How are people accounting for end of life care in FIRE? I'm watching my grandad in law burn money to the ground because he needs 24hr care (will only consider staying in his home), and it is crazy expensive. He's in his late 90s, and until recently had been in phenomenal health, so it's not unreasonable he could live for several more years. Without a crystal ball on how long to plan for, I'm concerned with where healthcare is today.

Probably to self insure. Often there will be some lower spending years, before a possible increase.
It’s rare to need intensive care for more than a couple years (before you die) and moving to a care home/ hospice is always an option.

Good for your grandfather if he has the money for great care at home.

This is something I’ve been thinking about as well. My parents have a great LTC plan. My dad is in memory care and is receiving $12k/month for 5 years, which more than covers the monthly cost of the facility. LTC plans are not what they were when my parents purchased them. We are RE and will look into a plan closer to 50. But I’m fully expecting our savings and inheritance will need to cover care.

Having been through exactly this, we started with home care. Expensive and hit or miss quality. Family, not my mom, made the decision to choose a skilled nursing/assisted living community near all family (not just one family member, if possible, so they don't get worn out by becoming the sole designated caregiver by the facility) and she was involuntarily moved there. She initially hated us for it, but eventually said it was for the best. But one, and preferably more, family member has to regularly be there and be in contact with the facility managers, director of nursing, and day-to-day caregivers by popping in unannounced on a regular basis. Check and double check the medications and care regimen so they know that somebody is watching them. Don't dismiss out of hand the complaints of your loved one, since they may be true. Get to be on a first name basis with the director of the facility and involve the director of nursing every chance you get. Unfortunately, finances will dictate the decision and your grandad ultimately won't make the decision - you and your family will because when his money and assets run out and he's still living, you're going to have to pay for it. So gather the family now and face that reality sooner than later. Figure out a plan that most, if not all, of the family will agree to, and go with it. You'll be glad you did. Ultimately, it's the only way you'll survive without going broke. The heartache and regret in some form is always going to be there, but it's for the best.

Really, the only thing that is a problem is early onset altheimer. Normal, high cost, end of care is usually short lived. There are exceptions but they are rare contrary to anecdotal evidence.

Long term care insurance used to be a good answer, but nowadays from what I read it is so poorly priced and poorly available that self insuring is a better plan.

Many people view their home equity as LTC insurance, but this can give short shrift to the spouses and heirs.

This is part of why I tend to plan for low WRs. They leave excess portfolio for LTC and/or bequest.

To answer question asked, I am factoring some need to spend money in the future but hope we make good decisions and have money left for a nursing home. But a lot of that can’t be predicted other than to leave a bit of a buffer for the unexpected. I am going to look into trust options (not my specialty).

Main risk is one of me or my spouse depleting savings. There is no insurance product. Plan is to figure out Medicare with a trust and 5 year look back in that case. Would appreciate others ideas, or anything to do sooner.

The key is staying healthy (strength training) and eating clean food and not being overweight. The majority of elderly have type 2 diabetes from our crappy American food. Lots of diseases (diabetes, high blood pressure, high cholesterol) can be mitigated by exercise and diet, which in turn keeps you healthy and off tons of meds which deplete your system of vital nutrients. It's a bad cycle. America needs to change its ways!

There are life insurance products out there that satisfy the need.

I recently converted a variable universal life policy I took out around 30 years ago to a new life insurance policy that has a rider which allows me to “borrow” against the death benefit to pay for long term care. it allows monthly expenses up to the IRS limit (currently around 12.6k/month.

It was a huge win-win - more than doubled my death benefit, eliminated monthly premium (I was contributing $400/month to old policy), got long term care coverage. I can withdraw my cost basis from the two policies without tax implications (it would reduce the death benefit), I can borrow money from the policy with 2% interest.

And if I don’t end up spending all of the death benefit for long term care, balance goes to my beneficiaries tax free When I pass.

Almost no US citizen has enough money to plan for large, unforeseen medical events that require long term care.

after 80 yo i guess we all will be eligible for assisted euthanasia as life span today is higher vs health span while social systems r not prepared for this life span

Cont. I also experienced the same with my grandma, who lived longer than expected with dementia. They spent every penny until my mom and aunts had to contribute too. Lost the house and anything they would have passed on paying for health care.

I'm scared I'll have to help my parents in similar ways and feel like FIRE is out of reach because of the unexpected health care aspects.

Oh and right now I'm 33 with 1M+ invested across investment portfolio.

Not an expert, but: assets into irrevocable trust well ahead of time, be asset poor on paper, take Medicaid at EOL. Apparently most everyone goes on Medicaid at the end, but you need to deplete your assets first. Irrevocable trust = not your assets any more, though you can still enjoy them

We pay a small fortune in long term care insurance but it gives some peace of mind and can help slow the exhaustion of life savings. But you might not need it - you could die suddenly or live healthy to 101 and pass quickly - or you might need a lot of care.

Probably not helpful but I married a foreigner. Our plan is to move back to Canada or France/Europe when we're 65+. Even if we have to pay out of pocket, it'd still be cheaper than the US.

Your family isn't caring for him?

Not sure. I’ve heard LTC insurance is pretty unreliable but would be open to what others are doing

What are the margins on EOL care services? Anyone know?

Always live below your means, research options before you need them, and be prepared to move abroad for care if planning didn’t work out

I was fortunate to purchase LTC insurance for me and my wife. Took 10 yrs, was expensive, but did it during my 40s. It pays $600 / day today and has an inflation rider.