Long-Term Care Costs: Medicaid vs Private Pay, Plus Talking Money While Dating

8:03Sara Rathner:Yeah, I mean, the only way out is through. And it starts with creating a culture in your relationship where not only do you openly talk about money, but you openly talk about money without fearing judgment from the other person. because that's what allows you to feel comfortable being honest. And so when you have something to say that's hard to talk about, if you feel like you could talk to your partner about anything and they might not agree with you, but at least they'll listen to you, then you're more likely to open up about what's going on for you financially. If they judge you, if they start a fight with you, if they make you feel in any way psychologically or physically unsafe when it comes to talking about your money, I mean, that should be a sign that that relationship might need to go somewhere.

8:47Sara Rathner:You know what I mean? Like, so you need to use these money conversations almost as a way of judging not your partner's spending habits, but your ability as a couple to talk to each other about these things.

8:59Sean Pyles:Right. A lot of times money can be used as a tool to play out power dynamics in a relationship that can develop in unhealthy ways over time. And if you are in a place where you feel like you can't talk about money or one of the partners is the one that's enforcing spending in kind of strict or maybe unhealthy ways, it might be a good idea to talk with a couples therapist, perhaps a financial therapist to really resolve these issues and get to a place of that mutual trust again.

9:25Sara Rathner:And I will tell you, if you think that the solution to the problems you have as a couple when it comes to money communication is to move in together to save money, to get married for the tax benefits, or to have a baby because you want to have a baby, I'm here to tell you that those things will make your life more complicated and make it harder to get out of a bad relationship. So have these conversations early and often before you take serious steps in your relationship to further entangle your lives. Yeah.

9:51Elizabeth Ayoola:And just one more thing on that that I was thinking is it can also be hard to be honest with your partner about your finances if you feel shame yourself. So there's one on one part, you being afraid of your partner shaming you. But then on the other part, there's you being ashamed of your own spending. So I think it's important to address any shame that you have around your spending and your finances so that you can also feel more comfortable sharing with your partner as well. All right. So let's pivot to deal breakers. Now, I was surprised that someone being a bad tipper was a deal breaker. I'm from the UK.

10:21Elizabeth Ayoola:We don't tip over there. So that is not a deal breaker for me. So 24 % of respondents said so. Now, what are some other financial deal breakers that you came across in the survey, Sarah?

10:32Sara Rathner:Yeah, well, these respondents were U.S.-based, so we have our firmly entrenched tipping culture here. And in the U.S., there is a circle of hell reserved for bad tippers, and they have to wait tables for eternity. in the United States where you're paying less than minimum wage to wait to wait tables and you're supposed to make it up in tips. So I can't say I necessarily agree with the practice, but it is what we have going on here. So tip your servers, everyone.

10:56Sean Pyles:Tip them well if you can.

10:57Sara Rathner:Yes. And so another deal breaker we found, and this has to do with going out to places where you might have to pay a tip, is when your partner typically expects you to pay for dates, it turns out a lot more people would actually rather share the costs a little bit more evenly. And another interesting one, 17%, consider it a deal breaker when the other person works a lot. Yeah. Oh. Yeah, that one surprised me because obviously there's a lot of pressure to be successful in your career and make a lot of money, but not at the expense of spending time with your loved ones.

11:27Sean Pyles:I think it goes to show that time is love, and the more time you spend together, the better your relationship is going to be. Sometimes it's best to close that laptop, just spend time with your loved ones.

11:37Sara Rathner:Yes, come home and spend quality time together. And a couple other deal breakers we found people don't like when their partner asks to borrow money from them. And they don't like. Yeah, I know. That's a deep one.

11:47Elizabeth Ayoola:I think it depends on the stage of the relationship, right?

11:50Sara Rathner:Yeah. If you haven't been dating for very long, that's, you know, probably don't ask. If you've been together for a much longer time, you can potentially work out a deal because you know the person a lot better.

11:58Sean Pyles:And there's that trust.

11:59Sara Rathner:But, you know, it can still be a really touchy subject. And people also do not like when a person has no savings or doesn't invest for their future, whether it's investing for retirement or other purposes, or when somebody has a low credit score.

12:13Sean Pyles:So I guess be on your best behavior financially at all times if you want any sort of love in this country, because people have high standards.

