements...just relating the facts.   If your parents have $Millions...don't worry, they'll be fine.

      The longer I live, the clearer I perceive how unmatchable a compliment one pays when he says of a man "he has the courage to utter his convictions." Mark Twain

      by Persiflage on Thu Nov 20, 2008 at 04:53:09 AM PST

      [ Parent ]

      •  You just described my parents (4+ / 0-)

        and you might want to add that many of the better nursing homes (in our community anyway) will NOT take Medicaid patients. Your choice of facilities is limited, and the better ones that DO have Medicaid beds available have multi-year waiting lists for those beds. What does the patient do during the wait, after Medicare has stopped paying because the patient is not showing progress in rehab and their own assets have run out. You, the family, either have to pay, or you have to move mom or dad to a facility you don't want them in.

        Been there, done that, wearing the t-shirt today. Fortunately, dad's in a decent facility. Unfortunately, it's 30 miles from mom's house. Best we could do.

    •  They're Being Picked Over by Vultures (6+ / 0-)

      I agree that they shouldn't be allowed to get a free ride while handing their wealth off to their undeserving spawn, but they deserve a service for their wealth which benefits them more than some callous shareholders.

      To me, they're my parents and I may at some time have space for them but I cannot quit work or the entire family ship sinks.  To the new high growth industry of assisted living, they're nothing more than fresh meat from which to extract as much wealth as possible from before they up and die, at which point the checks stop coming.  Every dollar spent on their care is a dollar of profit lost.

    •  One of our problems working with my dad to (6+ / 0-)

      figure out what his options were and how to pay for them was that he really really wanted to leave his properties (a small house and an apartment) to his children. We tried to get him to see that his own present needs were the first call on those resources. As it happened, pulmonary clots rendered it moot but he would have been very distressed if what he had always thought of as his inheritance for us had gone for his own medical care. We were fine with that, of course.

    •  Undeserving spawn that I am. (7+ / 0-)

      My mother plans to leave her savings from a lifetime on a secretary's salary to me so that I can look after my disabled brother's financial needs for the rest of his life.  So, yeah, if there's a way that we can protect that money for him, we will.

      And yeah, we'll protect that money when my brother gets Medicaid. Medicaid has a 7-year waiting list for mentally disabled people in some states and you can't get on the waiting list if you have any assets.

      Not everyone who gets an inheritance is undeserving spawn, and rhetoric like that will make a lot of people think that Democrats are out-of-touch and interested only in class warfare.  Thank goodness Obama knows better.

  •  true, this (18+ / 0-)

    I lived with a friend post divorce and he had a debilitating stroke at fifty. All of this is true but Persiflage forgot to throw in that the good folks you meet are Kafkaesque and the bad ones simply don't give a fuck.

    Work hard, pay your taxes, and when you need the government, bend over.

  •  Having lived through this (26+ / 0-)

    I can tell you, thanks, Persiflage, for giving this topic a shoutout.

    My father spent most of four years in assisted living before he died, and as you say, his savings paid the bills. His nest egg disappeared by almost half in those few years.

    His children are not all speaking to each other to this day, because of the decisions made then.

    The assisted living center never repaid thousands of dollars in up-front payments because of dissent about the means of dispersal.

    This topic is definitely one where the devil is in the details.  Ignore it at your own peril, kossacks.

    •  Be sure you understand that Assisted Living is (11+ / 0-)

      not covered by any government program.  I think the only way to pay for assisted living is thru a Long Term Care policy (which would likely also cover a Skilled Nursing Facility) or out-of-pocket.

      Assisted living is for folks who need minimal help with the activities of daily living....and who can afford to have someone help with these things.  Chances are good a transition to a SNF will be required some day and the expenses go up astronomically.

      The longer I live, the clearer I perceive how unmatchable a compliment one pays when he says of a man "he has the courage to utter his convictions." Mark Twain

      by Persiflage on Thu Nov 20, 2008 at 05:29:20 AM PST

      [ Parent ]

      •  Just got my mom (13+ / 0-)

        back home from a SNF. The interesting thing is that she got it all paid for through Medicare and Medicaid. Medicaid kicked in b/c she has no assets at all- just the condo she lives in. She had qualified for Medicaid 3 three years ago after sitting on a waiting list for 5 years. It's a Medicaid program here in N.M. called the "Elderly and Disabled waiver". Now my mother is 82 yrs. old, legally blind, has severe COPD (oxygen 24/7), diabetes, hypertension, cardiovascular disease and gout.
         The amount of paperwork we had to fill out again and again to get the measly $10.00 in food stamps and 10 hours of in-home help was astonishing. We have 4 post-grad degrees between us and it was still a lot of "cognitive labor". I kept wondering how any of the Hispanic grandmothers who had spent their whole lives raising a multitude of kids could even begin to navigate this system.
        I am so grateful for the help we did get, but it was a minefield of regs.
        My mother fell and broke her leg and I got her to the hosp. and immediately had to start looking for a SNF to transfer her to in the 3 day window.Talk about stress... The place I got her into has a "good rep" and did look better than most, but it was still pretty awful: horrible food, disengaged and changing staff.I kept emphasizing to my mom that she could stay as long as she kept "improving", and even then, we only had 60 days in the facility- if she stayed longer she would lose the medicaid.
        My mom doesn't even remember the first 2-3 weeks.
        Now she's home and has been reevaluated and gets the help of a home health aide for 21 hours/week. Not enough, but shifts some of the burden off me.
        The point being is that it can work if you're dirt poor and very smart.

  •  This is about making sure the middle class (24+ / 0-)

    does not inherit.  Only the wealthy inherit.  Many grandparents would like to see their grandchildren educated but that last thirty days of their lives will eat up 90% of everything they own.

    My husband's father had 250 thousand in CDs.  80% went the last 30 days he was in a coma from renal shutdown.  His heart could not stop because he had a pace maker.  The only reason his wife had anything left was in those days the time period was only two years.

    •  Well, we don't have (13+ / 0-)

      a right to inherit.

      My Mom is using the equity in her home to live now, through a reverse mortgage. My sister and I will inherit less. If anything.

      But Mom is living well.

      And why do we insist that people linger in comas for so long? It's a tough decision but one many of us will be faced with. It was difficult to know when to do less for my Dad and let him go in peace. But it made more sense than forcing treatments on his unaware body.

      Having parents is difficult.


      •  It's not a "right" - it's their desire. (11+ / 0-)

        Most parents have a sense of deep pride that they will be able to help support their families after they've gone, to help pay for a child's college, to help their kid's mortgage payments -- this is what middle class inheritance is about. If someone doesn't value these things, then sure, they have every right to spend it while they're here.

        But for many aged parents, they maintain a certain dignity from the dignity of their work over the years that allows them to pass along help and support to their family after they're gone. It is beyond demoralizing when they have to watch whatever savings they have dwindle to nothing in a matter of a few weeks.

        Texas: Our Permanent Lock on the Presidency. Key: 5 points in 4 years.

        by TX Unmuzzled on Thu Nov 20, 2008 at 06:31:21 AM PST

        [ Parent ]

        •  LIVING WILL (8+ / 0-)

          Make sure you and your parents have one.

          Unless you want to be kept alive without all the benefits of life itself.

          -6.13 -4.4 Where are you? Take the Test!!!

          by MarciaJ720 on Thu Nov 20, 2008 at 06:56:38 AM PST

          [ Parent ]

          •  And make sure it is up-to-date (2+ / 0-)
            Recommended by:
            cotterperson, Brooke In Seattle

            and consistent with current state law.

            My father's was prepared prior to a major change in Texas law. That created some avoidable additional drama.

            •  Can you tell me what that change is? (1+ / 0-)
              Recommended by:
              Over the Edge

              I live in Texas now, as does my whole family, and some made living wills back during the Terri Schiavo days.

              I'd like to know if they need updating.


              "It always seems impossible until it's done." - Nelson Mandela

              by Brooke In Seattle on Thu Nov 20, 2008 at 08:15:41 AM PST

              [ Parent ]

              •  My parents' were written several years (2+ / 0-)
                Recommended by:
                Persiflage, yoduuuh do or do not

                before the Texas Advance Directives Act of 1999.

                The terminology in my father's directive resulted in some potential legal trip mines for the physicians.

                As a result, the process to remove his life support was more complicated and created a potential scenario wherein he could have remained in a permanent vegetative state, the sole reason why he had a directive and what he feared the most.

                He was in Fort Worth Harris Methodist and with the exception of one of the attending physicians, I give the facility very high marks for their willingness to work with us to honor his wishes.

