I read a lot of the comments here and I am shocked that so many people would consider killing themselves. What place do we live in? Having worked in nursing homes for a number of years, I can only attest that everything that people have said is true. Dirty facilities, high staff turnover, burnt out nurses and horrible food are a reality in many places. During periods of CMI, patients on ventilators were put on therapy for over an hour just to squeeze insurance money out of them. I have seen places I would not send my dog to. I decided for me that i also rather do something drastically instead of giving my hard earned money to these cooperations. I don’t understand how a nursing home can even be profit driven.
27
I say it all the time: we've become spectacularly good at quantity of life, and spectacularly bad at quality.
What's truly insane is that the costs for assisted living cited in this article - averages or medians for this State or that - are, in my experience, for facilities where you'd sooner slit your wrists rather than sign a lease on an apartment.
17
The woman featured in this story gets $55,200 a year between her pension and social security. Since many of us in the younger generation have neither a pension or social security to look forward to, and since financial experts currently suggest pulling no more than 4% out of your retirement each year, I'd have to save $1,320,000 by the time I retire in order to pull as much monthly income as the woman in the article.
And yet, I think it's safe to assume that once social security is obliterated, I'd need to save more to account for the loss that social security income. And, the amount of savings noted above doesn't address inflation. Then, add the rising costs of health care and assisted living facilities on top of that.
Essentially us younger generations are screwed when it comes to retirement and aging.
13
Seeing this article when just the other day the NYTimes ran something about the many millions of dollars spent on lobster (to eat) in one month by the Pentagon (perhaps someone can share a link, my apologies)...
I think of articles like that when Republicans scream we don’t have enough money to pay for things for our citizens like health care, housing, school lunches for poor children, etc. “You’ll bankrupt the country!” They insist. Meanwhile, don’t look over here at what our military and defense division/corporate contracts are spending...
24
Follow the lead of Washington state and pass a version of the Long Term Trust Act that we just passed. A small payroll deduction will allow for people to have long term care insurance benefit of $36,000. Not enough but a help when needed. https://responsiblefuture.org/
9
If you don't plan your retirement and aging needs who will? People with insurance have more money for better care and in many cases can stay at home longer.
* 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. https://www.partnershipforlongtermcare.com
* An alternative are linked products, Life Insurance or Annuities with long term care riders, popular with people that have high net worth. In most states you can also use your qualified money (IRA/401k) to fund your plan. https://www.lifeinsuranceltc.com
Some companies have a cash option you can pay family and friends for care.
3
I am 45...just started a new job so I already know Im behind and all messed up...no kids, no spouse..so I already know im gonna be a ward of the state...so ive decided to end my life after my mom dies. No need to continue after that anyway. Ive seen how the country treats its poor elderly and the costs for these assisted living is for the rich..so unless i win a lottery or make a WHOLE lotta money...its the self assisted casket way for me. And I am ok with that.
11
My plan is euthanasia, assuming climate change doesn't destroy us first.
5
You fail to mention comprehensive Medicare for All legislation introduced this year in both House and Senate that includes long term care! HR 1384 (Jayapal/Dingell) and S 1804 (Sanders) both include. The private for profit insurance industry most certainly will not be a part of the solution - they are very much a part of the problem as your article points out (indirectly).
91
As an American closing on old age, may I offer a "modest proposal" concerning a novel method of providing inexpensive care for those who have had an insufficient numbers of descendants to support themselves in old age with sufficient security?
We currently have hundreds of thousands of individuals who decided to enter the US outside of the legal immigration system. Many have made the claim that, because the countries they live cannot offer them sufficient security in which they can live peacefully, they must be allowed to enter as legal immigrants claiming sanctuary. Regardless of the rationale behind such claims' legal merit, and the fact that only a percentage of such claimants ever prove their case, perhaps we should look at the situation according to what each group actually needs.
And so perhaps, we can off a trade. For those who want to live in America for the superior security it offers over their nation of origin, we can trade legal admission for their induction into a service corp in service to the aged for a period at least as long as it takes to apply for legal admission (say, 5 years). During that time they would work full time for nursing homes and the like while being provided sufficient, if spartan, room and board. They would be given education and health care, but receive only minimal pay, enough for very modest amusement and a start after finishing their term.
136
@Bob This sounds good in theory, but in practice, it would be a different story.
11
@Bob, really outside the box, but, it makes sense to me (age 77, in good health), and your proposal has much merit.
Need some of those brainy kids in college to run with this and figure it out. Worth a try.
27
@Bob.
Here’s a better idea. Build The Wall. And spend whatever it takes to keep illegals from entering the country in the first place. Take one problem at a time, thank you.
17
Currently dealing with this issue with my parents, mom age 80 and dad 90, with a solid annual retirement income of $70K. Dad has become paralyzed and just went into a "non-profit" nursing home, which in the Boston area is $13K per month, or $150K/year. By the way, this is a very bare-bones nursing home with prison-quality food, shabby interiors, and low staff. With the help of elder-law attorneys, we were able to get dad onto Medicaid -- which has some income and asset protections when there is a spouse at home -- but the six-months-long application process was pretty brutal and doesn't leave my mom with much remaining income. People mentioned "free" city and state social services to me all the time, but my parents didn't qualify as they are "over-income."
125
@cef - Exactly. My aunt just passed away. She was in her early 80's. Her husband, the same age, wouldn't know she passed away. He is suffering from dementia and he just keeps going on and on. He's on Medicaid because they lost it all going into business for themselves at the latter stages of his career. I have no idea what the cost to care for him has been or will be. But let's guess. What would it cost to care for someone who pees in a flower pots, etc. for the last 12 years?
Every story is different. They are all complicated.
24
Years ago my father-in-law purchased an LTC policy. Because it had no 90 day waiting period, no maximum coverage amount, and a high daily allowable rate it was expensive and the family thought he had been ripped off.
We were just talking to him about this during his recent 84th birthday party in his assisted living facility out on his apartment’s terrace. His life’s savings untouched and still earning interest.
62
@Harry
That's really great for your father and of course for the members of his family who don't have to pony up for his care. What about everyone who doesn't have one of those policies and can't afford assisted living? Can they move in with your Dad do you think?
22
@Harry
This should be the plan for all.
14
@greppers
No, they can move in with their own families.
15
How did families in the USA take care of elders say, before World War Two? Multiple generations more routinely lived in the same home. On Good Friday, with my Mom's short term memory failing, I moved into her place (and out of my smaller place) to help her in daily living. We talk and laugh together every day. I'm still able to keep working from a home office, now in her back bedroom. For the two of us, I think this will be enriching.
66
Your mom is very fortunate to have you
37
@Patrick Before WW2, most people died at younger ages. Usually it was a pretty quick death, from cancer, stroke, pneumonia, heart attacks so they did not require months or years of care where they could not walk, dress, feed themselves. We didn't have the same treatments then that we have now. That is why Medicare doesn't kick in until 65. At the time Medicare was created, a fair number of people had already died by 65 or not too long after.
What we need to do is look at how other countries treat their elderly, Like national health insurance, our system is ridiculous for the richest country in the world. We worry about my parents getting older and the care costs; in contrast, my Canadian cousins have no such panic since my aunt is taken care of by their national healthcare system.
55
@ms
Thank you MS in California. Very good points. Families sharing their homes aside (which will not solve the problem), this needs to be addressed nationally. I hope that the giant pool of aging baby boomers will be a solid voting block to put more pressure on finding solutions.
20
Depressing article. What is the point of extra years of life we “enjoy” if this is what we have in store?
85
Good Luck finding the labor that will be needed to provide the care.
Projections for percentage of U.S. population by age group:
2020
18 to 64 years: 61%
65 years and over: 17%
2040
18 to 64 years: 58%
65 years and over: 22%
2060
18 to 64 years: 57%
65 years and over: 24%
9
@Dan M
retired attorney F/70
And the workers, especially young immigrants with families/kids, who will work and pay taxes that contribute to SS and Medicare trust funds. Every body should know that what old people contributed thru their work years goes in part to Trust Fund and in part to pay current beneficiaries every month.
Wharton economists warn that in-migration of young workers who are having children and working and paying into SS and Medicare Trust Funds is our only way to not become Japan. Ratio of old and very old to working population is now 6-to-1.
When we hear that old people are jumping off bridges, know that these reports are true. Often the men and women sandwiched between their own not-working life and caregivers for very old family members.
15
@Dan M there's no labor shortage. The problem is that many low cost operators can only offer those low costs using undocumented immigrants who are not paid minimum wage and overtime. I'd argue these immigrants provide better care in many cases than their "legal" counterparts.
It's my belief that the government turns a blind eye to labor laws in this sector because they know if the laws were enforced the industry would collapse forcing more federal dollars into an already strained Medicaid system.
15
Qualifying for assisted living does not mean there aren't other options. Home health aides are called just that because they assist in the home. An aide can come in 2 hrs in the morning to help with dressing and meal prep, then 2 hrs in the evening for preparing for bathing and preparing for sleep. Expensive for sure, but a lot cheaper than assisted living. In NJ many of the senior centers accept elderly with mild or even moderate dementia (toileting can't be an issue). Surely Ms. Span is not implying that the 60% who will need assistance with ambulation will all need assisted living as a result. The need for assisted living facilities is exaggerated in this article, and frankly unhelpful.
28
@RJ
As a spouse and an adult child who has hired home health aides both through an agency and independent. I know it would be near impossible to have an aide come in for 2 hours, leave and come back for 2 hours in the evening. Most aides make very little money. They have children and families, They do not work two hour shifts.
Agencies do not send out aides for two hours.
88
@JS
I am a caregiver through an agency, and most of my shifts are 2 hours long, getting ready in the morning, and ready for bed at night. The way it usually works is 1 caregiver in the morning and another one to come in the evening. It works really well, being a morning person I would come in for 5 or 6 days a week.
22
Agreed. My mom lived in Virginia and aides worked a minimum of four hour shifts, either thru an agency or independent. I often called my mother to say goodnight only to be told the evening aide never showed up and she hadn’t eaten yet. Luckily I lived about ten miles away and could run down, but it was a hassle after working all day and feeding my family.
27
So why don't the middle income people have more savings? Maybe it is they lived outside their means. I'm middle income and we've been saving for the future. Why is this not the norm? This article is about an attorney, no kids and yet no money, why? I'm in my 50's, I have long term care policies in place for my wife and I. We save 10-15% for retirement, have a house payment, saving for college. We don't take many trips and when we do we go visit family.
If you don't save for the future, it's your failure, not the government!. As for medications, where's the insurance policy. Why don't people have insurance? In fact I would say we're over insured with life whole and term, auto, home, long term.
People should not rely on the government for anything, plan and prepare for yourselves.
50
@Mark Not very good at math and research, are we, Mark? Perhaps in your bubble you've missed out on the fact that middle-class wages have been effectively flat for 4 decades. Now, toss in the other facts - housing, health insurance, health care, education - have all been increasing higher than the rate of inflation. Now, add in the fact that many companies no longer offer health insurance, and pensions are long gone. Now factor in the rise of low-wage, part-time, no-benefit jobs. See, Mark, it's a complex puzzle. Perhaps you should stop crowing about your own good fortune and spend some time doing some research?
176
@Pete
Well said Pete however your assumption is all things remain the same. For most people, they advance their careers with education, job changing, advancing skills, self-marketing or moving to other locations. All of which negates the rise of inflation if your cost are basically the same. You are correct with flat wages but I don't believe people stay working at minimum wage and if they do, well.
Education from our elders about the great recession taught most to living within your means. Saving for the rainy day. Always be advancing.
Your thought is nobody will change and this is why people are failing to meet their basic needs.
14
@mark. I work in home care. Many seniors who planned wisely end up spending their life savings on home health aides. It's heartbreaking to see. Even those who were fortunate to be able to pay for long term care plans will find that many of these policies have limitations.
79
Here's how middle income seniors can get care: In exchange for hosting younger boarders. Many millennials can't afford to buy their own homes and are paying far too much in rent. If older people simply keep living in the home they raised their kids in they may have several empty bedrooms. In exchange for help with housework, errands and other things the older person may need the younger person gets free room and board. Seems like a win/win situation to me.
49
@Leeba W Some communities have nonprofits that do help set up homesharing. Some of the cases are like what you propose: a younger person doing chores in exchange for free/ much reduced rent. However, the major obstacles include matching people, assuring that expectations/ obligations are clear on both sides, figuring out liability issues (when it comes to personal care which may include bathing, toileting, lifting, etc.).
Finding the right person is also far from easy: at various times in our lives, my family has hired people for various things ranging from childcare to helping out with a sick relative. Fortunately, we found people through extended family members that we could trust. However, having worked with older (and younger people) in my professional life, there are workers out there who will steal and otherwise take advantage of an older/ weaker person. This is in spite of liability insurance and they can often do harm in such a stealthy way, no one knows until too late.
39
I saw a documentary where exactly this type of program was working in one of the Nordic countries with wonderful results.
10
Alas, many of us in USA cannot afford long term care when paying off university debts. Then in middle age when we want to buy it, we find it too expensive and too many exclusions.
Some commentators deny that reality.
60
@Someone
HMMM, if education debt is an issue, what did you do to limit the amount of debt in the 1st place? Did you receive a scholarship or did the family save money for school? All of which helps reduce the burden. I wonder how much a long term policy would cost if I was 25, anyone have a figure? I know what I paid at 55.
3
@Mark from Honolulu - over the last couple decades, education costs have skyrocketed to outrageously untenable levels at the same time that secondary education is becoming more and more necessary. Many young adults who would like to marry are not doing so because of this debt, and they are unable to purchase homes at the ages previous generations did. And, paying off astronomical student debt will chew into funds that otherwise would have gone into a 401K and other retirement savings.
25
@Mark a 25 year old non-smoking, healthy man can get a $100,000 a permanent life insurance + Long Term Care policy, for around $65.00 per month or $200,000 for about $100.00 per month (as an example). The prices won't change as they get older either if they get a Permanent policy. It's doable, most young people simply don't look into these policies as they do not think about their future too much, unfortunately.
There are tons of ways to protect ourselves and family members from this. We just need to know what our options are.
6
Meanwhile my parents in the UK have home care, emergency on call, nurses who visit daily and take good care of them. Not a single dollar or worry from us because I know they're in good hands. They never had to pay a single cent to overpriced insurance middlemen and worry about premiums going up with old age. The taxes they pay are still cheaper than expensive states like IL, CA or NY.
161
Radical idea: Take care of your own family. For generations and across the world older family members lived with younger ones. Sounds like everyone likes their freedom but wants to complain when mom/dad/auntie run out of all their money for 7k a month assisted living.
20
@Lauren
Lauren, you hit on the major issue facing aging Americans: Families do not want them living under the same roof. No wonder, since every social message suggests that older people are merely a doddering burden.
This is in contrast to the days before the aging populace began being shuffled off to lives spent in balkanized facilities.
When I was a child, there were four generations living together. My great-grandmother died at home at 102.
Now cellphones and laptops are better company than older people experiencing diminshments. Older? You're a bother.
I now live alone and wonder all the time in what crowd of strangers I will eventually live out my final years. However, among my friends there is one who, slightly younger than I, who has a big room in the home of her daughter, son-in-law and teen grandchildren.
They all eat meals together and my friend contributes in many ways, such as ferrying the kids around for the working parents.
Honestly, I am very envious, though very happy for her. She has no worries about having a place with extended family. Neither did my great-grandmother.
24
@Lauren
It isn’t always necessarily a matter of everyone wanting their “ freedom.” There were often challenges when generations lived together. Spouses who loathed their in- laws ( or vice versa) Children whose parents abused them verbally or physically. Marriages can be stressed to the breaking point from such tensions.
Long- term conflicts don’t just magically resolve themselves
Try caring for a parent who had ( or has) serious emotional or other issues. Try protecting your children from verbal and even potential violence from an aged family member with dementia who reacts from fear, confusion, and anguish ( I’m not implying that all those with dementia will act this way) .
Walk into an assisted living home and you’ll see angry, difficult and just plain unpleasant residents along with the sweet ones.
35
@Jayson
Of course there are challenges!!! Thus, is life.
You are speaking of the relationships that never worked or of relatives with dementia severe enough to endanger others, one way or another.
Then there is the 67.2 percent of the aging populace that does not fit these outlier profiles.
These people should have a home with family if that is what they wish and need. But that would mean accommodation to the "ideal" life that so many younger people desire and pursue.
12
One of the major societal developments in America over the past century, for better or worse, has been the development of suburbs and single family homes. It was an outgrowth of the type of jobs and post-city life many people gravitated towards.
In many other countries, many much poorer than us, people still live in multi generational homes where grandparents and great grandparents still live with their children and help with child rearing and domestic work for as long as they are able. The younger generations then take care of the elderly when that time comes.
Our country doesn’t venerate our elderly as much as we used to and our economy doesn’t provide for them when they are no longer useful in the labor force. Churches and communities, if they were stronger, could help provide an extended family of sorts for some of these lonely elderly.
18
@Andy
This is the proverbial elephant in the living room. Our society, unlike many, has no use for the aging, and certainly does not savor the idea of generations living together.
The diapers that parents once had to change on those infants were no less messy than the bladder control items worn by elders.
We like babies, not so much the aging.
10
It’s the frayed and broken family and community network that is the crisis. Seniors should help care for the children of working parents. Then the seniors move in with those parents when they need help. The cycle continues. Age in home with others. Be helpful where you can. Teach the young how to age and die with dignity.
26
@Julie I do not disagree, but what if an elder has no children/other relatives to care for them?
20
@Julie
Well said! Your statement is the Hawaiian and Asian way of living which I am not Asian; however, I believe your statement to be true.
4
@Julie y mother would rather eat a rat then live with her children. She never wanted kids and after my sister and i married and moved out she was thrilled. If I didn't have kids I doubt she would even call.
8
In the US the political decisions, at least among Republicans, seem to assume that (mainly) women will take on the unpaid labor of long term elder care while also taking care of kids and a husband. For free. No wonder there is so much push back when women dare to challenge gender roles.
88
@Facts Matter
retired AMA attorney D/70
Federal data show that 85% of daughters provide full-time care for a parent or the first-born child.
The sociology of caregiving shows that 86% of the time one person in a family will be the alternative reality promoter, to whom all others across generations acquiesce.
That was my family with my Dad's Alzheimer's. Mom insisted that Dad was stumbling around the yard and wetting his pants to embarrass her among neighbors+ friends. When I tried to intervene at their home, Mom threw me out and said "Don't come back." Siblings caved.
Months later, I called a three-generation intervention at my home nearby. Told siblings they would be taking Mom anywhere out-of-state and told grand kids to say goodbye to their grandfather who would be at my home. People Place Routine settled--no visitors that scared him.
I sold their home quickly after three days of three people, including an 8 year old boy inside filthy cabinets, cleaned every inch.
Shortly after my mother arrived at my alcoholic sister's house as her new residence, the joint investment account I'd handled for decades was moved. Small house $$+social security+pension were his only money. When the time came for an Alzheimer's apt at Brookdale nearby, I asked the Director to bill Mom and let balances build to the day Dad died. She agreed.
Mom's only words were to the funeral home after my fini email at death: "Take Alzheimer's off death certificate." She's 96 now; the boss.
6
After moving my dad into assisted living last year because of dementia I was going through his finances and found some social security statements. In the late '60s he was making $7,000 or so a year and supporting two small kids and our stay-at-home mom in a perfectly middle class apartment in a nice neighborhood in Cincinnati. His assisted living place with a supplemental aide was north of $5K a month. He recently moved to full long term care and that's $11k a month. He has some savings that we'll chew through but you see the problem and one shared by many Americans: they worked hard, raised families and now the care they need costs far beyond their salaries. It is a huge problem for our country and receiving appallingly little attention from elected officials and -- with this article an exception -- the media. I hope that changes but I know that is sadly unlikely.
129
@Steve Hymon
The Government is well aware of the need and considered it as a part of the ACA , but the costs were considered too burdensome . It is a huge problem that can be solved by individuals . Your dad probably could have purchased LTC Insurance at some point . Your parents could have done Medicaid Planning and protected their assets . Your family had alternatives .
4
Some European countries finance skilled nursing care under their universal health care legislation subsidized by taxes which do not require cost-sharing by patients as pointed out in an excellent article by AARP on European Experiences with Long Term care.
https://assets.aarp.org/www.aarp.org_/cs/gap/ldrstudy_longterm.pdf
Many Americans cannot afford LTC insurance. The only alternative for most is to become bankrupt of all assets in order to become Medicare dependent for long term care. In my opinion this practice is cruel and unnecessary, especially if either home care, assisted living or nursing home services could be financed through a universal health care plan. Isn't it time to channel our taxes to the people who need it the most?
53
@MSS
No. People need to prepare for themselves 1st and foremost. It's not other peoples responsibility to care but the families responsibility to provide.
2
@MSS,
Medicare, generally speaking, does not cover long-term care.
Medcaid, on the other hand, will cover long term care if you are eligible.
4
My mother’s nursing home on Long Island NY costs a staggering $13,556 per month. Every month I pay half from her savings and half from the long term care policy my dad purchased through his company decades ago. When I do, I always wish I could tell him how thankful I am for his prescience. Mom has full blown Alzheimer’s. The care she needs is endless, and the care she receives is excellent. It and would take every second of my day to care for her on my own. There are many like her at the NH, and I imagine there will be many more as the boomers age - where will they all these people go?
88
@LGM
I’m not sure if feasible for you, but my Mother-in-law has Huntington’s Disease, and is in the memory care unit in Denison, Tx at a facility and it is half that.
7
My spouse and I live solely on Social Security. No pension or savings, we went through that along time ago. Both of us have multiple chronic health problems. Additionally, we have an adult handicapped son. I had a social worker visit me yesterday at the request of the Visiting Nurses, Guess what? We qualify for absolutely nothing. All I was hoping for was a little help with my prescription co-payments. Assisted living was totally out of the question. On every turn,our "Big" SS income says we earn just a bit too much for help. I guess we should just die now and save everyone a lot of grief. My only concern is my son. I try for him.
95
I know that what you speak of is true. I have experienced it in my own family. Making just a little too much (interesting how that always is the case) to qualify. My sweet grandmother who never worked outside the home (due to the large number of children she had and a lack of formal education too) lived on pennies in NC with my adult uncle who had Down syndrome. My Mom (her daughter) gave her as much as she could to help her. She died in 1997 with only $62 to her name. She rented a little shack of a house that took most of her income. She was not an unusual situation especially today. My sister says we treat dogs better. I wish I had an answer to fix this one problem out country faces.
49
@george I don't know what state you live in but you should be receiving monthly benefits and support services for your handicapped son. This would include access to adult daycare, respite care, and group home options. As for your and your spouse, in California there is a non profit called "Light for Seniors" that can help with getting elderly support and services for a one time fee. You will still have to pay for some out of pocket costs. Our family used these services in the past for our in laws and family members. After my stepfather died (retired Navy), my mother moved back to Europe with my disabled brother. They are both thriving, with high quality support services, healthcare services, and out of pocket medical cost covered by their US military benefits.
