Are you afraid of wiping out your savings?

by Lauren

There are very few financial decisions that I disagree with my husband about, but we don’t agree on whether we need long-term care insurance. I read this article and reminded him about my concerns about certain illnesses that can wipe out even large amounts of savings. I’ve seen this with some of my friends with parents or grandparents that lived for many years after a stroke, or even my grandmother that survived 9 years after she exhausted her savings at the age of 90.

Do you have concerns about this situation?

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174 thoughts on “Are you afraid of wiping out your savings?

  1. I don’t worry about this.

    I have an aunt who has early on-set Alzheimers (in full dementia at age 67). She is in very good memory care facility that is relatively close to us. The cost is $2400/month, and that includes everything she needs on a day-to-day basis, including the nursing care at the facility. She gets approx. $1200/month as a Social Security benefit, and has supplement the remaining out of her 401(k), which she is able to do without drawing on principle. She is not married, had fairly modest but adequate retirement savings, and she’s in a worst-case scenario health wise. But she is fine.

    (Caveat – my numbers may be off by a few hundred in either direction – I am not handling the bills, but I stay in close touch with my parents about it,) (Also caveat – I do recognize that we live in a lower cost of living area and similar levels of care could cost more in different parts of the country.)

    One thing to keep in mind is that if you are very sick, and in long-term care, you are not traveling, not shopping, not entertaining, not maintaining a car, not buying Christmas presents – etc. She is paying less for full time care than she would pay to just live, had this not happened to her.

  2. It’s a sad story, of course.

    In regards to the fact that it’s portrayed in Lieber’s “Your Money” column, and the question about long-term care insurance, the article said the woman retired with a net worth of $600k. That’s not really in the same category as what the regulars here tend to suggest as their retirement magic numbers. I think that there comes a point when the sum of annual Social Security and 2-4% earnings on your investments exceed the costs of even an expensive nursing home, or even four full-time, ’round-the-clock caregivers, if you prefer.

    When my dad asked my thoughts on LTC insurance, I advised against it for them for this reason. It’s a little scary to feel that he was trusting me with giving lay advice, but since he agreed, I think I was only confirming his previous decision.

  3. The totebag median income is $270k and many say they are targeting 80% of that in retirement. That’s $216k. A nursing home more towards Albany is $308/day or a little over 9k a month or $108k a year. You can deduct healthcare expenses above X% of income. Can’t you just cash flow the $9k?

  4. This lurks in the background for me. I/we did not buy LTC insurance back ~10-15yrs ago when it would have been a better all around deal for us and I’m unconvinced it’d be a good use of our money now. It’s not a big worry (otherwise I’d actually be doing something about it).

  5. Like Lark I don’t worry about LTC wiping out my savings, maybe because I haven’t seen it with totebag percentile types and because when I run the numbers it appears highly unlikely. We think about other risks not covered by insurance that could put a dent in retirement savings, some of which we’ve seen among people we know. Mostly it involves adult children who get into trouble and parents spend a lot of money bailing them out.

  6. “10-15yrs ago when it would have been a better all around deal for us”

    Was it really a better deal, or were the premiums just more affordable because you were 10-15 years further from your statistically likely payout dates?

  7. The system seems to be working just as I would want it to. Except for the trust – why should she be able to shield her assets? She put money away, she ended up needing and amount of care that probably put her in the top 2% of patients and the government took care of her after the money ran out.

  8. Along the way, the insurance company declared her not sufficiently ill to warrant paying out on the policy. …

    …Just over three years into Ms. Sherman’s nursing home stay, her money was gone and the long-term care insurance had been used up.

    The coverage you buy may not work out to be what you expected. I’d hate to have to be fighting with an insurance company over what is covered. And she maybe or probably could not afford to have purchased a LTC policy with a longer period of coverage.

    “why should she be able to shield her assets?”

    I agree.

  9. ““why should she be able to shield her assets?”

    I agree.”

    I do, too. The only qualification that I’d make is that, when it’s a couple, a financial split makes sense. That’s what my parents had my grandparents do, with the help of a lawyer, when my grandfather required nursing home care. So half the money could have been drained before Medicaid kicked in. As it happened, he passed on before it ever got to that point.

  10. There are 2 schools of thought re: the irrevocable trusts etc. to shield assets from Medicaid. One is, why wouldn’t I take advantage of the loophole that allows me to give assets away and then 5 years later qualify for Medicaid? The other is, why would I artificially make myself poor so that the taxpayers pick up the tab for my long-term care? Interestingly, in my firm, there is one person whose clients all think #1, and for the other few of us, our clients overwhelmingly think #2. I think the $1M-$2M clients (or the $600K ones!) are more likely to fall into the #1 camp.

    In another 10 years or so we may look into the hybrid products that are long-term care and life insurance. The basic idea is that you start with $1M (or whatever) of death benefit, then draw that down during life to pay for long-term care, so if you need $900K of care during life the death benefit would then be $100K. There should be a robust market for these as the boomers get older.

  11. Milo – both. Yes, the premiums would have been lower but also, as I understand it, the policies written then were more gerenous/all encompassing than what’s available now. I could be wrong about the last. In any case the cost of LTC was really high in our opinions and didn’t fit well with our financial picture at the time. To compensate we increased our retirement savings figuring as Rhett suggests we’ll be able to cash flow it ourselves.

  12. We have disability insurance for both DH and me. We do not have life insurance or LTC insurance. I am less worried now than when the kids were younger and we were just starting our careers and building our nest eggs.

  13. L — Interesting. I would have thought most clients would be in the ” why wouldn’t I take advantage of the loophole that allows me to give assets away and then 5 years later qualify for Medicaid? ” camp. There are other government policies and regulations and “loopholes” with which I may disagree but that doesn’t necessarily prevent me from taking advantage of them.

  14. Are you afraid of wiping out your savings? Yes, but we decided to have kids any way (and send them to private school).

    We have life insurance and disability insurance both through work and privately but have not considered LTC insurance. Our current cash flow is allocated to other more immediate priorities.

  15. My grandmother, who was very UMC for her time, and who had excellent retirement savings thanks to her husband who was good with financial stuff, came very close to running out of savings. She was in assisted living for many years – started at the lightest tier, but as she got more fragile, ended up in a tier that was essentially a nursing home. The facility did not do Medicaid, so if she had lived much longer, she would have had to move. My mom was very concerned about it. No one knows how old my grandmother actually was but we think she was 97 or 98 when she passed away. She did not have hardcore dementia but she was very frail and not completely coherent by that point. Anyway, it always worries me, because I can see how it might happen.

  16. L,

    Can you explain: Then the trust, which is common and legal, did not hold up to state scrutiny because of a problematic passage.

    Wouldn’t the attorney have some sort of fill in the blank form to use when dealing with someone who’s finances are so simple? It’s not like she had $10 million in aircraft leases in a trust in Lichtenstein or something. She had a house and $600k. What could possibly have gone wrong?

  17. July – a lot of our clients have $10M plus, so they’re definitely not worried about it at all. For those who might otherwise worry, a lot of it is control. You can’t control anything that you put into an irrevocable trust after it is in there, so that is a big deterrent.

  18. Rhett- it was probably some language saying that she could get principal distributions “in case of emergency” or something. You have to be careful in drafting and make sure that the donor has NO access to principal in any case. Most likely it was a lawyer who doesn’t do these trusts all the time, and so as a result the form was defective.

  19. L,

    Are their pre-printed forms or a software package that attorneys use to prepare these documents?

