# How severely can Nursing Homes drain a Senior's Estate? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [January 18, 2017, 4:20pm UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475 "2017-01-18T16:20:30Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![RTFirefly](https://avatars.discourse-cdn.com/v4/letter/r/c77e96/32.png) [@RTFirefly](https://boards.straightdope.com/u/RTFirefly)\ **Post date:** [January 18, 2017, 7:31pm UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/21 "2017-01-18T19:31:46Z")
> [@aceplace57](#): > > The baby boomers represent a massive number of people who are already approaching 70. > > I’m hopeful that facilities for seniors will improve. I wouldn’t place a lot of hope in that. Over the next 15 years, the demand for facilities for seniors will increase a lot faster than the supply of good-quality care facilities can. And then one of two things will happen: either there will simply be a big shortage of such facilities, or a lot of really crappy facilities will spring up to meet the shortage. It’s not gonna be pretty. ---
**Author:** ![aceplace57](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aceplace57/32/3500_2.png) [@aceplace57](https://boards.straightdope.com/u/aceplace57)\ **Post date:** [January 18, 2017, 7:31pm UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/22 "2017-01-18T19:31:53Z")
A continuing care facility sounds very interesting. I’ll email my mom that link. I’m glad my mom has financial resources. I would never put her in one of those Medicaid nursing homes. I remember visiting my older relatives in the 1970’s. I hated going. Nursing Homes can be very depressing and scary places. ---
**Author:** ![Enola\_Gay](https://avatars.discourse-cdn.com/v4/letter/e/3ab097/32.png) [@Enola\_Gay](https://boards.straightdope.com/u/Enola_Gay)\ **Post date:** [January 18, 2017, 7:32pm UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/23 "2017-01-18T19:32:05Z")
> [@PastTense](#): > > If she is still healthy enough she may still be able to get long term health insurance now. It will be expensive of course. I was going to make this very point. We got long term care insurance for my mother when she was 78 and healthy. The policy was expensive but it has paid off big time. She went into an assisted living facility 4 years ago & insurance pays approx $7200 per month of the $10,000 bill. ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [January 18, 2017, 7:39pm UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/24 "2017-01-18T19:39:53Z")
> [@MLS](#): > > As I used to tell my younger co-workers before I retired: We made our parents build schools; we will make our children and grandchildren build us retirement homes. There are more of us than there are of you, and we vote. Get used to it. Not any more. “Millennials, whom we define as those ages 18-34 in 2015, now number 75.4 million, surpassing the 74.9 million Baby Boomers (ages 51-69). And Generation X (ages 35-50 in 2015) is projected to pass the Boomers in population by 2028.” ---
**Author:** ![Machine\_Elf](https://avatars.discourse-cdn.com/v4/letter/m/82dd89/32.png) [@Machine\_Elf](https://boards.straightdope.com/u/Machine_Elf)\ **Post date:** [January 18, 2017, 7:49pm UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/25 "2017-01-18T19:49:47Z")
> [@aceplace57](#): > > I’m hopeful that facilities for seniors will improve. My parents, in their assisted-living residence, can press a button and have an assistant stop by within a couple of minutes to help my mom go to/return from the bathroom. Someone helps her get dressed/undressed every day, and helps her shower every few days. Someone stops by several times a day with prescribed medications for both of them. All meals are prepared for them. Laundry is done for them. Housekeeping is done for them. Heat, electricity, cable, internet are all covered. There is on-sight entertainment and social gatherings; if my dad isn’t up for an event, my mom can summon an assistant to push her wheelchair to it. My parents tell me the staff there are unfailingly enthusiastic, cheerful and helpful - no small feat, when part of your job is helping old people go to the bathroom. Not sure what kind of improvement you might imagine on top of that. Maybe cost? My parents are paying somewhere around $12K a month for this level of service. But considering the level of care they’re receiving, I’m not sure they’re overpaying by a whole lot. > [@RTFirefly](#): > > And then one of two things will happen: either there will simply be a big shortage of such facilities, or a lot of really crappy facilities will spring up to meet the shortage. Ideally the market will fill the vacuum, albeit with some lag. But if there are old people with money, then we should see an increase in nice/livable facilities; if there are old people without money, then we may see a preponderance of Medicaid-funded facilities. It may well be the latter, given [the poor track record Americans have in saving for their retirement needs.](https://www.google.com/?gws_rd=ssl#q=average+nest+egg+at+retirement) My parents were on a waiting list for a few months to get into an independent-living facility, and again for a few months to get into assisted living. I would think that the existence of any waiting lists at all should spur growth in this business sector. ---