25
Millennials should take heed because even those with wealthy parents are likely to be financially impacted...and significantly .. My parents could afford long term care but that didn’t mean I could blithely stand back and assume they had the cognitive ability, as time passed, to handle their finances, assess whether an aide was trustworthy, remember to take meds, etc.
Luckily they recognized when their minds began slipping and gave me power of attorney. And luckily I didn’t put any possible inheritance above their safety and happiness. Without my supervision, they would have been financially fleeced ( I caught that) and died sooner . Most of their health care helpers were wonderful. But it only takes one...and there was one very incompetent caretaker.i got there in time.
And it took hours of my time and missed work , as well as most of my “ free” time to help out. I did this without resentment because I wanted to be there for them. I knew their time was fleeting.
But there was a financial cost, not just for my parents but also me. Things need to change , not just for the sake of those about to need care but those who come after them.
140
The old model of multi-generation households provided both care for the aging and care for young children. The 20th Century model of pushing young people out of the nest to establish a separate address, and the expectation that every young person, married or single, would be buying a "first home" on their way up the social ladder has resulted in this dilemma.
It's too late to go backward, and to be honest, not very many people want to give up their independence to live with old people and take care of them. So the aged, one way or another, are on their own.
The piecemeal approach of staying in a home, whether your own or an institutional one you may not be able to afford, is failing now and accelerating at a frightening rate. We need a national program to address this problem.
Where will we find leaders we can trust to address this problem with imagination and fairness, and not politicians who will see it as an opportunity to line their own pockets? We've had enough of that with the current administration.
68
The ads for long-term care facilities are cruel fantasies, as if assisted living were a kind of senior cruise ship. Both cruises and nursing homes involve noroviruses, but that's where the similarities end.
Assisted living facilities, which are out-of-pocket, look and feel like what we thought of as nursing homes 40 years ago. The residents are very elderly and very infirm. I've watched this scenario play out in my family for decades. This is not an eventuality for which I want to pay insurance premiums.
64
My 80 yr. old mother-in-law lived a healthy, active life and was financially prudent and responsible. She was felled by a stroke and is now in an assisted living facility. She can't speak clearly, no mobility, she needs to be cleaned. The experience has been an eye opener--and terrifying. She is in a shiny, new-ish facility with her own room. Just a room. $7500. Out of pocket. It's in a nice neighborhood where my husband and his sister take her out for lunch (she was quite the foodie pre-stroke). She still manages to enjoy that. But there aren't enough caregivers, and some people have more needs than others.
The money is not finite. It's been 10 months.
My husband has lived a fairly comfortable life where he just assumed "Social Security and Medicare will take care of everything".
I'm not sure this whole experience has opened his eyes. It is truly scary.
277
@moodbeast Yes. Wouldn't it be nice if we lived in a country that valued people and helped us all through these inevitable challenges. Alas, we are the wealthiest country ever, and cannot manage this simple task, because people will not 1) educate themselves and 2) vote. We citizens are responsible for the state of this union. Willful ignorance helps no one except the deceivers.
21
For seniors who own homes like the attorney featured in the article, they may wish to consider sharing their home with others by renting out a room or two. That rental income could go a long way toward defraying the costs of visiting caregivers and other support services short of full time assisted living. And having a younger housemate around could prove a blessing too — another person who keeps an eye out for the elder. Of course, it’s difficult to share one’s home after many years of solo living, but a decent housemate is not such a bad thing.
37
@voltairesmistress My grandmothers did this and it kept them out of nursing homes.
4
Some of the commentators seem to be missing the fact that Medicare doesn't pay for Assisted Living or Independent Living in a retirement community. And Medicaid only kicks in when your house has been sold for 5 years and all other assets have been exhausted. Also, as the article points out, there's just not availability of nice, but "ordinary" facilities for the middle class. I toured many Assisted Living places in Tulsa, OK before moving my mom in & they're all posh - not b/c that was what we were looking for, but b/c those were the only options. The one we chose was gorgeous, with a chef on staff, a movie theatre, and activities galore - but started at $4k/month & went up to $5k when she moved to Memory Care (which was also private pay) & then hospice. I'm grateful that she had savings to pay for high quality care, but I'm worried about my own future care. Middle Class options need to be developed.
229
@Jen Yes, you're right that more modest housing options are needed. I think developers throw in a lot of luxuries so they then can charge more.
32
Or perhaps Medicare should start paying for assisted living, what you described sounds like basic needs, hardly posh..
13
@Jen - If you're the "well spouse" of someone who must go into longterm care, you're allowed to remain in the family home. But in my state and probably some others, when the "ill spouse" dies, the state slaps a lien on the property for the full amount Medicaid spent.
38
I live in France. Here is my family's story, I'm telling to show humane solutions are possible. My aunt worked from a teenager until about 60, retirement at home till 86, then a medicalized retirement home, suffering from dementia, she could no longer live at home. As she had a fairly good retirement, it all went to pay for the home, about 2500 dollars a month; it is government run, clean; her studio apartment gave out to a public yard, food is excellent, the employees are professional, very attentive, get a decent salary. If she did not have enough, then it would have been paid for her by local and national government. She passed away this January in her sleep at 95. I was also her 'tutor', court appointed, to assume bill paying, and reporting. The bureaucracy was actually the hardest part, but from reading the comments here, I shall not complain and thank God every day to live in France.
310
@Jean louis LONNE,
Thank you for explaining that we in the U.S. need not live like this in our later years. Yes, France and many other countries are providing their seniors excellent care, at very reasonable costs. I'm thankful that my spouse and I have legal status in Europe (EU nation passports, as well as citizenship in another country outside the EU), and will be able to avail ourselves of these kinds of services. Both of us are native-born U.S. citizens; however, we know we will not live out our last years here in the U.S. We know we will be emigrating when our health begins to fail, and we know we can no longer live a decent life here. We know that we are extremely lucky, and we are only sorry that everyone in the U.S. does not have the options that we do.
36
@Anton Colicos
Anton,
I also have EU citizenship and my wife has Philippines citizenship. Regarding EU, don't you have to pay into the healthcare system there for many years before being able to benefit from it ?
6
@vic You have to be a permanent resident or citizen to access the health care.
4
This is immensely depressing. After a lifetime of education, work, work, work, saving, living cheaply, budgeting the hell out of everything, contributing to retirement savings, this is it? Spending the last few years of your time on Earth alone, poor, and unable to pay for a decent standard of living? Horrifying. And what's the alternative? I don't see any resolutions laid out in the article other than "be very rich." I doubt things will get better. Suicide, assisted or otherwise, will see a huge spike in the near future. And/or a massive increase in elderly homeless.
217
Long term care, retirement, health care -- all paid for by taxes in Europe. This is what we need. My father, in the top 1 percent of earners all his life, cannot afford long term care now that he needs it.
101
@Mopar, but people in USA don't want to pay higher taxes. Mine, in UK, teacher level salary, were 50%.
25
@Mopar
Unfortunately more one-percenters aren’t taxed more. The Con Man in Chief is an excellent example. Unless we robustly tax the Uber-wealthy and take away their loopholes NOW, we will have unprecedented senior homelessness and poverty. It will bring down our standard of living as a nation, not to mention the suffering the individuals experience, and the choices their children, if any, will face. For example, college for kids or Mom and Dad’s long-term care? Many will have no choice. Such widespread poverty and its real world consequences will affect local and national security. We’ve been warned.
53
@Jean - You could take the entire fortunes of all the billionaires in the US, not just their income but all the wealth they have, and it would pay for about six months of what the US spends on medical care.
What would we do after the six months? Yes, you're next.
9
My mom entered an independent living facility when my dad died 7 years ago. Cost was $4,000...now up to $5,000 a month.
Affordable with her social security, pension, and income from the house in NJ ( thank God for inflated prices).
Fast forward to 2019. After a series of hospitalizations, she can no longer remain in independent living, unless she has outside care. At $21 an hour, round the clock is $500 a day....$15k a month, close to $200k a year. Her aides are wonderful, but they get paid peanuts. I could hire privately, but if someone calls in sick, then what?
No one can sustain that cost( anyone have a winning lottery ticket?).
Can she come live with me? Well, I can’t lift her, she can’t get up or down stairs ( our bedrooms are all on second floor). If I could do it,I would. I can’t.
So, what to do? Nursing home? The ones around me, I wouldn’t put my dog in. Assisted living is an option, but her medical needs are pretty intense, some wont take her.
It’s the ugly downside to miracle medical care. Her docs are wonderful and treating her congestive heart failure, kidney failure, and all the other stuff that goes along with being 93. But at what cost? Both emotionally for her, and financially for me.
In days gone by, a family would rally around and take care of a sick elderly loved one.
But, so many of us have moved away from family for careers and other reasons, there is no support system there.
Plan and save as much as you can. It’s more expensive than you think.
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@Cheryl
a retired AMA attorney F/70
DIGNITAS Zurich. About $9K. You fly round-trip and Mom flies one-way.
Either that or, as her Power of Attorney if she is unable to be her decider, you are way past time to move to hospice. Document all of her conditions and build up her "pain" history. Then ask her hospice Medical Director to use morphine&methadone by inpatient IV. Morphine for pain and methadone to prevent nightmares morphine can cause.
A good death that ends her suffering in "three hours to three days" as my father's very young hospice Medical Director's physician promised. Took four quiet days. All good.
Why? Why has no one raised hospice for you and your Mom among her physicians?? It's time.
16
@Cheryl - Thank you for the real story.
12
I for one am pleased, relieved even to see so many commenters embrace suicide as preferable to the indignities, both natural and man made, of old age.
Here's where I'm at in life. I just turned 60, my partner is 58, and both of us are coping with elderly widowed mothers in our own way. My mother-in-law is nearing 90 and showing no signs of slowing down. My own mother is at a stage where her's is a life of constant medical upkeep -- with no end in sight, we being of hearty German Pennsylvania stock.
The point that I'm trying to get around to is that people these days are living too long.
At this rate, my husband and I can look forward to a future of arranging eldercare well into our 70s. Even now, the strain of caring for mom has broken the ties I had with the rest of my family, such as they were.
I don't think I could ever be so selfish as to want to inflict on others the obligation, the burden, to instill in those who would care for me the resentment I'm feeling now, and it's getting worse and worse all the time. Truly, I would rather die.
It is the advances in medicine that has prolonged life to the point where nobody's going to know what to do with all these old people. It would be nice if I could count on medicine to provide me the means to check out when I decide enough's enough.
178
I appreciate your honesty. I think you put into words what a lot of people think.
29
@Brian
retired AMA attorney F/70
As sole care provider for my Alzheimer's father, 11 months under my roof and 13 months in a nearby facility, I feel your pain.
Under my Power of Attorney for my father, the day that he was longer able to walk in that facility was the day that he was transferred to inpatient hospice. By prior arrangement, to build trust with a very young hospice inpatient Medical Director, we set a plan for morphine&methadone by IV.
Many people do not understand that hospice is for non-dementia and non-cancer patients too. When lingering suffering, for you and your partner and your Moms, is nobody's goal. Scores of people who have read my hospice pathway to end-of-suffering as part of a desired end-of-life plan or been informed by local hospice physicians choose this pathway.
Sleep well and then identify the best inpatient hospice nearby that has an open-minded Medical Director who will support your and your Moms - plural - choice? Build disability and pain records for the doc so he/she can be protected in this prescribing decision.
Then breathe . . .because you may have identified your own pathway too?
I am DIGNITAS Zurich 2023. About $9K plus airfares. Non-resident assisted-death is lawful in Switzerland. My "pain" record and soon-to-arrive Alzheimer's qualify me now. I will go before the dementia impedes my ability to get to Zurich.
P.S. As a product of the 1960s with its drugs/sex/rock'n roll, you need to be here to party for me!
22
@Brian I feel you. My mother is 99. People have zero idea unless they’ve been there.
33
Span has told us one of the key reasons many elderly people will not be able to afford to live: people no longer have pensions. When we had strong unions, we had pensions. But now corporations are spared from this expense and that is considered good for "the economy" (i.e. their profits). Also good for their profits is a "healthy" (i.e profitable) expensive private health care sector -- including retirement and elderly care facilities. A lot of profit is being made from chargin the elderly to live and by definition this is "good for the economy".
To have this "good economy" as many poor people as possible need to stop living because they are a drain on the "good economy". This is the capitalist system working to weed out the weakest and most vulnerable amongst us.
131
A few commentators have mentioned suicide as an option. I think a better way to look at this is how we provide/receive medical care over 80. After caring for my quadriplegic father before he died and for my Alzheimer's riddled mother (currently paying $10,000 a month for memory care in Canada as I decided to quit caring for her and go back to work), I would suggest no medical interventions after age 80. None other than comfort. No antibiotics, no blood thinners, nothing other than pain management. It's amazing how many people in their 80s are treated in hospital for flu and pneumonia. At that age, nature is just doing its job taking you out. If it's your time to go, it's your time to go.
134
I disagree. I know seniors in their eighties who are in relatively good health. Would make sense if elderly and in very poor health—comfort care.
30
@Susan Head "Relatively good health" can change in a heartbeat at that age. 80 years is a long happy life. We cannot live forever. Healthy 80 year olds getting treatments for things that should kill them at their age are dramatically increasing their likelihood of needing long term care in five years when they could have checked out like nature intended. I know this is harsh but it is the truth.
50
@Damhnaid
My uncle just turned 100 and my mom will be 96 this fall. They are both doing well, active and alert. My mom just sang Vivaldi's Gloria and some obscure (and difficult) Bach Mass with her excellent community choir, a highlight of her spring. She is also enjoying getting to know her new great-grandbaby. Has she had any antibiotics since she was 80 ? Yes, for a urinary tract infection. Would you really have denied her that ?
Medical care must be personalized on a case by case basis. Not just as the end of life nears, but for extreme prematurity and attendant complications at birth, and for all sorts of conditions in between. We are all different !
81
There needs to be a re-think about how this care is provided. Rather than assisted living facilities, we should be aiming to keep people like Ms. Harris in their own homes as long as possible, with care providers coming to them when and as needed. Many people like her do not need major hands-on care, just help with the cleaning, driving, home maintenance, and things like that. Some might need a home health aide for an hour a day.
Perhaps this work could employ many of the middle aged but still healthy who the job market has pushed out; perhaps young people could do it in exchange for student loan forgiveness. It would cost less than providing a full range of services to people who don't need them, and would have the benefit of keeping those at the beginnings of memory impairment in familiar circumstances. It would also keep them part of the community rather than sending them to senior ghettos (and no matter how well appointed they may be, segregating seniors in special group homes is creating out-of-sight-out-of-mind ghettos).
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@Nikki - Living alone as you age and find life more difficult, and lonely, isn't necessarily the best idea for everyone. Many seniors have thrived in LTC facilities where they meet new friends and where there's someone around who'll notice if you don't come to dinner so someone will check up on you.
20
@Nikki
There have been some creative attempts f to create circles of seniors in communities to share services, and another whole group of people who explore creating actual living situations, co-housing being one, to enable aging folks to remain at home, or actually move into a compact home where services can be shared, and more easily delivered.
16
@MegWright It is different for different people. My father held on to independent living in an apartment for dear life and until about the last five managed on his own. And he had day aides. They provided company he enjoyed (female!). It wasn't always easy for the kids but the ideas Nikki suggests should be explored.
15
Following the example of the hippies who came before us, collective-communes of elders of varying abilities, might be the way to go? Trailer-park co-ops seems to be a good start in this direction.
27
@kladinvt Count me in.
7
@kladinvt
retired attorney F/70
Heh, Duxbury, come to FL and try that plan: most mobile home parks are old people own the coach and rent the space. Park owners live in Palm Springs CA with a Pacific Coast yacht to get away from FL heat and humidity and Park maintenance.
I have to repeat over and over and over when generations of neighbors ask "What can we do when Mom's lot rents are increasing 5-8% every year?" Always the same answer: Lock the doors and windows and hand the key to the Park manager with your note that says "Lot #13. I'm outta here!"
Then leave the state for the two years (some are one year) statute of limitations to run on all things related to abandoning a dwelling.
I've seen never-drink people become happily drunk that first night at my house, usually with their dog zoned out too. And never-dance people refuse to sit down because they are so jazzed to be done with the rip-off!
6
The proposed "Medicare for All" should include long term care. That should, hopefully, bring in some of the Republican-voting seniors. However, the federal government should be building for assisted and dependent living and directly competing with the private sector. The private sector cannot accommodate all the people who need such services and will raise their rates even more to milk a federal program. That's what they do with Medicaid.
12
Obamacare provided long term care. But Obama refused to enforce that part of the law because he didn’t like it. Strangely, liberal Democrat media gave him a pass. Several current Democrat Presidential candidates want to repeal Obamacare and replace it with Medicare for all. Of course, Medicare provides almost no coverage for long term care. Where is the uproar of complaints in the media?
7
Trump promised to Make American Great Again.
Notes that he did not tell us for whom.
11
It's wonderful that more light is coming to this topic. I'm a senior care advisor in Arizona and the shortage of quality, affordable long-term care options is quickly becoming an epidemic.
Daily I'm receiving calls because people cannot afford the average cost of care and need assistance finding care they can afford.
The best advice I can offer is to plan. Many people dont fail to come to terms with the fact they are one hospitalization away from needing long term care.
Look into long term care insurance. Have an estate plan in place that would allow for Medicaid coverage. Have designated medical and general POA's in place.
Having a "middle" income certainly does not disqualify someone from receiving quality care, but not having a plan in place can result in diminished choices.
5
If you wish to preserve your home as an asset for your children, especially if they would have no other place to live, set up an irrevocable trust and be certain to have wills.
Meantime, remodel your home so that it has a proper handicapped accessible bathroom and adequate safe exit and entry to the outside. The costs of such a remodel are less than the costs of the extremely high rents that you would pay for so-called independent living. Such remodels will allow you to stay in your home when you become dependent on walkers (that WILL happen) or a wheelchair. Have an extra bedroom for an aide.
If you protect your assets (your home) in a trust, and make that home one that you can age in, you are most of the way there. Don't believe that the extremely overpriced for-profit independent living centers are a solution. I witnessed a woman weeping as the independent living facility evicted her to a nursing home because she had mild dementia. She thought she had a home for life. Now she is in a place where they pump her with drugs and put her in a wheelchair in a room with many others like her so one underpaid aide can watch an entire group. I cared for my parents in their 90's in my home for 5 years until they passed away.
10
@Kevin
Kevin, you are a very exceptional anomaly in taking care of elderly parents in your home.
While I do not know all the circumstances I honor you for creating a generous exit time for your parents. Truly lovely. Bravo.
When did opening our doors to elderly relatives become such an oddity? Do we not matter at all once we become old?
The answer is too painful. This is why so many elderly people, many who post on the NYT, start to think about the option of suicide.
4
How many people, old or young, have to do without, until we get to tax the rich the way many other nations do? Meanwhile, in the US, they break ground on mansion #5, or blow billions on figuring out future moon colonies (yes, I'm talking to you Jeff Bezos). Can we stop with the ridiculous disparity yet?
18
Three letter word for me: d I e. To everything there is a season. I for one do not plan to live past my expiration date. 82.
2
@karen: See if you still feel the same way when you are 81.
12
After living through this with my father I advise everyone to get familiar with your options early, like, this week, well before you are on the brink of choice. It’s awful. In a modern world where we can get everything at our fingertips ... you can’t get this. And IMHO it’s an enormous opportunity for innovation by the private sector IMHO. The government can’t solve this.)
2
My father had long-term care insurance, otherwise he likely would have put off moving to an assisted living facility-- if he ever entered one at all.
The negligence and understaffing at the assisted living facility in which he lived led to his early death.
If only he had never bought long-term care insurance.
8
My mom has long-term care insurance. Her granddaughter, who lives with her, looks out for her and is paid for doing so, through the long-term care insurance. They also pay my mom's niece, who is a Home Health Aide to take care of her three days a week.
1
I've been reading the comments because this is very apropos to my situation, I'm retired, with Mom in her 90's and my sister watching out for her as Mom just moved into an assisted living environment from her independent living environment.
While my dad was alive until the age of 97 and in relatively good health, mentally alert until the end, I think he enjoyed life. We shared the NCAA Basketball Tournament results and the PGA Tour via the phone.
We were fortunate. My parents saved all their lives. For about 10 years they lived in an independent living environment at the Desert Winds in Peoria, Arizona and it was like a vacation. Good food and a nice one bedroom apartment. You couldn't want for more and the cost was nothing like the $6000 or $11,000 costs that people in New York State and California are paying. It was closer to $4000 a month for the two of them combined.
We were very lucky.
16
@Steve You were lucky, and so were your parents. They got in at the golden time, long past now. Also, if they become infirm and unable to care for themselves, the "add-ons" add up fast When were your parents in the"independent living environment"?
2
My mom had long term insurance until she was 66. The company she worked for (Nortel) went bankrupt and the long term insurance was gone. Retirees were provided with a small payout, but it was too late for her to buy insurance on the open market. Not having long-term care insurance isn't lack of planning or outrageous spending that people should be shamed for. It is something that happens to lots of people--even people with money who plan.
60
@Elaine
Why was it too late for her to buy long term care? Health reasons? There are plenty of good options for LTC for people in their 60's.
2
@JJ: Do you have any idea how high the premiums are at that age - IF you qualify?
13
@JJ. There necessarily aren’t “ plenty of good options” for people who are 66. Insurance actuaries know that with age comes the increased risk of health issues. And there are fewer insurers offering long term care insurance. It wasn’t a viable business model for many insurers.
They didn’t anticipate how much health costs would soar or how many people would hang on to their policies or how many would live so long.
So premiums have risen. Significantly. And if you have any history of family health issues- cancer, heart disease, etc....you can be turned down. Better to buy early. And look at newer types of policies. The hybrid insurance models show promise.
6
The courage to die comes to mind. In this land, the big money is spent to prolong life. It is not necessarily however the good money. The USA can't afford to pay for it as an institution of government. I have to ask myself to leave it up to my kids:
"If you take care of me you get what money is left over when I die; If I pay someone to take care of me you get whatever money is left over.
I know the Democratic idea has a better idea that doesn't work without pulleys, strings, and fairy dust, but the Republicans like myself don't expect the nature of humanity - as created can be changed by robbing Peter to pay Paul.
I have lived a good life but I am faltering. Maybe my savings and the government programs in place now will prevent my death from being a lingering hell. But - you see - I am a traditional person inculcated with values - unlike those today which heap all of humaniy's problems at governments feet and say "where's my money?".
6
So are you suggesting "Republicans like (your)self" will be staggering into the woods and dying when your time comes? It's tough to get away and do yourself in when you're so ill you're disabled. So timing is everything. And suicide is not straight-forward. Starving yourself is really the only method that might be within your control when you can't move much. Good luck with that. Really.
Seems like the US government could significantly reduce its disastrous impacts on the "nature of humanity" and demonstrate appropriate values by ceasing the endless wars it creates and fuels. That one thing--switching from a war economy to one of peace(recognizing that war making has always fueled US business engines) would solve a heap of "humanity's problems", too.