  20. “a lot of it is control.”

    This is FIL…trusts, bloodline only (to keep his money-grubbing, gold-digging sons-in-law* from getting anything that’s not specifically granted to them). Specific business and real estate holdings are in his daughters’ names, with instructions that the intent is “never” to sell. Anything that’s liquid that has not already been placed in trust for kids/grandkids, is in FIL & MIL names only. Any significant monetary gifts DW&I have ever received always come with strings “here’s $X,000; use it to buy a piano” (when getting/having a piano wasn’t on the radar).

    *of the three of us, there is one about whom this is an actual risk (of course, that’s not me).

  21. “with instructions that the intent is “never” to sell.”

    A man after my own heart.

  22. Rhett – it depends. Smaller firms usually have their forms on the system/in their files, but some may crib from online resources. Bigger firms have software that they use, but you have to pre-populate it when you purchase it with all your own language for all of the different possibilities (unless things have changed since the last time I used those).

  23. Well of course I’m worried about this, because we have already established that I excel at worrying about irrational worst-case scenarios. :-)

    I think the problem is that the two experiences I am most close to were bad ones. My great-aunt struggled to stay in her home with enough help, and the Medicaid places were atrocious. She ended up dying in a Medicaid place after a hospital stay because when she called for help, someone told her she was fine and didn’t give her her breathing treatment.

    Of course, I am not poor like she is, so that was easy to rationalize away. But then my stepdad got the Parkinson’s diagnosis at 55-60, and by 69 my mom was realizing he would soon need a lot of care and ultimately need to go into a fulltime care home, and that that need might last for another 20+ years (his mom had Alzheimers and had been in a home for 20 years before she died in her ’90s). And he didn’t have long-term care insurance. And since they were married, she would need to spend down both his savings and her own before he’d be eligible for Medicaid. And so since she is healthy as a horse and will probably live to 100, she was very, very scared of being left having to stretch out very little for another 20 years.

    Then again, my mom is the one from whom I inherited my ability to fret about worst-case scenarios that will never happen, so things probably weren’t nearly as bad as I thought when she was telling me about all of this. But of course what sticks with me is the emotion, the fear and insecurity.

  24. L,

    Good to know. I would have assumed with something so simple there would be essentially no risk of error. Obviously I was wrong.

  25. I am concerned about running out of savings because I saw how expensive and involved the care was for my grandmother from 85-99. My father is late 70s, and he has very high medical expenses. He still has insurance from his old employer. The good old days! He retired with insurance and a pension. My FIL spends a fortune on medical expenses, but almost none of his own money due to a generous medical plan from his last employer.

    My husband thinks we can fund whatever we need from our savings. I know he has no intention of retiring early, so hopefully we will have enough put away. We are not buying long term care now, so it’s all about the savings and staying healthy. More Pilates!

  26. I’m like LfB — I’m a worrier by nature. The fact that I have earned a living for the past 20 years by imagining worst-case scenarios (and then planning for them) only adds to my natural paranoia. So yes, DH and I have big LTC policies. They were a group benefit when I worked at BigLaw, and the policy followed me when I left (as long as I keep paying the premiums, we will keep the insurance). The peace of mind makes it worth it to me. Some years ago, I was having some weird neurological symptoms, and for a time it was feared that I had MS. During those extremely trying times when I was waiting for a diagnosis, the one thing that kept me from losing my mind was the knowledge that even if I did need long-term assistance with activities of daily living, there would be a steady stream of insurance money to pay the costs of my care.

    I also hope to leave an inheritance to my kids, so that also plays into my decision to have the LTC policies. If I were OK with the idea of having a zero balance at my death, then I might make a different choice.

  27. I agree with Rhett — the system worked exactly as intended. I don’t see the issues here. This woman got the care she needed, didn’t have to eat cat food, and her daughter and son-in-law did not have to quit their jobs and drain their own retirement savings in order to meet her needs.

  28. The point of the article is that the government is planning to cut Medicaid. So they’re pointing out that even middle-class people should worry.

  29. This is FIL…trusts, bloodline only (to keep his money-grubbing, gold-digging sons-in-law* from getting anything that’s not specifically granted to them).

    That’s how it was done in my family too. Mom seemed to think it was perfectly normal that Grandma’s trust left everything to Dad and then Dad’s issue. Of course once Dad inherited, he retitled everything in his and Mom’s trust, and then Sis and I were the beneficiaries. The hell with DH and Sis’s boyfriend.

    In my turn, retitled everything in my and DH’s trust, despite my attorney (who is DH’s partner) advising me not to. DH advised me not to as well. But screw ’em, I don’t think DH will rip me off. Not and live long, anyway. And then our trust leaves it all to DSS, and not the DIL, because what if they get divorced? I figure DSS can do what Dad did and then what I did if he wants. Also it’s not like DIL’s parents are going to let her starve. Did I mention her father decided to postpone retiring for a year because he’s getting a million dollar commission from the renewal of some sale he made a few years ago? Yeah. She’s not going to starve.

  30. Some shades of this is going on at our house. In laws have a bank balance, don’t have their own house – so don’t qualify for Medicaid. They haven’t paid into the system so don’t qualify for Medicare. If something were to happen to either of them, they would have to spend their savings before they could get Medicaid help. They aren’t necessarily thinking their kids should inherit but they see their savings as sort of the last resort and beyond – it is about maintaining some semblance of independence.

  31. My MIL went through this with her mom. Sell the house, spend down the assets, document everything to a penny… And MIL and FIL still had to pay ~$10k per month out of pocket to keep things going between asset spend down and Medicaid.

    I think about this with my parents – but neither owns a home, and are so low on the totem pole that Medicaid will kick in probably the first month or two of nursing care. I don’t anticipate to inherit anything from either of them.

    I always worry about running out of savings – but like Kerri, I had the kids anyway. And we need a new car. My assets are tied up in food and shelter.

  32. Why should middle class folks worry? Honestly, I don’t get it. You save what you can, take care of your health, and if you lose the dementia lottery, then that is what Medicaid is for. The facilities that accept Medicaid may not be as nice as private-pay, but they will meet your basic needs. It is likely that cuts in the growth of Medicaid will focus on the expansion population (younger, able-bodied non-parents) rather than poor old people in nursing homes anyhow.

  33. “It is likely that cuts in the growth of Medicaid will focus on the expansion population (younger, able-bodied non-parents) rather than poor old people in nursing homes anyhow.”

    Which will just distort Medicaid even more. It is supposed to be a program for poor younger people, not a program for longterm care for what are really middle class people. Longterm care for the elderly should be part of Medicare.

  34. MM,
    What difference does it make to the bottom line whether the nursing home bill is paid by Medicare or Medicaid?

    And in any event, when an elderly middle-class lady has exhausted her resources, she becomes a poor person in need of Medicaid. What distorts Medicaid is expanding coverage to non-disabled, non-poor working-age adults.

  35. “The point of the article is that the government is planning to cut Medicaid.”

    No they’re not. At most, they’re planning to slow the growth, which absolutely needs to be done, regardless of what bill passes. And that won’t hit old people and children.

  36. Because if we fund things rationally, it is easier to figure out where taxpayer money is going, and to design good policy. I honestly think that one issue with our healthcare system is the crazy way funding streams get mixed up. It leads to policy distortions, and in some cases, paying too much.

