RPF-0023-Friday_QA-How_Do_I_Plan_for_My_Parents_Long-Term_Care_When_They_Dont_Have_Enough

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00:00:32.000 | Radical Personal Finance, episode 23.

00:00:35.000 | On today's show, how do I help my parents prepare

00:00:39.000 | for the prospect of needing long-term care services

00:00:43.000 | when they are not financially prepared?

00:00:46.000 | Also, what do I do about my 401(k)

00:00:49.000 | which has high fees, limited options,

00:00:52.000 | and no clear fiduciary?

00:00:54.000 | ♪

00:01:10.000 | Welcome to the Radical Personal Finance podcast

00:01:12.000 | for today, today being Friday, July 18, 2014.

00:01:16.000 | My name is Josh Rascheitz.

00:01:18.000 | I'm your host here with you every day.

00:01:20.000 | And today is going to be a Friday Q&A show.

00:01:24.000 | Going to be primarily handling two questions,

00:01:26.000 | the two questions I just mentioned,

00:01:28.000 | one about long-term care planning

00:01:29.000 | and the other about my 401(k).

00:01:31.000 | And then if we have time, we'll get to some inspiring reading

00:01:33.000 | for the weekend.

00:01:34.000 | ♪

00:01:43.000 | So these two questions today are going to be challenging.

00:01:46.000 | I don't expect them to be quick,

00:01:47.000 | but I do want to really give some good ideas

00:01:50.000 | to the people that have asked the questions.

00:01:52.000 | As you know, I'm putting out these Friday Q&A shows

00:01:55.000 | every week, and I think that next Friday

00:01:57.000 | will be a lot better.

00:01:58.000 | So over the weekend, I should be able to get up

00:02:00.000 | and add the application on the website

00:02:01.000 | to allow you to phone in your feedback,

00:02:04.000 | so that way we can have a nice audio message

00:02:06.000 | that we can play on the air.

00:02:07.000 | And I'm excited about that.

00:02:08.000 | It'll help us to get a better feel for you as a caller,

00:02:11.000 | as a questioner.

00:02:13.000 | It'll help us to get a little bit better of a feel

00:02:15.000 | and a little bit more personal, instead of the more

00:02:17.000 | impersonal emails and Twitter questions and answers

00:02:20.000 | that I've been answering so far.

00:02:23.000 | So I should be able to get that up over the weekend,

00:02:25.000 | over the early next week, and then I will announce it

00:02:27.000 | on the show as soon as that is ready to go.

00:02:29.000 | And then I hope that you'll call them in.

00:02:30.000 | But today we've got two questions that we're going to deal with.

00:02:32.000 | And then depending on how long the show goes,

00:02:34.000 | I've got a variety of articles that I'd like to talk about.

00:02:37.000 | If we get to them, if not, we'll push them to Monday.

00:02:40.000 | And so those two questions are going to be

00:02:42.000 | a question about 401(k)s and then a question

00:02:45.000 | about preparing for long-term care.

00:02:47.000 | And I've struggled with which one to start with

00:02:49.000 | because neither of them are easy questions.

00:02:51.000 | They're both pretty difficult for me to work through.

00:02:54.000 | And I hope you'll see today kind of the real challenges

00:02:58.000 | of financial planning because these are both

00:03:00.000 | real people's situations.

00:03:02.000 | And I don't have enough information to really give

00:03:04.000 | a comprehensive, complete answer that's going to fully solve

00:03:07.000 | the listeners' questions.

00:03:10.000 | But I'll try to give some ideas and point you

00:03:12.000 | in the right direction.

00:03:14.000 | And I think we'll lead off with the long-term care question.

00:03:18.000 | I think we'll start with that, and then we'll go into

00:03:20.000 | the 401(k) question afterwards.

00:03:23.000 | And so the long-term care question comes in from a listener.

00:03:26.000 | And this listener asked that I not share his name.

00:03:29.000 | So we will keep this listener anonymous.

00:03:31.000 | And by the way, I'm always happy to do that.

00:03:33.000 | I will generally try, unless I goof up somewhere along the way

00:03:37.000 | and mention something.

00:03:38.000 | You know, the Twitter question coming in,

00:03:40.000 | I'll mention your Twitter handle.

00:03:41.000 | But if you send me an email with a question,

00:03:43.000 | I'll never read your name except just maybe your first name.

00:03:46.000 | So feel free to lie about that if you don't want me to read that

00:03:50.000 | or feel free to say, "Please leave my name out of it."

00:03:52.000 | So this listener was writing in to me about

00:03:57.000 | a challenging family circumstance,

00:04:00.000 | and it involves long-term care.

00:04:02.000 | And basically I'll summarize the facts for you.

00:04:05.000 | Again, I don't have complete facts,

00:04:07.000 | but I was able to figure out some of the information.

00:04:09.000 | I'll summarize the facts for you.

00:04:10.000 | This listener says, "My dad just had a stroke,

00:04:12.000 | and he's in the hospital.

00:04:13.000 | He's getting out of the hospital, but he's not doing well.

00:04:17.000 | And he's 81 years old, and his mom is about 20 years younger,

00:04:21.000 | so I'm assuming 61 years old, 62, somewhere in that range.

00:04:24.000 | And evidently his health has not been good for a good number of years.

00:04:28.000 | He's actually been out of work for about 30 years

00:04:31.000 | due to some physical problems that he's faced.

00:04:33.000 | And now he's just had a stroke.

00:04:35.000 | And then the good thing about the stroke

00:04:37.000 | is that as part of being involved in the hospital

00:04:39.000 | and as part of being involved in the medical system,

00:04:45.000 | they diagnosed him as having some advanced degree of dementia,

00:04:49.000 | which really helped the listener to understand a little bit more

00:04:54.000 | about what was going on.

00:04:55.000 | His relationship with his father had been very challenging

00:04:57.000 | over the previous years,

00:04:59.000 | and now he understands a little bit better,

00:05:01.000 | ah, it was probably due partly to the dementia.

00:05:04.000 | And so that was really, in some ways,

00:05:06.000 | although it's not a pleasant diagnosis,

00:05:09.000 | in some ways it's really helpful to at least understand

00:05:11.000 | that there's some real chemical issue in the brain

00:05:16.000 | that would help to explain some of the off behavior.

00:05:22.000 | But the problem is, what do we do?

00:05:24.000 | We're not exactly sure what to do.

00:05:26.000 | Mom and dad live alone.

00:05:28.000 | They're together.

00:05:29.000 | They're together with each other, but they don't live with any family.

00:05:31.000 | They're about an hour or so away from the sun,

00:05:33.000 | so quite a ways away.

00:05:37.000 | The listener says, "I'm not able to financially,

00:05:42.000 | "due to my situation,

00:05:43.000 | "I'm not able to make a large contribution."

00:05:45.000 | And so I inquired about some of the numbers,

00:05:47.000 | and he shared with me,

00:05:48.000 | "Dad has about $800 a month coming in in Social Security income.

00:05:53.000 | "Mom works and makes about $18,000 a year doing various things."

00:05:57.000 | So if you add those numbers together,

00:05:59.000 | they give you an annual income of about $27,600.

00:06:03.000 | They have maybe about $5,000 of savings,

00:06:05.000 | and they have a paid-off piece of property,

00:06:07.000 | about three acres of land out in the country,

00:06:09.000 | maybe worth about $50,000,

00:06:11.000 | and then a mobile home on top of that

00:06:12.000 | that's falling into disrepair little by little.

00:06:15.000 | And so he's an only child, and he says, "What do I do?"

00:06:20.000 | And my heart goes out to him,

00:06:22.000 | because long-term care planning is something that's near and dear to my heart.

00:06:27.000 | And I may have shared on a previous episode,

00:06:32.000 | my grandfather had dementia for, I think it was five or six years,

00:06:36.000 | somewhere about the age of about 90 to 95.

00:06:39.000 | It's hard with dementia to always pinpoint,

00:06:41.000 | "Here's exactly the point where it starts."

00:06:43.000 | Many of you have worked through it with a family member with dementia or Alzheimer's.

00:06:46.000 | It's hard to point and say, "This was the day that it happened."

00:06:49.000 | But about five years is my memory is correct.

00:06:51.000 | And it's just a steadily progressing disease

00:06:54.000 | where it just steadily gets worse and worse and worse.

00:06:56.000 | And it's so tough to see a loved one that you know,

00:07:00.000 | a loved one that you know and love going down.

00:07:04.000 | And you don't have any hope that they're going to get better.

00:07:08.000 | And it's especially tough to deal with as a disease

00:07:11.000 | because it doesn't necessarily affect the body.

00:07:15.000 | It doesn't necessarily affect the physical health of the person who has the disease.

00:07:20.000 | So my grandfather, for example, he retired when he was in his mid to late 80s.

00:07:24.000 | I get dates confused just about every time.

00:07:27.000 | He was 84, I think, is when he retired, something like that.

00:07:30.000 | But he was hearty and healthy and full of vigor and full of life.

00:07:34.000 | Retirement kind of did him in a little bit.

00:07:36.000 | Once he retired and actually sat down, he started to get old quickly.

00:07:39.000 | But then he started to face dementia.

00:07:42.000 | And in working with dementia, I learned a lot kind of going through it as a young man

00:07:45.000 | trying to work and help my parents out.

00:07:47.000 | And it's really challenging.

00:07:48.000 | And one of the biggest challenges of dementia is that it doesn't affect you physically.

