Preparing to Age in Place

Posted by edsutton @edsutton, Apr 23 7:58am

Many of us in the Aging Well Support Group express similar concerns. We are currently doing o.k. in our homes, on our own, but recognize that disabilities may be on our horizons.
Can we be reasonably proactive about this?
What can we do to stay in our homes as long as possible?
What can we do to gracefully reach out for assistance when we need it?
What can we expect the costs will be as we try to imagine the economies of our lives as we age?
What modifications can we make now that will make life easier when we have less strength and energy?

Interested in more discussions like this? Go to the Aging Well Support Group.

@marye2

Everyone costs a lot of money for the help they give. Medicaid is a tough egg to crack. Like you, I would like to know more about the five year look back so I can act accordingly.

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Please let's talk about the original and ongoing purpose of Medicaid.

It is designed to provide assistance to those who have nowhere else to turn. That is no long-term care insurance, relatively low income, low assets, and high needs. I used it to help care for both my Mom and mother-in-law when ongoing medical costs outlived their savings.

Medicaid is not designed to assist those of us who have assets like homes, savings, retirement accounts or other property to "protect" them so we can pass them on to our heirs.

Spousal rules in most states to protect enough assets, like the family home, a vehicle, a burial policy, and modest retirement accounts, to prevent impoverishment. A lien for the value of Medicaid services provided may be filed against the home to be paid off when it is finally sold.

Back in the 1970's a whole "industry" sprang up to assist people in shifting and hiding their assets so they could collect Medicaid - thus were born the whole "5-year-lookback" rules (or in some cases a 3-year lookback.)

Off my soapbox now - I am old enough to remember when Medicaid (and Medicare) did not exist and my Dad and his brother, neither of whom could afford to do so, stepped in to take care of my Grandma's insulin, doctor and hospital bills.

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@edsutton

Here's my hard take on the risks of aging in place for non-multi-millionaires:

Remember that we have lived with uncertainty for our entire lives and have made it through to now with our personal mixes of joy and sorrow, pleasures and pains, successes and failures, seeking enough meaning to feel it's worth the effort.
And that's what it will be like until our last breath.
So far it has been more than good enough for me, and I deeply hope it is like that for everyone.

For me, aging in place means building a home and life that offer hope to continue with the most positive balance possible.

Money is part of this. It would be nice if we had a little more, but we do have enough to manage.
We looked into continuing care communities and found that the ones we can afford would require loss of our greatest joys (pets, woods, garden, fruit trees, river nearby, wild animals in our yard, family visits, favorite foods, musical instrument workshop) in return for a guaranteed bed in memory care.
The aging care professional we consulted felt we that with preparation we could have a far better life aging in our home, even with serious illness.

We have Social Security, some annuities and retirement investments. We can live without withdrawing funds for our usual expenses, and we have long-term care insurance.
Fancy vacations aren't likely.
We've always lived within our means, and sometimes those means were very slim, so we know how to find the joys of parks and the public library! In case of early death of one of us, a housemate is possible, as has been done in several nearby homes of similar design.

It's not a guarantee that our last days (or months or years) won't be difficult, but by staying where we are, I have had, since turning 70, five of the richest years of my life, so I feel the "wager" is worth it.

Looking at my balance sheet, if I had to choose between money and friends, the friends are what I need to nurture most because friends give my life more meaning, purpose, knowledge and sharing of world views, and without that, money is worthless.

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I really like this comment you made "Looking at my balance sheet, if I had to choose between money and friends, the friends are what I need to nurture most because friends give my life more meaning, purpose, knowledge and sharing of world views, and without that, money is worthless."

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I'm especially glad we live in a co-housing community that has people of all ages.
It's a wonderful moment when a one-year-old looks directly at me with a big smile.
Or when a nine-year-old tells me about her day in school. She's exceptionally bright, and really needs her conversations with adults.
It's also wonderful when an older friend with cognitive difficulties tells me her plans for the day, knowing that these simple conversations are a way she confirms that she will be o.k. today and reaches out to share our lives in the way she can.
We all have our skills - and shortcomings - in living with people, and we can help one another in our lifelong struggles to break through our limits to ever deeper connection with life.

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@marye2

Everyone costs a lot of money for the help they give. Medicaid is a tough egg to crack. Like you, I would like to know more about the five year look back so I can act accordingly.

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@marye2 the best information I saw was on my State’s Medicaid info site, and I just “Googled” Medicaid info for nursing home payments.

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@sueinmn

Please let's talk about the original and ongoing purpose of Medicaid.

It is designed to provide assistance to those who have nowhere else to turn. That is no long-term care insurance, relatively low income, low assets, and high needs. I used it to help care for both my Mom and mother-in-law when ongoing medical costs outlived their savings.

