What's your worst-case scenario plan?

[Ego]

I think the 'getting old and ill' scenario needs a community approach not lots of money. It reminds me of one of the ideas I liked in Jacob's book, namely that often you can save money by investing in relationships. With ERE you have the time to care for other people, to invest in them. Why wouldn't they return the favour if you pick good people? Yes, getting old or becoming ill might mean one needs a lot of care, more than we would ever ask of friends, but then we are back at the INTJ/Ps problem of letting oneself be taken care of....

So my idea of dealing with a worst case scenario is to have medical insurance, but to also invest in friends (or family if they are good people), who care. If this may seem utopian than just think about how utopian it seems to never have to work again! There is also a strong community spirit here on this forum. Why can't we come up with a better model of getting old and supporting each other than what is available to us in our societies right now? Given that most of us will probably get ill or weak at some point, how would you like things to be? Who says each one of us has to deal with this by themselves?

Great post!

The other day I had a frantic Pharmaceutical rep banging on my front door. She had found one of our tenants who suffers from mild and sometimes moderate dementia. He had gone for a walk, gotten disoriented and passers-by decided he needed help. This happens a few times a month. Ms. Pharma with her smart suit, high heels and ex-cheerleader legs was rather upset and slightly indignant that he was left to wander. She said her father-in-law was in the same condition and that the family had put him in a lovely assisted living facility where he had excellent care and was barred from leaving. I sat her down and we talked about it for a while. She repped for a drug company that sells dementia meds and somehow found it comforting that Medicare (our government program for the elderly) provided my tenant with every medication a demented person should be taking. But she was still upset that he had nobody to help him.

I have to admit, I am often bothered by the fact that he has nobody. He eats breakfast and dinner at a greasy-spoon restaurant every day. He has to cross a major road to get to it. He never makes it across the street before the light changes and will probably get squashed some day. I watched him cross a few weeks ago and he had a look in his eyes that said, "I ain't dead yet". I told that to Ms. Pharma. She said her FIL does not have that look.

It made me wonder how much of the suffering involved with this end-of-life stuff is really the suffering of loved-ones watching the decline, and the suffering of the declining person who has to see the sadness of their loved-ones. This guy has nobody who cares and he gets pissed off, as he did with Ms. Pharma-cheerleader-legs, when someone pities him.

[Gudrun]

Thanks Ego and firefighterjeff, glad you found my post interesting.

I agree, maybe quite often the sadness is with those, who witness the decline. I guess the question with your tenant is, is he happy to be where he is given that his condition can't be magically cured? Which turning that back to our discussion: How much is the issue with our anxiety today about becoming weak in the future rather than really getting ill? Maybe when the time comes we'll be ok, coping, getting across the road to our favourite diner even if a little too slow.

There is a really nice quote of someone in Irving Yalom's book Existential Psychotherapy: 'Death is just like a certain type of lecturer. You only take notice when you sit in the front row.' Maybe the cheerleader pharma rep didn't get it, because most of us, thankfully, only have to face the fact that life hasn't got an in-built, 'natural' happy ending later on. I fully agree with what someone said earlier, being present when someone dies changes one/has changed me. The fact that life can be brutal makes freedom, friends and love even more important.

[Ego]

Good Ted talk on this...

http://www.ted.com/talks/bj_miller_what ... nd_of_life

Here, this gets right at the distinction between a disease-centered and a patient- or human-centered model of care, and here is where caring becomes a creative, generative, even playful act. "Play" may sound like a funny word here. But it is also one of our highest forms of adaptation. Consider every major compulsory effort it takes to be human. The need for food has birthed cuisine. The need for shelter has given rise to architecture. The need for cover, fashion. And for being subjected to the clock, well, we invented music. So, since dying is a necessary part of life, what might we create with this fact? By "play" I am in no way suggesting we take a light approach to dying or that we mandate any particular way of dying. There are mountains of sorrow that cannot move, and one way or another, we will all kneel there. Rather, I am asking that we make space -- physical, psychic room, to allow life to play itself all the way out -- so that rather than just getting out of the way, aging and dying can become a process of crescendo through to the end.