10
Wow. There are 600 plus comments in this thread, mostly focused on government providing care for everybody or suicide. Obviously the LTC industry has not caught up with very recent advances in medicine which are allowing seniors to live longer if not necessary better lives. Looks like a great business opportunity to begin opening facilities with less amenities for middle class needs. And reforming immigration system to enable workers for these facilities to come here legally, illegals not hired at LTC facilities, and are desperately needed.
5
A quick scan of some of the responses suggests the truth and even the real solutions I posted are far less popular than demonizing the Government or those bad Insurance companies .
1
People, and countries, demonstrate their Values in the way they spend their money. We here in The Land of The Free (old, white, rich men) value the MIC and windfall tax cuts for the already Obscenely Rich Pluto-Corporatocracy.
MAGA! Vote (R)!
2
And my doctors think I'm foolish because I care more for the quality rather than the length of my life.
14
@V. Whippo The doctor's jobs rely on your willingness to submit to treatment for potentially terminal illnesses. Medical, surgical, and radiation oncologists, for instance, are aware their paychecks depend on patients continuing treatments for very prolonged periods. Even if such treatment is not in the patient's best interests, due to perhaps age and co-morbidities, or because the world is on fire and chemotherapy drugs are water soluble for 25 years. Like in all the rivers and oceans.
5
My mom has said that she doesn't want to live past 75 as for most people the quality of life is pretty bad and she doesn't want to spend the last years of her life rotting away in a some disgusting nursing home where the pills are routinely switched out and stolen and the food is pig swill. It's how my grandfather went last year. She thinks they were giving him aspirin and some type of nsid instead of his prescribed medication bc his kidneys started failing almost immediately after being moved to a nasty new nursing facility that was significantly cheaper, when they had never given him any issues before. Mom wonders if her brother was looking for a bad nursing home in the hopes it would off grampa faster and it seemed to have worked. I can't work up much concern though, cause Grampa was such a selfish ugly bigot and extremely abusive to his wives and children. Good riddance.
3
@Redd
Can she live with you?
2
Our leaders are a disgrace. Half or more of the national budget goes to the military. Obscene fails to describe it. If the citizens need LTC they should force the issue.
15
11 million undocumented.
They will not be eligible for Social Security or Medicare.
There's a train wreck for you to consider.
5
Our great American society is sounding more and more like the plot from the 1973 "Soylent Green" movie with Charleston Heston. An overpopulated, polluted world where the government offers the elderly a view of a utopia and nature as they administer them euthanasia.
Soylent Corp runs out of plankton food tablets to feed the masses, so instead they start feeding them the deads remains as a new Soylent protein food supplement. Yum! Coming to a nursing home near you folks.
5
While Paula Span writes about how aging boomers won’t be able to afford long-term care in ten years, she doesn’t mention how right now that burden is faced by unpaid family members and friends who, according to an AARP survey of 2013, involved 2.5 million family members in New York, an estimated at $31 billion in economic value based on the average wage of a home care worker.
The New York Health Act (A5248, S3577) now includes long-term care, paid for by a progressive tax based on income, a benefit which, according to the centrist 2018 Rand Corporation report will make necessary care available to the vast majority of working and middle-class New Yorkers. The legislation entails a preference for home and community-based care—not the institutional care that will be out-of-reach for so many.
This aligns with the U.S. Supreme Court’s 1999 Olmstead decision requiring that care be offered in the least restrictive form possible to be compliant with the Americans with Disabilities Act.
The legislation is universal and will include all benefits currently provided by Medicare plus prescriptions, vision, dental, hearing, mental health, reproductive care. It will cost 90% of New Yorkers less than they pay in premiums and deductibles for our current broken healthcare system. Hearings will be held in Albany on May 28th.
26
@Barbara Estrin: Just curious how "reproductive care" applies to senior citizens facing the end of life.
Let me offer some practical solutions that addresses what is the biggest financial problem for us once we are eligible for Medicare . That is the starting point because once you get Medicare you no longer have to be concerned about Hospital , Medical , and Prescription Drug Coverage for the rest of your live :
1- Recognize that only Medicaid that you have to be poor to get ( or have done Medicaid Planning ) or private insurance covers Long Term Care .
2- Recognize that Traditional Long Term Insurance will be tremendously expensive if you apply after age 60 ( for ex ), or have developed chronic health issues ( you could easily be uninsurable ) .
3- Consider the newer Hybrid Options that combine Life Insurance or Annuities with LTC benefits and if you can set aside some of your savings that are losing money in bank deposits .
4- Consider Short Term Recovery Care Options . These are very affordable and low cost and easy to get and can help provide care at home .
5- Sit down and imagine the worst case hypothetical . That the kids nor anyone will be able to help you . Your spouse will also not be able to help you much and without planning you may need to spend time in a nursing home that can drain your life savings .
By asking worst case you may come up with sensible alternatives like selling the house and moving into an apartment , or talking to your sister about moving back into your parents old house and helping each other (For ex ). Don't wait till it's too late .
14
@VB
s/b no longer how to worry for the rest of your life .
1
@VB
Your points 1 and 2 are completely wrong.
With Medicare prescription drug plans, certain drugs ARE very expensive. A & B do not cover everything. A good Medicare advisor can explain all of this and provide solutions to enhance coverage (Advantage or Supplement)
There are plenty of affordable options for LTC policy in your 60's. Lincoln MoneyGuard, NGL, Mutual of Omaha. These are not tremendously expensive.
2
The fact that this article and the real life example can evoke surprise and alarm is indicative of the biggest reason it is " the greatest financial problem in America once people have their health insurance needs funded by Medicare " unless of course they are poor enough to qualify for Medicaid ( or have done Medicaid Planning more than 5 years ago ) to take care of Long Term Care Costs .
But, the secondary headline is a little misleading for most middle income seniors will not be able to afford Long Term Care Costs right now much less ten years from now , and they themselves are to blame , or should I say it is human nature that is to blame .
The reality that we are either going to die before needing or we are going to need Long Term Care is too painful for us to handle . You mean there will likely come a day when we will need someone to help bath us . It is likely that at some point the activities of daily living that we take for granted we will be unable to perform on our own . We have a good chance of winding up in a nursing home among strangers away from the comforts of our home . These are realities that we avoid thinking about until some health even crisis makes us to .
Unfortunately , by then it is often too late to get Long Term Care Insurance , or find other affordable solutions. Sadly my experience as a Health Insurance Planner suggests 50 million - 100 million people will be worse off than this retired lawyer .
7
@VB
Haha—thanks for slipping in that you’re a health insurance planner there at the end—you sound like one! You make it sound like LTC is some kind of requirement that irresponsible people avoided—it’s an insurance policy that makes money for insurance companies (or at least that was the intention until the poorly conceived ones went broke). And it doesn’t cover most retirement housing or assisted living anyway unless the senior can’t do those pesky ADL’s. (And why are you using uppercase on words that are just words, not proper nouns?) The solution isn’t more commercial insurance policies, it’s affordable senior housing and care. A lot of people are making a lot of money in this senior living racket. Tell me a reason why an assisted living facility can’t be clean, comfortable and affordable—lower profits? It’s like other parasitic industries—the higher education-student loan racket comes to mind. People will figure out how to drain blood our of a turnip if it can make them rich.
26
@VB "Medicaid planning" = legal loopholes for people with privilege to shield/protect their assets so their children can inherit their estate while they take advantage of a program meant for persons who truly don't have assets.
15
@Kally the "pain point" for many senior living operators is labor costs. Large operators employ caregivers authorized to work in the United states and only pay a little more than minimum wage. Even at minimum wage the labor costs are huge for 24/7 care. This is reflected in their monthly costs.
Additionally, there is a shortage of good caregivers legally authorized to work in the US who want to care for the elderly at minimum wage.
There are affordable options available presently, but most of these smaller operators are skirting labor laws while everyone turns a blind eye.
3
Researching LTC facilities for my father, I found that if you didn't have good LTC Insurance that kept up with current charges for care you could be stuck in a facility that is sub-par.
I visited one that made me cry. The place was grubby, the floors needed to be cleaned, there was no TP in the bathrooms, very poor lighting, residents appeared drugged and set in front of a tv that was showing a Disney movie while attendants dozed nearby. Picnic tables off to the side were used for meals, apparently canned tuna was a frequent offering. Residents needed to provide their own bed, dresser, chairs, linens and I think there was an extra charge for laundry. The women's area appeared to be better cared for than the mens, which was interesting. But it was cheap - charging about $3k/month.
There needs to be less-profit taking focus on these places. I'd like to see the numbers on what a facility costs, staffing, insurance, operating costs - $3k should provide better than what I saw.
11
I find the timing of your article a little suspicious, as in the last several weeks I received a notice from Genworth, my long-term care insurance provider, that my rates will be increasing by approximately 30%.
While the issue is real, I hope you are not being used as a tool by Genworth.
9
@Charles
Several years ago my LTC insurer, John Hancock, raised my premium by 50%; I could have accepted a smaller increase but I wanted to continue to get inflation protection. Even so, I'm lucky that my group policy (my former employer no longer offers a LTC insurance plan option) still exists, grandfather in with J. Hancock which no longer offers new LTC insurance to anyone.
Most U. S. long-term care Insurance providers have bellied up in the past ten years, and there are very few still in the game. So, even those of us who have been proactive and looked ahead to needing old age help may have just poured many thousands of dollars down the drain, only to be without insurance when it's needed.
Private insurers seem unable to manage this crisis in the market. There is no starker example of a need for government programs.
38
@Constance Sullivan
Even if your insurance company goes belly up It’s unlikely you’ll be left without some insurance ( as things stand now) . The long-term care policies of failed insurance companies are guaranteed by fees assessed to other insurers and the amounts guaranteed for policyholders vary, depending on such variables as where a policy was purchased and the guaranty limits of that state, etc.
Here’s a link where you can see the guaranty limits for various states. Hope the link works: https://www.penntreaty.com/Portals/0/Updated%2011-8-18_GAChart%20-%20LTC.pdf
Take the case of Penn Treaty American Corp., a provider of long-term care policies. Despite being liquidated, claims were honored, up to at least $300,000, for most customers. Some, however, were guaranteed less.
But here’s an interesting point that I doubt most policyholders know: the long-term care policies of failed insurance companies such as Penn Treaty are guaranteed by fees assessed to other insurers.
In othe words, your insurer may well have helped pay for Penn Treaty’s obligations to its policyholders.
6
You are lucky. Read about GE. Billions lost in LTC.
3
Yeah, well, if the richest country in the world took care of health care of all its people, that $100K in home equity would be passed down to the family.
After a few generations, the accumulated wealth would make them rich.
We cannot require people who work their entire lives to go broke at the last minute because of obscene health care costs.
Most of the world does better. So can we, if only the super rich and corporations coughed up a few percent.
21
@Occupy Government
Sounds like heart inspiring " do gooderness " that many would agree except people who work in health care , or Insurance , or Government Programs or others who understand the causes of costs and those who get the bills for those costs .
Blaming health care costs " we cannot require people who work their entire lives to go broke at the last minute " like only the bad corporations are responsible is misguided .
The richest country in the World already provides care to the poor , the disabled , veterans of our military , children without parents , others , and many other benefits , and those with Long Term Care needs who are Medicaid eligible .
So , what more should be done and can be done , must also come from an understanding of the problems not some good sounding blame .
One of the biggest problems ( I am a health care planner ) is our natural aversion to thinking about and then realizing we only have two choices . We are either going to die before needing it , or we are gonna need it and not understanding we need to plan for this need long before we need it and affordable options are still available .
Obamacare ( another great program that has provided health insurance to tens of millions ) was originally gonna help with LTC , but after looking at the costs even the Government ran for cover .
Solutions cannot come from uninformed do goodness .
4
There are few consequences for old politicians that make bad decisions. Stop reelecting and voting aged politicians into office. They have little invested in the future. Elect people who are the future and have more to loose if they get it wrong.
The real issue is how does the US Congress find the military budget to interfere in foreign countries’ problems but lack the will to budget for domestic challeges like health, education and old age? No other country in the OECD considers this normal.
We are clearly not tackling the challenges we face with the politicians we elect.
We need to elect younger people to high office who have more invested in the future, not old people who have little time left in the future.
34
@BBB
Sorry BBB, but you have this completely wrong. Did you ever try and convince a young person to buy long term care insurance? Future long term care needs for younger people is just not a focus of their lives. Only older people, who have and are experiencing the full implications of long term care, will be willing to fix the problem. And, by the way, your bias against older politicians is discriminatory. Lets pick the right people for office for what they can do rather than race, age or any other discriminatory label.
11
@Jim
Long term care insurance is not a good investment for most people. Far better to invest the premium payment in a growth fund and see if you need it in the end. More young people would understand that.
but the idea that older people have given up on thinking is offensive.
11
@Occupy Government
my experience with long term care insurance over the last 45 years (as a family doc trying to help patients obtain promised benefits) suggests that it is mostly unfulfilled promise at best, and fraud at worst.
I lot of my older patients (older than me, that is) are now saying they just will crawl off into the woods and not subject their families to the obscene medical "system" that is raping us all.
12
After reading this article and then the comments thread, it astounds me that some commentators actually think suicide is a viable option rather than looking at this situation in a more constructive way - such as moving abroad where the USD can almost double in value, not to mention much lower costs of living and medicine and a better standard of living. With a bit of research, you can find different countries where growing older makes much more sense, such as Columbia where hospitals rank higher in terms of care than Canada and definitely the US. It appears people prefer to embrace a 'known' future full of fear and certain suffering rather than open themselves to something unknown and considering other possibilities.
17
@msytc
It's pretty hard to move when you are old, sick and poor.
That decision had to have been made a lot sooner -- when the possibility that things could work out in your own home country was still viable.
4
@msytc People think about their families too. I'm not so sure I would want to or be able to move to Colombia alone in my old age (provided Colombia would take me!). I would not expect my children to give up their families and jobs and move with me.
@Elaine
You're lucky if you have family that would consider moving with you!
1
My husband and I purchased an insurance policy with a long term care rider. It's expensive but the premium is fixed so at least we know what we signed up for. After you qualify they give the money directly to you for your care. Whatever money you receive gets taken off of the benefit. Whatever is left when you die goes to your beneficiary. I got a $250,000 policy for $278 a month in my fifties. That probably won't be enough but it at least will supplement my savings and social security.
4
@Diane That $250,000 certainly can go a long way in supplementing what you already have in place. I am an agent and I always try to get the younger people to secure these policies because it's SO much cheaper if you're younger. Sometimes, it's better late than never. I pray you live a long, healthy life!
1
@Tywana
$250,000 will get you about 3 years in a middling nursing home if you don't require too many drugs or services.
And $258/mo when you are 50 (likely quite a lot more if you start now at 50) -- will seriously cut into the budget of people in that age group, most of whom are still paying off mortgages, cars, kids' college loans, life insurance, car insurance -- and of course, food.
2
One thing that not even the New York Times will make me feel sorry for is the hardships of mid-western baby boomers. They voted for Trump, for Romney, for Bush, for Republicants at every level of government. It is way past time for them to get the limited government they've been asking for. This millennial with a six figure student debt has no appetite to finance the well being of people who consistently vote against my interests.
58
@Arthur Hornblower And what about all of those who didn't vote for any of those Republicans! We are older boomers who live in the South and have never once voted for a Republican.
But, we have compassion for all people, regardless of their political affiliation. There are so many people who are easily fooled into voting against their own interests. Why blame them, instead of those in power who have manipulated them successfully?
11
We keep way too many people alive at all costs when they are too ill to advocate for themselves. That should be the line. I don’t want to be at anyone else’s mercy..I don’t want to depend on others to care for me and I don’t want to spend my life savings to have someone change my diaper and feed me. I want the choice to go in peace and leave whatever I have to my kids and grandkids.
51
@Deirdre
Good idea!
But when and how do you decide to pull the plug, and how do you do it?
Soylent Green, anyone?
6
You can decide your fate. Who gave you or anyone else the right to decide mine?
6
@Deirdre
retired AMA attorney F/70
At Edward Potter's replies is my n.c.fl word-for-word text and process for writing your own one-page Physician Orders for EMS and ER docs and nurses. And how to get these instructions into The Medic Alert Foundation's 24/7 POLST database for when our inevitable end-of-life is near. This plain-English document covers unplanned things like car wrecks and well-understood diagnoses like dementias.
Do this for yourself and then share the text and process and your document with others?
3
I'm drunk. I stay drunk. How did this happen? Republicans? The party of Lincoln? Ha!
9
Let me guess. The young, who already will have to pay off their forebears 23 trillion (and counting) national debt will also be saddled with the medical care that has long been disastrously inefficient and underfunded by those who will suddenly call it a "right".
And the young are called entitled. Puh-lease!
22
@Junior
when you're older, you'll know more. nobody is asking young people to pay for senior health care. people are asking that very rich people and corporations pay a few percent of their net worth to the country that gives them so much value.
11
The only way Im able to survive now as a disabled senior is by living with family...in my case thats my son... After monthly expenses I have not enough money to meet medical expenses... Im 65 now but im sure my medical costs will increase as I get older...not a pleasant thought...
8
@James Ballard
retired AMA attorney F/70
Go to n.c.fl replies at Edward Potter in these comments.
I have created a one-page plain-English refuse all treatment document that is used across all states. The text and the process are included in my submission.
After you finish with your son helping you to get witnesses and Notary, you can teach others.
You and your family will sleep better knowing you're protected from the worst that modern medicine can do, but also can get the best that modern medicine can do: hospice inpatient IV of morphine&methadone for three hours to three days of quiet sleep and a good death.
5
My long term care is actually short term care and...exit. I have a Taurus .357 at the ready when life becomes to burdensome. At age 67 now but with some replacement parts and overall decent health. My goal is NOT to be playing bingo at age 95 in some oldster warehouse waiting for I Love Lucy reruns after mush for dinner and let's do it all over again tomorrow.
28
Fine. But before you go make arrangements for the clean up of your brain tissue and body fluids so your family doesn’t have to face it.
6
@h king
my MIL had a similar plan. but she had a stroke in her rocking chair and couldn't reach her medicine cabinet.
3
@NYCSANDI
My stepfather did this, but in a location far removed from home.
2
The problem is people not being able to afford long term care in the future is only going to get worse in the future. With trillion deficits on the horizon because of the massive and irresponsible $1.9 trillion Republican tax giveaway to the most elite people in America, and cuts to Medicaid, Medicare and Social Security on the horizon, watch out for more aging parents moving in with their adult children because the money just won't be there to pay for these benefits. Well, at least Jeff Bezos got his tax cut and Amazon pays no corporate tax cuts. This article just proves that there are real world consequences to the way that people vote.
38
@Stephen W So you're assuming the children of these elders will own houses? Increasingly, and rapidly, only the wealthy are able to buy houses. The old folks will have to move into the single bedrooms in their children's one-bedroom apartments, or to the couch, if that doesn't work out. Or squeeze into the RV the kids have to move every three weeks to avoid park fees of $500-$800/month. There are millions of people in these circumstances now. More are losing out on the idea of ever owning a home every day.
The generation dying out are much more likely to own a home than their children. The fortunate elderly in my little town have their children move in with them.
4
The goal of the system is wealth transfer. Ask yourself why the care homes are charging $5,000 to $7,500 per month - after, of course, you discover how much they are paying their staff. We're being rooked, and with a generation or two coming up that have no assets, what awaits them? Tax cuts for the wealthy and corporations? Billionaires on television?
16
@Pete
The goal of any "system" has always been "wealth transfer". As it should be. No one lives forever, and something has to be done with accumulated wealth.
I can't tell if our "system" is better or worse than what Shakespeare or Moliere described in their times and places -- but I suspect in the end, it always comes down to the same thing.
1
One of my basic medications cost $600 a month last year. I thought that was high. This year? It costs $2000 a month and i’ve been notified by our employee insurance plan, normally excellent, that they will no longer cover it.
There is no substitute medication that remotely controls my condition. We have appealed the insurance company’s decision. In the meantime we pay the cost.
Would most,of us accept and be able to afford that kind of inflation for other basic needs? For food? For clothing? Wouldn’t we be actively protesting... and aghast?
The $24,000 a year spent on my medication is money that can’t be saved toward retirement, including health care and long-term care costs. And if we decide to use a different, non-employer offered health plan, thise we’ve found thus far will cost far more than our current one, have fewer benefits, and still not cover this medication.
I know I’m not alone. Look at what happened to the price of epi-pens, as just one example. Perhaps others here have similar stories, including unexpected and unpredictable medical costs in today’s system.
And yet, in spite of this, we’re expected to save for long term care. We have been doing our best and we think we’ll be okay. But who really knows...especially when costs soar , just in one year, as they have for us?
46
@Jace
retired AMA attorney F/70
First-level health insurance claims are done by a computer. All denials not appealed are profitable. Those who write their own "medical necessity" and good versus bad outcomes with vs without a specific prescription drug have about an 88% likelihood of getting coverage. First round of appeal is the first time we a human review.
Keep taking appeals to an Administrative Law Judge if need be because you will succeed. Look for a separate submission here that I will write that includes essential language for all appeals.
16
@Jace
Have you attempted to change your life style, diet and exercise? Is this a per-existing condition from childhood? You say it cost 24k per year, is there alternatives you could do or take that will achieve the same results? Many questions I have and I'm sure others do as well. Be forthright and explain why this cost is the responsibility of the government and not yours?
Sincerely
Mark
@n.c.fl thank you. This is reassuring.
5
This is something that is slowly happening throughout the world( https://www.cnbc.com/2016/03/27/japans-elderly-turn-to-life-of-crime-to-ease-cost-of-living.html ). In Japan, the elderly are committing crimes in order to ease the cost of living. It is very worrisome.
11
But we have unlimited funds for health care for illegal immigrants. right?
15
@Cloudy - that is not a true and has never been true.
16
@Cloudy what are you talking about?
11
@Cloudy. I don’t know where you think all illegal immigrants are getting free health care. If detained I assure you they get the absolute minimum, if lucky enough to receive that. If not detained, they are ineligible for federal assistance. I think you have been listening to too many Russian bots.
18
Care and rent are two entirely different things. The rents for nearly everyone are too high relative to incomes, whether you are retired or working. The cost of care (assistance in the home, whether it is a home you own or one that you rent) is extremely inflated because the fees are largely consumed by the corporations and companies. You might pay between $25-$40 per hour for an aide, but the aide (most often a woman) is likely to be getting only $9 to $12 per hour.
Corporations, both the care industry and the real estate industry, are sucking the resources away from families all across America.
28
@Kevin That's called capitalism!!! The charges by assisted living facilities are beyond the reach of middle class,even with good income and savings($80-120,000/year)
3
The 'canaries' in the coal mine who should be alerting the public about immoral & cavalier disdain by our NYC and NYS administrations more often than not, have wanted to talk about frivolous things...elevating toilets...shower bars...you know-nice things...nice when you can afford to be kept safe & not tossed into the morass of NY Nursing Homes.
But even with an elder's modest 'nest egg'-if you age in NYC-you're choices are little to none-because the NYS DOH and its Public Health and Health Planning Commission are incestuously manipulated by Lobbyists and interests that are business driven-they do not give a whit about you or your aging loved one.