                His life support was removed and he died within hours on the day before Terri Schiavo's feeding tube was removed in 2005.

                The legislature considered some changes to the statute post-Schiavo in 2007, but the effort failed so presumably your family's would be up-to-date.

          •  Health care power of attorney (2+ / 0-)
            Recommended by:
            Persiflage, yoduuuh do or do not

            is less slippery. Then it's up to the designated decision-maker -- not the people who will profit from keeping them barely alive, especially in very expensive intensive care unit.

          •  More to the point... (1+ / 0-)
            Recommended by:
            yoduuuh do or do not

            include a health care power of Atty and a General POA.

            The longer I live, the clearer I perceive how unmatchable a compliment one pays when he says of a man "he has the courage to utter his convictions." Mark Twain

            by Persiflage on Thu Nov 20, 2008 at 12:17:54 PM PST

            [ Parent ]

          •  Both parents had living wills. When money is (1+ / 0-)
            Recommended by:
            miss SPED

            involved, nothing is cut and dried.  There can be a huge difference of opinion of what is extrordinary medical interference.

            Dying from renal failure is a long slow process of allowing the blood to become toxic.  Especially, if you have a pace maker.  Finally, the lungs fill up and you drown but that can take quite a while.

            I was a nurse and my husband a lawyer.  With his mother, they had already amputated one leg.  She was 95 and they will willing to amputate all her limbs.  We would not allow a food tube and they threatened court but we held tough.  Had we not been nurse and lawyer, we have no idea how long they would have prolonged the inevitable.

            I am constantly appalled at how simple people think these things are until it happens to them.  If they think they can get to the children's money too--they will go there.

            •  rec a thousand times (0+ / 0-)

              I wish I could.
              I saw the entire health care industrial complex keep my father alive (though he was amputated in to pieces) for years despite powers of attorneys and DNR orders and trusts and wills.

              From those who stole his wedding ring and cash, to those who used up his savings, to those who just had to resuscitate one more time, I learned there is not much respect for the wishes of the dying.

        •  Is it a realistic desire, though? (2+ / 0-)
          Recommended by:
          Persiflage, maxxdogg

          It may have been their goal all along, to keep taking care of their now-grown children. But if they keep having expenses (outrageously high as they may be) why shouldn't their needs be met first? We are grownups in this scenario and can fend for ourselves.

          In addition to good financial planning, I think we need to unburden our parents of any notion that we expect them to provide for us at their expense.


  •  Thank you (8+ / 0-)

    I will talk to my husband about setting up an appointment with a lawyer.  We both have LTC insurance (thank you Jim, our financial planner) but we both will be turning 65 in 2009 and need to face reality.  Our time is coming.

  •  My parents are deceased by over 20 years. (1+ / 0-)
    Recommended by:
  •  Well it depends on the state, Masschusetts info: (2+ / 0-)
    Recommended by:
    Persiflage, feeny

    Massachusetts elders can qualify for what's called the Frail Elder Waiver, which means they are clinically at a NF level of care.  They qualify for this waiver through a referral by their  Aging Service Access Points ( ASAP's). The financial criteria is 300% SSI FBR (Federal Benefit Rate is around 210% of FPL (Federal Poverty Level). There are some asset limits involved, but Massachusetts has some very liberal asset transfer rules.

    Once again, Massachusetts leads the way in comprehensive care for our most vulnerable populations.

    Dang, how about these numbers-> -8.00,-7.38 Does this make me the reincarnation of Gandhi?

    by HGM MA on Thu Nov 20, 2008 at 05:20:57 AM PST

  •  LTC insurance or how I got lucky with my dad (20+ / 0-)

    He's 88 years old. Back in the mid 90's, my sister talked him into getting LTC insurance with Met Life. (Actually, since he was a teacher, it was through TIA-CREF, but they sold their LTC division to Met Life)  If not for that, he and I would both be screwed because my sister later passed away and there's no one but me to look after my father now.

    But, as I said, he bought the insurance and is now at a very nice assisted living facility. It took a long time to get him there.

    I'd like to add a little about that LTC policy though, if I may. Watch out about their deductible!! Why? Here's where I got slipped up - and it was my own fault for not reading the policy more carefully but even if I had, there's a lot of jargon.

    Basically it said that the insured had to be approved by a health care provider that they approved of and had to need help with "X" amount of "ADLs" - like help getting dressed, help fixing meals, help bathing, etc. before the payments would kick in. My dad "passed" those with flying colors after a series of mini-strokes and other problems.

    But then his policy seemed to say that there was simply a 6 month deductible period, after which I assumed he'd be ready to go. Not so fast.

    It wasn't just 6 months; it was 6 months in which he received care. So that meant I had to document - and pay for - 6 months of care before Met Life's insurance would kick in.

    What constitutes "care"? Well they have to approve the caregiver. According to their definition of "care" it cannot be administered by a family member - in other words it has to be "care" that you pay for. So, in my case, I had a couple of local companies who'd send out an LPN to his house for a few hours a day to help out. Each time that happened, one day got knocked off that 6 month deductible.

    But those places that get approved by Met Life to do this aren't cheap; they typically run about $20/hr in Virginia. And having someone come in for, say, just 3 hours a day is a drop in the proverbial bucket in terms of the care needed. In my case, I'd have someone come in to give him a bath couple times a week.

    At any rate, it seemed like it took forever to burn up that "6 month deductible" because it wasn't just 6 months... again, it was "6 months in which he receives professional care* and they really didn't word it that way.

    And then.... I learned that they pay very different amounts for an assisted living facility versus a nursing home. Again, in the case of my dad's policy, they only pay $50/day for an assisted living facility, but $150/day for a nursing home. That's a huge difference!

    He was a bit too "healthy" for a nursing home, but way too in need of help to stay at home by himself and if I had tried to keep him at home, Met Life would've only paid $50/day. That's about 2.5 hrs of help a day and he needed someone around 24 hrs a day.

    I then found out that's all they pay when he's in an "ALF" (assisted living facility) too. The monthly bill for his ALF is $2500/month. Met Life pays $50/day for that, so each month they pay for ~ $1500 of that $2500, which still leaves him and out-of-pocket expense of $1,000.00 per month!! That's with his insurance!

    Fortunately, because he's retired and is collecting social security he can (barely) afford that, so he's doing OK - but if my sister had not (practically forced him) to get that policy, I would be taking care of my father 24 hrs a day and that would be, for me, very difficult.

    Moral of the story: If you can afford it, look into Long Term Care insurance. It's not cheap and the cost will vary depending on things like the state you live in and the deductible period you select. Then read that policy very carefully and ask questions. The wording will probably be very vague and you will probably have to call them to clarify some things. I would also stick with a "top tier" company that's been around a while.

    Met Life has been far from perfect, but they are (finally) coughing up money to help me take care of my dad so I give them a guarded thumbs up. Oh, and this isn't just about your parents; it's about you too - especially if you have kids and are nearing retirement age. You don't want to inflict some huge burden on your children to take care of you do you?

    This ain't no party. This ain't no disco. This ain't no foolin' around!

    by Snud on Thu Nov 20, 2008 at 05:25:13 AM PST

    •  LTC is not a good policy to buy (6+ / 0-)

      Companies who issued a lot of LTC policies in the past are really hurting now. They way underestimated the future benefits. They are now fighting every claim, delaying benefits and jacking up the rates on those who currently have it. Many are fighting to avoid bankruptcy.

      Some people, the people who bought early and started receiving benefits fairly soon, did very well. It is not such a good deal for everybody else.

      My employee, an insurance company, frequently buys blocks of business (policies) from companies that have gone under. Or we buy blocks of business from companies that don't really know how to manage what they have- frequently block of medicare supplement from companies who hopped into that field without knowing what they were doing. We will not touch LTC with a 10 foot pole. We did take over one small company's business, which included a medium size block of LTC, but we had contracts in place selling that to another company before we finished the purchase.

      Check Google News for LTC insurance. Look at Conesco stories for a start.

      Signature Impaired.

      by gttim on Thu Nov 20, 2008 at 06:21:13 AM PST

      [ Parent ]

      •  Maybe. But I'd be screwed with it. (3+ / 0-)
        Recommended by:
        mattman, cotterperson, Persiflage

        As I said, I gave a "guarded" thumbs up to Met Life. After AIG fell, I guess all insurance companies are hurting. Maybe my father got in while the getting was good, but as I said, if not for his LTC policy, I would be living with him 24 hrs a day/7 days a week and doing virtually everything for him.

        I'm not knowledgeable enough about how the financial markets have hurt companies like Met Life - and I'm sure they've been hurt. But again, in my case, it's been a God-send for my dad and me.

