Long term care…

[Coronita]

Worried about college debt?

That’s not going to be the only problem…

http://finance.yahoo.com/news/crushing-expense-kids-pay-174851144.html

Be nice to your kid(s). Your senior care depends on it.

Call it the Gray Tsunami. In less than 40 years, the number of people in the world age 80 and older will quadruple. That means a historically unprecedented number of people will need crushingly expensive long-term care, much of it provided by their unprepared children and grandchildren. Yet few countries around the world are paying much attention, at least not yet.
“There will have to be some kind of dramatic shift in the ways things work,” said Laurie Orlov, an analyst for the Phillips Center for Health and Well-being Aging Well Think Tank.
Why? Because not only is long-term care expensive, it is also not typically covered by health insurance. In the U.S., about 70 percent of the current population of those 65 and above will at some point need long-term care – defined as assistance over an extended time to manage conditions such as arthritis, a stroke or dementia. Long-term care can include assistance in your home, an assisted living facility or a nursing facility.
And the number of Americans who need that care will soon rise steeply: According to a study by the Deloitte Center for Health Solutions, the projected population in 2050 of individuals age 65 and above is 88.5 million – 20 percent of the total population at that time. That’s an increase of 49.6 million from 2008, when the figures were 38.9 million people 65 and over, or 13 percent of the total population.
(Read more: Eight Ways to Invest in Aging Asia)
Even now, 9 million Americans receive long-term care services from family members and friends, at an estimated cost of $199 billion annually.
Most European countries have begun to put in place mechanisms to fund long-term care. But only four countries worldwide – Germany, Japan, the Netherlands, and South Korea – have long-term care insurance systems. Germany’s fully covers the cost of care for six months.
Meanwhile, some countries – notably Ireland, Scotland, the U.K., and Japan – are aggressively researching technology-driven solutions.
Orlov said some countries are experimenting with what is called “tele-healthcare” – physicians’ visits conducted via Skype or other Web-based technology. They are also using home monitoring technology – for example, a camera installed near a refrigerator to make sure the homeowner is eating. Japan is even experimenting with using robots to pick up and move bed-bound nursing home patients because there aren’t enough young workers there to perform nursing and long-term care jobs.
These ideas are now being researched or piloted in the U.S., Orlov said. But she added that there isn’t as much attention paid to cutting-edge elderly care ideas in the U.S. because “the problem for us as a society is out in the future.” Meanwhile, in countries where governments contribute to the cost of long-term care, there is a clear incentive to accelerate innovation – which is why governments pay for long-term care research.
In many of those countries, the government controls the health care system, functioning in effect as a primary care gatekeeper. But Americans deal with a complicated soup of private health insurance companies (or no health insurance); individual state disability programs; Medicaid; and Medicare, the federal program that guarantees health insurance for Americans ages 65 and older.
(Read more: Caught Off Guard by an Aging Population)
That complicated soup is likely to be with us for a while, said Paul Keckley, executive director at the Deloitte Center. “You can’t take anything from another country and cut and paste it into the U.S.,” he said.
In the U.S., most long-term care isn’t covered by private health insurance or Medicare. If these policies cover nursing home care or home care at all, it is only for a short-term or limited basis. For instance, the maximum length of stay Medicare covers in a skilled nursing facility is 100 days.
Medicare spending is projected to increase from $523 billion in 2010 to $932 billion by 2020, while enrollment is projected to rise from 47 million to 79 million. During the same period, the ratio of workers to enrollees is expected to decrease from 3.7 to 2.4, according to Deloitte.
As a result, it’s clear the current system will have to change, according to Keckley.
He predicted Medicare will eventually evolve into a managed care model, with payments made to a team of caregivers with incentives attached to keep patients well.
He also predicted that medical care in general will become more “holistic,” incorporating aspects of acupuncture, yoga, and wellness as a way to keep people healthy for longer into their senior years.
(Read more: India’s Secret Weapon: Its Young Population)
But he and other experts agree that tweaks to Medicare and behavior modification won’t be nearly enough to handle the onslaught of elderly people in need of long-term care.
Jeff Salter, CEO of Caring Senior Service, said one solution might be to allow more immigration. He said he has more clients than caregivers to help them now – and the situation is bound to become more acute in coming years.
But he also said the baby boom generation may have surprises in store, even as it ages. “Our baby boom generation has shaped every step of the way, from social issues to women’s rights to ongoing issues today,” Salter said. “The unknown is how much they’ll stand up and say ‘we demand something different.’ They can demand robots. They can demand a different kind of housing. As they’ve done so before, they may rise up again.”

[bearishgurl]

…[Keckley] predicted Medicare will eventually evolve into a managed care model, with payments made to a team of caregivers with incentives attached to keep patients well.

He also predicted that medical care in general will become more “holistic,” incorporating aspects of acupuncture, yoga, and wellness as a way to keep people healthy for longer into their senior years…

Not sure about the “teams” unless they include holistic health practitioners (in place of pill-pushing MDs), but I feel it is often “too late” to try to keep patients 75+ years old “well” when many have been drinking, smoking, drugging, dipping, sunning, etc and binging on fast food for the bulk of their lives. By then, their “holistic” treatment … and holistic mindset … should have begun 30-40 years prior.