NYS Legislators and Cuomo have continued to reject an Aide ratio requirement...that means that when you're bed bound-you'll have to wait for hours to be fed, to be 'turned', to be cleaned-& if you don't like it-well, you may be quieted w/over-medication of psychotropic drugs.
Did you also know- 24 hour Aides only get paid for 13 hours by their Agencies? These are the folks caring for your loved ones. Slave labor, indeed-NYS says -sure!
So, yeah, if you're lucky enough to live to an 'old-old' age...when you begin that journey, perhaps in an ever-diminishing choice of facilities which have been churned into luxe housing-then must rely on a Nursing Home w/a dementia facility-what you will find is a flouting of decency abetted by a corrupt Albany who does not have your interests at heart.
Where is the reporting on this NYT?!?
19
@Sandy Reiburn
retired AMA attorney F/70
All true. Not just NY City and State. Everywhere.
As one early commenter said: "We've lost on our mind on what to do." $2T in debt from wars that are paid for off-budget -- so the public doesn't see these costs. $3T estimate now for 2017 federal tax cuts for the corporations and 1% of highest income people.
Then when AOC proposed a detailed plan to take us back to Eisenhower's (R) tax and infrastructure spending plans, Rs act like she's delusional. Starting with Dick and Liz Cheney running the country while Bush was President, Rs stole all current and future wealth! Now they're in a lather over whether Cheney daughter goes to House or Senate.
I will be dead soon, but until I'm gone I will support those trying to move the financial balance wheel back toward transparent and fair public policies.
21
@Sandy Reiburn. Rules have changed federally for 24 hour aides so NY must follow them. They must sleep at night or overtime paid if awaken. Your facts are outdated to some degree.
2
@Sandy Reiburn As someone who worked in a nursing home once told me. You go to die in a nursing home.
5
No country for old men. Or women.
24
@john Great! Someone need to use that for a slogan to get the attention of older, conservative voters who think they'll be "just fine" with Medicare and their savings. Unless you are a multi-millionaire, you will not be fine .
9
how can it cost more to live in norman than little rock?
5
A story of Moe and Joe. They are identical twins who earned the identical salaried over their entire lifetimes. They also were bachelors and died on the same day.
The only difference is that Moe was a big time spender and had only $2,000 at the time of his death. Joe on the other hand attempted to save for his retirement and had over $650,000 at the time of his death.
Because Joe had 'wisely' saved money for his retirement, he was forced by laws to use up all of his savings before being eligible for Medicaid subsidies.
It's no wonder that American hate the Washington effete elites. They have no interest in America except for their own self-interest: being eternally reelected to Congress.
Perhaps a march in Washington is in order.
17
@Enarco. I don’t think it unfair that a person with means must use up their own assets prior to relying on government ( taxpayer provided) assistance. I can’t speak to Moe’s irresponsible fiscal behavior but do we want government monitoring our behavior beyond the five year look back?
2
@Enarco All politicians are swamp people. Some are totally submerged and a few have their heads outside the muck.
@Enarco You can be sure the senators and numerous administrative hangers-on and their families get platinum medical care. Why should they care about anyone else? Compassion is for suckers.
1
A national disgrace, almost all of our peer countries do not have this problem because they have a universal, affordable, quality health plan.
A national disgrace, no other way to put it that millions of Americans will go bankrupt and suffer destitution because they can't afford this or any type of medical care.
31
I believe that long- term care insurance is needed but make mo mistake: these companies absolutely CAN -and often have - raised rates significantly within a given year ( see link) . Rate increases are often on older policies and those purchasing the newer “ hybrid” policies offered today may be less vulnerable to rate increases
Insurance company officials simply need permission by their state’s Department of Insurance- from that section which handles requests for insurance rate increases .
This link http://www.insurance.ca.gov/01-consumers/105-type/95-guides/05-health/01-ltc/rate-history-active.cfm provides state by state info on how often an insurance company requested a rate increase...and how much they were granted.
You can check on companies currently offering policies as well as those who no longer sell policies but will usually honor existing policies.
You’ll see that some companies were granted permission to raise rates by as much as 30, 40 or even 100%. The companies even, at times , requested increases of over 100% . It was not uncommon for them to request significant increasss on some groups of policies.
6
@Jace Isurance companies are for profit. They typically take 40% off the top before spending any money on policy holder's,doesn't matter which insurance you buy.
4
@Jace and, in many cases, you can also see if companies have frequently asked for significant price increases on your specific policy class in your state, right down to the class policy number. You can see how much was approved ( and, if it was, you already know that). But others can get a heads up on what’s happening in their state, how often requests are granted...and which companies frequently ask for premium increases. .
@Jace
Most long term care policies are at a flat rate upon the purchase date. These policies don rise in cost over time. For example my LTC policy is $1600 plus per year with a coverage for $400k over six years. I'm hoping to live long so I may be paying for 20-30 years which is far cheaper then not paying at all. The wife's policy costs $2400 per year, they live longer. Us guys are like shooting stars, we burn out quickly where women are like a sunset. Slow and beautiful.
Plan, prepare and prevent you failure.
2
I'm coming to the final act of Stage IV renal cell carcinoma and have set aside a substantial blue bag stuffed with opiods. I'm very grateful to Medicare for having picked up 7 figure medical bills over the past five years. Medicare will also cover my hospice care at home. At some end-stage point, I will likely take recourse to my blue bag. God have mercy on all of those people in this article who need it.
20
@David Goldin
retired AMA attorney F/70
Or hospice inpatient IV of morphine& methadone? Much less likely to vomit and throw-up your opioids.
Start now to arrange for your move from home-based hospice to inpatient hospice. Build the "pain" history to protect your inpatient hospice Medical Director who has to prescribe this morphine&methadone IV. Soon!
11
Thank you for your advice n.c.fl. Having had several operations under anesthesia, I do appreciate the advice about the IV, which is quick and seamless.
Without being overly gruesome, I have also considered buy a portable generator which would fill a room full of carbon monoxide. That would be another painless way to exit.
It's all complicated but in the end, it's the last of life's problems to resolve.
2
I'm surprised Netflix hasn't made a movie about this yet, it will become acceptable and normal to take a pill and end your life when you're getting too old to live by your own means, the industry is looking forward...
7
As I edge towards a reasonable (to me) expiration date of body and money, Edward G. Robinson's final scene in "Soylent Green" doesn't seem so bad at all.
14
This country is sunk. Sold to the highest bidder. We no longer care about children once they're forced into existence, and we discard our elderly. My wife and I are examining exit options. See ya!
18
@IZA
retired AMA attorney F/70
DIGNITAS Zurich via one-way First Class seats. Costs about $9K. My date is 2023.
8
If I get to the point where I am simply unable to care for myself and there is no one willing to help take care of me, I will simply take a deadly cocktail and call it a life
17
@nlitinme
If you figure out what’s in that and where to get it, let us know....
4
At 67 I was first going to buy into LTC, Omaha being the only policy offered in NYS for age group. I went ahead with it and cancelled at the last minute. The $500 a month was a big burden to swallow, despite me having a pension. My parents had policies that that paid religiously. But when it came time to use them, my father didn’t qualify of 3/6 activities of daily living. So no payout. Useless. And my Mom? Played bridge at 93 up until the time I found her on the floor or her apartment. She lived her life as she wanted, independently u til the end. So after much thinking, I’m not going to buy a$500/month policy which I may never qualify for. Dumb? We shall see.
14
@ClaudiaBee Were you surprised that the insurance company stiffed your parents???
3
@ClaudiaBee
Not dump but maybe to old for a cheaper policy. No sure what a 3/6 activities of daily living is though?
On another note:
Exploitation of vulnerable, yet capable, caregivers is already a thing. What happens is that caregivers are hired early, often in exchange for low wages or only room and board in exchange for what is called "companionship services" which is the FLSA's term for low- or no-skilled care (think high school babysitting) that has no wage or overtime requirements as long as household duties that are obviously wage-worthy (cleaning, laundry, etc) do not exceed 20% of the total hours. This creates a slippery slope problem for what is 'work' and what is simply 'watching'. The health decline is also a slope that can quickly go from 'light care' to 'I'm pretty sure you need an actual nurse' without warning.
There is a so-called 'Silver Tsunami' coming as the Baby Boomer generation approaches octogenaria. One thing I haven't really seen discussed much, either, is the fact that due to problems with recognition and diagnosis, as well as the stigmas surrounding mental illness when this generation was younger, there are bound to be many individuals with pre-existing, yet unidentified and therefore untreated, mental illnesses that will complicate their care as they age. Add to this the problem of the objectivity (re: lack thereof) of loved ones as they arrange care for their ailing, aging ancestors.
Traits which were considered 'quirky' or 'ornery' in someone's younger years could have been the result of personality or other disorders that will be exacerbated by dementia.
13
@Lucy An estimated 10% of people have psychosis and age certainly increases that risk.
2
I assisted my elderly parents for a decade & had a front row seat to the general horrific quality of 'care' for the elderly .
It was totally depressing & I realized that under No circumstances would I want to be under that 'care' .
Unless I happen to win the mega powerball lottery allowing me
a premium pick of legal & medical assistance ,
I will be opting for my own private exit .
One horrifying thought tho is the chance of an accident prior to that , resulting in a vegetative state where I am doomed to one of the nursing homes . ;-(
22
@Kathleen update your will and medical paperwork to request that no “extraordinary means” be used to keep you alive if you’re going to end up in a vegetative state.
It won’t cover all eventualities. It isn’t fool- proof. But it will be relevant to other situations...and offer you some protection. Better than nothing, anyway..
6
@Kathleen
My biggest fear as well. How many nursing home patients
now confined to a wheelchair and suffering from dementia, Alzheimer, or a stroke had planned a peaceful death at home but missed their opportunity? People say they never want to be ‘put’ into a nursing home but land in one anyway.
5
@Kathleen
retired AMA attorney F/70
One-page plain-English EMS + physician orders to NOT do diagnostic or treatment interventions if you are unable to communicate, e.g., car wreck mangled, is in n.c.fl Reply to edward potter nyc comment here.
Works in every state, including CA when there is a conflict, because it is anchored in our constitutionally-protected right to refuse treatment since 1990.
7
The Trump tax cut for corporations and the super rich needs to end so that there is money to fund programs for those that really need it.
11
@Dennis
Who are those? People who didn't prepare, isn't it the individual's responsibility to prepare for the future?
@Dennis There wouldn't be enough if you tax the wealthy at a top 90%!!!!
Am I so radical? I’ll forgo all care past 77. That’s it. Have had a good life.
Ready for Life 2.0. No burdens on anyone.
So simple. :-)
15
@Edward Potter lets see if it seems so simple when you turn 77 and need care
3
@Edward Potter
retired AMA attorney F/70
Since 1990, every U.S. resident has a constitutionally-protected "right to refuse treatment." Crosses state lines and overrides local/state laws that are more restrictive when there is a conflict. Here is essential pathway:
Put your directive in one-page Physician/EMS Orders for Life-Sustaining Treament + your full name: "If I am unable to communicate, I do not consent to any diagnostic or treatment measures beyond a physician's clinical evaluation, starting with EMS' standard operating procedures like implanting ports for ER physicians.
I do choose inpatient hospice for morphine and methadone by IV to avoid my history of nightmares with morphine alone."
Two witnesses and a Notary, who can be one witness. A bank or UPS office?
$15 buys us two years in The Medic Alert Foundation's 24/7 POLST database known to all EMS and ER docs. Get your Foundation bracelet with your name and the phone number for ER RNs to call to get to YOUR document and in big red letters carve POLST into the bracelet. Put a copy of your POLST in your wallet and under a magnet on the front of your frig too?
In smaller places than NYC, hand carry your POLST document to local ambulance and fire/police offices. Then to local hospital administrators and ER chiefs so there is no missing your intent. Any document that does not have these words and Notary+witnesses likely is disregard by EMS and ER.
Then teach others to do this too!!
11
I think the timing is tricky...there’s a sweet point when you can see the future and still be capable of action.
6
Little else better demonstrates the abject failure of “free market” reliance so commonly proffered as the solution for everything! Rather, elder care is clearly an example of market failure—in fact, failure so severe that it is almost a forgone conclusion that we can expect catastrophic outcomes. Like so much else it’s shamefully ignored by the powerful.
6
@Mike
Wrong for the most part. Medicare works, people failed not the free market and families have failed their elders. People need to take responsibility for their own actions.
Plan, Prepare and Prevent.
3
Excellent article! The attorney in this article is in difficult position and I wish her only the best.
Something for us all to contemplate: if you think it is bad now, just wait. McConnell’s stated goal is to eliminate Medicare, Medicaid, and Social Security (Bloomberg TV interview).
What then?
To the deeper point, why does the GOP hate people?
25
@Jimminie Cricket
They don't, they or (I) want people to take responsibility for their own actions. I don't want to pay higher taxes, I care for my close and extended families. People need to be responsible for which I see few who do.
It's education, drive and determination that makes people self-reliant. Quit living for the handout and do something for yourself.
2
The maximum taxable income (2018) for social security is 128,400. Those that make millions or even more than that cap should still be contributing. Those doing very well financially in this land of opportunity should have some noblesse oblige to go along with their good fortune of living here in the United States. Even the “I earned it” rationalization is meritless. Having a strong intellect and a healthy body is a blessing and does not entitle someone to all the marbles. Remove the ceiling on social security taxes.
19
@Phyllis Mazik
I'm far from making the maximum amount and I do agree the cap should be lifted.
4
This is a great article . I being Psychiatrist can see how some seniors are justifying a suicide in US , and unable to afford long term care .
This is a huge impending crisis and sadly politician are not talking about solving with options,like tax breaks, letting willing immigrants to help in middle class senior care. Even families , friends, doctors, don’t want to talk about long term care and death.
11
@C Loke
As a Psychiatrist you should also know, it's the person who needs to be responsible unless your insane. As for you immigrants arriving is a great thing as long as they do it legally.
You cannot help everyone, they must help themselves.
There should be a national program saying get you long term care in order at 40 or 50, don't wait til the end. Get your tickets early.
Plan, Prepare and Prevent.
1
@Mark Aren't you special for being so well prepared. No empathy for fellow citizens. Be sure to get back to us when you're 80 and let us know how you're doing with all your preparation. The GOP will take everything from you, as it has for generations of us , prepared or not.
7
For most of human history our end of life care was our children. People make choices. When you choose your entire life to isolate yourself why should anyone be forced (at gunpoint through taxation) to support you suffering under the weight of your bad choices?
At what point are we as a culture going to start letting people fail again? This is why failing early and investing your life into others is so important.
3
@Douglas Jones
I suspect that in 'prior times' relatives who were forced to care for elderly were pretty unhappy about it, and showed it too.
8
@Douglas Jones
Well said Doug.
Maybe declare a national emergency and divert funds from the military?
9
@SusieQue
A national emergency for the ineptitude of the people's personal responsibility to care for themselves.
Nice One.
1
I’m reading lots of comments about people thinking suicide is an option, but it makes me wonder why the option of putting pressure on our politicians to properly fund Medicare, Medicaid, and Social Security is less discussed than suicide.
So let me get this straight: we let our government spend trillions of dollars fighting ridiculous wars, take away regulations meant to protect us from getting sick from bad corporate actors who are messing up our environment (causing us to get sicker and needing medical care where we don’t have affordable health care options)... and all we can think about is “oh well time to kill ourselves”. is this what we are about now as Americans?
We’ve lost our spunk and what little fight we have left in us and would just prefer to kill our selves? Wow!!
Here’s the deal: we are living longer and become more frail and needy as a result and this is our new reality. So let’s change the way our tax dollars are used and even increase Social Security and other relevant taxes so that our parents, grandparents, and ourselves when we become old and frail can be cared for in a dignified way to the end of our lives. Massive suicide of our elderly and otherwise infirm is not a dignified way to leave this earth, it’s just a sad reflection of a country whose citizenry have given up all hope....we’re doomed with that attitude!
39
@PJS It's either the brand new Lockheed Martin F-105 for $1 Billion a pop or the people as far Politico's go. Ofcourse Lackheed Martin wins the tussle hands down.
8
Remember the film "Children of Men?" Society was falling apart because women could no longer conceive. The government issued suicide kits called Quietus, and broadly advertised them as a dignified way out for older folks. I think in 10 years that something similar will gain broad acceptance, as the costs of assisted care grow beyond the means of most working people (unless, by some miracle, the US becomes more like Denmark).
49
@JS
I wish there were “Quietus” kits. It would give me peace of mind to know I had an option should I decide I had no quality of life and a nursing home with me in a vegetative
state was my future. But no way in 10 years will this be accepted. Even now people fight tooth and nail ‘death with dignity’ legislation for the terminal ill because of their own religious objections.
7
Not sure where they are getting these low figures. We are currently paying LTC for mother in law (4200/month) one room. Aunt (3700/month) one room and my girlfriend her parents at 9500.00/month for two for a shared room. Paying for it by Social Security plus renting and/or selling their homes, assets and then forking out an extra 1k a month. The cost does not include meds, diapers, toiletries, etc. that's another 500 a month or so.
We purchased LTC insurance for ourselves and it will take 10 years to pay it off but it will cover us at 100pct for up to 7 years. In CA the expected LTC costs could skyrocket to 9,000+/month for one person. Our LTC insurance has an inflation clause and any good financial advisor is now adding this into the childrens budget as they will eventually be stuck with the bill especially if Alzheimer's kicks in which was the case in our situation(s).
6
@Iris
retired AMA attorney F/70
Alzheimer's arc (age 74 onset) averages about 14 years. Your DNA-driven Alzheimer's likely will be the same. Soon, I expect Invitae, the world's best by-physician-order genetic testing, to be able to provide more Dx data points for you as you get older. Stay away from 23&me.
Now, for any family members able to fly to Zurich, consider DIGNITAS. Assisted-death for non-residents has been lawful in Switzerland for many years. Power of Attorney holders can make all arrangements for dementia patients. About $9K cost.
While you're in CA remember that your new state law on assisted-death only covers the "easy diagnoses." Like advanced brain or other cancers. Your family and you personally are posters for the need to expand CA rules to cover end-stage dementias.
When he time comes for a good death in inpatient hospice, after there is no ability to walk or other issues like contractures arise, start now to locate a hospice inpatient Medical Director who will build the record to support morphine&methadone by IV.
The day my Alzheimer's father stopped walking was the day he was transported to inpatient hospice. I already had an agreement with a very young physician who was inpatient Medical Director. When my father arrived, he phoned me with a call we knew was recorded: "Your Dad has a long pain history and open skin cancer on his head, morphine & methadone OK?" Yep!! Quiet death four days later.
11
Much good advice and research. 23 and me? No way do I want that info out there for insurers to exploit.
4
I have been active in LTC sales for 30 years. The private market is disappearing because it has become unprofitable. I try to convince people of the need but most do not want to pay the high premiums. This article will be helpful.
In Texas, the assisted living/nursing homes are filled with many people from the East who look for affordable care. Those that have insurance will be catered to. Those without? Good luck but I don't like your future.
5
@coachv79 And as you know when a company offering LTC insurance goes belly up, Penn Treaty being one example, individual states provide limited guarantees of compensation and coverage for policyholders.
Those limits vary from state to state. Sometimes the compensation and coverage is close to what policyholders expected. In others, it falls far short . Even so, it may be worth the risk to buy insurance. As you note, those with it may at least have an easier time finding a spot at a nursing home and have some coverage before using other assets.
Many nursing homes are required to take only a certain number of Medicaid patients. As for the rest, good luck to them and their families.
4
Very nice timely article
Wish long term care become primary discussions among our politicians for upcoming 2010 elections.
Congress and President could give tax exemptions for for withdrawing money from our 401k and IRA funds for long term care.
5
I am a very pragmatic person. I have had this conversation with my children (college aged): when my body starts to fall apart, we are taking a trip to Europe, celebrating how wonderful life has been and I will proceed with end of life.
My choice, my way, not as dictated by business interests who have convinced many we are meant to live forever.
16
@Daswife
Not as easy as you make it sound. No one can predict when is the right time. That is the biggest joke on people. No knows when they will die or get close.
4
Thorough analysis of a very knotty problem. The Paula Span usual.
While it's too late for the current crop of seniors, I will add that basic financial education MUST become part of elementary and high school education. We are not doing ourselves or our country a service by ignoring this branch of basic studies. After all, we are a capitalist democracy, not a socialist democracy, and take individual responsibility for our financial lives. Yes, the government / laws help, but that is nowhere near enough...as this article so carefully points out.
Related to financial education is the "simple" matter of saving money. Just save. Start early, do it with absolute regularity. Out of each paycheck, some amount must go into personal savings -- not buying but saving. The rainy day will come much later, in the "senior" years. If kids started saving early and absolutely regularly, they would be much better off later on! Hard to do? Need money for other matters when younger? Sure! And then what? Humble themselves with forms of impoverishment later, when elderly? That is unacceptable. Start saving young and follow thru for a lifetime, till you hit the rainy days of older age.
And this should spur all of us to rethink the current problems and offer suggestions, to government and otherwise, on ways to fix them. It's not impossible. Innovations are happening already. More needs doing...rather urgently.
9
@Rea L.Ginsberg, You hit the nail on the head.
Very important thing is to maximize income.
More important than income is how much you save.
Even more important than savings is learning how to invest.
After I retire, I will spend my time educating young kids on personal finance.
5
@Rea L.Ginsberg
Fantastic statement.
2
There are solutions to the funding problems of social security, Medicare and long term care: working beyond age 65. I worked until age 73, and with the kids off the payroll and the house paid for was able to salt away an extra $100,000 on a $30,000 a year sunset career job working for the government.
Another partial solution is to increase the working population through increased immigration, but I’ll save that for another day.
7
@Welton Wells Sorry, I don't think that's a solution. Forcing people to work ever longer so we can fund billionaire tax cuts is both cruel and impractical. Many people work at jobs that are physically demanding or require long hours with a lot of stress and that's not sustainable into old age for many people. Many people may not even have a choice (even if they want to stay in their job) because layoffs disproportionately affect older workers. Finding other jobs in old age can also be extremely difficult. I do agree that increased immigration will be vital as the U.S. population ages.
14
@Welton Wells
Increasing our population through immigration won't help the problem. People, on average, get a lot more out of Medicare and Social Security than they put in. The people we might bring in will pay for awhile but then will retire themselves and cost future generations far more than they ever contributed to your generation.
It really is a Ponzi scheme. I don't know what the answer is but more people just equals more problems, as things stand now.
2
This is not new. My husband's family had a grandmother with MS in the 1970s. The doctor told her husband to get a divorce in order for her to get the care she needed. Her husband refused and used every cent the family had towards her care and had a mountain of bills to pay off after her death.
19
Hello our children our teens our professionals do not think as this being in their future. We are saturated with negativity but also realities of the extraordinary profitability of substandard places for the aged who sometimes could live at home but who cares. The separation of families cultivating fear.
Yes there may be a time to end our lives but it has become a frightening time to live.
5
There is a lot of relevant information that could be added to the article instead of being left out. Reading the comments, I can see that this a topic that scares some people. Please plan for something if you can afford it. There ARE affordable plans for middle class people.