        This ain't no party. This ain't no disco. This ain't no foolin' around!

        by Snud on Thu Nov 20, 2008 at 06:32:12 AM PST

        [ Parent ]

        •  I very glad for you! (3+ / 0-)
          Recommended by:
          Brooke In Seattle, Snud, Persiflage

          Don't get me wrong, it is wonderful that you have it. But buying it now is tough, the rates keep jumping and the companies deny almost every claim and make you fight for it.

          Sadly, there is little available for people needing long term care as they get older. This is an area where government single payer is going to have to step in. However, with more advanced and expensive healthcare keeping people in bad health alive longer, long term care will continue to be needed by more and it will be more expensive.

          Signature Impaired.

          by gttim on Thu Nov 20, 2008 at 06:39:40 AM PST

          [ Parent ]

          •  I absolutely agree about abt single payer! (8+ / 0-)

            Much of this would be un-necessary with single-payer healthcare and I'm all for that!

            But unless and until that changes - assuming one works within the confines of the current system - if one can get it and afford it, it's really something to think about.

            I have no children. If I make it anywhere near my dad's age - and we're still stuck with this crappy system - I'm screwed. I'll be living in a cardboard box on a heat grate somewhere.

            This ain't no party. This ain't no disco. This ain't no foolin' around!

            by Snud on Thu Nov 20, 2008 at 06:43:48 AM PST

            [ Parent ]

        •  Should be "screwed withOUT it" n/t (2+ / 0-)
          Recommended by:
          mattman, cotterperson

          This ain't no party. This ain't no disco. This ain't no foolin' around!

          by Snud on Thu Nov 20, 2008 at 06:40:57 AM PST

          [ Parent ]

      •  It depends on the state (1+ / 0-)
        Recommended by:

        Insurance is so state-to-state oriented. Met's LTC overall is solid,, at least in NY and FL.

        "Do or do not. There is no try." ---Yoda

        by nyunion on Thu Nov 20, 2008 at 07:07:27 AM PST

        [ Parent ]

      •  Penn Treaty and Conseco (0+ / 0-)

        were the primary insurance companies which had severe problems with their LTC insurance.  Not coincidentally, they were the cheapest as well.  Don't buy any policies that are significantly less expensive than those of other companies.  Ask whether the company you are considering has ever raised rates on already issued policies -- the top-notch companies have not.  Check complaints with your state insurance department -- on the agent or broker as well as on the company.  

        "What we have here is a failure to communicate."

        by mspicata on Thu Nov 20, 2008 at 08:05:05 AM PST

        [ Parent ]

    •  Surprising-to some extent (0+ / 0-)

      Did your Dad get retiree health insurance from his District to act as a medigap plan? If so, if it was a decent policy that should have covered at least 100 days in the SNF.  That isn't 6 months, but it's not day one either.

      Double check his medical plan, you may have time to syill file an appeal and get some cash back.

      "Do or do not. There is no try." ---Yoda

      by nyunion on Thu Nov 20, 2008 at 07:05:53 AM PST

      [ Parent ]

    •  Newer policies (0+ / 0-)

      do not read this way, as the federal government requires tax-qualified policies to kick in when the elimination period ends, regardless of what care was received during the period.  people who buy LTC policies should buy the maximum at-home benefit they can afford; most of us want to stay at home.

      Bottom line: Much has changed since your father purchased his policy, and for the better.

      "What we have here is a failure to communicate."

      by mspicata on Thu Nov 20, 2008 at 08:00:56 AM PST

      [ Parent ]

    •  Thanks for the info (0+ / 0-)

      we have the same metlife policy, and I'm going to go read it again now.

      In the unlikely story that is America, there has never been anything false about hope.

      by jancw on Thu Nov 20, 2008 at 08:47:12 AM PST

      [ Parent ]

  •  I can vouch for your diary (11+ / 0-)

    I learned all this the hard way last month!

    In October my dad was in the hospital, followed by rehab, and now moved into an assisted living facility at a cost of $3,000 per month. He was lucky to have had an AARP supplemental policy that covered everything in the hospital and rehab that Medicaid didn't cover. But the assisted living is coming out of his pocket, and he will probably be there the rest of his life. At 84 years old, it could be awhile (hopefully!) Since (I also just discovered) he lived like a pauper and saved significantly over the years, we don't have to worry about how to afford it for quite awhile. If we were in a different situation I don't know what we would do.

    Georgie Porgie Puddin Pie
    All he could ever do was lie.
    When the kids came out to play
    Georgie had planted landmines.

    by jetskreemr on Thu Nov 20, 2008 at 05:28:44 AM PST

  •  Looking for a continuing care facility is (11+ / 0-)

    another option in some cases.  I moved my 94 year old mother from California into an excellent non-profit continuing care facility near us in Cleveland four years ago when she needed assisted living.  Her only assets at that time were her CA condo (which we sold), a small amount of savings, and a very small monthly SS check.  The facility has independent living, assisted living, and nursing home care all together, and the resident moves gradually from one to the other as needed and pays in full for as long as her money lasts.  Once her money runs out (which it will in a couple of years from now), they promise (in writing, when she enters) to keep her in whatever level of care she needs for no cost.  If she is in nursing home care at that point, the facility receives medicaid funds for her.  Now this only worked because she still had some assets and could show she could pay her way for enough years to make it worth the gamble for them to take her on (they make this calculation using actuarial tables), but these continuing care facilities can be a good option in cases like these.

  •  we also need more support for home care (18+ / 0-)

    I cared for my mother at home for the last three years of her life after a stroke paralyzed her right side. (It was an exhausting but incredibly rewarding time and I'd do it again in a heartbeat.) We were lucky because I can work partially from home, so we only had to pay someone to sit with Mom 12 hours a week while I was at work. But that 12 hours a week added up to considerable expense. Thanks to Mom's social security check and my income, we made it. (Young people who bitch about social security have no idea how much it can help THEM for their parents and grandparents to have that check.)

    We saved Medicare (and ourselves) thousands and thousands of dollars by not choosing a nursing home but opting instead for in-home PT and OT and nurse visits. I would think that more families would choose to care for their elderly loved ones at home if they were able to afford to bring in help.

    Medicare needs to provide for this in-home help. It seems foolish to me that it does not because it would surely save Medicare millions of dollars for the elderly to be able to live in real homes with people who love them. It's a win-win all the way around.

    Furthermore, all hospitals need to have eldercare social workers who are adept at helping families sort out the different finances and resources for each option they have: skilled nursing facility vs. home care. Too many are left to forage for information on their own at a time when they are stressed beyond belief.

    •  Some states help keep folks out of nursing homes (7+ / 0-)

      ...understanding that if we can do so it saves everyone a bundle of money.  Unfortunately, the cash available is usually just a fraction of what the nursing home would charge.

      Virtually all of the care provided by hospitals and nursing homes can be done at home.  Ordinary people can learn how to run an IV or Enteral Pump; can learn how and when to use a Suction Pump; can learn how to prevent bed sores; can provide basic physical therapy.  Despite this, both home health nursing and equipment companies have come under fire over the last decade or so.

      There are times when nursing homes are the best solution, but too often families don't realize just how much they can do at home, despite what a hospital discharge planner might tell them.  

      •  MIssouri gutted its program (4+ / 0-)

        when the Republicans took over 8 years ago. I couldn't understand that but recently found out they did it because home health care workers might organize, since they're poorly paid, get few benefits and have a hard, hard job. Now that we have a Dem. administration again I hope the Blunt admin decisions are reversed and quickly.

      •  home care (2+ / 0-)

        There are times when nursing homes are the best solution, but too often families don't realize just how much they can do at home, despite what a hospital discharge planner might tell them.  

        Absolutely. I had no idea I'd be able to do all that I did--and the hospital personnel and doctor argued against bringing her straight home when she was discharged, arguing that she should be in a rehab facility. But when someone you love needs you, you're capable of doing all sorts of things.

        My mother had a horror of being put in a nursing home. She was shy to the point of agoraphobia and was always a homebody. I knew it would be psychologically disastrous for her and, after six weeks of the hospital and its rehab floor, she needed to be home. So she came home when she still couldn't walk. But she worked hard with the visiting PT and made tremendous progress--progress I'm sure she would not have made in an institutional setting.

        And she was gracious, which made everything easier. Whatever I or anyone did for her, she'd always say "thank you." Those thank yous were heartfelt and golden. Some caregivers have it much harder, so I'm careful not to judge everyone by my experience. It's different for everyone.