12:19Sara Rathner:Oh, my goodness. That sounds so harsh. I mean, it's not even just high standards. I think it's the recognition that when you're tying yourself legally, potentially legally, or for the long term to another person, their ability to prepare for their future is, it also helps you prepare for your future together. Because if you're with somebody who maybe has never invested at all for retirement, and you're going to be with them for several decades, eventually, that's going to catch up with both of you. And you're just not going to have as much money available to be financially secure in your retirement.

12:50Sara Rathner:And so people are thinking long term, is this something that's going to impact our ability to meet our shared goals as a couple? And it could be.

12:58Sean Pyles:You want to see that people's behaviors as well are, you know, built in trust and forward planning and all of those things that will give you a secure life later on. But at the same time, a lot of people are dealt circumstances that are outside of their control that may make it so they don't have retirement savings. And I think it's okay if you're dating someone and they're in a completely different financial situation than you and you love them very much. You can make it work because that's what love is. You'll make it work.

13:23Elizabeth Ayoola:That's it. And then I think it's important to differentiate, you know, financial values from life happening, right? So I think maybe a lot of people here are, you know, basing these deal breakers on assuming that if a person has a low credit score, they have debt, that their financial values don't align or aren't good, quote unquote. But that's not necessarily true. Sometimes life is happening. It takes time to get to know what their true values are. Yes, yes.

13:45Sara Rathner:You know, Sean, you talk about making it work. And, you know, if you are in a relationship with somebody that is in a tough financial situation, they haven't had the ability to save much. Maybe they're living paycheck to paycheck. They don't have savings for retirement or other goals. Making it work with them is not burying your head in the sand as a couple. Making it work is talking about it and coming up with some sort of plan that makes sense for the two of you going forward. So you can still set joint financial goals together, but in a way that honors where both of you are and where both of you hope to be.

14:19Sara Rathner:You don't want to, oh, my partner has like six figures of credit card debt. La la, whatever. No, let's talk about it. Let's talk about how we can move towards some sort of progress. And what does progress look like realistically rather than just ignoring the problem?

14:34Sean Pyles:So I'm loving the grace and thoughtfulness that we're all bringing to this conversation here. I think that we would all be great partners to anyone. Based on what we've just been talking about, obviously. That said, Sarah, would any of these be absolute deal breakers for you? The topics we've just been discussing around debt, credit score, all of that.

14:52Sara Rathner:Oh, I mean, well, I'll throw out another stat from the survey that I disagree with. So we asked folks a bunch of questions about different things they would consider to be red flags. 42 % said talking about money early in a relationship would be a red flag for them. Nope. I think that I'm in good company here in saying that I disagree with this. You don't have to bring your most recent tax return to your third date or anything like that, but talk about money from the earliest stages of your relationship. Even if it's just asking somebody like, how do you like to spend your time? Do you like to travel?

15:26Sara Rathner:What was your family like growing up? Asking these sorts of questions can teach you a lot about that person without, you know, asking them to tell you how much they make in a year. So, you know, if they have expensive hobbies, if they travel extensively, if they talk about, oh, my family's vacation houses, plural, you could get a pretty good idea of what kind of lifestyle this person lives without actually asking about money.

15:50Sean Pyles:Yeah. I think that points to how we're often talking about money when we're not talking about money. If you're on a first date and the person who took you out just goes and picks up the check without saying anything, that's a little conversation about money right there and who's spending it and what they want in the relationship. But eventually you want to get to the point of being explicit. And I would say do it sooner than later.

16:09Elizabeth Ayoola:Yeah.

16:10Sean Pyles:Okay. So Elizabeth, you're up next. Any deal breakers?

16:14Elizabeth Ayoola:You know what? I started this conversation with like, yeah, most of these are deal breakers for me, but now that we're at the end of the conversation, I think I have more flexibility, especially with the nuance that we've discussed. But still a lot of these things are deal breakers for me, but I would definitely say working a lot is not a deal breaker because I know how to keep myself busy. And then I guess it depends on how we define a lot as well. And a low credit score isn't either. And I think along those lines, debt isn't either depending on how low the credit score is and how much debt it is.

16:41Sean Pyles:Yes. And why they got into debt, because I think about that too. Some people get into debt again, because they have a hard time just making money sometimes, or something happens in their life where they have to have an expensive car repair and any number of those things can get you into debt. But if it becomes symptomatic of a deeper trust issue in the relationship, that could be a deal breaker.