There is a lot if incorrect information posted in the comments. Medicaid and Medicare are entirely different. Medicare does not pay for long term care. Medicaid pays for nursing home care if you do not have assets and have spent down. Insurance companies CAN NOT raise prices at will and prices are much more stable now.
A long term care policy can pay for care at home, assisted living and a nursing home. Yes, there can be a waiting period of 90 days for the policy to kick in. You can have a free consultation with an insurance advisor that will explain all of the details and options. But you can also have no wait period with certain policies or no wait period for home health care with certain policies. Many states have a partnership policy where for every dollar in long term care insurance you have, it will protect that much in assets. So if your policy provides 250k in benefits, that means the state leaves 250k of your assets untouched should you need to rely on Medicaid.
Yes, I am an advisor and yes I have my own policy. I have had family members with dementia and need care. No family member can take care of a dementia patient 24/7.
Consult and advisor who is licensed and actively sells this.
2
Long term care plans are very costly - I know as we have such a policy for me. The long-term care insurer accepted me as I have no medical condition. However, no insurer would accept my wife. Her only condition is osteopenia. No middle class American can afford the rates for these plans - even if they are accepted by an insurer. The long-term path to medical, and long-term coverage, for all Americans is a national program, whether an expanded version of the ACA, Medicare for All, a single-payor system, or insurance plans similar to those in Germany (there, insurers’ job is to pay the bill, not to question the medical necessity of the medical care provided).
Please do not use my last name.
24
@Robert
Your statements are not all true. Yes, people can be declined for long term care, that is a fact.
There are plans available that can cost 1000 per year person. Many states have partnership policies that protect assets dollar for dollar - if you have 250k in benefits 250k in assets is protected.
There are tax benefits for business owners who purchase LTC as well.
Stop telling people it is too expensive. Not everyone has the same needs. Any policy is better than none.
3
@JJ I bought long term care insurance which is paid up. The article failed to discuss the benefits of LTC. I'm 62 and feel somewhat reassured that LTC will help me cover some of the expenses of assisted living.
1
Investing was not taught in my excellent public school or prestigious private college. Luckily, the thought of owning the bank instead of dutifully putting money in it was put in my head early. What are we even thinking with student loan self-mortgages? If we can keep out enough immigrants, even expensive elder care will be hard to find.
4
The irony is that it doesn’t really matter how healthy a life you led...my very healthy mom still died an expensive and miserable death at 92. There was a time when living longer seemed like a reward for a life well-lived...now I’m not so sure.
54
Apart from the cost, most of those institutions are inhumane. This article doesn’t mention another issue. More and more of us remain single and childless. With no advocates, we’re likely to be abused and neglected even in so-called “good” homes. And after living alone for so many years, we won’t adjust easily to an environment without privacy.
We need to offer assisted dying as an option. Susan Jacoby’s book, Never Say Die, describes a man who jumped off a bridge rather than face life with a live-in caretaker. Many of us can relate. He shouldn’t have had to find a bridge. He was lucky he was successful rather than impaired.
Spy pilots in the Cold War got cyanide tablets to avoid torture in prison camps. Some of us would like to avoid torture in assisted living, nursing homes and even at-home care.
92
@PhillyPerson
You are not LIKELY to be abused in good facilities. Does abuse happen? Yes, it does.
To use the term likely is absurd.
2
So-called "seniors" (a euphemism) are being priced out of life. So hooray for the extended life-span we "enjoy".
We can rest assured that if the right-wing interests in Congress are not controlled, our medical care will continue to decline and we will die younger. Thanks, America, and health-care-for-profit, for making the short-term bottom line the most important thing for us all.
28
This is a serious problem for other reasons as well.
Pressure for a declining individual to transfer assets to friends or relatives in return for temporary assistance is common. It may be leading to more tragic outcomes than anyone has at yet tracked.
Excellent article!
15
@Sequel
It's a horrible article because it does not outline options that are available to many.
Many comments have incorrect statements
@JJ You must work for an insurance company. It seems likely that you've never had a member of your family with ALS, whose LTC simply ran out, or whom a reverse mortgage suddenly condemned to a cheap nursing home to await a death faster than even Ebeneezer Scrooge would have advised.
3
@Sequel
Wrong on both counts. I am an advisor and work for myself and my clients. I have never had a relative with ALS but I have had 2 relatives very close to me experience LTC events. My point was that the article not once mentioned solutions that are available and affordable to many. Most states have a LTC partnership program that allows you to protect assets dollar for dollar if you have a LTC policy. Example - 250k in benefits allows you to keep 250k in assets. 80% of people never need nursing home care. There are solutions.
My mom is in assisted living, with some additional care, and it costs her $9600 per month. Fortunately, she has LTC insurance which pays about 2/3 of the bill.So she still has to come up with $43,000 per year. And this is not even Alzheimer/Dementia care. The system is surely broken.
26
@Steven
That was a great decision to purchase LTC insurance then wasn't it? Now she can use her social security and savings to pay for the rest. Why would anyone else pay for it?
The premiums for LTC coverage are unachievable for the same reasons that so many middle-aged and older Americans don't have plentiful retirement accounts; there isn't that much left over after bills are paid. And if there is, they aren't thinking that the better use of that $$ is saving for life in a facility.
If you are reading this and you are under 30, start saving NOW. Imagine the 75 year-old you, and think about what a difference cash would make if you were the subject of this story.
The lawyer in the piece should consider taking some senior exercise classes and learning how to adapt her home for safety and ease. That could buy her a bit more time/independence before she needs LTC. But with her limited income and assets, she has very few choices left.
11
@Cathy
My husband and I have LTC insurance. I am 17 years younger, and getting it in my 40s rather than my 60s made my premiums half what his are (about 1800 vs 3500 a year). Our plan provides a certain amount per day to pay for care, and this increases with inflation. Our premiums stay the same. If one of us dies without using the benefit, the other can capitalize on it and use the benefit. It’s win win.
People should get such plans in early middle age while they’re more affordable. It’s worth the peace of mind when that bill comes once a year and we pay it. It wouldn’t pay for everything, but it aids in protecting assets and inheritance for us and my husband’s adult children.
And as you say, budgeting to be able to save for retirement so that one is not destitute in the golden years.
6
One thing many people do not realize that there are medical conditions — including completely unpreventable autoimmune diseases like MS and Crohn’s, that no lifestyle causes and no lifestyle will prevent—which make you ineligible for longterm care insurance. So understand that LTC coverage is not an option for everybody, affordable or not.
10
@Catherine Arnott Smith
This is 100% accurate and unfortunate. These are the conditions/situations that I believe should be aided by the state/federal government.
2
I have long term insurance, but in order to enact it, there are six areas of infirmity that I must be unable to perform. That can be a high barrier, especially if only four or five conditions can be met. I have paid into the plan for over twenty years, but I may never be able to use it unless I become completely dysfunctional. Then, a nursing home might have to be considered.
15
@JRCPIT This happened to my mother. Activating the long term care insurance she paid into for years proved impossible. She was 95 and needed it.
12
@JRCPIT Are you certain that you must be unable to perform ALL SIX? I believe the standard condition is to be unable to perform TWO out of the six. Unless your policy is unusual.
1
@Cece Your comment should be the top pick here.
2
For the wealthy they eliminate the inheritance tax, for the rest of us they make sure to take everything and then some before we're gone. Just another way the rich stay rich and get richer while the rest stay in their place.
34
@Zg, and Republicans are also working hard to curb immigration, which is the source of a lot of elder-care workers. So... fewer available elder-care workers for these facilities means higher costs.
11
With personal savings amounting to peanuts and the national debt roaring upward as never before, Americans in droves have wisely decided to place all of their hopes in Donald Trump and the Powerball Lottery.
This at least gives us the feeling that we are doing something constructive about our problems.
15
@A. Stanton Well put. It's funny how people are such vocal anti "socialism" until their old age and then start depending on SS.
5
Isn't it ironic that a political party which likes to trumpet its 'pro-life' stance in defending the rights of the fetus is equally insensitive and hostile towards the health and welfare of individuals instrumental in the creation of the wealth of the nation? I am taken aback by the resigned calls for suicide amongst the readers in this comments section. This sign of social decadence illustrates a country with skewed priorities. To put it bluntly : the elderly are invited to step out quietly as possible, even by their own hand if necessary. I am sure some GOP linked entrepreneur will imitate bodies in Switzerland and the Netherlands and develop a highly profitable 'life exit facility' replete with champagne toasts and a virtual reality gala to escort the redundant old folks to the river Styx….
27
I’ve saved and planned rather well, but as soon as I can’t do for myself, I’m done.
30
It has become impossible for most working families to save enough from wages for retirement and still pay for the costs of having children, housing, food, transportation to work and local, state and federal taxes.
The end of pension plans, the use of retirement savings plans which depend on the stock market and the failure of the US to join other wealthy countries in providing universal health care has changed what resources most families have available for retirement.
It doesn't help to have those who collected significant commissions from the forced use of 401K's and other plans to tell working families to "Earn more so you can support yourself in retirement". Those of us who saw our retirement savings dramatically reduced by the Bush II Recession and now fear the incoherent--and unnecessarily cruel-- financial policies of Trump are trapped by the Republican focus on the 1%.
Many people in their 70's and 80's have lived through more difficult times. We remember the suicides of farmers when their farms were taken over by banks they trusted. We look at the times of war and cold war when peace seemed out of reach.
The US did not have a president who advocated building more nuclear weapons and advisors who thought those weapons should be used. When disasters struck in the US to American citizens, we did not have a president who asked those victims of disaster to compete against each other, a president who consistently lies about how much aid was given.
57
We have a huge retirement and healthcare crisis coming in the future. Very few Americans are saving enough for retirement. And a single major health problem could wipe you out. That’s why we will see universal healthcare in the future. We simply cannot afford to stay on the same track as we are now in regards to healthcare costs. It’s unsustainable.
40
@Mike L Actually, no, we won't see single payer in the US. Republicans have convinced a massive chunk of ignorant midwesterners and southerners that such talk is socialism - no, it's communism! And, somehow, un-"Christian" as well. No way can these attitudes be reversed. People are going to die in poverty, and that's that, while we fall apart from the effects of climate change.
2
I live in a state with assisted suicide which I may certainly wish to avail myself of. Quality of life is a health outcome metric that has become a norm and I don’t think it is a stretch for anyone to believe that ending ones life in a nursing home is quality of life.
43
Question for those with LTC. Insurance:
Siince many policies require patients to need assistance with 3 out of 5 daily skills ( generally bathing, dressing, feeding, mobility or memory issues) , how many of those of you with policies - or who knows someone with one- has found that its difficult to get approved for reimbursementx...in spite of the fact that there are significant impairments? That is my fear.
15
My mother had a Prudential policy and had little problem. She had an hour visit with an evaluator and he concurred. Her assisted living center, where she lived, also kept meticulous records, including weekly notes by the roving physician. She received an evaluation every six months to maintain the qualification. I never knew anyone that was borderline. If you think you can just use it like an IRA when you want to move to a center, you may have a problem.
4
@Jace
retired AMA attorney
Four decades of wrestling with health insurers leads me to answer all are different.
Not sure your age, but understand that LTC insurers are facing enormous challenges as U.S. economic growth on invested premium dollars moves from an average of about 6% over the last 100 years to a number likely to be around 2% for decades.
As one commenter noted, if you're young 20-50, your LTC years are distant and will be vastly different than either the last 100 years funded by 6% returns or today's transit to the new normal economies.
The best lawyer that I know and my adviser on Medicare and other insurers policies, former national Blue Cross/Blue Shield attorney, did buy LTC insurance for herself so her kids would not be strapped with her care. Both parents lived into their 90s and spent lots of family money on staying alive. By virtue of prodigious savings and careful investing, she now has millions of dollars to pay her premiums and her bills too.
Today, for younger-than-60 people, she is warning that premiums paid may not guarantee care when the time comes. I recommend you find Jeremy Grantham's Marketwatch forecast on our "next twenty years" - at least. Then decide where to put your money given the substantial likelihood that Boomers can bankrupt LTC insurers?
13
@Jace I have it but haven't had to use it yet (thankfully). I'm nearing 70. Mine is thru my former employer (fed gov't). The good thing is that the premiums are deducted from my pension check so I don't have to worry about paying the premiums so the coverage won't lapse.. The bad thing is a few years ago they realized they were underfunded so they gave us a choice. Either pay an astronomical premium increase (I don't remember the amount) to continue the unlimited benefit, or accept a reduced benefit (maximum total dollar payout). I took the reduced benefit, hoping like heck I won't ever need it and I'm currently paying $125 a month. Who knows if they'll come back and reduce the benefit again?
8
For those with long term care insurance, please be SURE to have a back- up person on file who gets notified if premium payments start to lapse. Most policies have a 2-3 month grace period for late payments. I’ve known of at least one person whose early signs of dementia included forgetting to pay bills. That included the long term care premiums. The policy lapsed.
23
@Jace
When you purchase a policy - there is a provision in the contract required BY LAW, that states you can have notices sent to another person so that this does not happen.
2
Yes but policyholders need to follow through on filling out the form and of course submitting it. . That was the point of my comment. Have those safeguards in place.
3
@Jace
I agree 100%.
There is a specific section that must be answered Yes - I want someone to receive notices or NO - I do not want someone else to.
It should always be YES.
2
euthanasia Is legal in the Netherlands.
5% of deaths there are euthanasia deaths.
You know what they say:
If your not living on the edge, you’re taking up too much space.
16
@New World
retire AMA attorney F/70
Netherlands assisted death is well-established for its residents. Most in the UK and U.S. go to DIGNITAS Zurich for about $9K plus airfare to get to lawful non-resident assisted-death.
4
@New World
Under current Dutch law, euthanasia by doctors is only legal in cases of "hopeless and unbearable" suffering. In practice this means that it is limited to those suffering from serious medical conditions like severe pain, exhaustion or asphyxia.
3
As an affluent single retiree, I am self-insured. I can still afford to save a substantial portion of my income, so I watch my spending and try to increase my capital.
Retirees nowadays may easily be retired for 30 years. Now look back to 1989, about 30 years ago. Who retiring then could have imagined the world as it is today? Well, that's how different things will be in 2049.
So those who are forced to spend all their money just to live will reach their 90s in a strange new world where everything they are familiar with is gone. And if they have run out of savings as well, they will be in big trouble. Even if they don't have to go into a nursing home, they will still have difficulty managing their lives in an alien environment.
20
@Jonathan
You can likely spend 100k for a single premium and leverage your money to get a substantial LTC policy.
You can also include a death benefit so if you don't use it, the death benefit can go to a relative or a charity.
You can also buy a policy with unlimited benefits in most states. If you are still able to save money while retired this is a great option for you.
1
Our current government has no intension of fixing "entitlements". That leaves suicide, assisted suicide. We should be putting it on the election ballots. It would bring comfort to many in their final years. I think our leader, Mr. Putin, would even support it.
57
@sdt yes but you need to provide the bullet, Medicare won’t cover it.
5
People make decisions about their future based on very little information and misinformation.
I am including myself in this.
The current non system requires a financial advisor, a lawyer and a social worker just to understand available options.
13
@Fern No argument. An article a few weeks ago talked about how we're preached to about saving, but we don't really consider how we're going to spend it. I'm past retirement age now and they're right. Although I'm fortunate in that I haven't had to dip into my 401k and I'm a couple of years away from 70-1/2 when I planned to start social security, I don't know what's coming. The gov't recently pushed back the law so you don't have to start taking the required min dist until 72-1/2 from 401ks, up until then I had been frantically trying to figure out how to minimize taxes when I hit 70-1/2. One of the reasons I delayed taking social security so I could start converting some of my 401k while my income was lower. So this has now shifted my investment strategy again and instead of planning to withdraw, I'm refocusing on investment again. Who knows what's coming in the future? It is confusing
3
You have to look long and hard to find any research not funded by the Long Term Health insurance companies. I took a look a few years back. Seems the average stay in assisted living is around 28 months. Not 10 years.
The average age of someone (usually a woman) is 87. The vast majority of folks there came from their own home - not some other nursing home.
Articles like this are designed to scare you. How did your family members lives end? My mother died 4 months after her diagnosis. My father died about 5 days after they figured out what was wrong with him. Both were fully functioning, visited their friends and attended church right up until the end.
By the way, have you taken the time to figure out exactly what your monthly expenses will be if you don’t go into a nursing home? Probably at least $4,500 a month when to total up property taxes, utilities, food, home maintenance, cleaning and maybe a very part-time home health-care attendant.
Why isn’t someone writing about that?
17
My in-laws both had dementia. They were in assisted living/nursing homes for over 8 years. My mother was paralyzed by a stroke and in a nursing home for over 20 months. Medicare paid for almost none of it. So don’t talk to me about “averages”. Every life is different.
30
@Can The average person doesn’t hav3 their home destroyed by fire but still has insurance. As for averages, hose who have family histories of longevity and relatives who needed years of care ( no matter how healthy their lifestyle) should take heed. Two of my aunts needed years of care. Both lives into their late 90s.
Am I concerned about long term care? You bet!
3
Many people can live more than 10 years with all Alzheimers
4
as with the problem of unaffordable life in today's cities for most younger people, the problem of elderly adults without the resources for long term care can be partly solved through changes in law and in cultural assumptions that would help make the solutions of the past more available. Young professionals in expensive cities need the return of the rooming house. And elderly middle-class people need to share housing and pool their resources for the costs of help in their shared homes as they age in place. Baby Boomers look back fondly in many cases on the shared apartments and college dorms of their youths. They will need to share their homes and their CNAs too.
18
@sd I can only speak for San Francisco, but the renter protection laws are so draconian that they keep normal people from renting out space. If you rent to a bad apple, getting them out is incredibly difficult and expensive. My grandma ran a rooming house into her 80s, but I can't imagine her taking that kind of risk now.
1
This is a scary situation, which should worry most. Spending economy instead of saving economy is the bane of the society. It’s very unfortunate that the Government doesn’t encourage small savings in a big way.
If a childless attorney can’t cope up, who else can cope, very very scary ?
16
Reganomics finally kicking in. fire those getting close to 50. Pensions funding gets expensive after 50.
Regan like Trump fooled those who were not well informed-and voted against their needs. The business leaders and managers were bribed with large bonuses that they used to build. their Summer/winter homes while those they denied retirement went to work as a greeter at Wal Mart
35
Well said
1
We are fortunate to have Genworth long term care policies. that doesn't mean we'll be able to keep them as the annual costs for the policies continue to go up. They have nearly doubled our payment since purchasing the policies 15 years ago. What's the alternative?
5
I took the approach of getting a policy as a supplement, not as the sole payer for LTC. I am male and we typically do not last long in assisted living as any visit to a center will verify. 3 years probably covering 75 per cent of projected daily cost in 20 years kept the annual premium down. It is almost like paying for another vehicle on the auto policy. My mother had a gold plated plan of the type that drive many providers out of the business. It was great, but not viable for the insurance company.
I also made the decision to get my policy with a 5 as first digit in my age instead if a 6. I qualified for best tier, being in excellent health. The longer you wait, the greater the chance of getting a medical condition that could preventing getting a policy or could make your premiums higher.
I never understood a person, even with significant assets, planning to go on Medicaid to preserve money for heirs. Medicaid should be where you go if your plan fails. If you have the money, spend the money.
9
@Michael Blazin
My Mothers nut was 11K a month in a west Michigan, Oceana County nursing home. They did everything possible to keep her going, even the things we asked not to have done. i.e.swallow study, pureed diet, bed alarms etc. 11K a month runs downstream awfully fast. The way to preserve anything for heirs is to give it to them long before one gets close. 49 states, 5 year look back. I'll be checking out early thank you.
3
@Michael Blazin- I'll spend it, alright- on a one way first class flight to Switzerland!
3
So glad I purchased LTC policies (yes 2 policies) to cover just such contingency. With both I would have 6-10 years worth of funds should I have to leave my home.
Even with the increases for inflation clause, which is about every 3 years, it still was the best purchase I ever made. Costs a few thousand a year, but with no family within 2000 miles, I feel it is worth it.
6
Unless the insurance company rejects your application. They will dig through your medical records to find any excuse to deny you coverage.
4
@ME - Interesting. My brother-in-law took care of his parents who were in assisted living (mom was sharp as a tack, blind and in a wheelchair, dad was at the onset of dementia). His dad had purchased a number of LTC policies, which as my brother-in-law found out when it was time to file a claiim, that most of them were worthless.
Good luck.
4
@Steve
You mention this person had a number of LTC policies. When a new policy is sold the application REQUIRES disclosure if the applicant has existing LTC.
I have never heard of an insurance company issuing a new policy when someone already has 2 in place. I would verify what you are stating. If he had dementia that is a guaranteed trigger for coverage. He either had dementia or he did not. A medical professional determines this - not the insurance company.
Part of the problem is that the cost of health care + assisted living in old age can exceed lifetime earnings. It's not sustainable for individuals or society. I don't see an easy way around that.
29
My wife and I tool out MetLife Long-Term Insurance many years ago. Of course, the younger you are when you start, the lower the premiums. But premiums have been jumping up dramatically to ther point where some people can no longer afford them and need to cancel and drop out. This is a boon for the Insurance Company because it has collected premiums over many years and will have a zero payout to the insured parties. My main beef is that the State should be giving a substantial tax reduction benefit because the insured parties are eliminating the need of the State to support them via Medicaid (Medicare does not pay for this and few people can pay the full load of private care. Sadly, many people (such as my parents had to spend down all of their assets before Medicare kicked in. But the States (at least NY) give peanuts in tax relief while people are paying their premiums.
20
@JerryV
Some states do offer deductions for Long Term Care Insurance. Of course, generally, although not always, your total medical costs must be more than 7.5% of you AGI.
People with a lower income usually can't afford LTC.
In most of Western Europe, LTC is included in your cradle-to-grave Government benefits package.
18
@JerryV
In Maryland, if someone decides to cancel a LTC policy after they’ve been told of a premium increase, they are entitled to a refund of all premiums paid in prior years. This is a new law that tries to alleviate some of the pain and suffering from predatory insurance companies.
18
@JerryV - Unfortunately, Met Life has lost huge amounts of money on these policies. So have other insurers, like General Electric.
5
What about me? Someone who's income is less than $30,000.
What will I do? Seriously?
30
@NB After you spend-down nearly all of your assets, you can go on Medicaid and that will cover all costs, but probably in a facility that is not luxurious.
8
@David
well aware of medicaid. I rather meant there should be something that does not drain all my savings and that I could spend my pittance of a monthly income and not have to give all my money away 5 years before requesting medicaid.
Also, if I still have my house that money would go to medicaid, not my children.
1
@NB You can transfer assets to your children ahead of time, but check the "look back" for your state. Some states will claim assets going back years, others not at all.
1
As I said at the beginning of the 2016 election. They won't be happy until they have brought America to its knees. When are we going to fight back? Kids dying in their schools so we can protect guns. Seniors dying in their homes so we can protect profit. Our planet heating up and killing off all animal life so we can protect corporate monopolies on energy. Sea life choking on our plastics so we can protect capitalism. When??? When do we rise up and take back our planet and insist on intelligent leadership??