00:07:52.000 | So you don't--unlike some diseases where you maybe have a diagnosis of cancer

00:07:56.000 | and the physician may be able to estimate, well, this is your life expectancy,

00:08:00.000 | or some other diseases where you can say, well, this isn't necessarily expected

00:08:04.000 | to affect your life expectancy.

00:08:06.000 | With dementia, it doesn't affect your physical health; it affects your mental health.

00:08:09.000 | So you may be healthy as anything, and so it's very unknown as far as how to plan for it.

00:08:16.000 | And yet it's extremely challenging and extremely draining to work through that

00:08:24.000 | from a care perspective.

00:08:26.000 | And so my heart went out to this listener.

00:08:30.000 | And since I heard of his situation, I've just been thinking about the question

00:08:33.000 | and thinking about the question, trying to figure out what the answer is.

00:08:36.000 | And it's tough because in some ways there is no answer.

00:08:39.000 | And I'll try to do better than that.

00:08:41.000 | I'll try to give some ideas, but in some ways there is no answer.

00:08:44.000 | And I'm going to say some things, and I know the listener is listening,

00:08:47.000 | and I just want to say my heart is filled with compassion and empathy,

00:08:51.000 | and I wish that I had some good answers for you.

00:08:54.000 | I don't know of any good financial answer for the situation

00:08:58.000 | because there's not a lot to work with.

00:09:00.000 | And I'll give you ideas.

00:09:01.000 | I've got some ideas of some programs for you to research

00:09:03.000 | and just kind of walk you through how I would approach it.

00:09:05.000 | But at the end of the day, I don't have a good answer.

00:09:08.000 | But I want to bring a situation like this forward to encourage the rest of you

00:09:13.000 | to consider doing some planning up front.

00:09:16.000 | Because if you'll do some planning in advance for these things,

00:09:19.000 | then it's not going to make them emotionally easier,

00:09:24.000 | but it may make them a little bit easier if there's some plans in place already.

00:09:29.000 | And this is essentially how I think about financial planning.

00:09:33.000 | I don't understand why people don't want to do financial planning.

00:09:36.000 | This has been one of those circuits in my head that has never made sense to me

00:09:40.000 | because I guess I always joke about, well, you're going to die,

00:09:43.000 | so make sure you die with a will in force.

00:09:46.000 | Chances are this could happen.

00:09:48.000 | And for some reason that's never bothered me,

00:09:50.000 | but I know it really bothers some people to think about this planning.

00:09:53.000 | But I tell you, when you see somebody go through a tough situation,

00:09:56.000 | it really helps you to say, well, I've got to do some planning.

00:09:59.000 | And you've got to do what you can.

00:10:01.000 | You've got to do what you can when you can.

00:10:02.000 | I don't think necessarily financial planning is the magic cure

00:10:05.000 | that's going to fix everything.

00:10:06.000 | Not everybody is poor and broke because there's something somehow wrong with them morally

00:10:13.000 | or that they're just somehow not smart.

00:10:15.000 | That's not the case at all.

00:10:16.000 | There is bad luck that happens.

00:10:18.000 | There are situations that are beyond people's control.

00:10:20.000 | People get beat down.

00:10:22.000 | There are things that can happen, and that's across the board,

00:10:28.000 | that things can happen to all of us.

00:10:30.000 | And so I don't think there's any amount of planning that can guarantee anything.

00:10:33.000 | But I do believe that no matter the situation,

00:10:36.000 | a little bit of planning and some ideas can make the situation better.

00:10:39.000 | We see this all the time in our culture.

00:10:42.000 | That's why there are stories that are constantly written about somebody who is sick

00:10:45.000 | and look at how even though they were sick or even though they were an amputee,

00:10:49.000 | they still ran the marathon.

00:10:50.000 | I mean, bad luck can--if you're a soldier, bad luck.

00:10:53.000 | You walk over a bomb or an IED or a claymore or whatever they're called nowadays.

00:10:57.000 | You walk over a bomb and your legs are gone.

00:10:59.000 | That's bad luck.

00:11:00.000 | But once it's done, it's done.

00:11:02.000 | You've got to make the best of it.

00:11:03.000 | So that's kind of how I think about financial planning.

00:11:05.000 | So I'm going to do my best to give this listener some ideas,

00:11:09.000 | some very practical ideas, some programs to research,

00:11:12.000 | but also some big-picture ideas.

00:11:15.000 | But none of this is intended to be cruel,

00:11:17.000 | and it's a little hard when it's impersonal where maybe you can't sense my empathy

00:11:21.000 | or my compassion, but I want to give you some answers.

00:11:24.000 | But I also want to use it as a learning experience.

00:11:27.000 | First thing, this situation, the listener being an only child

00:11:30.000 | and having ailing, aging parents,

00:11:32.000 | and then this listener not being able to help his parents very much,

00:11:35.000 | this is the situation that we face generationally in this country.

00:11:38.000 | And right now it's especially prominent.

00:11:40.000 | The term that goes for it is the sandwich generation.

00:11:43.000 | And I don't know if this listener has children or not,

00:11:48.000 | but it really doesn't matter.

00:11:50.000 | It's especially more difficult with children.

00:11:52.000 | But what happens is there are millions and millions of us throughout the country

00:11:56.000 | who are now finding ourselves in this position

00:11:59.000 | or who will find ourselves in the position in the future,

00:12:02.000 | who will find ourselves in the position of needing to care for our aging parents

00:12:07.000 | and of caring for our own children at the same time.

00:12:11.000 | And this is incredibly challenging and incredibly stressful.

00:12:14.000 | And there are some demographic changes that have made this very challenging.

00:12:20.000 | And it comes down to the small number of children

00:12:22.000 | and the dispersion of families and the adjustments and changes in lifestyle.

00:12:27.000 | Now, I'm not going to make some values judgments on these things.

00:12:29.000 | You do what you want with them.

00:12:31.000 | But these are demographic realities, and they're facing all of us,

00:12:34.000 | which leads to the need for planning.

00:12:37.000 | And I'm going to draw some generalizations.

00:12:39.000 | I recognize they're generalizations, and they may not apply in every case,

00:12:45.000 | but I think it's important to understand and to think about

00:12:48.000 | because this question does not need only a financial answer.

00:12:52.000 | In the past, traditionally, how have we cared for our elderly and aged parents?

00:12:56.000 | Well, normally in the past, traditionally, the family unit was a lot tighter,

00:13:01.000 | a lot bigger, and a lot closer together.

00:13:04.000 | So in the past, we've had a society--

00:13:07.000 | and again, I recognize I'm idealizing a little bit,

00:13:10.000 | but I still think it's valid to do so in this situation to draw the lesson.

00:13:15.000 | In the past, we've had a society where the family units were much closer together.

00:13:19.000 | So we look at the Norman Rockwell painting of traditional U.S. America,

00:13:24.000 | and we see the family sitting down for dinner every day.

00:13:26.000 | Did that happen all the time? No.

00:13:28.000 | Were their families broken apart? Yes.

00:13:30.000 | But more than there is now, the family unit was in many ways much tighter,

00:13:34.000 | much closer relationship.

00:13:36.000 | There was a much larger family unit,

00:13:38.000 | and the work among the family unit was generally more integrated.

00:13:41.000 | So in an agrarian society, it would be very normal that children would grow up

00:13:46.000 | working with their parents every day, working with their parents,

00:13:50.000 | spending time with their parents, helping in the family enterprise.

00:13:53.000 | Traditionally, in the traditional view, this would be an agrarian enterprise, a farm.

00:13:56.000 | So on a farm, the children are working with the parents every day

00:13:59.000 | and really building this close-knit family.

00:14:02.000 | And then it would be unusual for the children to grow up and move very far away.

00:14:08.000 | Traditionally, in agrarian societies, generally, people will live somewhat close

00:14:12.000 | to where they were born and where they were from.

00:14:15.000 | And usually, you would have a high number of children,

00:14:18.000 | a much higher number of children than we have now.

00:14:20.000 | So maybe an average of 5 to 6 to 7 to 8 children,

00:14:23.000 | depending on what part of the world that you're in.

00:14:26.000 | Well, if you fast forward to today and look at how different our lifestyles are--

00:14:30.000 | OK, so before I go there, then as the parents age,

00:14:35.000 | traditionally, a farmer would never retire.

00:14:37.000 | I have a grandfather who was a farmer, the other grandfather,

00:14:40.000 | not the one who had dementia, although he also was a farmer, rancher, earlier in his life.

00:14:46.000 | But I have a grandfather who was a farmer, and he never retired.

00:14:48.000 | He died at 93 years old, and he never retired.

00:14:51.000 | He had to pull back.

00:14:53.000 | At the end of his life, he wasn't really able to go to the farm,

00:14:56.000 | but he was still working on paperwork.

00:14:57.000 | And so traditionally, as you aged, you were still part of the family,

00:15:00.000 | still part of the community, and you just simply took over some of the easier jobs

00:15:05.000 | that were less physically taxing.

00:15:07.000 | But you were still part and still very engaged.

00:15:10.000 | So I think people, because they felt engaged and as part of society, in my opinion,

00:15:13.000 | I think people aged a little bit more gracefully, and the family was able to help.

00:15:17.000 | So if all of the work is centered around the home, and so on the farm you have the farmhouse,

00:15:23.000 | you have the fields and everything relatively nearby,

00:15:26.000 | and if all of the work is centered on the home, you're always going to have many people there working.

00:15:30.000 | It's much simpler to have caretakers around to care for the aging parents.

00:15:35.000 | And so this makes, traditionally, people cared for their parents themselves.

