Assets and end of life care

[wildrice]

I am curious if anyone has advice about how to prevent your life savings being drained if you end up in a nursing home/memory care at the end of life. For anyone to be able to leave an inheritance, I feel like there must be some way to protect your assets?

My grandmother is in a facility that is upwards of 16k a month, so the nice million dollar nest egg she had a few years ago to leave to her heirs is probably going to be gone. This makes me wonder what my parents should be doing to avoid this, and later what I should be doing. It is going to piss me off so much if I'm saving a good chunk of our income now only to have it go to these exorbitantly priced facilities instead of being left to something I actually care about.

How can someone in their mid 60's prepare for this? What about someone in their 40's?


And yes, obviously not everyone ends up in this situation (I really hope to die before it gets to this point... ) but since you can't control that I'd love to have some control over how we get there! 

[tvlmm]

Talk to an Elder Law attorney about "asset protection trust."

[Susie]

When I was in law school, I worked as a law clerk for a small estate planning firm that spent a huge amount of their practice helping clients plan for exactly this scenario.  Preemptive planning was key, but the details are state- and individual-specific.  Medicaid planning and spend-downs, life estates in real property, trusts, etc. were all potential tools.

(I went a totally different direction in my career after that job.)

[janegold]

Yes, putting certain assets into a trust that is set up to comply with their state's Medicaid rules can help with this. But even that is not fail safe - my ILs did this 10 years ago but our state's position on how qualifying trusts must be set up has changed, and we've been warned by the attorney we hired that it may not be found valid if we have to rely on it.

Plus, it turns out that my ILs put TOO MUCH into their trust and now they are sort of stressed financially, but we risk invalidating the trust by using it the way my MIL now wants to use it. That's a story for another day but in short - it's pretty complicated and highly specific to the individual and state. Definitely consult with an elder law attorney, and search for ones that specialize in Medicaid planning or asset protection planning.

[minzy]

You can gift money as you go but to qualify for Medicaid to pay for nursing care in almost every state, there is a five year look-back period and time penalties apply if you have dumped assets in that window. This was a potential question with my grandmother but she died before she got close to draining her assets, despite the high cost of the home.

One way to “protect” yourself is to buy long term care insurance. My grandmother had a couple of those policies in place when she first went in, and that helped a great deal in preserving her funds.

[simpsongal]

Yup, this happened with my grandfather. He was suffering from dementia and desperately wanted to leave an inheritance for my mom. It was hard and sad.  Ultimately he died with about half his estate left.

Ditto OPs re finding a good estate planner. I hope my in laws consider this in their estate planning (b/c they apparently have NO WILL (!!!) - FIL is 75). They've said they'll help pay for our kids' school but they haven't set anything aside for it, so we don't really count on it. They both seem to assume they're invincible, but no one knows how things will go in the end.

[wildrice]

Aug 15, 2023 13:53:38 GMT -5 simpsongal said:

Yup, this happened with my grandfather. He was suffering from dementia and desperately wanted to leave an inheritance for my mom. It was hard and sad.  Ultimately he died with about half his estate left.

Ditto OPs re finding a good estate planner. I hope my in laws consider this in their estate planning (b/c they apparently have NO WILL (!!!) - FIL is 75). They've said they'll help pay for our kids' school but they haven't set anything aside for it, so we don't really count on it. They both seem to assume they're invincible, but no one knows how things will go in the end.

It's so sad! I think of my grandparents being mindful about spending their whole lives and I imagine it would crush them to know that nobody in their family will benefit from their hard work. Meanwhile my grandma is miserable and basically just waiting to die. She is physically in decent shape so it won't be surprising if she lives for several more years. The whole thing sucks.

Thanks everyone - i think I'm going to get on my parents about this. They are really upset about this situation for my grandma but seem to throw their hands up at the idea that this will happen to them someday. I think some actual information to share with them will make a big difference in that.