Reminds me of this short Alan Watts talk, Music and Life.
https://www.youtube.com/watch?v=ERbvKrH-GC4

[jim234]

How does everyone reconcile that it is possible that any of us could acquire a life-debilitating disease or medical condition such as stroke, Alzheimers, dementia, Parkinsons, ALS, etc., that could require long-term care? What is your plan to protect your investments and not bankrupt your family?

I've read horror stories of people spending their last dime on health care, losing their homes, and losing what medical care they had after becoming broke. How do we protect ourselves from this?

This gets down to Estate Planning. I am currently on expanded Medicaid so the medical bills would be covered with a Max OOP of $200 a year. What would not be covered is Long Term Care in a nursing home. LTC is covered under Medicaid, but you must be declared disabled, blind, or 65+, and then the old Medicaid rules apply which means minimal income and resources before it starts. So you have to spend down all your assets on medical care before they start to pay for LTC. Placement of assets in trusts and out of your name is the only way around this issue. That or buy long term care insurance.

Really no easy way to protect yourself from this risk.

[JL13]

As depressing as it may sound, I think suicide is a viable solution. I forget which, but didn't one of the stoic philosophers said the ability to take your own life is a gift from the gods, if it becomes impossible to maintain tranquility.

I think getting a terminal illness, or a life-debilitating one, itself is far worse than the financial ramifications. Money would cease to have much value to me. If I needed to protect principal though, I would look into one of the legal structures that can be set up so that you can qualify for medicaid and gov't support long term care before you exhaust all assets. May be a moot point now since the medicaid expansion through obamacare.

But....I doubt I would chose institutionalization over other alternatives.

Did anyone watch Still Alice?

[jim234]

I think getting a terminal illness, or a life-debilitating one, itself is far worse than the financial ramifications. Money would cease to have much value to me. If I needed to protect principal though, I would look into one of the legal structures that can be set up so that you can qualify for medicaid and gov't support long term care before you exhaust all assets. May be a moot point now since the medicaid expansion through obamacare.

Medicaid under Obamacare does not involve Long Term Care and does not cover it. Also Medicare will not cover LTC at all. Medicare will cover a short stay in a nursing home for rehab purposes only. If the person is deemed unable to ever get better then Medicaid will have to be used after all your assets have been exhausted.

The US now has two Medicaids, the old one for disabled, blind, and elderly which covers LTC, but has resource and income tests, and the expanded Medicaid under Obamacare with a sole < 138% FPL income test. Both have estate recovery provisions for benefits used from 55 yo or greater.

[JL13]

The structures I was thinking of are something like irrevocable trusts, so they are eliminated from the estate (they skip right to the beneficiary), but they are allowed to pay out a certain income to the person that is allowed under the LTC income tests.

Not well versed here, but there are lawyers out there that will set up something. The basic premise is not to keep your money, but to let it go somewhere (children, charity) of your choosing.

[SimpleLife]

Would it make sense or be feasible to buy insurance overseas and get medical care abroad? Nicaragua is supposed to be very inexpensive even without insurance.

[Dragline]

Rather, I am asking that we make space -- physical, psychic room, to allow life to play itself all the way out -- so that rather than just getting out of the way, aging and dying can become a process of crescendo through to the end.

That was a good TED talk. Dying never quite looks/feels like people imagine it: https://www.youtube.com/watch?t=209&v=wWPOG_hxkTE

Some combination of absurdity or silliness and kindness seems to matter the most. That story about the snowball from the TED talk also fits that bill.

[jacob]

"This dying is boring" - last words of Feynman.

[peerifloori]

I never planned to take care of my parents when I was growing up. Then I worked at a (shitty) long term care facility, and made the decision that I would take care of my parents regardless of the cost rather than see them in LTC. They're both healthy for now, but don't have much in the way of savings. Hopefully they'll live to a happy old age quite independently (like my 94 yo grandmother or 104 yo great uncle) and pass quietly in their sleep. But if they don't, I plan to take care of them.

I think it's pretty hard to plan for a long-term disability. I think about what will happen if I have a child with a disability. I think that the best you can do is to have a good financial buffer, then make do with what comes along. Life is unpredictable. I would prioritize taking care of my family over FI/ERE. I guess I've thought less about my own possibility for disability.

