# Can You Afford Assisted Living?



## Lon (Nov 27, 2016)

I don't need it at this point, but due to a few medical conditions I'm getting close.My daughter lives 10 minutes away but I would never ever want or expect her to be my caretaker. Due to Peripheral Neurophy in the right leg and foot I may soon have to give up driving. Does that bother me ? Damn right it does since I have always been a pretty independent SOB. Fortunately, if I get to the point of not being able to cook or clean for my self I can afford to have some one come in for that. Same for bathing, pill taking etc. Possible Dementia or ALZ ? I have LTC for that. Hopefully I will not need any of the foregoing scenarios and will just quietly Kick Off, but realistically, at almost 83 ya never know do ya?


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## SeaBreeze (Nov 27, 2016)

I hope that if I ever need it Lon, and if my husband is no longer alive to assist me, that I can afford someone to come to my home and care for me on a daily basis....or move to an assisted living facility.  Depending on the severity of my condition, I would rather quietly just 'kick off' when I knew the time was here.  You're lucky to have a daughter so close to you, I have no children or grandchildren to care for me if I become disabled.  I think I can afford it for a certain amount of time, not sure, cost of everything is rising by the minute.  Hopefully, I'll be in my right mind to make a final decision if need be.


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## Aunt Bea (Nov 27, 2016)

Like Seabreeze I can afford it today, not sure about tomorrow.  I take comfort in the fact that once a person is in "the system" even if the money runs out someone will provide me with three hots and a cot.

It is becoming easier to live independently for those people that are a little bit tech savvy so my hope is that I can be pretty well on my way to the cemetery before I would need to move into assisted living.

Lon, if you may need to give up driving I would suggest that you start making plans and testing options that do not require a car.  Things like public transportation or Uber for routine shopping and errands.  Home delivery of medication, groceries, supplies, etc...  You may be able to slowly wean yourself away from using the car instead of facing an abrupt change.

Good luck!


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## IKE (Nov 27, 2016)

SeaBreeze said:


> I hope that if I ever need it Lon, and if my husband is no longer alive to assist me, that I can afford someone to come to my home and care for me on a daily basis....or move to an assisted living facility.  Depending on the severity of my condition, I would rather quietly just 'kick off' when I knew the time was here.  You're lucky to have a daughter so close to you, I have no children or grandchildren to care for me if I become disabled.  I think I can afford it for a certain amount of time, not sure, cost of everything is rising by the minute.  Hopefully, I'll be in my right mind to make a final decision if need be.



Mama and I are in the same boat......no kids or grandkids to look after us or any other relatives for that matter.

Being disability rated 70% and above from the VA qualifies a vet for free elderly care in one of their facilities (there's one locally) and I qualify, plus with me being a Mason since early 1977 there is always the Masonic Home (for mama and I) and both offer assisted living and nursing home care......because of the VA Center being in town I'd elect for that first.

I've always been a tuff SOB and one who has always ran towards trouble as opposed to away from it but I'll be totally honest......nursing homes and being totally dependent on strangers for our care in the last years of our lives just scares the living crap out of me.


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## Butterfly (Nov 28, 2016)

I sure can't afford assisted living.  I've helped others find placements for elderly parents in either assisted living or LTC facilities, and the price of either is positively shocking -- thousands of dollars a month.  It would be cheaper to pay someone to live in and help.


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## debbie in seattle (Nov 28, 2016)

My husbands mom was in assisted living for about 5 years, she had zero money to do it.   Most of the kids pitched in (6 of them) and paid for her to stay there.


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## jujube (Nov 28, 2016)

Right now, I could afford some kind of assisted living...not one of the "country club" places but a decent enough place.  

The question is how much money I'll have if my mother (who _can't_ afford it on her own) has to go into assisted living one of these days.  She's healthy as an ox, organ-wise, but is getting increasingly unsteady on her feet.  We would first have to sell her house and when that money runs out, we'd all have to pitch in to supplement the costs.  Frankly, I see my mother living to 100 or beyond and my nest egg would have to go for that.  