[shortstax]

For my parents, they set up an irrevocable trust as part of the medicaid planning and put in some cash assets and their property. to protect them from the medicaid 5 year lookback rule. Not sure if they'll make it 5 years due to my dad's alzheimers, but it was an attempt.

However, just this week I had to swoop in and save my mom from breaking the rules of the trust. Their furnace died, and she was going to pay the $6k out of her checking/savings for it. Even though we sat with the lawyer and he was as clear as day about how they can't make big ticket improvements to their home--as medicaid will see that and argue that they're acting as homeowners instead of basically renters. The work was done, so I had to pay it and keep record of it so that when they sell the house (or pass away) i'll first reimburse myself out of the trust. It's so hard, because if your parents are like mine, they don't want to ask for help, but nothing about this whole process is intuitive at all.

sorry for the vent...

[litasail]

I think Long Term Care insurance can also be helpful here.

[simpsongal]

wildrice, yup - I can't help but wish my folks had talked to my grandparents about the cost of higher education and the prospect of helping their grandkids with school. They just never broached the subject and we all took out tons of student loans.

The whole idea of inheritance seems so....old school and outdated. If you live to a ripe old age, your adult kids may be in their 60s when you die, and probably not in as much need of help. When do we all need help? With paying for daycare, higher education, buying a home. The Russian roulette of end of life care just seems so unfair. The Washington Post did an article on the subject earlier this year: www.washingtonpost.com/business/2023/03/18/senior-care-costs-too-high/

[bee20]

Just like the public school debate in another thread, the best thing for you individually becomes a tragedy of the commons.

Everyone wants their granny's hard work to be passed down like she wanted, but hiding her assets from Medicare means that the public is paying for Granny's care and a chosen few (you and your cousins) are getting the payout. This further concentrates wealth inequality. In WA state the state had to implement a new tax, on everybody*, to cover end of life spending shortfalls from a combination of increasing end of life costs (the real problem) and people hiding assets to get the government to cover their care (the antisocial response to the real problem).

Think of what you are trying to do here and if it aligns with your morals. If you still want to hide the money, yes, eldercare attorney will help you set up a trust and gifting strategy. At the same time please set up healthcare directives. They can't resolve all issues but could reduce unwanted end of life care.

*Except those who had a private opt-out, so it's even more ridiculous

[TR]

In addition to bee20's point, it is HARD to get into a facility that takes Medicaid (Medicare doesn't generally cover long term care) and also they're usually...not great. So it doesn't even seem that appealing to me.

[wildrice]

Aug 15, 2023 15:11:37 GMT -5 TR said:

In addition to bee20's point, it is HARD to get into a facility that takes Medicaid (Medicare doesn't generally cover long term care) and also they're usually...not great. So it doesn't even seem that appealing to me.

This may be an UO but if I have such severe dementia that I don't understand how to perform basic tasks, I kind of don't care if I am in a "bad" facility because I won't remember the difference anyway. My grandma is in a top rated one but is convinced the bruises she has from falling are because the staff is abusing her. She has family checking in on her almost daily and I am sure they would recognize if she was being mistreated. And even if she IS being abused, she's in the best place her level of wealth can buy so there aren't really better alternatives.

My morals include healthcare, elder care, and a livable social security payment for everyone so I don't really know what to do with the moral question here. If the only people who can ever pass down any wealth are the extremely wealthy or are lucky to die without needing this level of care, that doesn't help with equality either. Really I think there should be caps on profits for these facilities and taxpayers should pay into a system to cover this care (expanding Medicare to cover it or a separate fee). Perhaps it should be a progressive tax that only is charged to those who make over a certain amount so taxes aren't raised for those at the bottom of the income scale. Anyway, corporations and the wealthy take advantage of all sorts of asset protections so I'm not sure I am convinced it is up to a working class family to absorb the impact of all of this.

