Mr. Lieber -
I think a good predictor to the course of events should Block Grants to states replace Medicare/Medicaid - look at how states handled the finances when federal hospitals for mentally ill were closed and states were expected to pick up the slack. (Lots of differences, I know... but still...)
1
Most well to do individuals either pay for longterm care out of pocket or transfer their assets to relatives so they can be subsidized by taxpayers. Instead of forcing taxpayers to subsidize others just scrap Medicaid. The "poor" will get by as they did before Medicaid was forced on the Nation in the 60s.
And if the "poor" realize that they have to become self-sufficient and responsible for their own health needs you might not have "poor" single Moms cranking out babies by the bushel because Government handouts increase with every new family member.
And if the "poor" realize that they have to become self-sufficient and responsible for their own health needs you might not have "poor" single Moms cranking out babies by the bushel because Government handouts increase with every new family member.
1
John: Perhaps you could suggest how the following situation might be handled:
My father spent almost his entire career in a factory, paying into its pension plan. The factory went bust, closed, everyone was out of work and the pension funds somehow vanished. He was out of work for some time, but we never took a dime of welfare. At 50+, he started over on the bottom rung of the civil service ladder. He died, still working, at 69. My mother had worked off and on when we were teens but at part-time, no-benefits jobs. So no pension, and her Social Security was minimal. For 26 years she was able to live on her own in a little apartment. Then 3 cancer surgeries, a stroke, and loss of sight made that impossible. She moved to Texas and lived on our place, in a separate mobile home. Fearing what might lie ahead, we "charged" her an exhorbitant "rent" that I deposited in a savings account in my name. She was 87 when a blood clot caused amputation of her leg and she went into a nursing home. She had to pay several hundred dollars a month from her savings until the balance was about $300 before Medicaid kicked in.
My folks worked hard, paid their debts, tried to save, do things the right way. Mom "cranked out" just 3 kids. What do you think would have happened without Medicaid? I bet there are more families like ours than your stereotyped "poor."
My father spent almost his entire career in a factory, paying into its pension plan. The factory went bust, closed, everyone was out of work and the pension funds somehow vanished. He was out of work for some time, but we never took a dime of welfare. At 50+, he started over on the bottom rung of the civil service ladder. He died, still working, at 69. My mother had worked off and on when we were teens but at part-time, no-benefits jobs. So no pension, and her Social Security was minimal. For 26 years she was able to live on her own in a little apartment. Then 3 cancer surgeries, a stroke, and loss of sight made that impossible. She moved to Texas and lived on our place, in a separate mobile home. Fearing what might lie ahead, we "charged" her an exhorbitant "rent" that I deposited in a savings account in my name. She was 87 when a blood clot caused amputation of her leg and she went into a nursing home. She had to pay several hundred dollars a month from her savings until the balance was about $300 before Medicaid kicked in.
My folks worked hard, paid their debts, tried to save, do things the right way. Mom "cranked out" just 3 kids. What do you think would have happened without Medicaid? I bet there are more families like ours than your stereotyped "poor."
27
Medicaid was not "forced on the Nation in the 60s". It had widespread support but several times was turned back by minority filibusters and paid campaigns featuring movie star Ronald Reagan. When the AMA got what it wanted, legislative opposition evaporated.
I did spend a few years studying anthropology. One repeated concept was that for primitive societies without social welfare nets, women would have more babies both to have some survive and to have support in old age. This seems to be what John Smith wishes to encourage, despite his accusing single Moms of "cranking out babies by the bushel".
I did spend a few years studying anthropology. One repeated concept was that for primitive societies without social welfare nets, women would have more babies both to have some survive and to have support in old age. This seems to be what John Smith wishes to encourage, despite his accusing single Moms of "cranking out babies by the bushel".
11
A little data would help understand the problem. The average length of stay in a nursing home is around 2.75 years but the median is just 5 months before death. In other words, half are in nursing homes for 5 months or less. As to those of us who actually planned during the past 45+ years, we have long term care insurance and sufficient savings to never require medicaid even if we are in a nursing home for twice the average. Alas, a majority of my baby boomer peers did not do so and will become a medicaid problem.
Medicaid is, and shall remain, an essential healthcare helping hand for too many Americans...to ignore ignominious "fake Trump's" intent to disembowel it. Educate yourself in it, and defend it, as you cannot trust politicians to look after your well-being without reminding them their allegiance is to you.
4
Obviously we need a national program and plan for caring for elders. But since we don't, whatever we (I am old) have accumulated is available for our care. This may be a sad and troubling situation--you want to pass something on to your children, for example--but why should the money we have accumulated NOT be used for our own care? Why should we feel entitled to "protect" it from our own costs? Who IS responsible for us? I think the real problem is that wealthy people have so many ways to keep their money while most of us don't have the wherewithal to play games; the playing field, as usual, isn't even. Which is why a national program based on regular contributions by everyone is needed. Say what you will, we are living too long not to face the cost.
15
By far, the best, most thoughtful article on long term care and aging that I've seen in a long term. Unfortunately, everyone thinks it won't happen to them - right up until it does. But buying the right LTCi policy can go a long way towards easing many of the burdens this care can create for a family. The problem is that most people (and agents who don't know any better) try to insure for the entire cost of a nursing home. Instead, take a look at the costs of care in your area, then consider your disposable income and think about buying insurance to pick up the difference. Example: My mother in law (with dementia - but very healthy) is in an Assisted Living Facility that runs $5100 per month. Her Social Security is about $1800 per month. Her ex-husband's pension is about $2300 per month - so all she really needs to make up is about $1000 per month. Of course, if she goes into a nursing home that will change - but the truth is, if she gets bad enough to need nursing home care, it is unlikely she will live much longer. Right now that $1000 is coming out of her savings and will last quite a few years. If she had a policy, that money would have gone to her children - which is what she wanted. And policy that pays $1000 a month would have cost peanuts. Don't let any agent tell you that you need to insure the entire cost of care - that's just not correct and leads to the false conclusion that LTC insurance is too expensive.
4
Reply to Equilibrist.
You write that your Mother lives in Assisted Living with rich people whose Assisted Living is paid by Medicaid. Medicaid DOES NOT pay for Assisted Living.
I've been caregiver for 3 relatives who had LTC Ins. and one with few assets who had to go on Medicaid. I've spent years in nursing homes and got to know lots of the sweet residents there. Most were on Medicaid and many had few visitors. They were so happy to have someone call them by their first names and talk and pay attention to them. I was a member of the Family Council at our nursing home.
You write that your Mother lives in Assisted Living with rich people whose Assisted Living is paid by Medicaid. Medicaid DOES NOT pay for Assisted Living.
I've been caregiver for 3 relatives who had LTC Ins. and one with few assets who had to go on Medicaid. I've spent years in nursing homes and got to know lots of the sweet residents there. Most were on Medicaid and many had few visitors. They were so happy to have someone call them by their first names and talk and pay attention to them. I was a member of the Family Council at our nursing home.
2
Yes, Medicaid does pay for care in Assisted Living Facilities. It's part of the Medicaid Waiver Program. It can be very difficult to get a Medicaid waiver, especially in areas with a high population. But in places like rural South Dakota, they are quite common.
4
My grandmother is currently in an assisted living situation at a nursing home in CO that has three areas: Assisted Living, Long-term Care, and Physical Therapy. Medicaid picked up the bill when she was in all three areas and will continue until she moves on. She is highly blessed; it's a great facility with wonderful people who care about their seniors. To pay into this program my entire life and not have it when I am old is scary.
5
When The Red states have no checks to send to the small board and care homes for millions of the old on Medicaid they will push grandma out the door in a wheelchair to the sidewalk .....and they may call a family member to hurry over 'as it is expected to rain tonight.
6
The Constitution does not give the federal government any authority to spend somebody else's money on somebody else Healthcare or whatever. That's what you get depending on so-called government then it's really funny that some of you think there's a difference between Republicans and Democrats sad
As a long-term Medicaid recipient, I'm grateful past counting for the assistance I've received. I wouldn't be alive today otherwise. Bouts of cancer, and auto-immune defects of blood clotting not withstanding, I take care of my brother's mental and physical disabilities, his wants and needs, and have done this ten years. Before that we both took care of our mom after her auto accident, out of and into her dementia for sixteen years in her home. We both had to give up our chosen careers in other areas in order to accomplish this without any financial remuneration but room and board, but living in an area where our home didn't sell, and our job opps were limited, we scraped for everything. Now we're faced with the dilemma of being "too qualified" [i.e. old/decrepit] for jobs here.
We got a reverse mortgage in order to stave off tax foreclosure, make home repairs and maintenance, pay Mom's deferred prop taxes - and promptly found out we were in violation by a couple grand of the tight Medicaid resource caps. Now we're poor again, having been forced to spend down the balance instead of saving it for future taxes & expenses [none of which will be a Hawaiian vacation]. The rev-mort outfit can take our home if we default on taxes or insurance. Looks like cardboard box condos beneath a bridge are in our future. So Repubs, you won't have to worry over paying our exorbitant Medicaid bills - just remember: There but for Fortune.
We got a reverse mortgage in order to stave off tax foreclosure, make home repairs and maintenance, pay Mom's deferred prop taxes - and promptly found out we were in violation by a couple grand of the tight Medicaid resource caps. Now we're poor again, having been forced to spend down the balance instead of saving it for future taxes & expenses [none of which will be a Hawaiian vacation]. The rev-mort outfit can take our home if we default on taxes or insurance. Looks like cardboard box condos beneath a bridge are in our future. So Repubs, you won't have to worry over paying our exorbitant Medicaid bills - just remember: There but for Fortune.
8
War...or business....the smart course is always the same...
..
............................ Attack the weakest, at their weakest ................................
..
The Republicans are smart to attack the elderly and sick who can't fight back.
And don't forget the American People voted "Uncle" Mitch, "Rob'em" Ryan and the rest of the Tea Party conservatives into office. Of course none of them seems smart enough to do the prerequisites - take the guns first!
..
............................ Attack the weakest, at their weakest ................................
..
The Republicans are smart to attack the elderly and sick who can't fight back.
And don't forget the American People voted "Uncle" Mitch, "Rob'em" Ryan and the rest of the Tea Party conservatives into office. Of course none of them seems smart enough to do the prerequisites - take the guns first!
9
If you are planning on living to a ripe old age clearly the chaos in Washington DC has a message for you. The economy is humming and Washington is in chaos. Do not plan on more government help but less. The Republicans tried to compete with Obama in terms of largesse and predictably they found out that Washington can not support all your wants. Strange that they did not see that one coming. A personal plan: cut unnecessary spending, downsize and live with your children. I know that seems tough but the handwriting has been on the wall for quite some time.
1
Many fulminate at heartless Republicans. At least concede that Trump's immigration policy is completely consistent with a saner financial future. We cannot admit, and make eligible for benefits, all those in the world who would like it. Not even all those in Mexico.
It is hugely irresponsible to advocate open borders and yet bewail the stresses on Medicaid.
It is hugely irresponsible to advocate open borders and yet bewail the stresses on Medicaid.
4
Jellytoes thinks that the first thing that needs to be done when you discover you can not afford what you assumed you could afford is to take away the other guy's guns. This thinking is precisely the evidence we need that things will get worse and not better. Jelly, it is the money fella.
You might want to get some facts straight before you assume immigrants are coming to "feast at the public trough": see http://money.cnn.com/2014/11/20/news/economy/immigration-myths/
1
Everything we see today dealing with healthcare is after the fact. Obama Care, Trump Care, Bernie care or Medicare isn't going to solve the problem. We have to use U Care! We can't rely on Congress insurance company's it's up to us to fix it. How do we do that? We must start by tackling the root cause and that's the " Low Fat My Plate" diet that has been shoved down our throats. The CDC estimates that 70% of American's are either overweight or obese and feeding folks extra carbohydrates only exasperates the problem. For the first time the American diabetes Association has acknowledged the "Low Carb Ketogenic Diet" is extremely effective at weight loss and the "Low Fat" diet is totally ineffective at weight loss. They also stated that the Low Carb High Fat Ketogenic Diet reversed Type 2 Diabetes symptoms in patients almost immediately! The things that cause Type 2 diabetes are the main cause of almost all chronic illness. The CDC says that 80% of all Chronic illness is preventable. That is the answer to our health care woes! "PREVENTION"
2
All well and good and I do most of what you recommend but how did I, a persistent jogger and walker, know that I would get arthritis in my hip or that my son, who is an athlete, watches his diet, and is a body builder would end up with life threatening diverticulitis. If you are a human being someday you need medical care. You can be in the greatest shape and have a drunk run into you when you are speeding along on your bike going for that morning 25 mile conditioning ride. You just never know but what you can be sure of is that no matter the prevention, some day, some how you're going to need health care. It's a universal truth about the human body and it needs a universal solution. Health insurance for all, single payer is the solution. This has been figured out by the entire world save the U.S. After we provide that system and during then, yes, by all means let's promote prevention. How about taking on the agribusiness and the junk food they keep producing for starts.
16
This Medicaid debate is so complex.
I'm finding myself thinking of all the things that impact it:
- burdening others
- personal dignity
- economics
- lifestyle choices
- greed
- faith
- love
- social darwinism
- rugged individualism
- the nature of community
- the nature of family
- guilt
- society and the individual
- the worth of human life
- poverty and wealth
- compassion
- indifference
And on and on. Any one of the above could have its own article.
I just hope that when its my turn to have my body fail
in some way, that I can thoughtfully face all the ramifications.
Peace to you all.
I'm finding myself thinking of all the things that impact it:
- burdening others
- personal dignity
- economics
- lifestyle choices
- greed
- faith
- love
- social darwinism
- rugged individualism
- the nature of community
- the nature of family
- guilt
- society and the individual
- the worth of human life
- poverty and wealth
- compassion
- indifference
And on and on. Any one of the above could have its own article.
I just hope that when its my turn to have my body fail
in some way, that I can thoughtfully face all the ramifications.
Peace to you all.
6
Mr. Lieber, please investigate how other countries take care of their elderly and write about that so we can see how this problem is tackled internationally. I am a geriatrician and it's interesting how the elderly are treated in this country compared to others. For example, my aunt in Canada was disabled by a stroke and gradually recovered much of her function over many years. During that time, she had in-home help with meals, cleaning, exercises,etc. along with transport to the occasional senior activity. She was not impoverished and neither was her family. In contrast, getting the same help here for my patients is very difficult.
19
Hopefully the Republicans will leave us the option of suicide; although the nursing home lobby, at the prospect of losing $100,000 per person per year, may make this illegal.
16
I am 60 and my wife is 61. We both bought long-term care insurance from a highly-rated, name-brand life insurance company back in our 40s, when we were healthy. Statistically, one of us is going to need it and, besides, we have accrued too much in assets to ever qualify for Medicaid to pay.
Americans simply don't plan their futures. Do they think children, college and rest home or in-home care don't cost money? Thirty years of long-term care insurance premiums are still less than a year of the cost of a good rest home. Have you seen the difference between a Medicaid old folks home and a private-pay facility?
We have no children, and after our pet trust terminates on the death of our surviving animals all of our money is going to charitable organizations, not members of our families. I don't want my estate going to a rest home or the IRS--I will have paid more than enough in taxes by the time I die.
Americans simply don't plan their futures. Do they think children, college and rest home or in-home care don't cost money? Thirty years of long-term care insurance premiums are still less than a year of the cost of a good rest home. Have you seen the difference between a Medicaid old folks home and a private-pay facility?
We have no children, and after our pet trust terminates on the death of our surviving animals all of our money is going to charitable organizations, not members of our families. I don't want my estate going to a rest home or the IRS--I will have paid more than enough in taxes by the time I die.
3
I've read many articles about problems and disappointments with long term care plans not paying out and not worth the money.
5
The LTCi industry currently pays out literally billions in dollars in claims every year. As with most insurance, there will always be those who thought they were entitled to benefits but didn't understand the policy requirements. Simply receiving care, being in a facility or being frail is not enough to trigger a claim - there are specific criteria that one must meet. Most often, the folks that are complaining are the ones who don't understand that.
1
One more "head in the sand" reality. Long-term care insurance is not a panacea. You can be rejected very easily. If you qualify, the premiums are expensive, and when it comes time to collect, you have to jump through so many hoops, and deal with so many bureaucrats, it is maddening. After that, there is a cop on the payments that many people outlive. We need to face the eldercare issue head on and soon.
6
Leah - you are only partly correct. If you wait until you already have a health condition then yes, you can be rejected. But you wouldn't wait until you crashed your car to call Allstate, would you? Unfortunately, that's what people do when it comes to buying LTCi. Most are convinced they will never need the insurance, until they do. Then they hurry up and apply hoping the insurance company won't notice they are already sick. And they get mad when they are declined. Go figure. If you purchase a policy when you are young (50-60) the premium is no more than a cup of Starbucks per day...that is also when you are most likely to health-qualify. It is also incorrect to think that most people outlive their policies. In fact, according to Genworth (who pays more claims than any other carriers) less than 12% of claimants end up exhausting their benefits. Women are most at risk because they go on claim more than men and their claims also last longer. You are however, correct in that we need to face the issue head-on. This is a train wreck headed for our country.
2
I agree with Ms. Stahlecker save for one item: I tell people to apply for LTCi between 45 to 50, UNLESS they are in extremely good health, physically active on a regular basis and have average-to-good family genetics - and that latter group is no more than 35-40% of the many folks we know.
We have had LTCi policies since our late 40's. We have paid less than $50K in total for 2 policies (over 2 decades). With 5% inflation compounding, our policies currently pay $135K/tax-free/yr. for each of us, unlimited (the last being almost unavailable these days, but 5-7 yrs should suffice for most people). Asst lvg and homecare are included.
Expensive, yes. But worth every penny for peace of mind. Our family members, who were offered the chance to buy LTCi through us from the same state government program, but refused, now deeply regret it....and so do their kids, who have careers, mortgages, their own young kids and future retirement, to worry about in addition to their aging Boomer parents who don't have sufficient savings or LTCi.
We have had LTCi policies since our late 40's. We have paid less than $50K in total for 2 policies (over 2 decades). With 5% inflation compounding, our policies currently pay $135K/tax-free/yr. for each of us, unlimited (the last being almost unavailable these days, but 5-7 yrs should suffice for most people). Asst lvg and homecare are included.
Expensive, yes. But worth every penny for peace of mind. Our family members, who were offered the chance to buy LTCi through us from the same state government program, but refused, now deeply regret it....and so do their kids, who have careers, mortgages, their own young kids and future retirement, to worry about in addition to their aging Boomer parents who don't have sufficient savings or LTCi.
A lot of people think Medicare is the safety net for aging people. I appreciate any dissemination of information that tells people it's Medicaid that provides for long-term care to the aging and disabled.
Yes, we could reform the rules that allow people to artificially spend down resources to allow wealth to be passed to heirs. That would make it seem more fair to use public funds for old, sick and disabled people.
The argument that we can't afford this is hollow. Someone will pay or people will suffer.
The baby boomers are approaching the time when many will fall into the category of very old. It's predictable that there will be costs associated with this. Too bad we didn't do something about this before. Capping Medicaid now is certainly not the answer.
Yes, we could reform the rules that allow people to artificially spend down resources to allow wealth to be passed to heirs. That would make it seem more fair to use public funds for old, sick and disabled people.
The argument that we can't afford this is hollow. Someone will pay or people will suffer.
The baby boomers are approaching the time when many will fall into the category of very old. It's predictable that there will be costs associated with this. Too bad we didn't do something about this before. Capping Medicaid now is certainly not the answer.
6
How true. We have, somehow, created poverty in this advanced/civilized society of ours, where capitalism always favors capital over labor, and inequality a rising factor...unless counteracted with sensible regulations to minimize it's inequities. And health benefits via Medicaid seem fundamental for our survival if longevity is appreciated, far too expensive for any given individual to bare. It behooves any society proud of it's diversity to be inclusive, and allow justice to prevail. And private compassionate assistance won't cut it, no matter how generous and well meaning. Now, don't get me started about the nasty, cruel and misguided republican plan to disenfranchise all of us from the rightful assistance we, the people, have deemed necessary in our less than ideal circumstances, when disease and trauma claim, sooner than later, our better selves, on our way to oblivion ( death, the ultimate redeemer of our unfulfilled needs).
7
Ron, I would like to know how some of the other developed countries, which have single payer health care, handle nursing home care for their elderly. Also, I would like to know if there are any countries that accept retired Americans as residents and allow them access to affordable health care and nursing homes. Or would those American ex-pats have to buy their own insurance? I know that Medicare will not pay for any health care provided outside of U.S. territory. Is that insurance affordable and does it cover long term care? As long as the Republicans are in power, I am beginning to think I should start planning now to retire in another country if we don't turn this around in 2018 or 2020. But the main question is: which countries offer the best long term solution in terms of political stability, economic costs and long term climate change for American ex-pats? It would devastate me not to stay in my country and fight for change, but I need to start planning for the next 30 - 40 years. I am only 60 now and have a long life expectancy, but I also have a chronic disease that will force me to require assistance during the end stage of the disorder. Which leads to my last question: Is it even possible to buy long term health care policies for care here in America or health care coverage in other countries with a pre-existing condition? Thank you for your coverage of this issue, Ron!
6
It can be very hard. I have some stats here. Good luck, and I hope to look at the global state of affairs soon.
2
Well, I am an ex-pat living in Mx but only 7 blocks from the U.S. border. I, too, have a chronic disease, which I am treating in the U.S. with m/care. But...medical care is so cheap here, I think I could have all treatment here (and drugs) for < transport/lodging costs to U.S. And probably as good. I mean, I'd like to know the value added for the 400$ lab bill in U.S. as opposed to equal for $12 here in Mx. I rent a pretty nice house here, bills < 250$ a month (total) and I pay a house-keeper maintenance man about 3$ an hour. People always ask me why I live in Mx, I always say: "financial freedom". I suppose for many, living like I do is totally out of the question. Their personal comfort zone will not allow it. And the fear factor also. Can't forget the drumbeats of fear for the Mexicans/Mexico. I have seen a place near Mx City (retirement home) for about $1000 a mo. People love it. So...the U.S. is not the only option for 'retirement" if you keep an open mind. Check it out.
Obamacare expanded the Medicaid eligibility rolls to include the working poor. Hence, more payouts. However, with the ever increasing needs of aging Baby Boomers requiring subsidized assistance once savings are depleted (or finagled through legal loophole schemes), the pool is being drained. The choice we now face is whether to continue to take from the newly aged poor to give to the working poor or raise taxes exponentially. (The previous poor will always exist). The idea that a few billionaires are going to cover the costs of everyone and everything in America is ludicrous. If you want socialism, then as in those countries, put your hard earned monies where your mouth is. Give half to the government and 10% to charity. Otherwise stop expecting something for nothing.
1
What have we become? People who rob and commit fraud are free to continue, and we warehouse and stack, like kindling, the poor, old and less fortunate. Is this who we truly wish to be?
6
Dear Ron,
Thank you for this clear and helpful article.
What direct action do you advise me, my friends and neighbors in northern Virginia, to take at this time? We are all 60's or more, living in our own homes in a good neighborhood and pretty healthy thus far. A lot of us have considered buying long term care insurance but the costs are pretty staggering. So many of us have taken to carefully investing a certain portion of our savings in low risk/low reward investments that could be tapped on short notice should we need those $ for care facilities. All of us at this point could not be eligible for Medicaid without a significant down turn in our assets, which we certainly hope will not occur!!
I had read some time ago that a few companies would start offering a form of convertible LTC policies, whereby a percentage of paid in dollars could be refunded if benefits were never paid out. Has that become true?
Many thanks in advance for any thoughts you can share with us.
Elizabeth
Thank you for this clear and helpful article.
What direct action do you advise me, my friends and neighbors in northern Virginia, to take at this time? We are all 60's or more, living in our own homes in a good neighborhood and pretty healthy thus far. A lot of us have considered buying long term care insurance but the costs are pretty staggering. So many of us have taken to carefully investing a certain portion of our savings in low risk/low reward investments that could be tapped on short notice should we need those $ for care facilities. All of us at this point could not be eligible for Medicaid without a significant down turn in our assets, which we certainly hope will not occur!!
I had read some time ago that a few companies would start offering a form of convertible LTC policies, whereby a percentage of paid in dollars could be refunded if benefits were never paid out. Has that become true?
Many thanks in advance for any thoughts you can share with us.
Elizabeth
Those policies have gotten very popular, and agents reaaallllly like selling them. Be very careful. Here's a story we did.