**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\ **Post date:** [January 18, 2017, 8:23pm UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/26 "2017-01-18T20:23:44Z")
> [@Tom\_Tildrum](#): > > Note that if she is receiving a pension (e.g., federal worker, military), it is unlikely that she will ever qualify for Medicaid. Actually, quite a lot of people receiving pensions qualify, because it is unlikely that their pension will cover the cost of the nursing home or assisted living. Their pension will end up going to the nursing home (except a small “resident allowance,” usually something like $60-75/month the last I knew), but the state will pick up the amount in excess of what they can pay. (The financial standards for Medicaid institutional care are quite different from the standards for “regular” Medicaid.) ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [January 18, 2017, 8:47pm UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/27 "2017-01-18T20:47:23Z")
> [@Machine\_Elf](#): > > My parents, in their assisted-living residence, can press a button and have an assistant stop by within a couple of minutes to help my mom go to/return from the bathroom. Someone helps her get dressed/undressed every day, and helps her shower every few days. Someone stops by several times a day with prescribed medications for both of them. All meals are prepared for them. Laundry is done for them. Housekeeping is done for them. Heat, electricity, cable, internet are all covered. There is on-sight entertainment and social gatherings; if my dad isn’t up for an event, my mom can summon an assistant to push her wheelchair to it. My parents tell me the staff there are unfailingly enthusiastic, cheerful and helpful - no small feat, when part of your job is helping old people go to the bathroom. > > Not sure what kind of improvement you might imagine on top of that. Maybe cost? My parents are paying somewhere around $12K a month for this level of service. But considering the level of care they’re receiving, I’m not sure they’re overpaying by a whole lot. Yes, your parents’ assisted living facility sounds very nice, but few people can afford $140,000 annually, at least not for very long. But I can see why the staff there would be more enthusiastic, cheerful and helpful than the staff at most SNFs, where they’re likely to be at the minimum wage. ---
**Author:** ![beowulff](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/beowulff/32/542_2.png) [@beowulff](https://boards.straightdope.com/u/beowulff)\ **Post date:** [January 18, 2017, 8:51pm UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/28 "2017-01-18T20:51:27Z")
We moved my mom from and assisted living facility in Maryland to one in Arizona, to be nearer to me. The other advantage was that the cost per month went from something like $11K to closer to $6K. She has 3 years of long-term care insurance, which is paying for 100% of that right now. After that runs out, the estate will have to pay. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [January 19, 2017, 12:16am UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/29 "2017-01-19T00:16:15Z")
> [@slash2k](#): > > Actually, quite a lot of people receiving pensions qualify, because it is unlikely that their pension will cover the cost of the nursing home or assisted living. Their pension will end up going to the nursing home (except a small “resident allowance,” usually something like $60-75/month the last I knew), but the state will pick up the amount in excess of what they can pay. > > (The financial standards for Medicaid institutional care are quite different from the standards for “regular” Medicaid.) And they may even be eligible for regular Medicaid. When my father got to the point that he either needed nursing home care or home attendants (neither of which Medicare would pay for, as it wasn’t for rehab) , his income went into a pooled special needs trust and was no longer considered for the purposes of Medicaid eligibility because he no longer had control over the money. The trust paid his bills - utilities, clothing, medical supplies etc. Even travel and entertainment. If he had rent or a mortgage to pay , it would have paid for that. Payments did have to be for his benefit, so he couldn’t buy gifts for his grandchildren. The advantage of this over simply “spending down” the excess income is that only medical expenses count toward the spend down, and often that doesn’t leave enough for living expenses. It’s not an issue so much with nursing homes as it is with home care- a single person must spend down any income over $845 and for a couple it’s $1229 in NY. The downside (and for my family, it didn’t matter) is that when the trust is terminated ( usually by the beneficiary’s death) any money left is either retained by the trust or goes to repay Medicaid. It can’t even be used to pay bills that were incurred before the beneficiary’s death. ---
