We opted to just invest every month toward our own long health care instead of paying into someone else's coffers. This way, if it turns out that we don't need it, wonderful, it's money we can spend on something else or our heirs can use it...better that than flushing it down the drain with some company...of course, if you pay in for all those years and end up needing it, she'll be happy she did it. There really might be a better option out there for her though.

Do you mean like a nursing home?

Have considered it, and talked with my advisor.
I opted out! and I am single

Ruthie hit the nail..best to take that $112 or even half of it every month and invest it in other ways..that way if need be...it's earned interest and will be available..

If she's in good health, has no chronic health problems or disabilities, and her only purpose for buying this insurance is fears described by the insurance company, then it's a rip-off.

Take that money and put it in a safe investment, like a money market or CD.

Why would anyone need/want longterm care insurance? If the worst happens, you need to be able to pay 2 years of care out of pocket. After that, you go on medicaid--and many of the really nice care facilities accept medicaid these days, and every year, add more medicaid beds. I'm my aunt's POA, and I cannot see how one would benefit from longterm care insurance. It's expensive, and especially for a single person with no children, it's totally unnecessary. more to the point, save and invest your own $$$, so that you can afford 2 years of care. And that way, if you don't need it, you'll have something to leave whoever you wish to name in your will--even if it's a charity.

Why would anyone need/want longterm care insurance? If the worst happens, you need to be able to pay 2 years of care out of pocket. After that, you go on medicaid--and many of the really nice care facilities accept medicaid these days, and every year, add more medicaid beds.

That's not exactly the way it worksor at least that's not the way it worked when my husband was in a nursing home. I never heard of a two-year limit; if you have enough money, you keep paying indefinitely. The government wants you to cover the full cost of the nursing home (in our case about $6,000 a month) until you've "spent down" to a certain amount.

To determine how much that amount is, the government figures out (yeah, right) how long you're going to live, and then lets you keep enough money so that you'll run out completely when you reach that age.

It's a scary process. I've heard people say they would kill themselves before they would go into a nursing homeÂbecause that's not where they want to be, and because they don't want to see their hard-earned money being sucked away by the nursing home rip tide. But of course there's nothing simple about that "solution" either.

Dave Ramsey....financial advisor says at age 60, everyone should have a LONG TERM care policy. My mother was married to a retired medical doctor. He made too much money for medicare or medicaid to pay....but the care is sooooooooooo expensive it eventually bankrupts you. Then your on a waiting list to get into a home. $112 a month is cheap compared to $4k a month for the service it will provide.

i was in excellent health, worked in the yard, etc, following my husband's death. at age 62, after a yard working outside ans in, fell to the ground with a sudden brain aneurysm........ my husband had us buy long-term care ins. and it was about $1,800/yr for mine with unlimited time coverage. foolishly, i reduced it after a couple of years to save money since i was so "healthy" and probably woudn't need to use it. fast forward 3 years later......they have paid me about $180k to pay caregivers to come to my home 24/7. it will run out in a couple of months and i kick myself every day for reducing the coverage. guess i'm not superman afte all!

What a lot of people leave out of the equation, when selling you long term care is that they keep talking "nursing home", which was 9K/mo in this area 5 years ago. Yes, they can drain the resources of most people in a very few years.

Nursing homes are for people who need skilled nursing care. They are basically hospitals with mainly trained nurses providing care.

Assisted living homes, which are being built at a rapid rate, are for seniors who do not need trained medical care, but want or need 24 hr care and services like (rides to their doctor's, shopping trips), housekeeping, meals cooked and served in a dining room, and just someone near who can help if help is needed..like getting bathed/dressed, make sure meds are offered and taken..things like that.

We found the cost and pleasant, humane surroundings of assisted living is less than half that of a nursing home....and residents get to keep their own doctors.

Probably 95% of seniors who are in nursing homes do not need to be there.

You have to look at the expenses of staying in your home (utilities, taxes, food) and possibly apartment rent or condo fee....and subtract that from the cost of a nice assisted living facility in your area.

Chances are, the 4K figure(that we paid for my mother getting max services in assisted living) would be halved, and then calculate estimated income from SS/Pension/IRA/investment income from sold home, etc.