17:00Elizabeth Ayoola:That's it. And I've put in so much hard work to get my finances to a decent place. And again, I know we're all starting at different places and all the different phases of our life, but I would just want to make sure even if I am compromising, the person again has similar financial values to me so they don't derail my finances.

17:17Sean Pyles:Yes.

17:18Elizabeth Ayoola:So Sarah, what are some ways to approach conversations about money within romantic relationships. As we've discussed earlier, it can be awkward. It can be uncomfortable to talk about, but it's definitely necessary. So what are your thoughts? Yeah.

17:32Sara Rathner:I mean, we talked a little bit about this earlier, but just creating that culture of safety in talking about hard things, especially when it comes to money, but other stuff too within your relationship and give the other person the level of understanding you hope that they would have with you. We talked so much about how judgmental people are of other people when in fact they are just projecting because they're judging themselves for the same things. So understand others as hard as you understand yourself and judge others, hopefully less than you judge yourself. How about that? Make that your role.

18:02Sara Rathner:Because you're not always going to agree about money. You're two different people. You were raised in different households. You have different lives and you're merging those lives together. You're never going to totally be the same person. You're never going to totally agree. But if you can talk about it and come to agreements about things and negotiate and compromise, then those are all good signs for the health of your relationship.

18:26Sean Pyles:Yeah, that's applicable across so many parts of a relationship, compromise communication. Kind of to wrap things up, I'm wondering if either of you has ever broken up with someone or avoided dating someone because of the state of their finances.

18:39Sara Rathner:I've never broken up with somebody because of money. There have been times where like a relationship I was in ended for other reasons. And then thinking back on it, I realized that we were also incompatible financially, but there were also other incompatibilities that came to the forefront sooner and ended the relationship.

18:57Elizabeth Ayoola:For me, similar to Sarah, it wasn't the sole reason, but it was a big reason for two relationships I can think of. So one was a complete spendthrift. And anytime any money came in their hand, they had to just buy something new and shiny. So very difficult to plan and save with them. And the other one just didn't like working. So just like to, you know, sleep all day. That's tough.

19:17Sean Pyles:It makes it hard to have money when you're not working like that.

19:19Elizabeth Ayoola:Exactly. So I was footing the bills and that was a bit rough too. So yeah. What about you, Sean?

19:25Sean Pyles:No, I haven't. I feel like I've been lucky. I've dated plenty of people where we had very different financial circumstances and we always find a way or have found ways to make it equitable. And that's what's important to me at the end of the day.

19:37Elizabeth Ayoola:Wonderful.

19:38Sean Pyles:This was a great chat, Sarah. We're going to keep you around for just a second longer as Elizabeth and I do a check in on how our no spend slash friction spend challenges are going for the month of February. Quick recap for listeners who maybe didn't catch last week's episode. We're doing a month long challenge where Elizabeth is not spending money on non-essentials. Is that correct, Elizabeth? That is correct. And I am adding friction to my finances where each week I'm doing something different. Last week, I didn't buy anything online. This week, I'm just using cash, which is already off to a rocky start.

20:10Sean Pyles:So let's look back first. Elizabeth, how did your week go?

20:15Elizabeth Ayoola:Actually, you know what? It went pretty good. Like I said, the brick has been helping me. I did. I was on Zara. You're bricking your phone.

20:21Sean Pyles:Yeah.

20:21Elizabeth Ayoola:Yes. Yes. For those who don't know what a brick is exactly just to help me, you know, restrict social media apps or whatever I don't want to use. But I was on Zara just window shopping. I didn't buy anything. And I don't know. I feel like I should be penalized for going to Whole Foods and spending$167 on groceries. It just broke my heart.

20:40Sean Pyles:You're buying like two sweet potatoes for that amount of money.

20:43Elizabeth Ayoola:I left with two bags. That was it. That was it. But that's an essential. So I guess to answer your question, I think I did good this week. I didn't buy any non-essentials, just food.

20:51Sean Pyles:Well, I'm proud of you for not buying anything from Zara, even though you'd attempt yourself with some window shopping. I know. How's yours going, Sean? Mine went okay until the last part of the week where I've been getting my greenhouse set up to start seeds for the spring and going into summer. And I realized that these seeds that I bought But for some like oriental chrysanthemums, if you guys don't know what those are, just Google them. They look like whipped cream on a stem. They're incredible. I bought these seeds and they're kind of hard to find. And then naturally, I immediately lost them in my house and cannot locate them.