        For Mom and me (and the dogs), it worked well for me to look after her at home. And I'll forever be grateful for that.

        •  "psychologically disastrous" can be exactly right (1+ / 0-)
          Recommended by:

          When you are in a nursing home, you no longer decide when you get up in the morning, when you will get dressed, when you get to eat breakfast, what you have for breakfast, when you get to leave the table, and the list goes on.  You have lost your independence and the ability to make decisions for yourself.  The effect has been compared to being in a concentration camp, and some of the same psychological processes are at work.

          You and I had the chance to prevent the dehumanization of our parents that happens to others every day.  I wish our institutions appreciated that the challenge is an opportunity, and one that shouldn't be passed up.

    •  I've been taking care of my (2+ / 0-)
      Recommended by:
      Persiflage, cassandraX

      dear, demented 89 y/o mother for eight years. If the time comes when we need nurses or other home-care, it is a minor expense compared to a nursing home. Much better for her and me, too.

      It wouldn't work for everyone, of course, but it is personally rewarding. All I've given up is my dissertation and eight years of work. She's already transferred her savings to my name -- knowing I'll never leave her and will pay for whatever is necessary. Best of all she (and I) get to stay at home.

      •  I know exactly what you're talking about (1+ / 0-)
        Recommended by:

        I felt exactly the same way about taking care of my mom. It was a gift, and it did more for me in three years than thirty years of off-and-on therapy ever did....Mom would be turning 89 next month if she were still alive--which I so wish she was. Considering yours is 89, I assume that 1919 must have been a good year for mothers.:)

        Bless you and your mom. May you enjoy each other for  many more years.

  •  Good post. About five years ago I served (7+ / 0-)

    as an attorney at an Elder legal services organization.  At that time there was a 3 year look back period, and you had to dance a little bit to get the proper paperwork in order.   Today, I am told, many Elder Law specialists are not even visiting that route because the laws are so convoluted and changeable that no one can keep up.  My parents are 69 and in excellent health.  How long ahead do we need to look before everyone gets screwed?  We'll see.

    Country First. Western Second. I don't know. . .Third base!

    by dditt on Thu Nov 20, 2008 at 05:54:09 AM PST

  •  My mother had a stroke (15+ / 0-)

    in September. Actually, she had two strokes, one on each side of the brain which is very unusual. She was in rehab for 3 weeks and practically thrown out in the streets even though she is still throwing up her food and can not go to the bathroom or feed herself on her own. I still think there is something else wrong with her because she has been vomiting all summer before that. She is 5'9" and is down to 115 lbs. My brothers and I have been working around the clock to take care of her and we all have children of our own. I have to with autism and it is very difficult. btw- my mother has both medicaid and private health insurance.

  •  This is so true (18+ / 0-)

    This summer I saw my dad through his end-stage prostate cancer and home hospice care in Massachusetts.  A drug interaction that his physicians failed to monitor for sent him to the hospital for 3 days, and then he was released to rehab.  After a couple of weeks (as soon as it was clear that he wasn't physically capable of doing physical therapy any more, thus ending his benefits), he had the choice of going home or staying in rehab at ~$400/day. While the rehab staff were terrific, Dad was declining rapidly, was miserable at being away from home, and his needs were unpredictable, so we opted for the more attentive care of round-the-clock home health aides at $25/hour (yes, $600/day).  Mom was in a panic at the cost, but I just ordered her to not think about it.  I handled all the decisions, in consultation with the Visiting Nurse Association (without them, the ambiguity in determining what to do would have been paralyzing). My dad died only a week later, peacefully watching his bird feeder and holding hands with his grandson.  We're so glad we had him come home.

    We're grateful that Medicare A and B covered his medications, hospital bed, and doctor visits (although not transportation to those visits).  But during home hospice, the only care visits covered were occasional nursing visits and a few hours a week of home health aides.  Dad needed much more care than that, as he couldn't walk at all and had swallowing/choking problems, not to mention pain management needs. I'm still grieving and in shock at how quickly this all happened.  But I can't imagine what people do when their loved one lingers for an open-ended period that can extend years, especially they don't have the resources to do the right thing.  

    I'm struck by the stark difference in how the transition from life to death is handled in Canada.  When my young sister-in-law was terminally ill early last year, home health aides were sent by the national health system, her oncologist coordinated all of her care in consultation with us, and experts were there to help make the hard decisions about when to move her to 24-hour-care in the hospital.  There were no costs to her family.  The care was skilled and attentive.  We were spared the heartbreaking dissonance of having to make impossible tradeoffs in a dire and ambiguous situation that we were entirely unprepared for.

    "Patriotism is supporting your country all the time and your government when it deserves it." - Mark Twain

    by Patience is Not a Virtue on Thu Nov 20, 2008 at 06:02:34 AM PST

  •  I manage a Seniors Only Apartment building,,,, (14+ / 0-)

    as does my husband.  Both buildings are for independent living only.

    My building is poor people, my husband's is up-scale.'

    However, the residents of both buildings are facing the same problems when they become incapacitated.  Finding an assisted-living facility is almost impossible.  We have tenants who cannot live on their own any longer but have no alternatives.  I have one lady with 4 different staph infections, MRSA, and she's morbidly obese.  She calls 911 literally every single day because she has fallen.  This has gone on for months.  A county nurse even had a protective order filed so the county couldn't send her back here after her most recent hospital stay, and yet after 4 weeks of rehab I'll be getting her back.

    The situation is completely intolerable.

    "But your flag decal won't get you into heaven anymore"--Prine 4200+ dead Americans. Bring them home.

    by Miss Blue on Thu Nov 20, 2008 at 06:08:37 AM PST

    •  You would think (2+ / 0-)
      Recommended by:
      Miss Blue, Persiflage

      that even if they couldn't look at the human suffering side of the tragedy you're describing, government officials would look at the money.

      How much do you think a 911 call a day is costing the ambulance district? Couldn't that money be better spent to put her in a facility that could give her the care she needs?!

  •  I would also plead with people (9+ / 0-)

    to get as physically fit as you are able and keep it up--this includes the elderly (even frail elderly) who can benefit hugely from fitness programs or physical therapy.

    I hope this doesn't sound frivolous in light of the seriousness of this diary, but I am trying to help an elderly friend in a horrific pickle whose life would be much different if she would agree to do some exercise to strengthen her muscles, especially her legs.

    I won't go into the details but she is falling down a hole. If she had spent just 30 minutes a day doing moderate exercise for the past 20 years of couch-sitting, her story would be happier.

    Oops! I'm gonna need a whole new sig!

    by sillia on Thu Nov 20, 2008 at 06:09:17 AM PST

    •  It's not a silly comment at all (2+ / 0-)
      Recommended by:
      Persiflage, yoduuuh do or do not

      I am somewhat angry at my parents (yes, I am) because they are NOT taking care of themselves at all.  My dad has high blood pressure and is obese and doesn't exercise.  My mother doesn't exercise and is overweight.  All they need to do is walk down the country road a few times a week and they don't even do that.

      Who exactly do they think will be taking care of them when the results of not being active come home to roost?  I remember them criticizing one of my grandmothers for not being active!

      They are, however, on top of the LT care thing.  So I'm grateful for that.

    •  This is so important! (11+ / 0-)

      My father (see my comment below) has a disability since birth, and even with physical therapy, is having a devil of a time regaining the relatively limited mobility he had when he was younger. It's an uphill battle and so discouraging that he keeps giving up and I have to cajole him into trying again.

      Even with fairly active people, sometimes the decline is so gradual that their loved ones don't realize how far they've deteriorated until it's too late to reverse or arrest the downward trend. That's what's happened to my father, who is so fiercely independent that he hid his decline from us for a long time. It's so sad.

      •  They see themselves as deteriorating (9+ / 0-)

        into old age, they see things as hopeless and irreversible, but it just isn't true--exercise can have a HUGE impact on the daily life of an elderly person.

        I see this 'fiercely independent' type too, and the ones I know are all or nothing--since they can't be as active or able as they used to be, ergo it's hopeless. They don't see the gradations of misery, gradations of happiness.

        Studies have shown that men in their 90's have the same muscle-building ability as 19 year-olds. The difference of course is that 19 year-olds are starting out from a much stronger point. But the effect of exercise on muscle is the same in the elderly as it is for everyone.

        Oops! I'm gonna need a whole new sig!

        by sillia on Thu Nov 20, 2008 at 07:02:03 AM PST

        [ Parent ]

    •  Not frivolous at all! This is good advice. (8+ / 0-)

      I feel very blessed that my mother (see "continuing care" comment above) is in excellent physical health at the age of 94 in part because she has walked at least a mile every day of her adult life.  She is in assisted living now because of some memory impairment, but the exercise routine she followed throughout her life has helped to grant her an old age free from pain and has saved me much heartache in watching her grow old and helping to care for her.