Good chance that it's not as expensive as the insurance salesman said.

...If the worst happens, you need to be able to pay 2 years of care out of pocket. After that, you go on medicaid...

That may have been the case for your Aunt. But that is absolutely NOT a rule & is factually inaccurate to make such a blanket statement. Medicaid qualification is "means tested". If you have the means, you spend YOUR $ & YOUR assets (sell house, property, stocks, bonds, etc) until such point as you've reached poverty level, then you can qualify for Medicaid. If you are impoverished already when nursing home care is needed a person can qualify from day one. Every situation is judged on the individual personal situation.

I did the math. $112 x 12 months = $1344 per year x 30 years =$40,320.
Most nursing homes cost MORE than $112/DAY.

$112 x 365 days = $40,880 for one year of NH. IIRC, the average stay in a NH is something like 2.5 years. So you might have to make aggressive, i.e. risky, investments to make that kind of NH "nest egg".

Not every NH accepts Medicaid. You have more options/choices for placement if you have LTC insurance. LTC insurance can help preserve an inheritance if you have an "estate" & money to leave heirs. Buying LTC in your 40's is cheaper than waiting until 60's, 70's, 80's. There is probably a "best age" to start buying it. Bottom line, it is an individual decision, based on your personal situation & finances & best made with a competent financial advisor.

This is very 'iffy' to me. I don't know at what age I might require assistance or how much assistance I'll need, or how long I'll need it. Knowing 'averages' isn't much help; I'm not average. Those averages are also compiled from 'past performance'.

From what I can glean about older people similar to me, I'm guessing I'll spend a few months at the end of life in nursing or hospice care. If I live to become one of the Old Old (90's and up), I'll need *some* assistance for *some* years. (Of course, I could suffer something today and need either assistance or a LOT of care for another 30 years, but those aren't *my* odds.)

Ms. *Average* Nursing Home Patient Today didn't have access to good nutrition and health care throughout her life, as I have. She had more stress in life and fewer financial resources.

We might venture to guess that most of the people in the insurance company pitch -- those spending years in nursing care -- would never have been able to afford the premiums for long term care!

My DH and I self-insure against the need for long term care.

Thanks everyone, for your replies which I've sent on to my sister. All in all, it's a crap shoot. Yes, she's fairly healthy but worries about her situation, as I suppose we all do. Having kids doesn't mean they'd be able to take care of you in a dire situation but if a little care is needed, I suppose they are a kind of an "insurance," if you're on good terms with them, of course.
Monica, I appreciate your post. :) (We disagree in HT.)

Here in Michigan, I would never buy long term care insurance. I have worked in a nursing home for 25 years. If you do not have money, you will go on State medicade. They do make you "spend" down your savings first though. You may keep your house.

Nursing homes are for people who need skilled nursing care. They are basically hospitals with mainly trained nurses providing care. [snip]....
Probably 95% of seniors who are in nursing homes do not need to be there.

I am guessing these are numbers you don't have a reference for?
I don't believe they are accurate.

The Levels of Care (Facilities) are
Acute Care .... For the acutely ill & surgical inpatient hospital care, covered by commercial insurance, Medicare and Medicaid.

Skilled Level of Care (SNF) ... for recuperation requiring RN care &/or rehabilitation from an acute illness or surgery following a hospital stay. Medicare pays for up to 100 days, if the patient meets the medical qualifications (which are stringent). Some (not all) commercial insurances have this coverage benefit. The care can be delivered in a hospital based SNF or a nursing home licensed for SNF care.

Intermediate Care (ICF) or Custodial Care ... This is care that is delivered in most nursing homes and is covered by Medicaid (NOT Medicare), Long Term Care insurance, and a very few commercial insurances. Again, the person must meet qualifications: for example, most have needs for 2 "Activities of Daily Living" (ADL), such a dressing, grooming, bathing, feeding, &/or some basic nursing care but not on a continuous basis.

Assisted Living (ALF) ... A type of long-term care facility for elderly or disabled people who are able to get around on their own but who may need help with some activities of daily living, or simply prefer the convenience of having their meals in a central cafeteria and having nursing staff on call. This is NOT covered by Medicare NOR Medicaid. Many LTC insurances do cover this level of care. Most often it is private pay, unless a particular state has some provision for coverage (Ohio does not).