21:26Sean Pyles:So I was on a tear of rectifying my own forgetfulness, I guess, and bought like$60 worth of seeds from Etsy, which may not be real because a lot of the photos look semi-AI generated. Etsy is kind of like a cesspool of AI slop nowadays, turns out. Anyway, so I just spent money in a fit of wanting to have these seeds. But beyond that, I didn't buy anything else online. And I feel OK about that.

21:52Elizabeth Ayoola:So it sounds like you get a B then, Sean. Or is it a C? Yeah, that's fair. You have to do a grading. C for chrysanthemum.

21:57Sean Pyles:Thank you. I love it. Is it any better that I knew I shouldn't have been doing it? Or does that make it worse?

22:04Elizabeth Ayoola:Sometimes that's the thrill, you know?

22:05Sean Pyles:Well, Sarah, I am wondering if you have any thoughts on how we did or what would you do differently in our case?

22:11Sara Rathner:Oh, for no spend? Well, I mean, I think the idea of doing things like breaking your phone and introducing friction are both great. One thing I would say is, you know, like, let's say your credit card numbers are saved on retailers' websites where you shop often. Just go ahead and unsave them. Make it so that you have to manually enter your credit card number every time.

22:30Sean Pyles:It's a great way to memorize it. And then you can't unsave it from your brain. Yeah, don't do that. That's my issue.

22:34Sara Rathner:I've done that in the past. Don't do that. But or like just put stuff in your cart and then commit to leaving it there for like 48 hours. And half the time you forget that you even put something in there. You don't go back and check. So those are all tricks that I play on myself that are really helpful.

22:49Sean Pyles:It's all about little games for yourself to get you to spend or not spend or save or not save. Well, thank you, Sarah, for coming on and chatting with us today. It was great. Thanks for having me.

22:57Elizabeth Ayoola:Up next, we're going to speak to a nerd about paying for senior care.

23:01Sean Pyles:But first, listeners, you know what's up. Send us your financial questions.

23:04Sara Rathner:Maybe you don't know how to navigate finances with your partner, and this episode has taught you that there's a lot you don't know yet. That's cool. Or you need tips on paying down debt. Whatever your money question, we nerds are here to help. Leave us a voicemail or text us on the nerd hotline at 901-730-6373. That's 901-730-N-E-R-D.

23:24Sean Pyles:You can also send us an email at podcast at nerdwallet.com or leave us a comment on Spotify or YouTube. Okay, let's get to this episode's money question. That's up next. Stay with us.

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25:31Sean Pyles:We're back and answering your money questions to help you make smarter financial decisions. This episode's question is a long one, so Elizabeth and I are going to split up reading it. Hi nerds, I'm a long-time listener of this podcast and really appreciate all the information you share. Here's something I'm not sure you've tackled. My father-in-law currently lives alone out of state, but this is not a good setup for him long-term, as he is starting to have health issues that could change his ability to care for himself at any time. We are looking at how we can have him move closer to us into an independent slash assisted living situation.

26:03Sean Pyles:He has some liquid assets that he has saved for his retirement, as well as a pension and Social Security for income. We have looked at a couple of places, and they vary widely in their payment structure and levels of care that they offer. Some seem to be based solely off a monthly payment, while others have a buy-in model, where you pay a lump sum up front, but then have lower monthly fees going forward. Some of these buy-in models are partially refundable.

26:27Elizabeth Ayoola:We would like to build a budget to help him understand what type of living situation he could afford and for how long. Can you help us understand the pros and cons of these different types of payment models? We think he has enough funds to enable sufficient time at an independent or assisted living facility, but there could be a time when he needs to transition to a nursing home where the costs then skyrocket. When his money runs out, I know that you can apply for Medicaid to pay for the cost of a nursing home. Can you talk a bit about what this process looks like and how we can prepare for it?

26:59Elizabeth Ayoola:All the best. And our listener signs it, senior living is confusing. Listener, I second that.

27:05Sara Rathner:And I third that.

27:07Elizabeth Ayoola:Oh, hey, Kate. So we have today with us to help us answer this question, nerd Kate Ashford, who is a certified senior advisor. Welcome back to Smart Money. Hi, guys. Happy to be here.