  37. Non-poor is your definition. Basically, Medicare was supposed to be for healthcare for the over 65 set, and Medicaid for the under 65 set that couldn’t afford healthcare. The definition of who can’t afford healthcare might shift around, and certainly it shifted in a dramatic way under Obama, but that expansion still conformed to the original idea – healthcare for under-65 who have trouble affording healthcare.
    Longterm care for the over 65 set should be part of Medicare. Most people have no idea that paying for elderly people is such a big part of Medicaid, and that influences their opinions and votes on Medicaid.

  38. Well, Rocky’s link is pretty informative.

    “Even in deep-blue Oregon, Democratic lawmakers recently suggested ending the state’s Medicaid expansion to 350,000 people in an effort to close a $1.6 billion, two-year budget shortfall.”

    It’s beyond a matter of right-left politics. There’s just not enough money there.

  39. How many people are like this lady ? Is she an outlier or the norm ? I would have thought $600k was more than enough for a single person.

    I have LTC insurance that is no longer accepting new people. It wasn’t much money from my paycheck every month, seemed like a good idea.

  40. There isn’t enough money because so much of Medicaid goes to formerly middle class elderly people. That is why we need to put longterm care for the elderly back into Medicare, so people can rationally assess how much money it takes to fund various populations and needs.

  41. “I would have thought $600k was more than enough for a single person. ”

    So, at MMM’s 4%, it’s $24k. Plus maybe $30k in Social Security?, and sure, it’s enough at $54k to live on.

    Is it enough to ensure that you never have to spend down the principal given the relatively unlikely scenario of extended nursing home care for dementia? No. Not it’s not. So be it.

    The part that seemed a little bit off to me was I thought that the thesis of the article was “give serious consideration to LTC insurance.” But this woman DID have a policy, except it only covered three years of the nursing home. What a shame! Their primary example would have been much better off having no LTC insurance, and she could have taken her kids on a luxurious cruise every with the money she wasn’t spending on premiums, and she still would have finished in the exact same place.

    I’d like to take a red pen to that article and write “Example contradicts thesis.”

  42. L – could you provide some online personal shopping assistance? I’m not a regular poster, but I lurk often and have gained a lot of helpful information from this site. I was recently invited on a business trip to Europe with my direct boss and the CEO of our company. I am an in-house attorney for an investment company. My typical dress is business casual, but I need to do better than that for this trip – probably not a full business suit every day though. The solution may be dresses, but I am not having luck finding anything that seems right. Everything right now seems too casual. The trip is still several weeks away (early Fall), so I have some time. I went back and read the recent post for tips for travel to Europe. It’s been over 20 years since I’ve been to Europe! I’m early 40s, borderline petite (just under 5’4”), size 2/small, traditional/classic style. I cannot wear v-necks. I’d appreciate any input! And if anyone can give some information as to what European women wear for business dress, that would be great too!

  43. , they’re planning to slow the growth

    If the number of people in nursing homes grows by 30% and you don’t increase spending by 30% but rather increase it by 15% or 5% or 0% – what do you think is going to happen?

  44. As a retire and rehire employee, I no longer have disability insurance through my employer. But, I still carry as small policy that was originally designed to cover the gap between my disability pay and my former wages. In my current status, it will just pay out the minimum unless I go to work somewhere else and am covered by that employers disability policy. I have a tiny life insurance policy (comes with my retirement) that was designed to cover burial costs, but is has no COLA so it is woefully inadequate to bury someone. I also have a larger life insurance policy, mainly because of the kiddos.

    Like LfB – I took out a LTC policy ages ago. The initial premiums were a bit larger, but it has a COLA on benefits.

    Sorry to disagree, but reducing the growth of Medicaid reduces the total dollar available to be spent across more people. Someone is not going to get the same level of care they received in the past. Sounds like a cut in sheeps clothing.

  45. “And if anyone can give some information as to what European women wear for business dress, that would be great too!”

    Belle- I was recently in Europe on business. A full business suit would be appropriate but you’d most likely be erring on the more formal, conservative side. My European colleagues typically wore (nice) business casual during the day and something more formal or more appropriate for the evening at night.

    I do not have the knack for finding business casual that is stylish on me (and I hate dresses) so I wore suits.

    L should definitely be able to assist.

  46. Looking at European female politicians, it seems that pant suits are appropriate.

  47. Also, which country? Professional women in northern countries like the Netherlands or Sweden or Germany tend to practicality, whereas professional women in France and Italy tend to be a bit more chic.

  48. It’s not my definition of non-poor but the government, which determines official poverty levels. The Medicaid expansion made non-poor people eligible.

  49. “I would have thought $600k was more than enough for a single person. ”

    On average probably yes, but she spent more time than average in nursing care. She spent 5 ½ years in a nursing home and some time before that in assisted care. So let’s estimate 8 years total. $600,000 today pays for about 4.5 years of nursing care.

    OTOH, my very rough calculation shows that $3 million will cover 22 years of nursing home care, way beyond average.

  50. Their primary example would have been much better off having no LTC insurance, and she could have taken her kids on a luxurious cruise every with the money she wasn’t spending on premiums, and she still would have finished in the exact same place.

    On the other hand she’d be in the nice nursing home for the first three years and by the time she was moved she’d be too far gone to notice or care vs. starting off a the shitty nursing home.

  51. She could still have started off at the nice nursing home, just spending down the principal at that point rather than relying on insurance payouts. And, if I’m not mistaken, I thought a lot of nursing homes have a policy that you won’t be kicked out if you have to switch over to Medicaid.

  52. Fred – We are going to NYC this weekend for the Patek show (I was invited to a private closed reception for watch collectors. I have a rare steel one from my birth year – not of great monetary value, but highly regarded among the cognoscenti) Another night we are also going to celebrate the 75th birthday of DH’s sole remaining relative – the sort of New Yorker who doesn’t travel – a cousin (his sister was the one who died recently). These fellas don’t do much to maintain contact, but the recent untimely death has softened them up. And I got DH tickets right behind home plate for a Rockies/ Mets game. His vintage wool baseball cap is beyond saving from sweat, so he needs a new one.

  53. Thanks for the input so far. I like the Talbot’s dresses, but am unsure about short sleeves. I’m from the south and think I might get cold in the Fall in Europe. High temperatures projected for mid-60s, which in my frame of reference is cool. Planned stops probably in Luxembourg, UK, and maybe Malta? Details aren’t nailed down yet. Definitely not France or Italy though.

  54. The arriving $15 minimum wage in Oregon combined with the reduction in Medicaid spending (which includes quite a bit of nursing home care) should be a fun train wreck to watch.

    Childcare costs are increasing dramatically with the annual increases in minimum wage. I read that one of the side effects of the increase in minimum wage in Seattle is fewer children in licensed childcare centers. Oregon mandates a 1 adult/3 infant ratio and a 1 adult/4 toddler ratio in licensed childcare. The childcare funding for eligible working parents tops out at $546/month for an infant in full-time center care and $619/month for the enhanced rate maximum (not sure what that is) in my zipcode.

    Not sure how $15+/hr for full time infant care, $546/month reimbursement and a 3:1 ratio work together. (That excludes building/utilities/director costs)

    Economists: 1
    Progressives: 0

  55. Belle – with those temperatures and being from the South, a pant suit may be the most comfortable. You can do mix and match pieces, different jackets and shells.
    If you go to a big department store, a stylist/shopper can assist you. Even smaller boutique saleswomen have been helpful to me.