242
@RCJCHC
As I have mentioned in other posts, the United States is in the throes of a low intensity and undeclared civil war pitting the mass of ordinary citizens against wealthy interest groups and corporate oligarchs. The kids who die in spree shootings at schools are 'mere' casualties in the oligarchs' self-righteous struggle to maintain certain fundamentals of the American identity as forged by the US Constitution. Their fanaticism mirrors that of the equally dangerous jihadist groups fomenting social divisions in Europe and elsewhere. I am afraid 'peace in our time' is now just a sad memory.
16
@RCJCHC
Thank you for your realistic poetry. Oh to have it on billboards all over the US.
7
@RCJCHC The answer is obvious: not today.
1
Financially I am set for life, providing that I die next week.
107
You gotta love this.
Liberals spend two or three generations tearing apart the fabric of the United States, then complain that things are falling apart.
They have destroyed the nuclear and extended family by providing a nanny state that does not need a father.
They have pushed people into levels of education they don't need to be successful by allowing crushing levels of debt to be backed by the government.
They have dramatically lessened the very number of people in our nation by pushing abortion at all costs.
They have diluted our national heritage by allowing floods of illegal aliens to overwhelm our systems, language, values, and our ethos.
They have celebrated the use of mind-altering substances so that we have multitudes of people who can not rationalize properly.
They have over-borrowed, over-taxed, and over-spent our national treasure -- the fruits of our hard-earned labor -- to throw it away on people who contribute less than nothing.
They so over-regulate every aspect of our society that no one feels the need to act with caution and forethought within their own responsibility, but first must get permission from government to do anything.
They remove God from all aspects of our public discourse and then expect the foolishness of man's philosophical and ethical relativistic pseudo-knowledge to provide any answers.
Liberals don't build; they tear down. They don't edify; they debase.
Then they blame conservatives.
And their ignorant followers believe them.
10
@Steve Crisp
It's the removal of God and/or ethical behavior from our private lives that Mr. Crisp should be worried about. There are millions of hard-working folks who have no time for lengthy self-pitying complaints such as those voiced here. What am I doing to make the world a better place? The person who asks him or herself this will not be blaming others. . . .
8
@Steve Crisp. Don’t worry Steve, Trump will make everything right for you. Don’t give the deficit a second thought.
28
@Steve Crisp, do you really believe this, or is it satire?
28
All I have to say...whether it is healthcare or eldercare...America is consuming itself...like Goya's painting, "Saturn Eating His Children." Your neighbor with the nice house and nice car and 1.5 children and perfect life got it and keeps it at YOUR expense and on the back of YOUR suffering. Thanks, Neighbor!
6
I gotta wonder why Ms. Harris, a retired attorney with no children, has no retirement savings of her own and still has a mortgage at age 72 on the house she has lived in for 36 years.
21
@Mark Frisbie No point in blaming her for a systemic problem. I'm so tired of this individualistic approach to things. The point is that health care is strictly a profit-making enterprise and that includes long term care.
53
@Mark Frisbie
Maybe she needed to remortgage to put a new roof on an old house? Or her health bills consumed the carefully stashed-away savings? Or she didn't get much in the settlement from her divorce?
22
@Mark Frisbie, perhaps this answers your question: "...Ms. Harris, 72, a retired attorney, has grappled with assorted health problems — heart disease, non-Hodgkin’s lymphoma, osteoporosis, rheumatoid arthritis — and takes a long list of prescription drugs."
10
All those so against immigration should consider who they imagine is going to take care of us all.
17
I have a plan but my nightmare is that I’ll lose my ability to implement it... I pray ( to my god) that I’ll be able to take a walk into the desert with a bottle of Jack a jar of pills and some pot and that it will take several years for folks to find my bones. I watched my mom go thru the assisted living nightmare that cost well over 400k while she deteriorated until Medicaid took over. She died two months later unable to recognize me or her grandkids and the nursing home gave me three days to remove her belongings so they could fill the space at 4300$ a month.... sad
53
@JD Hypothermia would be my choice, damp Cascade mountain air, forgot the rain jacket, a few hours lost amongst the tall trees after one drink too many, even 48 degrees C and lots of fog will do it. :)
13
@mkneller - That's interesting.
1
@JD
Appalling! Its SO appalling! My Mom did about 280K before the exact same demise. She would have just hated every last day of the last 2 years, no quality of life but "god" forbid we treat people as well as our old pets..
6
I have saved approximately 1000 opioid tablets for the future that I plan to share with/leave to my neighbors in the "rest home".
19
Study by Genworth, the company whose elder care insurance middle class Americans can no longer afford.
4
Suicide will be a leading cause of death among the age 70-90 cohort in the years ahead.
This article, grim as it is, doesn't begin to really get at the problems ahead. Unless you are extremely wealthy, or extraordinarily prescient, you will go into your golden years feeling like a cheap pewter coffee cup. My mother-in-law, who is a Rush Limbaugh-loving lunatic, is coming to live with us at age 88. Spry as a cat and with a mind as sour as key lime pie, she will more than likely cause both my wife and I to kill ourselves.
Why is she coming to live with us? She has no money, literally, but she also isn't sick enough or sufficiently disabled to qualify for assisted living. Even if she were financially able, the places she could choose from start at $3500 to $4000/month for a one-room apartment the size of a phone booth. She can't afford it, after years of online shopping and useless porcelain figurines. We can't afford it, either.
You want to know what America is really like? This is it, and more and more each day. Old folks are living longer, in varying degrees of health, but a lack of foresight and an absence of income have doomed millions of our parents (and my contemporaries) to face a future not unlike the one posed by TS Eliot's J. Alfred Prufrock:
" I have seen the moment of my greatness flicker,
And I have seen the eternal Footman hold my coat, and snicker,
And in short, I was afraid."
261
Love it, PaulB67 !
28
You are a gifted writer, and you are correct in what you say. Sending you and your wife strength!
16
I hope you will keep writing
4
Even in Canada we may encounter some problem to keep the quality of our public program covering long-term care.
6
Why shutter your elderly family members in a nursing home or assisted living home at outrageous expense? We cared for my grandmother, and then later my mother, in their own apartments with help from family, friends, neighbors, part-time paid caregivers, and eventually, hospice. It was challenging, especially in the last year, but we made it work.
I realize some old-age diseases require 24/7 nursing care. For the majority of frail elderly, I hope we don’t as a society, move toward mass incarceration in nursing facilities.
19
@60ish
Many people need to take care of their own children, and work full-time just to survive. There is no way these people can provide proper care for your parents.
It's very sad.
17
It looks mass suicide is the consensus, 60ish.
7
@60ish
How many people was that? Family (two? three?) + friends (say, three) + neighbors (two, one each side) + two shifts of caregivers. That seven or eight willing, free or low-paid, people able to help while also dealing with their own lives. It would appear you are living in a long-established, close-knit, kinship/friend-networked neighborhood.
I have a great friend circle, but they are in my generation and have their own children and problems to look after. I had my ailing husband and my own job to keep, to keep us in health insurance. My parents' kin were few and gone long before they needed their help, 3000 miles from where they were born.
I fear the experience of local friend/family safety nets is becoming more the exception than the norm. Chide not those of us who cannot manage to sustain our parents or other elderly kin in their own homes or ours.
19
"“I am going to need some long-term support, independent or assisted living, rather than just living by myself.”"
A recent article described the devoted care provided at low cost by recent immigrants, some here under TPC, a valuable source of willing support for staying in your home that the Trump administration is cutting off.
18
What is the point of this article? I have no quarrel whatsoever the with the woman in the photo - she resembles older family members in so many ways.
Our standard of 'living' is great until you can't afford the system. And lord knows, the system would be better off if we took ourselves out or at least went to the rooms that Aldous Huxley described so well in Brave New World.
The system can't be fixed until we fix the costs of running. The lobbyists and corporations demand a hefty return on their ROI.
10
Over 30 years ago, when I was in my mid 30s, my company started offering long term care insurance at a very reasonable rate. Knowing that I would not have children, I jumped at it. Many of my friends and co-workers thought I was nuts. “Why not just self-insure or depend on Medicaid” they said. I guess I was a lot smarter than they thought!
7
@Joe Z. Same here! And I chose the 5% compound inflation protection. I now have more than $550,000 in coverage for only $243 per month. When I started, the cost was $52 per month and the premiums have jumped, significantly, twice during the past 25 years, but it’s still a bargain...
4
@David
A quality, long-term care facility may cost you $10,000 or more per month (current prices), so you have about four years of care covered now...what if you survive more than four years?
14
@Joe Z. My parents paid for long term care insurance for years and years and the premiums increased annually. My mother didn't live long enough to get past the deductible period to get any benefit from it. My dad lived at home until he died. Thousands and thousands of dollars were spent paying those premiums. The insurance company made out like bandits while the money could have been spent on in home health care instead.
18
I am 71. My long-term care plan? suicide
I have already had 2 friends choose this option.
In fact, should I need hospitalization for more than an out-patient stay, it will be my option then, too.
This is Republicon health care in motion, They have already clipped Medicare so much that I have to be sick to find a doctor to treat me. And preventive services? You have got to be kidding.
The reality of Republicon/trump's America.
63
As a 31 year old, single, working female, with no dependents, I can’t help but wonder what it there will be to look forward to in the many years still ahead. Gloomy, me thinks.
10
@AmandaMyshelle I was there, too, and I bought long-term care insurance. My coverage is now more than $550,000 with a monthly premium of $243. I’m happy that I don’t have to worry about this...
@David I'd still pay close attention. My parents had LTC they purchased at a fairly young age. Then their insuring company went out of business.
5
@David Who will fight with the insurance company when they try to deny you coverage ? Who will advocate for you in the nursing home when you’re physically or verbally abused? Will you want to keep living in a home with bad food, indifferent attendants and no privacy?
5
I’ve been concerned about this recently. I know many low-to-middling income, unmarried, and/or childless friends who have no savings and low-paying jobs. If Medicare and Social Security is insolvent when they retire, what’s to become of them in old age? Even with government support, adults who just get by today will be devastated tomorrow as they age without savings, or the ability to hustle on the side. At 55, it’s better late than never to prepare for the grim future, a decade or two of extreme poverty, cut short by an early death due to inadequate care and lack of social support.
15
@Jean, It is highly unlikely that Medicare and Social Security will become insolvent. There are many potential revenue streams that will be tapped. The real problem will be assisted living and nursing home care
9
@Jean
They need to vote for Democrats. If the GOP continues its control, many Americans are going to quite surprised when they find themselves out on the street.
Medicare does not cover in-home or nursing home care.
13
@Jean I do not believe that either Social Security or Medicare will become insolvent. If that were to happen, the sitting President and Congress would be overwhelmingly voted-out in the next election. In addition to those who receive it, nearly everyone has parents, grandparents or other family members who rely on Social Security and Medicare, and they would not be happy to have to have to support their loved ones financially. Simple changes could be made to ensure that the “systems” remain solvent. For example, instead of capping withholding of Social Security tax to only those who earn up to $132,900, the cap could be increased to be subject to higher levels of income, without having to make any changes to the current Social Security benefit system. For Medicare, a small increase in the withholding tax would also erase any future deficit.
12
I am not optimistic about Congress stepping in to fix Social Security and Medicare funding, even though the fix is uncomplicated. It would require raising taxes, so unless gerrymandering and voter suppression are somehow stopped and lots of Democrats are elected, don't count on Congress...even though a significant percentage of Americans support liberal/Democratic policies.
16
@NorCal Girl I’m a liberal Democrat but I know dozens of retired conservative Republican voters who would “scream” and vote-out their own Republican Senators and Representatives if their personal Social Security or Medicare benefits were to be reduced or eliminated. Therefore, I do not believe that even Republican politicians can allow the “systems” to be greatly reduced or, worse, fail.
4
@NorCal Girl
So, you want your children to pay for what you wouldn't save for yourself.
1
@David - Those same Republicans that you claim would cry wolf to their Senators and Congressmen are sitting on their behinds doing nothing while letting George W. Bush and Donald Trump work at destroying Social Security and Medicare. George W. Bush's Iraq War and mishandling the Afghanistan War have added $3.0 Trillion to the national debt (and that's not counting his tax cuts for the rich) and Donald Trump's Tax Cut for the Rich have add another $10 Trillion over the next 10 years. Where do your enlightened Republican friends think the money is going to come from?
3
It's even worse than this article demonstrates. My mother-in-law recently died after a year in a shared room in a Catholic non-profit nursing home in Massachusetts. The cost $11,000 a month. On top of that is medical insurance, pharmacy insurance, medical and drug co-pays and personal needs.
My in-laws were people of modest means who who worked hard all their lives to own a small house and educate their kids. The house and all her assets went for her care.
If you are middle aged and think the Republicans and their funders are protecting your interests and the future of your families - think again!
170
@Fr. Bill
and why exactly do you think she shouldn’t be using her own assets to pay for her care?
10
@Fr. Bill my 93 year old MIL, physically healthy but mentally off, is in a lock down unit that cost almost $7k a month. She was of modest means and is using her assets, until they run dry in a few months time. Then she goes onto Medicaid and to a facility that will accept it.
That is what her money is for: to use for her care. My husband does not expect a penny - he agrees that her money is to be used for her care. And yes, it will eat up her assets but that is the way it is now.
16
@liberty Obviously she did use her own assets. Many of us do not have enough! I, too, worked hard my whole life but there is no way I could afford the high cost of nursing home care. I can only pray I have the 'big' one before that time comes Horrible situation. If only we were all rich like Trump...
24
Interestingly, article uses the old term Medicare "beneficiaries" as opposed to the more current "Recipients". It has been a subtle shift over the last 20 years.
18
@D. A. Belmont
this is the same as calling these "entitlements" even though we PAID for them all our lives. Shifts in language are important. Remember that the genocide of Yugoslavia i the 90s was reframed as "ethnic cleansing". We may call the inability to use our taxes to care for our health and well being instead of Amazon's or Apple's (who now, thanks to the republican party, pay no taxes on profits of billions) "geriatric cleansing" one day soon.
6
I'm an older citizen (close to 80), but I'm lucky to be able to pay for most basic medical necessities because I have Obama Care. If, however, I needed an operation for lung cancer, or heart problems, I would be in trouble. Only those with lots of available cash and assets can be assured of being able to die in dignity. It shouldn't be like this.
We don't need almost 800 atomic bombs, which cost many, many billions of dollars a year. We need health care for all which covers all medical problems and requires that every poor or middle class citizen has almost all medical bills payed for by our health care. The ultra rich, which Donald claims to be, should pay almost all of their own medical needs.
89
Why do people use their homes as a refinance bank and let themselves and up w a mortgage in their 70s and 80s? And act surprised?
13
@joan
Our culture does not provide decent financial education. Instead it subjects us to a barrage of advertising and advice from individuals and corporations with their own interest in mind.
We have been ENCOURAGED by banks and mortgage lender to refinance mortgages, with no reliable information to counterbalance all of the ads and pitches.
When was the last time you saw and advertising campaign against refinancing a mortgage?
Don't blame individuals. They do the best they can, often in very difficult circumstances.
39
Some of us had to start over after facing a natural disaster. Trust me you’re on your own when it happens.
13
@joan gee, i wonder why
One of my great aunts developed Alzheimer's. Her husband, who had worked extremely hard all his life in very high stress executive positions, spent every penny of their savings to fund her 'memory care' . This can't be right. She lived many years after losing all cognition...we should allow assisted death for these cases. Not require it, but allow it.
102
@Cal
Yes, definitely. My mother too spent 10 years in care home and now my dad. They only had their hard earned savings that paid for 3/4 of million for their care. That totally can't be right!
I want to be able to chose to die if dementia is becomes a factor. Please, please let me chose that choice when I am able minded. PLEASE
61
@Cal
retired attorney F/70
DIGNITAS Zurich offers assisted dying with the usual live-forever and/or in pain diagnoses like Alzheimer's or vascular dementia - 14 year arc from about age 74 to 86. Lots of horrible disabling old-age onset, but not cancer, diagnoses like Parkinson's where suffering is unspeakable.
DIGNITAS costs about $9K and airfare. It is a lawful middle-class option to suffering here or bankrupting three generations of families for housing those whose minds or quality of life are forever gone.
I go in 2023. One way First Class. Sleep really well knowing what is ahead and being able to give away my money to those who need it - all around me with caregivers for old neighbors in FL.
45
@Cal
Given the outrageous financial circumstances involved, "allowing" assisted death for these cases would be tantamount to requiring it.
6
How many of them voted for politicians whose policies put them in these straits?
45
We are the parents of an only child. She's happily married and pregnant with her first child. She knows one day she'll be caring for us, one way or another. So we made a plan. We had an old barn on our property about 20 feet from the main house. We renovated it for us, one floor, wheelchair compatible. Everything was built with old age in mind (we are in our late sixties). We hooked up both our electric and heat to the main house. The kids moved into our old farmhouse in November. They pay all the bills except food which we share, both buying and cooking. In a decade or so when we're gone they'll be debt free and own two homes. This was the best plan to keep us out of the nursing home, multi-generational living.
71
@Julie R
We bought a house we can move the parents I to when the time comes. Multigenerational living makes sense to me!
10
@Julie R It's a lovely plan, and godspeed. But the best laid plans . . .
10
@ Julie r ... spot on! Fantastic perspective and plan... it’s the “blue zone” philosophy.... multigenerational living needs to and should make a comeback .. it not only helps in circumstances such as yours ... but also society in general. We as a culture have lost the essence of what I affectionately call “peopling” . I am a firm believer that bringing people back together in this way is a bridge to restoring the sanity of our society. Best of luck to you and your and family moving forward. Think of all that precious family time you will get to enjoy as you age ... truly priceless!!
7
When my financial advisor asked me about long term care, I pointed to my wife and said "She's it". And when he asked her she pointed to me and said "He's it."
In any event we all decided long term care "insurance" was not the answer for a number of reasons. First it is not cost effective. They raise rates at will. Second it only clicks in after an extended period of need, mostly after 90 or 120 days when Medicare has paid for care.
It just wasn't worth paying for. Insurance companies have calculated they won't lose any money selling you long term care insurance.
28
For many people having a policy that pays only after a specified number of days (90, 120, whatever) makes sense. Many people can afford to pay for some care themselves,but they cannot pay for care that goes on for years and years. The deductible allows policies to be cheaper.
6
@Tom
Actually, several insurance companies like Metropolitan and Prudential lost so much money on their LTC plans that they ended them.
People lived longer, required more care, and market returns for the companies were lower.
So much for actuaries. :)
8
@Bob I agree with Bob. My spouse suffers from Alzheimer’s Disease and thankfully we purchased LTC insurance years ago. Although most waiting periods are 90 days, several members of my Alzheimer’s caregivers support group have paid for years of memory care for their spouses with their LTC policies. Withe the LTC policies paying, the non-dementia suffering spouse can continue to live in dignity instead of having to sell nearly all of their assets before MediCal (that’s what Medicaid is called in California) will step-in and cover expenses under less than desirable conditions in facilities that accept MediCal. After a patient enters the mid to advanced stages of Alzheimer’s, it’s impossible to an elderly spouse to care for them at home. That’s one of the reasons that more than 50% of Alzheimer’s caregivers die before their own spouses with the disease - exhaustion and 24 hour work taking care of their spouses overtakes them and they die of strokes, heart attacks, or have nervous breakdowns.
12
Long term care insurance- my father paid about 30K over 30 years. When it came time to collect, after a disabling stroke, the policy paid $75 a day, for care that cost in excess of $200/day.
Nursing home care- my sister’s MIL paid $150K a year for 12 years. Completely disabled by Alzheimer’s. My sister’s FIL is at home, and his care is costing around $225K a year, plus costs of maintaining his home.
Take away:
If you’ve saved anything over the years, it will be drained by your health costs. Forget leaving anything to your children.
We’d better hope Medicaid survives. It is the payer of last resort for most Americans.
Long term care insurance is not a solution.
73
@KJ
If you want to leave something to your children, pay off their student loans or ensure they do not need to take them out. The gift my parents have given me was to start my adulthood debt free.
41
Maybe we could make Social Security more robust if Congress started taxing income over the current $128,700 limit, and maybe were part of the social security system themselves.
174
@Leah All income should be taxed to support SS. Think of the incredible rise in income and wealth for the top fraction of one percent... think about how much we could do if this immoral clot of greedy leeches were properly shamed and taxed. Maybe we'd all get pensions back.
2
If we could achieve immigration reform (like what was suggested by the bipartisan panel several years ago), would that delay Social Security and Medicard insolvencies since millions more would pay into the system? Maybe a reason to consider it again. And why hasn't Congress raised the SS income tax threshold to allow more funds into the system? It's capped around $135k (estimate) now. Even when the Dems had both Houses, this wasn't contemplated.
30
Today I went and check into a nursing home/rehab facility which is charging $230 a day per patient.
In that simple-minded perspective of mine I figure that, with a 150 patients, and over the course of a year, I come up, assuming 100 employees paid, on average, $50,000 a year we have, per year:
Ingoing: 230*150*365 = $12,592,500 a year
Outgoing 100* 50,000 = $5,000,000 a year.
Perhaps someone, more knowledgeable than I, can tell me why I am overlooking a lot of things and therefore should be coming up with a more decent profit making system since I am not taking into account the cost of building the facility as well as its running cost (laundry, kitchen, supplies, beds, equipment, etc.)
6
@BG Start by adding another $1 million for employees benefits; add outside consultants, and other providers. Meals, diapers, medical equipment, building maintenance, insurance, utilities, etc. and things add up. Yes, there are some facilities where owners are making huge profits, but not many
3
@BG - Surely insurance and compliance are big expenses. You need attorneys and compliance officers to make sure everything is legal and do regulatory reporting.
Another big item is rent. If you were an investor, you might have heard of medical REITs. Many of them are triple-net-lease nursing homes REITS. Investors who own shares are getting a good payout, sometimes 6-7%. They are a popular investment among retirees, of course.
1
@BG The nursing home industry is only 2nd to the nuclear industry in the number of regulations and hoops involved. Some of those regs really needed -- in a prior position, my colleagues were the people who set up the national healthcare rating system of nursing homes -- but others make less sense.
Nursing home care in general is dismal mostly: don't let the fancy furniture at places fool you: it's the staff that counts. Most places do not value their staff at all and the funds go to the pockets of major healthcare conglomerates that own the homes. There are huge profits to be made but that comes at the expense of skimping on care. My colleagues and others' findings: in general, avoid the big nursing home chains, seek nonprofits or family-owned homes. The latter are getting more scarce: they often don't look fancy but have low staff turnover and long waiting lists.
5
So many commenters here seriously planning to take their own lives when they become unable to care for themselves. Horrifying, and yet I can see their point.
I don't know that I could or would go that far. I'm 57, and the PLAN, at least, is to stay in the best health possible for as long as possible. But yes--stuff happens.
I could probably afford long-term care insurance, but I'm getting the impression here that it's pretty worthless.
I'm not afraid to die (I'm pretty sure I don't have an alternative!), but I am afraid of being dependent on others, and spending my last years at doctors' offices trying to wring every last second out of life. That's what happened to my mother, and...absolutely not.