27:18Sean Pyles:Hey, Kate. Good to have you as always. We love bringing you on for the most technical topics. So let's just get right to it. Start by laying the groundwork for how much our listeners' father-in-law or really anyone in this situation might expect to pay for senior living care. So the challenge here is that it's pretty much universally expensive, but that the cost really varies so much depending on where you live. So I looked into some numbers here, and in Alabama, the monthly cost is about$4 ,700 a month. Meanwhile, in Hawaii, the cost is over$11 ,600 a month, or about$7 ,000 more each month. So given that, it seems like our listener first needs to figure out how much the typical cost could be where they're living, or maybe where the father-in-law is currently living, and also how much money is available to cover these costs right now.

28:07Sean Pyles:So in a sense, that's a pretty typical cost-of-living budgeting challenge. Are there any other unique factors that folks should think about as they're considering their budget for assisted living?

28:18Sara Rathner:Sure, Sean. So first, I would really want to point people toward the Genworth and CareScout cost of care survey. It's something they put out every year. It's got numbers for all sorts of care, from home health aides to assisted living, nursing homes, adult daycare. And you can dig in by state, which is really helpful because, as you mentioned, data really is different depending on where you live. And it can also be different by locality. I mean, New York City, very different from upstate New York, but this will give you a general sense and it's a good starting point. And then once you're looking into your local prices, please know that there are different fees for different room types.

28:55Sara Rathner:So what is this person's father-in-law hoping to have for a living situation? A single room, a shared room, some places have apartments, even two bedroom apartments if it's going to be a shared living space. There's memory care. And then, of course, there's a base rate versus an all-in cost at most of these facilities. A base rate might include things like meals or light housekeeping, social activities, transportation to doctor's appointments. But then there are probably add-ons like help with activities of daily living, like getting dressed, higher level care tiers as someone's needs increase.

29:29Sara Rathner:There generally is extra money for things like memory care. And then each year, there's probably an annual increase in these prices. Just like anything else, your rent goes up. Rent goes up in these places as well. So you should budget for that and model different length stays. So there are a lot of variables and it's kind of a complicated starting point. But there you go.

29:52Elizabeth Ayoola:Sounds pretty complicated. But our listener's question seems to basically be, how do I pay for senior living care? But it could just as easily be, how can anyone afford senior living care with how expensive all of these prices are you guys just mentioned? So how do people typically gather the funds for this? Are people using their retirement funds? Are they using Social Security? Are they using cash savings? And I imagine that people have to get creative here in terms of paying for it.

30:19Sara Rathner:Absolutely, Elizabeth. I think it really is an all-hands-on-deck situation. If you have the money somewhere, I think you're using it. So people are certainly using Social Security for these expenses, their personal savings, retirement accounts for sure. I mean, this is what that money is for, right? You're in your retirement years. So definitely pull from those accounts. Home equity. Some people will sell their home and use that equity toward long-term care or reverse mortgage if there's a situation where you're trying to stay in the house and have in-home care. Some people have long-term care insurance.

30:49Sara Rathner:Some people are veterans. And there are some veterans benefits that are available to folks who have served at certain times or in certain places. So contact the VA if you have questions. I would note that Medicare does not cover long-term care. So that's not an avenue to go down. And there's this sense as people are contemplating this decision that they don't want to spend down their assets because they're trying to leave a nest egg to their heirs. But I would say that your heirs would probably tell you they would rather you live comfortably at the end of your life. So spend it.

31:20Sean Pyles:And once you do spend down those assets, it'll be easier to qualify for Medicaid. Although be careful when you're trying to qualify for Medicaid, you have to have a very small amount of assets to qualify. And there is what's known as a five-year look back. So if you just try to deplete all of your assets, give them to your loved ones, that's going to be looked into and found, and you can be fined and punished for that. So don't try to trick the system because they are one step ahead of you.

31:44Sara Rathner:They're definitely watching out for that.

31:45Sean Pyles:Yes. Yes. So ahead of this conversation, I scoured a lot of Reddit threads, as I love to do. And I was trying to figure out how random people on the Internet just handle this affordability question when it comes to senior care. And I did see a lot of suggestions about depleting your assets to qualify for Medicaid or getting roommates or even moving to a less expensive country. And, you know, looking through these threads, it was frankly pretty depressing. And I think it really highlights how little support our government provides seniors, especially depending where you live, since some programs are state run.

