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Home care robots can't get here soon enough.

The Future Looks Terrible for U.S. Nursing Home Costs
https://www.bloomberg.com/news/articles/2019-06-25/u-s-nursi...

Another trend that may be driving up costs is tied to Wall Street. Four out of the 10 largest for-profit nursing home chains were purchased by private equity firms from 2003 to 2008, according to a case study analyzing a private equity takeover.

Research on the impact of private equity has yielded mixed conclusions, though one study revealed how a nursing home chain that was taken over by a private equity firm showed a general reinforcement of profit-seeking strategies already in place, while adding some strategies aimed at improving efficiency. Other reports, however, have detailed darker results.

</snip>


intercst
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Since you're always thinking long-term, curious what your current LTC strategy is (e.g. in-home care, CCRC, robots)?
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fdoubleol asks,

Since you're always thinking long-term, curious what your current LTC strategy is (e.g. in-home care, CCRC, robots)?

</snip>


I have the resources to pay for a nursing home (or presumably a robot). But after 40 years of living on my own and doing what I want, when I want, I doubt I could adapt to having someone else supervise my activities.

Fortunately, Washington State has assisted suicide. Failing that, I'll probably buy a tank of helium and do it myself.

intercst
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Fortunately, Washington State has assisted suicide. Failing that, I'll probably buy a tank of helium and do it myself.

Helium? . . . . Hmmm. . . haven’t heard of that one. One could only hope that dementia will allow me to remember that option.
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Hmmm. . . haven’t heard of that one.

Yes, you inhale and start reading Shakespeare soliloquies out load and soon you're dead from laughter.

Pete
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Failing that, I'll probably buy a tank of helium and do it myself.

Is that better than nitrous oxide?

PSU
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MoneySlob writes,

Fortunately, Washington State has assisted suicide. Failing that, I'll probably buy a tank of helium and do it myself.

Helium? . . . . Hmmm. . . haven’t heard of that one. One could only hope that dementia will allow me to remember that option.

</snip>


Good point! I don't have any history of Alzheimer's or dementia in my family. But I do occasionally take one of those online cognitive tests to see if I have an incipient problem.

My big worry is getting disabled in an accident and becoming paralyzed. Then you've lost control of what happens to you.

Why Helium?
https://www.motherjones.com/politics/2016/01/assisted-suicid...

</snip>


intercst
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PSUEngineer asks,

<<Failing that, I'll probably buy a tank of helium and do it myself.>>

Is that better than nitrous oxide?

</snip>


Experts who've studied the issue report that helium is the gas of choice.

intercst
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LTC expenses are just expenses. To be paid for same as any other expense. The stats are that most people do not have any extraordinary end-of-life expenses. Some do, but most don't.
LTC policies, like annuities, are slanted heavily to the benefit of the insurance companies and against the policy holders.

I don't know about "assisted suicide". For a government to promote such a program seems to be rife with danger. Tales out of Holland(?) show that there is a large opportunity for abuse.

Anyway, there's always sleeping pills + vodka.
Not to mention freeways with concrete bridge abutments.
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Thanks for sharing the article, intercst. It is very surprising what the median annual costs for nursing homes are across the country. I'll now look at my LTC policy benefit in a different light (now at 15k/mo and compounding annually-had it for years).

Best,

Bill
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Rayvt writes,

I don't know about "assisted suicide". For a government to promote such a program seems to be rife with danger. Tales out of Holland(?) show that there is a large opportunity for abuse.

</snip>


I'm not aware of any Gov't "promoting" assisted suicide (in the US or overseas.) You may be a victim of another unvetted email.

I know that former Sen. Rick Santorum got embarrassed repeating a claim a while back about the Netherlands "that 10% of the deaths are assisted suicide." But of course, that's not the first crazy thing he's said.

https://www.factcheck.org/2012/02/santorums-bogus-euthanasia...

In Oregon where the "assisted suicide" law has been on the books the longest, very few people actually take advantage of the law. And many of those who go through the fairly rigorous process of getting the pills from a doctor, don't actually use them. Just knowing that they have them on the shelf if they need it, provides enough comfort during their last days.

https://www.oregon.gov/oha/ph/providerpartnerresources/evalu...

intercst
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Not to mention freeways with concrete bridge abutments.

(Hopefully) by then, the car will not let you do that.
I'm sorry Dave, I'm afraid I can't do that. Daisy...daisy...