Conditions arising from former abuse of one’s body can’t easily be fixed well after the fact. A large portion of the over 50 crowd has the health issues they do solely because of their chosen lifestyles and even “settling” throughout their lives for unhealthy working environments.

[UCGal]

I’m hyper aware of the long term care issues right now.

Medicare does not cover nursing homes except under very limited terms… – following a 3 day or longer qualified hospitalization, for 20 days… then a partial payment for a few more months… but the family still needs to pony up $141/day for this partial coverage… then – that’s it…. medicare is done and won’t cover any more.

Medicaid is a social welfare program that covers long term care once you have depleted all other assets. Kiss any inheritance to your children goodbye. Kiss your house goodbye. Kiss your social security, pension, RMDs goodbye. There is some set aside for a spouse… but it is limited.

Over half the seniors in nursing homes are under medicaid. The cost is offset by their income (soc sec, pensions), medicaid picks up the balance.

It is much cheaper to have in home care. That’s what we have for my in-laws right now. But we’re reaching the end of that path.

Be nice to your kids indeed. They may be cleaning your ass when you’re no longer able.

[CA renter]

UCGal,

When you say, “reachingg the end of that path,” what exactly do you mean? Is it because your in-laws (IIRC) are getting to the point where they need more help that cannot be provided at home, or??? What sort of options are you considering, and why?

We are also dealing with this issue in our family, but he’s not a blood relative (multi-decade companion of my MIL, though they never married), so we’re not given much say, and everyone else (his bio kids) is trying to ignore the obvious. This is something that I think will greatly affect future retirees because so many were divorced, which really changes the family dynamics and how people perceive their obligations to their divorced parents — especially if they remarried and had more kids. It can get awkward, to say the least.

You are totally right about being nice to your kids. I don’t see any other way to deal with this issue outside of foisting it upon the kids. Not what anyone wants to do, but until we come up with a better solution, it’s the only way we’ll be able to manage this number of elderly patients.

Personally, I’m in love with the way they manage things in some European countries, but that would be “socialism,” and we can’t have that here.

[UCGal]

MIL has been reluctant (refusing) to have in home help more than a few hours a day, a few days a week. She’s old and getting frail, and starting to show signs of dementia, and physically is no longer able to handle the physical demands of caring for FIL. It’s getting to the point where FIL needs better care than she’s able to provide with assistance.

His last CT (after a fall from his wheelchair) showed that he’s had more small strokes – the end result is that he’s not able to assist as much in transfers to/from the chair. So more strength is needed to do the transfers… right when she’s getting weaker.

Unfortunately, she isn’t recognizing her limitations. Social workers are involved, etc. We’re exploring getting guardianship/conservatorship of both parents. But that’s going to be an emotional firestorm because of the denial factor.

They aren’t currently in CA – so my sister in law is dealing with the front lines. But we all want them back here. MIL is putting up roadblocks to that and making unreasonable, and impractical suggestions for the next steps. Denial and dementia is a bad combo.

Unfortunately, the legal system is set up to make doing the right thing (conservatorship) a very expensive legal process if the conservatee fights it. It’s a court proceeding, with hired specialists, etc. We’ve done the initial discussions with an attorney – but the family hasn’t reached a decision on the next step.

[desmond]

UCgal,
Have exact same thing going on with in-laws. After what I went through when my mom (bitch) died and left everything to my once very close two brothers I could not even fathom having my wife try the guardianship route. Let me know how that goes.

[UCGal]

Sorry you’re dealing with it (again) Desmond.

Fortunately, or unfortunately – depending on your POV, in my in-laws case the inheritance is not an issue. (Hence my new knowledge on medicaid spend down rules.)

My husband has some siblings who seem to think there’s some inheritance in their future… To which I answer “good luck with that.” Ironically, these are the siblings not stepping forward to help the parents.

[livinincali]

[quote=CA renter]
You are totally right about being nice to your kids. I don’t see any other way to deal with this issue outside of foisting it upon the kids. Not what anyone wants to do, but until we come up with a better solution, it’s the only way we’ll be able to manage this number of elderly patients.

Personally, I’m in love with the way they manage things in some European countries, but that would be “socialism,” and we can’t have that here.[/quote]

It’s always going to boil down to your kids or somebody’s kids. The current generation of retirees are reaping the benefits of having a lot of children. As soon as you personally stop being productive you rely on others to provide you with the basic necessities of life. The reality is that we don’t have enough resources for everybody to be taken care of but still maintain an independent lifestyle going forward. In essence there’s just not enough kids to support the next generation of retirees at the current level of care. If you’re not moving in the with kids you’ll probably have to move in with other seniors so that a single care taker can provide for more than 1 person.

Automation will help somewhat, but it’s going to come down to working longer in life assuming you’re able and living with less than you thought. That’s just how the demographics and math work out, unfortunately.