[SusanBAnthony]

For me the moral question is pretty clear. I don't believe it's moral to hide assets to avoid paying end of life care costs. I believe you should use up all your assets if that's what it costs. So we don't plan to do anything to hide our assets.

If we want to help our kids out financially, like a PP said we'll do it when they are 25-35ish and buying a house or paying daycare. Not when they are almost ready to retire themselves.

[quesyrah]

I’m confused….how do you pay for end of life care without having money? I’m curious what your plan is.

My parents memory care facility was also upwards of $16,000 a month. I sold their house and that’s how I paid for it.

I talked to elder law attorneys, social workers, etc and the only option anyone had was that it’s all out of pocket. Maybe I missed something??

[quesyrah]

Aug 15, 2023 15:11:37 GMT -5 TR said:

In addition to bee20's point, it is HARD to get into a facility that takes Medicaid (Medicare doesn't generally cover long term care) and also they're usually...not great. So it doesn't even seem that appealing to me.

The one facility near me that takes Medicaid (which my parents didn’t have anyway) was awful. My mom was there for a month following a stroke and she came home with bedsores and all she did was cried while she was there.

[quesyrah]

Aug 15, 2023 16:48:14 GMT -5 wildrice said:

Aug 15, 2023 15:11:37 GMT -5 TR said:

In addition to bee20's point, it is HARD to get into a facility that takes Medicaid (Medicare doesn't generally cover long term care) and also they're usually...not great. So it doesn't even seem that appealing to me.

This may be an UO but if I have such severe dementia that I don't understand how to perform basic tasks, I kind of don't care if I am in a "bad" facility because I won't remember the difference anyway. My grandma is in a top rated one but is convinced the bruises she has from falling are because the staff is abusing her. She has family checking in on her almost daily and I am sure they would recognize if she was being mistreated. And even if she IS being abused, she's in the best place her level of wealth can buy so there aren't really better alternatives.

My morals include healthcare, elder care, and a livable social security payment for everyone so I don't really know what to do with the moral question here. If the only people who can ever pass down any wealth are the extremely wealthy or are lucky to die without needing this level of care, that doesn't help with equality either. Really I think there should be caps on profits for these facilities and taxpayers should pay into a system to cover this care (expanding Medicare to cover it or a separate fee). Perhaps it should be a progressive tax that only is charged to those who make over a certain amount so taxes aren't raised for those at the bottom of the income scale. Anyway, corporations and the wealthy take advantage of all sorts of asset protections so I'm not sure I am convinced it is up to a working class family to absorb the impact of all of this.

This breaks my heart for your older loved ones.

My parents may not have known where they were or much of what was going on around them, but the amount of love they were surrounded with still brings me to tears when I think about the staff.

I cannot imagine just sending a loved one off to a sub par facility so I could have their money. They’re still people with feelings and emotions; even in end stage dementia.

[wildrice]

Aug 15, 2023 17:53:25 GMT -5 quesyrah said:

Aug 15, 2023 16:48:14 GMT -5 wildrice said:

This may be an UO but if I have such severe dementia that I don't understand how to perform basic tasks, I kind of don't care if I am in a "bad" facility because I won't remember the difference anyway. My grandma is in a top rated one but is convinced the bruises she has from falling are because the staff is abusing her. She has family checking in on her almost daily and I am sure they would recognize if she was being mistreated. And even if she IS being abused, she's in the best place her level of wealth can buy so there aren't really better alternatives.

My morals include healthcare, elder care, and a livable social security payment for everyone so I don't really know what to do with the moral question here. If the only people who can ever pass down any wealth are the extremely wealthy or are lucky to die without needing this level of care, that doesn't help with equality either. Really I think there should be caps on profits for these facilities and taxpayers should pay into a system to cover this care (expanding Medicare to cover it or a separate fee). Perhaps it should be a progressive tax that only is charged to those who make over a certain amount so taxes aren't raised for those at the bottom of the income scale. Anyway, corporations and the wealthy take advantage of all sorts of asset protections so I'm not sure I am convinced it is up to a working class family to absorb the impact of all of this.