    •  YES. I said the same below. Younger Next Year (2+ / 0-)
      Recommended by:
      sillia, yoduuuh do or do not

      for men and women is the book to read.

      Stay fit and healthy and then die, instead of slowly going downhill for 30 years!!

  •  This diary reads like my life in 2008 (18+ / 0-)

    If only I had read this diary in 2004 instead of 2008. Then my mother and I would not be in the position we find ourselves. We're living the scenario you describe here.

    I moved my 84 year old widowed mother in with me a bit over 2 years ago. This summer she fell and broke a hip. The medical care was excelent, the insurance paid for everything - until her rehab period ran out.

    At that point mom was still in the rehab facility and the $8000/month started coming out of my pocket. "Title 19" is the only form of long term-aid available, and that requires we turn over to the government everything except $2000. But here's the catch: all our remaining family funds are currently in both my name and hers. So were I to invoke Title 19, I would have to impoverish myslef, possibly then losing my home too, and going utterly bankrupt.

    So I sought to remove my mother from the rehab center and bring her back home. That took 5 weeks at ~$2000/week because the employees of the rehab center kept oving the goalposts on me, constantly raising new objections to moving my mother to her own home. Realize that the county social servioces official assigned to my mom's case was approving the move - it was only the people raking in $8000/month who acted as obstructionists. Finally though the physician assigned to the case trumped the objections from the rehab center and mom came home some $10,000 poorer and in no better health after that massive expense.

    Now the she is home a not-for-profit nursing group comes by a couple times a week to check on mom. This service is paid for my Medicare but only until a bedsore she picked up at the home heals. But the nurse fomr the non-profit clued me in to some other resources, including a doctor's office that does nothing but make house calls on th elederly. These nice folks from the non-profit act in such a remarkably different way from the for-profit employees that the difference is both sickening and stark.

    The best information the non-profits gave me was the hospice option. Under hospice, Medicare once again picks up the costs. But hospice app;pies only to those patients who are on a steady health decline. Now, that steady decline might take years, the hospice patient might well outlive the "long-term care" patient, but the hopice costs are covered so long as that condition of steady decline exists.

    To wrap this all up, the one bit of advice I can offer to people in a similar situation is to look into the hospice option. That, and to structure family funds so the parent transfer most of their wealth to the children long before terminal health issues arise.

    You do not want to me in the same lifeboat as mom and I. The American health-care system bankrupted my family in the 50s and 60s when my uninsurable father had strokes, heart attacks, and finally dies. Now the American health care system is looking to bankrupt my family again.

    Fuck the American health care system.

    •  What a story!! So sorry! (3+ / 0-)
      Recommended by:
      zett, Quicklund, addisnana

      There are some other options to veterans who served at least one day during war time.  My wife's parents both served in WWII and we're going to check this out for them.  They have few assets.

      The longer I live, the clearer I perceive how unmatchable a compliment one pays when he says of a man "he has the courage to utter his convictions." Mark Twain

      by Persiflage on Thu Nov 20, 2008 at 06:22:28 AM PST

      [ Parent ]

      •  No WW2 vets here (1+ / 0-)
        Recommended by:

        Dad could not serve because he had rheumatic fever as an infant. That left him with a fragile heart - and that in turn ensured no insurance firm in America would cover him. So everytime he got ill, the family went straight back into poverty.

        Now mom is ill and the same fate looms.

    •  In Calif to get hospice you must certify the (1+ / 0-)
      Recommended by:

      expectation of death in six months.  My husband died at home with this help.  BTW, his dying at home had to be disclosed when the house was put up for sale and was considered a substantial negative.

      •  Dunno where state, federal laws come in (0+ / 0-)

        My information came from a home-care nurse. According to her, some patients have been on hospice for years. Dunno if the difference is due to state laws, or what accounts for the difference.

        As for home sale, that is not an issue with my family. but I imagine in today's slow real estate market, anything off-perfect can be a deal-breaker.

        Sorry to learn of your loss. My hopes life remains a joy for you.

  •  Medicaid WILL Pay Assisted Living (For the Momnt) (3+ / 0-)

    This is a subject we've been researching.

    The lookback for the patient's finances and gifts is 5 years, and lawyers have suggested to us that it could be more if they enter a facility full time that begins draining their savings, and they should make a gift to kids etc. I think Medicaid might be able to refuse to begin paying even 6+ years into the future until someone pays their care for the equivalent of whatever the gift was.

    --Of course, just because Medicaid (at present) will cover a certain kind of care, doesn't mean you can easily get into a facility that accepts Medicaid residents. Those that do generally tell us they want the resident to spend several years as a normal paying resident before going onto the dole. And not all facilities will accept Medicaid, and those that do may have only a few slots available.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Thu Nov 20, 2008 at 06:21:17 AM PST

    •  There are anomalies to be found, I'm sure (2+ / 0-)
      Recommended by:
      el dorado gal, kktlaw

      and every state may have some different rules.  But, generally speaking I think you'll find Assisted Living is not covered.  Again...Speak to an's worth the cost.

      The longer I live, the clearer I perceive how unmatchable a compliment one pays when he says of a man "he has the courage to utter his convictions." Mark Twain

      by Persiflage on Thu Nov 20, 2008 at 06:24:58 AM PST

      [ Parent ]

    •  Medicaid Coverage Varies (5+ / 0-)

      from State to State.

      My mother-in-law had Medicaid and we were able to get her all the health-care she needed, except to fight the hospital infection that eventually killed her.

      We put her in a nursing home and that is when we found out that Medicare will only pay, as the writer above notates, for only a limited time.  However, since she had Medicaid she was covered until her death.

      We already pay to lock up children who are so mentally retarded or disabled for life, seems we could do the same for our older fellow men and women.

      I have MS and I know people who have have gotten so disabled they had to go into a nursing home - but they had no assets to begin with.  Others that I know come from wealthy families and have at-home care.  The difference in care is solar systems apart.

      -6.13 -4.4 Where are you? Take the Test!!!

      by MarciaJ720 on Thu Nov 20, 2008 at 06:44:06 AM PST

      [ Parent ]

  •  Dealing with this re: my father (12+ / 0-)

    He's in assisted living right now, but as his condition continues to deteriorate, we're having to consider other options. He really wants to go back home, but while he can afford the assisted living right now, he can't afford the level of care he would need to return to his home.

    It costs $3250 a month for the assisted living, which doesn't include medications, supplies, Depends, nutritional supplements, etc. We are going to have to start liquidating his assets (home, cars) sometime within the next couple of years.

    With the possible exception of one especially greedy sibling, none of us care whether there's anything left for us to inherit. We just hope there's enough to care for Daddy until the end of his days, as none of us are in a position to take on any significant amount of his expenses. And I am simply worn to a frazzle trying to coordinate everything (can't get any of my many siblings to make a significant contribution of time to his care - argh).

    I'm thankful my late stepmother was so thrifty. I don't know what we'd do if they hadn't been able to save.

  •  Stepping back, the real point is... (14+ / 0-)

    ...our system is remarkably screwed up.  Some people figure out how to work the arcane rules and exceptions and come out way ahead of others.  Responsible efforts to sustain self-sufficiency as long as possible get punished.

    The answer here isn't getting everyone to hire a lawyer to work the system.  The answer is to fix the system to make it more equitable.

    The McCain-Palin Campaign: a transitional medium through which Monty Python skits are transformed into SNL skits

    by Minerva on Thu Nov 20, 2008 at 06:23:18 AM PST

  •  Another thing to consider is (0+ / 0-)

    having two living trusts, and splitting any accumulated assets between them.  My  understanding is that the assets in the living trust of the one not needing the care are subject to the spend down rules.  

    Virtue carried to the extreme often becomes vice.

    by phonegery on Thu Nov 20, 2008 at 06:25:12 AM PST

    •  I think your understanding is totally incorrect. (4+ / 0-)
      Recommended by:
      lotlizard, mspicata, Quicklund, kktlaw

      Sorry...but it would be good if you found out now rather than later.  Find an expert.

      Irrevocable trusts may do this...but I'm pretty sure Revocable trusts don't.

      The longer I live, the clearer I perceive how unmatchable a compliment one pays when he says of a man "he has the courage to utter his convictions." Mark Twain

      by Persiflage on Thu Nov 20, 2008 at 06:28:27 AM PST

      [ Parent ]

      •  I believe you are correct. (1+ / 0-)
        Recommended by:

        Trusts have entirely different IRS tax ID numbers (people use their Social Security numbers as theirs).