  56. I thought a lot of nursing homes have a policy that you won’t be kicked out if you have to switch over to Medicaid.

    I heard they go over you finances with a fine tooth comb before they’ll agree to that.

  57. I am kind of laughing at this discussion along with the info about the Patek show.

    I’ve mentioned before the lady I knew who’s husband owned a successful business that he eventually lost. The stress of which killed him. His widow lived in comfortable if vastly reduced circumstances for many years by slowing selling off her jewelry. An argument can be made for keeping a little something in a form not an index fund.

  58. “I heard they go over you finances with a fine tooth comb before they’ll agree to that.”

    As well they should.
    But if you have truly exhausted your savings, a wide tooth comb will be sufficient.

  59. The risk, as LfB alluded to, is that one of a married couple gets early dementia or a stroke and requires years of round the clock care that leaves the survivor with very little left over for his/her own final years. The LTC benefits from older cadillac policies helped with that. The three year max capped policies you can buy now just extend the time a bit before exhausting the savings. I consider it to be wrong to set up trusts just to preserve a modest inheritance for the kids at taxpayer expense (and there is usually one janey on the spot who gets the same share as the ones whose lives and finances were not impacted by the decline).

    I don’t worry at all about outliving my money, and I don’t have much by L’s practice standards. Any inheritance would be split between 4 kids and 3 for the present grandkids – not life changing even if I croaked tomorrow, much less in another 20 to 25 years.

    Most private nursing homes have limited Medicaid slots, and they check the finances to make sure you are full pay for x number of months before Medicaid kicks in. The state will attach a lien to the home of elderly Medicaid recipients, and after the second to die spouse vacates it, it will recoup some of its costs from the proceeds.

    2400 dollars a month for memory care sounds like third world prices to me. It would 4 times that at least in eastern Mass.

  60. Meme, my children can put me in memory care in either Sheffield, Iowa, or Pierre, South Dakota. Both facilities are very nice. And if I have any faculties left, perhaps I’ll realize I should go for a walk during a blizzard in Pierre.

  61. This is somewhat related in that I’m trying to improve my odds for maintaining good health in the long term.  But mostly I’m on a mission to improve my balance in hopes of being successful in trying out SUP.  I was surprised (well, not really) at how difficult I found these two exercises.

    One-Legged Squat Reach and Pendulum

    I’m sure many of you yoga/Pilates/other YOUNGER fitness enthusiasts have no problem with these.  I will try to be diligent with daily practice and see if I can improve my balance.  I’m also standing on one foot whenever I think of it.  One thing I noticed was a considerable difference between left and right legs when trying to maintain balance.  Anyone have other tips/exercises for improving balance?

  62. “I also hope to leave an inheritance to my kids”

    I don’t.

    I hope to live long enough to see my kids become fully self-sufficient and give me grandkids. I hope any inheritance I leave goes to my descendants separated from me by at least two generations.

  63. One of my friends is moving her mom from a rehab nursing home place on the upper east side to assisted living on the UES – NYC. The price she received today from a nice, but not luxurious assisted living place was $6,000 a month. This actually isn’t a bad deal in NYC when you consider that it includes meals and all utilities except cable. The reason it is expensive for her mom is that she will be leaving a rent controlled apartment in the west village. No doorman, elevator building, 900 square feet and she pays $1370 a month because she has lived there since the 70s. She can’t go back there because there are steps to get into the building, and two steps in her apartment.

  64. “I was recently invited on a business trip to Europe with my direct boss and the CEO of our company.”

    Just wondering, are your direct boss and your CEO one and the same person, or two separate people?

  65. “One is, why wouldn’t I take advantage of the loophole that allows me to give assets away and then 5 years later qualify for Medicaid?”

    I can think of four reasons:
    -Losing the cost basis step-up for those assets.
    -Increasing EFC for kids going to college.
    -Losing control of those assets.
    -Not wanting to be a burden on taxpayers.

    “In another 10 years or so we may look into the hybrid products that are long-term care and life insurance.”

    Why in 10 years, and not now?

    My parents had a hybrid product. I don’t know the details, but they each put $50k into the product. My mom never needed LTC, so her estate got a little over $60k when she died (I think they’d bought the product at least 10 years before she died). My dad did need LTC, so it paid for much of his LTC.
    Are you familiar with this or similar products?

  66. “The risk, as LfB alluded to, is that one of a married couple gets early dementia or a stroke and requires years of round the clock care that leaves the survivor with very little left over for his/her own final years.”

    That’s why some couples get divorced. Government benefits are a major factor in a lot of marriage/divorce decisions for older people.

    “The state will attach a lien to the home of elderly Medicaid recipients, and after the second to die spouse vacates it, it will recoup some of its costs from the proceeds.”

    I think this policy makes a lot of sense. I’m guessing that for many boomers, much of their net worth is in their homes, and this is a humane way to tap that.

  67. 2400 dollars a month for memory care sounds like third world prices to me. It would 4 times that at least in eastern Mass.

    Yeah, that sounds awfully cheap for a decent memory care facility, even out here. My great aunt spent her last 6 months or so in an Alzheimer’s facility in Manhattan about 10 years ago, and it was $9,000 a month. Obviously that has the NYC price tag, but still.

  68. I also hope to leave an inheritance to my kids

    My grandfather always told us he wanted us to enjoy his money while he was alive to see it rather than have us inherit it after he died.

    Ideally our kids (or grandkids or whoever) will inherit just enough to cover our funeral costs and whatever other expenses need to be taken care of. I’m with Grandpa – I want everyone to enjoy the money while I’m alive to watch.

  69. “A nursing home more towards Albany is $308/day or a little over 9k a month or $108k a year.”

    Seems about right. My uncle’s LTC facility cost about $10k/month.

    DW and I have LTC insurance, but as our asset levels have increased, we’ve decided to turn down the options to increase coverage and self-insure the increase (existing coverage still seems a good deal, due to our premium payment history).

    OTOH, we might need to revisit this decision as we pay DS’ school bills, and even moreso if DD gets into a similar school.

  70. “I’m with Grandpa – I want everyone to enjoy the money while I’m alive to watch.”

    Me also, but the spectre of LTC costs and our conservative approach to finances make it statistically probably that we will leave an inheritance.

  71. “I thought a lot of nursing homes have a policy that you won’t be kicked out if you have to switch over to Medicaid.”

    Not the facility my grandmother was at. They would have kicked her out pronto.

  72. “What difference does it make to the bottom line whether the nursing home bill is paid by Medicare or Medicaid?”

    Scarlett- not entirely sure what you meant by this, but Medicare won’t pay for nursing home care. They will pay for up to 100 days of rehab in certain circumstances, but not for “getting old, need help, need a facility” kind of care. Also, if you break your hip, go into rehab, you may be told to go home or switch to private pay after a few weeks – the 100 days is a limit not a minimum; if you only require “custodial care” you will no longer qualify. I had a recent breakthrough in understanding that “custodial care” (which is never covered by Medicare) is the same thing we provide for babies – cleaning, feeding, keeping safe.

    Interesting discussion. I doubt my parents will run out because they have good cash flow and live in a low COL area. If they do, so be it. One grandparent (the wealthiest of the four) ended up on Medicaid because of 3-4 years of falling for every telephone and mail scam, depleting his robust nest egg. It’s tricky to spend a life being smarter than everyone in the room and then spend 10 years not being clever, but not realizing this. .