00:15:38.000 | They've been able to produce and be productive,

00:15:40.000 | even though they're not necessarily earning an income.

00:15:44.000 | A grandparent can care for a grandchild much more easily.

00:15:47.000 | A grandparent can still help out with certain less physically demanding tasks.

00:15:52.000 | And so this is kind of the historical view.

00:15:55.000 | Well, fast forward, and there's been this dramatic shift over a couple of generations,

00:15:58.000 | and the dramatic shift has encompassed a few things.

00:16:00.000 | Number one, instead of an agrarian society, you have an industrialized society.

00:16:04.000 | So instead of home-based employment, where the family unit is working together,

00:16:08.000 | we have out-of-the-home-based employment, where the family unit is split.

00:16:12.000 | And traditionally, the male in this country may have been out of the house,

00:16:16.000 | and now it's more normal that both parents are out of the house.

00:16:18.000 | So this leads to a much more fragmented family.

00:16:21.000 | This leads to less time with the parents spending time with the children.

00:16:25.000 | This leads to the need to hire people for the raising of children,

00:16:28.000 | which is where you have the public education system comes in,

00:16:31.000 | and whether it's aspects of education, which is usually how it's thought of,

00:16:34.000 | or whether it's aspects of child care, which I believe there is, if you go and study it,

00:16:39.000 | there would be some evidence to say that that wasn't necessarily ignored

00:16:43.000 | when the system was established in the way it is,

00:16:45.000 | is that to make the transition to an industrialized society,

00:16:48.000 | and to incorporate both workers into the workforce,

00:16:51.000 | so that you can reduce the cost of the workers by increasing the supply of labor,

00:16:55.000 | go research it. I'm not convinced of it, but certainly there is literature

00:17:00.000 | that would indicate that people were not surprised by that development.

00:17:05.000 | Then, if you were to go and research this, you would find that we need something

00:17:12.000 | to care for the children, so therefore you have school that happens during work hours,

00:17:16.000 | and this provides for the child care.

00:17:19.000 | Well, this leads to a more fragmented family, where children and parents

00:17:22.000 | have a less intimate relationship with each other.

00:17:27.000 | They may be very busy, less together.

00:17:30.000 | We're not working on a common family enterprise,

00:17:32.000 | but we're each working on our own enterprises.

00:17:35.000 | Father and mother each have their own jobs.

00:17:37.000 | Children are encouraged to have their own jobs,

00:17:39.000 | and it's unusual if you find a family that's working together.

00:17:42.000 | Then this leads to a geographic dispersion, so with the increase in monetary wealth,

00:17:45.000 | with the pool of jobs, it's very abnormal for people to stay close to where they are at home.

00:17:50.000 | With the reduction of the number of children, you have a dramatic change,

00:17:54.000 | where now you have one or two children.

00:17:56.000 | You have one child, in the case of this author, and this child has two parents.

00:18:01.000 | Instead of five children and two parents.

00:18:04.000 | So you have this dramatic generational change.

00:18:06.000 | Two children, two parents, one child, two parents.

00:18:08.000 | Then when you take that into a spouse, and you say,

00:18:11.000 | "Okay, we have a male spouse who has his parents, and a female spouse has her parents,

00:18:19.000 | and maybe there's one or two siblings among them."

00:18:22.000 | Now we wind up in a situation where we may have four parents and two children

00:18:27.000 | to care for the four parents, or two, three, four children, depending on the numbers.

00:18:32.000 | Then in an age of changing family dynamics,

00:18:36.000 | it's more likely that it's possible that the parents are divorced,

00:18:39.000 | and now we have parents and step-parents.

00:18:41.000 | Now you're in a situation where instead of it just being one couple with a total of four parents,

00:18:47.000 | there's all the other step-parents involved.

00:18:49.000 | So it changes the dynamic.

00:18:51.000 | This is the reality that's facing the Social Security system,

00:18:54.000 | of the reduced number of workers that are working based upon the increased number of retirees.

00:19:00.000 | This is the challenge that's facing us demographically in this country.

00:19:03.000 | Well, it hits close to home when it comes to long-term care,

00:19:05.000 | because that means that all of the responsibility for the care of the parents,

00:19:09.000 | should the child choose to assume that responsibility as a child,

00:19:12.000 | is placed upon one or two children.

00:19:15.000 | This can be very challenging.

00:19:18.000 | So with these demographic changes, it leads to a difficult situation.

00:19:21.000 | I point it out because it leads to a need for a whole new area of planning.

00:19:27.000 | It is simply how do we care for ourselves as we age?

00:19:31.000 | In the past, it was simple. Family. That was the answer.

00:19:34.000 | It's that the family will care for me, so there's no problem.

00:19:36.000 | The family had the capacity.

00:19:38.000 | But how on earth do you have the capacity nowadays?

00:19:41.000 | How on earth do you have the capacity if you have children that are working,

00:19:45.000 | financially challenged, not able to necessarily do extremely well economically for them,

00:19:52.000 | and now they are faced with the challenge of supporting and being responsible for their parents

00:19:57.000 | as their parents need to care as they get older?

00:19:59.000 | So then that leads to the natural growth of the government programs that are in place.

00:20:02.000 | That leads to those government programs being overly taxed,

00:20:05.000 | which is what has happened with the government programs for care.

00:20:08.000 | One of the things that I have observed in paying attention to it

00:20:12.000 | is that while the expansion of traditional health insurance benefits has been steady over time,

00:20:21.000 | where those programs have been--the government has little by little increasingly picked up the expansion of those--

00:20:29.000 | expanded their care up to and including the Affordable Care Act

00:20:34.000 | and the changes that that has brought in the health insurance marketplace,

00:20:37.000 | it has been the--quietly over the last couple of decades,

00:20:41.000 | it has been the exact opposite in the areas of long-term care.

00:20:44.000 | And long-term care meaning ongoing custodial care,

00:20:47.000 | not for a critical illness that is expected to get better,

00:20:51.000 | but ongoing custodial care for something that is not expected to get better.

00:20:54.000 | And so if you go back and you trace the history of the tax law--I won't do that today in a Q&A show--

00:20:59.000 | but if you go back and trace the history, little by little,

00:21:01.000 | benefits have been removed consistently and steadily,

00:21:04.000 | even to the point of one of the things that got very little news,

00:21:07.000 | except among the professional advisor community,

00:21:09.000 | was there was a component of the Affordable Care Act called the CLASS Act.

00:21:13.000 | And I think that CLASS, if my memory is correct,

00:21:16.000 | stood for Community Living Assistance Something or Other, something like that,

00:21:20.000 | Community Living Assistance Program,

00:21:22.000 | and it was basically a federally organized version of long-term care insurance.

00:21:27.000 | Well, the program was such a disaster, actuarially speaking,

00:21:31.000 | and everyone knew it was and everyone said it was,

00:21:33.000 | that it was just quietly eliminated about--I think it was a year or so after it was passed,

00:21:38.000 | maybe a couple of years--the dates are fuzzy in my mind.

00:21:41.000 | So the benefits that are available, the government benefits,

00:21:43.000 | facing this demographic problem, the government benefits have been steadily reduced,

00:21:47.000 | have been steadily drawn back because there's no money available to pay for them.

00:21:51.000 | And so this is a big, big area of planning that we need to pay attention to,

00:22:00.000 | especially as we're responsible for guiding people.

00:22:03.000 | I'm not going to go deep into long-term care plan today,

00:22:05.000 | but I'll tell you the one that ticks me off is when people put an age in for long-term care.

00:22:10.000 | "Well, you should start planning for long-term care at age 60."

00:22:13.000 | Guess what?

00:22:14.000 | You should start planning for long-term care as soon as you're around,

00:22:18.000 | but you need to figure out where it comes in in your terms of financial priorities,

00:22:21.000 | and I'll cover that another time.

00:22:23.000 | But if you can ever prove to me--this one drives me nuts--

00:22:25.000 | if you can ever prove to me an age where all of a sudden it makes sense to plan for long-term care that age

00:22:32.000 | and it didn't before that and it doesn't after that, it's absolutely ridiculous to put an age on this.

00:22:36.000 | Plan for it when you can, and I promise we'll do extensive, in-depth planning shows on long-term care.

00:22:42.000 | So we need to do planning, and this is going to be a very challenging situation for this listener.

00:22:48.000 | And I don't know how challenging.

00:22:50.000 | The listener's father may be in excellent shape after he comes out of the hospital

00:22:58.000 | and may be able to care for himself,

00:23:00.000 | but then again he may need full-time care on an ongoing basis.

00:23:03.000 | And so it's impossible for, obviously, me to know,

00:23:05.000 | and I've just had an email that I'm answering publicly here,

00:23:08.000 | but I hope that I can have some thoughts and some ideas.

00:23:13.000 | So where I want to start with this is anytime you're starting with long-term care planning,

00:23:21.000 | start with the non-financial stuff.

00:23:24.000 | Don't start with the numbers, because no matter what the numbers are,

00:23:28.000 | just start with the non-financial stuff.

00:23:30.000 | And the biggest misconception about long-term care is that it's a financial planning situation.

00:23:35.000 | It is, and you can do some things with financial planning, but I say start with non-financial.

00:23:42.000 | And in this situation, I want to speak directly to this listener,

00:23:45.000 | you need to do some careful thinking and research on the impact that care and caregiving has on family.

00:23:52.000 | It can be an incredible blessing to care for your aging parents.

00:23:56.000 | I consider myself very fortunate to have been able to serve and to honor

00:24:00.000 | and to love my grandparents as they aged.