Elizabeth: At your age, the premium should not be "staggering". The mistake most people make is they try to design their policy according to the costs of a nursing home near them, without considering their other disposable income. According to the Genworth Cost of Care Study, here are the average monthly costs in your state: Adult Day Care: $1408, Assisted Living Facility: $3950 Nursing Home Private Room: $7422. Take a look at your income and decide - if you ever needed care - how much of your own care you could afford to self-insure. A policy that pays $3500 a month in benefits would be more than enough to cover home care, Adult Day Care and Assisted Living. a 3-4 year plan would run you about $250 a month in premium - hardly staggering. If you did end up in a nursing home, you would have to make up the shortfall from your income/investments. But the insurance would still be paying the bulk of the claim. The most important thing to know is this: When it comes time to enter a nursing home, the first question will be "Who is going to pay for this?" and trust me, those with a ready supply of cash (such as insurance) go straight to the top of the list. It's not fair, but that's the way it is. Yes, you'll be spending down your assets, but at a much slower rate.
2
An extra $250/month? No one I know has that extra money. We are all desperately downsizing, saving, cutting expenses and live in lower income marginal neighborhoods, because we just don't make enough money to get out of them. We do service jobs that pay $60,000 or less annually. We are so very careful with everything. We don't have children or families to live with either. The only other thing would be to cut my "luxury" subscription to the Times online and the attending internet access. I volunteer in an Alzheimer's medicaid facility, and I see the horrors that are coming. Moving to a state where you can choose to die doesn't seem so far fetched.
Although not for everyone, an option for protecting your assets and ensuring high quality long term care, is moving into a Life Plan Retirement Community, also known as a CCRC, continuing care retirement community. CCRCs offer an excellent retirement lifestyle with the assurance of moving into assisted living and skilled nursing at a cost much lower than described in the article. There are over 2000 CCRCs in the country serving around 680,000 people.
Before moving into ANY facility, but especially a CCRC, you need to do research into not just the care quality and environment, but the finances. And in Northern CA CCRCs are not cheap: an average 300 sq. ft. studio runs a base cost $2800-3900 without any assistance, and even the smallest assistance costs hundreds of $$/mo. in addition. A CCRC skilled nursing unit runs $8-14K/mo. Buy-ins to CCRC range from $4K to $800K.
My spouse and I, and my MIL (for whom we did this research) are fortunate to have sufficient funds. But none of our middle-class family/friends can stretch their budgets for these kinds of costs, when their houses are paid for and their overhead is comfortably in the $1-2K/mo. range.
My spouse and I, and my MIL (for whom we did this research) are fortunate to have sufficient funds. But none of our middle-class family/friends can stretch their budgets for these kinds of costs, when their houses are paid for and their overhead is comfortably in the $1-2K/mo. range.
4
I know someone who was bankrupted by caring for his elderly father, a diabetic amputee, who he'd placed in a very fancy nursing home, wanting to give the old man, who was supposed to have a short time to live, the best experience. This was after a year or two of caring for both of his parents at home.
His father, rebounded, and went on to live for several years.... eventually, his son filed for bankruptcy, and lost his home.
The experience of aging in America has become a nightmare. My step-father passed away in hospice and home care, exhausting my 82 year old mother with the stress of caring for him. Earlier that year, he'd been diagnosed with pneumonia. He had COPD and kidney failure, and had signed living wills multiple times. Instead of slipping away in hospital, he lived for six more months, with an awful quality of life. Madness. We need a national conversation to address this on all levels.
His father, rebounded, and went on to live for several years.... eventually, his son filed for bankruptcy, and lost his home.
The experience of aging in America has become a nightmare. My step-father passed away in hospice and home care, exhausting my 82 year old mother with the stress of caring for him. Earlier that year, he'd been diagnosed with pneumonia. He had COPD and kidney failure, and had signed living wills multiple times. Instead of slipping away in hospital, he lived for six more months, with an awful quality of life. Madness. We need a national conversation to address this on all levels.
1
Hi Jessica - this sort of situation can be abated by going to an elder-law attorney who handles Medicaid-planning matters.
Medicaid planning is a way to protect people’s assets from the threat of long-term care expenses. Most of my clients are between 65 and 90, own their own house and have between $50,000 and $750,000 worth of assets on top of the house. What many people don’t realize is exactly how expensive long term care expenses can be – the average costs of a skilled nursing facility, in Florida, is $8,662 per month. So someone can be solid middle class or upper middle class, have saved their whole life and think that they’ll have plenty of money for whatever happens only to suffer a stroke, major heart attack or get an Alzheimer’s or Parkinson’s diagnosis and need help with their activities of daily living. If they have this six-figure per year expense, most Floridians would lose everything – and many do.
Some form of Medicaid planning is available in all 50 states.
I have written several articles about Medicaid planning. Here is one: https://www.elderneedslaw.com/blog/what-is-medicaid-planning
Medicaid planning is a way to protect people’s assets from the threat of long-term care expenses. Most of my clients are between 65 and 90, own their own house and have between $50,000 and $750,000 worth of assets on top of the house. What many people don’t realize is exactly how expensive long term care expenses can be – the average costs of a skilled nursing facility, in Florida, is $8,662 per month. So someone can be solid middle class or upper middle class, have saved their whole life and think that they’ll have plenty of money for whatever happens only to suffer a stroke, major heart attack or get an Alzheimer’s or Parkinson’s diagnosis and need help with their activities of daily living. If they have this six-figure per year expense, most Floridians would lose everything – and many do.
Some form of Medicaid planning is available in all 50 states.
I have written several articles about Medicaid planning. Here is one: https://www.elderneedslaw.com/blog/what-is-medicaid-planning
1
When I was a teenager (mid-1960s) one of my mother's aunts developed dementia. In those days, people whose families could no longer care for them got committed to state mental institutions. Well, Republicans, states have closed most of those. What will happen to seniors with dementia if cuts are made to Medicaid? I don't approve of involuntary euthanasia.
1
I'm a nurse and a major Hospital in Pittsburgh and I deal a lot with Medicare Medicaid patients I am curious why some people are rejected for home care when they need IV antibiotics which would be so much cheaper to teach a family member at to help assist most of the days of the week rather than go in a nursing home and and it would cost four or five times more I think you really need to push Medicaid for qualified people mostly seniors that need medicated home that really don't want to go into the nursing home because of infection and all the problems that are occurring there right now. So I just wanted to let you know I'm a nurse and in home care and I come across this everyday and I have patients that have to go into nursing homes that really don't want to that are all nearly in tears about going into nursing homes and if they stayed home like we usually teach family members to give IVs so we don't go in 5 days a week it would be 2 days it would be so much more cost-effective can you please tell me why you're not doing this I would love to hear your answer thanks RN from Pittsburgh. Thank you Cindy Mandrier RN
1
In order to be eligible for Medicaid home services, the patient has to have spent down their assets. If they need skilled nursing care after a hospital stay of at least three days, and are expected to recover, Medicare will pay for it but the co-pays are fairly expensive. Medicare will sometimes pay for limited home care, but if the patient is fragile and lives alone, in particular, they will opt for the more expensive but safer solution of skilled nursing.
1
>>so much more cost-effective can you please tell me why you're not doing this....>> If the article did not make it clear, Medicaid is administered by the STATES, not the Feds. This is an issue you could get behind as a local/state voter, perhaps? But do keep in mind, as ebmem says, many elderly are at higher risk at home, if the medical instructions end up being forgotten ("oh, I'll do it later, I'm sure I'll remember") or misunderstood. We helped care for my MIL, and quickly learned we had to be there to hear what the doctor actually said. She very often misunderstood what he was saying, even tho she smiled and nodded and said "yes" in all the right places.
2
This is true. My dad is in assisted living here near me, in Oregon, which compared to other parts of the country is considered more affordable. His basic expenses--room and board at his ALF-- are over $4,000 a month.
He is happy there, and so to me, it's worth it. However, the majority of the other residents are there on Medicaid. Without that system in place, many of our nation's seniors will be without care, and many of them are veterans. I'm not saying that it may not need reform, but let's put them first when we make those choices.
He is happy there, and so to me, it's worth it. However, the majority of the other residents are there on Medicaid. Without that system in place, many of our nation's seniors will be without care, and many of them are veterans. I'm not saying that it may not need reform, but let's put them first when we make those choices.
4
"it is hard to predict or quantify how painful the cuts will be for seniors compared with children and adults who are poor or have disabilities". Actually no. Those with life-long disabilities (code word for multiply handicapped, mentally retarded -- you know who) will go first. Why? to quote one esteemed member of the house - they are a drag on society. Then poor adults - because they are responsible for their own plight. "Normal" children and old people will be last because they are the deserving poor.
5
Thanks for this detailed and informative article.
1
This article makes it obvious why McConnell and his dishonest caucus wrote their legislation in total secrecy and without a single public hearing: Much of what is described here would have been publicized and reached the majority of citizens, who don't read the NYT. And, that's not what the Republicans want.
9
Live in Norway,Sweden,UK,Canada........they take care of their Elders.....and also provide payments for Family Members in the Caregiving.......My Dad who is 96 yrs. old WW2 Vet has Aid and Attendance Stipend thanks to the Veterans Administration........only discovered by me his daughter at 96 yrs old........Thankgod for this...it has helped tremendously.......My Mother passed in her home being taken care of by my Brother for six yrs. with no help..Planning for the unpredictable can leave children with feelings of helplessness,guilt...and Bankruptcy.......
7
In the U.S., almost criminally negligent on these issues, the only solution - if it continues to refuse to address and implement single-payer health insurance for all, dignified anxiety-free elder care solutions, face the already arriving tidal wave of Alzheimers/Dementia victims - will be to set up euthanasia centers and pass right-to-die laws in every state.
2
no one wanted to hear it but death panels are coming along unless we get very much more wealthy.
Great article. I would argue though that Medicaid is not usually associated with being young or disabled. It is associated with being black, like welfare. That is why so many GOP loyalists detest it so much. Even among whites who are enrolled in Medicaid, I would suspect the blame for runaway costs is directed at black people who are abusing the system. There is just too much evidence for this (lies about welfare queens driving Lexuses, etc.) to negate this.
2
And here's some great evidence that the abusers of the systems come in all shapes and sizes: http://www.foxnews.com/us/2017/07/06/6-more-new-jersey-couples-charged-i...
Medicaid is really an umbrella term for multiple different programs. Medicaid for the elderly/disabled/long term care is, very much a program utilized by Americans of all races and ethnic origins.
mike, ridiculous. That same medicaid programs that now covers the poor your want to use for everyone's medical bills
Time for a real revolution...!!!
4
chuck, you think single payer is going to lower the cost? I am here from the Veterans Administration. Don't you love it.
Excellent article
If a 65+ legal inmigrant arrive as an refugee...and because he can not care for himself due to disbility..then who pays for his nursing home, medicaid and social security checks.
If a 65+ legal inmigrant arrive as an refugee...and because he can not care for himself due to disbility..then who pays for his nursing home, medicaid and social security checks.
I know someone in a nursing home in NYC due to alcoholic demrntia. Her Guardian told me that the lawyer they hired told her that since this woman had started taking her IRA MDR prior to admittance that the home can only take the MDR from her accounts to apply towards her bill.
take care of your mom. Like society used to.
Right on! Like I took care of my elderly mom for her last 7 years of life, significantly cutting into MY retirement savings.
But, like society used to do, my kids will take care of me.
Ooops, I don't got no kids!
Can I adopt you?
But, like society used to do, my kids will take care of me.
Ooops, I don't got no kids!
Can I adopt you?
There is a disconnect Ron in your article. The healthcare system years ago recognized the increasing crisis of care for aging boomers. An ongoing major thrust towards helping people "age in place" to avoid institutional care began. This was years before the recent Republican efforts to dismantle Obamacare. Medicaid coverage for Home Care is far less costly, preferable and the government knows it. One such example is the "Jewish Home at Home" program in Northern NJ administered by the Jewish Home at Rockleigh, a nursing home.
Furthermore, there has been a growing body of private practice geriatric social workers assisting families to "age in place" across the country. Medicare, itself, has encouraged home visits by extending reimbursements to providers for such care. That includes social workers, physicians, PT's, OT's and nursing care. The reality is that there are far too many aging baby boomers to accommodate expensive institutional care for all. Period. Your article serves to only incite fear.
Furthermore, there has been a growing body of private practice geriatric social workers assisting families to "age in place" across the country. Medicare, itself, has encouraged home visits by extending reimbursements to providers for such care. That includes social workers, physicians, PT's, OT's and nursing care. The reality is that there are far too many aging baby boomers to accommodate expensive institutional care for all. Period. Your article serves to only incite fear.
The problem being that these innovations are the services most threatened by the proposed transformation of Medicaid into a capped system. Medicaid coverage of nursing home care is mandated under federal law. Home- and community-based services, which enable people to age in place, are optional for states. As states receive less and less adequate federal Medicaid funding under a capped system, optional services like the ones you describe could be the first place a state would have to consider making cuts.
2
Jane, Obamacare did not work. Maybe you need more of it. No more money. Just as is. See how it works out for you.
What a great opportunity for "Trump Elder Care Hotels". Reserve me the presidential suite.
3
Can you comment on potential effects on the Medicaid TBI Waiver services in NY State?
"according to the Kaiser Family Foundation, 62 % cannot pay their bill on their own"
What happened to these folk's families?? Do the relatives of this 62% not care enough to take care for their own? Or, do they think the rest of us with our own health cost issues should pick up the tab...a sorry situation and the government should have never gotten into the health care providing business.
What happened to these folk's families?? Do the relatives of this 62% not care enough to take care for their own? Or, do they think the rest of us with our own health cost issues should pick up the tab...a sorry situation and the government should have never gotten into the health care providing business.
So then you are fortunate enough to have an extra $82,000 a year, just lying around collecting dust, that you can fork over to care for your Mom? Or an extra $164,000 a year if both parents need care? And what about your spouse's parents? If the elderly adult is unable to afford care, it's unlikely their children will be able to fully fund their care either. And, frankly, if we had universal health insurance like every other developed country in the World, we could easily afford to pay for care for everyone merely by cutting out the enormous administrative costs and profits that currently go to insurance companies. But they have better lobbyists than you and I, so we just carry out with an expensive, inadequate system.
6
Many of us do not have a family.
2
John - I am an elder-law attorney. I can tell you (at least from my anecdotal experience), that in almost every case, when the family has the resources to help - they do. However, there is a difference between a $15/hr home health aide and $8,602.00/month, which is the average costs of skilled-nursing care in Florida.
Most families just cannot afford the latter expense.
Most families just cannot afford the latter expense.
4
The statistics for dementia are about 40% of us are impaired at age 90.
Why is nursing care so expensive? CEO salaries? dividends? Let's start telling the truth about how the money paid for the patient's care trickles down or up as the case may be. Lots of us do well or well enough in the service industries... all of them including education. (How much really should a principal make? Is that person so much more impt than a teacher a really decent one?)
Why is nursing care so expensive? CEO salaries? dividends? Let's start telling the truth about how the money paid for the patient's care trickles down or up as the case may be. Lots of us do well or well enough in the service industries... all of them including education. (How much really should a principal make? Is that person so much more impt than a teacher a really decent one?)
1
"Among the people living in one today, according to the Kaiser Family Foundation, 62 percent cannot pay the bill on their own..." So who is paying for it? It is a myth that anybody besides these people themselves are paying for it. The government taxes us into poverty and then 'houses' us when we are poor. If the government was not taxing the daylight out of you, you could pay for nursing homes yourself.
The State is the great fiction through which everyone endeavours to live at the expense of everyone else - Frederic Bastiat. LOL
The State is the great fiction through which everyone endeavours to live at the expense of everyone else - Frederic Bastiat. LOL
This article just told me the Medicaid debate WILL affect me, with no qualification. Then it immediately admits only one in three old folks end up in a nursing home, and 62% of them can't pay alone. That's just over 1/6th.
So which is it, will it definitely effect me, or is it a 1 in 6 chance that it will?
You are the New York Times. Stop with the clickbait. Make an argument and let it stand on it's merits.
So which is it, will it definitely effect me, or is it a 1 in 6 chance that it will?
You are the New York Times. Stop with the clickbait. Make an argument and let it stand on it's merits.
2
CC - the reality is that the older you get, the more likely it is that you will need long-term care. Especially with diseases such as Alzheimer's, where the mind goes, but the body subsists for considerably longer.
Medicaid might pay for nursing home, but assisted living is a families responsibility. so, the people who save end up spending all of it in the last 2 years of their lives. Right to die would be a nice alternative to making us work hard to spend it all at the end !!!!
Apparently, "Medicaid is welfare" when it is for other people.
When it turns out your parents or spouse must resort to it, Medicaid is magically no longer welfare.
When it turns out your parents or spouse must resort to it, Medicaid is magically no longer welfare.
7
This column is very informative, but I have some trepidation about the "How to Protect Your Family's Assets From Devastating Nursing Home Costs" link. The website teases many secrets, the book isn't available in bookstores, hence you must buy sight unseen. It may be detailed and plain-English, but it's nearly $50 and seems a little breathlessly hyped in the sales pitch. I'd like to be able to check it out from a library.
Checking it out from a library is exactly what a family member of mine did with ease. It's clearly written and informative. Any good elder law lawyer would be able to inform you on the contents' subject matter too -- though at a great deal more than $50.
If this is something you are thinking about, you really want to meet with a local elder-law attorney who focuses on "medicaid planning." There are plenty of articles that discuss different medicaid-planning strategies online.
https://www.elderneedslaw.com/blog/how-i-can-help-your-mother-or-father
https://www.elderneedslaw.com/blog/how-i-can-help-your-mother-or-father
Is it welfare?
That's like the adage:
It's a recession when your neighbor loses his job and a depression when you do...
Medicaid is highly resented when used for other people's parents...and eagerly accepted when it's for your own...
That's like the adage:
It's a recession when your neighbor loses his job and a depression when you do...
Medicaid is highly resented when used for other people's parents...and eagerly accepted when it's for your own...
11
How true.
4
We got trump.
We have been trumped by trump.
Alas we all suffet but for those who voted republican
and for the Donald I say you voted for him.
Voting has consequences.
Live with it: I'm done with compassion
for trump voters.
Because that is why healthcare and Medicaid is
being gutted.
We have been trumped by trump.
Alas we all suffet but for those who voted republican
and for the Donald I say you voted for him.
Voting has consequences.
Live with it: I'm done with compassion
for trump voters.
Because that is why healthcare and Medicaid is
being gutted.
5
and when, under the current plan that the author endorses, will medicaid be broke?
"If current spending trends continue, Medicare will be insolvent by 2028, according to the Medicare Trustees Report released Wednesday."
And what happens when there is not enough income to cover medicare expenses? Why draconian cuts are made.
Choose the form of your destructor but at least tell ALL of the story.
"If current spending trends continue, Medicare will be insolvent by 2028, according to the Medicare Trustees Report released Wednesday."
And what happens when there is not enough income to cover medicare expenses? Why draconian cuts are made.
Choose the form of your destructor but at least tell ALL of the story.
Thank you for this extremely important article. Very few people understand just how awful the proposed Medicaid cuts will mean for all of us. It's a tsunami and people will be caught in this tidal wave... it's going to be horrible unless we as a nation say "no". Of all the things that can be done, the one that makes the most sense to me would be to eliminate the loopholes that legally allow people to shelter their money for their heirs. I say this because it levels the playing field. If I end up needing Medicaid then using all but $2000 to pay my home care and nursing home bills will be the same for everyone else. I have no children so turning to someone else to foot the bill isn't going to be possible. IMO, we need our government to be there for those that need care at the end of our days. We just have to decide to do it.
3
Much of the planning around "loopholes" is to ensure that a surviving spouse or other family member has sufficient funds with which to survive on rather than become a welfare case in turn.
1
There are quite a bit of legal and ethical ways to protect the assets of the middle class. However, the reality is the assets saved are typically in the thousands to several hundreds of thousands of dollars (a drop in the bucket in comparison to Medicare/Medicaid spending). Furthermore, the assets saved allow the elder to lead the highest possible quality of life until the end. Medicaid pays for a lot, but not everything, so protecting the assets of the middle class allows the elder to have money available to pay for therapies, other care providers, private room, entertainment, etc... that Medicaid wont pay for. Many medicaid-planning techniques also require the state to be paid back upon death (although, as a Medicaid-planning attorney, I do try to minimize that as well).
1
Anyone who has watched parents grow old and need care understands the awful implications of what's going on in Congress right now. My husband and I, although we have worked all our lives and saved enough to be self-supporting through old age, would never have enough to cover the enormous cost of assisted living or nursing home care should be need it. Saving that much is only possible for "the one percent."
2
Mr. Lieber:
Thanks for this article. As an immigrant couple in our 40s, my husband and I are quite unaware of the costs of long term care and we don't have any acquaintances who are in LTC. So this is a totally closed book for us. After reading your article, I'm beginning to think it's about time for us to start educating ourselves since we have some chronic conditions and will probably need to buy an LTC policy soon or risk being denied later. Please do follow up with articles about the LTC sector as a whole. A guide to what to look for in a good LTC policy would be extremely appreciated.
Thanks for this article. As an immigrant couple in our 40s, my husband and I are quite unaware of the costs of long term care and we don't have any acquaintances who are in LTC. So this is a totally closed book for us. After reading your article, I'm beginning to think it's about time for us to start educating ourselves since we have some chronic conditions and will probably need to buy an LTC policy soon or risk being denied later. Please do follow up with articles about the LTC sector as a whole. A guide to what to look for in a good LTC policy would be extremely appreciated.
1
No amount of middle- or upper-middle class savings will keep you safe. Pre-seniors need to sell the big house or condo or coop they live in and purchase a small mortgage-free home in a low-property tax area in a state where seniors get a good reduction in those taxes. The house should have a bedroom and bath that can become a semi-private area for the live-in companion you may need. You often can find a person who is willing to have their own job outside the home and live with you in exchange for free rent and utilities. Get the best Medicare Supplement you can afford as soon as you qualify. Keep good relations with your children and/or closest younger family. Then ou can just live your life. Unless you are a billionaire....
1
Many people retire to New Hampshire because it has no sales or income tax. There is a huge population of elderly in the state while younger people have relocated in large numbers. It's one of the most challenging states to be old and have any need of services because there's little tax revenue to even support the services of Councils on Aging never mind more substantial services. So there has not been adequate planning and development for the quantity of nursing homes that there is now a growing need for to the point of crisis. There are also insufficient younger work force to provide services. Ironically it is an example (along with Florida where people are on 6 year long waiting lists for funds to afford nursing homes) of one of the worst places to plan to retire to. Even the closest of families can not necessarily be counted on to take on the mammoth and life-changing task of providing care.
2
I did not see a link in the article to the proposed bill, which would be the key to understanding who the cuts would hurt. It seems that the Medicaid expansion, for non-disabled adults age 18-64, would be modified first. The effect of changing the income and asset guidelines to cover the indigent only (100% FPL) would seem to have as big an effect as the non-discretionary, across the board cuts discussed in the article.
I am a liberal. I am also living on medicare and when I stop working it will be my only source of income. So I can relate and emphasize. What I can't accept is the cost. Sorry, but I think it is outrageous. I have has the displeasure of being in a nursing home where the candidate was paying. It was disgusting, she got substandard care and they finally killed her. Did I sue, no. Go prove it.
$82,000 a year. Most of these people never earned anything like that in their lives and they managed to stay alive and well. It's just ridiculous and I firmly believe it is a result of incompetence and corruption.
I never voted Republican in my life and never will. I know Trump well and detest him and every shadow of him in the government.
I think the Republican bill is a scourge.
But Nursing Home care - now that has to be fixed.
$82,000 a year. Most of these people never earned anything like that in their lives and they managed to stay alive and well. It's just ridiculous and I firmly believe it is a result of incompetence and corruption.
I never voted Republican in my life and never will. I know Trump well and detest him and every shadow of him in the government.
I think the Republican bill is a scourge.
But Nursing Home care - now that has to be fixed.
3
At the end of your enlightening article, it reads as if Ms. Phillips thinks it all but inevitable that the mean-spirited, hard-hearted and fiscally irresponsible Republican-proposed "repeal and replace" healthcare legislation will pass and be signed into law.
Surely there are still enough Republican Senators with the courage, common sense and decency toward their constituents to defeat this ill-conceived bill. And then work with the Democrats to craft an improved version of the 2010 Patient Protection and Affordable Care Act.
Surely there are still enough Republican Senators with the courage, common sense and decency toward their constituents to defeat this ill-conceived bill. And then work with the Democrats to craft an improved version of the 2010 Patient Protection and Affordable Care Act.
While Republican plans for Medicaid are appalling, I would appreciate better information about what is the average stay in a nursing home. How likely am I to need one and for how long? Neither my parents nor my wife's parents spent a day in one. Of my ten aunts and uncles only one spent time in a nursing home. I know people who are so obsessed with the need to be able to pay for an extended nursing home stay that they don't enjoy life while they can.