  73. In checking quotes here against an onsite estimator I see quite a variation.

    Manhattan UES “The price she received today from a nice, but not luxurious assisted living place was $6,000 a month. “

    Estimator: $1,442/month

    “A nursing home more towards Albany is $308/day or a little over 9k a month or $108k a year.”

    Estimator: $132,000/year

    I would say a couple of things:
    Assisted living facility prices could range sifnificantly depending on services and level of luxury.
    NYC, and Manhattan specifically, is a whole other world for price variation.

    https://www.genworth.com/about-us/industry-expertise/cost-of-care.html

  74. Ada,
    I know that Medicare doesn’t cover nursing homes. My question was why MM was advocating for moving the Medicaid nursing home program over to Medicare. Ultimately, the taxpayers are paying the bill and it’s unclear why the substance of the coverage would be changed under her proposal.

    In any event, there are fewer than 1.5 million nursing home residents at this time (by comparison, there are more than 10 million Americans over age 80), and average length of stay seems to be under two years (numbers are surprisingly hard to find). We can all think of people who had a stroke or contracted dementia at an early age and spent many more than 2 years in nursing homes, but they are outliers. (We can also probably think of people who died within months of entering a home.)

    Even if the percentage of the elderly who need nursing home care doubles in our lifetimes, that’s less than 20% of that age cohort. Most seniors will never end up in one.

  75. “You can deduct healthcare expenses above X% of income.”

    Are LTC expenses considered to be medical expenses that are deductible? If so, that’s inconsistent with Medicare not considering them to be medical expenses, and thus not covering them.

  76. One grandparent (the wealthiest of the four) ended up on Medicaid because of 3-4 years of falling for every telephone and mail scam, depleting his robust nest egg. It’s tricky to spend a life being smarter than everyone in the room and then spend 10 years not being clever, but not realizing this.

    It’s a huge problem.

    https://www.google.com/amp/s/mobile.nytimes.com/2017/01/06/world/asia/i-thought-i-was-impervious-to-scams-readers-denounce-indias-phone-swindlers.amp.html

    And there often isn’t anything you can do.

  77. Finn,

    According to the 1996 Health Insurance Portability and Accountability Act (HIPAA), “long-term care services” may be tax deductible as an unreimbursed medical expense on Schedule A. Qualified long-term care services have been defined as including the type of daily “personal care services” provided to Assisted Living residents, such as help with bathing, dressing, continence care, eating and transferring, as well as “maintenance services”, such as meal preparation and household cleaning.

  78. And in other news, the flash flood overwhelmed the storm drain along the back of our townhouse block and we have six feet of very wet carpet.

  79. I do worry about this. We have a family history of Alzheimer’s and I have an aunt who had early-onset. My sister and I always hoped there would be better treatment by the time we were older, but it appears time is marching on. I read the article over the weekend, and it seems to me the $600k was referenced as being from the late 90‘s. It made me worry about how adequate my nest egg will seem 20 years after I retire.

    I identify very much with LfB and will probably always worry about running out of money. WCE raises a good point, my kids could plant me back in my small-town hometown and save everyone a bunch of money.

  80. And in other news, the flash flood overwhelmed the storm drain along the back of our townhouse block and we have six feet of very wet carpet.

    Ack!

  81. Well, DD can sleep on the sofa tonight and then in our bed upstairs for three days while we are away. It won’t be all dried out by Sunday night, but we’ll cross that bridge then. However, as soon as she moves out, the piano is going into temp storage and we will redo the basement floors. I am considering polished concrete or that really nice garage finish some of my friends have. These floods are out of my control. I have a giant area rug that will cover it nicely and can be rolled away from any future flood.

  82. “for people like Rita Sherman who lead healthy lives for three-quarters of a century, it is often their brains that give out first, not their bodies. ”

    I think this is a bigger fear than running out of money. I can do something now to prevent running out of money, but I don’t know how to prevent my body from outliving my brain. OK, well, I could do something along the lines of what WCE suggests; that is how some societies have addressed this issue.

    I suppose at some point– maybe 80 or so??– I could stop taking medications and start indulging myself in foods I’ve been avoiding due to their supposed negative impact on my health.

    OTOH, if I have grandkids by then, I might want to stay as healthy as possible to help with their care.

  83. I don’t know how to prevent my body from outliving my brain

    Oh there is a way. And if you get them on sale at Bass Pro Shop they’re only $0.21 each. If your lucky you only need one. Although I’m more of a nice barbiturate smoothie kinda guy.

    And with the stories of the incontinence and the bed sores and the night terrors and the violence. Do you really want to spend $100k a year keeping that going?

  84. Rhett, I’ve been thinking the same thing through this whole discussion. My grandmother had enough lucid moments to know she was losing it, and it scared her to death. She would frequently say that she had a long, wonderful life but she was ready to join Bill (her deceased husband), and would ask why God wouldn’t take her. (Not in a self-pityng way -she was just eminently practical). If I hit that point, I intend to address it.

  85. “And there often isn’t anything you can do.”

    Well, I always take these calls, or call them back and keep them on the line as long as possible with false names and promises to buy the iTunes gift cards. My dad does the same thing, but, unfortunately, MIL with early stage dementia gets calls like these and falls for them. And so do some of my dad’s fellow retirement community residents. I have asked the powers that be there to schedule a talk with everyone to warn them of these scams.

  86. “Do you really want to spend $100k a year keeping that going?”

    No.

    “on sale at Bass Pro Shop they’re only $0.21 each”

    Don’t you need a delivery mechanism?

    CO doesn’t seem unpleasant.

  87. Belle – I am not sure re: business dress in Europe but I would probably try to go for dress + blazer or a pantsuit, then you can take the jacket off with either one if you end up being too dressy. With petites I might go to a personal shopper at Bloomie’s or Nordstrom if you are near one of them – they will be able to pull things that don’t need too much alteration. You could also try Boden but I find sometimes their collars are harder to do a blazer over. http://www.bodenusa.com/en-us/womens-dresses/smart-day/j0039-red/womens-post-box-red-marisa-ottoman-dress

  88. Me also, but the spectre of LTC costs and our conservative approach to finances make it statistically probably that we will leave an inheritance.

    Of course it’s almost impossible to allocate the money perfectly.

    Not the facility my grandmother was at. They would have kicked her out pronto.

    They can’t kick someone out if they don’t have a place to go.

    In any event, there are fewer than 1.5 million nursing home residents at this time (by comparison, there are more than 10 million Americans over age 80), and average length of stay seems to be under two years (numbers are surprisingly hard to find).

    But the issue isn’t just nursing home level care. There are millions (I don’t have a cite for an exact number) of people who live in assisted living facilities or have significant in-home care. And the two year stays in a nursing home is an average. I know quite a few people who have been in a nursing home for 5-10 years.

    WCE raises a good point, my kids could plant me back in my small-town hometown and save everyone a bunch of money.

    But would you really want to live out your final days/years with no family around?

    I can do something now to prevent running out of money, but I don’t know how to prevent my body from outliving my brain.

    According to the studies, exercise is the best thing you can do for your brain. Keep the blood flowing to it.

    Oh there is a way. And if you get them on sale at Bass Pro Shop they’re only $0.21 each. If your lucky you only need one.

    You better be lucky, because you don’t get a second chance if you miss. I have a patient who missed, and he’s somewhat functional, but he doesn’t have a nose and gets all his food through a tube.

  89. When I searched for “Geschaeftsfrau Kleidung”, the German-language sites that came up all used the phrases “dress code” and “business casual”

  90. Meme, I hope the info I left you on the other page about a tour with your husband was helpful to you.

  91. “If I hit that point, I intend to address it.”

