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How to Die in Dignity Without Leaving Your Spouse to Starve

Dennis Miller | Jun 30, 2014, 9:39 a.m.

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.

So where does that leave people unlikely to qualify for Medicaid but unable or unwilling to self-insure? Long-term care insurance, of course.

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