**Author:** ![kopek](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kopek/32/337_2.png) [@kopek](https://boards.straightdope.com/u/kopek)\ **Post date:** [January 19, 2017, 4:13am UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/30 "2017-01-19T04:13:49Z")
My MIL was Roman Catholic and we were lucky enough to get her into one of their church-operated facilities. The bad news was that basically it drained everything her and her husband had built over their lives and the house and everything had to be sold. The good news is that she got excellent care and had she outlived her savings (it came close) they would have maintained that level of care as long as she lived for what Medicare/caid payed. I will be frank; I am no fan of the Church in Rome. But I am damn glad we had them through all that time. The Sisters and staff were way better than any money could have provided in the private sector and while the bill was high (say 8k a month) it was worth 10 times that in what we received. ---
**Author:** ![Svejk\_1](https://avatars.discourse-cdn.com/v4/letter/s/ea666f/32.png) [@Svejk\_1](https://boards.straightdope.com/u/Svejk_1)\ **Post date:** [January 19, 2017, 4:29am UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/31 "2017-01-19T04:29:27Z")
> [@aceplace57](#): > > I will inherit the annual income from the Trust. But can’t access the principle. Mom and Dad designated that it goes to charities they selected after I’m gone. So your wife and kids won’t be beneficiaries? That’s ice cold! :eek: ---
**Author:** ![Gatopescado](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gatopescado/32/5711_2.png) [@Gatopescado](https://boards.straightdope.com/u/Gatopescado)\ **Post date:** [January 19, 2017, 5:39am UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/32 "2017-01-19T05:39:38Z")
Maybe I’m just cynical, but I would think that between doctors and lawyers, every cent will vanish pretty damn quick. ---
**Author:** ![usedtobe](https://avatars.discourse-cdn.com/v4/letter/u/ec9cab/32.png) [@usedtobe](https://boards.straightdope.com/u/usedtobe)\ **Post date:** [January 19, 2017, 6:41am UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/33 "2017-01-19T06:41:11Z")
My mother went through this hell. Medicaid will cover the cost - but not until the patient’s assets are below a certain point (in 1989: $2000, which was less than the cheapest new car). The Nursing Home knew all about the “Spending Down” as they called it. This is where estates get drained so mamma can suffer through more chemo… See lawyer about getting the trust OUT of your mother’s name - and do that NOW! There is a look-back clause wherein they look to see if the patient had transferred wealth in the preceeding (was 6 months). If it was transferred within 6 months, the coverage would be delayed. SEE LAWYER NOW! ---
**Author:** ![Flyer](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/flyer/32/7298_2.png) [@Flyer](https://boards.straightdope.com/u/Flyer)\ **Post date:** [January 19, 2017, 6:52am UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/34 "2017-01-19T06:52:07Z")
> [@RTFirefly](#): > > I wouldn’t place a lot of hope in that. > > Over the next 15 years, the demand for facilities for seniors will increase a lot faster than the supply of good-quality care facilities can. > > And then one of two things will happen: either there will simply be a big shortage of such facilities, or a lot of really crappy facilities will spring up to meet the shortage. > > It’s not gonna be pretty. It’s still semi-invisible, but that’s already starting to happen. We’re now in the first stage of a massive real estate and construction boom for various healthcare facilities for Baby Boomers. > [@](#): > > A report released by Revista shows that the health care real estate construction pipeline is active and growing with $97.1 billion in projects either under construction or in late planning stages by the end of 2015. This represents an increase of 12 percent from the $86.7 billion under construction or in planning by midyear 2015. > **[Medical office buildings lead health care construction growth | HFM Magazine](https://www.hfmmagazine.com/articles/2100-medical-office-buildings-lead-health-care-construction-growth)** > > Revista: MOB total square footage expected to nearly double this year ---
**Author:** ![Aeschines](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aeschines/32/16251_2.png) [@Aeschines](https://boards.straightdope.com/u/Aeschines)\ **Post date:** [January 19, 2017, 10:27am UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/35 "2017-01-19T10:27:21Z")
> [@Dinsdale](#): > > I know this sounds harsh, but I really don’t understand why anyone would think that someone’s assets should NOT be spend on their end-of-life care. I think it’s the idea that Medicare is one’s health insurance and it should cover things like this. “Should it or should it?” is a relevant question that doesn’t admit of an easy answer. The fact that many people often use up vast sums of money just to live a few last uncomfortable months or years is a pressing issue of our times. The fact that such care can nuke a massive pile of money leads to some perverse incentives. There was speculation that, when the Captain and Tennille got divorced a few years ago, they were doing so to prevent upcoming medical expenses from taking _all_ their money, since they didn’t seem to have any actual marital problems. Reading Wiki now, it’s not clear if that is the case or not ([Captain & Tennille - Wikipedia](https://en.wikipedia.org/wiki/Captain_%26_Tennille#Divorce)), but it was at least plausible at the time. Personally, I have no intention of being a sad old man in a nursing home, but I think society pressuring seniors to take the cheaper way out would also be a said state of affairs. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [January 19, 2017, 11:59am UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/36 "2017-01-19T11:59:40Z")