    That’s what everyone says now. Seems the vast majority have a change of heart.

    I remember reading some book about Adams and Jefferson. Maybe it was just McCullough’s “Adams.” Supposedly, the two of them, who both, like us except with greater justification, fancied themselves superior intellectuals, shared their great fears with each other of their bodies outliving their brains. In the end, their fears were unfounded — their bodies were definitely shutting down and crippling them physically as their minds remained as lucid as ever.

    It’s just life. It’s going to end one way or another. I’m regularly amazed at the degree to which some people on here overestimate their control of the outcome. Recently, a father from my kids’ school died of brain cancer. I’ve already lived longer than he did, so rigjt now that alone seems lucky.

  92. ” I always say that the people who most want to be 92 are the 91 year olds.”

    Except for the 91 year old lying in a bed in a distorted position because he’s lost control of his body and he’s unable to move. He can’t talk only moan, and it’s unclear how much he’s able to understand and how much he’s suffering. I doubt he wants to be 92. As I think was mentioned, the timing of addressing this situation may be the biggest challenge.

    That Boden dress is exactly my style, but I don’t need it and it wouldn’t fit me like it does that 6 ft, 110 lb. model. :)

  93. And come to think of it, that “91 year old” may have lived many years in that horrible state precisely because he was so darn healthy and his body did not give out completely. Maybe if he had taken less care of himself, and had a weaker heart and lungs he would have died sooner. Ironic?

  94. While there are people like you describe, feeding tubes in the elderly have really fallen into disfavor. Which means if you don’t eat, you die. So there are very few people who live for long periods of time with no control of their bodies.

    The much more common scenario is the mildly demented woman who is happy to see family and watch tv, needs significant help with toileting and hygiene, only wants to eat fruit loops and coffee and cannot safely be left alone. That 91 year old is eager to be a 92 year old.

    I had a patient in late 60s the other day that wanted some advice about whether he should have some surgery. He was functional, but had a few heart attacks and a laundry list of other medical problems. I stated that if the surgeons thought is should be done, sooner is probably better than later. I can’t remember exactly how I stated it, but I mentioned that we could hope for 30 more good years after the procedure. He was clearly pissed that I implied he would only live to the ripe old age of 97.

  95. Interesting about feeding tubes falling into disfavor. The “91 year old” I’m thinking of did not have a feeding tube. He could still swallow soft food. A couple of years ago a relative was given the choice to use a feeding tube for his 90-something mother who I believe was immobile and unaware after suffering some heart issues. The children disagreed among themselves but ultimately decided against a feeding tube.

  96. Speaking of suicide and (previous discussion) schizophrenia, I saw on a tabloid website that one of the identical twin actors who, in 1989, played Sigourney Weaver’s baby, Oscar, in Ghostbusters II (whom Bill Murray diapered with a sweatshirt), recently killed himself after long suffering from mental illness. And he was John Denver’s nephew.

  97. @SM – I posted this yesterday on July 11 thread. It was helpful.

    Thanks for all your discussion on the other thread about the Tauck model. I owe you a travel agent commission. I could never figure out why their tours were a) so expensive and b) seemed to be not what I wanted despite the great itineraries and selection of attractions. Now I know that they are unsuited to us as a couple.

  98. “The much more common scenario is the mildly demented woman who is happy to see family and watch tv, needs significant help with toileting and hygiene, only wants to eat fruit loops and coffee and cannot safely be left alone.”

    Well, if that’s the worst-case scenario, that doesn’t exactly suck (at least for me). Just give me my fruit loops and all the chocolate milk I want and hand me the clicker.

  99. On the topic of losing control of your care when you can’t speak for yourself. The key is to trust at least one of your kids or someone else of your choosing and make him/her your legal and medical proxy/POA. Document your views. However, some people just have strong constitutions. You can have no treatment for pneumonia and still survive. And although WCE joked about wandering away from a facility in a blizzard, you really wouldn’t want people to lose their jobs over it (and by then they will be putting a tracker chip in your arm upon admission anyway).

    I know my husband will want to live as long as he can still play cards. Given his weak heart, he is unlikely to survive in a vegetative state or live into his 90s even with his resident “home health aide.” I trust my girls to make the best choices for me.

  100. I suppose at some point– maybe 80 or so??– I could stop taking medications and start indulging myself in foods I’ve been avoiding due to their supposed negative impact on my health.

    I have a friend who started smoking again when she turned 70, because fuck it.

  101. Ada/DD – is there more awareness and acceptance of the end of life stage than there was before ? Or more frank discussions by doctors on what can be realistically done and the quality of life the family can expect for their loved ones ?

  102. Louise, in Colorado, every person moving in to a nursing home or assisted living needs to fill out a scope of treatment form (or their POA if they are unable). It asks if they want CPR, or other treatments such a a feeding tube. Most of the time, the staff just has them do it as part of the admission paperwork, so there isn’t too much of a discussion, but at least they have to think about it on some level. When I do the forms with patients and families, I explain very clearly why DNR is a much better way to go. Basically, CPR is unlikely to be successful on the the elderly, and even if it is, the life expectancy following it is only about 3 months and that will be spent in significant pain from a bunch of broken ribs.

    There is definitely more awareness of end of life issues, and among my patients, there is a good trend toward not wanting to extend life at all costs and to go peacefully when it is time. It’s family members who are more inclined to want to do “everything possible” than the patients. The patients are pretty accepting that their time is coming.

    The much more common scenario is the mildly demented woman who is happy to see family and watch tv, needs significant help with toileting and hygiene, only wants to eat fruit loops and coffee and cannot safely be left alone. That 91 year old is eager to be a 92 year old.

    However, in my experience, the 91 year old who is fully aware of her situation is much more likely to be ready to go and does not want to spend years living like that.

    I have a friend who started smoking again when she turned 70, because fuck it.

    If she smoked long term when she was younger, she’s right. The damage is done. I have several patients with COPD and other issues who started smoking again. Why the hell not – it makes them happy and it calms then down. As long as they remember to leave their oxygen tanks inside when they go out to smoke, it’s not going to hurt them at this point.

  103. Belle – LMK if you need further suggestions. I don’t usually shop in petites so am not sure which brands are better. :)

  104. You better be lucky, because you don’t get a second chance if you miss.

    That’s why the pure nitrogen option looks like the best bet. Or sky diving without a parachute. Then again there is someone who had a parachute fail but hit a deeply plowed field and survived.

  105. From S&M’s post – this has to be the most seriously hideous outfit I have seen in a long time. It looks like the model tried to squeeze into an outfit sized for an 11 year old.

    I was just in Bologna, which is a very fashionable city, and saw nothing like that. Older women that I saw in work clothes seem to tend to the slightly avant garde, which isn’t surprising since it is a university town. I saw a lot of women in lineny, Eileen Fishery, type outfits, and also a lot of straight skirts that went to just above the knee, with sandals. It was very hot. There were also German and Swedish women at my conference, and they were well dressed, more than an American female academic would be.

  106. ” I always say that the people who most want to be 92 are the 91 year olds.”

    Is that somewhat of a selection bias issue? I’ve heard that if it’s your time that last thing you want to do is go to the ER. Maybe you don’t see the ones who are happy to check out?

  107. All this talk of ending it is pretty unrealistic. Most people fail slowly, and it is hard to recognize when things won’t get better, plus there are always family members involved. By the time you aren’t enjoying things any more, you won’t have the cognitive capacity or the strength to do things like jump out of a plane.