I don't realistically expect any help from my daughter.  One has to face facts and that's one fact I have to face.  It's not my granddaughter's place to support me, even if she could.   She has said, though, that I will always have a home with her.  That warms me.


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## Aunt Bea (Nov 28, 2016)

jujube said:


> Right now, I could afford some kind of assisted living...not one of the "country club" places but a decent enough place.
> 
> The question is how much money I'll have if my mother (who _can't_ afford it on her own) has to go into assisted living one of these days.  She's healthy as an ox, organ-wise, but is getting increasingly unsteady on her feet.  We would first have to sell her house and when that money runs out, we'd all have to pitch in to supplement the costs.  Frankly, I see my mother living to 100 or beyond and my nest egg would have to go for that.
> 
> I don't realistically expect any help from my daughter.  One has to face facts and that's one fact I have to face.  It's not my granddaughter's place to support me, even if she could.   She has said, though, that I will always have a home with her.  That warms me.



jujube,  This may sound cold but I don't think you should use your life savings to fund your mother's final days in an assisted living facility.  IMO it would be better to have your mom placed in a facility near you that accepts medicaid so you can oversee her care and visit with her on a regular basis.  You can still contribute in small ways for little items that improve her quality of life without using your nest egg.

Good luck!


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## Shalimar (Nov 28, 2016)

IKE said:


> Mama and I are in the same boat......no kids or grandkids to look after us or any other relatives for that matter.
> 
> Being disability rated 70% and above from the VA qualifies a vet for free elderly care in one of their facilities (there's one locally) and I qualify, plus with me being a Mason since early 1977 there is always the Masonic Home (for mama and I) and both offer assisted living and nursing home care......because of the VA Center being in town I'd elect for that first.
> 
> I've always been a tuff SOB and one who has always ran towards trouble as opposed to away from it but I'll be totally honest......nursing homes and being totally dependent on strangers for our care in the last years of our lives just scares the living crap out of me.


Scares me too, Ike. Mason eh? My grandfather was a 32nd degree Mason, mother and gramma Eastern Star.


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## Butterfly (Nov 28, 2016)

Rosemary said:


> I agree with Aunt Bea, I can't imagine your mother even wanting that.  I know I wouldn't want to burden my kids and use up their savings.
> 
> There must be other options available...although I know it's not easy finding them.



I agree with Aunt Bea, too.  My mother would have never wanted that.


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## mathjak107 (Nov 28, 2016)

our ny state partnership plan for long term care covers assisted living


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## Victor Meldrew (Nov 28, 2016)

From what I understand, if doctor declares that you are medically in need of nursing home care, it doesn't matter if you have the money or not, the state will pay for it out of their Medicaid funds. Don't know if that applies to in-home care. I suppose if you have a home, that is considered an asset and Medicaid would come after it as part of their Estate Recovery program.


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## mathjak107 (Nov 28, 2016)

in order to get medicaid you have to have  very little  in assets as well as in many states the surviving spouse  has to live on very little money a month or medicaid takes it .  basically the stay at home spouse can only have about 70-110k in assets not including house or car . in ny income can't be more than 2990  a month . that is for both the spouse and person in the home .  basically that is a life of impoverishment here .

the home is only a protected asset if not held in a trust .

medicaid dictates whether you stay at home or get shipped off to some urine smelling medicaid home up to 100 miles away  , wherever there is a bed .

NOLO 
*Income Limits*

Most states have more flexible income guidelines for Medicaid reimbursement of long-term care. In most states, you can make up to 300% of the SSI income limit and still qualify for nursing-home-only Medicaid (300% of the SSI limit, $733, is $2,199 per month in 2016).
Income guidelines for Medicaid may also vary according to the type of long-term care you are seeking. For example, a state whose Medicaid program covers in-home care services (known as home and community-based (HCB) waiver services) may have a lower monthly income limit for those services than it has for nursing home services. To find out whether you qualify for Medicaid assistance with the long-term care expenses you need, you should contact your local Medicaid office.