Don't overlook suicide as an estate planning tool. Why extend life after its only purpose has become the transfer of wealth from family heirs to the health industry?
5
I agree. I very much believe most people want to be in charge of their own 'exit plan.' The religious and pious in the US and the Senate prevent us from making this choice. Sure, we can buy drugs on the black market and save them for when we decide 'enough is enough,' but that should not be the case. The evangelical Christians have way too much power in this country.
1
The same people who take every step to outlaw family planning programs and methods as well as "exit plans" are also the ones that take every step to avoid programs intended for supporting existing lives they claimed were sacred before leaving the womb.
4
Medicare and Medicaid for the elderly are life support systems for Social Security. Too many people are living long after they should have been allowed an easier death. I am on Medicare and would like to be able to choose physician assisted suicide if I am no longer capable of caring for myself with minimal assistance from others. I have long term care insurance to help pay for that assistance.
Re nursing home care: my mother lived to an advanced age or over 100. However she spent last year's in 2 nursing homes. Monthly cost was thousands. The first setting was excellent. She had to be moved when funds became close to Medicaid level and home did not accept. The next setting was also thousands but accepted Medicaid. But the care was terrible- more administrative than care staff, limited rn nurse staff, lack of reports to family. And dangerous situations such as falls due to poor caregiving and oversight. She passed away after 2 months due to the conditions. Further family not notified when she was in last hours. We were contacted after the fact and could have arrived at the start. The point is this...even if individual and /or family is able to fund at a high cost, it is very uncertain if u get what you pay for. Family and Buyer beware....further many facilities do not accept Medicare or Medicaid.
2
I am interested to learn how these Medicaid cuts will affect Long Term Care policies. The policy my husband and I have works with the insurance co. Paying a set amount for the 1st 3years and then Medicaid taking over it also has a home care component. This policy is through a company in addition to new york state administrating the Medicaid funds. I really want to know if those Medicaid funds would still be available and that this policy would still be workable for us when we need it. How would we determine the viability of this policy ?
they will be GONE... read the article!
I was the Medicaid nursing home social worker for my rather large county some years ago. In my experience, few people divested themselves of assets in order to have Medicaid pay their nursing home bills.
The majority were lower middle class or poor working folks who had never been able to save much money. Once family could no longer take care of them--it's very hard to care for a bedridden person--a nursing home covered by Medicaid was the only choice.
A logical society would have home-care options as the first resource. It's much cheaper than nursing homes and is better for most patients. Staying in one's home environment leads to less confusion. Moving to a nursing home can accelerate dementia in patients.
But a compassionate and reasonable society must continue to provide nursing home care for those too ill to remain at home. Those with no family will often need it as well.
Some on the far right believe the community should provide this care voluntarily rather than through governmental assistance. A nice thought, but totally inadequate for the needs of most patients.
In short, we *must* protect both Medicare and Medicaid. If we don't, we are dooming our elderly and disabled citizens to much misery and substandard care.
The majority were lower middle class or poor working folks who had never been able to save much money. Once family could no longer take care of them--it's very hard to care for a bedridden person--a nursing home covered by Medicaid was the only choice.
A logical society would have home-care options as the first resource. It's much cheaper than nursing homes and is better for most patients. Staying in one's home environment leads to less confusion. Moving to a nursing home can accelerate dementia in patients.
But a compassionate and reasonable society must continue to provide nursing home care for those too ill to remain at home. Those with no family will often need it as well.
Some on the far right believe the community should provide this care voluntarily rather than through governmental assistance. A nice thought, but totally inadequate for the needs of most patients.
In short, we *must* protect both Medicare and Medicaid. If we don't, we are dooming our elderly and disabled citizens to much misery and substandard care.
7
If you are fortunate enough to reach 85 or 90 years of age, you will need assistance. Even the best savers will exhaust their savings by their mid-90s, and it's silly to expect them to pay out of pocket for care at these advanced ages. Let's be serious and provide funding to care for our brothers & sisters when it's needed most. My church is great, but it can't pay for everyone in need. Our government can, and we should ensure it does.
1
Back in my 30s when I'd read about retirement financial planning I never saw any mention of nursing homes or home care. I used to think having a million dollars saved was plenty, just live off the interest. How naive I was.
I do not know how so many people around me can afford a house, 2 cars, health insurance premium, 2 or more kids, college, vacations, cable tv, smartphones, dining out and still have enough left to save up for years in a nursing home. Maybe they can't. Maybe they're just faking it. Or maybe they haven't thought that far ahead.
I do not know how so many people around me can afford a house, 2 cars, health insurance premium, 2 or more kids, college, vacations, cable tv, smartphones, dining out and still have enough left to save up for years in a nursing home. Maybe they can't. Maybe they're just faking it. Or maybe they haven't thought that far ahead.
1
Thank you for this informative article. What happens when a husband requires a level of care that can't be delivered by the wife at home, but the wife is in reasonably good health? If they have assets--their house and modest pensions--but no long-term care insurance, and they can't afford to pay out-of-pocket for in-home assistance, what are they to do? They can't sell their house because the wife needs to live in it...but the husband requires care that they can't afford to pay for??? This is the dilemma of my parents. If they sell their house to pay for assisted living-level care for my dad, my mom has no home and the money wouldn't go very far for very long. If they stay in their house, they can't afford to pay out-of-pocket for the level of care my dad will require. What are they to do??
1
suicide...a horrible solution. But with no kids spouse or living relatives this is exactly what I personally face in the future! thanks Trump! the new GREAT America... for the 1%...
Medicaid should pay for assisted living. I some people in nursing homes that really are at the level of care for assisted living but are in the nursing home because they have no money. on the other hand, they should do an asset search going back ten years so people do not avoid paying for care. By the way if you are a millionaire, if you live too long, you may end up on Medicaid. Finally, the government could subsidise Continued Care packages which is the best deal.
This is an incredibly painful reality for our most vulnerable citizens who have lived productive lives and given so much to us. Let's take a look at the "right" to have babies we as taxpayers support thanks to the Medicaid safety net. I believe I read it in this newspaper: 40-50% of all children born are on Medicaid?? And do they miraculously become independent of Medicaid assistance as they grow older? We know the answer to that. We cannot sacrifice our elderly and disabled but I'm sure willing to draw some perimeters around young parents who need to grow up and accept fiscal responsibility for the children that they have.
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What often happens is an elderly person goes to the hospital and then recovers enough to no longer need hospital care, but needs more than is available at home. Hospitals don't like to discharge someone without an acceptable place for them to go. If Medicaid cuts are severe, expect elderly people stuck in expensive hospitals.
Far too many people believe that this system and its huge costs are static. We fail to take into account our choices make on health care providers. If a much greater level of long term care came from consumers pockets an new players would enter the market to offer lower cost and specialized care options. Competition between the various options would drive down costs and drive up quality over time. This is true in all competitive industries including long term health care. It would be true of medical drugs as well if the government did not make the patent protection and approval so complex.
As a society we would be far better off giving every adult a SMALL guaranteed income and allowing individuals to determine how to spend or save it, than arguing endlessly over the vast number of retirement, healthcare, unemployment, etc programs and the correct amount for each.
SMV
SMV
As a society we would be far better off giving every adult a SMALL guaranteed income and allowing individuals to determine how to spend or save it, than arguing endlessly over the vast number of retirement, healthcare, unemployment, etc programs and the correct amount for each.
SMV
SMV
My father, who died last year at 99, was savvy enough to know that toughing it out at home w. a nearby sibling to care for him, was the best of all not so great choices available to him. He managed to stay at home till the last 15 days of his life. My mother was home up until 3 days before she died. They were both keenly aware of the costs involved and I'm grateful they passed away before incurring debt. In fact they left a modest sum for each of their 5 children. And as other contributors here have said: my father in particular as a son of immigrants worked hard his whole life to earn that money that eventually came to each of us. I'm grateful they are gone in that the current end of life care system would have failed them both miserably. And it is, frankly, a terrifying look ahead at what can happen to the aging, the poor, those w. disabilities. Cruel times ahead.
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I don't understand why this kind of information isn't common knowledge. Thank you, Mr. Lieber. Keep it up. Please make this and subsequent articles accessible and easy to find.
I'm sad that nursing home insurance is one of my few options for growing old with a shred of dignity. I don't want to live in a urine-soaked warehouse for people. I can foresee that a little bit of assistance at home will keep me healthier and away from institutional care for years. Where's the lobby advocating insurance for that?
I'm sad that nursing home insurance is one of my few options for growing old with a shred of dignity. I don't want to live in a urine-soaked warehouse for people. I can foresee that a little bit of assistance at home will keep me healthier and away from institutional care for years. Where's the lobby advocating insurance for that?
2
I have not seen mentioned here that one needs to check if you have an air tight "do not resuscitate" legal document, one that is written by a lawyer with living witnesses and updated by you at intervals. It needs to be entered into your hospital's system. In some states it covers EMT and ambulance staff who will resuscitate unless you have a document to hand to them (manila envelope on the back of a door or on the fridge). If you do not want to be in an expensive vegetative state, do it. Now is a good idea. Everyone should consider this including the young who might want to have their preferences honored and spare parents some agony.
2
I'm sure that people commenting in support of euthanacia for the elderly are doing so with the best intentions. But to me it says a lot about our priorities as a nation that we are so unwilling to find a solution that will allow our elders to live with dignity and in a safe/caring environment, that our first solution is to advocate for the right to commit suicide if we can't afford to continue to live. What a time we live in!
3
The article speaks of nursing home cost, but tells us nothing of why the costs are so outrageous. Is it due to regulations and are they reasonable?
So we have to soak the taxpayer so that heirs can inherit a home and an elderly parent's other assets ? Shielding family assets to stick it to society is reprehensible, and that is what this article advocates.
It's not reprehensible. It's legal, and in that sense no different than good tax planning.
I have been looking into LTC insurance and have not found one that will pay out more than 5 years of care, not much good if one has an illness requiring nursing home care that lasts longer than that. Anyone have luck finding a policy that will cover the remainder of your life? I understand that such policies were sold years ago but no longer....
1
I have wondered about that. Presently I do not have a LTC plan. My mother was in assisted living the last 8 years of her life (paid for by her thanks to $$ my father left her). When I hear of plans that pay for 2 years of assisted living, I am not encouraged to buy it. 2 years is nothing.
The cost of the assisted living (memory unit) that my mother lived in was about $6600 a month.
The cost of the assisted living (memory unit) that my mother lived in was about $6600 a month.
Estate planning and probate attorney in Texas, and this article is spot-on. Many people are surprised to learn that Medicare and private health insurance don't cover long-term care. The proposed Medicaid cuts are a huge issue for seniors with ripple effects impacting everyone.
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I will be able to pay for myself in my old age.
I worked hard and well for 40 years.
I lived within my means.
I take care of myself and my health as not to be a burden on my family, friends or society.
I chose to limit the number of children I have.
I saved my money and invested well, seeking professional advice along the way.
I will be able to pay for myself in my old age because I have always had a plan.
I worked hard and well for 40 years.
I lived within my means.
I take care of myself and my health as not to be a burden on my family, friends or society.
I chose to limit the number of children I have.
I saved my money and invested well, seeking professional advice along the way.
I will be able to pay for myself in my old age because I have always had a plan.
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Your tax dollars will then pay for others who have been less fortunate and/or who spent all their money along the way or who took it out of their name and put it in their children's names so as to qualify for Medicaid . Like you, My father paid for himself after a lifetime of planning to do just that. That being said, the cost of assisted living and nursing homes is outrageously high and the quality is not good, in many cases, regardless of what you pay. So something has to happen there
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Thank you for pulling the covers back and exposing the inevitably uncomfortable decisions and conditions we must ponder as part of a responsible retirement plan. This is very important stuff. As important as any aspect of estate planning. Even if we've planned for what income we will need in retirement to provide the lifestyle we envision, there will be the downside of ever advancing years when lifestyle becomes not so much a choice but a condition to be managed.
The question is, how much must people save in order to take care of themselves in older age?
Of course, no one knows the answer to the question. Last year, at 64, I bought long-term care insurance to the tune of $3,100 a year -- until I turn 90. That protects $156,000 of my estate that Medicare pay down can't touch. I can use that if I outlive the 2 years my long-term care insurance will cover.
I still work full time and will until I am not competent at my job or drop dead, whichever comes first. I am afraid to retire because of the looming costs of healthcare.
Of course, no one knows the answer to the question. Last year, at 64, I bought long-term care insurance to the tune of $3,100 a year -- until I turn 90. That protects $156,000 of my estate that Medicare pay down can't touch. I can use that if I outlive the 2 years my long-term care insurance will cover.
I still work full time and will until I am not competent at my job or drop dead, whichever comes first. I am afraid to retire because of the looming costs of healthcare.
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I acutely aware of what cutting back on medicaid might mean to senior citizens. My mother and aunt both died at home, ages of 98 and 95. I was the coordinator of their care and part-time caretaker.
For a while, around the clock care was paid for by their savings, after that community medicaid was available to them. This enabled them to have 24/7 care at home. The program subsidized the cost of their home health aides. This did not mean that they had no living expenses, it was a combination of their remaining money and some help from me that enabled them to live at home comfortably. It also meant that I was available to help shop, make and keep medical appointments, and assist them with almost all other activities of keeping a household running. I am grateful everyday that we had such a program available to us. During this time my husband and I were raising our children, paying for college and saving for our retirement. I might also add that my husbands parents were able to maintain themselves at home without medicaid services, which they did until they, too, died at home.
I fear that many who have not yet had to rely on such programs don't understand how fortunate we are to have this available. By the time this administration get done with their idea of health care reform it will be too late.
Yes, this program and more like it cost money, but I believe it is money well spent and that a society that appreciates that is one which I want to live in.
For a while, around the clock care was paid for by their savings, after that community medicaid was available to them. This enabled them to have 24/7 care at home. The program subsidized the cost of their home health aides. This did not mean that they had no living expenses, it was a combination of their remaining money and some help from me that enabled them to live at home comfortably. It also meant that I was available to help shop, make and keep medical appointments, and assist them with almost all other activities of keeping a household running. I am grateful everyday that we had such a program available to us. During this time my husband and I were raising our children, paying for college and saving for our retirement. I might also add that my husbands parents were able to maintain themselves at home without medicaid services, which they did until they, too, died at home.
I fear that many who have not yet had to rely on such programs don't understand how fortunate we are to have this available. By the time this administration get done with their idea of health care reform it will be too late.
Yes, this program and more like it cost money, but I believe it is money well spent and that a society that appreciates that is one which I want to live in.
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Thanks for illuminating what may be the most important, and neglected, personal finance issues most families will have to face. Our family and my wife's family have had to deal with devastating dementia of our mothers. My mother died after 3 years in a very good nursing home and my mother-in-law is moving into a nursing home next month after a year of in-home care. Both are fortunate -- lots of loving family and enough money for excellent, but not gold-plated, care in their final years. Where did the money come from? In both instances, their children bought long-term care policies while they were in their 60's (my mom died at last year at 84 and my mother-in-law is 83). In my mother's case, we paid a long-term care premium of $4,600 per year for 14 years before she need the benefit -- and the insurer paid out $274,000 over 3 years. New York nursing homes are expensive.
Truthfully, our motives in buying those policies were both love for our mothers and selfish concern for our own finances. All of us children knew we would mortgage our houses and "borrow" from our retirements rather than put our mothers in sub-standard facilities. And it has been bad enough even in places where they have received compassionate and skilled care. Not everyone can afford to buy long term care insurance, but everyone needs a financial plan for the potential costs of nursing home care.
Truthfully, our motives in buying those policies were both love for our mothers and selfish concern for our own finances. All of us children knew we would mortgage our houses and "borrow" from our retirements rather than put our mothers in sub-standard facilities. And it has been bad enough even in places where they have received compassionate and skilled care. Not everyone can afford to buy long term care insurance, but everyone needs a financial plan for the potential costs of nursing home care.
Solid concise article. I could fund Medicaid in its entirety if I received a nickle every time someone expressed surprise that Medicare doesn't pay for nursing home care (non-rehab).
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Ron Lieber. I can't find your "digital byline." So, I'm using the "comments" section to register my remarks. Wow, what a wake-up article. I'm 73 and I'm in good health. So, perhaps, I haven't been thinking about this subject as much as I should. I realize, of course, health insurance and health care will be vitally important to me as I age. I've been following the healthcare debate. I've paid closest attention to the Medicaid issues as, I understand it, Medicare is not being affected and no one is talking about changing Medicare. So, your article is very enlightening and eye-opening to me. Fortunately, for me and my siblings, my parents were financially able to handle this healthcare needs. Therefore, my brother and sister and I didn't experience the devastating financial impacts that some of your readers describe. Thus, we are not as acutely aware and informed. Bless them for taking care of their parents and loved ones. Please keep your articles coming! Your links to additional information are very helpful. Thanks.
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I've read through nearly all of the comments and it seems to me that we are talking about putting a bandaid on a major laceration.
The ONLY solution is Single Payer for all. Health care should be a birthright, not something doled out by a Congress. Furthermore, if members of Congress had to purchase their own health care insurance and incur their own medical care expenses, just imagine how good and how fast we'd have a national health care program, and one that is far better than Obamacare.
The ONLY solution is Single Payer for all. Health care should be a birthright, not something doled out by a Congress. Furthermore, if members of Congress had to purchase their own health care insurance and incur their own medical care expenses, just imagine how good and how fast we'd have a national health care program, and one that is far better than Obamacare.
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Great call to action - but what's the 'go do'? Protest in the street? Call our local representatives?
1
I remember the horror stories of the '70's, and with our government fully in the hands of laissez-faire capitalists, I expect a return to those dark days. But perhaps with a difference: the Internet. Instead of just hearing about the lack of care, we will all get to see it up close and personal. I won't have the stomach for it, but a certain political party and all its supporters apparently do.
1
I have had long term care thru Genworth for the past 15 years my premium wasn't suppose to go up but Genworth has increased my payment. I hope it doesn't increase past my means I have yet to use it but if I land up in a hospital it will pay for that and we might not have medicate which pays for nursing homes. Everyone should wake up we are all going to be there some sooner than later. NYT times has a great article on forest cemeteries that ought to brighten up your reading experience for today.
We have mandated hospitals and physicians to provide free or very discounted health care to patients since Medicaid was implemented. It is time to do the same to the for-profit multi-billion dollar nursing home industry, where average annual charges are $82,000 per your article. Surely cost savings, discounting are in order for that sector. How about analyzing how "cost-effective" the current Medicaid expenditures are on durable medical equipment makers, pharmaceuticals and other various vendors that thrive on Medicaid.
This article affirms the truth about the Republican plan to replace the Affordable Care Act. The plan will greatly benefit the wealthiest Americans, as the prelude to large tax cuts that will transfer more of the nation's wealth to their Cayman Islands accounts. The plan will also benefit Republican members of Congress (at least in the short term), by finally delivering the principal promise they've been making to their loyal "base" for the last seven years.
But these benefits for Republican politicians and the wealthy donors who fund their campaigns are to the detriment of everyone else in the country. The CBO has quantified that detriment as at least 22 million people losing their access to health insurance. Under the Republican plan, health insurance also will become unavailable, unaffordable, and/or unusable for many millions of older and sicker people. And there are numerous wide-ranging detrimental effects, including the loss of Medicaid support for elderly people in nursing homes (who clearly can't just go out and get a job with health benefits, the facile solution offered by Trump's spokeswoman).
As the truth becomes widely known, support for this indefensible plan continually erodes among all but the few who will benefit from it. That's why Republicans feel they must shroud it in darkness and rush it through Congress. The bills solely address the partisan agenda to cut taxes for the wealthy and erase Obama from the history books. They serve no other purpose.
But these benefits for Republican politicians and the wealthy donors who fund their campaigns are to the detriment of everyone else in the country. The CBO has quantified that detriment as at least 22 million people losing their access to health insurance. Under the Republican plan, health insurance also will become unavailable, unaffordable, and/or unusable for many millions of older and sicker people. And there are numerous wide-ranging detrimental effects, including the loss of Medicaid support for elderly people in nursing homes (who clearly can't just go out and get a job with health benefits, the facile solution offered by Trump's spokeswoman).
As the truth becomes widely known, support for this indefensible plan continually erodes among all but the few who will benefit from it. That's why Republicans feel they must shroud it in darkness and rush it through Congress. The bills solely address the partisan agenda to cut taxes for the wealthy and erase Obama from the history books. They serve no other purpose.
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For my Dad the last 18 months have been many trips to the hospital and into lengthy rehab. We moved him into assisted living in January.
We specifically chose a place with a continuum to nursing home; this puts you at the front of the line. Nursing homes in southern Maine are a 1-2 year wait. While he is not rich, he could pay for about 4-5 years. Seeing his own father and then recently his sister have 5 and then 10 year nursing home runs we figured he'd be in for a long stint. We did see an elder lawyer and we were indeed advised to move his assets and place them in a trust. This really is presented as "the rule" not as advice, and the state as the Medicaid provider goes along and has a plan in place for this practice.
Even if you can manage to pay it, $6500/month for assisted living, then $10,000 for a SHARED nursing home room is astonishing when you see what you get for it.
When the time came in June for the nursing home, there was exactly one bed available for a man at this place, and they had clearly taken a single room and put a curtain between. Instead we moved him back to his apartment where the staff there required us to provide our own 24 hour care in addition to theirs. Meanwhile my sister and I were still running over there all the time. He could afford that for maybe 18-24 months.
Now deemed hospice, my Dad is in my house where we have extra care 30 hours a week and can increase if needed. I think this type of arrangement will be more common in the future.
We specifically chose a place with a continuum to nursing home; this puts you at the front of the line. Nursing homes in southern Maine are a 1-2 year wait. While he is not rich, he could pay for about 4-5 years. Seeing his own father and then recently his sister have 5 and then 10 year nursing home runs we figured he'd be in for a long stint. We did see an elder lawyer and we were indeed advised to move his assets and place them in a trust. This really is presented as "the rule" not as advice, and the state as the Medicaid provider goes along and has a plan in place for this practice.
Even if you can manage to pay it, $6500/month for assisted living, then $10,000 for a SHARED nursing home room is astonishing when you see what you get for it.
When the time came in June for the nursing home, there was exactly one bed available for a man at this place, and they had clearly taken a single room and put a curtain between. Instead we moved him back to his apartment where the staff there required us to provide our own 24 hour care in addition to theirs. Meanwhile my sister and I were still running over there all the time. He could afford that for maybe 18-24 months.
Now deemed hospice, my Dad is in my house where we have extra care 30 hours a week and can increase if needed. I think this type of arrangement will be more common in the future.
We, as citizens, as voters, over time allowed healthcare to become another commodity. It happened to housing; the same thing is happening to education.
The corporate private sector and the elected officials they fund do not care about the sad anecdotes of real life. Citizens need to stand up and assert themselves with their elected representatives and in their communities to change housing policy, change health policy, change education policy, in order to regain control of these fundamentals of our standard of living - one of the things that really made us great.
The corporate private sector and the elected officials they fund do not care about the sad anecdotes of real life. Citizens need to stand up and assert themselves with their elected representatives and in their communities to change housing policy, change health policy, change education policy, in order to regain control of these fundamentals of our standard of living - one of the things that really made us great.
1
So depressing. Is it that other countries honor their elders more than here that they truly do care for their elderly? This may sound way out of whack but this is a country that is willing to crucify Medicaid, eliminate the ACA, as proposed by our lovely president, to repeal without replacement. But the country almost in every state is opposed to assisted suicide.
Not so sure that would be a personal mission, but for those that absolutely do not want to suffer for what could be years in a nursing home, is it wrong to deny them of an alternative?
Not so sure that would be a personal mission, but for those that absolutely do not want to suffer for what could be years in a nursing home, is it wrong to deny them of an alternative?
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I've given up hope. You would not think that there would be no more then 10,000 Americans in favor of the GOP bill, and that everyone in Congress that votes for the bill would be out of office the next time their seat came up for a vote. It is so obviously harmful to the vast majority of Americans that even the GOP is having trouble packaging it so that it appears palatable. They are again removing coverage and lowering taxes on the wealthy. Of course, what else do they ever do?
But it will eventually pass and they won't lose their seats. I guess that American is getting just what it deserves, with too few voting, and the few voters we have not investigating the issues. To the pols, the population must appear to be complete fools, and who is to argue with that assessment?
But it will eventually pass and they won't lose their seats. I guess that American is getting just what it deserves, with too few voting, and the few voters we have not investigating the issues. To the pols, the population must appear to be complete fools, and who is to argue with that assessment?
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This is terrifying. It would be interesting to know how the senators and congress people pay for their elderly and how many former members of congress are destitute and in nursing homes.
These guys are happy to tell the rest of us how to live while they don't have to participate personally in any of it.