    I think the more common approach is what both my father and FIL took, which was simply to not elect aggressive treatment towards the end of life. But neither of them had dementia.

  108. @ Belle – I would just add – remember your client is your CEO, not the folks you are visiting. You want to wear something that projects authority/expertise/knowledge/general I-have-my-shit-together-and-am-generally-fabulous to him or her, and it doesn’t matter what the locals are wearing.

  109. and it is hard to recognize when things won’t get better

    Is that really the case with an initial diagnosis of dementia? Does it get better?

  110. Lark – I totally agree! I view this trip as an opportunity to increase my standing in his view.

  111. Yesterday – I saw a woman in a navy blue skirt suit with red peep toe heels. She looked very smart and the whole look just worked for her.

  112. Not that I recommend Belle wear red heels on her European trip :-), just my observation.

  113. I’m not the red peep toe heel type – that would require maintaining a pedicure ;-) ! But I do have a nice navy skirt suit that will be making the trip.

  114. I think the urge to carry on is stronger than we realize (with the obvious exception of profoundly depressed, suicidal people). Perhaps that is the magic of being human.

    I don’t see lots of end of life care in my current position, so I don’t think there is a lot of selection bias. Today I saw a septuagenarian who came in for a minor complaint, but was transplant listed for an organ. Kind of blows my mind – the idea of going through such invasive surgery at that age, prolonged recovery, uncertain outcome. I bet she would really like to become a mildly demented 92 year old, I suppose. I recently had a patient with severe COPD on home oxygen at a pretty high level (which is indicative that he had months left to live). He was fairly young (<70) and had intact mental capacity. In talking about his illness, he kept saying, "if I die" or "if this gets worse". I thought about having an end of life conversation with him, but he was not ready to accept his mortality.

    I do meet people who have planned well for death and will not be in the hospital for their last moments (probably and hopefully). However, those people are few and far between. I also get the impression that they would transplant list themselves if they thought it would do any good.

  115. “Is that really the case with an initial diagnosis of dementia? Does it get better?”
    People always hope. Or at least hope it stays stable.

    I overheard a conversation when I was waiting to see a doctor about a year ago (yes I know overhearing a conversation violates HIPAA but it happens all the time in medical facilities). A lady who sounded older, was being prescribed one of those drugs that *might* slow down Alzheimer’s. The doctor was telling her that she had to avoid alcohol while on it. The lady was protesting that she just liked a glass of wine in the evening when eating with her husband. She was told firmly that she had to give that up, and she seemed not very pleased about it. The thing is, she sounded completely lucid, and was just voicing her opinion which seemed rational to me. She must have been at a point in the Alzheimer’s process where she was still happy with her life and not wanting to give up a small pleasure. I doubt she would have been considering suicide at that time. But by the time she gets to the point where she can’t enjoy being with her husband, maybe because she no longer recognizes him, it will be too late to make those decisions. The process is gradual.

  116. Rhett,
    Dementia is a progressive but unpredictable disorder. Our experience with MIL, and the anecdotal accounts from friends suggest that the mental deterioration is often extremely gradual, with relatively long periods of relative lucidity/normality interspersed with increasingly frequent episodes of confusion and agitation.

  117. L, it isn’t the skinny suit per se – it is the extremely poor fit. I don’t think I have ever seen one in real life with such a shrunken jacket. It doesn’t suit the proportions of the skinny pants at all,

  118. “The thing is, she sounded completely lucid, and was just voicing her opinion which seemed rational to me.”

    In brief interactions, especially with relative strangers such as medical personnel, MIL can seem completely lucid too. But if that person returns in 30 minutes, she will have *exactly* the same conversation, with absolutely no memory of the earlier interaction.

  119. July – I’m responding to your 4 pm post yesterday on tips for improving your balance. When I brish my teeth, I stand on my left foot in the morning and my right foot in the evening. After my balance improved, I started closing my eyes. It not only provides entertainment for my family, it has definitely improved my balance. I picked this tip up a couple years ago from a book by Gretchen Reynolds “The First 20 Minutes: How we can exercise better, live longer…”

  120. Is that really the case with an initial diagnosis of dementia? Does it get better?

    No it doesn’t. You’ll have better days and worse days, but it will be a continual progression. There are meds that have been shown to slow the progression, but nothing yet that can stop it or reverse it.

    I do meet people who have planned well for death and will not be in the hospital for their last moments (probably and hopefully). However, those people are few and far between.

    As Rhett said, when you work in the ER, you don’t see the people who don’t go to the ER. I have seen quite a lot of people who have made end of life plans – and stick to them – and don’t go to the hospital. To throw out the obvious – all the people on hospice don’t go to the ER when they take a down turn.

    The doctor was telling her that she had to avoid alcohol while on it. The lady was protesting that she just liked a glass of wine in the evening when eating with her husband. She was told firmly that she had to give that up, and she seemed not very pleased about it.

    I don’t understand when providers tell people this. If someone wants their daily wine, let her have it. (With the caveat that they are supervised so they won’t get drunk and fall, etc.)

  121. “I don’t understand when providers tell people this. If someone wants their daily wine, let her have it”

    It sounds like she wanted the doctor to tell her that she could have her daily wine and it would not significantly interfere with the efficacy of the medication.

  122. People always hope. Or at least hope it stays stable.

    That’s just foolish – it’s not going to stay stable and sure is hell isn’t’ going to get better.

  123. thank you seattlesoccermom — That’s a great tip and I want to get to the point where I can close my eyes and easily keep my balance.

  124. I think it was some kind of interaction with the medication. I didn’t see the people – I could just hear them from the other exam room.

  125. Most providers are not very knowledgeable about medication interactions and so CYA. The studies probably categorize drinkers of 5+ drinks daily with people who drink one drink daily, and the actual effect of 1 drink/day on medication efficacy is not considered, just “Don’t drink”. If estimates/judgements by providers didn’t have legal effects, medication compliance rates might be better.

    I remember arguing with a nurse practitioner about whether I had to wean because a hormone would get into my breastmilk and potentially harm my baby. My argument that I didn’t need to wean because 1) the amount in my breastmilk would be minuscule and 2) if the baby got it, his digestive system would digest a hormone like any other protein went exactly nowhere. So I ignored her.

  126. “That’s just foolish – it’s not going to stay stable and sure is hell isn’t’ going to get better.”

    Well, once we’re past 25, that’s true for all of us, for pretty much everything.

  127. You know, I have done too many things in my life that I at one time vowed I’d never do to state with any certainty what my end-of-life preferences would be (assuming I have the opportunity to voice one).

  128. Well, once we’re past 25, that’s true for all of us, for pretty much everything.

    That’s most certainly not true. Any number of ailments can be treated and or cured. But if the writing is on the wall that it’s time to check out, just check out. No need to make a big fuss and be a burden on everyone.

  129. It most certainly is true. Just about all of your physical (and probably mental) abilities begin a slow decline after 25. Sure, you may lose weight, you may train and get stronger or faster at something. But your baseline capabilities, your underlying capacity for doing so, or your potential, is in a slow and steady decline until the grave.

    You’re slower, weaker, and frailer. You’re less fertile, and you’re less sexually virile. Like you said, it isn’t going to stay stable, and it sure as hell isn’t going to get better.

  130. I listened to some audiobook by a urologist that supposedly addressed all of the questions men were too afraid to ask their doctors, many of them about the effects of aging. God it was so depressing.