[no_such_reality]

[quote=CA renter]
Personally, I’m in love with the way they manage things in some European countries, but that would be “socialism,” and we can’t have that here.[/quote]

I’m curious as to which, and from which time period? European elder care has been undergoing significant transformation, much like ours and much like their general economy.

At the moment, Greece is having a problem with people taking their elderly parents out of assisted living centers back home to basically get the pension payments into the house since the economy is so bad. The really bad part is that in general, the Greek family tradition of providing support, means elderly parents don’t go to home in the first place until it’s way over-due and beyond the providers means.

It’s a matter of our priorities being messed up. The sad fact is that when you look at all levels of government spending on a per capita basis, the USA spends on par with France, Netherlands, Belgium and about 10% more than Germany and UK. Sweden only spends 8% more than us per capita. And Norway, flush with nationalized oil money spends 20% more, but is the #2 spender, behind Qatar’s oil money.

We have European spending, we don’t have European services.

[flyer]

Sorry to hear of your very involved family issues, UCGal. It has to be a drain on all family members, and I hope it can be resolved soon.

It’s nice to hope your kids will be there for you when you need them, and we hope ours are, but, going forward, I think many young people are going to have a challenge taking care of themselves, let alone their parents or grandparents, so it’s still no guarantee. Even if they end up staying at home forever, the money still has to come from somewhere.

We’ve been extreme about saving for retirement, and I tell friends and family that you really want to have a seven-figure retirement plan, (and very careful estate planning) because, as the OP illustrates, health care costs alone will be astronomical. It’s just better to be safe than sorry.

[cvmom]

[quote=flyer]We’ve been extreme about saving for retirement, and I tell friends and family that you really want to have a seven-figure retirement plan, (and very careful estate planning) because, as the OP illustrates, health care costs alone will be astronomical. It’s just better to be safe than sorry.[/quote]

Given the estimates of health-care cost increases, social security payout decreases, and the lack of pensions for most of us, I just can’t see how anyone could plan to sustain a basic CA standard of living for 30-40 years with anything less than $1-3M of savings.

[CA renter]

[quote=no_such_reality][quote=CA renter]
Personally, I’m in love with the way they manage things in some European countries, but that would be “socialism,” and we can’t have that here.[/quote]

I’m curious as to which, and from which time period? European elder care has been undergoing significant transformation, much like ours and much like their general economy.

At the moment, Greece is having a problem with people taking their elderly parents out of assisted living centers back home to basically get the pension payments into the house since the economy is so bad. The really bad part is that in general, the Greek family tradition of providing support, means elderly parents don’t go to home in the first place until it’s way over-due and beyond the providers means.

It’s a matter of our priorities being messed up. The sad fact is that when you look at all levels of government spending on a per capita basis, the USA spends on par with France, Netherlands, Belgium and about 10% more than Germany and UK. Sweden only spends 8% more than us per capita. And Norway, flush with nationalized oil money spends 20% more, but is the #2 spender, behind Qatar’s oil money.

We have European spending, we don’t have European services.[/quote]

Yes, unfortunately, their social care systems have been dealing with many of the same problems as ours: rising healthcare costs, an aging population, declining birth rates, weak economies, etc. My information and experience with family members there is dated, and I know that things have become more “Americanized” over the years, but the citizens in Europe definitely seem to get more for their money, and I’ve not personally heard of anyone who was bankrupted because of medical problems. This is mostly regarding Austria, but also Germany, and it’s based on people who were in their pension/nursing home systems a couple of decades ago (many changes since then).

As you point out, we are paying more and getting far less out of our own system. I think there is a better way, though no system is perfect.

[CA renter]

UCGal,

Sorry to hear about your dilema. I thought they were living with you in your guest house(?). That sounded like an exceptionally good situation for all.

The fact that your FIL is becoming weaker and unable to help with the transfers does make this very difficult, as even you and your DH will probably have a difficult time trying to care for him unless you have substantial outside help.

This is a horrible thing to be dealing with, and dementia makes it so much worse. I wish the best for you and everyone else involved. Getting old is no fun. 🙁

[UCGal]

I wish they were still with us. MIL insists on doing this vagabond thing. So they’re with us about half the year. But she’s threatening not to come back. Even though this is the best place for them.

Did I mention dementia is setting in? She’s not making rational decisions… which annoys the crud out this engineer type.

[no_such_reality]

Sorry to hear of your troubles UCGal.

I’m knocking on wood that I have many more years before I come to the same situation, but know it could be any time since both sets of parents are mid-70s.

Your MIL may (or may not) actually be making rational decisions, just using different criteria. She may be placing more value on your family’s well being and independence, a desire to maximize what’s left of their quality of life, etc.

For many elderly, the issue of becoming dependent on someone, and in their view, a burden, is traumatic. Moving in with family often means a perception of loss of independence, isolation from friends, defeat and depression.

From a care standpoint, being with your family is best. At some point, each of us is going to face a transition in illnesses from prevention, to combating, to hospice.

In America, our medical establishment is extensively focused on combating. We under emphasize hospice and the non-physical natures of illness and aging.

[Author]

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