As you can see the levels of care delivered & patient needs drop down with each level... the most complex is Acute care, the least is Assisted Living.

My Mother is in an ICF nursing home. She is probably the most functional resident there, even tho' she's 96 yrs old. She is mentally sharp, able to self feed & bathe, & walk but qualifies medically for Medicaid coverage due to blindness & deafness. I am certain she could have gone to an ALF when she entered the NH 5 years ago, but I was shut out from the decision making by my sister who stole our Mother's final assets. She is well adjusted to the facility & actually loves it there (they love her too). I can't remember seeing another person in this 100+ bed facility that could manage in an ALF. Most have some level of dementia. Otherwise if they are alert & oriented, they have severe physical disabilities. A few are admitted to the facility for recovery/rehab from strokes, broken hips, or serious illness and they recover enough to return to their homes after a length of stay. This happens only occasionally. Most are long term residents, like my Mom.

Long Term Care insurance typically covers SNF (after Medicare 100day is exhausted), ICF, ALF, and in home care. The benefits depend on how much you want to spend & how long you want the coverage for (typically 2, 3, 4 years). LTC insurance is sold by SALESMEN, who will give you a sales pitch & sell you (& sometimes "say") anything. That is why it is best to compare policies, do some research, & talk to a financial advisor.

Bee...your description of Assisted Living is different here in Pa and in NJ. In looking at facilities, none had cafeterias (one had a soda shoppe, tho) They have dining rooms that resemble a good restaurant, and patients are given a menu and have waitress service.

They also have physical therapy rooms.

Yes Medicare pays for the first 100 days in a nursing home, and many nursing homes get around this by having the home's doctor send the resident to the hospital for various excuses, and have then stay the minimum days in hospital(Medicare paid) to re-set the 100 days clock for Medicare reimbursement.

But the biggest difference is that, in Assisted Living, residents keep their own doctors. THIS is a big plus.

Generally speaking the ALF's have a more "homelike", less institutional feel, milieu, decor, etc. They range from posh to very basic, with price tags to match.

many nursing homes get around this by having the home's doctor send the resident to the hospital for various excuses, and have then stay the minimum days in hospital(Medicare paid) to re-set the 100 days clock for Medicare reimbursement.

No, Monica. The Medicare benefit clock cannot be re-set in this manner. The person would have to be out of the SNF & the hospital (i.e. home) for 60 days before a new "spell of illness" could begin. Then they would have to have an illness that medically justified them to be admitted to an acute care hospital for a minimum of 3 days. At which time they would have to again meet "medical necessity criteria" to qualify for a new 100 day stay. The 100 days coverage is NOT guaranteed. Medicare SNF can be cut off sooner if the criteria are not met thru out the stay. An example would be Physical Therapy wherein the patient had met all their goals or plateaued their progress, but was still not independent enough to perform their own self-care (i.e. still needed custodial care, which is not a qualifier for SNF.)

BTW, Medicare only pays 100% of the first 20 days out of the 100 available for SNF coverage. Days 21 thru 100 have a $137.50 deductible that the patient pays (or if they have a co-insurance or LTC insurance). So with that you're right back to paying a significant chunk of change for long term care, (IF you can medically qualify for the whole 100 days).

(I should add that my info is relevant to "traditional" Medicare. The "Advantage Medicare" is possibly different ... I am not familiar with the details of it)

We decided not to buy it and I am glad we didn't. When my husband was diagnosed with AZ I consulted an estate lawyer and he told me what to do and what to expect. He said the day he goes into a care home, call SRS, make an appt and do a division of assets. I did that and the agent confirmed everything the lawyer told me would happen. I got to keep the house, car of my choice and half our assets. I got to control the money, got to live off of his share and buy a new car. Now that I am a widow, I don't need long term insurance. It can all go for my care. I tell every one about the division of assets and am shocked that most people don't know about it. They just spend their life savings on the care home and the spouse ends up broke.