This breaks my heart for your older loved ones.

My parents may not have known where they were or much of what was going on around them, but the amount of love they were surrounded with still brings me to tears when I think about the staff.

I cannot imagine just sending a loved one off to a sub par facility so I could have their money. They’re still people with feelings and emotions; even in end stage dementia.

Huh? My grandma is in a great facility. She's not fine but that's because she's confused constantly. She is well cared for. I also wouldn't send my parents to a sub par facility, though my sentiments about how ridiculous it is to have assets drained are the same that my mom shares. If it came down to it I think we'd hire a caregiver vs putting my parents in a home. 

I was strictly talking about myself not caring if myself is in a sub par facility. I would rather my money go to those I plan to leave it to, or to a charity. We are not poor by any stretch but we also would live in a nicer house and/or have a nicer car(s) if we weren't saving for retirement. The last thing I want to do is for that money to go to further bloating the pockets of the people who own care facilities. We all know darn well that it isn't going to the caregivers themselves.

We don't have kids so I honestly don't know what will happen to us in old age when it gets to this point. Without an inheritance of some sort, we certainly won't be able to afford this kind of care ourselves. We'll be lucky to be able to save enough to live a comfortable retirement. So perhaps that point is moot for me anyway.

[quesyrah]

Aug 15, 2023 18:05:35 GMT -5 wildrice said:

Aug 15, 2023 17:53:25 GMT -5 quesyrah said:

This breaks my heart for your older loved ones.

My parents may not have known where they were or much of what was going on around them, but the amount of love they were surrounded with still brings me to tears when I think about the staff.

I cannot imagine just sending a loved one off to a sub par facility so I could have their money. They’re still people with feelings and emotions; even in end stage dementia.

Huh? My grandma is in a great facility. She's not fine but that's because she's confused constantly. She is well cared for. I also wouldn't send my parents to a sub par facility, though my sentiments about how ridiculous it is to have assets drained are the same that my mom shares. If it came down to it I think we'd hire a caregiver vs putting my parents in a home. 

I was strictly talking about myself not caring if myself is in a sub par facility. I would rather my money go to those I plan to leave it to, or to a charity. We are not poor by any stretch but we also would live in a nicer house and/or have a nicer car(s) if we weren't saving for retirement. The last thing I want to do is for that money to go to further bloating the pockets of the people who own care facilities. We all know darn well that it isn't going to the caregivers themselves.

We don't have kids so I honestly don't know what will happen to us in old age when it gets to this point. Without an inheritance of some sort, we certainly won't be able to afford this kind of care ourselves. We'll be lucky to be able to save enough to live a comfortable retirement. So perhaps that point is moot for me anyway.

Sorry, I misunderstood your post.

I thought you were looking to protect your parents assets so you could have an inheritance. That would leave you with very few options, most likely Medicaid facilities which are typically sub par and difficult to get into.

My apologies.

[wildrice]

Aug 15, 2023 17:16:38 GMT -5 SusanBAnthony said:

For me the moral question is pretty clear. I don't believe it's moral to hide assets to avoid paying end of life care costs. I believe you should use up all your assets if that's what it costs. So we don't plan to do anything to hide our assets.

If we want to help our kids out financially, like a PP said we'll do it when they are 25-35ish and buying a house or paying daycare. Not when they are almost ready to retire themselves.