Mike
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Not to mention freeways with concrete bridge abutments.
--------------------------------
The problem with doing something like that, or jumping off a tall building, is the unknown number of other people who could be endangered by it.

In the unlikely event that I would choose to end things early, I've got an extra 20+ days ration of blood pressure pills that would do the job. My current supply will probably lose its potency over time, but something like that is my general idea.

Bill
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QuickCarrera writes,

Thanks for sharing the article, intercst. It is very surprising what the median annual costs for nursing homes are across the country. I'll now look at my LTC policy benefit in a different light (now at 15k/mo and compounding annually-had it for years).

</snip>


I'm glad you purchased an LTC policy that has worked out well for you. Unfortunately, that's uncommon today.

All you hear is complaints about rising premiums and insurance company obstacles on claiming the benefits you've paid for when the time comes.

I continue to believe folks are better off keeping the LTC premium in their own investment accounts and cutting the insurance company out of the process.

intercst
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I continue to believe folks are better off keeping the LTC premium in their own investment accounts and cutting the insurance company out of the process
----------------------------------
Statistically, that should work, just like self-insuring your auto coverage should work - unless you're one of the unlucky few who has a catastrophic event. In which case, your investment accounts will be depleted before your time is up. You don't have to be very old to have a disabling but not lethal event, like a spinal cord injury or a stroke, for example.

Bill
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Wradical writes,

I continue to believe folks are better off keeping the LTC premium in their own investment accounts and cutting the insurance company out of the process
----------------------------------
Statistically, that should work, just like self-insuring your auto coverage should work - unless you're one of the unlucky few who has a catastrophic event. In which case, your investment accounts will be depleted before your time is up. You don't have to be very old to have a disabling but not lethal event, like a spinal cord injury or a stroke, for example.

</snip>


That can happen even if I have an LTC policy. I don't think they even sell a policy with unlimited benefits today. The longest I've seen is a 5 year benefit period which is even too expensive for most people.

Unless you're a one-percenter, a long stay in an LTC facility is going to liquidate your investments anyway. An LTC policy just delays the inevitable move to Medicaid.

In reality, most nursing homes accept Medicaid. And can't evict you once you move to the Gov't program. I don't need to be wealthy enough to private pay for 20 years of care. I just need to be wealthier than the other people on the waiting list to get into a good facility. In most places, if you can afford to private pay for 2 or 3 years of care, you'll vault to the top of the list.

Long-term care is like being chased by a bear. I don't need to outrun the bear. I just need to be faster (or wealthier) than the people running with me.

intercst
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"Not to mention freeways with concrete bridge abutments."

(Hopefully) by then, the car will not let you do that.


Actually, I was thinking that I'd buy me a Tesla with the self-driving option and telling it to drive me from California to New York via the roads with the most trucks. ;-)
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The problem with doing something like that, or jumping off a tall building, is the unknown number of other people who could be endangered by it.

Bridge abutment at midnight...not so much of a problem.

The 30-ish son of a fellow church member off'ed himself in the living room via 1250 FPS lead poisoning. Now *that's* rude. That emotionally impacts people for a long time.


"sleeping pills"...In the unlikely event that I would choose to end things early, I've got an extra 20+ days ration of blood pressure pills that would do the job.

Yeah, my thoughts about pills is informed by watching a close relative suffer Alzheimer's. When I mentioned the sleeping pill idea to my doctor, she didn't say anything....just gave a small nod and changed the subject. Never thought about blood pressure pills. Can you really OD on them?

The trick is to do the deed in that period after you know that you're a goner but before you are so incapacitated that you can't do it.
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I don't need to be wealthy enough to private pay for 20 years of care. I just need to be wealthier than the other people on the waiting list to get into a good facility. In most places, if you can afford to private pay for 2 or 3 years of care, you'll vault to the top of the list.

Unfortunately for you -- and other people who retired wealthy in their 30's & 40's -- the Baby Boom generation will be occupying up all the space in the nursing homes. Got in with a whole bunch of money and staying in (on Medicaid) after their money ran out. Somebody has to be paying the bills since they can't kick the BB's out when their money runs out.

And it's going to be your cohort.

Sorry.

Oh yeah....and those wealthy (until the nursing home depleted their fortune) baby boomers will be living a looooong time, so they won't be leaving a space for you when you want to get in.
Sorry.



