I'm feeling guilty

@Mame,

Mame wrote:

There are lots of govt-funded homes here, from assisted living right up to long-term care, and some of the private homes set aside a few govt-funded rooms.
Yeah, I would guess VERY few, as they are not money makers, and they are always kept full, with a long waiting list.

Increased nursing and care are provided in the LTC homes, and the patient just pays what they have - if you don't have much or any $$, you have to see a govt geriatric social worker and they organize it.
This is how Medicaid works in the U.S. if you have no money, the Medicaid program pays for your care. If however, you do have assets, you have to use them to pay for your care, until you spend down to the allowable limit. So, assets you intended to leave to your heirs is gone baby gone, unless you protect it in a trust that is irrevocable, so Medicaid can't touch it. Like I was saying before, the community spouse can keep what may seem like a lot, I think around $110,000 in cash assests, and the home for the vaule under $500,000.
$110K may seem like a lot to many people, but not if you had saved $310K, and now had to shell out $5K a month for care. That would only last 3.5 years, and after that you'd be left with a third of your money. I don't think anyone saves and invest their entire lives to simply be able to spend the bulk of it on LTC, which is basically high cost babysitting 95% of the residents day, and 5% making sure you are being given your meds properly, getting exercised, etc.

There are longer waiting lists for govt-funded spots, but they are there.
More and more homes are being built all the time since families can't or won't look after their aged family.

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@JPB,

JPB wrote:

I think you should investigate LTC insurance. Rather than shelter your assets so that he qualifies for a Medicaid facility, those same $$$ that you spend on the trust could be used to pay the LTC premiums which would enable him to get long term care in a much better setting/facility.

I don't know about Texas, but Medicaid qualified patients don't get into the nicest places (or even the semi-nice places) and if there are no Medicaid beds available in your community they're shipped off to another community to get a bed there.

LTC policies have a waiting period of 180 days (maybe it's 90) so you can't wait until he needs the care and then find insurance that covers it immediately. Like life insurance, the younger he is when you take out the policy the lower the premiums are. I'm at high risk for needing long term care so I took a policy out on myself about five years ago. I don't have one on Mr B but I'll get one eventually.

I'm thinking it would be a good idea to have both?

The LTC insurance that would cover a nicer place for however long, and a trust to protect assests long term.

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@chai2,

It's definitely a good idea to talk to an estate planner. I assume the attorney you're meeting with does estate planning. What happens to the principle in the trust after you both pass away? I know a lot of folks were looking at life annuities a few years back. There are many options how those can be structured to pay out (single lifetime, double lifetime, x-years guaranteed, etc.) Ultimately, though, I believe the principle goes to the company who underwrites the annuity. Is it the same with a trust?

1 Reply

@JPB,

JPB wrote:

Sorry, I just reread your OP and you don't want this to be a discussion of options. You asked about guilt. No, I don't have any such guilt. I'm the older and less healthy of the two of us. I've done what I can to protect our assets in the event that it's me that needs the care. I haven't done anything yet toward LTC for Mr B. That's something we need to do - I'll add it to the long list of things I'm not spending money on until he finds employment.

My eldest sister was in a very similar situation to yours. She was significantly younger than her husband and was the primary breadwinner. I have no idea if she carried LTC insurance for him but when his many health issues became too much for her/him he entered hospice and she took care of him at home for about four months before he died. I believe he was in his early 80s at the time and she was in her early 60s.

Edit: I'll also add that I have NO interest in living for as long as I can live just for the sake of doing so. The idea of languishing for years is an anthema to me. I'd rather be dead. I'd much rather enter hospice care and live out the rest of my days without pain than enter into a LTC situation that results in languishing for years.

No JPB, that's fine. I'm not one to wallow in guilt. Cool

I hear what you're saying about no, you don't feel guilt. I wouldn't either if I were making these plans with the idea that I would probably be the one needing it.
You (the general you, including me) can't be Mr. Spock and logically look at the other person and say "Statistically, you will be more likely to be a demented person in a wheelchair, needing someone to care for all your needs for years, until you finally drift away"
The guilt part is this feeling that saying it makes it so, or like wishing it to happen, or appearing mercenary.

Re the "I'd rather be dead"....well yeah, I'd feel that way, probably most of us do. That doesn't mean you will die just because you mentally think life isn't worth living.

I'm remembering a novel I read. A mother dealing with an adult child, who was diagnosed with a terminal illness. The story related in part all the stages the son (in his 30's) went through, his starting Hospice care, etc.
While under Hospice care, he went through all the anger stuff, etc. and at last got to the point where he said to his mother and nurse "I'm ok with dying."

The nurse said "ok, but that doesn't mean you're going to die right now you know."

That hit me between the eyes. Sure you can be ok with dying. Doesn't mean your gonna for quite some time. The body can keep clocking along for a long time after you'd wish it would stop.