I guess this conversation is just confusing me - I wasn't posting to ask about hiding assets, I was posting to ask about how to plan for a secure future for your family in old age. I don't know that that's possible - from what my family is seeing, it wasn't done and my parents don't have a plan, nor do myself and my H - but if there are legal protections you can set up, I don't see why you wouldn't. I'm not talking about opening a bank account in the Caymans

[wildrice]

Aug 15, 2023 18:09:49 GMT -5 quesyrah said:

Aug 15, 2023 18:05:35 GMT -5 wildrice said:

Huh? My grandma is in a great facility. She's not fine but that's because she's confused constantly. She is well cared for. I also wouldn't send my parents to a sub par facility, though my sentiments about how ridiculous it is to have assets drained are the same that my mom shares. If it came down to it I think we'd hire a caregiver vs putting my parents in a home. 

I was strictly talking about myself not caring if myself is in a sub par facility. I would rather my money go to those I plan to leave it to, or to a charity. We are not poor by any stretch but we also would live in a nicer house and/or have a nicer car(s) if we weren't saving for retirement. The last thing I want to do is for that money to go to further bloating the pockets of the people who own care facilities. We all know darn well that it isn't going to the caregivers themselves.

We don't have kids so I honestly don't know what will happen to us in old age when it gets to this point. Without an inheritance of some sort, we certainly won't be able to afford this kind of care ourselves. We'll be lucky to be able to save enough to live a comfortable retirement. So perhaps that point is moot for me anyway.

Sorry, I misunderstood your post.

I thought you were looking to protect your parents assets so you could have an inheritance. That would leave you with very few options, most likely Medicaid facilities which are typically sub par and difficult to get into.

My apologies.

Not exactly, though I guess I can see how that would come across. I would like my parents to be able to make an informed decision about what they want to do - from my conversation with my mom, it doesn't sound like they've ever talked to an estate planning professional. My mom was saying that she doesn't want their money to run out from long term care instead of leaving an inheritance, like my grandma's money is, and how much it sucks that that seems like that's how things go. It got me thinking "there have to be other options". I would also like to think ahead about this for myself and my H. 

My parents have 3 kids who they are close with so there is no way they will be dumped in a shitty facility, no matter what they do.

[quesyrah]

Aug 15, 2023 18:14:14 GMT -5 wildrice said:

Aug 15, 2023 18:09:49 GMT -5 quesyrah said:

Sorry, I misunderstood your post.

I thought you were looking to protect your parents assets so you could have an inheritance. That would leave you with very few options, most likely Medicaid facilities which are typically sub par and difficult to get into.

My apologies.

Not exactly, though I guess I can see how that would come across. I would like my parents to be able to make an informed decision about what they want to do - from my conversation with my mom, it doesn't sound like they've ever talked to an estate planning professional. My mom was saying that she doesn't want their money to run out from long term care instead of leaving an inheritance, like my grandma's money is, and how much it sucks that that seems like that's how things go. It got me thinking "there have to be other options". I would also like to think ahead about this for myself and my H. 

My parents have 3 kids who they are close with so there is no way they will be dumped in a shitty facility, no matter what they do.

Right but….the money you save for retirement is intended to support you through the end of your life. Sure some people have gobs of money and preserve some for future generations AND have enough to cover end of life care. Most don’t.

In my experience (from getting to know the other families at the facility) most residents are being supported by a combination of their retirement/investments, proceeds from the sale of their home and their families.

I think I see now where you are coming from, but I really don’t think it’s realistic to expect to not spend your own money supporting yourself. Even if it feels unfair.

I do think there need to be changes about how we handle end of life care, but I don’t know what the answer is.

[wildrice]

Aug 15, 2023 18:26:01 GMT -5 quesyrah said:

Aug 15, 2023 18:14:14 GMT -5 wildrice said:

Not exactly, though I guess I can see how that would come across. I would like my parents to be able to make an informed decision about what they want to do - from my conversation with my mom, it doesn't sound like they've ever talked to an estate planning professional. My mom was saying that she doesn't want their money to run out from long term care instead of leaving an inheritance, like my grandma's money is, and how much it sucks that that seems like that's how things go. It got me thinking "there have to be other options". I would also like to think ahead about this for myself and my H. 