00:24:04.000 | What a way to give back for those who have cared for you and provided for you.

00:24:08.000 | And my parents are in excellent health, but should the opportunity arise to care for them,

00:24:15.000 | I will consider it an honor and a blessing to be able to serve them in a way to honor our parents.

00:24:21.000 | So it is an incredible blessing.

00:24:23.000 | It's also an incredible challenge.

00:24:25.000 | And I want to read you some statistics here.

00:24:27.000 | And these statistics I'm pulling from, this is a little bit old,

00:24:30.000 | a 2004 National Alliance for Caregiving Survey.

00:24:34.000 | And there are a few different sources of this list of statistics that I'm going to read,

00:24:39.000 | but I think they hold valid.

00:24:41.000 | So first of all, the majority of care that is provided for people who are chronically ill

00:24:48.000 | is provided by informal caregivers.

00:24:51.000 | And informal caregivers simply means family members, unpaid caregivers.

00:24:57.000 | So this would be you caring for your parents and providing the physical daily care that they need.

00:25:02.000 | Many children are going to be expected to care for their parents.

00:25:07.000 | And the challenge is that caring for the chronically ill parent often makes the caregiver chronically ill.

00:25:17.000 | And this is an incredible epidemic that most people just simply aren't familiar with.

00:25:22.000 | But I guarantee if you've been involved in the care of a parent or grandparent,

00:25:25.000 | you're nodding your head with me right now,

00:25:27.000 | is that it is a tremendous challenge and a tremendous burden on the family.

00:25:33.000 | It can be a joyful burden and an honor, like I said, but it's a burden.

00:25:37.000 | There's about 45 million informal caregivers in the United States, 21% of the adult population.

00:25:43.000 | So in 21% of households, there's an informal caregiver.

00:25:47.000 | 60% of these informal caregivers are women, 40% are men.

00:25:51.000 | Women still account for most of the caregiving hours per week, about 71%,

00:25:56.000 | although it is estimated that the percentages of men giving care will increase substantially

00:26:00.000 | because future families will have fewer children.

00:26:04.000 | The median age of informal caregivers is 45 years old.

00:26:07.000 | 62% of informal caregivers are married.

00:26:10.000 | 41% have children under 18 at home.

00:26:13.000 | Informal caregivers contribute on an average $200 out of their own pockets per month to subsidize care,

00:26:18.000 | so just simply contributing money out of pocket to pay for people to give them relief from the care.

00:26:23.000 | 67% reported providing care between 8 and 20 hours per week.

00:26:29.000 | On average, an informal caregiver provides care for 4½ years.

00:26:34.000 | Informal caregivers provided services that if they had been provided formally

00:26:38.000 | would have cost around $350 billion, about the same as Medicare's total spending.

00:26:44.000 | 22% of informal caregivers to the elderly are depressed, around twice the rate in the population as a whole.

00:26:52.000 | 55% of caregivers living with dementia patients suffer clinical depression.

00:27:00.000 | I'm going to repeat that.

00:27:02.000 | 55% of caregivers living with dementia patients suffer clinical depression.

00:27:07.000 | It is incredibly challenging to care for somebody with dementia on an ongoing basis,

00:27:12.000 | and you need to be very, very careful, very, very careful to make sure that you are providing the support for the caregiver.

00:27:23.000 | An elderly informal caregiver has a significant risk of death as a result of his or her sick spouse's hospitalization.

00:27:30.000 | The risk to spouses was highest when the hospitalization was for a chronic disabling illness like dementia.

00:27:36.000 | Quote, "What this shows is that people are interconnected, and their health is interconnected,

00:27:41.000 | and seeing a person that you love suffer, seeing them ill, harms you,"

00:27:45.000 | said study co-author Dr. Nicholas Christakis of the Harvard Medical School.

00:27:50.000 | Elderly informal caregivers run a 63% higher risk of dying from stress-related illnesses.

00:27:58.000 | Informal caregivers who responded that their health has gotten worse as a result of caregiving

00:28:04.000 | most commonly report a loss of energy and sleep, 87%.

00:28:09.000 | Stress or panic attacks, 70%.

00:28:12.000 | Aches or pain, 60%.

00:28:15.000 | Depression, 52%.

00:28:17.000 | Headaches, 41%.

00:28:19.000 | And weight gain or loss, 38%.

00:28:22.000 | In addition, they tend to spend less time with family or friends, 69%, and at work, 37%.

00:28:29.000 | Abuse of the elderly by family members has risen significantly,

00:28:33.000 | 73% of caregivers listed prayer as the best way to cope with the stress and sadness of providing care.

00:28:39.000 | Alzheimer's disease is a major cause of the need for long-term care.

00:28:44.000 | One in eight people 65 and older have the mind-destroying illness.

00:28:48.000 | Half of all people over 85 are affected.

00:28:52.000 | Ten million Americans are currently caring for a person with Alzheimer's disease

00:28:57.000 | and tend to be stressed to the breaking point financially, emotionally, and physically.

00:29:04.000 | The challenges about distance between -- the challenges about distance from parents.

00:29:10.000 | This is a study from MetLife.

00:29:12.000 | 15% of caregivers leave at least one hour away from their parents.

00:29:16.000 | 33% provide care at least once a week.

00:29:20.000 | Respondents estimated that care and travel amounted to one full workday per week.

00:29:24.000 | 23% reported that they were the only caregivers their parents had.

00:29:28.000 | Nearly 50% stated they spent an additional 3.4 to 4 hours per week arranging or monitoring care.

00:29:34.000 | 40% reported providing direct assistance with the most difficult activities of daily living.

00:29:40.000 | Caregivers reported spending an average of $199 per month on travel,

00:29:45.000 | in addition to the $200 per month they spend to help their parents.

00:29:50.000 | And so one quote here from this book that I'm referencing here

00:29:55.000 | is a quote out of a PBS documentary entitled "And Thou Shalt Honor It."

00:30:00.000 | And one woman when being interviewed replied,

00:30:03.000 | "When I got married, I never really understood the vow in sickness and in health.

00:30:08.000 | Now I do. His sickness, my health.

00:30:12.000 | For it to be easy for me, it would have to be over for my husband.

00:30:16.000 | That's unacceptable.

00:30:18.000 | I often wonder, will there be anything left of me when he passes away?

00:30:23.000 | Will there be anything left for me?"

00:30:30.000 | It's probably a good place to stop.

00:30:33.000 | So I take a moment just to read those statistics

00:30:35.000 | because I had seen prior to my learning those statistics,

00:30:38.000 | and I learned that years ago.

00:30:40.000 | I was reading those statistics from a manual that I had,

00:30:45.000 | a financial planning manual for a certification I got years ago

00:30:48.000 | called the Certification in Long-Term Care Planning.

00:30:51.000 | And when I read those statistics, it was the first designation

00:30:54.000 | that I went out and pursued after becoming a financial planner

00:30:57.000 | because of my experience with it

00:30:59.000 | and also because it was kind of an easier designation to get.

00:31:03.000 | And when I read those statistics, I was just stunned.

00:31:05.000 | I had never had any idea.

00:31:07.000 | And, again, those are a little bit dated.

00:31:09.000 | I'm sure they're even more significant now.

00:31:11.000 | So I point them out to you just to be aware of them

00:31:16.000 | because this makes a big difference.

00:31:19.000 | Now, if you're aware of something, you can put plans in place

00:31:24.000 | to avoid the major problems.

00:31:26.000 | So, for example, if you're aware of the fact that a tremendous percentage of parents--

00:31:32.000 | I forget the statistics. I'll have to check them some other time.

00:31:35.000 | But if you're aware of the fact that there is a tremendously high divorce rate

00:31:40.000 | among parents who have either lost a child to death

00:31:44.000 | or who are dealing with a child who's disabled,

00:31:47.000 | then if you lose a child to death or you have a child who's disabled,

00:31:50.000 | you can plan for that and you can recognize, "My marriage is in danger.

00:31:55.000 | I need to take extra special steps for this."

00:31:58.000 | Or if you're aware of the fact that the majority of lottery winners

00:32:01.000 | become broke or bankrupt soon after winning their lotteries,

00:32:04.000 | then if you win the lottery, then you can make plans

00:32:07.000 | and you can say, "Wait, I need some careful and special--

00:32:10.000 | this doesn't have to happen, but I need to do something very carefully

00:32:14.000 | to make sure that I avoid it."

00:32:16.000 | So I spent a lot of time with those statistics to say,

00:32:19.000 | "You need to recognize," speaking to the listener,

00:32:21.000 | "You need to recognize that in the situation you described to me

00:32:24.000 | with an 81-year-old father and a mother who's 20 years younger

00:32:27.000 | who will be his primary caregiver,

00:32:30.000 | the tremendous amount of stress that she will be under

00:32:33.000 | and how that can affect her health and her happiness tremendously.

00:32:38.000 | And you need to put plans in place to avoid that.

00:32:41.000 | You also need to recognize the tremendous stress

00:32:43.000 | that it's going to place on you and on your marriage

00:32:46.000 | and put plans in place to deal with that as best you can.

00:32:50.000 | It's going to be financial stress--

00:32:52.000 | again, the average is $200 a month of contributions to pay a caregiver

00:32:56.000 | to give your parents some sort of extra help,

00:33:00.000 | plus $200 a month of travel expenses just to get there.