        I believe as long as the trust cannot be changed or dissolved by the beneficiary, it is considered a separate and distinct entity.

        -6.13 -4.4 Where are you? Take the Test!!!

        by MarciaJ720 on Thu Nov 20, 2008 at 06:46:40 AM PST

        [ Parent ]

      •  I am basing my understanding (0+ / 0-)

        on a newspaper article wherein the wife and husband had separate trusts.  When all the assets in the husbands revocable trust and their joint holdings had been spent down to the minimum required by Social Security, they wanted to make her pay.  The Court held that they could not require her to spend the money in her living trust for her husbands care, although they would clearly have to be applied for her own care.  I could be misremembering, though, it was a long time ago.      

        It's and interesting point though.  I tried Google, but ended up with no clear statement about two trusts, and both required to be spent for expenses of only the first party. Whether community property states makes any difference I don't know.
        Thanks for raising it.  

        Virtue carried to the extreme often becomes vice.

        by phonegery on Thu Nov 20, 2008 at 03:11:24 PM PST

        [ Parent ]

    •  My mistake. Are not subject to (0+ / 0-)

      Are not subject to spend down rules.

      Virtue carried to the extreme often becomes vice.

      by phonegery on Thu Nov 20, 2008 at 11:10:21 AM PST

      [ Parent ]

  •  When my time comes... (7+ / 0-)

    When my savings runs out, my choice will be nitrous oxide or possibly some other simple chemical process.

    "Culture of life", my ass.  This society doesn't give a shit about life.

    It is, however, very supportive of fetuses and transferring maximum amount to the rich to support them in their golden years.

    Lenski is a screen-nym, not my surname.

    by lenski on Thu Nov 20, 2008 at 06:37:37 AM PST

  •  From experience, the central point here is STUDY. (10+ / 0-)

    I won't go into the years-long saga of my Alzheimer's father and recently deceased long-term invalid mother.

    The one thing that needs to be stressed over and over is GET THE DETAILS.  Work it out step by step.  Don't be counting on something you have may have heard, something someone has told you.

    Expect to spend a lot of very focused time and attention on this matter.  This is difficult because it's a subject all of us would rather not think about.

    While it may be painful to do the research and get all the I's dotted and the T's crossed, it's much less painful than finding later that something you thought was true is not.  The system really doesn't care for your good intentions or the fact that you were too busy with something else.

    But I'm here to tell you, if you bite the bullet and do the advance legwork, you and your family will get through it.  So I hope Persiflage's scare tactics work.

  •  I am one of those who HAS lost everything. (14+ / 0-)

    And I am not elderly. I had a bad accident earlier this year disabling both my right arm and my left leg. I spent from April through August in a "SNF." Actually two of them. I put "SNF" in quotes because in the facilities where I lived, there was definitely very little "skill" involved. I got scabies and a staph infection in the "SNF." Actually, the scabies was an epidemic. Both facilities were mostly run by CNA's (unskilled and non-English speaking aides who had no training.) There were several social workers who did nothing to help anyone. It is really difficult to figure out all the rules when you are so incapacitated that you really can't function. I went through all my savings during this time period, and my savings was substantial because I am self-employed (attorney who knew nothing about insurance and nursing homes, but now I do.) After all the money was gone, I was finally "rewarded" to qualify for Medical. (Like Medicaid, California's version.) I am now home and get occasional visits from my insurance company's home health nurse, only because the staph infection is recurring and I am on intravenous antibiotics through Christmas. I got physical therapy for a couple of weeks, and none now. The "SNF's" where I lived were abominable. There are so many helpless senior citizens there with no access to any resources. At least I got out. Most of them won't. And from my conversations with them, they weren't all that sick when they arrived. It was the "care" that made them sicker and unable to return home. Also, they had mostly lost their homes to pay for the nursing home. It's a real racket. I am channeling my efforts now to become an advocate for nursing home patients. However, I can't drive, so am limited in my efforts. And the diarist is so right. Part of the big problem is that the laws and rules vary widely from state to state, and even more between primary insurance companies. So it's a difficult area to research and to document accurately. Plus, my experience is that even those within the system don't know their own rules, and therefore are incapable of helping anyone.  

  •  Good advice--I'm dealing with this right now (5+ / 0-)

    My in laws are in their 80's and didn't do the right things as you state.

    Fortunately, since money management was never their strong suit, the pretty much fall within the existing liquidation threshold without a substantial change in quality of life for my healthy in-law.

    One thing that you fail to point out however, is that if the senior stays with traditional Medicare (A+B) and purchases a good Medigap plan and a stand alone drug plan (Part D) they will receive lifetime SNF coverage (and really good health care in general.) In a high cost areas the total price will be about 7000 per person per year (with fluctuation depending on health.

    The other option is to take a good Part C option (PPO/HMO) and buy the separate LTC plan.  That will cost about $5000.00. But if you buy your LTC plan in your 20, 30 or 40, before having any substantial illness, the premium cost will be under $100.00 a year and will index at a low inflation rate, drastically reducing the cost of when you become a senior. In essence you pre-pay the high cost early on when you don't use the plan.

    Of course if you have the plan as a young person and wind up in a debilitating state from a car accident of MS etc., you get the added bonus of protecting your family's well being.

    Also if you have LTC and elect the traditional medicare with medigap, you MAY get a reduced premium vis-a-vis the normal age premium.

    Hence: buy LTC as young as possible, even before you get married!

    "Do or do not. There is no try." ---Yoda

    by nyunion on Thu Nov 20, 2008 at 06:51:50 AM PST

    •  I wish they would offer that to those 45 (0+ / 0-)

      like medicare and Social security. Where you prepay your long term care while you are young enough.  Starting it at 45 would not be a burden to the younger workers.

      "Democrats can't do any worse than them, but they seem to be trying by votin for Joe."

      by relentless on Thu Nov 20, 2008 at 10:38:15 AM PST

      [ Parent ]

  •  One last point (2+ / 0-)
    Recommended by:
    mattman, kktlaw

    LTC plans are NOT reimbursable under PArt B of a 125 Flex plan's "privately held premium" option.

    One can only wonder as why this is, since a good employer provides you with the medical, vision, dental and LTD.

    Just like with HSA's, the tax code encourages bad employer policies.

    Also, under the part C Dependent care of the 125, you are limited to withholding $5000.00 a year.

    So if you have one family member (adult or child) in care (nursing, daycare, etc.) is $5000.00 period. Not one dime more.

    This is part of the "middle class tax cut" that is never discussed; raising this limit.

    "Do or do not. There is no try." ---Yoda

    by nyunion on Thu Nov 20, 2008 at 06:59:12 AM PST

  •  Consider this scenario (9+ / 0-)

    You became incompetent to handle your own affairs and you're  placed in a nursing home or other institution by a relative or someone appointed by the court.  It may not be someone who understands your preferences and needs, and they may not exercise good judgement in handling your affairs.  But, you will be virtually powerless to change things even if you are aware enough to know that you're absolutely miserable.

    Plan ahead.  Plan carefully.  You could be a long time miserable.

    •  Yes, that was what I experienced in the SNF's (5+ / 0-)

      with older patients. They were often placed there by their families who didn't want to deal with them any more. They just got sicker and less aware. And really miserable. And soon, they have no voice at all. This is why my new mission is to advocate for nursing home patients. I believe this would also be a good path for the many Obama volunteers who have a lot of good energy.

      •  Good Start (1+ / 0-)
        Recommended by:
        Deep Harm

        Just keep in mind that (as I'm sure you know) many of these patients wind up in such a state because they didn't get proper psychiatric treatment when they were younger. As seniors their underlying issues remain, now exacerbated by the damages of physical illness and age.

        We can do insurance and structural reform to a point, but to holistically improve quality of life for institutionalized seniors, real mental health (not tell about your problems Mr. Soprano) care must be emphasized as a real social investment.

        "Do or do not. There is no try." ---Yoda

        by nyunion on Thu Nov 20, 2008 at 07:13:56 AM PST

        [ Parent ]

      •  Thank you, kktlaw (3+ / 0-)
        Recommended by:
        Persiflage, kktlaw, feeny

        There is a great need for caring oversight.

      •  want to deal vs. couldn't deal (2+ / 0-)
        Recommended by:
        JillR, Deep Harm

        They were often placed there by their families who didn't want to deal with them any more.