*Resource Limits*

For the states who use the SSI standards, SSI has a $2,000 limit on countable assets for one person, and the limit is $3,000 if both members of a married couple are receiving care. But SSI/Medicaid does not count all resources. For example, your home is usually not counted, if you live in it or may return to it (up to a certain amount of equity, $525,000 to $750,000, depending on your state). See our article on SSI eligibility for more information. And again, some states have their own resource rules, so you should check with your state Medicaid agency.
If you have assets that put you over the Medicaid resource limit, you won't be eligible for Medicaid until you have "spent down" your resources below the limit. Many people enter a nursing home or assisted living facility as a “private pay” patient, paying for their care out of their own pocket, and then apply for Medicaid when they have spent down their savings to the point that they meet Medicaid’s eligibility guidelines

If only one member of a married couple needs long-term care services, Medicaid will not require the other spouse to give up all assets and income so that the spouse needing care can qualify for it. Every state has its own “spousal protection” rules so that the healthy spouse can continue to live in the community. The rules allow the healthy spouse to keep anywhere from $22,000 to $110,000 in assets, depending on the state. The rules for the amount of income the healthy spouse can keep are more complicated.

[h=2]Future Medicaid Claims Against Your Estate[/h]If you are over 55 and receive long-term care through Medicaid, or if you are permanently institutionalized before you turn 55, your state’s Medicaid program will have a claim against your estate after your death for the amount that the state spent on your care while you were receiving Medicaid. This is called Medicaid estate recovery. However, the state will not try to recover from your estate until after you spouse dies and only if you have not left any minor or disabled children. Some states, including California, can also recover the cost of Medicaid services other than long-term care services -- as long as they were incurred after you turned 55.





http://www.nolo.com/legal-encyclopedia/when-will-medicaid-pay-nursing-home-assisted-living.html


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## Victor Meldrew (Nov 28, 2016)

mathjak107 said:


> in order to get medicaid you have to have  very little  in assets as well as in many states the surviving spouse  has to live on very little money a month or medicaid takes it .
> 
> the home is only a protected asset if not held in a trust .



You can have up to $2,000 in assets and a small monthly income. But if you have more than that while not having enough money to afford a nursing home after a doctor declares that you absolutely need to be in one, they will put you in a state run nursing home and charge it to Medicaid. If you own a house, they can put a lien on it or go to court and take it.

When my dad had to go in a nursing home, my mom owned (still does) the house and they had a fair amount in the bank. My mom was told she could have up to $80,000.

The state paid the nursing home bill and nobody touched my mom's house or money. But that applies to surviving spouse only. Children have to give it up.

Also, if a child lives in a parent's house as a caregiver for 2 years, the house cannot be siezed under the Medicaid Estate Recovery.


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## mathjak107 (Nov 28, 2016)

i  just added the asset limits to my post above while you were typing .

i can tell you this  , trying to live here on 2990 a month and only 115k in assets for the stay at home spouse  would be a life of impoverishment . certainly nothing we would ever want .

which is why we have a partnership plan with our state.

we have 100% asset protection with no limits , no income limits at all for the stay at home spouse  .  we have 3 years nursing home care and 6 years assisted living or in home care . 

but it is the perks after the insurance runs out that makes it worth it .

as long as the private facility we are already in as a full paying cudstomer takes medicaid , then a special version of medicaid picks up all our bills .  no assets are ever touched . we looked in to the local facility's and they said as long as you are in and paying for 3 years they would take assignment from medicaid if more time was needed .

if care is needed we can elect in home care and not be forced away as medicaid can do . we call our plan anti-nursing home care insurance .


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## mathjak107 (Nov 28, 2016)

you don't believe what ?  those are the limits , so unless you are under those limits income wise and asset wise you will not be eligible for medicaid . so not sure  what it is you don't believe . for folks with a fair amount of assets 115k left  is near broke . in fact here in nyc that is our 1 year budget . nursing homes run 120-140k a year here .


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## Aunt Bea (Nov 28, 2016)

mathjak107 said:


> i  just added the asset limits to my post above while you were typing .
> 
> i can tell you this  , trying to live here on 2990 a month and only 115k in assets for the stay at home spouse  would be a life of impoverishment . certainly nothing we would ever want .
> 
> ...