32:19Sean Pyles:So, Kate, do you think that these threads I was reading are actually representative or was it just an especially bleak corner of the Internet?

32:26Sara Rathner:It does sound like a bleak corner of the internet, but it also sounds like a representation of a lot of people being confused and stressed because they're in situations where they don't have a lot or maybe anything at all saved. And they're not sure how to swing the cost of this care because it's expensive and Social Security isn't going to cover it all the way. And Medicaid is confusing and it really can feel bleak. For sure, the majority of people are not leaving the country. There's something like 61.2 million people in the U.S. over age 65. And I went looking, there's something like 670 ,000 people getting Social Security abroad.

33:02Sara Rathner:So that's 1%. It's teeny. Roommates are not the cure-all. Maybe you can set up kind of a golden girl situation.

33:10Sean Pyles:That's the dream.

33:11Elizabeth Ayoola:I always love those. I came across an Instagram post a couple of years ago of elderly women who did that. They all bought a huge house and just lived together. And I thought, how cool is that?

33:20Sean Pyles:That is my go-to comfort show. I would love to live in that reality.

33:23Sara Rathner:Oh, yeah. Who wouldn't want to be in the Golden Girls? Again, those ladies were all in good health, and no one there was looking for long-term care. So if you're talking about someone who needs care, it's a slightly more complicated equation. So generally, it's hard, and it's costly. And in a lot of cases, older adults are getting by with family caregivers. Sometimes they're moving in with them. Sometimes their caregivers are moving in with the older adults. because really there's only a small percentage of the over 65 folks are in assisted living or nursing homes. It's only about three and a half percent.

33:54Sean Pyles:Oh, wow. That's a lot less than I thought it would be. Yeah, it is.

33:58Elizabeth Ayoola:And when I think about it, Kate, because I do know many people who are in the sandwich generation currently and having to take in their parents, well, not having to, choosing to take in their parents. I don't know many people who have or anyone who has their parent in assisted living care or a nursing home.

34:14Sara Rathner:I think for as long as people can, they try to get by with family or some situation where they don't have to go someplace else that isn't home.

34:22Elizabeth Ayoola:Well, our listener mentioned two payment structures, monthly payments and also a buy-in structure. So Kate, can you outline how these work typically?

34:30Sara Rathner:Sure. So you're basically looking at two setups here. Facilities with monthly payments, it's exactly like it sounds. You're paying rent. There's a monthly fee that covers a certain base level of services. That's the typical setup for assisted living facilities and nursing homes. Buy-in facilities are generally things like continuing care retirement communities. You might hear them called CCRCs. And those are the places that offer different step-up levels of living. So they'll have an independent living location, assisted living and skilled nursing kind of all on one campus. And as you need more care, you kind of step up in housing.

35:03Sara Rathner:And those usually require an upfront lump sum, like a big deposit and an ongoing monthly fee. And those can be a really good option for certain people at certain times of their lives, it's worth noting that you must be healthy enough to live independently when you move into a CCRC. They're not looking for folks that are moving in and going immediately to assisted living. They're looking for folks who can live independently for a while and exist in that community for a few years.

35:27Sean Pyles:This might be totally out of left field, Kate, but have you heard about Margaritaville? I have not heard about Margaritaville. Wait, wait, wait. It is a boomer living facility. I believe it's in Florida, and it's for folks who love Jimmy Buffett and Margaritaville. And you can live there and live your Margaritaville dream in your older years. So that's a little bit less focused on the healthcare side of things and more the lifestyle side of things. But I think it shows that there's a huge range of options available and some might be more fun than others.

36:00Sara Rathner:For sure. That does sound more fun than many options. Gotta say.

36:05Sean Pyles:Okay. Well, continuing on with the important and listener-focused part of this conversation, They said that they could potentially get a refund for the buy-in structure. How would that work?

36:16Sara Rathner:So I just want to mention up front, this depends. Rules vary by facility. So in general, you can sometimes get a refund, but not always. Make sure you read the paperwork. You might find that a CCRC will refund some or all of your buy-in money if you move out within a certain period of time. Some are refundable on kind of a declining scale over five years. Some are partially refundable. Some are fully refundable. read the contract so you understand the terms. My grandparents actually bought into a CCRC in the early 2000s. And then my grandmother passed away kind of unexpectedly pretty soon after they moved in.