1 Reply

@JPB,

JPB wrote:

chai2 wrote:

What happens when a person becomes incontinent (I don't mean just needing Depends, I mean no control, and they can't clean themselves, and neither can the person living with you), starts taking falls, maybe breaking a hip (or even if they don't, they keep falling)

....

Unfortunately, a person can go on in an increasingly debilitated state for years.

I would be under hospice care before it ever came to that.

Don't you have to qualify for hospice care?

Otherwise their services would be requested for just about everybody.

1 Reply

@JPB,

JPB wrote:

It's definitely a good idea to talk to an estate planner. I assume the attorney you're meeting with does estate planning. What happens to the principle in the trust after you both pass away? I know a lot of folks were looking at life annuities a few years back. There are many options how those can be structured to pay out (single lifetime, double lifetime, x-years guaranteed, etc.) Ultimately, though, I believe the principle goes to the company who underwrites the annuity. Is it the same with a trust?

No, with a trust, the money would go to the beneficiary.

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@chai2,

True. My father languished with progressive dementia until his disease was done with his body. He was gone (dead) in many ways long before that happened. He was in a Medicaid facility. My mother told us that the qualification process was the most humiliating experience she'd ever lived through. Their job is to assume that you're trying to get benefits that you aren't truly entitled to get. Your job is to prove otherwise. In their case there were no significant assets to protect - he was easily eligible - but the process was horrifying for her.

1 Reply

@chai2,

Your doctor has to determine you to be "incurable" and "not likely to live for longer than 6 months". I disagree that most people would request hospice. Most people are terrified of dying and have a religious upbringing that prevents them from searching out a death option -- it's all in the hand of God and the best care technology can provide. No thanks.

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@chai2,

I'd vote for the LTC insurance if you can afford it.

Did you consider if you both need some sort of care in the future? It can get difficult as often times if you go into a nursing home then you and your husband may have a situation where you do not share a room. We went through this with my husband's grandparents. Fortunately for them they had a good chunk of change so they stayed in an assistant living arrangement - more like an apartment where they could get the care they needed.

It was hugely expensive - they had the money for it, but if you have the right insurance or enough money, you then can make choices - otherwise even with certain assets protected you end up losing some choices/where you want to stay/circumstances, etc.

My grandmother required care after breaking her hip and she ended up having very limited choices.

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@JPB,

JPB wrote:

True. My father languished with progressive dementia until his disease was done with his body. He was gone (dead) in many ways long before that happened. He was in a Medicaid facility. My mother told us that the qualification process was the most humiliating experience she'd ever lived through. Their job is to assume that you're trying to get benefits that you aren't truly entitled to get. Your job is to prove otherwise. In their case there were no significant assets to protect - he was easily eligible - but the process was horrifying for her.

I hear ya, on all counts.

You reminded me of a story.
I was working in the Social Services dept of a nursing home, and the Social Worker left. The new SW was right out of school. She had all the book learning down, but frankly, her counseling skills at that point had all come from her school experience, role playing, and her internship, where she had limited access to honing her skills.
Because of her youth, and where she was financially in her life, just starting out. I don't think she really understood how important certain things became to us as we grow older. She was let's say 24. I was maybe 36, and had owned a home for a about 3 years in another state (where I am now) and could not wait until I could move back into it.

We had a new resident, a male. His wife came to the Social Worker to find out how all this payment stuff worked, Medicare, Medicaid, etc etc.
This poor woman was probably like your mother. All this was horrifying to her, she wasn't knowledgeable in all this, wasn't something she wanted to think about, was upset that her husband had to be there, and so on.

She was sitting there, twisting her hanky in her hand, asking the SW what she had to do. The SW told her she needed to apply for Medicaid ASAP, started to tell her of the financial limits etc.
The woman said they didn't have any money, the only thing they had was their home that they'd lived in for 40 years.

The SW calmly said "Well, you're going to have to sell that house, then spend down the money until you reach the asset level"

Shocked

I thought that poor woman was going to keel over dead right there. I know I would have.

Now, I tried to keep out of whatever the SW usually was saying, as I think she was a little uneasy with her new position and might take my speaking up or disagreeing as threatening.
This was no time to wait until this woman left, to tell her this, leaving this woman traumatized, even for a little while.

"Oh NO!" I said. "Mrs. Jones, you don't have to sell your home! Medicaid states your home is exempt, if the spouse (you) is living in it, or your husband states his intent is to move back there one day"
She probably asked me a dozen times. "Are you sure? Are you sure?" I kept saying "yes definately" while the SW looked annoyed saying "I'll check on this"
When the woman left, I could tell the SW was getting ready to tell me we should have "discussed" this without the wife in the room, but I was ready for her.
In so many words, I told her "I'm saying this with respect Mary, but you can't tell someone just like that they have to sell their home. This isn't just a house, it's a home where she raised her babies, have friends and neighbors around her, her community. It's her life. I've only owned my home a few years, and I'm not even there right now, but I would get hysterical if you told me I had to sell it."