00:33:05.000 | And you can understand if you live an hour away from your parents

00:33:08.000 | and you're going to travel there for one hour a week--

00:33:11.000 | excuse me, at least a day or two a week--

00:33:13.000 | that's going to bring a tremendous financial burden

00:33:15.000 | just doing gasoline and wear and tear on a vehicle.

00:33:17.000 | So we need to make some plans that are going to help to improve this.

00:33:25.000 | Now, unfortunately, I don't have any good plans

00:33:28.000 | because you've got to look at the actual situation.

00:33:30.000 | You've got to say, "Well, what do my parents need?

00:33:33.000 | What do they have?

00:33:35.000 | Is there a way that we could somehow live together to diminish costs?"

00:33:40.000 | Now, that may or may not be possible depending on the situation.

00:33:43.000 | "Is there a way that I can contribute financially?

00:33:46.000 | Is there a way that--?"

00:33:48.000 | You've got to find a plan.

00:33:50.000 | I'm going to talk through some of the benefits that you need to research

00:33:53.000 | to see what's available to you as far as for extra help.

00:33:56.000 | But the big thing is not going to be any kind of benefits

00:33:59.000 | because, frankly, there are none.

00:34:01.000 | And I say that as a blanket statement.

00:34:03.000 | There are a few, but there's generally not much.

00:34:06.000 | And this is because it's an epidemic that we're facing in the country.

00:34:09.000 | And unless you've done prior planning

00:34:11.000 | and unless you've saved money for this situation,

00:34:14.000 | unless you have money to pay for a caregiver, a formal caregiver,

00:34:17.000 | or unless you have something like a long-term care insurance policy

00:34:20.000 | that can fund it, then there's not a financial solution.

00:34:26.000 | There's not.

00:34:28.000 | You have to commit to providing the care and figuring it out as you go.

00:34:31.000 | Now, you shouldn't feel bad about not planning

00:34:33.000 | because the reality is that if you had started five years ago with this planning

00:34:36.000 | and you were sitting in my office and we said, "Okay, if your dad and mom

00:34:39.000 | as we're sitting there and your dad is 75 years old,"

00:34:42.000 | and then considering some of the other health problems that you shared with me,

00:34:46.000 | I would have said there's nothing you can do.

00:34:48.000 | It's too late. It's too late.

00:34:51.000 | After those health problems, after you have certain health problems,

00:34:54.000 | you can't buy insurance, and you don't have the money, and you're not working.

00:34:58.000 | So don't beat yourself up about not doing the planning in the past.

00:35:01.000 | Just recognize that it's going to be very much a non-financial answer,

00:35:04.000 | not so much a financial answer.

00:35:06.000 | So continuing on, okay.

00:35:13.000 | I've got to pick up the pace here.

00:35:15.000 | So what do you need to do?

00:35:17.000 | You need to start researching.

00:35:19.000 | There is no one place that I would encourage--that I can send you to

00:35:22.000 | to say, "Here's the information.

00:35:24.000 | I'm going to give you some ideas of some things that I think you need to research

00:35:27.000 | and some programs to investigate," and a broad brush stroke of how they work to see,

00:35:32.000 | to see what may or may not be available to you.

00:35:35.000 | But the key is you've got to become a researching hound

00:35:39.000 | to find the information that you need.

00:35:42.000 | It's not served up to you on a platter anywhere that I've ever been able to find.

00:35:45.000 | First of all, you said that your father was a Korean War veteran.

00:35:48.000 | This is good because there may be some veteran benefits,

00:35:51.000 | although it's usually unlikely.

00:35:55.000 | So first of all, what about veteran benefits of the traditional--the health insurance benefits?

00:35:59.000 | You should know by this point what benefits your father is entitled to.

00:36:03.000 | And in general, the Veterans Administration will provide some long-term care benefits.

00:36:11.000 | And real quick, a quick thing you need to understand.

00:36:13.000 | Long-term care--when I use that word, what long-term care refers to is

00:36:17.000 | long-term care refers to something called a chronic illness.

00:36:20.000 | And a chronic illness is for something that's not expected to get better.

00:36:25.000 | So the example here would be Alzheimer's.

00:36:28.000 | Alzheimer's is not expected to get better.

00:36:31.000 | There's no cure that anyone that I'm aware of, anyone has found for Alzheimer's.

00:36:34.000 | There's not really any treatment that I know that can be expected to improve it,

00:36:38.000 | although maybe it could be slowed down through brain stimulation and physical exercise.

00:36:42.000 | I've read some of the studies on that, but I'm not aware of somebody saying

00:36:45.000 | we can improve the situation through this certain treatment program.

00:36:48.000 | So something like Alzheimer's, once you're diagnosed with Alzheimer's,

00:36:51.000 | it's something you have, and you're not going to get any--it's not expected to get better.

00:36:55.000 | Now, that would be compared with falling and breaking your leg.

00:36:58.000 | Well, that's considered to be an acute illness, and it's something that is going to get better.

00:37:02.000 | So when I say long-term care, I'm talking about ongoing what's called custodial care,

00:37:08.000 | care with the activities of daily living, care with bathing, dressing,

00:37:12.000 | help assistance with toileting, with transferring between a bed and a chair,

00:37:17.000 | those types of things, those are all considered to be activities of daily living.

00:37:21.000 | And if you spend some time--so that's custodial care.

00:37:27.000 | So when I talk about long-term care, I'm talking about ongoing custodial care,

00:37:30.000 | not, okay, you went into the hospital.

00:37:32.000 | Your father is covered under the Veterans System and also under Medicare.

00:37:35.000 | So that's going to take care of some of the hospital benefits based upon what part Medicare is he in,

00:37:40.000 | does he have a supplement plan or not.

00:37:42.000 | That's all you should be familiar with that by this point.

00:37:44.000 | But the Veterans Administration provides limited long-term care services,

00:37:49.000 | but they do it based upon priorities.

00:37:52.000 | And so, as you should be familiar with by now, the veterans' benefits are divided into eight tiers,

00:37:58.000 | so tiers one through eight with some sub-tiers based upon whether or not a veteran has

00:38:04.000 | a service-related disability, so a disability that was related to their service in the military.

00:38:10.000 | And so priority group one is veterans that have a service-related disability,

00:38:15.000 | that is 50% or more disabling, or veterans who were determined by the VA to be unemployable

00:38:22.000 | due to service-related--service-connected conditions.

00:38:25.000 | So if you are extremely disabled because of some injury that you received while being in military service,

00:38:32.000 | then you're in priority group one.

00:38:34.000 | And in this situation, there's a very high chance that you will qualify for long-term care benefits

00:38:38.000 | under the veteran system.

00:38:40.000 | Priority group two would be veterans with service-connected disabilities rated 30% or 40% disabling.

00:38:46.000 | Priority group three, veterans with service-connected disabilities rated 10% or 20% disabling.

00:38:51.000 | Veterans who were former prisoners of war, veterans awarded the Purple Heart,

00:38:55.000 | veterans whose discharge was for a disability that began in the line of duty,

00:38:58.000 | veterans who were disabled because of VA treatment or participation in a VA vocational rehabilitation program,

00:39:03.000 | and it goes on down through the eight lists.

00:39:07.000 | And if you go down into groups six, seven, and eight, there's sub-priorities.

00:39:11.000 | So in group eight, for example, group eight--priority group eight,

00:39:15.000 | veterans who agree to pay a specified copayment with income and/or net worth above the VA means test threshold

00:39:20.000 | and the geographic means test threshold.

00:39:22.000 | Sub-priority A, non-compensable 0% service-connected veterans enrolled as of January blah, blah, blah.

00:39:27.000 | So there's all these sub-priorities.

00:39:29.000 | Go Google it.

00:39:30.000 | You'll find it right on the Veterans Administration website, all this information.

00:39:33.000 | You want to find out what group your father is in and just see if there's any chance of getting benefits.

00:39:39.000 | I do not know how far down this list they are currently providing benefits.

00:39:44.000 | In the past, when I have researched it, it was only the first few,

00:39:48.000 | and basically as the costs have gone up and as the budgets have gotten more thin,

00:39:53.000 | the VA has had to cut back on benefits.

00:39:56.000 | So the best thing to do there is just become very close to the VA consultants that are at the VA

00:40:03.000 | and see if there's some program that they know of.

00:40:06.000 | Now one thing that would not necessarily be connected to that priority system would be what's called the aid

00:40:14.000 | and attendance special pension.

00:40:17.000 | And so what this is is the special pension that will pay for additional amounts of money for a veteran

00:40:23.000 | who is receiving care at home.

00:40:25.000 | So I will put a link in--I'll put a link in the show notes here.

00:40:29.000 | I'll put two links here, one from VeteranAid.org and the other from Benefits.VA.gov.

00:40:34.000 | And so the VeteranAid.org says, "Eligibility for the aid and attendance pension.

00:40:38.000 | Any wartime veteran with 90 days of active duty, one day beginning or ending during a period of war,

00:40:43.000 | is eligible to apply for the aid and attendance improved pension.

00:40:47.000 | A surviving spouse, marriage must have ended due to death of a veteran or of a wartime veteran, may also apply.

00:40:54.000 | The individual applying must qualify both medically and financially.

00:40:58.000 | To see the periods of war that have been qualified by Congress, follow this link.

00:41:01.000 | To qualify medically, a wartime veteran or surviving spouse must need the assistance of another person

00:41:06.000 | to perform daily tasks such as eating, dressing, undressing, taking care of the needs of nature, etc.

00:41:11.000 | Being blind or in a nursing home for mental or physical incapacity

00:41:15.000 | or residing in an assisted living facility also qualifies."