36:50Sara Rathner:But my grandfather left the community and got a lot of his buy-in back because they weren't there for very long. So that is a thing you can get out of those arrangements if the contract says you can.

37:01Elizabeth Ayoola:Certainly a silver lining there. Yes. How can people determine which might be best for their family situation, because we know this varies according to your situation. Does it involve some morbid estimation of how long your loved one might live or need this kind of care?

37:18Sara Rathner:Kind of, yes, it does. I mean, this is going to depend on your older adult, right? So if you've got someone who needs a lot of help, or you've got someone who just needs some companionship and meals and line housekeeping, those folks are going to have different timelines. There are services out there like a place for mom where you can call in and describe your loved one's needs and what they're hoping to get out of the care they're looking for. And they can point you toward the facility that best fits it in your area at your price point. So it's kind of a nice resource if you are looking for someone to talk to about that.

37:50Sara Rathner:And you're doing some longevity calculus. If you have a more independent older adult who's moving into assisted living, they're probably going ill and moving into skilled nursing, more or less. In terms of averages, I actually spoke to someone. I talked to Bill Comfort, who is a long-term care insurance specialist in North Carolina, and he gave me some data from the perspective of long-term care insurance claims that cover this kind of care and how long those claims are paid out on average. So how long is someone getting these claims paid? Keeping in mind that long-term care insurance doesn't typically pay until someone needs help with at least two activities of daily living.

38:29Sara Rathner:So dressing, bathing, eating, or continual supervision for safety if someone is cognitively impaired. That number is a little skewed because about 40 % of claims last less than a year because people are quite ill. But if you give a little leeway for that, the advice for men is generally to expect probably two to four years and for women expect three to six as your kind of basic starting point. A financial planner can help you run longevity numbers. Your family doctor might be willing to give you a timeline, although in my experience, not always. It's a big educated guess.

39:03Sean Pyles:It sounds like it'd be really hard to pin down this exact number, even if you are working with a financial planner, because part of it comes down to your family history as well, and how long people tend to live, what sort of illness you might have. And it just makes it hard to really know what's what. So how do you think people can best navigate that?

39:21Sara Rathner:It's incredibly specific. I think you have to model for all the scenarios. I think you have to decide, you know, if my loved one beats the odds and lives for another 20 years, could we manage that? Or, you know, what do the numbers look like if that happens? You just have to build that into your equation.

39:36Elizabeth Ayoola:I just want to say these sounds like such difficult decisions to make, number one. And also, as I'm listening, I wish we started learning about this earlier on in life, right? Because it seems like it'd be a lot more stressful to have to make that decision in the moment. Whereas if you learn about it early, which is what we're hopefully doing through this podcast and sharing the information, you can start thinking about it and planning for it, you know?

39:58Sean Pyles:Yeah. And beyond learning about it and hearing about it on a show like this, it's also really important to have these conversations with your family. And something that you and I have talked about before is how this isn't just a one conversation thing. It's something that you need to continue to bring up because covering all this ground at one time, it's just overwhelming and stressful and not really feasible. So take it a little bit at a time and just try to make a plan, but do have that conversation.

40:22Elizabeth Ayoola:Don't shout at me. This is making me sad. Both of my parents are still alive. And honestly, we've not had this conversation. And luckily they're both healthy and independent, but they're aging and that might not always be the case.

40:33Sean Pyles:So add this to your to-do list, Elizabeth.

40:36Elizabeth Ayoola:I'm sad. A little bit at a time.

40:38Sean Pyles:Yeah. And Hey, I mean, for me, I feel more empowered by this. This is something that I need to be talking about my parents with. And I think in order to avoid feeling sad later, you talk about it now, right? Like what, what do they want given all that could happen? How can you best make sure they have the later in life care that they would like to have while also making it feasible financially for everyone involved?

40:59Sara Rathner:I feel like if you, if you normalize talking about it, it becomes less taboo and weird and depressing. It's just, you're just talking about it the way you would talk about any financial planning topic, right? It is something that comes up for everybody. So yeah.

41:13Sean Pyles:Reduce the stigma around it.

41:14Sara Rathner:Yeah.

41:14Sean Pyles:Well, let's pivot now over to Medicaid because our listeners seems like they might want to be taking advantage of that for their father-in-law once their assets are depleted. So Kate, can you run us through quickly the Medicaid application process and again, how you qualify for it?