In terms of end of life, I am very pro-hospice, anti-needless intervention, which I think is true for most in the medical field. I try to advocate with all my friends and family and patients to make plans and to know what to expect. One thing that I think a lot of people miss in planning their Advance Directives/End of Life wishes is what they DO want when they are dying, ie: company vs solitude, touch, music, something religious or spiritual, whether they'd prefer to be more lucid or more comfortable.

If I had a terminal condition, I would move to a state with physician assisted suicide.

Here's an article that is great about end of life wishes and dementia: The Last Day of Her Life

[bryan]

if I knew I was getting close to death and didn't have too much to live for, I would probably become a sort of lowtech batman. there seems to be a ton of high life scum to be cleaned up out there; even perhaps corporations that offload costs to the commons.

I predict this will be blasé or outmoded by the time I get the chance.

it might even be worthwhile if I did have some nice things to live for.. fake my death and spend a couple years carrying out my master strokes.

muahahaha

[Ego]

I decided to pull this over here as my reply fits better than in the recommended watching thread. For reference, the documentary being discussed is Some Kind of Heaven https://www.imdb.com/title/tt11358166/

I was talking about this documentary with one of my polys who is 10 years older than me and quite affluent, while lying on mattress on the floor of my tiny apartment, and I noted that I related a little too closely to the old-guy-cruising-in-van-at-81 character, and he replied "Well, I've always admired your ability to get by on very little."

I can understand you concern. I have run through worse-case scenarios like that old guy and learned some facts for our location.

You may remember my violin teacher . He lives in a subsidized apartment on his Social Security and whatever tips he can get busking. It is a small studio in a large, well maintained building with a balcony and view of the sea. Market rent would be about $2400+. I do not know how much he pays but I know it cannot be much as he was very low income during his working years. The building is maintained by a religious institution but they get lots of government funding. There is a long waiting list to get in. Another extremely frugal friend has been on the list for years and is currently in a much less desirable low-income single-room-occupancy (SRO) apartment with no kitchen.

While we were Census workers, Mrs. Ego and I had the opportunity to see how others in our area live in these low income senior housing properties. Most are not at all what I would have imagined. Many of the apartments are as nice as the market rate properties in the area, though the lobbies and common areas are not appealing at all. One with very nice one-bedroom apartments that also had a spectacular view of the bay, had a lobby that looked like it was leading to a prison.

Currently we have a tenant who works for a social service agency that places people in these buildings. She is very talkative and loves telling me how the "feeder" system works. The federal government pays them an initial $7400 lump sum per needy senior they help. The agency determines eligibility and then send them to a half-dozen doctors to screen for every likely health problem. The agency takes care of all of the paperwork and coordination of appointments as well as transportation. They provide new glasses, hearing devices, medications and medical equipment. If the person is experiencing housing issues, they get to jump to the top of the waiting list at the desirable properties. The properties encourage this cheat because the social service agency takes care of all of the paperwork and provide someone to help the person if a need arises. The agency gets additional funding to provide the people basic furniture, bedding, linen, clothing, kitchen supplies, cleaning supplies and deliver food regularly. They are basically experts at navigating the system. If I were in the position of that old guy, I would begin looking for a local version of that agency.

The one caveat for these places/agencies is that they have a means test. There are loopholes.

AAlso, I will have to do some actuarial research to determine when die off rate of Boomer men will result in equilibrium with Old Gen X/Gen Jones female population. etc. etc.

I may have mentioned one of our tenants from a previous property who was a widower in his late 70s with a car. He was a kind, soft spoken man who went to the senior center and health club regularly. He was literally fighting off the ladies. Every time I spoke to him, we were interrupted by one of his "lady friends" calling. The fact that he had a car made him particularly attractive.

[7Wannabe5]

@Ego: Yes, but on the other hand, rational analysis would reveal that I have a lot more going for me than living-in-van-guy, so mostly I'm kind of just trying to motivate scare-myself-straight with variation on ending-up-a-bag-lady paranoia. I just turned 58, and if I made a bit of an effort to pull my act together, I could probably lock myself into fair semblance of above-average-achiever lifestyle by the time I turn 60. IOW, there's not that much preventing me from getting a full-time salaryman job paying maybe $80 k, marrying somebody like the Yacht Guy, and whipping myself back into something like reasonably attractive, stylish, and fit. There she is, future me, looking a bit more alert than usual, scrolling through her ToDo list while waiting on line at Healthy Expensive Market! Maybe she is happy?