Medicaid is not designed to assist those of us who have assets like homes, savings, retirement accounts or other property to "protect" them so we can pass them on to our heirs.

Spousal rules in most states to protect enough assets, like the family home, a vehicle, a burial policy, and modest retirement accounts, to prevent impoverishment. A lien for the value of Medicaid services provided may be filed against the home to be paid off when it is finally sold.

Back in the 1970's a whole "industry" sprang up to assist people in shifting and hiding their assets so they could collect Medicaid - thus were born the whole "5-year-lookback" rules (or in some cases a 3-year lookback.)

Off my soapbox now - I am old enough to remember when Medicaid (and Medicare) did not exist and my Dad and his brother, neither of whom could afford to do so, stepped in to take care of my Grandma's insulin, doctor and hospital bills.

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@sueinmn and gone are the days when several generations of a family lived together and helped take care of each other. When did that change, and why?

I’m going to, more than likely, use my assets to pay for my care. If I have enough to pay for 4 years, and then when it’s gone can I get Medicaid? Is that how it’s supposed to work?

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@SusanEllen66

@sueinmn and gone are the days when several generations of a family lived together and helped take care of each other. When did that change, and why?

I’m going to, more than likely, use my assets to pay for my care. If I have enough to pay for 4 years, and then when it’s gone can I get Medicaid? Is that how it’s supposed to work?

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That is how it works in Minnesota. My mother in law exhausted her assets in just over one year, and Medicaid picked up the last several months. My Mom, whose house when sold yielded a decent sized Annuity policy, and whose retirement income was more, managed 5 years of self pay for increasing levels of care. We used Medicaid for about one year, and she had enough in her checking account at the end to pay for a catered funeral lunch (one of her final requests)
We ( 2 daughters and to a lesser extent 3 sons and several of her 18 grandkids) were heavily involved in her care up to the end, in spite of career and family obligations. It's what we were taught throughout our lives.

Also, I split my year between 2 communities with large immigrant populations. Multi generation and multi family households are still the norm. I feel sad for those who don't have these resources.
My kids have already shown they are ready and willing to step up, as have several nephews. So though we are preparing to pay as we go, family plans to be in the wings to oversee and assist.

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Over the last three weeks I've been working through one of the most difficult tasks of my recent years - My little shop had become so filled with left over parts, paints, glues and fillers, special tools...all left over from projects of the last 35 years. Doing any large project was delayed and burdened with the need to clear space for anything new, which became harder and harder.
So, I have done it.
Thrown out all those "maybe I'll need it some day" screws, bolts, electrical fittings, etc., etc.

It was depressing and hard work, as part of my identity was "the guy who can fix anything in his magical shop." Or maybe it was a mostly museum of my past efforts, a diary written in junk.

So now the shop is ready to welcome some new, big projects.
It's already paying off in the ease of efficient working.

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@edsutton

Over the last three weeks I've been working through one of the most difficult tasks of my recent years - My little shop had become so filled with left over parts, paints, glues and fillers, special tools...all left over from projects of the last 35 years. Doing any large project was delayed and burdened with the need to clear space for anything new, which became harder and harder.
So, I have done it.
Thrown out all those "maybe I'll need it some day" screws, bolts, electrical fittings, etc., etc.

It was depressing and hard work, as part of my identity was "the guy who can fix anything in his magical shop." Or maybe it was a mostly museum of my past efforts, a diary written in junk.

So now the shop is ready to welcome some new, big projects.
It's already paying off in the ease of efficient working.

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Congratulations! What a job well done!

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@edsutton

Over the last three weeks I've been working through one of the most difficult tasks of my recent years - My little shop had become so filled with left over parts, paints, glues and fillers, special tools...all left over from projects of the last 35 years. Doing any large project was delayed and burdened with the need to clear space for anything new, which became harder and harder.
So, I have done it.
Thrown out all those "maybe I'll need it some day" screws, bolts, electrical fittings, etc., etc.

It was depressing and hard work, as part of my identity was "the guy who can fix anything in his magical shop." Or maybe it was a mostly museum of my past efforts, a diary written in junk.

So now the shop is ready to welcome some new, big projects.
It's already paying off in the ease of efficient working.

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I'm facing the same thing with my personal library. Books I won't live long enough to re-read, books on subjects I've lost interest in, etc.

It's really painful because nobody wants books anymore, so I literally can't give them away. Heartbreaking.

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@SusanEllen66

This is a gentle reminder to address your Comments to the person you are responding, or writing to.

It gets confusing when the messages are posted without the recipient address.

Their address is the @…….

For example, if you want to write only to me, @SusanEllen66
That is my address.

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How do I write to u

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