I went out and looked at the information on the NYS site and was not clear on the cost of this coverage.  They show a chart with various rates but do not indicate if they are monthly or annual.  In my case the rate was 3.5K-4K.  Do you know if this is a monthly premium, if it is I think I would be better off to go _*commando*_!


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## Victor Meldrew (Nov 28, 2016)

mathjak107 said:


> in order to get medicaid you have to have  very little  in assets as well as in many states the surviving spouse  has to live on very little money a month or medicaid takes it .  basically the stay at home spouse can only have about 70-110k in assets not including house or car . in ny income can't be more than 2990  a month . that is for both the spouse and person in the home .  basically that is a life of impoverishment here .
> 
> the home is only a protected asset if not held in a trust .



Below edited/added into post after my last post above.



mathjak107 said:


> medicaid dictates whether you stay at home or get shipped off to some urine smelling medicaid home up to 100 miles away  , wherever there is a bed .
> 
> NOLO
> *Income Limits*
> ...



Pretty much agrees with what I said above.


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## Victor Meldrew (Nov 28, 2016)

mathjak107 said:


> you don't believe what ?  those are the limits , so unless you are under those limits income wise and asset wise you will not be eligible for medicaid . so not sure  what it is you don't believe . for folks with a fair amount of assets 115k left  is near broke . in fact here in nyc that is our 1 year budget . nursing homes run 120-140k a year here .



"I don't believe it!!!" is my sig line.

Based on the character I usernamed myself after.

http://www.bbc.co.uk/comedy/onefootinthegrave/


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## Victor Meldrew (Nov 28, 2016)

mathjak107 said:


> i  just added the asset limits to my post above while you were typing .
> 
> i can tell you this  , trying to live here on 2990 a month and only 115k in assets for the stay at home spouse  would be a life of impoverishment . certainly nothing we would ever want .
> 
> ...



That's all well and good, but the older you get, the higher the premiums for long term care insurance gets.

And just pray that the insurance company stays in business.


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## mathjak107 (Nov 28, 2016)

not true . the older you start  the more the premiums . but one you have a current policy which are now priced properly  we have had no increases after the initial year .  that is not to say you won't get cost increases , but they have more to do with costs going up than age . we are into our 3rd year with no increase the last 2 .

in fact we don't really care about the 3 years coverage we had to take . it is the partnership perks after wards that are priceless .

the policy's are generally priced so by around 80 you pay in 1 years care in premiums .


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## mathjak107 (Nov 28, 2016)

the rates are yearly yearly , but in nys there are different kinds of plans . private non partnership plans in my opinion are not worth it as you get no perks afterwards like total asset protection and no income limits if medicaid picks up the bills . nys partnership plans also offer dollar for dollar plans that are cheaper but offer no total asset coverage .

itook it a 62 and my wife was 64 and i am diabetic . we pay for the two of us 7800.00 a year and get a 1600 dollar tax credit from nys plus get to deduct some off the federal . we took 350 a day  with 5% yearly inflation adder .

but we do have sizable assets  so it is important to us . we do not want to get bogged down in trusts and shifting assets . our state put together one of the best deals in the country as most states are not total asset protection on their partnership plans .


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## Aunt Bea (Nov 29, 2016)

mathjak107 said:


> the rates are yearly yearly , but in nys there are different kinds of plans . private non partnership plans in my opinion are not worth it as you get no perks afterwards like total asset protection and no income limits if medicaid picks up the bills . nys partnership plans also offer dollar for dollar plans that are cheaper but offer no total asset coverage .
> 
> itook it a 62 and my wife was 64 and i am diabetic . we pay for the two of us 7800.00 a year and get a 1600 dollar tax credit from nys plus get to deduct some off the federal . we took 350 a day  with 5% yearly inflation adder .
> 
> but we do have sizable assets  so it is important to us . we do not want to get bogged down in trusts and shifting assets . our state put together one of the best deals in the country as most states are not total asset protection on their partnership plans .



Thanks for the information, I think I will look into this.