        I'm sure you have seen some things I never have but my most recent experience with LTC, SNF, etc. made it clear that you can't be quick to judge families in these situations. My girlfriend's grandmother died a couple of years ago. Her family had everything going for it: substantial financial resources, highly educated children, etc. Even with both adult children and all three adult grandchildren helping with care the burden on everyone was substantial.

        To give people a sense of how difficult to deal with these issues are: my GF's mother was a County Administrator for Health & Human Services, her uncle a dean of the School of Social Work at a large university. It was still incredibly stressful and the right thing to do was not always crystal clear.

        The more common circumstances probably involve the elderly parent's children living paycheck to paycheck, with young children of their own. Considering that, I'm surprised things aren't worse than they are.  

        Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read. - Groucho Marx

        by Joe Bob on Thu Nov 20, 2008 at 08:45:21 AM PST

        [ Parent ]

  •  Wonderful country this America (8+ / 0-)

    A nation unwilling to take care of our old and writing laws so as to get their life savings; say...I’ll have my parents title their home to me, give me their other assets and then they won’t have anything to give the Government.  Wrong! There is a 3 to 5 year "look back" period (varies by state) and any assets transferred during that time will be counted...and your parent(s) will be disqualified from Medicaid-paid SNF for one month for every $5000 of transferred assets. They’ll want all the bank statements and other financial records.

    So we need to plan ahead. Our government turns us all into scam artist just like the people we elected.

    •  Couple of comments about funding. (2+ / 0-)
      Recommended by:
      Persiflage, yoduuuh do or do not

      The two programs - Medicare and Medicaid - are set up for different groups of people and they are funded differently.

      But the truth is, the taxpayer is funding both of these programs.

      Medicare is paid for by you through your payroll taxes.   Those FICA taxes that everyone grouses about.  But those taxes are woefully insufficient to cover the total cost of the program.  So COngress set up a premium for the Part B benefits.  But alas that premium also does not cover but about 25% of the total cost, and consequently a portion comes out of the general treasury.  The general treeasury is funded by your income taxes.  Medicare is for people who have attained insured status under Title II of the Social Security Act through working and paying into the system to fund it.

      Medicaid is paid for totally out of the general treasury - your income taxes.  It is set up for people who have never worked and paid into the Social Security system, consequently are not eligible for Medicare.  The spend-down provisions for qualifying for Medicaid are there to protect the tax payer.  If a person has resources to take care of themselves, they are required to use them before being cared for on the taxpayers' dime.

      Neither of these programs is mandatory.  You don't have to use them.  So don't criticize those who know they may have need of the programs and get themselves educated as to the eligibility requirements and the rules that govern continuing eligibility by calling them "scam artists."  Knowing what consequences your financial planning decisions may have is what every taxpayer should do.  In 20+ years of practicing Social Security disability law, I have rarely met anyone who was willing to basically impoverish themselves just to qualify for Medicaid.  By the time they need Medicaid, they have already pretty much spent everything they own.

      The medical providers - doctors, labs, hospitals, SNFs, etc - which are the ultimate primary beneficiaries of these programs [they are the ones who end up with the money] know how the system works.  The individuals who need care are not much more than the profit units that allow the medical professionals to make money off of them.

      •  Listen to me a second (4+ / 0-)

        If I need to call my Dear old Dad and say that in order to leave what little he has left to his children he must transfer everything now so he appears to be a pauper, I feel like a dirty filthy scam artist.

        This bullshit should not be going on. Americans should not be forced to make such decisions in the twilight of their years. People in other industrial nations don't have to. Do they?

        My government has no respect fro our elders but I do and I would never make that call to my Dad so if this scenario plays out they will just get everything.

        I'm pretty sure that this government that only respects lobbyist know that I won't make that call.

        And that's why I wrote what I did. They suck.

        •  Okay. I hear you. (3+ / 0-)

          You are like most of my clients - you do not want to make that call, because it feels wrong for the government to put you in that position.  The PR making you feel guilty for doing what is legally permissable to avail yourself of a program you have funded has been amazingly effective.  We have had it drummed into our heads that using these programs is welfare, and entitlement programs are killing the country financially.  But these are the only programs we have right now.  I hope that changes for the better in the future, but until it does change, we all need to be aware of the what the programs provide and what the eligibility requirements are.  Medicaid, as a safety net, has some gaping holes in it.  If your dad falls through one of those holes, the consequences could be financial disaster.  If you can help him avoid that, I think you will.  You are after all funding these programs.  Why should you not benefit from them?

          I'm sure you read a few more of the posts in this thread, and realize that many people made financial planning decisions, not for the purposes of qualifying for Medicaid, but which were actions that had the effect of disqualifying them at a time when they did not know they might need to program.  Then they got caught.  

          Knowing what consequences your actions may have is what planning is all about.  And it's a good thing to get professional advice when doing that.  Many financial planners know nothing about Medicaid, or the consequences some of their recommendations may have on eligibility for that program.  I think that is what the diarist was posting about.  Don't get caught out.


        •  It may work out if you did it as a family unit. (1+ / 0-)
          Recommended by:
          Eddie C

          Talk with your brothers and sisters and then set down with him and tell him in detail what the rules are, that he will have to give it all to medical costs and nursing home costs.

          I never said anything to my mother, but my sister did. Mom's goal became 'not to let the doctors or hospitals or nursing homes get the money her and dad worked so hard for".  She gifted and she gave us most of what she had of value the last several years.  There was ten of us kids so it wasn't much by the time she spread it around, but it helped us all.  I kept telling her that if she kept her money that the kids were more likely to try to keep her at home and wouldn't send her to a nursing home, but she said she wasn't going to take that chance.

          She said she would rather see us enjoy it and that we would probably fight over it if she left it for us.

          Bless her heart, she started having chest pains, she was immediately taken to the hospital and died 8 hours later.  All she had to pay was her deductible, but that would probably have made her mad. I still love and miss her.

          "Democrats can't do any worse than them, but they seem to be trying by votin for Joe."

          by relentless on Thu Nov 20, 2008 at 10:29:00 AM PST

          [ Parent ]

      •  Our elected officials get free insurance (2+ / 0-)
        Recommended by:
        yoduuuh do or do not, WiddieDawg

        when they retire and other perks that we don't get.  They have a Cadillac insurance which probably has long term care in it.

        They don't have to worry about pauperizing themselves to give to their children.

        That needs to change.

        "Democrats can't do any worse than them, but they seem to be trying by votin for Joe."

        by relentless on Thu Nov 20, 2008 at 10:11:33 AM PST

        [ Parent ]

    •  Why do we save, unless it is to pay our own way (0+ / 0-)

      as we progress in life?

      If you believe that older people should have a free ride (not an unreasonable position) then I'd say that all of us should have a free ride and we should dramatically change all laws regarding the right to health coverage so that it is free for all.

  •  Don't get sick!! Don't end up in the health (5+ / 0-)

    care system at all.

    Read, Younger Next Year. EXERCISE your way to health as you age. Stop eating crap. Lift weights.

    Learn Reiki for yourself or meditate for stress and immune health.

    Stop eating High Fructose Corn Syrup and transfats. Stop eating sugar and processed carbs.

    80% of disease is lifestyle related.

    My goal is not to get sick and old.

  •  I love this diary Persiflage, it is SO important (3+ / 0-)
    Recommended by:
    gooderservice, Persiflage, kktlaw

    for us all to talk about these issues and experiences and to exchange otherwise hard to find information.  The comments so far show a heartbreaking range of experiences and tentative, provisional strategies that people have used to negotiate this healthcare labyrinth until we achieve universal coverage.  Until that day, EVERYONE will face these problems either in caring for their parents or for themselves or both.  So thank you for getting this conversation started!

  •  It is a terrrible situation (2+ / 0-)
    Recommended by:
    gooderservice, feeny

    My sister and I cared for our mother until she died several years ago, and when my brother in law became bad enough with Alzheimers, they committed double  suicide rather than go through the hell they saw with her.

  •  Where I live (2+ / 0-)
    Recommended by:
    cotterperson, Persiflage

    the cost of SNF is $500 per day.  Do the math, and that is $182,500 per year.  I have a family member who is in a SNF.  They were approved by medicaid to stay in the SNF for 100 days (paid by medicaid), but before the 100 days were up, we got the bill.  Now, we are trying to fight that decision, but I have a feeling they will stick us with the bill because they were done with the rehab.  
    Now my family member is going home, and there will be 24/7 care provided by my state.  
    The planning is so important.  Elder care attorneys are very important to have because the rules are always changing, and there are so many different circumstances that make huge differences in situations.  