These guys are happy to tell the rest of us how to live while they don't have to participate personally in any of it.
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Great article!
1. Less than 6% of age eligible adults have long-term care (LTC) insurance, and note, it is insurance, the carrier can deny coverage to anyone. My application was denied due to a comment; I discussed and my doctor documented in my medical records that I was concerned about having dementia in the future. Take away: one cannot have a confidential discussion with physicians because you’re required to release medical records to LTC insurance companies if I want to be considered for coverage.
2. There is a tension between the GOP wanting to cut Medicaid while also expecting you to take care of yourself, for example, by having proper insurance. If you live on minimum wage or less, you cannot afford both health care and LTC insurances. If you are healthy without a preexisting condition, LTC premiums alone, may run between $4-$6,000 annually (if you purchase it early enough in life). If you are unhealthy, you won’t be charged more. You will be denied coverage. Period. End of story.
The tension is that people CAN afford taxes if they are working (regardless of the wage), but they CANNOT afford the premiums if they are unemployed or working and earning less than $50,000; and the median wage is in the US is about $50,000 (about $24/hr). So where does that leave half of the population who earns less?
The GOP plans to let the safety net (Medicaid) dissolve, give the dwindling monies to the states and to let them play bad-cop when forced to conduct triage on its citizens.
1. Less than 6% of age eligible adults have long-term care (LTC) insurance, and note, it is insurance, the carrier can deny coverage to anyone. My application was denied due to a comment; I discussed and my doctor documented in my medical records that I was concerned about having dementia in the future. Take away: one cannot have a confidential discussion with physicians because you’re required to release medical records to LTC insurance companies if I want to be considered for coverage.
2. There is a tension between the GOP wanting to cut Medicaid while also expecting you to take care of yourself, for example, by having proper insurance. If you live on minimum wage or less, you cannot afford both health care and LTC insurances. If you are healthy without a preexisting condition, LTC premiums alone, may run between $4-$6,000 annually (if you purchase it early enough in life). If you are unhealthy, you won’t be charged more. You will be denied coverage. Period. End of story.
The tension is that people CAN afford taxes if they are working (regardless of the wage), but they CANNOT afford the premiums if they are unemployed or working and earning less than $50,000; and the median wage is in the US is about $50,000 (about $24/hr). So where does that leave half of the population who earns less?
The GOP plans to let the safety net (Medicaid) dissolve, give the dwindling monies to the states and to let them play bad-cop when forced to conduct triage on its citizens.
3
Mom had dementia-found unconscious by a neighbor in 2008. I flew down, stayed at her bedside in the hospital for 2 weeks, then thrice-daily visits to her during her follow-up nursing home recovery stay. Most of it was covered by Medicare. Medicare didn't cover $48,000, which was fortunately picked up by mom's Medicare Gap Insurance. After release from the nursing home, I moved her into my home to care for her.
I thought I was prepared. Large home, successful home-based business, supportive network of friends, pre-arranged assistance for in-home help with her care.
Skip forward to two years later...
Mom's dementia continued to worsen. What started as simply preparing her meals, assisted bathing, watchful eye on her to prevent mishaps, turned into 24/7 monitoring--mom would try to get up at night and wander, often falling.
My business, which could support her needs at the beginning, couldn't keep up with her increasing care costs. 3 hours a day, twice a week, is nothing compared to an 8 hour night nurse.
Unable to cover her increased care costs, I cut back on my business hours, thinking it wouldn't be much longer.
After three years, she entered hospice. Finally, enough help to keep mom safe, and help me stay sane. But that only lasts 6 months, even though it was obvious she was not thriving.
Skip forward another year. Mom dies.
By the end: mom's savings gone, my savings gone, my business gone, my house foreclosed. I declare bankruptcy. I am 61 and surviving on SSI now.
I thought I was prepared. Large home, successful home-based business, supportive network of friends, pre-arranged assistance for in-home help with her care.
Skip forward to two years later...
Mom's dementia continued to worsen. What started as simply preparing her meals, assisted bathing, watchful eye on her to prevent mishaps, turned into 24/7 monitoring--mom would try to get up at night and wander, often falling.
My business, which could support her needs at the beginning, couldn't keep up with her increasing care costs. 3 hours a day, twice a week, is nothing compared to an 8 hour night nurse.
Unable to cover her increased care costs, I cut back on my business hours, thinking it wouldn't be much longer.
After three years, she entered hospice. Finally, enough help to keep mom safe, and help me stay sane. But that only lasts 6 months, even though it was obvious she was not thriving.
Skip forward another year. Mom dies.
By the end: mom's savings gone, my savings gone, my business gone, my house foreclosed. I declare bankruptcy. I am 61 and surviving on SSI now.
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Alys, you said hospice lasted 6 months, then your mom died a year later. What happened after hospice until she died?
I'm so sorry. What an awful story. Reading yours and other stories in these comments has only added to my anxiety about the future. If you assume $100k/year for nursing home that works out to $1 million for ten years...per person. Double that for a married couple. Who has that kind of savings after a lifetime of house payments and child expenses like college?
I'm so sorry. What an awful story. Reading yours and other stories in these comments has only added to my anxiety about the future. If you assume $100k/year for nursing home that works out to $1 million for ten years...per person. Double that for a married couple. Who has that kind of savings after a lifetime of house payments and child expenses like college?
1
25% of Medicaid spending in New York is funded by the counties resulting in some of the highest property taxes in the nation. Trumpcare would have only the state pay. In most other states, only the state government pays that state's share.
I feel so sorry for you Americans. Instead of a thoughtful and democratic process to reform and improve your health care Repubicans are sabotaging your social safety net to reduce taxes on the rich. The revenues for health care subsidy should not come from taxes on health care they should come from general revenues and a graduated income tax system. All Americans should have confidence that they will not face financial ruin or destitution because of poor health like other first world nations.
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New Yorkers should know about NYSARC. My father had transferred his assets to family members well in advance of the "look-back" period then in effect.
When he needed full-time care, he qualified for home care through Medicaid because his pension and social security went to NYSARC.
They paid his monthly expenses ( rent, food, clothing, etc.) out of this income.
The paperwork was onerous but worth it. He lived out his days at home with home care attendants paid by Medicare.
His assets remained with the family. And nobody went broke.
The rules may be changing , but it's worth looking into.
When he needed full-time care, he qualified for home care through Medicaid because his pension and social security went to NYSARC.
They paid his monthly expenses ( rent, food, clothing, etc.) out of this income.
The paperwork was onerous but worth it. He lived out his days at home with home care attendants paid by Medicare.
His assets remained with the family. And nobody went broke.
The rules may be changing , but it's worth looking into.
1
Well, aren't these elderly people in nursing homes just lazy? Sure they used to work, but now aren't they merely "takers"?Shouldn't our octogenarians and nonagenarians get jobs instead of lying around in nursing homes with their alleged infirmities?
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This is Nina Castro:
Even the ACA (Obamacare) began to address the issue of management of geriatric citizens by planning to offer a daily stipend to the 40+ million caregivers (as per AARP). It addressed, even if only in a planning capacity, every healthcare issue we face for the foreseeable future. It is comprehensive in that way, I believe. Medicaid too, has begun at the state level to offer "assisted living waiver" programs for those needing help but not reduced medically to the point of needing nursing home care. As a functioning country, we had already begun to manage our insurance company driven healthcare system, with its needless mark-up inserted between providers and patients, and a millstone around employers necks. Now, we face the prospect of having healthcare reduced to a budget problem picked to pieces by people who are clearly able to count, but don't have a lot of other pertinent skills for this job. To the GOP moderates who maybe have some idea of the social disruption to come, I say, do not vote for this Senate bill and rebuke the House bill as well. I hope that you do not lack imagination and/or compassion for the consequences which will come. Even maybe, after you're out of office. But, I think, we're strengthening our memories for this issue.
Even the ACA (Obamacare) began to address the issue of management of geriatric citizens by planning to offer a daily stipend to the 40+ million caregivers (as per AARP). It addressed, even if only in a planning capacity, every healthcare issue we face for the foreseeable future. It is comprehensive in that way, I believe. Medicaid too, has begun at the state level to offer "assisted living waiver" programs for those needing help but not reduced medically to the point of needing nursing home care. As a functioning country, we had already begun to manage our insurance company driven healthcare system, with its needless mark-up inserted between providers and patients, and a millstone around employers necks. Now, we face the prospect of having healthcare reduced to a budget problem picked to pieces by people who are clearly able to count, but don't have a lot of other pertinent skills for this job. To the GOP moderates who maybe have some idea of the social disruption to come, I say, do not vote for this Senate bill and rebuke the House bill as well. I hope that you do not lack imagination and/or compassion for the consequences which will come. Even maybe, after you're out of office. But, I think, we're strengthening our memories for this issue.
Euthanasia and assisted suicide should be a viable option to mitigate the problems related to nursing home care.This would help families save on spending,preserve assets for heirs and save society a boatload of MONEY!!!
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Yes except think of the potential for abuse when the elder has given up the right to make medical decisions (i.e. a medical power of attorney) to an heir. They are the ones that can make a decision to kill the elder for the inheritance (current and unfortunately common model is child denies medical care for parent to hasten death). Right to die is great in principle but without very strong safeguards for elders they will be at great risk from coercion and pressure from families, even if they (supposedly) retain their right to make medical decisions. Spending your last days on this earth feeling selfish for living if you chose life not assisted suicide??
Jerry (from my home state I see), I definitely agree. It might seem a cold thing to say, but I've been thinking the same way lately. (I'm in my mid-70s). For one thing, I don't want my family financially destroyed trying to keep up, knowing they would soon be facing their own needs, to say nothing of their current obligations. Further, after working almost 60 consecutive years (Aug 1959), I really don't need the (quite understandable) hostility that's bound to occur from the younger generations who themselves are facing more and more financial insecurity. It's crystal clear to me that I will never have the financial ability to pay for long-term care and anyhow I need the rest.
Assisted suicide, yes. Not to save money, but to give a suffering person a right to end the suffering. Euthanasia implies someone other than the person or loved ones is making the choice. A slippery slope.
"Long term care is the largest unsecured risk facing Americans today" – Money Magazine.
Jonathan Pond, America's Financial Planner, says that 90% of estates are spent this way: 1) nursing home, 2) IRS, 3) children, 4) grandchildren, 5) charity. More people are worried about the IRS taking their money than about having to spend it on a nursing home.
The Federal Deficit Reduction Act provided for every state to have a Partnership program to provide asset protection for those who buy qualified long term care insurance policies. http://www.partnershipforlongtermcare.com/
Jonathan Pond, America's Financial Planner, says that 90% of estates are spent this way: 1) nursing home, 2) IRS, 3) children, 4) grandchildren, 5) charity. More people are worried about the IRS taking their money than about having to spend it on a nursing home.
The Federal Deficit Reduction Act provided for every state to have a Partnership program to provide asset protection for those who buy qualified long term care insurance policies. http://www.partnershipforlongtermcare.com/
8
My mother, a survivor of the Depression and employee of Curtis-Wright Aviation during WWII (she didn't rivet, but worked the line building planes) required nursing home care the last year of her life because her dementia was beyond what could be cared for in home. In Philadelphia, her costs were between $11K and $13K per month. At the end, I had to fight to get the care she needed despite being private pay.
My parents saved and saved and saved. She had enough to cover that year and a little more, but I had to shift to part time work in the last five years of her life to coordinate her medical care and deal with other issues for her. As a result, my children, 14 and 17, do not have college savings, because we didn't have extra to put away. I'm saddling my kids with loans because I took care of my mother - where does this make sense.
While Medicaid helps, the requirements are so arcane that even as a lawyer,, I wasn't always sure I had interpreted things correctly. I don't know what the answer is, but something needs to be done so my children do not suffer this same fate when I'm older. As it is, I probably won't retire - my youngest will graduate college when my husband is 68 and I'm 64. I'll be working until 80 to help them pay their loans. I might squeeze out a year or two before they carry me out of my office in a pine box.
My parents saved and saved and saved. She had enough to cover that year and a little more, but I had to shift to part time work in the last five years of her life to coordinate her medical care and deal with other issues for her. As a result, my children, 14 and 17, do not have college savings, because we didn't have extra to put away. I'm saddling my kids with loans because I took care of my mother - where does this make sense.
While Medicaid helps, the requirements are so arcane that even as a lawyer,, I wasn't always sure I had interpreted things correctly. I don't know what the answer is, but something needs to be done so my children do not suffer this same fate when I'm older. As it is, I probably won't retire - my youngest will graduate college when my husband is 68 and I'm 64. I'll be working until 80 to help them pay their loans. I might squeeze out a year or two before they carry me out of my office in a pine box.
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If you and your husband are/have been working and you're a lawyer, then it seems to me you would have had enough income to pay the costs for a family of four that CAN/COULD be low enough -- and comfortable enough -- to have allowed you to still save money over those 5 years.
It was your choice to reduce your work time and do things for your mother. No adult child MUST take care of a parent. Period.
You assume your children will take out loans for college, but that is not necessarily true/always the case. Maybe junior prefers to be a plumber; college isn't the answer for everyone. Community colleges allow One to acquire basic college credits at reasonable prices prior to having to attend a 4-yr. college. Also, Junior could work during college years -- I did, paid my way -- of course when tuition fees were so much less-expensive.
Time to stop Oh Woe Is Me-ing for goodness sake. Some of what you report is/are YOUR choice(s), and some are merely assumptions.
It was your choice to reduce your work time and do things for your mother. No adult child MUST take care of a parent. Period.
You assume your children will take out loans for college, but that is not necessarily true/always the case. Maybe junior prefers to be a plumber; college isn't the answer for everyone. Community colleges allow One to acquire basic college credits at reasonable prices prior to having to attend a 4-yr. college. Also, Junior could work during college years -- I did, paid my way -- of course when tuition fees were so much less-expensive.
Time to stop Oh Woe Is Me-ing for goodness sake. Some of what you report is/are YOUR choice(s), and some are merely assumptions.
You may find that your idea to work until you are 80 years old will not pan out because no one will employ you. If we are going to deal with "reality", we should undertake a bit more scrutiny of the "work til you die" idea. See who will hire you when you're 77.....or 67? And while our health care is tied to our employment, I suspect employers will not be eager to front your care at that age. Warren Buffet is correct when he says that having to provide health care to employees makes our businesses non competitive with those that are not on the hook for this unpredictably expensive necessity.
The choice to fund our parents last years in the misery of a nursing home or our children's education is a bargain no one should have to make. Health care needs to be single payer and cost controlled using evidence based medicine, and education needs to be free. Then our society can move in the direction of sanity. What we are setting up for ourselves now is madness.
The choice to fund our parents last years in the misery of a nursing home or our children's education is a bargain no one should have to make. Health care needs to be single payer and cost controlled using evidence based medicine, and education needs to be free. Then our society can move in the direction of sanity. What we are setting up for ourselves now is madness.
Working until you are 80 is a valiant but unreliable plan. I thought I would be doing that, too, but had to retire at 63 for health-related issues. I saved as much as possible during my working years and have always lived frugally, but I can't see that I'll be able to do more than cover my basic living expenses if my retirement years stretch on and on.
Terrific article, especially with the many links to more detailed info. My wife will be retiring next year. I will retire a couple of years later. So, we are definitely trying to wrap our heads around this issue. Thanks!
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My mother's ALS terminal illness was not covered by her long term disability plan or Medicaid (california). After all their assets were sold, house, stocks, insurance policy, my husband and I refinanced our home twice to pay for their in- home 24-7 care running 15k per month. 2 years of juggling. No insurance or plan paid for anything. Medicare available of course but nothing could treat ALS. VA great for my WWII dad. We did all this on our own and proud of it. We now have our long term plan and hope it pays for some home care costs. We are not wealthy but we are saving for these costs. They died at home within 10 days of each other. They were never "warehoused". His biggest fear he would be warehoused.
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You are to be commended for stepping up to help your family. Only wish there were more like you.
Here is what asking adult children to pay the bills for nursing home care for parents means in the long run: Those adult children's assets could be drained so that when THEY need nursing home care, guess what - they have nothing. I suppose the thought is that then THEIR children will pay, and so on. Basically you bankrupt the retirement of each generation. My Dad was in a nursing home for 4 months. All his retirement income (with no allowance for tax with holding by the way) went to the nursing home. My Mom was left with about $1,000 a month in income, from which she had to pay the nursing home the tax deducted from his gross check. In my state, someone on Medicaid in a nursing home can only have $2,000 in assets. Had my parents not done some estate planning years before, my mother would like have lost her home as she would have been unable to afforded to maintain it. Does driving the well spouse into poverty solve any problems? Does draining the retirement savings of the children solve anything? These are important questions. My Dad was 17 years older than my Mom, so some estate planning was vital. I am now retired and am the caregiver for my 85 year old mother. I'm doing my share. I have no children, so I have long term care insurance. I hope I don't need it - but I worry a lot about my future. A nursing home could have my assets, but given the rising cost of care they probably wouldn't last long. Then what -into the parking lot to die?
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Yes, exactly. The buck stops when you don't have your own children to rely on. Or your children simply can't afford to keep you going.
Have relative who married into liberal - leftist redistributionist family, centered mostly in Massachusetts, 25-30 years ago.
Well, starting with the grandparents, who were essentially as socialist - communist "tax the hell out of the rich," "you people who work have to be taxed heavily to help the poor, aged, minority, education, blah, blah, blah, etc." as they come, suddenly they became "do as we tell you, not do as we do."
So many "estate planning attorneys" arrived, and shortly there after the two generations of grandparents and parents, quickly set up all manner of complex trusts, deed transfer + shell games over a multi decade period.
End result,
19 + 12 years of Massachusetts medicaid care in a top notch nursing home on Medicaid for Grand Parents 1 + 2. 6 and 13 years of similar care for other set of grand parents.
Then for the parents, 18 years for him (Parkinson's) and 13 years for her...infirmities of age, both also in a well paid for Massachusetts medicaid nursing home.
And the three houses in Hamilton, Ipswich and Manchester by there Sea went to the kids of my generation, scott free.
Do the math, these people were the Bernie Madoff family of the Medicaid asset diversion industry.
The extended family scammed Massachusetts, legally of course, out of what was probably millions of dollars, when you count the interest on the draw downs over two plus decades.
And people wonder why I don't really love liberals, as everything applies to us and not for them.
Well, starting with the grandparents, who were essentially as socialist - communist "tax the hell out of the rich," "you people who work have to be taxed heavily to help the poor, aged, minority, education, blah, blah, blah, etc." as they come, suddenly they became "do as we tell you, not do as we do."
So many "estate planning attorneys" arrived, and shortly there after the two generations of grandparents and parents, quickly set up all manner of complex trusts, deed transfer + shell games over a multi decade period.
End result,
19 + 12 years of Massachusetts medicaid care in a top notch nursing home on Medicaid for Grand Parents 1 + 2. 6 and 13 years of similar care for other set of grand parents.
Then for the parents, 18 years for him (Parkinson's) and 13 years for her...infirmities of age, both also in a well paid for Massachusetts medicaid nursing home.
And the three houses in Hamilton, Ipswich and Manchester by there Sea went to the kids of my generation, scott free.
Do the math, these people were the Bernie Madoff family of the Medicaid asset diversion industry.
The extended family scammed Massachusetts, legally of course, out of what was probably millions of dollars, when you count the interest on the draw downs over two plus decades.
And people wonder why I don't really love liberals, as everything applies to us and not for them.
15
An important goal of healthy communities is to share the risk of catastrophic events so no one individual pays the entire cost of life events that cannot be foreseen such as many of the diseases which occur or extensive damage to community and personal assets from weather or wildfires. People are often eligible for funds when their property is damaged; their use of this legal benefit is morally neutral despite their voting record on sea level rise due to climate change.
Many other catastrophic life events are subsidized by federal and state funds including paying for medical expenses in nursing homes after an individual's assets have been "paid down" to the state regulated number. Lobbying by the nursing home industry and senior living facilities is the primary support for this decision, not the "kindness" of the legislatures. Families who apply and qualify for Medicaid benefits for members in nursing homes must be eligible for this benefit. No official asks a "moral" question about using Medicaid dollars to keep one's parent or spouse alive. No one's voting record is checked (yet) to determine the "worthiness" of a person receiving Medicaid. This is a legal benefit provided to every person who can manage the qualification process and is determined to be eligible.
When we use "loaded" words like " scam", "shell game", "scott free" and liberal as an insult, the conversation is damaged so little progress in reaching an understanding of the Medicaid problem happens.
Many other catastrophic life events are subsidized by federal and state funds including paying for medical expenses in nursing homes after an individual's assets have been "paid down" to the state regulated number. Lobbying by the nursing home industry and senior living facilities is the primary support for this decision, not the "kindness" of the legislatures. Families who apply and qualify for Medicaid benefits for members in nursing homes must be eligible for this benefit. No official asks a "moral" question about using Medicaid dollars to keep one's parent or spouse alive. No one's voting record is checked (yet) to determine the "worthiness" of a person receiving Medicaid. This is a legal benefit provided to every person who can manage the qualification process and is determined to be eligible.
When we use "loaded" words like " scam", "shell game", "scott free" and liberal as an insult, the conversation is damaged so little progress in reaching an understanding of the Medicaid problem happens.
120
To assume that all "liberals" (and "conservatives," for that matter) are the same is exactly the kind of rhetoric that is making working together towards a real solution so difficult. Anyone can spend the day firing off tales to make the bully's case for their thinking. It's whiny and unhelpful.
105
So because a rich family took advantage of legal loopholes, like many rich people do, that justifies removing all legal protections for those who aren't wealthy? Just because one family gamed the system, we should throw the whole thing out rather than try to fix it? Of course, throwing the whole thing out just plays right into the hands of all those rich people who control the Republican Party and who will get a huge tax break by getting rid of Medicaid. Seems to me we should be fed up with rich people, not liberals, and focus - as the article does - on the middle and lower class people who will suffer most if Medicaid is gutted.
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Medicaid helps poor people both young and old, that's how it was designed. There was never any intention that poor people would lose Medicaid availability just because they got older.
Thank goodness there is some support for our growing ranks of elderly poor.
Thank goodness there is some support for our growing ranks of elderly poor.
23
My sister in law was threatened with neglect by a hospital over her estranged father's care. He had no assets, no savings and no credit cards. He was using the ER repeatedly for basic care. His second wife was in the later stages of Alzheimer's and in a nursing home. The hospital wanted his first wife and children to step in take care of him physically and financially or they were going threatened legal action. My mother in law had divorced him 30 years prior and she was still bitter that he had refused to pay spousal or child support. My in laws were getting called by healthcare vendors looking for payment for my father in law's outstanding ambulance and Medical bills. My mother in law had to remind the vendors daily that she had divorced the SOB 30 years prior. My sister in law ended up reaching out to Lights for Seniors for support and advice. For a fee, they helped the family get services and support for my father in law and the hospital backed off. My sister in law still has to cover the cost of adult diapers, take his middle of night calls, and deal with his nursing home disputes. My husband steps in and helps physically and financially whenever needed. The whole situation has has shaken the entire family to the core. They openly talk about how grateful they will be when he passes away.
36
Gross. If he didn't pay any child support, there should be a way to divorce your parent who divorces you.
26
You bring up an important point. Every state has different laws on whether, or not, nursing homes and health care providers can come after the rest of the family for payment. I fear this will become a common practice when the states experience huge cuts in funding. We all need to look at our own state's rules (and any future changes to them) and be prepared.
Ron,
This might be a good time to revisit the topic of Filial Responsibility Laws that require children to financially support their parents. In 2012 a Pennsylvania appeals court found a son liable for his mother's $93,000 nursing home bill under the state's filial responsibility law. Health Care & Retirement Corporation of America v. Pittas (Pa. Super. Ct., No. 536 EDA 2011, May 7, 2012).
The last time I asked an attorney about this there were 30 states that had such laws, including CA. I haven't seen a lot of publicity on states using these laws, other than the Pittas case, but we might see more of it in the years to come.
This might be a good time to revisit the topic of Filial Responsibility Laws that require children to financially support their parents. In 2012 a Pennsylvania appeals court found a son liable for his mother's $93,000 nursing home bill under the state's filial responsibility law. Health Care & Retirement Corporation of America v. Pittas (Pa. Super. Ct., No. 536 EDA 2011, May 7, 2012).
The last time I asked an attorney about this there were 30 states that had such laws, including CA. I haven't seen a lot of publicity on states using these laws, other than the Pittas case, but we might see more of it in the years to come.
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Article, map and link here http://guidetolongtermcare.com/filial.html
4
Yes they need to be eliminated.
10
A very important issue for all people to become familiar with so they can be prepared. Thanks for posting.