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## mathjak107 (Nov 29, 2016)

the total asset plans  are only total asset in ny . if you move ny has no say over the perks so the plans revert to dollar for a dollar plans . that means if medicaid spends 200k then 200k  in assets are protected .

we were going to self insure but we learned that would have been a poor choice .

money magazine did a feature story on us years ago .

they wanted to put their team of pro's against me  since i did all my own planning .

i wanted to self insure and they were against it for so many reasons . they were right .

those who say they are self insuring really have no plan . they hope they don't need care and they hope they have the funds .

but once the stay at home spouse goes in to survival mode those funds become a battle ground usually .

the issue with self insuring is that like any insurance :

you need the funds to cover you day 1 . you have to invest that insurance money in a safe and secure fashion . it can not just be thrown in the pool of money generating your income since that assumes it can always go to zero doing so .

to self insure  properly means safe low returns on that money .

for just a small percentage of the gains from keeping our money invested normally we can pay for a full blown , inflation adjusted policy that covers 3 years in a snf or 6 years assisted living or in home care .

so we ended up going the policy route .

most of our attorney's work today is the self insurer's . they are scrambling at the last minute trying to preserve assets and to protect the income of their spouse .


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## mathjak107 (Nov 29, 2016)

there are lots of reasons the insurers had trouble getting the costs for premiums correct . the biggest being the statistics are way way off as far as usage .

all these numbers about how low the odds are of needing care were incorrect . they were based on a generation ago as most boomers are not yet in the range .

boomers are living longer and tend to have different health issues . there are also 2x as many boomers as the older generation had . in 1999 medicaid slashed the budget for skilled nursing facility's in half and folks were sent more to assisted living facility's than nursing homes so it showed low usage of long term care in nursing homes  which really was not the case .

the biggest issue is many tried to care for older parents ourselves and it split family's up in droves .
i can tell you with my dad there was no way anyone of us could have taken care of him in our home .

usually by the time snf is needed it is well beyond family .

how it typically plays out is a family member gets hurt trying to move 200 lbs of limp flesh if they are moving someone paralyzed from a stroke and they are both in trouble or the person becomes violent with memory issues and someone gets hurt ...

the best way to bust up a family is have one sibling step up to the plate and take in a parent who needs care . odds are the other siblings step back and the battles begin . 

usually the person providing the care takes a monetary hit , a career hit , a social hit and maybe even loses a job .

if you have a spouse odds are you can kiss that marriage good bye once the spouse starts on why do we have to do it and sacrifice so much and your brothers and sisters do nothing .


one of the worst things parents can do to their kids is drop their long term care burden on their children .

 many boomers have lived this and will end up spending a lot more money on long term care costs then estimated previously . insurers found out the hard way that times have changed , the population  numbers have changed and those with insurance are spending far more on care for longer than the insurer's thought .

early policy's were way under priced and many saw huge jumps up to reality .  but so far it looks  like they may finally have nailed it . many states also are part of a long term care insurance price stabilization group .  increases are very carefully monitored


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## mathjak107 (Nov 30, 2016)

one option are those cross linked life insurance policy's but while better than no insurance they end up being very costly and have very limited coverage .

they basically force you to plunk down a big pile of cash in exchange for a death benefit of 2x what you give them and the ability to draw even a bit more if long term care is needed .

you get little interest if the policy is held to death and any long term care payments are subtracted out .

it may be like trying to be a little bit pregnant , it may be so far from being able to support a home down the road that it does no good regardless .

as michael kitces pointed out :

The primary issue, as I’ve discussed previously on this blog, is that those buying hybrid life/LTC or annuity/LTC policies are at risk to losing out on significant long-term returns, because if/when rates ultimately rise, there’s no guarantee that hybrid policies will pay competitive fixed income rates of return. In other words, if a client puts $200,000 into a hybrid LTC policy, and interest rates rise to 5%, the hybrid policy might only pay out 3%, and the client “loses” $4,000/year of return as an indirect “cost” of holding the policy. In fact, the whole reason hybrid LTC policies can guarantee the LTC insurance costs is BECAUSE they are NOT guaranteeing to pay fair market returns when rates rise! _Of course_ the company can guarantee that the LTC costs in your hybrid policy won’t be increased by $4,000/year (or at all), when the company can simply under-pay on the return by $4,000/year to get the same result with impunity, because_they control the money_!


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