  131. “I get the sense you’ve never had a significant medical problem.:

    Not yet, why?

    I’m thinking of my grandmother, when the early stages of dementia were becoming apparent. She would say things in her old sarcastic way like “Oh honey, I’m doing great if I can remember all of my grandchildren. Show me pictures of your kids [great-grandchildren] but I’m NOT keeping track of their names!” (To be fair, she had, let’s see, 24 great-grandchildren.)

    Point is, though, she was still lively and having fun and even traveling under escort for various events. And for quite a few years like this.

    It would not have made much sense to say, “Well, this is not going to get better. Put a bullet in the magazine and get on with it.”

  132. “I’m regularly amazed at the degree to which some people on here overestimate their control of the outcome.”

    I’m not. E.g., the fears LfB and I have expressed here are based on our recognition of our lack of control.

    But OTOH, as discussed recently, such overestimation of control may be contributing to our resilience.

  133. “No need to make a big fuss and be a burden on everyone.”

    Sounds like my mom, whose biggest fear was that she would be a burden on others.

  134. Not yet, why?

    Let’s say you had sever hypothyroidism. You’d be freezing cold, constantly exhausted you wouldn’t be able to go to work or take care of your kids or even walk to get the mail. You go to the doctor put you on sythroid and you’re soon good as new.

    That’s something entirely different than a diagnosis that it’s going to get worse until you eventually die in a very drawn out and unpleasant manner.

  135. It would not have made much sense to say, “Well, this is not going to get better. Put a bullet in the magazine and get on with it.”

    Would you prefer a bullet when you can no longer eat or the current treatment of no feeding tube and letting you slowly starve to death?

  136. There might be situations for what you say, but the early stages of dementia do not qualify, imo, based on the example I gave. That statement that my grandmother made was during a very fun lunch we had with her, my parents, DW, and me at Legal Seafood in Boston while she was on a cross-country trip.

    The dementia was there. It had moved in and taken hold. But life was still worth living.

  137. “Just about all of your physical (and probably mental) abilities begin a slow decline after 25.”

    Perhaps a bit later. A while back I read a book by Bill James, the baseball statistics guru, and one point he made was that MLB position players generally peak in their late 20s. Pitchers generally peak somewhat later.

  138. “Would you prefer a bullet when you can no longer eat or the current treatment of no feeding tube and letting you slowly starve to death?”

    No feeding tube, plenty of morphine, a sip of water here and there, or a few drops on my lips, FOX News on the television :). I’ll drift off peacefully.

    A bullet is too harsh, for the family moreso than the deceased. And this way the undertaker can make me look incredible again, down the basement in the “wax museum” as my dad dryly refers to it.

  139. But life was still worth living.

    At that point by all means keep going. But at some point your quality of life falls to the point where your previous self would agree that it’s time to go. I wish there was some way to chose that option ahead of time.

  140. No feeding tube, plenty of morphine,

    Totally. I certainly don’t want to leave a mess. But if they can crank it up to 11 and I can go today I’m much rather do that then spending another 50k to linger slowly wasting away.

  141. “Is that really the case with an initial diagnosis of dementia? Does it get better?
    No it doesn’t.”

    The caveat, I believe, is to make sure the initial diagnosis is correct.

    A couple of anecdata:

    -My grandma fell and broke her hip, I think when she was in her early 80s. After she was released from the hospital, she was put in a nursing home, her mental condition appeared to deteriorate quite rapidly, and there was, IIRC, a preliminary diagnosis of dementia. However, as she physically recovered, her kids started taking her out of the nursing home briefly, and she exhibited lucidity on those excursions. When she was physically able, her kids took her out of the nursing home, and she regained lucidity, eventually moving into an apartment on her own.

    -My uncle had a back problem when he was, IIRC, in his late 70s, and at about the same time his mental condition seemed to indicate early dementia. However, after his back issue was finally diagnosed and treated (surgically), he also regained lucidity, and remained largely lucid (albeit with deterioration of short-term memory) through the rest of his life.

  142. “WCE joked about wandering away from a facility in a blizzard”

    She was joking?

  143. I once spent about a month in the hospital not allowed to do anything other than a 5 min shower every day. I think I kind of mentally deteriorated during that time. I see how easily it would be for an old person to kind of just give up. That’s one of my reasons for wanting to live in an active retirement community if I make it that far. I am going to sign up for all the activities until I cannot. Idleness is not good for your mind.

  144. “Maybe if he had taken less care of himself, and had a weaker heart and lungs he would have died sooner. Ironic?”

    Not sure about the irony, but that’s the dilemma I’ve discussed here before. But I want the strong heart and lungs as long as I’m lucid; I want to be able to help others, not require assistance.

  145. “Nitrogen is better.”

    Or perhaps nitrous oxide?

    I thought I wanted to go in my sleep, but dying laughing might be better.

  146. “But I want the strong heart and lungs as long as I’m lucid; I want to be able to help others, not require assistance.”

    Yet in order to help others, THEY need to be prepared to accept your assistance. At some point, those of us lucky enough to live past 50 are going to need help from others, and IMO it is part of aging well to accept that some tasks are now beyond our strength. FIL stubbornly insisted on getting up on the ladder to put in the storm windows long past the point where that was a good idea and MIL now insists on dragging laundry baskets up and down the stairs risking another broken bone. She doesn’t want to “be a burden” but doesn’t realize that by engaging in this behavior, she is doing just that.

  147. This! “She doesn’t want to “be a burden” but doesn’t realize that by engaging in this behavior, she is doing just that.” This is my in-laws. They don’t want to need help so they are continually making messes that we need to clean up. My mother did a lot of direct care with her inlaws and her own family and all the time says, “I will do whatever you tell me, I promise.” She saw what “not being a burden” did to actually make everyone’s life difficult.

  148. She doesn’t want to “be a burden”

    Not doing that is part of not being a burden. If it’s easier to move near the kids, you move near the kids, if you need to move into a single story, move. If it’s time to give up the keys and/or move to assisted living you go. Don’t make “not being a burden” into being a burden.

  149. I think people really mean they want to be independent. Even if that isn’t possible.

  150. I think people really mean they want to be independent.

    I don’t understand. If I could afford a staff on whom I could be totally dependent I most certainly hire one.

  151. Have you ever actually been dependent upon someone for basic things like food or getting you around? It kind of sucks.

  152. And I imagine if sucks even more when those who are providing those services are those people for whom you used to literally change their diapers.

  153. Have you ever actually been dependent upon someone for basic things like food or getting you around?

    Like the hotel bar and an uber?

  154. Not exactly. At least that isn’t how it was for me. Maybe for a few lucky seniors.

  155. “She doesn’t want to “be a burden”

    My mom was more concerned about not being able to do basic things on her own, like go to the bathroom, feed herself, bathe herself, etc.

    As my parents got older, they both were willing to have their kids do more stuff they used to do themselves. E.g., my dad happily let me and my brother do a lot of the little repairs around the house.

  156. “feeding tubes in the elderly have really fallen into disfavor. Which means if you don’t eat, you die.”

    I think this is how a lot of people decide when it’s their time—they stop eating.

    I’ve heard that as people age, the feeling of hunger diminishes, and they increasingly skip meals because the cost (effort to prepare meal and eat it) exceeds the benefit (no longer feeling hungry and/or the enjoyment of partaking). Thus this seems not an unpleasant way to go.

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