My parents have 3 kids who they are close with so there is no way they will be dumped in a shitty facility, no matter what they do.

Right but….the money you save for retirement is intended to support you through the end of your life. Sure some people have gobs of money and preserve some for future generations AND have enough to cover end of life care. Most don’t.

In my experience (from getting to know the other families at the facility) most residents are being supported by a combination of their retirement/investments, proceeds from the sale of their home and their families.

I think I see now where you are coming from, but I really don’t think it’s realistic to expect to not spend your own money supporting yourself. Even if it feels unfair.

I do think there need to be changes about how we handle end of life care, but I don’t know what the answer is.

Oof, I guess you're right about your money being for your end of life. I tend to think of it more in terms of living reasonably comfortably during the years after you are done working but I guess end of life care is part of that.

I think what I find enraging is that it's out of pocket costs. The idea of spending 240k a year for me to miserably sit in a hospital bed is just crazy - that's almost what we paid for our house! I think it's reasonable for people to expect to pay a fair cost for their own care, but that's not fair. It feels extremely predatory. But I don't know what the answer is, either. Something that is probably never going to happen in this country regardless.

[shortstax]

Aug 15, 2023 17:16:38 GMT -5 SusanBAnthony said:

For me the moral question is pretty clear. I don't believe it's moral to hide assets to avoid paying end of life care costs. I believe you should use up all your assets if that's what it costs. So we don't plan to do anything to hide our assets.

As with most things, I think there's nuance invoved before making a blanket statement that there's a clear moral superior answer here. 

PDQ

For example, there's a wide range between shielding significant weather vs. planning for a person's spouse to not lose all financial security for their future. Anecdote--my Dad was diagnosed with alzheimers at 62. He's 5 years in and probably won't be able to live at home much longer. However, my mom is a few years younger than him and could easily live 30 more years.  Through the state's medicaid formula, it was estimated that she would be able to keep approximately $2400 a month of his pension/SS as to not fall into "spousal impoverishment" if he were to need to go into a nursing home--the rest would go to medicaid.   Physically, he's a quite healthy 67 year old, so he could live a long (for alzheimers) time.

With mom's healthcare costs, prescrptions, etc that doesn't go very far.  Also, she may need to move from their home into a condo or something without stairs due to her limitations.  But, under medicaid, if she sold the family home any proceeds would enter into the Medicaid calculation and she would qualify for about $800/month in housing stipent. That's not sufficient. So our goal is to protect their property and a small amount of assets so that when he does eventually pass, she's not living near the poverty line while grieving that she lost her spouse to an awful fucking disease.

I'll step away from the computer now, as I'm clearly emotional/defensive about this, but I just wanted to share that it's not as simple as a "the moral question is pretty clear."   Have a little empathy.

[quesyrah]

Aug 15, 2023 18:47:50 GMT -5 wildrice said:

Aug 15, 2023 18:26:01 GMT -5 quesyrah said:

Right but….the money you save for retirement is intended to support you through the end of your life. Sure some people have gobs of money and preserve some for future generations AND have enough to cover end of life care. Most don’t.

In my experience (from getting to know the other families at the facility) most residents are being supported by a combination of their retirement/investments, proceeds from the sale of their home and their families.

I think I see now where you are coming from, but I really don’t think it’s realistic to expect to not spend your own money supporting yourself. Even if it feels unfair.

I do think there need to be changes about how we handle end of life care, but I don’t know what the answer is.

Oof, I guess you're right about your money being for your end of life. I tend to think of it more in terms of living reasonably comfortably during the years after you are done working but I guess end of life care is part of that.

I think what I find enraging is that it's out of pocket costs. The idea of spending 240k a year for me to miserably sit in a hospital bed is just crazy - that's almost what we paid for our house! I think it's reasonable for people to expect to pay a fair cost for their own care, but that's not fair. It feels extremely predatory. But I don't know what the answer is, either. Something that is probably never going to happen in this country regardless.

