Not a question so much as a suggestion for insurance companies.

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I closed down my business in 2008 to be a caregiver to my dad and my wife. My dad was in late middle stage Alzheimer's and in memory care. As he progressed he became more and more aggressive and combative which meant I was receiving calls to come quite often. At that same time my wife was diagnosed with "early onset" Frontal Temporal Dementia. Soon she progressed to the point that it dangerous to leave her unsupervised. The economy was crashing and I needed to devote a lot more time to business and that may still not have been enough, or I could choose family first and take care of them. I chose family first. My dad passed away in 2014 and my wife has progressed to the point that I have had to place her in memory care. I visit her multiple days a week.

I will get thorough it but the cost of doing this has been substantial and it has required me to alter my retirement plans considerably. I so am thankful that I was financially able to make that decision and not worry about how to pay the bills. Over the years though, I have met and watched several families struggle with the same decision. During this time I realized that their needs to be a new type of long term care insurance for income replacement for caregivers who are taking care of loved ones. The cost of memory care locally is well over $7,000.00 per month. I suspect that the payouts would be less than half that amount to just replace the income of the average family member/caregiver.

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Unless something changes I suspect we will have two systems of long term care. One a private system for those willing and able to pay 100 percent for their care and one for those on medicaid. As you say, it will not be pretty.
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Requiring LTC isn't feasible unless LTC insurance becomes totally governmental & available for all whether they work as a CEO of a fortune 500 co, or a preK teacher, or at home. I just cannot ever see the current congress passing anything like what LBJ did with the M&M's where it's required by almost all to contribute into.

But besides that one of the big issues is that LTC insurance needs to be profitable to stay in biz & it's the premiums paid in that are supposed to do that BUT with low interest rates these past few years those premiums aren't making $ anticipated AND add into this so often policies done before 2001 are having to pay out more than they ever anticipated, so LTC underwriting is not very profitable.

In clearing out my moms house (50+ years), I ran accross all sorts of insurance ltc solitications, I'd say half of the companies do not exist anymore. JDP, Your actually fortunate that your parents policy was consumer friendly & whomever your parents insurer was stayed in business & could pay put over 400k on a 48k investment. 400k out on 48k in is not a viable business model.

My crystal ball is out for service but my prediction is for a reset on end of lfe options in the US. Oregon style death laws will be the new norm. There's already a pretty definite hemlock society subterranean happening in US to support law changes. After watching my mom on hospice 18 mos in a NH get tinier & tinier and be living in only a struct technical definition, I have no desire to live a long life without being competent & cognitive. I'd do the Sol Roth walk to death with no qualms & my family knows this.

Medicaid just isn't supportable by state budgets. My state -Louisiana - is facing 750M shortfall for this year & something like 1.4B for 2016. Jindal was the most fiscally irresponsible governor ever. Edwards has quite a challenge. There's going to be very hard decisions made or serious downgrading. What LA does will be looked at by other states planners to do or not do for their state for medicaid. I'd bet that: -the required 20 hrs work for food stamps will be put into law. Gov Bryant in MS signed this in last mo & 40% cut in costs of SNAP is anticipated in MS by EOY. LA could easily expect the same savings if not more.
- house & car as exempt medicaid asset for NH medicaid will cease unless they can establish reasonable return to home....applicants will have 6 mos to have it exempt so it can be sold (then off Medicaid due to proceeds from sale) or their ineligible for Medicaid if house is kept; If family has exemptions or exclusions those will need to be documented and determined if valid before the elder is eligible for Medicaid, as opposed to after death determination.
-reasonable right to return, I'd also bet the states will require some sort of documentation and sign off by the elders physician as to their ability to return. Kinda like the TX form H1280 for optional benefits on homestead. If you can't get it, the property is non exempt.
- the few states w/tight property laws (Lady bird deed states) probably won't change as to house being exempt for lifetime.
- the medical at-need documentation to be medicaid eligible for skilled nursing will be more defined and require 2 physicians (internist or gerontologist) signature (like what already is in place for hospice by Medicare).
- Medicaid Pending will not start till a set # of days at the facility private paid. Maybe 20 days as so many enter NH as a Medicare paid rehab benefit. Or 60 days as most application reviews are supposed to be completed within 60 days.
Doing these maybe decrease applications by 1/3. A win for Medicaid cost containment. It will not be pretty.
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Well at least it would be good if legislators blocked the loopholes so that people would not get on state money (Medicaid) who were not genuinely impoverished. That would be a better way. Heirs be damned! I mean, the parent's assets at least should be for the care of the parents and not hidden through legal maneuver.
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Let me first say, I have spent the better part of the last 7 years dealing with and paying for assisted living and memory care facilities. My mom was caring for my dad at home with my sister, my wife and myself helping out as needed. Out of the blue she was diagnosed with stage IV colon cancer so we moved them into an assisted living facility near my home. My mom only lived 6 months and my dad's Alzheimer's seemed to go into overdrive when she passed. My dad spent the next 6-1/2 years in assisted living the last 7 months in memory care. Because he was so "aggressive" after my mom died combined with his nicotine addiction, we had to keep a full time sitter with him when he was awake so the facility would not force him out. During this time, my wife was diagnosed with "early onset" Frontal Temporal Dementia and finally had to be placed in memory care early in 2015. My mom and dad's care cost over $800,000.00 and about half that was from the estate and the other half was from LTC insurance. This past year my wife's expenses are over $72,000.00 and in neither case have we received one $$$ in medicaid. Had we needed medicaid, it was there, but we did not. Would my parents have been happier if that money went to me and my sister....absolutely, would it have made our lives easier....absolutely. Am I bitter over spending the money.....no. But, what I did realize however, was we were paying full retail while others there on Medicaid were paying considerably less. So, in effect we were taxed for Medicaid insurance that we did not need or use, and then taxed again to make up for the additional costs of those who were there on Medicaid and paying less for the same services. I met and talked with many other families over the years and I can assure you their were quite a few who could have easily paid care. But instead chose to “impoverish” their parent and let Medicaid pay for it.