> [@Aeschines](#): > > I think it’s the idea that Medicare is one’s health insurance and it should cover things like this. I’m not going to say people don’t think this- but I’m not sure why they would, since other _health_ insurance has the same limitations as Medicare (won’t pay for custodial care, will only pay for a short stay after hospital admission, etc). I mean, it’s not like Blue Cross or Aetna will pay for an unlimited amount of time in a nursing home, or for custodial care and it’s only Medicare that doesn’t. That’s why long-term care insurance ( which most people don’t have) exists. ---
**Author:** ![Machine\_Elf](https://avatars.discourse-cdn.com/v4/letter/m/82dd89/32.png) [@Machine\_Elf](https://boards.straightdope.com/u/Machine_Elf)\ **Post date:** [January 19, 2017, 2:34pm UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/37 "2017-01-19T14:34:31Z")
> [@Dewey\_Finn](#): > > Yes, your parents’ assisted living facility sounds very nice, but few people can afford $140,000 annually, at least not for very long. But I can see why the staff there would be more enthusiastic, cheerful and helpful than the staff at most SNFs, where they’re likely to be at the minimum wage. My point was not that it was particularly cheap. Quite the opposite: the level of care needed by people in assisted living and/or skilled nursing is rather high, which guarantees that it’s going to cost a lot, unless you want to cut corners: threadbare carpet, cranky/sluggish staff, no social activities, and so on. OP is hoping “facilities for seniors will improve;” I merely wanted to point out that good facilities are already available, but they’re not cheap, and I don’t think they’re likely to get much cheaper. ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [January 19, 2017, 2:42pm UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/38 "2017-01-19T14:42:49Z")
One of the reasons that the Japanese government had a big push to develop robotic technology is because of their aging population. The idea is that robots like Asimo might be able able to help care for aging seniors. So perhaps if the technology matures, robotic help will lower the cost of elder care? ---
**Author:** ![JackieLikesVariety](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackielikesvariety/32/296_2.png) [@JackieLikesVariety](https://boards.straightdope.com/u/JackieLikesVariety)\ **Post date:** [January 19, 2017, 3:59pm UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/39 "2017-01-19T15:59:27Z")
I’ve worked in nursing homes, sorry Skilled Nursing Facilities, for decades now and I strongly suspect some people here - like the rest of the country - greatly underestimate how bad our “healthcare” “system” is - and I have news for you. the older you get, the worse it is. :mad:☹ ---
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [January 19, 2017, 4:23pm UTC](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475/40 "2017-01-19T16:23:43Z")
> [@doreen](#): > > I’m not going to say people don’t think this- but I’m not sure why they would, since other _health_ insurance has the same limitations as Medicare (won’t pay for custodial care, will only pay for a short stay after hospital admission, etc). I mean, it’s not like Blue Cross or Aetna will pay for an unlimited amount of time in a nursing home, or for custodial care and it’s only Medicare that doesn’t. That’s why long-term care insurance ( which most people don’t have) exists. They’re mostly assuming that their other health insurance will also pay for custodial care. They’re wrong of course. “It involves my (lack of) health so somebody else pays, right?” seems to be the depth of most people’s thinking on the topic. At the end of the day, the Boomers collectively haven’t saved the money it’ll take to give all of them a decent trip through the independent -\> assisted -\> SNF -\> funeral cascade. Some are well-provisioned; most aren’t. It won’t be pretty. Folks up-thread who assume the Boomers will vote themselves whatever spending they need are missing something. The only entity with that kind of money is the Feds. So Boomers will need to vote in enough congressmen and senators to carry the legislation. Boomers are numerous, but they’re also widely dispersed. I have no doubt that much of Florida’s congressional contingent could become single-issue pols in response to a single-issue elder voting block. The rest of the country? Not so much. The Boomers sold the young (~\<40 yo) folks a bill of goods once already that “some day you’ll get your’s too” on the whole US economic success story the kids have read about in History class but have never seen. They’re not inclined to fall for that trick again. Couple that with the fact the Boomers are 95% white and the \<40s are ~40% white (and becoming even less so with every year) and there \*may \*be some friction on increasing intergenerational transfer to the oldsters. It really won’t be pretty. [Previous page](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475.md?page=1) [Next page](https://boards.straightdope.com/t/how-severely-can-nursing-homes-drain-a-seniors-estate/777475.md?page=3)