I also would never want to burden my son with my care. I've told him that if I get cancer or something that I will do what seems reasonable to deal with it, but that I'd rather have quality of life (and death) than helpless quantity. I have had a wonderful life, and he's a huge part of the reasons for that.
So I will eat well, get lots of exercise, and do the things that matter to me until it's time to stop and get on to whatever the next phase may be. God willing.
69
@NGB It would be nice to have the public option of long term insurance. Commercial firms have left the long term market, dumping customers or leaving the remainder with much increased premiums. Those that remained double premiums or more. I have taken the money that I would pay into premiums and invested the funds. The few people I know that have had long term insurance have seen rates double to quadruple, over 20 years. Read the fine print, most insurance only covers 24 to maximum of 60 months. Average need for care is 21 months, that means many folks run out of coverage.
12
@Peter , thank you for that information and advice. I had similar thoughts about getting "health insurance" for my dog--it seems to make more sense to simply put money aside for any eventualities. As for me, if I never have to use what I've put aside, it can go to my son rather than doen the drain.
3
@NGB Just this week my cousins decided to take my 88-year-old aunt off dialysis. She's been in assisted living for five years due to the kidney issues, but in that time she's also suffered several mini-strokes. The hilarious, talkative, vivacious woman I knew has become a little old lady slumped and drooling in her wheelchair, interested in nothing but staring at the TV. The assisted living facility is allowing my aunt to receive hospice care there, but it was a fight. Long-term insurance may be all well and good, but if living to 88 means ending up like my aunt, I'll take a long walk in the woods with a gallon of rum first.
71
retired AMA attorney F/70
1979: Listening to the AMA's Board around a suddenly silent oval table consider what the AMA's position should be on adding one preventive medicine item to Medicare coverage: pnuemonia vaccine shots. The consensus was that "pnuemonia is every lingering old person's gift. A chance for family docs to talk to family members about whether to treat this disease or let it be as close as we can get to a good death." My notes as their silent counsel who would write the AMA's position paper.
Medical students and residents, young docs, on the AMA Board were horrified by this unambiguous message from their seniors. They persuaded enough of the Board to change their votes that the AMA did, on-the-record, lobby Congress for adding pnuemonia vaccine to Medicare services covered.
I did include the caveat about what likely would be lost as end-of-life communications with family docs changed from "It may be time to consider quality of life and daily activities limited or never returning." To one more check-off on the Medicare patients' paperwork that office nurses handle: Have you had your pnuemonia shot in the last five years?
As the Board Chair, a smoker and pulmonologist, said: "This will come back to haunt you." Looking at the medical students and residents.
31
@n.c.fl WOW. Thank you for that memory.
8
@n.c.fl
Aging is difficult. While dying in your sleep is considered ideal, as my friend’s 93-year-old mother did, it is often prefaced by months of sleeping 16-hour days, so weak you pee the bed. It entails numerous trips to the physician, using a walker to slowly get around, and help changing clothes or bathing. My friend’s mother had her own home, a pension provided by her deceased husband’s former employer, and a full-time caretaker, her eldest son. She had friends and family visit occasionally, yet felt depressed and alone. I thought, if this woman is unhappy, God help the rest of us, without her advantages.
36
@Jean
DIGNITAS Zurich costs about $9K and airfare.
You can save this sum and set a plan to use your family's DNA-driven old age patterns to qualify for assisted death under Swiss law or irremediable injuries from accidents. Just knowing about this lawful option for non-residents sometimes helps us sleep at night?
17
Second comment here, my mom (late 70s, lives alone, still sharp and healthy) converted her garage into a micro apartment, and the bedroom/bath addition also into a micro apartment. The money she earns from one supplements her current living expenses with Social Security. The other she plans for the time when she'll need a live-in caretaker when it gets serious.
She'll probably have a live-in Filipino immigrant with her in one of the rooms. It will not cost as much as a home or ANF. But I will be the likely one to care for her. My mom and I are close. I'm actually okay with it, we are lucky to have a good support of family nearby.
We're also Filipino, we have a different way of doing elder care. I'm not saying we're better, but we are more flexible.
Good luck everyone, I shoulda thought of this stuff when I was in my 30's, especially nowadays: We're living longer, the money for Social Security mathematically is not possible, and finding compassionate assistance is a gamble.
41
I have savings and equity in my home but watched my parents savings dwindle after having to place my Mom in nursing home care. The care Mom received was excellent and we knew she was well cared for and not at risk being at home but the monthly costs in this area, in 2006, ranged from $5-7k. My parents had too much to spend down for Medicaid and we were even advised against it for subpar care. We have no regrets for what we paid for Mom's care and I watched my Dad proudly pay it to take care of my Mom, my only worry was what would have happened and how we would have paid for it had my Dad needed it too (fortunately he did not). While I've got about 10-12 years to go for retirement as a single woman with no kids I wonder how I can pay for and/or qualify for LTC insurance for myself. That's partly why I save as much as I possibly can while still trying to live and enjoy life.
18
@Rose If you decide to opt for LTC insurance, get it sooner than later, before you acquire any pre-existing conditions. I know several people who intended to obtain LTC insurance but then developed conditions that precluded them from obtaining it, and they regret it.
5
@David After reading this article I've realized I really need to do the prudent thing and educate myself on LTC insurance. Several commenters, like you, are for it, while others have had negative experiences. I'm in my 50s with a preexisting condition that could impact so I'm not sure I would qualify or be able to afford. I did read here the policies with inflation adjustment and annual rate increases are best to consider. I don't even know who are good companies for LTC...at one time I recall ads for Genworth (I think that's the name). I have married friends where both of their parents have Alzheimers/dementia who got it in their mid/late 40s and they pay through the nose.
@David
Good advice, however, how do we know what company to go with?
Thank you for any viable recommendations.
Some attention has been paid to difficulties farmers will face due to fewer immigrants able to enter the US, but of equal importance is the shortage of workers to attend to the elderly needing help with activities of daily living. Baby boomers are going to explode the need for custodial services in the next decade. Long term care providers and assisted living facilities will be short staffed, no matter how much money you have for care. US-born children have not been raised to have the empathy, patience, or desire to work with an elderly population for low remuneration. Families have to work themselves and fewer today can give up compensation to provide home care. We are going to have a mess on our hands - and will need to recruit foreign-born and -trained caregivers as part of a more enlightened immigration policy. We need an administration with the wisdom to recognize the importance of this impending crisis and take action to address it.
51
@Pshaffer
Staffing low-wage health care aide jobs shouldn't rely on illegal immigration. There's no reason, given the worldwide demand for US residency, why the legal immigration processes we already have wouldn't serve the purpose.
4
@PWR
Except the horror in the White House wants to limit legal immigration both in numbers and the type of immigrant - only highly educated, English-speaking and "contributing". Which Norwegian scientist do you think will agree to a salary of $10/hour to change your diapers?
2
The article projects costs in future dollars rather than current dollars. It is far easier to keep everything in current dollars as that is our current reality. Yes, inflation will grow those costs in the future, but Social Security goes up with inflation as do most pensions. And for those with investments, a very common investing goal is to make sure the investment income grows with inflation. So, there is no need to project to future costs unless there is reason to believe future costs will go up for reasons other than inflation.
As to the problem of long term care - it is indeed something that weighs heavily on our minds (we are 68 amd 71). LTC insurance is debated heavily in retirement forums and the predominate opinion is that it is so expensive with such limited benefits that it is not worth it. Basically, we will just roll the dice. I am not adverse to taking matters into my own hands if I am headed to LTC.
16
I guess my wife and I are fortunate. We have long term care insurance that will pay around $10K a month that costs us about $3,500 a year. We have savings and equity in our home. We don't believe our accumulated wealth for our heirs. It is ours and we can spend it any way we want.
18
@Art Layton what company is providing this policy? how old were you when you bought it?
3
@Art Layton - Good luck. To collect on most LTC policies you've got to get sick the "right" way. Just going into an assisted living environment might not be enough.
5
@Anna
Find a local independent advisor to help you review options. There are MANY good options today. Availability can vary by state.
1
The article touches upon a critical and chronic problem in the fastest growing residential care option for elders in this country — Assisted Living Residences.
The persistent barrier to access to this important type of care setting — due to lack of ability to afford paying for living in it — was addressed over 15 years ago in an extensive manner by the National Assisted Living Workgroup (2003), which was reported to the U.S. Senate Special Committee on Aging.
This historic Work Group was comprised of 50 stakeholder organizations and only recommendations that passed a two-thirds majority vote were adopted...
The adopted recommendations related to addressing the serious and complex affordability challenges in Assisted Living Residences across the country spanned 51 pages of the final report.
While the comprehensive examination of this issue needs to be updated due to significant changes in the Assisted Living Industry in recent years, a lot could still be learned from the 18-month of dedicated work this Work Group spent on improving understanding of this growing problem and the ways in which it could be addressed.
11
Seems like many people are saying that when I get to the point that I can’t take care of myself, the best solution would be to kill myself. People would rather have that than come up with a solution where we pool our resources and take care of our elderly population. That’s pretty scary.
So, what if I’m not ready to go yet? What if I want to stick around and see my grandchildren, enjoy life some more? I worked hard all my life, paid taxes, voted. Am I not entitled to any more than a needle in the arm at the end? Should I have to end my life so that the wealthy people who seem to run everything now don’t have to miss their third home or private yacht? Is life so cheap now?
388
@Kristen Rigney--As one of those people who is planning to kill herself when the time comes, I can assure you that it is NOT that I'd "rather" do that than "come up with a solution where we pool our resources." It's that I am facing the reality of the country we live in, which is becoming more cruel, more selfish, and more divided into the ultra-rich and then everyone else with each passing year. I would love to think that a "solution" will be found in time for me, but I'm in my mid60s. It won't. I have to think about what is actually going to happen in my remaining years, with the financial situation I have, and plan accordingly. Of the options available, suicide is the most palatable. As I said upthread, I just hope that my husband and I (or whichever of us is the survivor) get the timing right, and that we're not felled by stroke or Alzheimer's before we've made the decision to end our lives.
71
@Kristen Rigney Yes, life is cheap when you have so much of it. 7 billion humans makes human life seem expendable. That's a problem. When will we address human over population? I'll tell you when. Never. Because it is counter-intuitive to unbridled capitalism AND because of religion and patriarchy.
45
@Kristen Rigney
Kristen, I hope you enjoy a long healthy life. But what if you are bedridden with a painful disease, losing more and more of yourself each day with dementia?
Suicide may seem far more attractive then.
23
This is why I started shopping for industrial carbon monoxide.
I'm not kidding.
I told my wife that we can't afford to retire - ever - and that, one day, my body or circumstances will simply not permit me to work. I may be able to afford our housing and limited utilities through Social Security, but there is no way that we will be able to afford even the healthcare that we now have.
So, as upset as I have made her, the logic of the situation is inescapable. Thus, when the time comes, so does the carbon monoxide.
46
I watched both of my parents lose their short term memory and eventually pass away from dementia/Alzheimers. This grisly process worked itself out for fifteen years. No thank you. The Hemlock Society is my best friend.
116
My parents paid for long term care for years. By the time my mother needed it, the payout per month was so small as to be meaningless.
The cost of care is going up so quickly that these policies can't keep up. AND they cost a fortune. My father bankrupted himself to pay for my mother's care.
322
@Candasan sorry to hear about your parents' experience. I checked into LTC policies a few years ago, and the most they would cover is 5 years of nursing home or assisted living care. I decided to pass and take chances on funding it myself.
50
My parents were denied LTC coverage due to prexisting conditions and were self-pay for Mom's nursing home care. I have a girlfriend who's Mom had LTC insurance (her Dad was deceased), and like you, when it came time to use it found the benefit was minimal in spite of the exorbitant premium her Mom paid. She and her husband had to help supplement her Mom's care because her Mom hadn't saved extra thinking her LTC policy had her covered. Now they wonder if they'll have enough for themselves when/if they need it in the future.
30
@Rose - My brother and sister-in-law paid $3500 a month for almost 10 years keeping her dad in assisted living. He never got bad enough to qualify for skilled nursing, which Medicaid would pay for, in their state. I don't think the rules are the same for every state, but they've spent a fortune out of their retirement money. My s.i.l.'s dad spent all his own savings keeping his wife in a nursing home until she died.
29
retired attorney F/70
TuraLura - This for for your Mom suffering with Parkinson's.
With advance planning using our medical history and clearly-stated preference for a no-pain death, we can fly to Zurich where assisted dying has been lawful for non-citizens for many years.
My DIGNITAS date is 2023. About $9K plus airfare so it can be a middle-class family's option. Catholic church is OK with "comfort care only" too.
Until I leave, I help others around me who believe they're bullet-proof healthy write POLST so physicians here won't try to rescue them if they get mangled in a car wreck.
And I help those who need assistance preparing medical records to support the Swiss law's requirements for assisted death. Then I pay for First Class flights to Zurich. One way for the one who chooses to not suffer and round-trip for the family or friend who will fly back.
Those returning from Zurich have seen what a really good death, a quiet end-of-suffering, can be. Often, they are beyond furious at how backward this country is in adopting my mantra borrowed from a friend: "Death is not the enemy. Suffering is."
138
@n.c.fl
Thank you for posting this information. I'm glad to know about DIGNITAS in Zurich. Just looked it up and will file that information away (both mentally and on paper) for future reference. Much appreciated!
16
@A former Republican
don't "file" this information! Pass It On! Look around and see suffering and ask one question of caregivers: "Does your family know about DIGNITAS in Zurich. Good death for about $9,000?"
Wait for that to sink in and then answer the next question: "is that legal??" Yep. Straight froma retired AMA attorney!
18
@n.c.fl Here on the West Coast, we are fortunate to have legalized physician-aid-in-dying. As a physician who is only middle-aged, it gives me great comfort we - talking about myself, my family, my patients, and my colleagues -- at least have that option. Doctors actually have been helping their patients die for decades, just "under the table" and among docs themselves, we talk with each other about our wishes.
28
America. So exceptional. What a delusion.
88
@Just Curious
Exceptionally deluded is more like it.
43
Where do you think long-term care for America's elderly (beyond the take-all-your remaining-assets Medicaid support) will fit in the socialists' priority list: free college for all, reparations, open borders, college loan forgiveness, Medicare for all, everything free for undocumented immigrants, etc.?
I am betting Congress will approve (and provide billing codes for) doctor-assisted suicides and end-of-life encouragement for those too old to take care of themselves. (Oops, already in place in some states.)
9
@Mon Ray
Socialists? To whom are you referring? Sanders is a Democratic Socialist, a much different bird. There are no Socialists in the US.
20
@Mon Ray First you don't seem to read. No one is asking for free college for all. Some Democrats are suggesting this only for community colleges. Obviously you cannot force private colleges to be free. And you have no understanding of long-term investments. I grew up poor and with no choice other than to go to tuition-free City College of New York (1951-55). The additional taxes that I and my colleagues paid throughout our working lives because of our college educations were far beyond the actual cost of this college. Stop listening to Fox News and learn a little about the value of long term investments in people. P.S. It would help if your Emperor President and his tax cheat buddies paid their taxes.
17
@Mon Ray
I think that assisted dying will be offered for a price....in that we will be paid to kill ourselves to prevent financial ruin and heartbreak for our families and suffering for ourselves. Take this $10K for the "gentle easy exit" and if not...well you are a selfish resource gobbling blight on society and the scourge of your family. As long as insurance companies run our politicians, the price of extended dying will only go up.
2
For Ms. Harris, clearly an educated woman ... might I suggest contacting local elder network(s) and finding out what type of 'help' services they might be able to offer or suggest? I.e., driving, shopping, help with house / yard, etc.
Also, might there be a nearby school with nursing students? Maybe find a couple good ones who could trade room & board (her ranch home must have an extra bedroom or two) plus even outright payment for some care services?
Neighborhood networks, if they could be established, might save a lot of seniors angst and big money, if they could truly -- and safely -- age in place.
17
@jazz one - get a roommate now.
2
Long term care insurance including home assistants is available but the costs have been rising fast. And some insurance companies are having trouble paying out.
8
@memosyne oh they are having "trouble" paying out ....? Because they don't make enough profit off the sick?
1
@memosyne
This is 100% false. Name the company.
The inconvenient truth is people are living too long and long beyond their means. It does no good to say it takes a community because modern society is not a community. Throughout most of humanity’s existence, those who lived longest were hardiest and had a legacy of off-spring to care care for them. In today’s world, hardy or not, caring off-spring or not, there is a sense of entitlement that all should receive equal care regardless of the cost or who pays. Like much else in modern society, this is unsustainable.
41
Long term care insurance (LTCI) is a waste of money if not scam. My sister and I got my mom LTCI 20+ years ago and the premiums has steadily doubled over the years. Then this last renewal, the premium was increased by an outrageous 92%. When I inquired and plead, all they say is b/c the state insurance dept let them. The fact is you would most likely need your LTCI in your old age and the insurance companies are counting on most of their policy holders to die before they have a chance to use it. But life expectancy keeps increasing in the US so the insurance companies are losing money on these policies. They then get the OK from state insurance commissioners they have bribed to increase the premiums at the expense of their long time customers when they need it the most and least able to afford to pay the increased premiums. So if you don't die like you were suppose to, their aim is to force you to cancel your policy through unaffordable premium increases.
A better strategy is to start saving and investing as young as possible. The best strategy is to save and buy a house so in your old age, you don't have to worry about rent or mortgage. And if you have to go into assisted living, you can sell your house or rent it out to help pay for it. Another strategy is to max out your Roth IRA or 401K Roth. Earn money tax free and take it out later tax free when you need it. LTCI is wasted if you don't use it but you can pass your Roth to your beneficiaries tax free.
27
Memo to seniors (and to seniors in training): (1) grab bootstraps tightly, and (2) pull up hard. And whatever you do, stop bellyaching.
7
@Blue Dog
hey, if some of us bend over and pull really hard on those bootstraps, ( if we can find them , that is) we'll probably fall on our heads ( and can't get up . . . ) and end up in the ER, adding to the out of control Medicare costs . . .
1
@Blue Dog
The comment above does not advocate any solution. Hectoring, claiming that other people's misfortune is their own damn fault solves no problem (other than possibly making the person expressing the sentiment feel better briefly).
Every person in this country has free speech and has a right to petition government (also known as the rest of us) for help and redress of grievances.
2
We have been living beyond our means now for decades, both individually, and as a country. No one wants to deprive himself of anything, even if it means there will be little later on when it is sorely needed.
I have a cousin in this situation. She was a "spender" and an impetuous one at that. Now she's in a situation where she could not live at home if her 65 year old daughter was not living with her, but the daughter still works, as she decided to go back to college at age 55 and racked up $65,000 in student loan debt.
She does own a house but cannot afford to maintain it properly and one sale fell through due to this. I asked her why no LTC insurance and she said she guess she just wasn't "good with money" and didn't realize that $300,000 wouldn't last that long if one was constantly spending it or "loaning" money to her children (she will never see that money again).
I feel very sorry for her - I love her very much. If I were a wealthy woman, I would help her but I'm not and must be prudent so I don't end up in the same situation. I do not have LTC insurance but do have other sources of money to pay for LTC, but they are not more than I might need myself.
People today expect to live like those who have far higher incomes. They want what they see on TV. They talk about "vacations". When I was growing up, vacations were something for VERY wealthy people; middle-class people drove to visit their relatives once a year, and stay with them when they get there.
42
@India - Many seniors today lived very frugally. But their earnings were during the years when salaries/wages were much, much lower than today. If they didn't have a good union job or a well-paid professional career in a company with a defined benefit pension, they find themselves in trouble when they get old.
30
When my 89-year-old dad had glioblastoma (brain tumor), Medicare would have paid for radical and inappropriate interventions. However, it wouldn't pay for the daily care he needed (which I'm sure was less costly). Fortunately, Dad did well in life and we could afford the care. But I am much more middle class; I'll have some resources, but not as much as Dad and Mom.
On paper, we look great. We've saved and will own our home. But we can't sustain the huge amounts projected 15 years from now.
For a long time, our economy has failed poor people. But there are elements of it that are failing or will fail, middle and upper-middle-class people. It really depends on luck, the kind of health we have towards the ends of our lives.
59
It truly is obscene that what is “covered” is so backwards.
3
Like many supposedly "high cost" needs (university education, LTC, etc) people look to how we can raise the money to pay for exhorbitant costs rather than looking at the cost side and try to lower the cost of the services. Most new ALF's are built by mega-profit seeking developers who build expensive buildings with white linen table cloth furnishings. I am familiar with a very nice family-style 30 bed facility where costs are in the $2,200-$2,500 month range for a semi-private suite with bath and veranda and $3,000-$3,500 for a private suite. This is an industry that could develop nice, full-service facilities for much less cost.
28
@Mister Ed We call this "magic fairly dust". Labor is the key cost in ALFs . Sure folks who don't need help are cheap. Try finding care of an Alzheimer's patient
13
@Mister Ed
Mega-profit seeking developers are not going solve anything (any more than developers are going to build affordable housing) but robots and automation in the future may help. The Japanese have a much worse problem than the US does. Reports are that robotic assistants for the elderly there are being developed.
Self driving cars would be a huge boon but it is doubtful affordable vehicles will ever be developed.
2
I was turned down twice for Long Term Care Insurance. My husband was approved, though he had more medical issues than I did. For me, a pillow over my face, will be just fine when the time comes.
I watched my mother deteriorate for a year and a half with twenty four hour care. She had broken her hip. The hip healed and everything else fell apart.
55
@Suzanne Victor I signed up for LTC twice through an employer when I was younger and had no health issues. Both times, it was impossible to make the payments through automatic debits. It was the only one of similar expenses that was like that. And you would get bumped out of the program with little notice. I called up the employer administrator of the program and complained and while we were on the phone, she goes, "Oh my gosh, I think this has happened to me too." It seemed like they wanted to kick you out. I had a very, very hectic life at the time, commuting between two states, and I just couldn't keep on top it -- it seemed like they wanted it that way.
11
@Elizabeth - I'm glad there are lot of people complaining about LTC Policies. Just put your money in the bank or spend it on yourself while you can enjoy it.
6
So why am I paying $5000 a year for long-term care insurance? Planning for the future seems so irresponsible. We should be spending now and let the government care for us when we get old. After all, why save today if you don't know how long you will live?
6
@Tony - Many people don't 'make enough to pay for long term care insurance. How about we work on raising pay and getting companies to return to offering pensions so people CAN save.
33
@MegWright, sure, okay. Overnight the cost of everything we buy or consume will skyrocket to pay for all of the salary increases and pensions for workers.
3
@Tony Food for thought:
I considered and reconsidered, but didn't buy one.
In part it was because there was no guarantee that the companies would be there, able to pay out what was promised, when the time came. SO I tried to save and invest what ever I might otherwise have spent on LTCI.
Someone I worked with has had a policy for years, for a time without major increases, but then the cost rose to around $8000 a year. That gives arise to another realistic fear: what if you could no longer afford your policy ? If you drop it, you have nothing to show for your payments.
46
Most elderly,excluding the ultra rich,have less than $4200/month.
64
@Laura What is the source for your claim?
4
@Jackson
I don't know about her, but I know I sure will have less than that. That's about what I make working full time (after taxes). Retirement will be far leaner, especially since, like many of my generation, I've never worked for an employer that offered a pension.