41:28Sara Rathner:Absolutely. I feel like my answer to all of your questions today is it depends.

41:32Elizabeth Ayoola:Welcome to the finance world.

41:35Sara Rathner:And Medicaid is kind of like that. It's administered by state. The rules vary by state. So it's kind of hard to generalize and there is no central process. So that's super helpful, right? In the most general sense, qualifying for Medicaid as an older person is going to be income-based. You typically must have income and assets below a certain level. That's going to depend on your state. There are people in your state who are going to have information about this. So I encourage people to call and ask. Easiest place to start is your state Medicaid office. You can probably find that at medicaid.gov, although that site is a little hard to navigate.

42:07Sara Rathner:So you can also just Google your state Medicaid office and go from there. Your local office on aging is a good place to go. You can find that at eldercare.acl.gov. You can find the one closest to you. There's also a website called Medicaidplanningassistance.org. It's a site from the American Council on Aging. It's got a lot of information on Medicaid. And then if you really are just like, I don't know what to do. This feels complicated. There are folks out there called certified Medicaid planners. You can talk to them. They do cost money. They may offer a free consultation to get a sense of your situation and whether they can help you.

42:42Sara Rathner:I actually did this when I was working on something for my mom a couple of years ago, and it was helpful, and I didn't need anything beyond the free consultation. So no harm in calling.

42:52Sean Pyles:Do you recall what the person's fee may have been if you did decide to go ahead and hire them?

42:57Sara Rathner:It was a few thousand, but keep in mind, I'm in the Westchester, New York City area, so everything is a few thousand.

43:04Sean Pyles:Walking out your door is a few thousand dollars over there. Exactly.

43:07Sara Rathner:If you're in a really prickly situation, you might want to call an elder law attorney. I actually, speaking of Reddit, saw a story of someone that moved their father to a state where he could qualify for Medicaid if his assets were structured in a certain way. And that worked for them. So sometimes the upfront cost for this might be worth it. And keep in mind, a lot of facilities will accept private pay and Medicaid and can transition your loved one to Medicaid when they've depleted their assets. So that is something to keep in mind, too. They could move in on private pay and be transitioned to Medicaid later at some facilities.

43:40Sean Pyles:Yeah, what I'm hearing from all of this is that there are a lot of resources and people that can help you navigate this. You're not alone in figuring this all out.

43:48Elizabeth Ayoola:Absolutely. Kate, do you have any other advice for our listener or anyone else dealing with this process for their loved ones?

43:54Sara Rathner:As Sean mentioned, there are so many resources out there. I'm a big fan of asking people I know for advice. If you know anyone who knows anyone who might have information that's helpful, reach out to them. I think people want to be helpful and they're happy to speak to you. When I was working on things with my mom a couple of years ago, I spoke to friends of friends who were geriatric nurses and acquaintances who were going through similar things with their parents and people on Facebook groups and generally anyone who would talk to me for 10 minutes. So it's stressful. So take your time. It's not worth rushing.

44:27Sara Rathner:Ask those questions and take care of yourself because, again, it's hard.

44:31Sean Pyles:Yeah, good advice. Kate, thank you so much for coming on and talking with us.

44:35Sara Rathner:Yeah, thank you for having me again.

44:37Sean Pyles:And that's all we have for this episode.

44:38Sara Rathner:If you want the nerds to help you answer your money question, call or text us your questions at 901-730-6373. That's 901-730-NERD. You can also email us at podcast at nerdwallet.com, or you can leave us a comment on Spotify or YouTube.

44:56Elizabeth Ayoola:We love your company, so we want you to join us next time when we talk to a couple about how they're planning for retirement in an age gap relationship. Follow Smart Money on your favorite podcast app that is Spotify, Apple Podcasts, iHeartRadio to automatically download new episodes.

45:13Sean Pyles:Here's our brief disclaimer. We are not your financial or investment advisor. This interview info is provided for general educational and entertainment purposes and may not apply to your specific circumstances.

45:23Elizabeth Ayoola:This episode was produced by Tess Vigland. Hilary Georgie helped with editing. Nick Karisameen mixed our audio. And we want to say a big thank you to all of our editors for all of their help.

45:33Sean Pyles:Until next time, turn to the nerds.