00:41:18.000 | And it goes on and talks about how to get eligibility.

00:41:21.000 | So this is an additional pension benefit that you may be eligible of in addition to the other monthly pension benefits.

00:41:30.000 | So you would want to research this.

00:41:32.000 | You need to be housebound.

00:41:33.000 | And so this might be an option where even at housebound with in-home care,

00:41:38.000 | if your father needs in-home care, this may be something where you may be eligible for an additional pension.

00:41:43.000 | Now, depending on the income limits, you need to check out the income limits on this program

00:41:49.000 | and you need to look at the eligibility limits.

00:41:52.000 | But this would be something that would be something to research and see if you would qualify or not.

00:41:58.000 | As far as any TRICARE benefits, TRICARE doesn't cover long-term care.

00:42:02.000 | Basically, that's the broad brush stroke because TRICARE is similar to health insurance.

00:42:08.000 | So let's just leave it there and not talk about any exceptions to any of that.

00:42:11.000 | So the next program, Medicare and Medicaid.

00:42:13.000 | So in broad strokes, Medicare will not provide any long-term care benefits.

00:42:19.000 | So now that I've said that, here's what they will provide.

00:42:21.000 | Long-term care -- excuse me, Medicare will provide long-term care benefits if care is received in a nursing home following,

00:42:28.000 | I think it's a three-day hospital stay.

00:42:30.000 | And the way they do that is they will pay for the first 20 days of care that are needed in a nursing home after a hospital stay.

00:42:37.000 | They'll pay for the first 20 days each 100%.

00:42:41.000 | And then they will help pay for days 20 through 100 as long as you pay a daily copay.

00:42:47.000 | And I think the current daily copay rate is in the vicinity of about $150 a day.

00:42:51.000 | So if your father is getting out of the hospital and he goes into a nursing home,

00:42:55.000 | Medicare -- because he's in the hospital for a stroke, Medicare will pay for the first 20 days,

00:43:00.000 | and then for days 20 through 100, you'll pay $150 a day copay and Medicare will pick up the balance.

00:43:06.000 | After 100 days, there are no more Medicare benefits available.

00:43:10.000 | So in general, Medicare is not a solution for ongoing long-term care.

00:43:14.000 | That's why I say Medicare doesn't provide any long-term care benefits.

00:43:18.000 | Now Medicaid, which is financial assistance for people for their health situations who are broken

00:43:26.000 | and who don't have any money and don't have any assets, Medicaid will provide long-term care benefits.

00:43:32.000 | In general, Medicaid will provide long-term care benefits primarily in nursing homes.

00:43:38.000 | Now there have been some changes in this situation over the last few years where Medicaid has been

00:43:42.000 | testing various programs in different states to try to provide more in-home health care.

00:43:47.000 | And there's something that's -- this is a challenging area of government policy because when they try

00:43:52.000 | to provide in-home health care, that's cheaper.

00:43:55.000 | It's cheaper for the -- it would be cheaper for the government to provide in-home health care

00:44:00.000 | for many people more so than providing for facilities.

00:44:04.000 | So just go with nursing home versus in-home health care to simplify our example.

00:44:08.000 | It's cheaper to provide in-home health care.

00:44:10.000 | Now the concern is that if those benefits are too generous, then what will happen is that because the

00:44:15.000 | majority of people receiving care are currently doing it informally with no compensation,

00:44:23.000 | so this would be your mom caring for your dad at home, she's not going to get any compensation

00:44:27.000 | for doing it informally.

00:44:29.000 | Because they're currently receiving care informally, if Medicaid starts paying for people to receive

00:44:35.000 | in-home health care, the concern is that there's going to be caregivers coming from all over the place,

00:44:41.000 | coming out of the woodwork and saying, hey, pay us money or just pay for me to keep my family member

00:44:47.000 | at home and that way I can do less of the physical work of the care and yet they can still be at home.

00:44:52.000 | So the concern is that if Medicaid starts paying for people to receive in-home health care,

00:44:58.000 | they can still be at home.

00:44:59.000 | They actually call this the woodwork principle and it's a big deal in government policy to try to figure this out.

00:45:04.000 | Now Medicaid is a state-run program, so each individual state will have their own benefits.

00:45:09.000 | And again, various states are testing their programs.

00:45:13.000 | I don't know which state you live in.

00:45:15.000 | I live in Florida, so I'm somewhat familiar with Florida's Medicaid laws, but I'm not familiar with your state,

00:45:20.000 | and so I'm not going to make any comment about what your state will do.

00:45:23.000 | Just remember that as a big, broad brush stroke.

00:45:26.000 | In general, Medicaid will provide for care.

00:45:28.000 | Most of the care they'll provide is for a nursing home.

00:45:31.000 | And this is kind of the constant challenge because very few people want their family members to be in a nursing home.

00:45:36.000 | Most people would prefer their family members to be in the comfort of their own home where they're familiar with the

00:45:42.000 | surroundings and they're comfortable and have the things that they value around them.

00:45:45.000 | However, there are very few government benefits available for that.

00:45:48.000 | So you want to make sure that you are aware of that.

00:45:51.000 | If you feel that Medicaid is going to be a solution, if you check out your services

00:45:56.000 | and you check out the information on your state's Medicaid programs,

00:46:01.000 | you need to find out the qualification and how do you qualify it and what are the restrictions on qualifications.

00:46:06.000 | In order to qualify for Medicaid, you have to have income and assets under certain strict numbers,

00:46:15.000 | and then you have to qualify medically.

00:46:17.000 | So you have to have income and assets under certain numbers.

00:46:20.000 | With each state, it's a little bit different.

00:46:22.000 | But in general, there are three different categories of assets.

00:46:26.000 | There are what are called countable assets, which are called non-exempt or available assets in some states.

00:46:31.000 | There are non-countable assets or exempt assets.

00:46:34.000 | And then there are inaccessible assets.

00:46:37.000 | And so the key is to look at your parents' asset mix and figure out which of their assets under your state's Medicaid laws

00:46:44.000 | would be countable assets versus non-countable assets.

00:46:47.000 | So countable assets are any personal resources that are owned or controlled by an applicant for Medicaid benefits.

00:46:53.000 | So these must be spent on care before qualifying for Medicaid.

00:46:58.000 | Usually this would include stocks, bonds, cash, investments, pension plans, annuities, a primary residence,

00:47:07.000 | life insurance, vacation properties, investment properties, basically any assets.

00:47:12.000 | With a primary residence, there's almost always an exception for a spouse.

00:47:16.000 | So we'll talk about that in a second.

00:47:18.000 | Then you have the non-countable assets, which would be a small amount of money, usually a few thousand bucks.

00:47:22.000 | Primary residence, especially if there's a spouse that is surviving, a community-based spouse.

00:47:29.000 | Maybe some life insurance, some term life insurance, or some kind of business assets,

00:47:34.000 | and maybe an inexpensive car for personal use, and then various personal items.

00:47:38.000 | In general, Medicaid, you're going to have to get rid of all of your assets except for those non-countable assets.

00:47:44.000 | As far as the primary residence, there may be a state, a cap on an amount of value that's set by your state.

00:47:51.000 | It's usually either about a half a million or $750,000.

00:47:55.000 | So under this scenario, your dad's house would be fine.

00:48:00.000 | Then also there's usually exceptions for the spouse.

00:48:03.000 | The laws are generally written such that you're not going to be required to impoverish your mother in order to provide for your father.

00:48:09.000 | In general, that's going to be the situation.

00:48:17.000 | Again, there are exceptions.

00:48:20.000 | So check your state's Medicaid laws to see what your actual situation would be.

00:48:25.000 | Then you're going to look at inaccessible assets.

00:48:28.000 | Inaccessible assets would be anything that the government says this has to be provided for the care.

00:48:38.000 | So they're trying to -- maybe if this would be where you get into the situation where someone's trying to transfer assets to their children

00:48:45.000 | or transfer assets to a friend, and then the Medicaid administrator looks at it and says,

00:48:51.000 | "Well, this is a fraudulent transfer.

00:48:52.000 | Even though this asset isn't accessible to you, it has to be spent on your care before you're eligible for Medicaid."

00:48:58.000 | There is now a five-year look-back period for Medicaid eligibility.

00:49:02.000 | So what that means is that on the date that you go to apply for Medicaid,

00:49:05.000 | there is a five-year look-back period under which the Medicaid administrator can technically undo any financial transactions that you have done

00:49:13.000 | or count them towards your Medicaid bill.

00:49:21.000 | So, for example, if you have half a million dollars of cash and you transfer that to your son

00:49:27.000 | and then you go and apply for Medicaid the next day, well, that transfer is going to --

00:49:32.000 | you're going to have to spend that half a million dollars is going to have to be spent on your care

00:49:35.000 | before Medicaid will provide you with the care that you need.

00:49:38.000 | So this is a much longer transfer period.

00:49:41.000 | So you would want to consider doing some Medicaid planning.

00:49:44.000 | Now, in your situation, it's going to sound pretty simple, but once you research your state's Medicaid laws,

00:49:48.000 | it might be worthwhile for you to just look at your parents' assets and prepare your father to qualify for Medicaid whether or not you choose to apply.

00:49:56.000 | And so knowing that there's going to be a five-year look-back period

00:49:59.000 | and not knowing whether your father is going to live for 10 or 15 years,

00:50:02.000 | if he has any assets that are going to disqualify him for that, then you may consider doing some Medicaid planning.

00:50:08.000 | And I'm going to basically quit with that and stop there just because it's so state law dependent.