  •  this is not unusual elsewhere in the world (3+ / 0-)
    Recommended by:
    JillR, cotterperson, Persiflage

    In Ireland - my mother had a stroke in February, the state health care service paid for her hospital care for six weeks, but as her prognosis wasn't good she had to move to a care facility and because my parents are above a certain income level, they were on their own. State run nursing homes are better, but there are waiting lists,

    Private nursing homes cost from €800 per week - My mother is in one which costs €1150 per week. All their life savings are being eaten away. When they run out, the value of the family home  would be taken into account and would need to be sold. The government means test and have only given €80 towards costs. My parents lived through a time when they paid very high taxes on their income.

    A friend of mine from Japan told me that her parents will sign their home over to the local council when they need eldercare.

    Yes, there are ways of working the system, but the truth is that nursing care is incredibly expensive nearly anywhere in the world and unless you pay very high taxes for a good service you will get a mixed bag. There are choices too that many people don't want to talk about - making a living will - how much lifesaving do you do at advanced age with bad prognosis.

    I know a little of the US system, but I can assure you that medical systems are far from perfect elsewhere in the world.

    "live simply so that others may simply live"

    by Maevpmcc on Thu Nov 20, 2008 at 07:46:38 AM PST

  •  Thanks for the warning, Persilage. Sadly, you're (3+ / 0-)
    Recommended by:
    cotterperson, Persiflage, feeny

    about 8 years too late. My dad had a massive stroke Feb 2000 and died last year. It was, and still is, a financial nightmare for my small family.
    That said, I'm very glad to see this diary, being prepared and informed is crucial.

  •  Until 2 days ago, I didn't know (3+ / 0-)
    Recommended by:
    cotterperson, Persiflage, feeny

    that everyone wasn't automatically eligible for doctor care and visits by just turning 65.

    I didn't know that there is a difference between Part A and Part B, or that you have to pay extra to get anything but hospital stays. I thought Part D just dealt with meds.

    My mom and older brother are on the Federal Employees Retirement benefits plan, so they don't deal with Medicare, so I have no experience with it.

    That sucks. What if you don't have money to pay for the extra benefits? You're just screwed?

    I'm so tired of being poor. I thought when I got to be 65 I could at least see a doctor.

    "It always seems impossible until it's done." - Nelson Mandela

    by Brooke In Seattle on Thu Nov 20, 2008 at 07:54:18 AM PST

  •  This is happening to a close friend (1+ / 0-)
    Recommended by:

    of mine.  Her mother is in her 90s and is currently in a nursing home, recovering from a bout of pneumonia and a broken ankle. The cost to keep her in the nursing home will be about $8000 a month, but my friend can't take care of her by herself - she can't lift her and has a full-time job.  My friend has lived with her mother for years, but the deed is still in her mother's name, so they could lose their home.

    It's an incredibly sad state of things - the elderly are treated like trash that should have been taken to the curb already.  Take the diarist's advice - plan ahead and meet with experts.

    With the first link, the chain is forged. The first speech censored, the first thought forbidden, the first freedom denied, chains us all irrevocably. JL Picard

    by slandurgurl on Thu Nov 20, 2008 at 07:58:36 AM PST

    •  Once she is over pnumonia (0+ / 0-)

      she should be able to stay at home, if she has a good mind, with visits from home health care nurses. She would need a wheel chair or a crutch.  Sometimes you can get someone to check on them whom you trust from the neighborhood. You could hire a lot of help for her and still beat paying $8000 a month.

      "Democrats can't do any worse than them, but they seem to be trying by votin for Joe."

      by relentless on Thu Nov 20, 2008 at 08:35:50 AM PST

      [ Parent ]

  •  Excellent info, Persiflage (2+ / 0-)
    Recommended by:
    cotterperson, relentless

    Thank you for this!

  •  Same sceniro true w. Hospice. Once Dr. determine (0+ / 0-)

    no futher medical treatment will improve health of dying patient, funds are cut off.  The patient is sent home to die --- just when the most skilled nursing or pallative care is needed to make the patient comfortable

  •  Even more complications for my family ... (1+ / 0-)
    Recommended by:

    Besides the Medicare realities mentioned in this diary ...
    Ten years ago within a 3 month period ... after 43 years of marriage my father left my mother and married his "tart", my father's company where he had worked for 45 years was sold to another firm & then my dad retired and my mother was diagnosed with Multiple Sclerosis and forced to close her in home day care center of 35 years.
    Our family had to deal with 2 corporations and their 2 different health insurance companies, divorce lawyers, tax lawjers, Social Security, Medicare, State health departments etc. etc.

    Two years ago my father passed away and eventhough he had divorced my mother several years prior, everything regarding my mother's healthcare changed again.

    In addition to the diarists excellent advise ... I would reccommend that you talk to your father and suggest that he should not divorce your mother and run off with his "tart".

  •  Thank you Persiflage (1+ / 0-)
    Recommended by:

    needless to say, I am pretty shaken up. I am a bit over 71, have Medicare + husband's insurance (now AETNA - PPO) supposedly for life.
    My husband is on Medicaid in a nursing home (brain damage due to Alcohol).
    Receive half his SS, a small amount from my German SS + a certain amount from Medicaid, because I am a so called Community spouse.
    That's it, no savings, partly my fault. Determined to pay off debts (abt. 4000), save whatever I can, eat the right things, try to exercise. Walk a lot, because I have a Jack Russell Terrier.
    It is frightening.
    See my therapist today and will bring up the subject of this great diary.

    Thanks again to all of you.


  •  We work and save to leave it to our children (2+ / 0-)
    Recommended by:
    Persiflage, yoduuuh do or do not

    I have heard the last day of life is usually the most expensive, medically.

    It is sad that we work all our lives, then when we become old, everything is taken for our health care.  Before 'greed is good' took over this country, all the elderly ladies in my home town could go to an 'old folks home' for what their social security check was.  They would lock up their home and it wasn't touched.  They may have gotten some help from Medicare too.  Medicaid will pay once you are a pauper.

    I wonder about the gift you are allowed to give your children.  You can give them $12,000 each year, their spouses $12,000 each year.  With three children you could gift $72,000 each year.   You can even gift to friends, relatives and grandchildren, all tax free. Do you have to fill out a certificate and do you have to file it?  I googled gifting and one link took me to a legal certificate to buy for gifting.

    If you have gifted money for five years, then had to go to a nursing home, would they make your children give that money back since that is legally allowed?

    "Democrats can't do any worse than them, but they seem to be trying by votin for Joe."

    by relentless on Thu Nov 20, 2008 at 08:53:49 AM PST

    •  Gifts of up to $12K can be made annually (1+ / 0-)
      Recommended by:

      to whomever and as many as you wish....and there will be no Federal Gift tax.  Depending on the size of your estate you could give, for example, your children a LOT of money tax free.  

      HOWEVER...taxes have NOTHING to do with this discussion.  Medicaid will look back (in some states 3 years and in some 5...all moving to 5)for any asset transfers...which will be considered to have been made to avoid paying for your own care.

      The tax status doesn't matter.  

      The longer I live, the clearer I perceive how unmatchable a compliment one pays when he says of a man "he has the courage to utter his convictions." Mark Twain

      by Persiflage on Thu Nov 20, 2008 at 12:40:02 PM PST

      [ Parent ]

  •  Something very important to look for (0+ / 0-)

    when buying the supplemental insurance that pays the 20% that Medicare doesn't pay and the copays.  Make sure it pays for excess charges.  Some of the lower cost policies don't.

    Excess charges is what doctors charge over what Medicare approves of.  Most people buy the F policy in the supplemental.  We bought J because it pays some home health care.

    "Democrats can't do any worse than them, but they seem to be trying by votin for Joe."

    by relentless on Thu Nov 20, 2008 at 09:01:31 AM PST

  •  In my state (0+ / 0-)

    A, B, C, D, E do not pay for excess charges.   F, G, H, I and J  do pay for excess charges.  K and L don't pay for them.  G only pays 80% of them.
    Be careful, there are two policies for each F and J and one of them is a high deductible.  
    I had to type in my state and county so this may vary with different states.  This info is for Arkansas.

    Here is a link to Medicap link to Medicare that has a search box so you can search in your area.

    Once you decide on the letter you want, Medicare says that all policys of the same letter are identical, so buy the least expensive for the letter you want.

    My husband has Medicare A and B, then a supplemental and a prescription drug plan.

    If you buy the other plans where they are all together this link won't help you.  

    You can go to and find out probably.

    "Democrats can't do any worse than them, but they seem to be trying by votin for Joe."

    by relentless on Thu Nov 20, 2008 at 09:26:35 AM PST

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