I'm sure the SW meant well, she was a good person. But she was still at the stage of life; single renting apartments that were interchangeable in her mind, no strong ties to her community/neighbors, etc.

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@chai2,

Well folks, that appointment was a complete waste of time.

When I had called around to some attorneys, one of them advertised that they do a free initial consult to discuss options.
I Totally did not expect to get services I should have to pay for, but I got as much information, or discussing of options, as if I talked to a random person at a bus stop.

Well, not quite, I did pick up a couple of factoids, but nothing worth a fee. Just a couple, exactly 2, little things that made me say "oh, I didn't know that."

I had figured that we would present what assests we had, what we were trying to accomplish and to hear "We can do that (or say what they could do that would accomplish the same) and that will cost you between XXX and XXX. Except if we find there is a lot more info you did not provide, etc."

He came in, we passed pleasantries, and then he just sat and looked at us. Not even, "well, I understand you're hear to discuss this and such."

So, not being shy I said "Well, let me tell you why we're here. Here are our assets, and this is what we hope to accomplish. Is this, or something like this possible?"

His long winded reply was obviously this standard "estate planning 101" that started off 50 miles away from anything I had said, at one point wandered as close as 15 miles, only to take off and start traveling to the next state.
It started with him looking at me gravely, saying "estate planning (narrowing his eyebrows) is complicated, (further showing how complicated by squinting his eyes) VERY complicated." I think I was supposed to blanche.

When he paused for a second, I said "Isn't it true that (fill in blank)"

Yes, that's right.

"So, if this, then that happened, this would be the result. Can this be done?"

Him: Medicaid law, and protecting assets (narrowing and squinting at the same time) is complicated, VERY complicated.

Yeah...I get that. Our main concern that brings us to you is (explained again)

As we painfully inched toward the next useful bit of information, I was jotting down points. After the first one, I repeated it back to him, and he verified. He added a second point, and I repeated so "#1, then you can #2" He verified.

He added a third, then forth point, and I read back to him "So, #1, then you can #2, then #3 comes next, and at the end you come to #4?"

He verified.
Then he went off with the "if something happened to you first, who would you pick blah blah blah. After you're both gone, who will make sure that blah blah blah. What happens if your daughter doesn't end up with what you wish"

Wally was ready for this one. he said "my daughter is already the sole heir of 2 of her aunts, and she'll get our house. She has a good job and I'm not worried that she's not going to end up well off."

Guilt trip = major fail.

So this goes on, us saying we wanted to protect our assests in the event of ending up in LTC, him again repeating how "complicated" this was. Finally giving us paperwork to fill out that would list our stuff in more detail, explain goals etc.

Around that time I said "let me go over what you had said. I then repeated the same scenerio above, If #1 happens, then #2, then #3, then we #4"

He says "no."
I looked down and said, "that's what I wrote, and read to you before." Oh never mind. I had his number. So I said...

Ok, and with this you make a plan?

Him: For a retainer we take your information and provide you with the various options.

How much?

$5,000.

uh...and for that $5000 we are set up with the trusts or other options?

No. The $5000 is to look at your info, and provide you with a list of various plans.

and.....actually writing the trust is another fee?

Yes.

How much?

Well, blah blah blah...another $4500 - $5000.

So, for $10,000 you give us a list of a few ways to go, we pick one, you create a trust that does that (in so many words)?

Yes.

**** you. Laughing

There had been another attorney I'd called, who charges $400 for a 2 hour consultation. I'm going to call them back and point blank tell them that for for nothing I got the run around, and for $400 would I at least walk away with some useful information to make decisions with.

Oh, as far as LTC, I looked into that, and with the cost at Wally's age, and the 90 day waiting period, it makes just as much sense to pay for 90 out of pocket, then to be insured for a few years with no needs.

3 Replies

@chai2,

Before you hand over $400 have you looked to see if you can get the same info for free?

http://www.elderlawanswers.com/Elder_Info/Elder_Article.asp?id=701

1 Reply

@chai2,

Wow, what a waste of time and what a hefty price! I'm sure there are better ones out there, but are you going to risk possibly wasting your time again? You didn't come out of there very far ahead, right? Total bummer. Hope I don't get someone like that!

1 Reply

@Mame,

Mame wrote:

Wow, what a waste of time and what a hefty price! I'm sure there are better ones out there, but are you going to risk possibly wasting your time again? You didn't come out of there very far ahead, right? Total bummer. Hope I don't get someone like that!