One thing no one has mentioned is a Continuing Care Retirement Community. This is a setup where you enter in good health & have an apt/house of your own, and you pay upfront for it. You then have an amount paid monthly which covers gas, elctric, etc and part of the amount goes toward the increased care you will need as you age. When you need more care because of being unable to live independently, you may be moved to another part of the campus for assisted living, and when you need long term care, you're moved to that part. You still pay a monthly amount, but you're in a place where you've lived for years and you know the people, and its not an "institution."

bee....you're talking about the RULES for Medicare and hospitalizations from and to nursing homes.]
Now, real life....nursing home doctors have two purposes....to keep residents calm and not too much "trouble" for staff, but also for the ability to submit reports to Medicare that take advantage of the exceptions to Medicare and Medicaid that insure max payments from the two government agencies, and not leave the institutions with residents they cannot "evict".

It's the core of Medicare and Medicaid scamming.

Scamming & fraud of Medicare/Medicaid does exist, I agree, as it does in probably all facets of life.

But what you described Monica, "resetting the clock" by taking a nursing home patient who has used their 100 Medicare days and on day 101 readmitting to them to the hospital with a made up illness, then transferring them back to the NH after a 3 day hospital stay, for a new 100 days of SNF Medicare coverage is not just against the rules....... it simply can.not.be.done...period. The patient has to have had a break of 60 days where Medicare is not billed in order to reset the clock. I suppose someone naive or stupid could perhaps "think" they could get away with it, but it would be caught by the hospital's utilization review department, their billing department, & the Medicare paper trail (billing) created by both the NH & and hospital. There just isn't anyway to get around that in your specific example.

Your views of NH's, doctors, hospitals, Medicare & Medicaid come across as rather cynical to me. I have dealt with all & have more than a passing knowledge of how things work in "real life". My experience is the exact opposite of what you project.

Your estate has to be below $2000 to recieve Medicaid. My sons facility costs are near $10000 per month, and partly paid by his disability carrier. He still sees his own doctors, but there is a facility doctor, who has his own practice, that helps manage day to day care. As Bee has stated there is no reset for the 100 days.There is therapy available in most homes, but they offer very little, often because they are so over run with the book keeping, they are required to do. We moved our son because one facility did nothing for him except put him on a reclining bike and called it good.
Something not mentioned here is the fact that with the huge numbers of aging Americans, there will not be enough facilities to accomodate everyone that needs the care. I don't know the percentage, but Bee is also right that many are in nursing homes that could be in their own homes if they just had a little assistance. It would free up beds that are needed for the more infirm, and the ones that could stay home would be more comfortable and the costs are very low. If anyone is interested, in the latest issue of AARP, there is a very good article about this very thing.
Monica, I have been dealing with these types of facilities for almost 20 years, in three states and have never seen care like you are discribing. There are always exception, but I have not seen any of this. There are some facilies better than others and some don't work for everyone, but it takes very special people to work under these conditions. The regulations are very tight and facilities shut down with any proven abuse. Even the types of medications are monitored by the state and fed regulations to keep from having the type of medical abuse you seem to think is the norm. Any change of medical treatment or condition, it is required that the patients advocate, family, law or doctor must be advised immediately. I have been called at 3am because my son had a spasm and hit his shin on the bedtable. It just was a nick, but they were required to call us. Thank God, for the most part the bad old days of nursing care, are gone.
As far as a decision to buy or not to buy LTHC, each person should consult their own financial advisor.

Perhaps it is different now, but when I looked into SNF's thirty years ago for my MIL, the only requirement was that there be ONE RN on duty (presumably to direct administration of controled substances). As is the case in hospitals today, LPN's and aides performed the direct patient care. Most towns and small cities do not have departments of public health and rely on ridiculously small staffs from the county or state to inspect and certify nursing homes.

Too few people buying into pretty retirement homes investigate the very nursing facilities for which they are paying overmarket monthly charges. Nor do they think that the best financial interest of the many for-profit-run establishments is to limit the time residents consume expensive SNF care.

I'd prefer a month-to-month retirement home and my choice of SNF as needed.

Cathy_ID is right on all points. My father just moved into a high level of assisted living and when his money runs out (which won't take long at $5000 a month), he'll move into a nursing home.