00:50:14.000 | Now, you want to be careful with this because there may be other tax considerations.

00:50:18.000 | For example, maybe with their property -- so this would be where, as you're considering your plan,

00:50:24.000 | let's say that you mentioned your parents live out in the country and it's far away from you.

00:50:27.000 | That's probably not a place that's very conducive to your parents receiving care.

00:50:31.000 | It may be a lot better for your parents to receive care in a town where there can be a caregiver that's nearby that can come by and help out.

00:50:39.000 | So you're going to have some trouble.

00:50:42.000 | You're not probably going to want to consider selling that.

00:50:44.000 | But if all of a sudden you say, "Okay, we've got a non-accountable asset.

00:50:49.000 | We've got a privately owned residence here with a spouse that's living in it, and then we go and sell that asset,

00:50:55.000 | and now we've got $100,000 sitting in a checking account.

00:50:58.000 | Well, now we've changed a non-accountable asset into an accountable asset.

00:51:02.000 | And so now that $100,000 has to be spent on the cost of care before we can qualify for Medicaid."

00:51:07.000 | So that would be something that you would want to be careful of.

00:51:11.000 | Now, you may want to sell that property and move to another property, or you may be able to arrange some other plan.

00:51:16.000 | Like, there are many things that you can do, and again, without knowing the situation,

00:51:21.000 | I can't give you more information than this just to say this is how I would think through it.

00:51:25.000 | And I would encourage you to contact a qualified planner locally and have them help you to talk through some of these things.

00:51:32.000 | So consider Medicaid planning.

00:51:34.000 | Consider just taking a look at what assets would need to be spent down.

00:51:38.000 | Consider doing this.

00:51:40.000 | The rules have tightened up significantly, so be suspicious of anything.

00:51:44.000 | So assume anything you hear or read about Medicaid planning is probably wrong until you check it out.

00:51:50.000 | Because in the past, there were many things that could be done.

00:51:53.000 | There were certain trusts that you could establish and you could transfer your assets into that.

00:51:57.000 | There were certain transfers of assets that you could accomplish, but all of those laws have been tightened up.

00:52:01.000 | It doesn't mean there's not something available.

00:52:04.000 | There are various planning tools available, and without -- it's already gone on much longer than I thought.

00:52:09.000 | So without going into the depths of Medicaid planning, I would just encourage you to consider just researching it,

00:52:17.000 | find some books on it, and consider speaking with an elder law attorney

00:52:21.000 | and finding someone who is qualified with your state's information.

00:52:25.000 | So there are various tools that you could use.

00:52:30.000 | There are various things that you could look at, but I think that's enough for that.

00:52:35.000 | My next point and my last three points, and with this I'm done,

00:52:40.000 | and I may have to cut off and not answer the next question.

00:52:44.000 | I've gone a lot longer on this than I intended to.

00:52:47.000 | So the next one would be look for and research any kind of community-based programs.

00:52:53.000 | So there's not going to be a magic bullet, at least that I've ever found, that's going to solve your financial problem.

00:52:59.000 | But there may be some local community programs that may be helpful to you.

00:53:03.000 | And so look for things like community programs such as Meals on Wheels.

00:53:07.000 | Those types of programs are usually community-based.

00:53:10.000 | They're often not a cost, and so that can help.

00:53:13.000 | So that can help relieve some of the burden.

00:53:15.000 | Now you may have to go out and research those things.

00:53:17.000 | There are many programs out there, but you have to really take it on and just talk to everybody.

00:53:22.000 | So get in the habit of talking to everybody and saying, "Do you know of anything that you can help?"

00:53:26.000 | And you'll find something there in whatever little local town is.

00:53:30.000 | You may find a program that's available that I don't have any concept of here in West Palm Beach, Florida.

00:53:37.000 | So look for any kind of community-based programs.

00:53:40.000 | Consider research to see if there are any adult daycare facilities.

00:53:44.000 | So this is another form of community-based care that can really be a blessing.

00:53:48.000 | And maybe there's something that's at a discounted cost, and this would allow --

00:53:53.000 | an adult daycare facility is essentially an opportunity program that's set up where you can take your person --

00:54:01.000 | where the person who's needing care can be cared for during the day in a community-based setting

00:54:06.000 | so that the caregiver can go to work.

00:54:09.000 | So if your mom is working continually, then she would be able to continue working while someone else would care for her husband during the day,

00:54:20.000 | and then she would have the care in the morning and at night.

00:54:23.000 | So consider that and research to see if there's something available.

00:54:26.000 | Sometimes there are hospice benefits that are available.

00:54:29.000 | I know that when we were caring for my grandfather, the hospice organization was incredibly beneficial.

00:54:34.000 | And although they couldn't send a nurse out, they couldn't send a nurse out to help full-time and just do things.

00:54:40.000 | They could send a nurse out -- because of my grandfather's condition, they could send a nurse out for one or two times per week.

00:54:46.000 | And that's incredibly helpful because it provides what's called respite care,

00:54:50.000 | which is basically just to give the primary caregiver a respite, a break from the care.

00:54:55.000 | And so it was incredibly valuable to have an evening where my parents could get out of the house and have an evening off,

00:55:01.000 | because that's the big thing, is that when you're primarily responsible, it's a 24-hour a day, 7-day-a-week care that's being provided.

00:55:10.000 | And so it's a blessing to be able to have a day off.

00:55:14.000 | Consider to see if there's some kind of inexpensive way that you can get some help.

00:55:19.000 | So instead of hiring a large home health care agency where you're going to negotiate a contract for 8 hours a day

00:55:25.000 | and your monthly cost is going to be $5,000, that's not going to be feasible.

00:55:29.000 | But do some research to see if maybe there is a long-term care nurse that would like, on the side,

00:55:35.000 | to come by for a little bit in the evening, for an hour on her way home, or come by in the morning for an hour on his way home,

00:55:41.000 | or on an hour on his way to work, or things like that, to care.

00:55:44.000 | And in exchange for a much smaller amount of money, they can provide a little bit of care, and that can be tremendously valuable.

00:55:50.000 | I know we negotiated that in my family, and it was an incredible blessing just to have somebody come by for a half hour,

00:55:55.000 | an hour in the morning, and a half hour, an hour in the evening.

00:55:58.000 | And then it really made the physical needs of care a lot better and really made it a lot helpful.

00:56:04.000 | So look for some of these alternative strategies.

00:56:06.000 | Also, the other idea that I would have is in the example you described to me with your parents,

00:56:13.000 | with your father being older and your mother being younger, consider to see and research to see if you could get some additional

00:56:21.000 | Social Security income for her based upon filing for a spousal benefit and then deferring her own benefit.

00:56:32.000 | So perhaps she can file a spousal Social Security benefit, depending on her age.

00:56:35.000 | I think you have to be at least 62 years old.

00:56:37.000 | So she could file for her spousal benefits and receive a partial Social Security benefit while still continuing to accrue her own retirement benefit.

00:56:45.000 | And then she can defer her own retirement record up until the maximum latest age, hopefully at least until 70.

00:56:51.000 | So that will help her to be able to provide for herself down the road.

00:56:54.000 | It would be a major mistake for her to apply based upon the income scenario that you described to me.

00:56:59.000 | It would be a major mistake for her to apply at 62 to be able to -- at 62 for her retirement benefits.

00:57:07.000 | But if she could file on a spousal benefit on her husband and then continue to accrue her own benefits

00:57:13.000 | and file on her own record at 70 with a much higher benefit after it's had the time to be the late benefit

00:57:19.000 | and after she's had time to continue contributing to the system under her earnings, that might really make a big difference.

00:57:27.000 | Last thing is this.

00:57:29.000 | And I think I am going to stop with just this one question.

00:57:32.000 | And I apologize to -- I think it was Jason who had asked me the question on the 401(k).

00:57:37.000 | I didn't mean to go on this long about this question, but this is a big passion of mine

00:57:42.000 | and I want to provide this as a helpful resource.

00:57:44.000 | And the last thing I would say is this.

00:57:47.000 | It's very challenging when you're in the middle of a situation like this to figure out kind of what's next.

00:57:53.000 | And we don't know what's next.

00:57:55.000 | We don't know if your father is going to have another stroke and next month he's going to die

00:57:59.000 | or we don't know if we're going to be caring for him for the next 10 years.

00:58:02.000 | Nobody knows.

00:58:04.000 | So be flexible.

00:58:06.000 | But do whatever you can to try to make it the most amazing situation that you can.

00:58:12.000 | And one of the things that I've observed, and I see this happening a lot,

00:58:15.000 | is if your mother is not working in a job that's conducive to providing care,

00:58:20.000 | don't be scared to think outside of the box and find something radically different that's way more exciting,

00:58:25.000 | that's far more lucrative, and that helps her to have the ability to still provide care.

00:58:32.000 | There are so many options that are available.

00:58:35.000 | And the biggest thing that I've observed is that as people tend to age,

00:58:38.000 | they tend to lose their flexibility of thinking and flexibility of change.

00:58:42.000 | And yet I could point to dozens and dozens and dozens of scenarios, and we all know them.

00:58:47.000 | The most famous is Colonel Sanders when he started Kentucky Fried Chicken when he was 65 years old.

00:58:52.000 | So the key is to really consider those same kind of fluffy things that I always talk about.

00:58:58.000 | What do you want?

00:58:59.000 | Redefine yourself.

00:59:00.000 | Reinvigorate your life.

00:59:02.000 | Get additional education.

00:59:04.000 | Figure out what would my dream be.