You can go far towards avoiding the problem by networking...talk to others who have gone through the process, see who they used and liked.

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@hawkeye10,

I've been doing that as well.

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@chai2,

I see. Complicated. Very Complicated.

Well, of course it's complicated. That's why you made an appointment with a damn lawyer.

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@roger,

I'm reading along. I won't post today, as it's not completely relevant re what you, Chai, should do now - more along the lines of don't trust, verify, which you are already working at without my comment.

So today I'll just say this - very interesting and useful thread.

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@hawkeye10,

hawkeye10 wrote:

Before you hand over $400 have you looked to see if you can get the same info for free?

http://www.elderlawanswers.com/Elder_Info/Elder_Article.asp?id=701

yes, hawkeye, I'm well versed in the generalities of trusts, however, the info I need is to find out in my specific circumstances if what we want is allowable. I'm obviously not discussing particulars of my finances here, and suffice it to say I need a face to face with an attorny.
These websites provide broad, general information.

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@roger,

roger wrote:

I see. Complicated. Very Complicated.

Well, of course it's complicated. That's why you made an appointment with a damn lawyer.

No ****.

Actually, and addressing both you, and mame's comments....WTF?

I'm in no way disparaging the role of an attorney, or their education. No more than I disrepect a physician, accountant, or other degreed experienced person who work in a special field.

However, you know the old joke "What do you call someone who graduated in last place in medical school?".......

......Doctor.

There's good and bad, and guess what, even if you're top notch in your field, that doesn't make someone else totally in the dark about what you're doing.

The law holds no interest to me. However, I know how to read and comprehend. I know how to write specific questions to bring with me when visiting doctors, attorneys, accountants etc.
I have some sort of idea of what types on answers to expect. A least some sort of idea, sometimes I'm validating what I already know, or have an inkling about.

Mame, what bugged me upfront about this guy (and Wally, after we left told me he felt the same), was the way he spoke to us at first. Not condecending, but as if every single person he has visiting his office is rather quaint and maybe a little befuddled.

At first he spoke in what I knew had to be a slower pace than his normal way. Using the false gravity was meant to make the listener doubt themselves, like anything they were thinking just couldn't be right.
I won't say at all he was thrown when I basically said "here's our story, this is what we're trying to protect, and is it possible that (fill in the blank) would work? But I don't think that's the ususal way it happens.
Like I said right up front "We're looking for a trust, I guess if would be irrevocable, where I could still collect income."
He didn't even address that, and went on with estate planning 101, saying, I don't remember, something really "duh, who wouldn't know that" I said "ok, but what I'm interested in is a trust that blah blah blah" and he just picked right back up where he left off. I brought it up a third time, and realized he was going to keep going on his own agenda.
The way he kept trying to lead me into other areas was designed to lead me to believe what I wanted wasn't the best course.

Heh, I just remembered, he did at one point say something like "what you are saying might not be the best choice/course" I said "Well, what are the options?" To which he reply I'd have to fill out the paperwork so they could research the options (with $5K in his hands of course)
I'd bet you anything what he'd come up with would be the few areas we covered, and maybe one more, maybe 2 if one of the options totally wasn't feasible.
When asked a question, once or twice he would stop and put a look on his face like "hmmm, I'm carefully thinking about this. I don't know if I've ever been asked such a question" Oh bull, you know the anwer, I can see it floating over your head.
Actually, I did ask him one question, about if my house was emempt from medicaid spend down, would I be able to take out a reverse mortgage on it?
He looked a me, well, diffrently for a moment, looked off for a second, really thinking and finally said "I don't know." I think it was a good question, I'm not surprised he didn't immediately know the answer.

Everyone's situation is slightly different, but there's enough similarities that there's a general group solutions. Don't tell me you aren't sitting there already Mr. Attorney, and already have 80-90% of how it's going end up going in the back of your mind.

1 Reply

@chai2,

Well, Chai, that's how some of them earn that $5000... dragging it out, getting you to sign up for **** that's easy... I would run from that guy. You are not going to get intelligent, personalized advice.

My friend's husband is a tax lawyer. I asked him a few questions and he told me a wonderful solution in a nano-second. Don't tell me that they do this stuff all day but they have to 'analyze it' and give you options.

I spoke with my financial planner about something and right away he said, you're in the wrong tax bracket for that. What YOU want to do is X, Y, or Z.

Ask your financial planner/advisor for a recommendation to someone. I really think that's better than going through the Yellow Pages (or whatever you did). You need a reference. These guys all walk in the same circles and as long as you trust ONE of them, you likely will trust his recommendations.

I'm in the same boat - we have to do this, too.

Who's your executor, by the way? Family or friend? I haven't chosen mine yet. I thought maybe a sister, but that might be hard on them.

1 Reply

I'm feeling guilty

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