(Didn't read that on Fox News, BTW........figured it out all by myself.)
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Rayvt writes,

<<I don't need to be wealthy enough to private pay for 20 years of care. I just need to be wealthier than the other people on the waiting list to get into a good facility. In most places, if you can afford to private pay for 2 or 3 years of care, you'll vault to the top of the list.>>

Unfortunately for you -- and other people who retired wealthy in their 30's & 40's -- the Baby Boom generation will be occupying up all the space in the nursing homes. Got in with a whole bunch of money and staying in (on Medicaid) after their money ran out. Somebody has to be paying the bills since they can't kick the BB's out when their money runs out.

And it's going to be your cohort.

Sorry.

Oh yeah....and those wealthy (until the nursing home depleted their fortune) baby boomers will be living a looooong time, so they won't be leaving a space for you when you want to get in.
Sorry.


(Didn't read that on Fox News, BTW........figured it out all by myself.)

</snip>


Yeah, I thought I detected the typical "air of innumeracy" in that analysis. <LOL>

At age 63, I'm right in the middle of the Baby Boom cohort, so there's still room left.

intercst
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costs will get high enough that you can stay home and it will be cheaper...
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How about the idea of investing in an endless cruise aboard ship? I seem to recall someone touting that because of the great food, doctors aboard, etc.

I'm not an advocate, regardless. I have no love for cruises.

Just asking...

Vermonter
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RetiredVermonter asks,

How about the idea of investing in an endless cruise aboard ship? I seem to recall someone touting that because of the great food, doctors aboard, etc.

I'm not an advocate, regardless. I have no love for cruises.

Just asking...

</snip>


You can only do that if you're healthy. The medical clinics onboard just provide basic services. And if you get sick, the cruise line is pretty quick to send you ashore at the next port -- and then you're on your own.

intercst
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intercst:

Thanks for the reply. I kind of figured it sounded too good to be true.

Vermonter
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Unless you're a one-percenter, a long stay in an LTC facility is going to liquidate your investments anyway.

Not necessarily. States with "partnership" policies will protect your investments.

I have no idea what such a policy would cost these days but there are various states that have such rules.
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It's not that it's too good to be true, it's that there are limitations.

There is a medical center on board, but it is basic medicine. Fully equipped--they have X-ray machines, walking boots, etc. Anything major, they send you to a shore-based facility. Dental problems, you go to a dentist on shore.

But it's not like they just dump your luggage on the pier and wish you Good Luck.

We cruise a lot, and have a couple of times run across one of these "permanent cruisers". One is a lady named Dolly, we've met her on more than one cruise.

You get food, laundry, allatime new people to play bridge, canasta, etc. with. Swimming pools, entertainment, everyday you look out the window and see new scenery, meet new people all the time not just the same couple of dozen old faces...... As long as you don't need extended medical care, it works out.

Cost is doable, too. We just got off an Alaska cruise, you can do it for ~$1200 for 2 weeks, $2500-$3000 per month. You could probably get a quantity discount.
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It's not that it's too good to be true, it's that there are limitations.


A nursing home and assisted living are NOT the same thing. Cruising may work as an alternative to assisted living, depending on what kind of help you need.

But a cruise is never going to be a substitute for an actual nursing home. If you need to be in a nursing home, you need much more care than you would get in assisted living—or on a cruise.
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I continue to believe folks are better off keeping the LTC premium in their own investment accounts and cutting the insurance company out of the process.

Like taking SS early, it’s a personal choice of course. I happen to agree with Wradical. My wife and I purchased the policy around 20 years ago. Like our life insurance, I bought it in case my plan (funding my family’s financial future) didn’t work out. The benefit amount compounds annually to help offset inflation and has no time limit once past the 90 day waiting period.

Bill
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Rayvt:

"You get food, laundry, allatime new people to play bridge, canasta, etc. with. Swimming pools, entertainment, everyday you look out the window and see new scenery, meet new people all the time not just the same couple of dozen old faces...... As long as you don't need extended medical care, it works out."

Interesting. That's sort of what I had heard somewhere. And $2500-3000/month sounds like less than the cost for the "assisted living" places I hear about. I bet the company and food are better, too!

Not my cuppa tea, mind you, but neither are the so-called "living" places.

Vermonter
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MissEdithKeeler:

"Cruising may work as an alternative to assisted living, depending on what kind of help you need."

That's what I meant -- not a full-blown nursing home, obviously.

Vermonter
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