We've got a huge problem facing us when the baby boomers go into retirement facilities. Huge.

Thank you all for the valuable perspectives.
The LTC is a pot of $ to be used either in a facility or at home. I think the most important aspect is being able to use the money for partial care at home, before I'm so bad off I'm in a nursing home bedridden. Because when that happens, I'd rather start hiking and enjoy the scenery then keel over and check out.

We bought LTCI last year at the ages of 49 and 51, and we're glad we did. I did not go into this with eyes half shut. I did uncountable hours of research, attended seminars, talked to people, interviewed agents, etc. I'm the type of person who doesn't allow anyone to talk me into anything - period.

We bought a great policy through an A++ rated company, John Hancock. The average age one should buy LTC is 60ish - before health problems begin and the premiums are outrageous if you can even get it with certain conditions. I wasn't waiting 10 years to do so especially since our premiums would double by then even if we remain healthy...but who knows how our health will be in 10 years. Sure, we're healthy now and healthier than our parents were at this age, but no one has a crystal ball to determine how our health and at what age, will affect us. I'm not taking chances knowing DH's parents history.

We have no kids or family that will care for us should we need it now or later, and to put 100% burden on the other spouse isn't fair, IMO. And even if we did have kids, who's to say they would want to interrupt their lives to care for sick parents. As cruel as this sounds, I prefer not to care for my mother as she's a difficult one now and she's relatively healthy. This LTC is piece of mind for us. While humans are living longer these days, from my research, it states that a very high percentage of people will require some kind of nursing home facility and the average time is 2.5 years. Should that time come now or later, the insurance is already there to be used. If we were to invest $$ for a rainy day to use toward this, it will take A VERY LONG TIME to match what insurance money is available to us NOW. We hope to never have to use it, but good to know it's in place if we have to, and we're lucky enough to be able to afford it. I realize many cannot.

There's much to know about the various companies offering this including their ratings, how their policies work with the options & riders offered, claims stats, etc., and then choosing what is right for each individual. While most people tend to not think about LTC or discount it all together, I really think more people should learn about it and give it serious consideration. (No, I don't sell it).

Frankly, IMHO, your sister is wise in thinking about her elder years that way.

My very smart mother bought LTC (John Hancock, BTW) and while we hoped she would never need it, she eventually did. She became sick with lung cancer and could no longer manage to live in her own home. She went to assisted living, in a nice two room suite (so I could be there too), without shelling out a single dime.
Toward the end, her care cost roughly $6,000 a month (ten years ago). LTC took care of all the bills related to the facility, no burden or worry for us. Even if in the end she paid more in that she got out, I still think it was worth it. She could have paid for it out of pocket, but if the market had tanked, or her house value plummeted (imagine that!) she might have not have been able to. This is what insurance is for. John Hancock was a great company to work with.

debi, just wondering whether you can direct me to sites that you found useful in your decision to buy LTC. I'm 53 and think this would be a good time to start the research.

marita40: Just wanted to acknowledge your request. I'll gather up some links and post them tomorrow for you and others who may be interested.

Here's a few links to get you started sorry so lengthy.

Gives company ratings. Best to choose a company with an A rating or better
http://www.aaltci.org/long-term-care-insurance/learning-center/company-ratings.php

Explains what the ratings mean:
http://www.longtermcarewiz.com/LTCWiz/resources.htm

http://ltc-info.com/

http://completelongtermcare.com/

Not sure how updated this info is, but there's much to read and a discussion board:
http://www.mrltc.com/

http://www.pueblo.gsa.gov/cic_text/health/ltc/guide.htm#whatis

Do a seach on "long term care insurance info" and you will find a wealth of info. Just read, read, read and take notes on questions you want to ask an agent. I had pages. Its best to work with an agent that is specific to this field; not an agent that sells all kinds of insurances.

Know that when you get quotes from different salesmen for the exact same policy, the rates cannot change from agent to agent. As long as you are matching apples to apples with the same LTCI company (JA, Genworth, Prudential, etc), no agent can give you a better rate. Hope that makes sense.

Good luck, hope this helps.