Thank you for this article! You have spelled out in plain language something that has alarmed me from the beginning of this debate. I spent 42 years working in health care as a social worker, advising people about their options. People are often shocked to find out Medicare does not cover long term care. I also have personal experience; my mom had Alzheimer's. she went from her home to an apt to an assisted living to a nursing home during the last years of her life. She exhausted her Long term care insurance and all her funds before going on Medicaid. And she still lived 2 years on Medicaid before finally dying last year. Finally, this has consequences not only for the huge numbers of my fellow baby boomers heading to old age, but also for all the family members who will have to fill in the gaps. This will have an impact on their income, their own retirement savings and the economy in general.
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In California, current law prohibits nursing homes and the state asking adult children to chip in for nursing home care for a MediCal (Medicaid) recipient. Do you think this could change in the future?
6
So far in recent times only Pennsylvania as used the "filial law" to require a family member to repay Medicaid for costs. More info here: http://guidetolongtermcare.com/filial.html
1
My 86-year-old mother died last year after spending her last year in a nursing home. She qualified for Medicaid after selling her house and draining her meager assets down to almost zero to cover her assisted living costs. When she became too ill, she had to be transferred to the nursing home. Medicaid took most of her Social Security, leaving her with about $100 a month for personal needs. I provided additional funds as best I could, but my mother was essentially destitute. The financial and physical downward spiral led to severe depression for my mother, which hastened her death. Many other family members will experience similar scenarios as their elderly parents age and deteriorate. If you think Medicaid is only for the poor, think again. You too are likely to be reaching out for Medicaid when you least expect to need it.
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You are in a nursing home so I assume you get food, shelter, etc. What more do you actually need? And yes Medicaid is only for the poor.
7
How about clothing, a book, a pen, an occasional treat, a birthday gift for a grandchild, a haircut? Would a cellphone be considered an extravagance?
(Writing from a nursing home)
(Writing from a nursing home)
1
"What more do you actually need?"
Laundry services, which are an additional cost. Shampoo, deodorant, etc. A haircut. A newspaper. Adult diapers. My father and father-in-law required assisted living and a nursing home, respectively. Staring at the same 4 walls can be depressing, so the facilities did field trips, such as lunch at a restaurant, minor league baseball, an evening outing to see fireworks, etc. All of these events were charges above the basic charge. Both places had cable television, but patients were billed as though each room was an apartment. Television is not necessary for life, but, I considered it a necessity as the option was staring at the walls every day. My father had tremors, and refused to eat in the dining room. We paid extra for meals to be taken to his room. My mother-in-law would visit only if it was during a meal, and, of course, we paid for her meals. My father paid a cleaning staff separately for weekly dusting and sweeping.
While I consider shampoo, deodorant, haircuts, cleaning, diapers, and laundry essential, the other items were quality of life expenses. We paid for my FIL's television. My MIL didn't consider it worth the money, though it was in their home, and she watched it most of the day. We found many families used the other expenses as a way to punish or torment.
We have long term care insurance, but it is a gamble. My ancestors lived until their 90's. What if we need more than 3 years?
Laundry services, which are an additional cost. Shampoo, deodorant, etc. A haircut. A newspaper. Adult diapers. My father and father-in-law required assisted living and a nursing home, respectively. Staring at the same 4 walls can be depressing, so the facilities did field trips, such as lunch at a restaurant, minor league baseball, an evening outing to see fireworks, etc. All of these events were charges above the basic charge. Both places had cable television, but patients were billed as though each room was an apartment. Television is not necessary for life, but, I considered it a necessity as the option was staring at the walls every day. My father had tremors, and refused to eat in the dining room. We paid extra for meals to be taken to his room. My mother-in-law would visit only if it was during a meal, and, of course, we paid for her meals. My father paid a cleaning staff separately for weekly dusting and sweeping.
While I consider shampoo, deodorant, haircuts, cleaning, diapers, and laundry essential, the other items were quality of life expenses. We paid for my FIL's television. My MIL didn't consider it worth the money, though it was in their home, and she watched it most of the day. We found many families used the other expenses as a way to punish or torment.
We have long term care insurance, but it is a gamble. My ancestors lived until their 90's. What if we need more than 3 years?
1
Unless you live long in perfect health -- which is possible, but those are the outliers -- or have children who are devoted, responsible and who live near you, man, old age is terrible.
Save, save, save. Get LTC if you can. And mostly, pray for a swift, painless, drama- and hospitalization-free death.
Right-to-die legislation nationally would be a huge help and relief to so many.
Save, save, save. Get LTC if you can. And mostly, pray for a swift, painless, drama- and hospitalization-free death.
Right-to-die legislation nationally would be a huge help and relief to so many.
83
Medicaid covers adults without health care who are poor, children who live in poor families, disabled people, and the nursing home care for elderly people. In short, these are people who cannot help themselves and must be supported by the program (i.e., by us who pay the taxes). Now, the Republicans are trying to cut back on those funds in order to subsidize a tax cut by their supporters (mostly wealthy). So, which of these groups will be hurt the most? Poor adults (34% of Medicaid recipients)? Children (43%)? Disabled people (14%)? Elderly under nursing home care (9%)? See:
http://www.kff.org/medicaid/state-indicator/distribution-of-medicaid-enr...
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Republican Senators, which group's Medicaid subsidies do you cut? I would like to know. Is any one of you willing to stand up and tell us which group of people have to take less so that you can fulfill your promise "to repeal and replace the ACA"?
http://www.kff.org/medicaid/state-indicator/distribution-of-medicaid-enr...
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Republican Senators, which group's Medicaid subsidies do you cut? I would like to know. Is any one of you willing to stand up and tell us which group of people have to take less so that you can fulfill your promise "to repeal and replace the ACA"?
49
Medicaid is welfare.
Medicare is what you pay into from your paycheck.
Medicaid is welfare.
The debate concerns 1.) a regression to prior levels of federal funding and, 2.) the requirement for individual states to pay more. The bill reduces the federal government's fiscal burden and empowers citizens of the individual states.
California's Governer Jerry Brown hates it because he's got a big money challenge and doesn't have the skills nor the sway over the public employees unions to fix it.
Medicare is what you pay into from your paycheck.
Medicaid is welfare.
The debate concerns 1.) a regression to prior levels of federal funding and, 2.) the requirement for individual states to pay more. The bill reduces the federal government's fiscal burden and empowers citizens of the individual states.
California's Governer Jerry Brown hates it because he's got a big money challenge and doesn't have the skills nor the sway over the public employees unions to fix it.
8
Medicaid is 'welfare' until it's your aged relative who has exhausted all her savings and can't afford nursing home care. When it happens to your family, and you don't have the money in your budget to cover your own family's living expenses plus $9K/month nursing home expenses for your geriatric parent, then you'll think differently.
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Whoever the states decide, or nobody if they can improve the costs.
2
Ron, I'm still trying to get educated about all this ( on a detail level, not the politIcal ) so wanted to leave you a big THANK YOU for all your reporting, which, especially crucial at this particular point in time. This story along with the entire so-called "debate" on this subject still screams to me the only way is Medicare for ALL, cradle to grave. And one less war could pay for it.
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The work my colleagues are doing on this will take your breath away. This is from today (Sunday).
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Thanks. Please keep reading/subscribing, we appreciate your support.
9
Indeed, it does. Tossing elderly out of nursing homes would wreak havoc in the economy for generations because to care for them family members would have to quit working (thereby losing their own health coverage), stop paying for their kids' college and futures, and abandon the chance to save for retirement, etc. And let's understand, too, that not all can be cared for at home even with support, and that many nursing homes are excellent.
37
The Democrats need to start running television commercials to get this information out to the electorate. People need to understand that this is how the GOP wants to not address the challenges of a rapidly aging society. As someone now in their mid-fifties, I find it absolutely terrifying and despicable.
104
I would say that the Democratic Party excel at poor communication...
You are absolutely correct. Where are the Democrats? Where are the TV spots disseminating and explaining this to the masses and the Dump dopes et al. who think it doesn't apply to them? This is our future and I know it all too well. It matters and this needs to be out there pounded into people's heads until they GET it!
2
Oligarchs are not interested in this boring topic, except perhaps as an investment.
23
Never elect sociopaths to government positions.
Simple truth.
Simple truth.
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Sorry but this is a very shallow truth.
The real lesson that everyone should learn is that elections do not guarantee wise or even competent leaders.
If you don't trust Trump to have X authority, then the presidential position should not be granted that authority. If you wouldn't entrust the Congress packed with Trumps, Republicans or Democrats, to spend wisely then no congress should be entrusted with that amount of money to spend.
If the energy used to try to sway government to address the problems we care about was instead used to find creative private solutions we could worry a lot less when the election process gave us another joker.
The real lesson that everyone should learn is that elections do not guarantee wise or even competent leaders.
If you don't trust Trump to have X authority, then the presidential position should not be granted that authority. If you wouldn't entrust the Congress packed with Trumps, Republicans or Democrats, to spend wisely then no congress should be entrusted with that amount of money to spend.
If the energy used to try to sway government to address the problems we care about was instead used to find creative private solutions we could worry a lot less when the election process gave us another joker.
We have Pennsylvania's Republican Sen. Pat Toomey to thank, should drastic cuts to Medicaid destroy the lives of the most vulnerable Americans. For Toomey has been credited with writing the Medicaid sections of the Senate health care bill.
29
The reason this fight makes little sense to the average citizen is because they don't really understand how the Republicans are funded for office and where their loyalties are. As a result of the 2010 Citizens United decision and the 2014 McCutcheon decision congressmen can receive unlimited secret money. The Republicans are simply trying to create the best health care system for their secret donors NOT Americans in general.
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Secret money? Do you have objective evidence of that or is it just more alternative reality?
2
Vulcan, it is very real. It's more commonly referred to as dark money. Money can be contributed to campaigns with anonymity from big donors, like the rich and corporations. This is completely legal and a possibility due to the Citizens United decision.
https://en.m.wikipedia.org/wiki/Dark_money
https://en.m.wikipedia.org/wiki/Dark_money
1
Thank you for your article about this opaque subject.
It was explained to me by a street-wise end-
of-life planner that Everyone in the United States ends up on Medicaid.
It was explained to me by a street-wise end-
of-life planner that Everyone in the United States ends up on Medicaid.
14
Everyone does not end up on Medicaid. As the article point out, 62% of nursing home paitients end up tapping Medicaid at some point. Medicaid is insurance for Americans in poverty and is not a good place to be. At least our poor have access, which keeps them off the streets.
7
About 45% of all Medicaid spending goes to 6% of Medicaid recipients in nursing homes. Clearly things have to change in Medicaid spending for long term care of the elderly by allowing at home care in place of only nursing home care. The better alternative to protect against forced destitution of qualify for Medicaid is LTC insurance. With LTC insurance, there is the option for home care in addition to nursing home care. Affording LTC insurance is another story.
20
As long as we allow insane laws to regulate that in home care IS NOT covered while the far more expensive residential nursing home care IS covered, we are only digging ourselves into a hole. The nursing home industry, usually a collection of shell corporations with impossible to find owners (in order to protect them from any liability as a result of the miserable state of their care) lobbies for these policies that benefit no one but the corporate masters of the health care industry. Wake up!
I looked into it. It would cost me $1200./month to insure against the distant possibility of needing long term care. Only the wealthy can afford that kind of premium. It's not the answer for middle class seniors.
as long as the policy covers what you think it will, and as long as the insurance company stays in business, and as long as you already haven't spent nearly as much money on your LTC insurance premiums as the actual cost of the home care...
A frightening article but all too true. Sadly, not enough people know this and many of them believed Trump when he started attacking medical care. They voted for him, and half of the senate and house members and put the deplorable members in charge. I am looking at my retirement now, and should I go into a nursing home, my wife will have nothing to live on, if I pay even half the amount stated in this article. That is on a government retirement after 29 years of employment. Over the years I have paid hundreds of thousands in taxes, figuring that was going into medicare and medicaid, plus retirement funding to cover me until end of life. This administration wants to help the rich, and to hell with the rest of us. Thankfully we had no long term disabilities, children that were healthy, and able to make it on their own, but no extra to help us out. Tell your neighbors and friends, and the folks down the street, what is happening here. Get them involved in telling their representatives to obey the Lord 11th Commandment: Do unto other as you would have them do unto you.
47
Ron,
You could check with the National Academy of Elder Law Attorneys naela.org to see if they have some data for you, although I imagine they wouldn't want to publicize it.
Ron Lieber is an NYTimes reporter Your Money columnist 2 hours ago
I am now curious if there is some way to know how many people are setting up these sorts of Medicaid trusts (in addition to those who do plenty of advance planning/gifting in other ways). It doesn't seem exactly practical, since nobody knows when their time of need will come or if they'll ever have one...
You could check with the National Academy of Elder Law Attorneys naela.org to see if they have some data for you, although I imagine they wouldn't want to publicize it.
Ron Lieber is an NYTimes reporter Your Money columnist 2 hours ago
I am now curious if there is some way to know how many people are setting up these sorts of Medicaid trusts (in addition to those who do plenty of advance planning/gifting in other ways). It doesn't seem exactly practical, since nobody knows when their time of need will come or if they'll ever have one...
3
There is no way to know the number of families making transfers or setting up trusts. These are done privately with the help of attorneys who’ve learned hundreds of medicaid regulations. The transfers / trusts must generally be completed 5 years before the client makes a medicaid application. Otherwise, they create a period of ineligibility. As they should, because if one could just transfer assets or set up trusts a week before applying, the abuse of the system would be worse. So the attorneys calculate how much each client must keep to “last” the 5 year ineligibility period, an inexact science that can expose clients. The look back period could be made longer, or penalties for lying about prior transfers scarier, or applicants required to disclose more financial records going back farther. But to process all that additional info, more agency staff would have to be trained, managed and paid, reducing funds for the intended population, and adding to more processing mistakes and delays. It will remain a thorny problem to fix, until citizens of some means feel more shame in doing it. My view is we keep discussing the issue with legislators, friends and family, and not be afraid to point out behavior that while may appear justified given the cost of care, desire to ensure heirs an inheritance, and anger at the perceived greed of nursing homes, really makes victims out of us other taxpayers who pay for their care, and who may not have the safety net in the future.
6
I also suggest looking into tightening up the rules -- e.g., perhaps requiring the trusts be set up further out -- like 10 years. Also some states are better than others at determining whether assets have been taken out recently and, as a relative once pointed out to me, can't do much about out of state relatives who may have recently helped themselves to some money.
Thank you for sharing this information. Too many people do think that Medicaid is just for "the poor." My father went into a nursing home after having a massive stroke; his pension paid much of the costs. I got my mother to "gift" my siblings and me so she would qualify for Medicaid, if need be. After Daddy died, the state Medicaid office came after my mother for $44,000, threatening to take her house. I hired an attorney and she kept her house. After my father died my mother was diagnosed with Parkinson's. She landed first in an assisted living facility, paid for with her assets and money from my brothers and me, and then in a nursing home in my state. The only reason she got a nursing home bed was that she was coming from a hospital, and bringing two months of full payment with her. I don't know if the system still operates like this, but I'm sure you do. She died in the nursing home. Unlike her home state, my state doesn't take houses from Medicaid recipients. When I sold her house, I had to pay the $44,000, but I was happy to do so. If you haven't dealt with Medicaid and/or Medicare, you have no idea how it works. Thanks again for your work to inform the head-in-the-sand public.
61
Every state has the right to recover Medicaid Dollars - some states just don't enforce it as well as others do. And the majority of people don't realize it - they think Medicaid is "free". This is just another way a long term care insurance policy can help. Most states have passed "Partnership" legislation. This means if you buy a long term care policy that meets the specifications, the policy will protect your estate on a dollar for dollar basis. Here's what that means in English: Let's say you have a policy that pays out $250K on your behalf. You go on claim and use up all the benefits and now you have to apply for Medicaid - because you had a policy that paid $250K, you will be allowed to protect $250K from the spend-down that Medicaid will require. If your policy paid $400K, then you get to protect $400K! Again...most people aren't aware of this feature. Just another reason to consider looking at long term care insurance to help protect you and your family.
Medicaid for the elderly, disabled, and children is caring for those who have no other alternatives. There are 76 million on Medicaid now. The qualification has long been those at 138% and below of the poverty level.
During the Obama Administration and with the advent of the ACA 11 million more adults were added from 31 states in 2009. 20% of the spending is on children that comprise 43% of the total enrolled. 8% are elderly and 13% are disabled. The 36% of adults number and the additional 11 million people that were added in 2009 should be looked at again in 2017.
Being elderly and aging is going to happen to us all. A child born and being dependent is understandable. Having a disability that keeps that person from caring for themselves and earning a living is a given...Those that are able-bodied, can work, and on this program need to be matched with jobs, trained and assisted to get off this program in a determined reasonable time-frame.
What is the plan?
During the Obama Administration and with the advent of the ACA 11 million more adults were added from 31 states in 2009. 20% of the spending is on children that comprise 43% of the total enrolled. 8% are elderly and 13% are disabled. The 36% of adults number and the additional 11 million people that were added in 2009 should be looked at again in 2017.
Being elderly and aging is going to happen to us all. A child born and being dependent is understandable. Having a disability that keeps that person from caring for themselves and earning a living is a given...Those that are able-bodied, can work, and on this program need to be matched with jobs, trained and assisted to get off this program in a determined reasonable time-frame.
What is the plan?
3
Ron, a question about the stats in your third paragraph. You say that a majority of people cannot and do not pay for their expenses themselves in old age. Then you say that one in three people (i.e., 33.3%, and thus less than a majority) who turn 65 end up in a nursing home, and of those, 62% can't pay the bill. So, did you mean to say that a majority of nursing home residents can't pay their expenses, rather than a majority of all older people?
5
Well, that was inelegant. Or incomplete at least. I should have also cited the number of people on Medicaid getting help outside of nursing homes and the % of folks who get some help from family too... Thanks for pointing it out, I will look for a way to add/adjust/correct.
10
This article is informative (and the facts need to be better known, but I think the denial of aging is widespread). Here is a related issue that I would like to know more about: long-term care insurance. My husband and I are older (late 60s/early 70s) and retired with pensions and Social Security sufficient to live on. We are also both still working part time, which pays for things like trips and dental implants. We do not have a huge amount of savings, are not in much debt, but do have quite a bit of equity in our CA house. We wanted to buy long-term care insurance and applied though Calpers, which offers the insurance for employees, current and former, and their relatives. After extensive interviews and giving access to medical records, the underwriters accepted me, but not my husband (pre-existing conditions!). The LTC I signed up for would also pay for home care. Still looking for an option for my husband. I read about a type of life insurance that turns into long-term care, but not sure if it is valid. Practically all the information I can find on this topic is advertising. I surely wish there were something straightforward to read. Maybe there are just not many good options.
16
It indeed has been too long since we wrote about this, so I'll fix that soon. Here's a piece from 2010 and another one from a few weeks later when a big player backed out of the market. This lament from 2011 has some good links. And here's our Wealth Matters columnist Paul Sullivan from late 2016 on the life insurance/long-term care insurance hybrids that 1-2 of you have mentioned here in the comments.
12
Susan,
As a CFP in Southern CA, I recommend you not rely on CalPERS' long term care insurance (LTCI) as the first and last word on your husband's coverage eligibility. They're not exactly a mainstream insurance carrier. Please see an independent agent that specializes in LTCI (and no, I don't sell insurance, I'm fee-only, so I'm not touting my services) to see what the major providers in the field might offer him.
And yes, a good agent can also talk to you about alternative products such as life and/or an annuity with a LTC rider.
As a CFP in Southern CA, I recommend you not rely on CalPERS' long term care insurance (LTCI) as the first and last word on your husband's coverage eligibility. They're not exactly a mainstream insurance carrier. Please see an independent agent that specializes in LTCI (and no, I don't sell insurance, I'm fee-only, so I'm not touting my services) to see what the major providers in the field might offer him.
And yes, a good agent can also talk to you about alternative products such as life and/or an annuity with a LTC rider.
3
Perhaps I can assist Susan regarding her husband and long term care. It is my understanding that the hybrid policies that are longer term care and life insurance combined are not as restrictive regarding pre- existing conditions. If you have not looked at the hybrids, you may want to speak with a financial planner who works with an insurance broker who has access to the various hybrids that are on the market. You should look at multiple policies from various companies.
4
Yes it might effect you depending on your state and what they do. Federal medicaid has expanded too much, not only can't we afford it, it is not in the constitution and is doubtful if it is actually in the "common good".
1
vulcanalex,
Are social security and Medicare mentioned in The Constitution for the Common Good?
Are social security and Medicare mentioned in The Constitution for the Common Good?
9
You better pray that you or one of your close family members never has to go to a nursing home. The cost is about $80,000 annually. Better start saving now if you don't like Medicaid.
11
Most ardently anti-socialist Americans vote Republican and have no idea how the Social-Democratic nations handle the elder care issue.
A Swiss friend of mine recently helped move his mother-in-law into an elder-care facility, secure in the knowledge that she would be humanely treated and that her care would never cost him anything out of pocket, period.
Socialized elder care diminishes anxiety on the part of both elderly parents and their aging children. (My friend is himself in his late 70s.)
The GOP agenda seems dedicated to raising the anxiety levels of the poor and lower-middle income families. I guess high levels of working-class anxiety and job insecurity must be good for business and highly beneficial to plutocratic interests.
Widespread anxiety makes so much sense within America's gun-saturated environment!
You have just have to applaud the GOPs agenda: Increased economic anxiety is a brilliant basis for securing social order and domestic tranquillity.
A Swiss friend of mine recently helped move his mother-in-law into an elder-care facility, secure in the knowledge that she would be humanely treated and that her care would never cost him anything out of pocket, period.
Socialized elder care diminishes anxiety on the part of both elderly parents and their aging children. (My friend is himself in his late 70s.)
The GOP agenda seems dedicated to raising the anxiety levels of the poor and lower-middle income families. I guess high levels of working-class anxiety and job insecurity must be good for business and highly beneficial to plutocratic interests.
Widespread anxiety makes so much sense within America's gun-saturated environment!
You have just have to applaud the GOPs agenda: Increased economic anxiety is a brilliant basis for securing social order and domestic tranquillity.
54
We are not the Swiss give me their population and culture and then such benefits would be appropriate. With our much more varied population it is not.
1
Dear Vulcanalex,
You argue that in America, since we have "a more varied population" and such cultural diversity, a Social-Democratic approach to eldercare is not appropriate. As a Tennesseean you no doubt endorse states rights. Perhaps the state of Utah, which is certainly far less varied in population and culture, should run an experiment to see whether this more communal approach to eldercare would work within our fairly homogeneous context.
I'll make that recommendation to Governor Herbert, and to Senators Hatch and Lee.
As John Dewey urged, within our democratic republic, it is important to keep the spirit of social experimentation alive and vigorous.
You argue that in America, since we have "a more varied population" and such cultural diversity, a Social-Democratic approach to eldercare is not appropriate. As a Tennesseean you no doubt endorse states rights. Perhaps the state of Utah, which is certainly far less varied in population and culture, should run an experiment to see whether this more communal approach to eldercare would work within our fairly homogeneous context.
I'll make that recommendation to Governor Herbert, and to Senators Hatch and Lee.
As John Dewey urged, within our democratic republic, it is important to keep the spirit of social experimentation alive and vigorous.
5
vulcanalex,
Are you planning to return to the Land of your Ancestors?
Are you planning to return to the Land of your Ancestors?
5
Believe it or not, my fellow Americans, there are countries in which elder-care is viewed as a not-for-profit publicly financed communal endeavor.
Of course we know better. It is self evident that profit-making enterprises are always run with superior economic efficiency. Indeed to be an American is to believe that every enterprise is so much more economically efficient when its chief end-in-view is the enhancement of shareholder-owner value. Economic efficiency, of course, demands that the interests of consumers and workers must always be subordinate to this central goal.
Sure consumers pay a lot and workers are called upon to make sacrifices in order to maximize profits and shareholder-owner value. But such costs and sacrifices are ennobling. Those paying the costs and making the sacrifices should bask in the glow of patriotic pride: They are underwriting the blessings of freedom, American style--the freedom to choose among the many varieties of available eldercare, for example, and the freedom to have access to whatever level of eldercare either you or those who love you can afford.
Of course we know better. It is self evident that profit-making enterprises are always run with superior economic efficiency. Indeed to be an American is to believe that every enterprise is so much more economically efficient when its chief end-in-view is the enhancement of shareholder-owner value. Economic efficiency, of course, demands that the interests of consumers and workers must always be subordinate to this central goal.
Sure consumers pay a lot and workers are called upon to make sacrifices in order to maximize profits and shareholder-owner value. But such costs and sacrifices are ennobling. Those paying the costs and making the sacrifices should bask in the glow of patriotic pride: They are underwriting the blessings of freedom, American style--the freedom to choose among the many varieties of available eldercare, for example, and the freedom to have access to whatever level of eldercare either you or those who love you can afford.