30
Healthcare in America is damned-if-you-do, damned-if-you don't: if you have good insurance, good health, and good luck, you can live to a ripe old age...when you will run out of money, die a pauper, and be institutionalized in your final years. If you don't have good health insurance, you can count on stress and poverty to take you well ahead of your peers. We have got to get better at this!
I am 43 and balked when offered long-term care insurance. After considering it for a few weeks, I decided to bank on the fact that this will be a huge problem for the Boomers and, hence, may lead to a policy solution in time for our much-smaller generation. I'm sorry to say it, but it may be that my parents' generation will have to be the sacrificial lamb that leads to a better future (a cynic might say that it's about time the Boomers did something for someone else; I'm not quite that down on them).
20
@Jason
This is not a necessary outcome.
1
How does an attorney end up with no savings? Wow. Let’s talk about the poor savings habits of most people and then let’s discuss LTC. Both are important.
20
@Da10031
There are a couple of hints. She is divorced, so she has had no help with expenses for some time. She has had serious health problems, such as lymphoma, which probably affected her ability to work and also racked up large medical bills. Also, not all lawyers make piles of money. It depends on where and what type of law you practice.
106
@Da10031 I was wondering that myself.
1
@Da10031
If you get sick it’s smazing how fast the money runs out, even if you have insurance. I know quite a few people who were wealthy—until they got sick. If you look at this lawyers list of medical problems it’s easy to see where her money went.
25
We, of course, hear constantly how we can’t afford this and we can’t afford that. What we can afford, however, is to lose two wars in the last twenty year while burning through $2.5 Trillion.
537
@Walter Bruckner
And we gave the rich two major tax cuts in the last ten years and corporations a significant tax cut last year, but what the heck, the SCOTUS says that corporations are people too.
92
So true. Such a waste.
9
@Walter Bruckner A thin veil for what we as a society are really paying for - wealth transfer.
19
Regarding solvency problems for both SS and Medicare in a few years, the quote is:
"It’s hard to imagine that Congress wouldn’t step up to make sure they remain viable for future generations” -- by the director of the Kaiser Family Foundation’s Medicare policy program.
Eegads, have they been paying attention? Congress wouldn't "step up" to agree on buying a new 12 dollar mailbox if the old one had rotted and was laying on the floor in pieces.
96
@Dale M
I don't think it can be overstated how powerful the most reliable voting bloc (older people) can be. The very suggestion of lowering benefits they are entitled to (because they paid for them) would light an enormous fire under congress' behind.
44
The burgeoning assisted living business is focused on making HUGE profits for the developers of these complexes and they have no interest in regular middle class clients. They are only interested in helping the well-to-do because they are the ones who can pay $8,000 - $10,000 PER MONTH.
68
@Carrie
An assisted living complex near us markets relentlessly. The materials they send out weekly are expensive. As soon as one section of the complex fills up, the heavy machinery moves in and construction starts again. Residents who don't know this and move in often become extremely angry at the horrific noise, dust, etc. I have heard there is no oversight to "assisted living" since they are not nursing homes and do not offer medical care. So they can do and charge what they wish, but their shiny picture of what life is like in their brochures is not how life really is, according to people who have been there. No thank you, we have long-term care insurance and plan to stay at home as long as possible.
11
@Carrie - If someone needs a nursing home, I can highly recommend the Good Samaritan homes run by the evangelical Lutherans. In our considerable experience, stay away from the for-profit homes and go for one subsidized by one of the religions, whether Catholic or Presbyterian or evangelical Lutheran, or others.
79
@MegWrightMy Mom lives in one run by the Lutherans in Maryland. Even when her LTC runs out they wont kick her out. They asked for a $30k buy in when she moved in, so we figure if she still lives there for a year after her LTC runs out, she comes out financially ok as they charge her about $115k a year. Works great for her as she is Lutheran and her pastor is the pastor there.
2
Honestly, a pension of $4,600 a month ought to be sufficient for any one person to live on/be cared for until death. This, and a similar out-reach-for-the-middle class, true cost of college, are THE moral dilemmas that my generation in particular (Gen-X) are shouldering the costs of.
While still paying off my own student loans (at 50+) over half my income goes to pay for my son’s education. My aging parents will spend their life time savings on their LTC. There will be nothing left to “pass on”. Both of our households are considered solidly “middle class”. Ha!
Meanwhile, the top 1%, and even top 5%, are seeing their wealth multiply to extremes, while the bottom 90% are barely holding on. Wake up America. We’re broken.
“The moral test of government is how it treats those who are in the dawn of life...children; those who are in the twilight of life...elderly; and those who are in the shadow of life...the sick...the needy...and the dis|abled”. - - Hubert H. Humphrey
• sent from a pocket computer: try to do what you used to do. (Blondie, 1978).
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@dr tel This latch-key 49-year-old salutes you and is in complete agreement.
16
And for those of us considered middle class, but without the benefit of owning a home, the picture is even bleaker
63
Humans were never meant to live this long. Given the costs of healthcare in this country - is this at all suprising?
18
There is a very modest proposal for preventing the baby boomers
in America™ from being a burden on their parents
or Country©, and for making them beneficial to the publick....
3
People live too long these days.
12
@Russell
Speak for yourself, not others.
10
The assisted living entity is all about money and greed .
What’s the point of keep on living when your body and mind are giving in ?
If one is wealthy will have the guarantee of caring until the money runs out .
I would rather be helped to die with dignity once the politicians and religious zealots will get their act together.
We have more respect for our pets when dealing with end of life .
75
Some people may not realize, but when you are offered long-term care as part of you employers health insurance, even if it is optional and the payments for it are "extra," it is only good as long as you are employed by them. Once you retire, you don't have that coverage and have to buy it yourself. At that point, you are old, and it is going to cost quite a bit.
35
@Moonstone
This is not always true. We purchased LTCi policies from an insurer through my spouse's employer, but it was always clear these were separate from his employment. He's been retired for a decade, and we still have the policies.
4
@jeanaiko have your rates gone up? do you think the policies are/will be worth it?
1
@AnnaI have 2 -- one I bought on my own and one thru a former employer. Both have inflation increase clauses that increase your benefits but also your premiums increase to cover. I take both everytime. I have no family to care for me when/if I will need help. My mother is 94, lives in assisted living paid for by her LTC. I would rather pay $3000 year for 2 policies that will pay me $140,000 year each when I need.
I learned from my mother's experience.
1
Good health and the means to preserve it are true blessings. My 96-year old mother-in-law lives with me and is physically a marvel. She does have some memory issues but is in the main pretty sharp. I think she'll make it to 100 and I hope to help her blow out the candles.
I'm a supporter of Medicare for All or at least some modification of this to provide timely and consistent health care as needed. I'm also a supporter of a living wage so that all people can meet their reasonable needs for food, shelter, education, and some enjoyable pastimes. We can and should do better for our country.
127
@MAF Medicare doesn't cover nursing home expenses after 90 days and does not help at all for assisted living. In many areas of this country, there are not enough home healthcare workers available (poor wages, poor benefits.) If one does not have family available to help, it's not a good situation.
30
@Mary Anne - I know that Medicare does not cover nursing homes cost after 90 days or assisted living costs. My father spent the last 6 weeks of his life (2000) in a nursing home to the tune of $11,000. He did not have Medicare A due to lack of Social Security credits. He did have a Federal Employee Health Plan that did not cover nursing home care. Mother paid the bill out of savings.
My husband spent the last 8 weeks of his life (2017) at home in hospice care. The hospice team was superb and dedicated. Thanks to Medicare and private insurance our outlay was manageable.
Healthcare workers should be well compensated and respected as professionals.
You're right about family and friends. They're essential.
33
@MAF
My m-i-l was like your mother. Made it to 100 and 6 mos., nary a health issue until the last month or so.
Sharp as a tack, still handled all her finances with total accuracy. Attended all family functions -- her 100th birthday was a 4-day family reunion extravaganza of which she didn't miss a minute, an event or activity, outlasting many of the younger generations in attendance :)
She was a gift and a blessing to all her family in all regards. As is your mother. I know you realize this, especially as one looks around and reads all the articles and comments.
Most of us won't be as fortunate. But you may well, as you have at least that genetic component going for you on one side of the clan.
Happy Mother's Day to all Moms, here and beyond.
37
Technology may offer assistance in the form of robot care givers
programmed to maintain the elderly in their own home, but that's probably 20 years in the future. A progressive administration could begin the process of a medicare-for-all health care system if the 2020 elections go well. If all else fails, there's always Derek Humphries book "Final Exit" for those in chronic pain or have simply struggled enough...
24
Every time I hear a presentation about suicide prevention I think about what is coming as the boomers need care and there are not enough resources to provide for them. It makes me crazed that I see no entity planning and developing services for a rapidly aging population who are alone. If one has family they are usually scattered geographically and family has traditionally been how people are cared for in their elder years. This is a crisis; perhaps one of the people running for the Democratic nomination would like to present a plan for elder care.
81
@Mary Anne
I know that I have maybe 5 or 10 years left before I have to stop what I'm doing and go care for my parents. When they pass, there's not much left for me. I don't have a family, not much savings, stopping to care for them will blow out any potential for my own retirement, and I figure it will just be a downhill spiral until I reach an unsustainable point and decide it's time to punch out.
I don't know any members of my generational cohort that, when you get them drunk and honest, have much more optimistic prognosis for the next 20-30 years of their life than that.
The boomers will make it through. It's their children that will be left after caring for them, and a lot of them will probably start punching out early.
25
Your Boomer-resentment is misplaced and sad.
Boomers are not swimmingly wealthy, blissfully financially secure people. Most have been “sandwiched,” as the term is, between caring for the so-called “Greatest Generation” (those octo- and nonagenarians with pensions) and the generations to which the Boomers gave birth.
But if misdirected bitterness somehow satisfies you, you won’t self-correct.
36
@Sean I hear you.
5
For several years now, my parents have been giving my siblings and I a couple thousand dollars each, at the end of the year. I've always been grateful and never questioned the choice. But when my Mom last came to visit, the subject came up.
It turns out that she and my Dad think that they should give us their savings in regular doses before they get too old because otherwise "they" will take it. When I asked who "they" is, the best I could figure out is that "they" is a mixture of tax collectors and retirement homes.
My parents believe that if they have less money, they'll have to pay less for their stays in retirement homes! They are working class and have saved carefully all their lives, so they feel rich now even though they still have very modest incomes and savings. I think maybe they're thinking of the need-based financial aid I got when I went to college, as well as the opportunity my grandmother got to live in what I think was Section 8 housing near the end of her life.
I know my parents are wrong to think that their elder care will somehow magically be subsidized as long as they're poor enough, but I really don't know where to start to research the logistics of their age of infirmity. And it's time to start.
9
@Amy- they are not completely wrong. They might also consider putting their home in a trust or in their children’s names.
15
@Bjz - Medicaid has a 5 year look-back period. If they need nursing home care before the five years are up, the state will claw back that money, no matter who it went to.
17
@Amy
This may be the most foolish thing I have ever heard. Your parents could be paying for a LTC policy that protects their assets. LTC partnership policies protect assets dollar for dollar. Please look them up.
1
My mother was in assisted living for a couple of years before her death. Her cost in Ohio was far more than what is indicated in this article, because she was required to pay extra for services that she was not permitted to do for herself or have us do for her. The cost of the room is the least of it. After her death, policy further changed so that residents could only get supplies and medication through the assisted living establishment at a huge markup. It was very expensive with none of it going towards its mostly minimum wage staff.
155
@Vickie
It's a racket to be sure. And if you want terrible nightmares, look up the power of attorney abuses that can occur when the assisted living org seizes control of what assets the patient has left.
23
I completely agree with the other commenters about suicide as an option. Suicide must become more widely available and easily administered.
153
@June, Good luck with this. It won't happen in most states and if it does, currently it will take many years to implement. Death with Dignity and Compassion and Choices don't just happen. And even after they're put into action, it is difficult to find a prescribing or helping doctor.
It's not easy to find.
2
@June
Part of me rages at the idea that the only solution to rampant, corrupt capitalism that destroys the elderly and sucks their estates away into corporate profit statements is suicide. That feels so offensive to me on a basic level that I can't even begin to form my disgust in words.
And yet, realistically, it's probably what is going to happen as a practical solution.
5
One more job for government. And we complain about big government but maybe we should embrace it.
54
What most people don't know is that if you save, and plan for retirement, when you get to the age you need a little help, the hospital will get most of your savings and the nursing home will take everything else. Most end up on Medicaid sharing a small room in a nursing home, allowed only $60 a month to spend, the government takes everything you have. I laugh when I read comments from people talking about doing away with Medicaid, they don't know what they are saying, and at some point it will be democrats and republicans alike who will be using it.
344
@Missy. You are right. Illness and old age are a great leveler. As one who finally had to place my brother in a nursing home ($3800 a month), because I could no longer lift him, I marvel at the stupidity of those spouting off about doing away with Medicaid etc. Their time will come. It does for everyone.
197
@Missy - 60% of Medicaid money goes to help seniors stay in their nursing homes when their own life savings are exhausted.
27
So who thought Donald Trump wasn't a thinker capable of long term planning ? All of his provocative actions on the economic and geopolitical fronts are barely disguised ways to reduce the dependent American populations in a variety of ways. The 18,000 dead in France during the 2003 heat wave will be mere cipher compared to what will confront senior citizens in the US in the months and years to come. Decency flew out of the window, folks, ages ago !
84
That’s why I’ve been calling the Republicans “the Death Party” for several years now.
35
Import labor.
3
@Robert
That's already happening. Quite a few people from Africa were employed at the facility my mother lived in for 7 years.
8
@Robert
Plus pay them a good, realistic living wage, welcome them and show them both respect and appreciation?
Or get the useful human commodities as cheaply and dismissably as possible?
15
@Robert, or turn Mar a Lago into a retirement home, where they are already importing plenty of labor.
12
The "I've got mine crowd" is not affected so it will take massive public pressure on the politicians to get those Social Security FICA taxes placed on all incomes, not just those up to $129,000. Buffet, Gates, Adelman, Singer, Soros, Mercer, Koch, Trump and their ilk should not be getting a FICA tax pass on all their income above $129,000.
345
@R. Anderson FICA benefits should be tied to contributions (there is some redistribution so top contributors are earning slightly negative real returns). That is the law and the intent of passage and why FICA has received widespread support for generations. There has to be a cap --else why should Buffett pay in millions just to get almost the same amount sloshed backed years later?
If you just want to just take the extra taxes and not increase higher income earners' benefits, then you are asking for a 15% tax hike on all income above 129k. That is a general tax, and nothing simple about just doing that either -- it pushes the Federal marginal tax from approx 24% to 39% at the 129K boundary, and well above European levels at higher income levels (not including state, local and property taxes). The whole program will lose support from the major taxpayers in the upper middle class, especially if spent on FICA benefits and not growth-inducing infrastructure, youth etc
FICA taxes on the middle (say 60k -100k family income) is insufficient for what has been promised. Only for the higher earners in the USA do FICA contributions start to pay for benefits promised.
If the US voter wants to live in a more European country, it will have to buy a European tax structure and start taxing the middle class more broadly. Warren cannot buy everyone's lunch.
https://www.urban.org/research/publication/social-security-and-medicare-lifetime-benefits-and-taxes/view/full_report
10
@fc123 Social Security benefits are already capped. Furthermore, payroll taxes do not apply to investment income which is how the wealthy earn a living. Maybe they should!
Social Security is still running a surplus, which goes into the Social Security Trust Fund. That is invested in low interest government securities that basically subsidize the budget deficit. Maybe we should return the favor when the program is insolvent and pay for its deficit with government debt.
If you add to our taxes the contributions we make to health insurance premiums, retirement savings, and saving for college (or paying college debt) we spend more than our counterparts in highly taxed European welfare states. The difference is that many of our contributions go to the private sector which is not democratically accountable to us.
57
@fc123 No matter how you slice it and dice it, the supremely rich in U.S. society are getting disproportionately preferred treatment at a bargain because they BUY it from politicians who are notoriously subservient to the supremely rich, be they oligarchs or corporations or banks. The only thing our so-called representatives want to fund is their own re-election campaigns and job perks plus the defense establishment they believe might protect them from their irate constituents. We well know it's always been, don't tax me, don't tax thee, tax that man behind the tree
38
When I read through the obituaries in my local newspaper, it seems like at least a third are well into their 90's. It's only going to get worse as more baby boomers age. No clue where we're gonna warehouse all these ancient people.
29
@Andy if I get a bad prognosis in my old age, I intend to refuse all medical care except palliative, and eat nothing but ice cream until my heart gives. Just being mildly facetious.
74
@Andy
Forget where we'll house them....how will we be able to LOOK at them, with all the wrinkled tattoos and holes from piercings?
11
@Ignatz It is not the boomers that have a lot of tattoos, it is the younger generations: From a Harris Poll 2015:
nearly half of Millennials (47%) and over a third of Gen Xers (36%) saying they have at least one, compared to 13% of Baby Boomers and one in ten Matures (10%). Millennials and Gen Xers (37% and 24%) are also exponentially more likely than their elders (6% Baby Boomers, 2% Matures) to have multiple tattoos.
5
Aside from those refugees running from gang violence and dictators, I don't see any reason why folks want to come to our once fine country. It's over. My advice. Grow old somewhere else. It was a myth all along anyway.
184
We as a nation need to apply more of resources taking care of our citizens and lot less on warmongering which we do very well.
67
I hope Ms Harris's cousins are able and willing to help when she is in need. Sometimes family is unable to stretch their time and resources even if they want to help.
36
Sadly, even if you do have family, you may not be able to rely on them.
6
@Rose Right: and you may not want to rely on them! I would not ever, ever, ever want my family members involved in my care. Toxicity comes in all forms, sometimes sugar-coated.
We need "quietus" kits, or a more effective Hemlock Society. I am going to investigate DIGNITAS. The problem is, one never knows when a stroke or other accident will make it impossible to choose a dignified death.
5
“The United States unlike many Western Democracies ....”
I see a version of this phrase almost daily in one Times article or another. And it’s rarely in any context that reflects well on us or our leadership or our priorities or our choices.
180
Our nation certainly has the money for this. We simply need to make it a priority. I suggest a line about a home and care for seniors be added to this quote from President Dwight D. Eisenhower's 1953 Chance for Peace speech. Then remind Americans of these words from one of history's greatest military leaders:
“Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed.”
255
How are they affording it now? What will change?
2
As a physician for 30 years I can tell you that this is the true crisis in health care.
The cost of surviving into old age has indeed made suicide a viable option.
I would like to thank the author for drawing attention to this issue. I wish there were solutions. Maybe the cost of care should be a shared public/personal responsibility.
349
@Brian Gamborg MD
My wife Dx with Pakinson's more the 20years ago and living in NYC we face this horror ,even paying thousands of dollars to establish a special Medicaid needs trust for her eventual nursing home care costs w/o the trust we would be broke in a just 2years paying for such a home.
I must add one has to find a good home that takes Medicare+ Medicaid+ Medicare supplemental insurances.
Even if one has private insurance for long term care needs they cease at age 85 ,then it's out to the wood bin for you.
I know as a PD caregiver group member what horrors long term care consists of even if indigent therefore .I pray (as an atheist!!) that she die before me so that I don't have to abandon her,scared and frightened and confused to a Nursing home ,with the State in control .
By the way in many instances applying for Medicaid long term care ins. in this city is far worse then managing the disease of your loved one. and oh yes if you have any savings or income or still work, there are other issues with the screwball rules of a 5 year look back on earnings that may disqualify one from Medicaid..who the heck wrote this script?
Certainly no person working 24/7 in health care of diseases that are un curable.
84
@Carlyle T. I am so sorry.
32
@Carlyle T. - My husband lived with PD for 32 years (he was diagnosed in his 30s). His last 8 years were a nightmare for both of us. I wish you and your wife well. I wish I had good advice for you.
29
For me, suicide is a viable option.
271
@Bucketomeat Although I have Long Term Care Health Insurance, I have never eliminated suicide as a viable option. After watching what happened to my parents, I discovered there are many things that are far worse than death. I think most "baby boomers" might agree.
291
@Bucketomeat - Yes. I wish it were made easier for anyone who wants it.
75
@Bucketomeat Agreed. I just turned 50, have modest yet insufficient retirement savings and a long-term care account. Yet I've still started considering suicide as a viable option.
73
Years ago I looked at LTC policies; the premiums are prohibitive; and if you don't use it, you loose it.
A medicaid LTC option appears to be the only potential alternative to help folks like Ms. Harris (and eventually, myself).
35
@Phil Hurwitz
I looked at LTC insurance, too, and was repelled by the premiums (my wife and I are now 60ish). Fortunately, I think we will have the assets we need if we need LTC. Not many do, apparently.
Something will be needed. My mother-in-law, 82, spends $5200 a month on assisted living. She is barely mobile and has Diabetes and other chronic issues. She'll run out of money in 7 or 8 years at her current rate, far sooner if she needs full nursing or dementia care. And she has a good nest egg and decent Social Security.
79
@Phil Hurwitz
There are single premium LTC policies available where if you don't use the benefit (which is paid tax-free) the entire premium is returned to your beneficiaries (again, tax-free). In addition, you can get the entire premium back at any time. The downside is a steep, one-time premium ($50,000 +) which I realize is a non-starter for many people. Keep in mind the longer you wait to get LTC coverage the greater the likelihood you won't be insurable.
9
@Phil Hurwitz I'm 74. Years ago we invested in a LTC plan for me, which seemed like a good deal at something like $1500/year. (I was probably in my 50s.)
Within a very short time, it jumped to being in the range of $5000/year with no increase in benefits. We canceled and got about half of our money back. Score one for the company, nothing for us.
It's a crap shoot, but the dice are loaded.
Who can realistically plan for the economy, health, politics and fate ten years down the line?
173
I suggest taking a look at Japan where it is common to see newspaper articles reporting on an older person living by themselves who starved to death. They were too proud to ask for the little help available and were invisible to their neighbors until the corpse began to smell. Not pleasant, but that is what happens when social safety nets fall apart.
197
We can only hope that Trump and other Ayn Rand-types are continually voted out of office.
170
@Anonymous
It doesn't solve anything to just blame and vote in the negative. Congress can certainly get involved but there is little incentive for them to do so at this point. One potential solution is to relax zoning regulations and make it easier for existing homeowners to add cottages in their backyard to take care of elders.
30
@Anonymous. And I continually hope that you will be paying for all the free stuff the Dems promise.
6
What did Obama do to address this looming crisis? Or Pelosi? Or Biden, the Clintons, Hoyer, Schumer, ....
21
Mitch McConnel and his friends will be able to afford it.
Unfortunately, many of these people who are reaching this sad conclusion have voted strictly along party lines and not thought about "entitlements" that they may need one day. It is a pity that we don't "respect life" of the elderly who have worked hard all there lives and helped build the economy.
140
@PJZJR Some of us have been paying for long term care policies for years. Of course, thought was required.
17
@Jackson should you ever need it, I hope it will be easy for you to collect it.
45
@Jackson and money for the expensive premiums
28