As I stated, Medicaid is there for those who need it thankfully, but the money would go much further without the artificial “impoverishment” of many who could pay for all or at least some of their expenses.

The biggest problem I see is evident just reading the question on this forum alone. Many people, maybe most think that medicare and/or medicaid will pay for your care when you get old including the cost of a facility or home care. They are totally surprised to find that is not true. With the number of elderly increasing and the number of working taxpayers being static at best....as I said long term the numbers just do not work. I think is about three or less working for everyone on medicare. You just cannot tax three people enough to pay for one persons care.

As for solutions.....yes I have one. Knowing what we know now, why not require everyone to buy an LTC policy the first day they go to work and maintain it during their whole working life?

We can keep a body going when the brain has given up or we can keep a brain going when a body has given up....but should we ? After watching what I have watched and am still watching...that's the question that haunts me.
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JDP, you raise some important issues, including the issue of Medicaid funding, particularly the practice as you tactfully describe it as "artificial impoverishment". I've found that offensive for years; it was one of the reasons I quit one of my jobs because I didn't want to work for an attorney who advised people how to manipulate the system and get a parent on Medicaid, especially since those particular people were in what would be considered a higher social class with ample funds to pay for their parents' care. They weren't what we now refer to as 1%ers, but they weren't that far away.

But what are the alternate solutions? Legislators will fund pork barrel projects for constituents before considering something more basic such as health care funding for the masses. Look at all the cutbacks Medicare made because of "sequestration."

Care for the aged is a major issue, a critical one which I think will become more so, but I also don't have a good grasp on alternatives, other than providing more opportunity for stay-at-home care for those who can still live in the community.

Care facilities are profit oriented; they aren't going to sacrifice their own financial needs for those of elders.
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That's true but many just see the cost of the LTC insurance and just do not want to pay it even if they can afford it. My mom and dad made the decision to purchase LTC insurance late in life (I was shocked I must admit) and paid around $4500 per year for it. They could afford it and it gave them peace of mind. They paid around $48,000 in total premium which many thought was outrageous. However he got all that back the 1st year in assisted living and over the next 6 years they paid an additional $400,000 +/- for his expenses. I have some on myself, my wife's health issues made it impossible for her to get too I pay for her stay out of pocket.

Frankly I do not see how medicaid can continue to pay for everyone who needs to be in a facility. I had several employee's and the medicaid insurance deduction is very small. If they are truly in need....that's what it is for and I am glad its there, however with so many now being artificially "impoverished" (my attorney's term) thru legal maneuver's so medicaid will pay 100%, the numbers just will not work long term. In my state, the department of health and human services already spends 75% +/- of its yearly budget on medicaid alone.
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Families don't plan for a nursing home. They really want to believe they can keep mom home for all her days. Then there is mom herself, who promises them the house if they care for here. They take the bait, feel all heroic and then reality sets in.
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