71
Thankfully, there is Medicaid in our country to pay for elder care for poor Americans. At least we have that to fall back on if we're not able to afford long term care insurance.
1
For profit enterprises do not provide better outcomes if the people that consume the services are not the ones paying the bills.
"Economic efficiency, of course, demands that the interests of consumers and workers must always be subordinate to this central goal."
Sorry this is simply wrong. A competitive system demands that the interests of shareholders and workers are subordinate to, those making the buying decisions and spending the money, the customers. Watch how quickly shareholders abandon a company if sales drop because customers switch to a competitor.
Customers can remake any industry as long as they are making the spending decisions. Look at any industry that does not have significant government involvement and you will see businesses fighting to please customers.
SMV
"Economic efficiency, of course, demands that the interests of consumers and workers must always be subordinate to this central goal."
Sorry this is simply wrong. A competitive system demands that the interests of shareholders and workers are subordinate to, those making the buying decisions and spending the money, the customers. Watch how quickly shareholders abandon a company if sales drop because customers switch to a competitor.
Customers can remake any industry as long as they are making the spending decisions. Look at any industry that does not have significant government involvement and you will see businesses fighting to please customers.
SMV
This article about living at home with dementia fits with the topic http://nexav.org/2scOB2J
3
My husband and I have no children. We're retired now. We had good professional jobs. lived frugally, and saved money like crazy. We still live frugally and do all that we can to take good care of ourselves. We got long-term care insurance almost 10 years ago and faithfully keep up the premiums. We have no one else to take care of us so we have done our best to save as much as we could to pay for much if not all of our own care when the time comes. I am well aware that many, many people are not in our position. They are the ones who really need Medicaid for nursing home care. I have major problems with people in our income bracket and those who make a lot more who hide their assets (with the help of lawyers) and expect Medicaid to pay their freight.
24
Say what? I do not know how many fraudsters you know, but that is the least of our problems.
Single payer, civilized society, which we are not.
We spend more per capita om healthcare and have the poorest outcomes. Even your money could run out and the hucksters here will figure out how to scam your long term nursing home plan.
It's a country running off the rails and the huge aging population will get us there faster.
Single payer, civilized society, which we are not.
We spend more per capita om healthcare and have the poorest outcomes. Even your money could run out and the hucksters here will figure out how to scam your long term nursing home plan.
It's a country running off the rails and the huge aging population will get us there faster.
19
Permanent nursing home coverage needs to be put back into Medicare. Everyone will be hurt by cuts to Medicaid to think otherwise is foolish, well unless you are Bezos, Gates or the like who can pay for anything.
26
Who pays for it? We are 20T in debt and way behind on some actual constitutional federal responsibilities. And I am not like them but I bet I won't be needing Medicaid, or accepting it if I might need it either.
1
Sounds like you have a plan ?
How old are you?
How are you insured now. How much money do you have for retirement.
Do you have a Long Term Care Insurance policy?
How do you know that a serious debilitating illness, loss of employment, or living so long as to outlive your savings informs you that " I bet I won't be needing Medicaid, or accepting it if I might need it either."
Are you that clairvoyant to know your future, or so wealthy that you know you would never need Medicaid and you are bragging that you would not accept it if you needed it. Doesn't make sense - what will you do if you did need it and not accept it? Live on the street?
How old are you?
How are you insured now. How much money do you have for retirement.
Do you have a Long Term Care Insurance policy?
How do you know that a serious debilitating illness, loss of employment, or living so long as to outlive your savings informs you that " I bet I won't be needing Medicaid, or accepting it if I might need it either."
Are you that clairvoyant to know your future, or so wealthy that you know you would never need Medicaid and you are bragging that you would not accept it if you needed it. Doesn't make sense - what will you do if you did need it and not accept it? Live on the street?
23
Most Republicans "engaged" in the Medicaid "debate" have already resolved this issue to their own satisfaction.
They simply once again posed their guiding question:
WHAT WOULD SCROOGE McDUCK DO?
For Republican legislators, asking that profound question is always so enlightening. Republican policies are generally self-evident and predictable responses to this Scrooge-query.
They simply once again posed their guiding question:
WHAT WOULD SCROOGE McDUCK DO?
For Republican legislators, asking that profound question is always so enlightening. Republican policies are generally self-evident and predictable responses to this Scrooge-query.
14
It has not been settled but it should be. Block grants to the states under some formula for the next say 10 years. States can decide what their citizens want and are willing to pay for.
1
Place this article on the cover of the New York Times with 'Your Money' by Ron Lieber in bold Capital letters. It may receive the care and attention it deserves.
9
We are in denial about the realities of both our own destinies as we age and become more infirm AND what the NY State Nursing Home sub-par care offers patients even at luxury prices most can ill afford.
Homework is required by NYT's readers as well as by Ron-though much of what the journalist is spotlighting, is appreciated and long overdue.
First-note that Leading Age (Ron references) is a lobbying group for the owner/operators of the nursing home industry and among the biggest donors to Governor Cuomo & our legislators who determine nursing home freedom from
accountability. I wouldn't trust my dog with these people.
Secondly, the NYS DOH Public Health & Health Planning Council continues to license the worst predatory consortia of long term care facilities in NY State...save all the money you will for your dotage-but these are too often, places that victimize and over-medicate old people into stuporous lethargy because greedy owners don't want to spend the money to improve aide/nurse to patient ratios...and are now trying to force binding arbitration so victims are no longer able to sue if they are harmed.
I recommend you open this video link...it says a lot about the state of nursing homes and all the reasons that you must try to avoid being placed in these miserable facilities...miserable with rare exception.
https://www.youtube.com/watch?v=nCzAvR_zW9E
Homework is required by NYT's readers as well as by Ron-though much of what the journalist is spotlighting, is appreciated and long overdue.
First-note that Leading Age (Ron references) is a lobbying group for the owner/operators of the nursing home industry and among the biggest donors to Governor Cuomo & our legislators who determine nursing home freedom from
accountability. I wouldn't trust my dog with these people.
Secondly, the NYS DOH Public Health & Health Planning Council continues to license the worst predatory consortia of long term care facilities in NY State...save all the money you will for your dotage-but these are too often, places that victimize and over-medicate old people into stuporous lethargy because greedy owners don't want to spend the money to improve aide/nurse to patient ratios...and are now trying to force binding arbitration so victims are no longer able to sue if they are harmed.
I recommend you open this video link...it says a lot about the state of nursing homes and all the reasons that you must try to avoid being placed in these miserable facilities...miserable with rare exception.
https://www.youtube.com/watch?v=nCzAvR_zW9E
14
I hear you, Sandy Reiborn. Too familiar with what happened to the residents of the Prospect Park Residence. Any suggestions on what we can do to protect ourselves?
5
Unless or until investigative journalists (such as those at ProPublica) keep peeling back the scam that is the NYS /DOH enabled Nursing Home predation-we are lost.
The LLCs and shell maneuvers by the owner/operators must be exposed and are not. The incriminating actions of the Governor , yes and the AG who rarely prosecutes (!) and the many state legislators who defer to powerful long term care lobby groups which fund their campaigns must be revealed...and they are not.
Individual's actions can do very little in the face of a welter of unconscionable owner/operators and government inertia or even actual collusion with these greedy predators.
Perhaps Mr Lieber will do some more digging? The NY Times has failed to step up to this urgent matter and one can only wonder why.
The LLCs and shell maneuvers by the owner/operators must be exposed and are not. The incriminating actions of the Governor , yes and the AG who rarely prosecutes (!) and the many state legislators who defer to powerful long term care lobby groups which fund their campaigns must be revealed...and they are not.
Individual's actions can do very little in the face of a welter of unconscionable owner/operators and government inertia or even actual collusion with these greedy predators.
Perhaps Mr Lieber will do some more digging? The NY Times has failed to step up to this urgent matter and one can only wonder why.
6
Since unconscionable government inertia keeps a shameful system of harm to the most vulnerable in place while benefiting predatory owner/operators...we must hope that reporters such as Ron and the NYT will emabrrass lawmakers into vigilance. They have failed to do so.
4
I have had first hand experience in opposite sides of the spectrum regarding elderly care. The first one was when my mother-in-law became widowed in 1998 at the age of 84. We noticed that she had more significant dementia than my late father-in-law let us to believe. We then went through the 5 year process of spending literally all her money. since she did not have ling-term care insurance.
At that point, we have no choice but to have her admitted in a nursing home and to get her on Medicaid, This was after we were audited by the state of Maryland, to make sure all her financial assets were truly used for her physical and psychological care. ironically, after being accepted by Medicaid, she died just 1 month later.
The other scenario was my own mother, who at the age of 87, was suddenly stricken by stage 4 pancreatic cancer, after living a very vibrant life. Because she worked at the A. Holly Patterson Home for the Aged and Infirm at Uniondale, NY for 20 years, she was aware of the financial problems her residents has, Therefore, she purchased Long-term care insurance, with a 90 day waiting period, to be used in case she couldn't live independently. This covered at home care as well as nursing home care.
The premiums, to say the least, were not inexpensive. She died 30 days later without benefit of using the insurance.
Therefore, the only solution I can see is to have the ACA or some facsimile offer long-term insurance as either a rider or having it mandatory.
At that point, we have no choice but to have her admitted in a nursing home and to get her on Medicaid, This was after we were audited by the state of Maryland, to make sure all her financial assets were truly used for her physical and psychological care. ironically, after being accepted by Medicaid, she died just 1 month later.
The other scenario was my own mother, who at the age of 87, was suddenly stricken by stage 4 pancreatic cancer, after living a very vibrant life. Because she worked at the A. Holly Patterson Home for the Aged and Infirm at Uniondale, NY for 20 years, she was aware of the financial problems her residents has, Therefore, she purchased Long-term care insurance, with a 90 day waiting period, to be used in case she couldn't live independently. This covered at home care as well as nursing home care.
The premiums, to say the least, were not inexpensive. She died 30 days later without benefit of using the insurance.
Therefore, the only solution I can see is to have the ACA or some facsimile offer long-term insurance as either a rider or having it mandatory.
32
Some version of this was tried with the "Class Act," during ACA but it ended up being actuarially unsound. It's very difficult to pull it off without sky-high premiums and/or collecting smaller amounts from younger adults for a very long time. The political will/personal discipline/desire just isn't there, it seems.
10
So as usual progressives only see two solutions, how stupid. People make choices if your relative had just saved that money instead of buying insurance they might have been fine. Everyone will die eventually sometimes sooner is better than later. And the government is not responsible for everything.
2
If I were to advise a young person, I would recommend they take out a big whole life policy instead of long-term care insurance. The plan would be to use it for exhorbitant medical co-pays and nursing home care in the event of severe illness or debility by borrowing against it if needed. I'm in my 50's and followed the conventional "wisdom" of buying term life because life insurance would not be needed after raising the kid and paying off the mortgage, whole life is not a great investment and term insurance was cheaper. The plus side to a whole life policy is you are not at the mercy of market fluctuations when you need it and it covers your need for life insurance as a younger adult.
3
Only a fool who has never seen parents through old age would still be telling him or her self these "I'll never be poor" stories."
As far as "The most detailed, plain-English guide I’ve found to the rules so far is called “How to Protect Your Family’s Assets From Devastating Nursing Home Costs" is concerned, this is one reason why Medicaid costs us taxpayers so much, especially in states like New York, where people spend thousands setting up "Medicaid trusts" for middle and upper middle class (and above) parents, to guarantee the kids an inheritance. I can understand protecting something for a surviving spouse, but for the life of me do not understand why I should be expected to guarantee an inheritance for a fellow taxpayer's children. I am told former NY Republican Governor George Pataki's father, who owned millions in Hudson Valley real estate, was on Medicaid when he was in a nursing home.
While I think we should be voting on universal healthcare, not Trumpcare, I also think we should be setting up more stringent rules on "preservation of assets" for people who want to go into a nursing home on Medicaid or who want 24-hour home care on Medicaid (yes, NY provides that too).
As far as "The most detailed, plain-English guide I’ve found to the rules so far is called “How to Protect Your Family’s Assets From Devastating Nursing Home Costs" is concerned, this is one reason why Medicaid costs us taxpayers so much, especially in states like New York, where people spend thousands setting up "Medicaid trusts" for middle and upper middle class (and above) parents, to guarantee the kids an inheritance. I can understand protecting something for a surviving spouse, but for the life of me do not understand why I should be expected to guarantee an inheritance for a fellow taxpayer's children. I am told former NY Republican Governor George Pataki's father, who owned millions in Hudson Valley real estate, was on Medicaid when he was in a nursing home.
While I think we should be voting on universal healthcare, not Trumpcare, I also think we should be setting up more stringent rules on "preservation of assets" for people who want to go into a nursing home on Medicaid or who want 24-hour home care on Medicaid (yes, NY provides that too).
35
I am now curious if there is some way to know how many people are setting up these sorts of Medicaid trusts (in addition to those who do plenty of advance planning/gifting in other ways). It doesn't seem exactly practical, since nobody knows when their time of need will come or if they'll ever have one...
10
And no matter what system you create there will be a way around it for those who care more about their money than their country. As with most programs elimination is the way to eliminate corruption. Charity is much more effective in eliminating such.
1
Lots of them, not only for Medicaid but for Military benefits as well. Here lawyers want you to put your assets in a trust very early.
Our family never thought our parents would have to rely on Medicaid. Our mother, a public school teacher, and our father, a minister, were middle class. They lived frugally, couldn't save much because of their salaries, but had a small inheritance from my grandmother. That $350,000 allowed them to get into a "good" nursing home and for 2 years they both payed in full for nursing home care. But, coincidentally, the month my Dad died, the money had been exhausted. My mother lived another 4 years, until she was 93, and had to rely on Medicaid for that entire time. Every month her whole pension went toward paying the cost of the nursing home and the remainder was paid for by the State of Georgia. We were fortunate in a couple of ways. First, we consulted an elder care lawyer as our parents were headed down the nursing home path, and thus we knew how to manage their limited funds; the chief benefit was knowing to pay for the funeral in advance. Second, my sister researched many nursing homes to make sure to choose one where they would not be "kicked out" when they had to rely on Medicaid. Mr. Lieber, please continue your informative articles. Most folks do not understand Medicaid or Medicare. Our family learned through experience.
107
I'm glad it worked out for you. As I understand it, nursing homes that take Medicaid never kick out current full-pay patients who run out of money and end up needing Medicaid later. Admission staff know that is a possibility and, I think, try to suss out how long any funds will last. If anyone knows or has experienced something different, please let me know.
6
I should have said that my sister had to work hard to find a nursing home that would accept Medicaid after their money ran out. It was difficult to find. There were other places that met our standards but it was clear from the outset that these didn't
accept Medicaid. We didn't want to risk putting them in the latter places, and we're glad we didn't, as things turned out.
accept Medicaid. We didn't want to risk putting them in the latter places, and we're glad we didn't, as things turned out.
3
Nancy, I'm sorry to hear it was so hard. One thing that is way less than clear to me generally (and varies by region and luck/circumstance too), is if you draw a circle around you 100 miles in each direction on any given day, what % of nursing homes in that circle do not take Medicaid at all and what % won't have Medicaid beds on any given day? Maybe she'd be willing to post here or send me a note at lieber @ nytimes dot com.
2
The article brings out one of the moral issues dealing with this subject, but misses a big moral issue that I never hear as part of the conversation. (1) Should we as a nation pay for all Medicaid services that a politician determines should be included? (2) The missing moral issue, that is not discussed, is whether we should leave a financial legacy for our children and grandchildren that they cannot afford. As Suzy Orman always says: Show me the money! The long-term moral issue is discussed when we talk about climate change, but the long-term financial issue is not discussed when we talk about Medicaid or other social programs.
2
Perhaps your moral issues are best handled by charity, putting morality into government laws is quite dangerous. Is it moral to say change your gender?
2
Exactly what has happened in my own family. We are working class and when my mother's dementia got so bad that she had to go into a nursing home, all of her savings was turned over and once that ran out, she went on Medicaid. If Medicaid funds are pulled, what are we supposed to do? Even if we tightened the belt and were able to contribute a hundred or two a month each, it wouldn't make a dent in the cost, so then what?
People need to stop using the term burden to describe the elderly. Aging is not negotiable. Some people are lucky enough to be lucid and go in their sleep eventually. Not everyone is though. I cannot help but be irritated reading headlines about the opioid crisis and that billions and billions of dollars are being set aside to help people who chose to take drugs and made a mess of their lives yet our parents are considered burdens who should be put into the street and just die already because they are a drain on the system. No one seems to care much about that. It's all about cutting them off because since they are old and helpless, their contribution to society has been exhausted so let's just get rid of them.
Watch the show Intervention and see how difficult it is for people-- who fully want to, and with one on one assistance-- to get off drugs. Relapses, follow up care, we will be paying in perpetuity to keep these people off drugs if they can manage to do it at all, but we can't enable our elderly citizens to live out their lives in a nursing home?
People need to stop using the term burden to describe the elderly. Aging is not negotiable. Some people are lucky enough to be lucid and go in their sleep eventually. Not everyone is though. I cannot help but be irritated reading headlines about the opioid crisis and that billions and billions of dollars are being set aside to help people who chose to take drugs and made a mess of their lives yet our parents are considered burdens who should be put into the street and just die already because they are a drain on the system. No one seems to care much about that. It's all about cutting them off because since they are old and helpless, their contribution to society has been exhausted so let's just get rid of them.
Watch the show Intervention and see how difficult it is for people-- who fully want to, and with one on one assistance-- to get off drugs. Relapses, follow up care, we will be paying in perpetuity to keep these people off drugs if they can manage to do it at all, but we can't enable our elderly citizens to live out their lives in a nursing home?
165
We should set aside the funds to do both. Taxes need to go up. Trump, always creative, said taxes are the highest in the US. nothing could be further from the truth. The far left candidate in France, Melenchon. who I don't agree with, wants to tax the super wealthy 100 percent. So no, the US with 35% tax and all the loopholes and havens is NOT the highest. Let's take care of our elderly, drug addicts that have no hope, and make higher education affordable again.
1
Yes, just like smoking. Musician Tom Petty (R.I.P.), a great guy, said on VH1 that he was a "smoking addict" and had been vaping in the last few years. And his system just wore out. Ditto, George Harrison of "The Beatles."
Former addicts will tell you -- you quit when you realize, you must be the one to do it. For others, and for yourself.
Ron,
I am almost 65, retired, with a public pension and SS income of $53,000, with no debts. I have about $40,000 in savings but nothing else, not even a house. I am presently in good health. Under today's Medicaid rules, if I needed to qualify for Medicaid in the future for a nursing home, would it be easier or harder for me to do so than someone who had more assets but less income? My mother had around $100,000 cash but only $400 monthly SS income when she needed a nursing home, so she went to assisted living for 6 months and then transferred to a nursing home while she still had around $50,000 cash. This allowed us to choose the nursing home because she wasn't entering as a Medicaid patient. After the $50,000 was gone she received a Medicaid bed in that nursing home. We consulted an elder lawyer who advised us about all of this and who did all the paperwork to qualify her for Medicaid. I'm just wondering how difficult it would be for me to get Medicaid assistance if I need a nursing home since I have a much larger income than she had but much less cash. I realize Medicaid would take my income once I was in a nursing home; I am just curious about eligibility. Thank you!
I am almost 65, retired, with a public pension and SS income of $53,000, with no debts. I have about $40,000 in savings but nothing else, not even a house. I am presently in good health. Under today's Medicaid rules, if I needed to qualify for Medicaid in the future for a nursing home, would it be easier or harder for me to do so than someone who had more assets but less income? My mother had around $100,000 cash but only $400 monthly SS income when she needed a nursing home, so she went to assisted living for 6 months and then transferred to a nursing home while she still had around $50,000 cash. This allowed us to choose the nursing home because she wasn't entering as a Medicaid patient. After the $50,000 was gone she received a Medicaid bed in that nursing home. We consulted an elder lawyer who advised us about all of this and who did all the paperwork to qualify her for Medicaid. I'm just wondering how difficult it would be for me to get Medicaid assistance if I need a nursing home since I have a much larger income than she had but much less cash. I realize Medicaid would take my income once I was in a nursing home; I am just curious about eligibility. Thank you!
12
I don't know, but the link to the NJ rules from that master link in the piece should get you started. Good luck.
4
And they could change at any time.
2
You need an instrument called a Qualifying Income Trust. It lets you keep excess income (if any).
Not a lawyer - just helped both parents go through this.
Not a lawyer - just helped both parents go through this.
Caps on Medicaid will be devistating for the overwhelming majority of our society, although everyone wants to think it is the other guys who will be hurt. On the other hand, I am really disturbed by the notion of asking the rest of us to pay for your end of life care while you "Protect Your Family's Assets." Or, in harsher words, "How to make sure your children remain rich while you plead poverty."
This is another distortion created by the lack of universal health care. Access to health care and quality education are two of the biggest factors in perpetuating the ever growing class divide in the US. Covering everyone from before birth until death is not only far cheaper (as the experience of the rest of the OECD nations have shown) it is the only approach to health care that is consistent with the idea of a democracy with universal sufferage.
Capping Medicaid converts it from a defined benefit to a defined contribution program, placing the burden of the out-of-control health industry on people who do not have the means to carry it.
Medicaid can be viewed as an "entitlement" only in the sense that life, itself, is an entitlement.
Leaving your fortune (such as it is) to your heirs, however, is not.
This is another distortion created by the lack of universal health care. Access to health care and quality education are two of the biggest factors in perpetuating the ever growing class divide in the US. Covering everyone from before birth until death is not only far cheaper (as the experience of the rest of the OECD nations have shown) it is the only approach to health care that is consistent with the idea of a democracy with universal sufferage.
Capping Medicaid converts it from a defined benefit to a defined contribution program, placing the burden of the out-of-control health industry on people who do not have the means to carry it.
Medicaid can be viewed as an "entitlement" only in the sense that life, itself, is an entitlement.
Leaving your fortune (such as it is) to your heirs, however, is not.
67
Unfortunately, many, if not most, Americans do not know how these things are handled in other countries. It makes a huge difference in quality of life and productivity when people can count on at least basic universal health care and when children can attend university by working part-time and not by taking out huge loans it will take them decades to repay.
7
I too find it offensive that people are allowed to "gift" their money away to their children and then ask the rest of us to pay for their care. I don't mind paying for their care if they truly are out of money. Why is this allowed to happen. Congress should be outlawing the practice.
While your argument is good, Medicaid and inheritance rules aren't nearly this clear cut or fair. Why is the house exempted in some states, but not others? Here's my case: I've spent the last 8 years providing elder care for my parents, in addition to working full time. My siblings and I provide coverage at their home 8+ hours/day, hopefully to avoid a nursing home. All of this is completely unpaid. Yet, if nursing home care is needed, the house must be sold and all proceeds used before a dime of Medicaid benefits kicks in. This is really unfair to all involved.
1
I paid the nursing home bills when my mom was a dementia patient. Three years came to over $200,000. We sold the home my parents lived in, which my dad had built, to pay for it. (She died in 2011, so I'm sure the costs are more now.)
And if the family is paying like we did, it's absolutely critical to track when Medicare picks up the tab (if your loved one ends up in and out Of The hospital), because trust me, the nursing home doesn't want you to know so they can keep the family payment as well as Medicare payment. the nursing home bills come ahead of the coming month, you see, you pay it, meanwhile mom goes back into the hospital and when she initially goes back to the nursing home, Medicare pays for some days.
After my mom died the nursing home and I had different figures for what refund we were due. I had to get assistance from a S.H.I.P. counselor and in the end the refund was $9,000 . Buyer beware.
And if the family is paying like we did, it's absolutely critical to track when Medicare picks up the tab (if your loved one ends up in and out Of The hospital), because trust me, the nursing home doesn't want you to know so they can keep the family payment as well as Medicare payment. the nursing home bills come ahead of the coming month, you see, you pay it, meanwhile mom goes back into the hospital and when she initially goes back to the nursing home, Medicare pays for some days.
After my mom died the nursing home and I had different figures for what refund we were due. I had to get assistance from a S.H.I.P. counselor and in the end the refund was $9,000 . Buyer beware.
15
Plenty of research now demonstrates the link with stress, immune response, poor health and so on. What could be more stressful than being elderly and confronted with complex, and now uncertain, medicare/medicaid decisions? This is another part of Ryan/McConnell policy changes that rarely receives much coverage. Not only does BCRA create cruel uncertainty in our most vulnerable but these changes could be cost INeffective as well due to the declining health linked to mental stress. The developed world has figured this out while we wallow in some fuzzy mindscape of unbridled capitalism. With careful planning, less greed, and compromise we can create an equally reasonable policy for all.