I don’t disagree with you at all about the outrageous costs associated with end of life care. It’s absolutely crazy and very stressful when you don’t know how you’re going to pay for it. Especially if you have a family member who outlives their money.


I am so so so thankful that during a very stressful time, my parents had the money to be able to take care of them.

[wildrice]

shortstax I am so sorry your family is dealing with this. I think you bring up a really good point about the nuance, and it also highlights the importance of having something in place even if inheritance isn't the goal.

I've been thinking a lot about the equality discussion today, and it's made me wonder what equality really looks like here. I know inheritance impacts equality, but even that is very nuanced to specific family situations. But I also wonder about the morality of private payers being the only ones able to access the "good" facilities while leaving the shitty ones that accept Medicaid just for people poor enough to qualify. That isn't equitable at all.

I actually wonder if we placed MORE burden on the government to pay for LTC if we would see some changes that could make good care more accessible for everyone. Families with other resources (postsecondary education, access to legal help, flexibility to be available to visit relatives in care homes) could potentially advocate better for changes that would help their relatives and at the same time help the relatives of others. If there aren't people who are able and willing to pay 200k a year for care, more places might have to accept Medicaid, including the "good" ones. If we need to raise taxes to support everyone having access, is that really a bad thing or a thing that may equalize people's aging experience? Are we really being moral by accepting that the wealthy will get the best care, the middle class will get ok care, and the poor will be mistreated and neglected? Things I'm definitely mulling over.

[lamore]

We are going through this with my husband’s parents and have made the following changes to our end of life care. First, my husband (8 years older with a shorter life expectancy) got an universal life plan with a long term care rider. It is more expensive than term life but it helps protect our assets if he needs care and I’m unable to take care of him. We plan to downsize our current home and move to where our only child is between 70-80. Third, put all of our rental houses and main house in a trust.

We found some options for protecting their house if they go on medicaid (they qualify) but they refuse to do that. The biggest thing we found was that they had no plan and thought they would die in their house (but did not plan for the financial aspect of it). Having a plan early seems to be key.

[jobae1234]

I know end of life care is expensive, but is it overpriced? When you consider housing, food, furniture, activities, utilities, taxes, round the clock nursing staff and aides, doctors, mental health services, front desk staff, accountants, marketing teams, someone to coordinate funerals and with families, pharmacists… who’s to say that doing all that well doesn’t cost $16,000/mo?

If there’s an exposé somewhere I’d like to see it, to understand better.

[ohgillian]

My only contribution here is that once on these boards I said I felt like a sucker for saving so much for college because my kids wouldn’t be eligible for financial aid. I took a lot of similar morality flaming, lol. (It was prob justified, to be clear)

[aprilsails]

I have so many things to say but not much time now so I will come back to this thread.

I'm in Canada, so while some things are different (no Medicare/Medicaid nonsense), much is the same. It is very common for private LTC facilities to cost in the range of $4k - 14k per month dependant on the level of services. In a bizarre twist, in my region at least, once your needs surpass the abilities of a private facility you move to a city run facility, where costs are capped at $2500 per month, no matter your ability to pay. While the finishes aren't as nice, I actually think the programming and quality of care is better, at least in my experience with mine and DHs grandparents. It is obviously paid for with taxpayer dollars.

So people tend to try and get on the waitlist for the city run facilities as fast as they qualify. That saves money and guarantees a complete care model.

My grandfather should be moving to care soon, and would qualify to go directly to the city run services. However, my grandma is in good health and is doing everything because they live way out of town and she doesn't want him away. Nonetheless, he doesn't know who she is anymore and his needs are accelerating.

On the flip side, I do a lot of work with LTC facilities, both government run and private. Everything costs a fortune in that world. Particularly construction and staffing. That being said, the private owners are multimillionaires and splash around money for themselves but are tight fisted when it comes to needed building improvements. It's very frustrating.