How to Die in Dignity Without Leaving Your Spouse to Starve

We’d all been waiting for the big day, but the chapel the ceremony took place in was very small—just a room with Christian symbols and a few chairs. My wife Jo's father was waiting for us in his hospital bed, grinning from ear to ear. Despite the feeding tube, he still managed to devour a few bites of our wedding cake. Parkinson’s is a powerful disease; it can take the sturdiest tree in the forest and wilt it like an aging rose.

Yes, Jo and I got married in a nursing home chapel. Little did we know that we would spend the better part of the first 18 years of our marriage dealing with nursing homes and assisted-living facilities for both sets of parents.

Constant care is expensive. Jo’s father didn’t have long-term care insurance, and in 1988 his care cost close to $3,000 per month. Fortunately, he and my mother-in-law had the money to pay for it.

It’s frightening to imagine a time when you can no longer bathe, dress, eat, transport yourself, or hold your bladder and bowels. In insurance-speak, those are called “activities of daily living” (ADLs). Mercifully, not everyone reaches that point. However, two out of three Americans over age 65 will need some form of long-term care during their lifetime. That might mean home health care or moving to an assisted-living facility or a nursing home. Regardless, it’s pricey.

Nationwide, the average cost of a single-occupancy room in a nursing home is $6,653 per month. Home care averages $3,432 per month; assisted living, $3,300; and adult day care (which sounds just awful), $1,322.

Years of paying those costs can spell financial ruin for an aging couple—the surviving spouse in particular. My aunt spent close to 10 years in a nursing home with Alzheimer’s disease before she passed away. Her long stint is not at all unusual. While most patients live an average of 4-8 years after an Alzheimer’s diagnosis, many live as long as 20.

Medicaid Is Not the Solution

While Medicaid will usually pick up the tab for lower-income people, the income and asset limits to qualify are quite stringent. While the rules vary from state to state, a helpful rule of thumb is that an individual must make less than 300% of the Supplemental Security Income limit, or $2,130 in 2013, and have less than $2,000 in countable assets to qualify. Although your home (up to a certain amount of equity) is not normally a countable asset, many if not most of our readers don’t fall in this camp.

After a recent chat on long-term care insurance with fellow financial authority David Holland on his radio show, David mentioned that anyone choosing to self-insure should have at least $2 million in liquid assets. I agree, but even then, it’s risky. One of my biggest fears is needing long-term care, having the ability to pay for it, depleting our assets, and leaving Jo flat broke.