10
Genworth, quoted in the article and a key provider of Long Term Care in the US, has now begun increasing premiums to the point of forcing many elderly to cancel their coverage (after decades of faithful payments). This is creating an economic bomb ready to go off and most state insurance agencies would rather not talk about it.
18
Yes of course such care and its use is larger than insurance companies expected, In fact I expect such insurance to disappear as it is basically impossible to estimate the future costs.
6
Personally, I think ltc insurance has become a waste of time to even think about, unless perhaps issued and guaranteed by a public entity, like a state.
5
Exactly what happened with my parents. Genworth has capped their reimbursement at the amount they paid into their accounts for several decades, but getting Genworth to agree to pay for anything at all has been a nightmare. The company sends someone to re-evaluate my parents' "condition" every six months in case they maybe don't need assistance any more. My exasperated mother finally said to one of them, "there's no cure for being 98, you know. We're old, we need help with everything!"
8
Good thing that guns are legal and plentiful....best retirement plan going.
8
I'm booking a flight to Switzerland for assisted suicide as soon as I'm diagnosed with anything terminal. You need to be lucid to do this, but I will NEVER go into a nursing home- I would rather have my children spend the money than stare at the ceiling day after day.
1
But David Devonis, who is going to pull the trigger? Will you for yourself "at the right time"? And will you be able to? Will you be able to for your loved one or friend? And if you do this for your friend or family at their written and notarized request will you be prosecuted?
What will happen to nursing home residents on Medicaid if this bill passes? Will the family's get billed? Will they get put out? My 94-yo Dad is in a nursing home on a trache. He never recovered from an infection 6 months ago. He has not been approved yet.
7
I do not believe anyone will be put out in the street. The cuts won't come fast and hard enough for that kind of crisis to emerge that quickly, if anything like the current proposals pass. But things will change for people who are 5-10 years away from needing care.
17
I think what it mostly boils down to is states will have more limited amounts to deal with and at some point in the future may have to decide what they are going to continue funding. I agree it is unlikely to affect your father, and don't believe they can bill the family, at least not yet.
I believe the proposed federal legislation also places a cap on the amount of home equity exempt in determing Medicaid eligibility -- think will be around $500,000 -- but am not sure of that.
I believe the proposed federal legislation also places a cap on the amount of home equity exempt in determing Medicaid eligibility -- think will be around $500,000 -- but am not sure of that.
2
NY state, as a result of ACA Medicaid expansion, made some money available for in-home care for seniors. Moreover they extended funds beyond charitable organizations to for profit service providers. Early results show that keeping seniors in their own home lowers total care costs, and has better patient outcomes.
The basic "philosophy" of the ACA is that regular, secure, access to healthcare at any age improve health outcomes and system costs. In country after country with universal healcare, that's the experience.
The basic "philosophy" of the ACA is that regular, secure, access to healthcare at any age improve health outcomes and system costs. In country after country with universal healcare, that's the experience.
21
Those who need nursing home care in BC are not required to lose everything to qualify. They are charged according to income, from 0 to sometimes $50K or more, depending on their annual incomes. But they don't have to drain their savings or sell their homes. This seems like a fair plan to me.
8
Thank you for finally stating the obvious: that it is much cheaper and better for government to support in-home care for the elderly than nursing homes. For years, the home health industry has been trying to get this argument across to members of Congress and state governments with little success.
The reason for the failure, frankly, is that the industry hasn't had enough dollars to spread around as campaign contributions. The hearing of legislators suddenly improves when campaign dollars accompany the discussions. Because of this lack of clout, many home health providers don't even participate in Medicaid because the slim government reimbursements for such services don't even cover their costs.
Journalists have also largely ignored the efficiency and quality of life available through in-home elder care. They have preferred to focus on sensationalizing the isolated incidents where a home health aide is accused of stealing grandma's jewelry.
So, thank you, Ron Lieber, for highlighting something that many of us have known for years. If we took all the money spent annually on nursing homes by Medicaid, individual families and long-term care insurers, it would probably be enough for Medicare to offer a new, in-home care benefit to all elderly Americans.
The reason for the failure, frankly, is that the industry hasn't had enough dollars to spread around as campaign contributions. The hearing of legislators suddenly improves when campaign dollars accompany the discussions. Because of this lack of clout, many home health providers don't even participate in Medicaid because the slim government reimbursements for such services don't even cover their costs.
Journalists have also largely ignored the efficiency and quality of life available through in-home elder care. They have preferred to focus on sensationalizing the isolated incidents where a home health aide is accused of stealing grandma's jewelry.
So, thank you, Ron Lieber, for highlighting something that many of us have known for years. If we took all the money spent annually on nursing homes by Medicaid, individual families and long-term care insurers, it would probably be enough for Medicare to offer a new, in-home care benefit to all elderly Americans.
88
Not in New York it isn't. There are people here on Medicaid who get 24 hour home care, which is more expensive than nursing home care. I am not saying they shouldn't get it; I am just saying it is not cheaper than nursing home care.
For people who don't qualify for Medicaid, say are more "middle class," and want some in home care, even 4 or 6 hours a day, it can be terribly expensive here, and what drives people from middle classes to lower classes, and ultimately either out of state to some place less expensive, or perhaps just into a local nursing home.
For people who don't qualify for Medicaid, say are more "middle class," and want some in home care, even 4 or 6 hours a day, it can be terribly expensive here, and what drives people from middle classes to lower classes, and ultimately either out of state to some place less expensive, or perhaps just into a local nursing home.
10
And of course no government program is way cheaper than anything. Not that I am proposing that but insisting that there are only a limited number of solutions is foolish.
Maybe I wasn't clear enough Ellienyc, but there are many cases where the elderly could function well in their own homes (including not needing 24-hour care), but they are shunted into nursing homes because there is no other choice if relatives can't or won't provide the care or if the family can't afford assisted living, which is not covered by government programs, except in certain circumstances.
There is no in-home care benefit for Medicare that is not tied to a medical procedure or to hospice, but there should be. There are many cases where older people could stay in their own homes and receive adequate help for daily functioning that would be far cheaper than institutional care. No, I'm not talking about a 24-hour home health aide at $20-$25 per hour. I'm talking about a set number of hours a day or week in which an aide would help with cooking, cleaning, bathing, toileting, medication compliance and checking vital signs. This could be a new Medicare benefit that would cost far less than nursing home care in NY, which I believe is well north of $10,000 a month these days. It would help to relieve stress for many families with limited time and/or incomes and for the elderly who are still too alert to endure a nursing home.
There is no in-home care benefit for Medicare that is not tied to a medical procedure or to hospice, but there should be. There are many cases where older people could stay in their own homes and receive adequate help for daily functioning that would be far cheaper than institutional care. No, I'm not talking about a 24-hour home health aide at $20-$25 per hour. I'm talking about a set number of hours a day or week in which an aide would help with cooking, cleaning, bathing, toileting, medication compliance and checking vital signs. This could be a new Medicare benefit that would cost far less than nursing home care in NY, which I believe is well north of $10,000 a month these days. It would help to relieve stress for many families with limited time and/or incomes and for the elderly who are still too alert to endure a nursing home.
18
It amazes me how little lower to upper middle income Republicans understand about what Mr. Lieber and many others are saying about the grim future they face as the result of what our Republican run government is trying to do to dismantle Medicaid and their ability to get adequate health care now and in the future.
Unless information like Mr. Lieber's gets through to millions of unaware voters, they will not appreciate the safety net that protects them until they fall without one. Charities will only be able to pick at the edges of this worsening health care nightmare.
Unless information like Mr. Lieber's gets through to millions of unaware voters, they will not appreciate the safety net that protects them until they fall without one. Charities will only be able to pick at the edges of this worsening health care nightmare.
16
The Republicans may not understand much about this legislation, but believe me, when the time comes REpublicans are among the sharpest at figuring out how to get someone else to pay for their parents' care.
8
The anti-male bias in this article is sickening, it is not even perfunctory, it is deliberately going out of its way. I certainly will not read on after that, and having spent my life with ongoing ridicule and venom spewed at me because the few top executives tend to be mainly male.
2
Is this directed at me, Ron? Or is it from some other piece and it randomly ended up here? In many older couples, the man is older. And men die younger. Which means more often than not, women take care of men. If the money runs out before their days on the planet do, well...
That's the only reason I mentioned gender here. Sorry for any offense caused.
That's the only reason I mentioned gender here. Sorry for any offense caused.
31
I just came back here after reading the article about Pence not meeting with women alone. Lots of anger in the comments over there. Sounds like this was meant for that area and not this one.
4
Great article and long overdue. Now would you write something about how the ACA affects Medicare. As I understand it, it does.
4
Congratulations to Ron Lieber for shining a bright light on a critically-important subject.
Ron -- I volunteer for the Medicare Rights Center and I'd be thrilled to help you dig out and publish information on all of this. PS, I am an Amherst alum.
Ron -- I volunteer for the Medicare Rights Center and I'd be thrilled to help you dig out and publish information on all of this. PS, I am an Amherst alum.
16
Thanks! You'll be hearing from me.
7
Thanks so much for this "health exchange". I spent several hundred hours visiting my mother during her last several years in a nursing home. It was good for her. Stopped her smoking and falling, extended her life I think. However, I observed that few men adapted and lasted long. Too passive for them. A sports room, a stock market room, and a horseracing room would help men abide. Are there relevant stats? As for governments problem with money - our economy can afford custodial care for the old. Improves productivity and life quality for prime age people, provides jobs for a spectrum of workers from physicians to cleaners.Medical costs are peaking now but will trend down per capita as people live and eat better, as treatments advance past development stages, and genetic science becomes applied.
Hey fellow seniors...just wait till those Congressional geniuses (all of whom have lifetime health insurance and generous pensions) come after Medicare and Social Security. Don't say you weren't warned.
20
The 'comfortable' people can plan for their future by having an insurance policy for Long Term Care. No need to wait for the government to do everything for you, Think ahead! Let Medicaid do what it was designed to do and not expect it to stretch it into the single payer plan. The country cannot afford nor do they know how to be in the business of healthcare!
11
Long term care insurance, as offered by most private insurers, has become too expensive for most middle class people. The upper class people don't need it because they have enough money to pay on their own.
11
What most people dont realize that coversge is limited even WITH these insurance policies. And the number of companies offering them is DECREASING, since they are not profitable for the companies. Those that remain have raised their prices. While helpful, they are not the solution to the problem. And "comfortable" people will go thru their assets very quickly. My uncle was a doctor, but when both my aunt, then himself, had to go into a nursing home, they quickly went thru all of their assets, including a reverse morgage on their home. Once both were in the nursing home, the bank quickly claimed the home.
11
My mother was fortunate enough to have long term care. She got it at age 69 when my father passed away. Initially, it was 800.00 a month. By the time of her death at age 90 it went up to 1300.00 a month. My mother was not rich. She was a nurse with a good pension and she also had my father's pension. He worked for the Port Authority for 30 years. Those kinds of jobs and pensions don't exist anymore.
My mother was able to have 24-hour care at home up until the end but even then the care was not great. My mother lived in Newark, NJ and only one provider in NJ would service here there. Over a 10 year period, we fired close to a dozen aides for stealing, incompetence, or neglect. We discovered that one aide who had been working with her for over a year couldn't read and was giving her the wrong medications at the wrong time.
Yet, my mother was very fortunate because she did not have to liquidate all her assets and sell her home.
Only the very richest in our country with an endless supply of assets and money get the best care.
My mother was able to have 24-hour care at home up until the end but even then the care was not great. My mother lived in Newark, NJ and only one provider in NJ would service here there. Over a 10 year period, we fired close to a dozen aides for stealing, incompetence, or neglect. We discovered that one aide who had been working with her for over a year couldn't read and was giving her the wrong medications at the wrong time.
Yet, my mother was very fortunate because she did not have to liquidate all her assets and sell her home.
Only the very richest in our country with an endless supply of assets and money get the best care.
3
The only facts you need to know from Kaiser Family Foundation are these: 1 out of 3 of us who turn 65 will end up in a nursing home. Of those people, 62% or more will need to rely on Medicaid to help pay their bills.
According to the Population Reference Bureau, there were 46 million Americans 65 or older in 2016. It predicts that number will grow to 98 million by 2060. Of course, this doesn't take into account medical advances which might make that number far greater.
The damage this administration and GOP leadership in Congress is planning on doing to Medicaid will have a damning impact on recipients now and for years to come.
Nursing home bills don't simply threaten the fiscal wellness of the patient. Countless adult children and other family members will be bankrupted attempting to pay for their care, or unduly burdened by attempting to take care of chronically ill parents in their homes.
Medicaid isn't a government "handout". It is a services provided to protect those among us who cannot protect themselves.
In the Preamble calls on the government to "promote the general welfare" of our citizens, not hang them out to dry.
According to the Population Reference Bureau, there were 46 million Americans 65 or older in 2016. It predicts that number will grow to 98 million by 2060. Of course, this doesn't take into account medical advances which might make that number far greater.
The damage this administration and GOP leadership in Congress is planning on doing to Medicaid will have a damning impact on recipients now and for years to come.
Nursing home bills don't simply threaten the fiscal wellness of the patient. Countless adult children and other family members will be bankrupted attempting to pay for their care, or unduly burdened by attempting to take care of chronically ill parents in their homes.
Medicaid isn't a government "handout". It is a services provided to protect those among us who cannot protect themselves.
In the Preamble calls on the government to "promote the general welfare" of our citizens, not hang them out to dry.
185
BUt do the Kaiser Family Foundation data also show the average length of stay? I have heard it is generally not years and years, but more like months, especially in the case of women. I would be curious to know if the Kaiser data supports that, as they are a reputable group.
4
Here are some older numbers from the industry that wants to sell you insurance to pay for some of the costs.
4
Hard as it is to face, it is inevitable that the baby boomers (I am one) will have to accept that the normal healthy lifespan is about 85 years. Fifty percent of those who make that mark will have dementia. Many others will have conditioins that rob them of life quality. Those who are living miserable lives simply have to timely die, rather than bankrupt society with life prolonging, expensive and utterly pointless treatment.
This TrumpCare (talk about an oxymoron!) plan IS the Death Panel the Republicans were talking about with the ACA. The Dems should make that perfectly clear.
23
Lots of good points in the article. But perhaps a different perspective would be helpful.
- if we do nothing, the federal medicare and medicaid programs will not be here in our future. The current funding / benefits gap is simply not sustainable. Some may rather raise taxes than cut benefits, but that has other negative consequences.
- The health care bills currently on the table seek to move the provider of health care from the Federal Government to each state. Currently it's about 90/10 and the goal of the current Senate version is to get it closer to 50/50 split - which is consistent with much other spending. Many people want to see spending decisions made locally rather than by a federal government that has different perspectives. Again, pros and cons of this approach but the portrayal of spending cuts (by the Feds) need to be balanced by the expectation of state increase. Obviously many states will not be able to sustain this fiscally without major changes.
- Money is a limited resource. Therefore some sort of cap in terms of spending is necessary. Basic Economics. The current law has no caps on spending. Another fact that makes it unsustainable. Limited resources mean that there have to be hard decisions made - which in turn means that someone has to lose and someone has to win. Choices have consequences. Sorry but unless we invent a way unlimited funding, some will have to suffer.
Just some alternative perspective to the discussion.
- if we do nothing, the federal medicare and medicaid programs will not be here in our future. The current funding / benefits gap is simply not sustainable. Some may rather raise taxes than cut benefits, but that has other negative consequences.
- The health care bills currently on the table seek to move the provider of health care from the Federal Government to each state. Currently it's about 90/10 and the goal of the current Senate version is to get it closer to 50/50 split - which is consistent with much other spending. Many people want to see spending decisions made locally rather than by a federal government that has different perspectives. Again, pros and cons of this approach but the portrayal of spending cuts (by the Feds) need to be balanced by the expectation of state increase. Obviously many states will not be able to sustain this fiscally without major changes.
- Money is a limited resource. Therefore some sort of cap in terms of spending is necessary. Basic Economics. The current law has no caps on spending. Another fact that makes it unsustainable. Limited resources mean that there have to be hard decisions made - which in turn means that someone has to lose and someone has to win. Choices have consequences. Sorry but unless we invent a way unlimited funding, some will have to suffer.
Just some alternative perspective to the discussion.
4
Thanks. The federal government does not pay 90% of Medicaid. It's more like 60% I think -- the poorer states pay less and the richer ones pay a bit more. The feds do set rules for what Medicaid must (nursing homes) or can (community/home-based care) cover, but they do not provide the care -- there are no federal nursing homes or hospitals that I know of save for the VA.
18
Excuse me, Ron -- isn't it working taxpayers who pay, with their taxes? Last time I checked, the government was a bunch of buildings and workers with better benefits than most Americans.
You may think that is picking nits. Well, visit the post office on April 15, please. Thanks.
You may think that is picking nits. Well, visit the post office on April 15, please. Thanks.
What is long-term care? Long-term care is custodial care, which means that we need help with some of the everyday activities of living: eating, bathing, dressing, toileting, continence, and transferring (mobility). Or, because we are cognitively impaired, we need guidance.
Custodial care is different from medical care, as you can see. I may need help because I am weak, for example, or unsteady on my feet--but I do not need to go to my doctor for it because this is my condition now, and the doctor can't cure it.
Most Americans do not have a plan to handle long-term care needs. They mistakenly think that Medicare will take care of it. And now, the real backstop--Medicaid--may not help us either.
Some plan is better than no plan. Accepting individual responsibility for planning is the first step. There are only three ways to pay for long-term care expenses: private money, long-term care insurance, or Medicaid. If Medicaid will not be an option, how will you pay for your long-term care?
Time to make a plan.
Jim Robertson, lifelongcarenetwork
Custodial care is different from medical care, as you can see. I may need help because I am weak, for example, or unsteady on my feet--but I do not need to go to my doctor for it because this is my condition now, and the doctor can't cure it.
Most Americans do not have a plan to handle long-term care needs. They mistakenly think that Medicare will take care of it. And now, the real backstop--Medicaid--may not help us either.
Some plan is better than no plan. Accepting individual responsibility for planning is the first step. There are only three ways to pay for long-term care expenses: private money, long-term care insurance, or Medicaid. If Medicaid will not be an option, how will you pay for your long-term care?
Time to make a plan.
Jim Robertson, lifelongcarenetwork
2
My grandfather died 18 1/2 yrs. ago - at 97 - after spending 1 1/2 yrs. in a nursing home. He had severe dementia and his physical condition had also deteriorated significantly. He'd carefully saved what seemed like a lot of money - in order not to be a burden to his family and to also leave us some money - but most of it was used to (private) pay for the nursing home. It was supposed to be one of the better nursing homes in the (D.C.) area - and if so, I'd sure hate to see the worst....
Six months later, my husband & I (then 47 & 43) decided we'd better take out LTC policies. We don't have children, but we were very worried about potential payments for private-pay aides wiping out our (eventual) retirement savings and therefore possibly leaving whichever one of us survives the other one nearly bankrupt. After observing my grandfather's experience at the nursing home, we most definitely didn't (and don't) want to ever end up in a nursing home.
We have a very good LTC policy because we were young and very healthy at the time of its inception, but it costs a small fortune and naturally we must pay for it forever. This year there was a big increase (for the first time) - and they legitimately obtained permission from NY State - because people are living longer and the company must remain financially viable. Still; we would have to pay 50% of the aides' cost, and that could still "wipe us out" financially if we each required many years of (separate) care.
Six months later, my husband & I (then 47 & 43) decided we'd better take out LTC policies. We don't have children, but we were very worried about potential payments for private-pay aides wiping out our (eventual) retirement savings and therefore possibly leaving whichever one of us survives the other one nearly bankrupt. After observing my grandfather's experience at the nursing home, we most definitely didn't (and don't) want to ever end up in a nursing home.
We have a very good LTC policy because we were young and very healthy at the time of its inception, but it costs a small fortune and naturally we must pay for it forever. This year there was a big increase (for the first time) - and they legitimately obtained permission from NY State - because people are living longer and the company must remain financially viable. Still; we would have to pay 50% of the aides' cost, and that could still "wipe us out" financially if we each required many years of (separate) care.
7
People can stay in their homes or have their children care for them. But sometimes (stroke or such) people need skilled nursing around the clock and that is where it gets very $.
5
This is sohy on Fred's account. I have worked as an RN for over forty years, primarily either in certified home health agencies or for the last 18 years in a small long term care facility. I am well aware of how these programs work. About half of my current clients are receiving help from Medicaid. Many of these folks could be cared for by children but most children don't want the responsibility of caring for their aging parents, and often times aging spouses are not physically capable of caring for a spouse with dementia.
Dementia is the primary reason why people enter long term care facilities. Caring for people with dementia, especially in the middle to later stages is very difficult and due to our longer life spans, more of us will be afflicted by some form of dementia if we live beyond our 85th birthday. This is a huge problem which will only get worse as my generation ages. Even for those of use who have what might seem like adequate savings, long term care is not affordable.
I don't know what the answer is to this pending problem, but I know that I don't want any aggressive care once I reach the point where I am not fully cognizant or fairly independent. Maybe that's where we need to start the conversation. We need to stop thinking of quantity of life and start discussing quality of life and work on what we can do to remain fairly independent until we are very close to the end of life.
Dementia is the primary reason why people enter long term care facilities. Caring for people with dementia, especially in the middle to later stages is very difficult and due to our longer life spans, more of us will be afflicted by some form of dementia if we live beyond our 85th birthday. This is a huge problem which will only get worse as my generation ages. Even for those of use who have what might seem like adequate savings, long term care is not affordable.
I don't know what the answer is to this pending problem, but I know that I don't want any aggressive care once I reach the point where I am not fully cognizant or fairly independent. Maybe that's where we need to start the conversation. We need to stop thinking of quantity of life and start discussing quality of life and work on what we can do to remain fairly independent until we are very close to the end of life.
21
Thank you Ron! I am going to print your article and give it to a person who does not realize the reality of it all, or does not want to realize.
2
Love to have an analysis of long term care insurance. Who should buy it, how much to buy, hybrids versus non hybrids etc. how much assets are needed to self insure. I spent a lot of time with our financial planner who pulled in a LTC broker. We turned these programs upside and inside out. I have expertise in insurance for corporations, but not LTC coverages. Frankly I could not find a LTC package that was that great. Maybe we are missing something?
10
Google my name and "long-term care insurance." I wrote a lot about it when the cracks in the straight-insurance market first appear. The hybrid life insurance policies seem... complicated. But I should return to this... thanks.
7
Ron, thanks and I had read your articles when assessing LT C insurance policies. Your article were very helpful. It appears the crack in the straight insurance market have widened since then. It would be great if you would return to this topic in another article. I spent hours analyzing these policies with experts and I just did not see where the current LTC nor hybrids made sense. But I may be missing something.
8
Agreed, it's time to return to the topic, thanks.
9
Ron,
My experience with elder lawyers is that they have people divest themselves of their assets so that Medicaid will pay for their nursing home. That way their dependents get their money and Medicaid gets the bills. In NY state their is a 5 year look back period and the amount you can divest without paying inheritance tax is 5 million dollars. Perhaps the way to control Medcaid costs is to changes these laws. What do you think?
My experience with elder lawyers is that they have people divest themselves of their assets so that Medicaid will pay for their nursing home. That way their dependents get their money and Medicaid gets the bills. In NY state their is a 5 year look back period and the amount you can divest without paying inheritance tax is 5 million dollars. Perhaps the way to control Medcaid costs is to changes these laws. What do you think?
18
I think this exactly the right question. Watch this space. And if you have a professional or personal interest in this one way or the other, please drop me a note at lieber @ nytimes dot com.
11
Ron, great info. I'm in my 60's and I have no health issues, but I'm worried that if I have dementia or I'm hit by a car that affects my ability to think, how can I put an iron clad directive in place so I'm not on a ventilator/ feeding tube for 10 years? I've lived a good life. I've read, once your in the hospital system and you have assets, they won't let you go- you are a cash cow.
Many of us would rather die than accept this expensive care, which often comes with very low quality of life. More and more of us will have no family and therefore no advocate to protect us from nursing home abuse. We need to make assisted dying more widely available. And there's no such thing as "preventive" care. Just risk reduction and early detection which do not always equate to prevention.
104
I was waiting to come across a comment like this.
How much anguish, grief, and ultimately monetary expense (if that's what we're concerned about) would be allieviated if people were given the humane choice of euthanasia to leave this life behind? I wish like a DNR or living will, I had the opportunity to outline the circumstances where I'd like my life to be terminated if I can't do it myself. I have no desire to live in pain, or with my mind gone, let alone burden my fellow humans with exorbitant expenses just to extend the length of my life. I don't want to be saddled with debts to pay for others who have no quality of life, nor do I want others to do that for me. Leave the money for the living, not dying. I fear my body living on when I ought to be dead far more than my life ending. We have to decide if we actually value life: let's care for children and adults, their healthy eating, education, and mental and body care over those who given the choice would rather die.