00:59:06.000 | What new skills can I learn?

00:59:08.000 | And transform your life.

00:59:10.000 | And I haven't been 65 years old, so I don't know what it's like to be 65,

00:59:14.000 | but I've seen enough people who have been there and watched them

00:59:18.000 | and just seen how dramatically they changed their lifespan and changed their situation as time goes on.

00:59:25.000 | So I hope that you can spend some time with your mom really just talking about goal setting

00:59:31.000 | and figuring out what's going to really serve the family well.

00:59:34.000 | And I hope that you guys, with a little bit of this information,

00:59:37.000 | can develop a plan that is going to really help you to come through this in a really positive way,

00:59:46.000 | and it can be a huge, huge benefit for you.

00:59:50.000 | I think that's it for today.

00:59:52.000 | And I didn't expect this show to go this way.

00:59:54.000 | If you've stuck with me through the end, again, even if just the one listener has listened,

00:59:59.000 | then consider this a personal conversation and my best effort to give you some thoughts

01:00:04.000 | that I hope will steer you in the right direction.

01:00:06.000 | And I'm thrilled to be able to do that.

01:00:08.000 | That's the advantage of podcasting, right?

01:00:10.000 | I often have gotten frustrated listening to financial radio

01:00:13.000 | and listening to someone give a four-minute answer to a question.

01:00:16.000 | And I know that you can't give a four-minute answer.

01:00:18.000 | And even I've spent, at this point, 59 minutes answering your question.

01:00:22.000 | And I think I've just given you some things to think about because I don't have an answer.

01:00:26.000 | And there is no answer except search it out and work on it.

01:00:30.000 | And I hope you can find a local advisor, someone who knows your situation.

01:00:35.000 | And I would encourage you, reach out to a local advisor,

01:00:38.000 | because reach out to somebody that is competent in this area.

01:00:42.000 | Search for somebody.

01:00:43.000 | What I would do is I would look for somebody who is an elder law attorney and talk with them.

01:00:49.000 | Start with the library.

01:00:50.000 | Let me rephrase.

01:00:51.000 | Start with the library.

01:00:52.000 | In every local library, there's going to be some really good resources on this

01:00:55.000 | in the public affairs section.

01:00:56.000 | And there's going to be some good books about it, and it will talk about your state's systems.

01:01:02.000 | Talk to every person that you're in contact with.

01:01:04.000 | So when you're at the hospital, ask them, "Do you know of anything?

01:01:07.000 | Do you know of anything?

01:01:08.000 | And do you know of any programs that are available?"

01:01:10.000 | And you'll find out about a lot that way.

01:01:12.000 | Try to find maybe a local financial planner.

01:01:14.000 | Try to find a local person who specializes in long-term care planning.

01:01:20.000 | And so whether this is someone with a CLTC designation, they have a listing on their website.

01:01:25.000 | The Corporation for Long-Term Care can do that, and that will be a lot of insurance people,

01:01:31.000 | a lot of investment people.

01:01:32.000 | I think some elder law attorneys, the man who founded that was an attorney,

01:01:36.000 | and he's done a great job really trying to promote long-term care planning.

01:01:42.000 | Consider, again, reaching out to somebody in the local community, just asking people for help.

01:01:47.000 | And I know for me--I know that you may be short on money.

01:01:51.000 | I know for me I always try--I've always wanted to help people as much as I can

01:01:55.000 | and at least point people in the right direction, so I would be happy to have a phone call with you.

01:02:00.000 | Just call a local advisor that you can find and just say,

01:02:02.000 | "Do you know of anyone that specializes in this that might be able to help us?"

01:02:06.000 | And even if you need to pay for an hour of somebody's time, that will be tremendously helpful to you.

01:02:11.000 | This is one of those situations where I can't give you an answer without knowing the whole situation,

01:02:15.000 | but yet I'm too far away to ever be able to know the whole situation.

01:02:20.000 | So I think that's it for today.

01:02:22.000 | That's my Friday show.

01:02:23.000 | I want to leave--I'm going to take just a moment and hopefully to kind of send us out on a good note--

01:02:29.000 | well, not a good note.

01:02:30.000 | This is really--this is why I have such a passion for financial planning,

01:02:35.000 | because you can hear even in this is that I wish somehow--

01:02:39.000 | my dream has been over the last years of doing financial planning,

01:02:42.000 | my dream has been to help families do better planning sooner so that their later situations are much more joyful.

01:02:49.000 | And so this is not a depressing thing, even though it's just really challenging.

01:02:52.000 | I feel--I wish I could convey a better answer.

01:02:56.000 | I wish I had a solution.

01:02:57.000 | I wish I had a magic bullet, but I don't have one.

01:02:58.000 | I don't have an answer that's going to do better than that.

01:03:01.000 | But I didn't mean to imply that this was depressing.

01:03:04.000 | It's just a different type of show than my normal, "Hey, let's go get it" type of thing.

01:03:11.000 | I really love doing this, and I really feel passionately about that.

01:03:14.000 | So I've got a bunch of other articles.

01:03:16.000 | I think maybe Monday I will make this the article show of some articles I've collected this week that I wanted to talk through of some interesting ideas.

01:03:22.000 | Jason, I will save your question for next week about what do you do about a junkie 401(k),

01:03:27.000 | and I could talk for an hour about that, but I will not do that today.

01:03:31.000 | So I apologize.

01:03:32.000 | I had told you I would put it on today, but I've just spent too much time on this already.

01:03:37.000 | I hope you've enjoyed this, and I hope that this weekend you are able to really consider some of the information that I've shared this week

01:03:49.000 | and really make some progress towards your goals.

01:03:51.000 | Remember, you have to actually do something with it.

01:03:54.000 | It's good to learn, but now take it and create it.

01:03:56.000 | If you haven't created your family statement of financial condition, go do it.

01:04:00.000 | Create the balance sheet for yourself and figure out what it says, and take a look at your own situation.

01:04:06.000 | And I thank you for listening.

01:04:10.000 | This has been really fun for me.

01:04:11.000 | I have really enjoyed this week.

01:04:13.000 | Thank you for those of you who have continued to leave iTunes reviews.

01:04:17.000 | I have awesome news to report.

01:04:19.000 | I think if my answer is checked, we are in the new and noteworthy section for the investing section of iTunes.

01:04:25.000 | So thank you.

01:04:26.000 | That is one goal that I was really hoping would help to get the show some more attention, and I'm so thrilled that we're there.

01:04:32.000 | The next, I would love it if you would continue helping us out with those ratings and reviews and subscribing.

01:04:37.000 | And I would love to get into the new and noteworthy section for business.

01:04:40.000 | I'm not changing anything I'm doing based upon that, but it is nice.

01:04:44.000 | It's really encouraging just to be able to think of how many--to be able to help more people.

01:04:48.000 | It's really encouraging to have that as a possibility.

01:04:51.000 | And so thank you for those of you who have left some iTunes reviews.

01:04:54.000 | We have three new ones.

01:04:55.000 | Left Bite says, "Not the usual financial fodder.

01:04:58.000 | Joshua dives deep into interesting topics.

01:05:00.000 | Not the typical financial fodder we usually hear."

01:05:03.000 | He gets me thinking.

01:05:05.000 | And also, "I was glad to hear a mention of finances with special needs kids in mind.

01:05:09.000 | I plan to do several shows on that and cover special needs planning in depth.

01:05:13.000 | It's very specialized and yet incredibly important, and there's some really great techniques that can be implemented."

01:05:19.000 | So I will do that.

01:05:20.000 | It's not going to be for a little bit, but I will do that.

01:05:22.000 | Thank you for the review.

01:05:23.000 | Stay tuned and sign up for the e-mail newsletter where you'll get the show notes every day,

01:05:27.000 | so that way you can see when those shows come out.

01:05:29.000 | Hands down my favorite podcast.

01:05:30.000 | Thank you, Quinn.

01:05:31.000 | And great information, but I love this game.

01:05:33.000 | Thank you for those five-star reviews.

01:05:35.000 | I really, really appreciate it.

01:05:37.000 | Remember, failure is an event.

01:05:39.000 | It's not a person.

01:05:40.000 | Yesterday really did end last night.

01:05:42.000 | Today is the first day of the rest of your life.

01:05:44.000 | This weekend is the first weekend of the rest of your life.

01:05:47.000 | Go out and make it count.

01:05:48.000 | Spend time with people you love.

01:05:50.000 | Do work that matters.

01:05:51.000 | Don't let your finances get in the way of that.

01:05:53.000 | Rather, shape your finances so you can do that constantly.

01:05:56.000 | Have a great weekend, everybody.

01:05:58.000 | [Music]

01:06:28.000 | I appreciate you listening.

01:06:30.000 | Cheers.

01:06:31.000 | The holidays start here at Ralph's with a variety of options to celebrate traditions old and new.

01:06:37.000 | Whether you're making a traditional roasted turkey or spicy turkey tacos,

01:06:41.000 | your go-to shrimp cocktail, or your first Cajun risotto,

01:06:45.000 | Ralph's has all the freshest ingredients to embrace your traditions.

01:06:49.000 | Ralph's. Fresh for everyone.

01:06:51.000 | Choose from a great selection of digital coupons and use them up to five times in one transaction.

01:06:56.000 | Check our app for details.

01:06:58.000 | Ralph's. Fresh for everyone.

01:07:00.000 | one.

RPF-0023-Friday_QA-How_Do_I_Plan_for_My_Parents_Long-Term_Care_When_They_Dont_Have_Enough_Money