How much anguish, grief, and ultimately monetary expense (if that's what we're concerned about) would be allieviated if people were given the humane choice of euthanasia to leave this life behind? I wish like a DNR or living will, I had the opportunity to outline the circumstances where I'd like my life to be terminated if I can't do it myself. I have no desire to live in pain, or with my mind gone, let alone burden my fellow humans with exorbitant expenses just to extend the length of my life. I don't want to be saddled with debts to pay for others who have no quality of life, nor do I want others to do that for me. Leave the money for the living, not dying. I fear my body living on when I ought to be dead far more than my life ending. We have to decide if we actually value life: let's care for children and adults, their healthy eating, education, and mental and body care over those who given the choice would rather die.
An excellent column and long overdue. Now, how can we reach the people who don't read the business section of the NYT, especially reality-denying Trump supporters? The Dems certainly haven't!
41
Have you talked to Trump supporters? Facts just don't penetrate their brainwashing.
Everyone who has access should check out Tom Donlan's editorial on Medicaid spending in today's Barrons.
He gives the basic facts: total Medicaid spending is $553 billion, of which $118 billion is long-term care. This number will probably increase dramatically as the first group of baby boomers reach 85 in 2030.
The substance of the editorial is criticism of the asset-hiding methods used to make large numbers of people eligible, and the looseness with which the current rules are enforced.
He gives the basic facts: total Medicaid spending is $553 billion, of which $118 billion is long-term care. This number will probably increase dramatically as the first group of baby boomers reach 85 in 2030.
The substance of the editorial is criticism of the asset-hiding methods used to make large numbers of people eligible, and the looseness with which the current rules are enforced.
7
Those "asset hiding methods" are what most people call retirement savings. In our on-your-own society, they are essential in order to spin off enough interest and dividends to pay for things like rent and food and even things neither Medicare nor Medicaid will cover for health reasons.
True, if we lived in a society where everyone got an old age income sufficient to live on - which Social Security generally isn't - one would not need such a large store of assets, and then that money could be put to better use than in the bloated asset markets.
But that is not the world we live in, is it?
True, if we lived in a society where everyone got an old age income sufficient to live on - which Social Security generally isn't - one would not need such a large store of assets, and then that money could be put to better use than in the bloated asset markets.
But that is not the world we live in, is it?
15
The problem is that the asset hiding is often either being undertaken by or instigated by employable adult children looking to guarantee an inheritance.
4
Ron, please explore the idea you touched upon that by being penny-wise and pound-foolish, society may end up paying more than it has to. The person who can't afford proper assisted living now may become more of a financial burden on society later. Just as insurance companies have recognized that paying for gyms, smoking cessation programs, etc., will keep their insureds healthier and generate fewer health care claims, society should recognize that taking appropriate care of the elderly and disabled may save us money in the long run.
36
Oregon has led the way here -- I'm going to look and see if there is any data showing how this has worked out for them. Readers, if you have any leads, please send them my way or post them here.
15
This is a very important point. WHen my mother reached her mid 80s and started to find living on her own challenging she fortunately had a home that had appreciated a lot that she could sell and use the money to move into assisted living near me. Not everyone has that.( By the way, my brother didn't want to let her sell the house -- he wanted to force her to stay in her house in a remote area and die "naturally" --when that failed, she sold the house, and later got sick, he wanted us to take all the money that remained, claim poverty and put her in a nursing home, as "Elder Planning" lawyers would likely suggest).
3
This raises a really important point, which is that even if the individual/couple plan for their care and agree on it, the kids (if there are any and there are more than one) may not agree and may attempt to influence the outcome in their financial favor. This goes on all the time, and it's not an easy thing to solve for. Families are complicated.
20
Great article Ron. I have been a RN Case Manager for over 25 years, making those referrals and transfers to nursing homes for many patients.
Many people in this country do not have the amount of savings necessary to pay for nursing home care when they age. Those that did, took in their adult children during the recent recession and supported them. Many baby boomers will be working much longer than their parents to pay for their retirement and healthcare. Families are smaller, and the kids move away to better jobs. It will not be possible to put that burden on the adult children.
I believe quality healthcare is a right and not a privilege. If affordable health care was available to all, especially those with chronic illnesses (e.g. Diabetes, heart failure, respiratory disease) the cost of treating people as they age would not be so astronomical. The inability to discuss death and dying and how one wants to live out their last years drives up the costs.
Preventable healthcare, treating diseases early speaks to a single payer system. We already have that in Medicare. Taking the profiteers out of healthcare would allow money to provide more healthcare to more people. It's not impossible but takes innovative thinking and courage.
Many people in this country do not have the amount of savings necessary to pay for nursing home care when they age. Those that did, took in their adult children during the recent recession and supported them. Many baby boomers will be working much longer than their parents to pay for their retirement and healthcare. Families are smaller, and the kids move away to better jobs. It will not be possible to put that burden on the adult children.
I believe quality healthcare is a right and not a privilege. If affordable health care was available to all, especially those with chronic illnesses (e.g. Diabetes, heart failure, respiratory disease) the cost of treating people as they age would not be so astronomical. The inability to discuss death and dying and how one wants to live out their last years drives up the costs.
Preventable healthcare, treating diseases early speaks to a single payer system. We already have that in Medicare. Taking the profiteers out of healthcare would allow money to provide more healthcare to more people. It's not impossible but takes innovative thinking and courage.
61
Excellent points. Like your reminder that many baby boomers took in their adult children during the recent recession. Try telling that to the Millennials who constantly post how everything is the fault of the baby boomers. And that boomers will all be dead soon and that's a good thing.
6
I agree. Since one-in-five Seniors merely on Medicaid to pay their Medicare premiums. So, if Medicaid said is slashed, as expected many of us older folks will deforced to decide between food or health care. Generally, the younger and healthier Medicare participants would be the ones to forego it--choosing food.
Even those of us--the other 80%--who pay our own Medicare premiums will probably see our premiums jump, the the risk-pool, the universe of Medicare participants, will become more skewed toward older and sicklier participants.
Health Insurers take-on risk, and protract us from illness and injury. So, in order for them to remain in business, their premiums have to adjust to increasing risks--older and sicker participants--as the pool of participants changes.
https://thetruthoncommonsense.com
Even those of us--the other 80%--who pay our own Medicare premiums will probably see our premiums jump, the the risk-pool, the universe of Medicare participants, will become more skewed toward older and sicklier participants.
Health Insurers take-on risk, and protract us from illness and injury. So, in order for them to remain in business, their premiums have to adjust to increasing risks--older and sicker participants--as the pool of participants changes.
https://thetruthoncommonsense.com
1
It is always better to have money and be able to pay yourself. Government programs can be cut, or they can lower the costs by cutting the quality. You don't want to be the helpless old guy in the cut-price nursing home.
5
Jonathon writes, "It is always better to have money and be able to pay yourself." Thank you for those words of wisdom! Now explain how someone earning minimum wage can save enough money to pay $80,000+ per year for nursing home care.
137
Any ideas about how we can all do that, say, if you make $40,000/year?
65
@NorCal, Chadwick - Of course they can't. These people are screwed.
But if you are making $150K or $200K, save as much as you can. I know more than a few people who made big money, and saved little or nothing.
But if you are making $150K or $200K, save as much as you can. I know more than a few people who made big money, and saved little or nothing.
5
Thanks much for your timely, and sobering, column Mr. Lieber. During the upcoming Congressional recess, I wish it were possible for you to be booked on every major t.v. network and cable outlet. It is vital that the subject matter you discuss be disseminated far and wide. Millions of American futures depend upon it.
26
The fact that there is an industry that helps people shelter assets from the government in order to qualify for Medicaid, ie Medicaid planning, is ridiculous. No one should plan to go broke and rely on the government to pay your bills. I hope states start enforcing filial laws to reduce fraud in your system. Besides why shouldn't families be responsible for taking care of their parents instead of taxpayers? I think people would plan for their senior years more carefully if they knew their kids might be on the hook for their nursing home bill...
9
Some people have no family to take care of them. What are they supposed to do?
42
One of the major problems with our system is the requirement to practically run out of money before Medicaid kicks in. As a pastor I worked with more than one couple in which one needed nursing home care, but the spouse was healthy. Their assets are joint, so the options are terrible. Should they spend down all that they have in order to get nursing home care for one leaving the healthy spouse in dire poverty? Should they get a divorce after decades of loving marriage so that the healthy spouse can hold onto some assets (I knew one couple who struggled with this agonizing question)?
Old age is a crap shoot. Some will die suddenly without needing a nursing home; some will die within 6 months of entering one (a fairly common outcome); some, though, will spend years in such a place.
Even with resources and the best of intentions, sometimes nursing home care is necessary. We kept my dad home with live in help for a while, but at age 90 with moderate vascular dementia he was becoming unmanageable at home. We were, in a way, 'fortunate' for while decisions were in process, he had a stroke and died at home. That saved us the painful decision of moving a man who did not want to leave his own home to an institution. It also saved money, as 24/7 home care was definitely more economical. That said, he did not have many physical medical problems - those often cannot be managed at home.
Old age is a crap shoot. Some will die suddenly without needing a nursing home; some will die within 6 months of entering one (a fairly common outcome); some, though, will spend years in such a place.
Even with resources and the best of intentions, sometimes nursing home care is necessary. We kept my dad home with live in help for a while, but at age 90 with moderate vascular dementia he was becoming unmanageable at home. We were, in a way, 'fortunate' for while decisions were in process, he had a stroke and died at home. That saved us the painful decision of moving a man who did not want to leave his own home to an institution. It also saved money, as 24/7 home care was definitely more economical. That said, he did not have many physical medical problems - those often cannot be managed at home.
30
We have legal industries that assist folks navigate all kinds of tax laws not only those pertaining to receiving Medicaid assistance. We also have the fraud and other sad manuvuerings. We have folks who plan, those who do not and everyone in between.
But our elderly still need care. Even if you have the resources, the miserly ,less generous and kind environment towards our elderly seeps into our culture Money does not afford an escape.
Very interested to learn what is going on in Oregon.
But our elderly still need care. Even if you have the resources, the miserly ,less generous and kind environment towards our elderly seeps into our culture Money does not afford an escape.
Very interested to learn what is going on in Oregon.
5
For Ron Lieber. No obligation now for relatives to help pay nursing home fees, but if Medicaid funds are reduced significantly, relatives could be one possible source of revenue. Now, no such possibility. I believe at one time, years ago, California did look at relatives as a possible source of payment. My brother, a retired county social worker, tells me it was amazing how seemingly very prosperous citizens suddenly became near-paupers, thus evading liability.
21
In some other countries, there are far more people cared for by their families in some way shape or form, come what may. And a lot of bad things do come.
11
Also, in some countries, e.g., the UK, care outside the family may cost less. I think state-provided care in the UK is pretty restricted to people who really can't pay for it (and don't believe they have the "asset protection" strategies we have) but have always had the impression from people I've talked to there that care in a "care home" or the like isn't as outrageously expensive as in the US for self-payers (like over $150k a year in NY -- I have been told nursing homes here "have" to do this o make up their "deficit" from Medicaid patients).
2
Steve,
Actually, there are at least 30 states that have Filial Responsibility laws on the books, and a Pennsylvania appeals court ruled that an adult son of a nursing home resident was responsible for mom's unpaid $93,000 bill:
https://www.forbes.com/sites/howardgleckman/2012/05/16/will-adult-childr...
Actually, there are at least 30 states that have Filial Responsibility laws on the books, and a Pennsylvania appeals court ruled that an adult son of a nursing home resident was responsible for mom's unpaid $93,000 bill:
https://www.forbes.com/sites/howardgleckman/2012/05/16/will-adult-childr...
1
So interesting, no one wants to talk about divesting. That is people who do have wealth giving family members their assets so they can qualify for Medicaid. Then "the state" needs to pay for their nursing home care - while the kids go on their merry way.
This is wrong. It defunds the Medicaid supply so poor and disabled will have less benefits if the present legislators continue to prevail with their plans.
Taxpayers should not be responsible for nursing home care for those that have divested. It's not right.
This is wrong. It defunds the Medicaid supply so poor and disabled will have less benefits if the present legislators continue to prevail with their plans.
Taxpayers should not be responsible for nursing home care for those that have divested. It's not right.
19
How, precisely, would you change the loopholes that exist? Which ones? All of them? And do you take every legal tax deduction and accept all tax breaks? (I do, even though I know that 529 plans disproportionately favor the affluent. Should I stop saving this way for college?), for instance Or do you not believe that the two issues exist on the same plain?
9
Agreed! Perhaps if the government didn't offer to pay for people's care when they get older they'd take saving for retirement more seriously. The fact that there is an entire industry set up where lawyers help people shelter assets so they can qualify for Medicaid and get taxpayers to pay for their care is ridiculous.
13
I will probably write about this industry too. More/more detailed comments about why this is not akin to CPAs helping you get every tax deduction are welcome.
9
Cutting Medicare will affect everyone, as the cost of elder care will trickle down to the adult children. Can you save for your own retirement AND pay $80k a year for your parent's nursing home? I know I can't.
39
Three friends in their mid-to-late 60s continue to work and tell me that they may never be able to retire. A childhood friend in Canada, another hard worker but retired, is border-line poor but receives excellent health care.
If you had asked me in my 20s if I could save for retirement and pay $30k a year for my parent's nursing home, I would have thought you were making a bad joke at my expense.
Ron Lieber is discussing the pitfalls of cutting 'Medicaid'. Bad news all around.
If you had asked me in my 20s if I could save for retirement and pay $30k a year for my parent's nursing home, I would have thought you were making a bad joke at my expense.
Ron Lieber is discussing the pitfalls of cutting 'Medicaid'. Bad news all around.
29
My husband and I are still working at age 72. But can't save much because we're helping our children. A lot of people our age are in this position. Things are tough all over.
8
So right on, but don't forget about paying health insurance premiums of $20,000 or so while you care for that elderly relative, save for retirement and get your children educated!! That's assuming everything is going well and no family member develops a serious (expensive) medical problem. Meanwhile, Trump and his fellow billionaires will be partying over at Maralago! Infuriating!!
14
Thanks for the article. The Medicaid connection to nursing home charges has been woefully under-reported. Too many people are ignorant of Medicaid's importance in paying for nursing homes. My father tapped out his savings in about two years and then was covered by Medicaid, with no change in care. One point that should be emphasized is the possibility that if Medicaid funds are reduced, relatives of nursing home patients now covered by Medicaid could be asked to contribute. This possible liability, for good reason, would panic many people.
58
Great column. I'm sure that many of my fellow boomers will sleep a little less comfortably because of the reality you so aptly described. But not here are two factors which may make nursing home care fiscally out of reach for many. First is of course the funding for such care. This has been pretty well covered. Less often mentioned is the cost of such care.
Thinking of the expenditure for nursing home care ( health care as well) as a giant pie, most of the slices should go to the people who actually provide care, the nurses, doctors and aides, and most of the rest to providing a decent physical facility and operating costs. However when the average CEO of a nursing care facility is paid an AVERAGE of $484,000 in total annual compensation, and elder care attorneys take also their slices, what is left for providing care? When we can get the expenses for people who do not provide a single bandaid or help an old person sip their soup, reduced to more reasonable levels, then perhaps the Medicaid expenses can be reined in and better coverage can be had.
Thinking of the expenditure for nursing home care ( health care as well) as a giant pie, most of the slices should go to the people who actually provide care, the nurses, doctors and aides, and most of the rest to providing a decent physical facility and operating costs. However when the average CEO of a nursing care facility is paid an AVERAGE of $484,000 in total annual compensation, and elder care attorneys take also their slices, what is left for providing care? When we can get the expenses for people who do not provide a single bandaid or help an old person sip their soup, reduced to more reasonable levels, then perhaps the Medicaid expenses can be reined in and better coverage can be had.
18
Good point, Concerned Citizen, but what about the expenses for raising children?
The Democrats are absolutely pathetic at conveying the great achievement and importance that is Medicare and Medicaid. No one under 55 even knows what Medicare is - or thinks about it. Who would? No one wants to consider that they'll eventually get old. A simple explanation about what Medicare does would put across what a truly miraculous program it is. No one who hasn't dealt with an elderly parent who's run through all his/her money truly understands that Medicaid saves them from literally dying on the street. The Republicans are ruthless liars - and that is not fake news. I don't understand how Republicans get away with it, considering the people they hurt most are their supporters. Their genius is that they convince their supporters "someone else" is ripping them off, when in fact it is the wealth-kowtowing Republican establishment, with the president on top of the pyramid scheme. Republicans weren't always this way, but the whole culture of that party has become deeply corrupted and hateful.
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I don't know that I've heard any lies about this issue in particular. If anyone sees any about Medicaid and elder/long-term care from either side of the aisle, please post them here or send them to me. (I'm aware that President Trump said early in the campaign that there would be no Medicaid cuts. Somewhere along the way, I think he stopped including Medicaid in his Medicare/Social Security list of things he would not cut. I'm curious to know who revised his script, if anyone knows, and when exactly.)
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Excuse me, Madam -- any fool can spend the earnings of others. It is a lot harder, making sure the money is spent properly. Contrary to the Democrats, there is no such thing as a free lunch -- someone always has to pay.
And raise taxes? OK -- lose jobs. Which one?
Reality bites. Someone tell the Democrats, please. Thanks.
And raise taxes? OK -- lose jobs. Which one?
Reality bites. Someone tell the Democrats, please. Thanks.
1
Yes, B, let's create more Detroits. Heck, USA's already $20,000,000,000,000 in debt, with Asia rising -- why not just keep spending? Whose afraid of bankruptcy?
/sarc/
Hi Ron,
Thank you for requesting reader feedback. There is a related issue flying under the radar that urgently needs your attention. One of the tax cuts under TrumpCare is a stealth attack on Medicare funding. i have been hoping someone would discuss this issue as well and not bury it in the final paragraphs.
Linda Burke
Thank you for requesting reader feedback. There is a related issue flying under the radar that urgently needs your attention. One of the tax cuts under TrumpCare is a stealth attack on Medicare funding. i have been hoping someone would discuss this issue as well and not bury it in the final paragraphs.
Linda Burke
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Thanks. Lieber @ nytimes dot com is my email address if you want to share more -- or do it here.
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Old people - I'm looking at you, Sun City! - are going to be ruined by the actions of the GOP and its candidate (whom they, in huge numbers, voted for, most especially in retiree-laden states like Florida and Arizona).
These old folks voted in GOP power because the GOP and its standard-bearer were going to reduce their already low taxes. But - voila! - the biggest tax of all, (eliminating their life savings and/or whatever they planned to leave their heirs), is knocking on their doors.
Will they notice that their finances are falling (into notorious hands) and may not be able to get up?
Probably not. That is why this demographic is often victim of scams - they never see what is as plain to others as the nose on their face.
These old folks voted in GOP power because the GOP and its standard-bearer were going to reduce their already low taxes. But - voila! - the biggest tax of all, (eliminating their life savings and/or whatever they planned to leave their heirs), is knocking on their doors.
Will they notice that their finances are falling (into notorious hands) and may not be able to get up?
Probably not. That is why this demographic is often victim of scams - they never see what is as plain to others as the nose on their face.
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Trump voters: Granny WILL be moving in with you. You will be legally responsible for her care, 24/7. For the rest of her life.
Think about that, please. Enjoy.
Think about that, please. Enjoy.
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No, you are not legally responsible for a parent's care. If you want to put grandma in a wheelchair and leave her at the entrance to an ER, you cannot be thrown in jail or charged for her care. You are legally responsible for your children's care.
Actually, 27 states now have "filial laws" that state if you are financially able to care for your parents, then you must do so. Most states don't enforce those laws, but it doesn't mean they won't at some point in time. The fact is with 79 million baby boomers coming down the retirement pike, the government cannot possible afford to pay for everyone's care. We must get folks to understand that they have to make plans to care for themselves.
The dog and I visit once or twice a month nursing homes that care for Medicaid and VA clients. She does the work. I just tag along to help her. These are sad places, sad. We do not visit the high-rise, luxury facilities with continuum care. These homes are for folks at the last station on the line who have nothing, just a ticket for the next stop. Most are sleeping, or daze speechless at her, or lie askew under the sound of a television. The staff are somber, leaning on each other's humanity to care for the shadow of the humanity around them: a young man disabled by a botched brain surgery, a veteran weakened by multiple strokes, a man resigned to his wheel chair after diabetes took his feet one by one, the young woman whose elderly parents could no longer manage her care, and a heavy-set man rocking on the piano bench playing the same few chords quietly, but over and over. Think that you can stand alone in the wind of years that grow stronger the closer you approach the source? I tell you, you cannot. You will not. No one has ever. If you will let us, the dog and I will stand with you.
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Thank you, Michael, and for some reason it brought to mind 'The Heart of a Dog'. In the meantime, it would be heartless on my part to share this article with my peers. My parent died in a nursing home in Paris which she thought was a small hotel. A widow, her husband left her comfortably off and counting multiple blessings that her son and I did not have to go through this trauma. She was also frightened enough before her descent into dementia.
Most, or many of the people, where I am staying voted for Trump, or in fairness on The Republican Ticket. A lot of them seem to be ill at a relatively young age. Keeping this latest from Mr. Lieber up my sleeve, and again, you sound kind and considerate.
Most, or many of the people, where I am staying voted for Trump, or in fairness on The Republican Ticket. A lot of them seem to be ill at a relatively young age. Keeping this latest from Mr. Lieber up my sleeve, and again, you sound kind and considerate.
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The odds are good that most of us will die either in hospital or a nursing home. Few will have the blessing to die sleeping in our own bed, in our own home, at a time we choose.
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If this is true (and I wonder if the data bear it out), I don't think it will continue to happen in this way. It isn't what people want, and it costs too much. It can't go on like that, right?
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The argument: I want a semi-private room at $82K/year and I want someone else - not related to me - to pay for it has a logical fallacy built into it.
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But what is the alternative for people who didn't earn much along the way, lived a long life and have no kids or relatives? I don't mean for this to be a rhetorical question -- I'd like to know what you propose. I don't know of nursing dorms, but maybe they're out there.
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Even elderly with kids or relatives may not be able to afford nursing home care, if their kids or relatives don't earn enough to pay for it. And then, of course, if family members are contributing to elderly relatives' nursing home care, how are they supposed to be able to save for their own future care?
9
A semi-private room is not a luxury; and $82K/year gets you only basic care. Remember that at this point you have no savings or income of your own. You are stuck with the food, clothing, decor and roommate that the facility is able to provide. I am sure that no one in that position is happy to be there.
And, in fact, the patient *has* paid for it himself. What we are talking about here is insurance. Some number of us are going to burn through our savings because of Alzheimer's or frailty or living to be 90 years old; and, knowing that, we choose (collectively) to have a portion of *our* taxes go to care for the ones who draw the unlucky lottery number. I am praying that it won't be me.
And, in fact, the patient *has* paid for it himself. What we are talking about here is insurance. Some number of us are going to burn through our savings because of Alzheimer's or frailty or living to be 90 years old; and, knowing that, we choose (collectively) to have a portion of *our* taxes go to care for the ones who draw the unlucky lottery number. I am praying that it won't be me.
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Many of the Trump enabler´s and voter´s of the Republican Congress and Senate will probably die penniless on the streets of their rural communities and cities due to the cuts in Medicaid proposed by the Republican leadership. It´s the price they will pay for willful ignorance and prejudice. As Senator Bernie Sander's has said, ¨We are not a nation of compassionate people.¨
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Thanks for your long-overdue article. I have agitated for some time to get more of what you wrote in The Times. Nursing home fees and the connection to Medicaid is a critical subject and, as you say, is largely unknown to the ignorant general public. You didn't mention the possibility that relatives, meaning sons and daughters, could wind up being partially responsible for parental nursing home charges. Spread that word around and you will have created a concern that could approach panic in many people.
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Thanks. How? Medicaid eligibility does not look to adult children's assets unless there has been a recent gift/transfer, right?
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Some states have laws on the books known as filial responsibility laws. They require adult children to help provide for their parents if they are able to. They often aren't enforced but if budgets tighten they might start being enforced more often.
10
So many people haven't a clue about how Medicaid contributes to the care of most of the elderly at some point in their lives. When you add a large influx of babyboomers ( including me) who are just at the cusp of old age, in 12 to 15 years elder care services - and nursing homes and home care services - will be overwhelmed - especially if funding is withdrawn. And if various financial reports are correct, few have savings enough to pay for anything. It's going to be ugly.
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