patrick.net

I'm confused. How much is a million dollars after a new Maserati, tons of blow, and a six month world tour of Rin's whorehouses?

CBOEtrader says

Have any of you heard of assisted living facilities? Opportunity: The demographic of people who need assisted living is exploding. Medicaid pays for 80% of seniors, so youd never not get paid. Medicaid pays the same amount regardless of location, meaning you could buy a 6 room queen Anne in small-town USA and rent each room for the same as-if you had a home in downtown Chicago.

I've had to learn about assisted living facilities to sell LTC insurance policies. Effectively assisted living facilities can be any private residence w as few as 3 rooms. as long as the home qualifies w Medicaid as an assisted living facility, Medicaid will pay anywhere from $2k to $4k for assisting each healthy senior. The hospice care is late stage assisted dying... totally different.

You might want to confirm that. First, a lot of Medicaid policies are state based, not federal like Medicare, so they aren't the same in every state. Plus, I've never seen Medicaid pay at a assisted living facility. All the assisted living places I went in, were all self pay, or long term insurance paid. The places that were paid by Medicaid were the skilled nursing facilities, where the people needed a lot more medical care, and were closer to $8K a month if you self paid.

Also, you might be confused, that claim of "pays 80% of seniors" sounds like the normal Medicare policy, not Medicaid. Medicare will pay for a short term stay in a skilled facility if someone needs short term rehab. Everything Medicare covers is only 80%, except for Part A in the hospital. Medicare does NOT pay for assisted living expenses.

But, I agree, these type of facilities will be in BIG demand, as the poor, fat Baby Boomers transition into old age.

MrMagic says

You might want to confirm that.

I am by no means an expert on how these facilities work. Would require a full research project to understand the opportunity.

MrMagic says

But, I agree, these type of facilities will be in BIG demand, as the poor, fat Baby Boomers transition into old age.

Gotta be a real estate opportunity in there somewhere. I particularly like businesses that rely on consumer choices w govt paying the bill :)

Yes we are discussing medicaid not Medicare. It is my understanding that 80% of seniors end life on Medicaid, and medicaid also pays for 80% of hospice care. Perhaps less in assisted living (50%?). The opportunity I'd like to invest I would be a real estate income producing business operating as a medically necessary facility for seniors who will most likely never live autonomously again.

The first stage of that process requires lite medical treatment and pays about half of that $8000 total you mentioned above. $8000 is for hospice, I think? I'm looking for answers if you know where to find them?

MrMagic says

Solution: Senior Barracks. Set up a barracks situation, just like the military. You can have mess lines and other structure just like the military. You can schedule a Medicare physician to come in once a week for medical care. The residents sign over their S.S. checks and you provide all the necessities.

Where else are they going to live on $1300/month?

Add a slow-mo drone fly-by w music and we could finance this. Rinse, get on it :)

We'll call it Patrick's Post-Retirement Paradise, where activities are pure joys like license plate craft time and cold calling for bill collectors.

CBOEtrader says

MrMagic says

Solution: Senior Barracks. Set up a barracks situation, just like the military. You can have mess lines and other structure just like the military. You can schedule a Medicare physician to come in once a week for medical care. The residents sign over their S.S. checks and you provide all the necessities.

Where else are they going to live on $1300/month?

Add a slow-mo drone fly-by w music and we could finance this. Rinse, get on it :)

I know it sounds like a strange concept, but I got the idea after talking to my son, who's the Director of Sales for a senior retirement community. He said they're seeing less and less of retirees who have the required financial assets to live in the community.... So I got thinking...

The facts are, there will be MILLIONS of retirees in their 70's who are active, but broke.... Where are they going to live?? In their kids basements?? Oh, wait, their kids are still living in their basements, the kids don't own houses.

Maybe instead of barracks, how about dorms, just like college? These retirees, without major medical issues, will need to live somewhere on their S.S. checks..

Or, just go long refrigerator boxes...

CBOEtrader says

I particularly like businesses that rely on consumer choices w govt paying the bill :)

That's what I did before retiring. Provided custom medical equipment that was paid primarily by Medicare and Medicaid.... Guaranteed money!

In fact, I don't remember much of the last financial meltdown, as it didn't affect us. Wifey and I were both working in the medical space in 2008, so our incomes and jobs were affected. The 401ks took a hit, but since came back, but since our income was indirectly paid by the government, there was no issues.

CBOEtrader says

It is my understanding that 80% of seniors end life on Medicaid,

It could be either one. Medicaid requires you to have zero financial assets, and does a look back over many years, so if they hadn't depleted all their assets, they would still be on Medicare, and Medicare would pay for hospice.

MrMagic says

Medicaid requires you to have zero financial assets, and does a look back over many years,

A LTC policy allows you to spend down the policy money rather than your own assets. However, yes the spend down into expensive end of life assisted care is the point. 80% of seniors (and there are millions) are requiring anywhere from assisted living to hospice before they die. If medically necessary, medicaid pays for it after the senior pays down their own assets.

By end of life 60%? of seniors have paid down their assets and are living recieving medical care from medicaid.

This money flows to private care taking facilities. How do we place ourselves downline of this cashflow?

MrMagic says

He said they're seeing less and less of retirees who have the required financial assets to live in the community....

How do you become the section 8 provider? Legit question.

If I cant find ^^ then I'm going w trailer park management company. Saw a documentary on a FL trailer park specializing in renting to ex-sex-convicts. Because they had no choice they were packing 2 of these guys into a trailer for $1200/month per trailer. Amazing.

Because they had no choice they were packing 2 of these guys into a trailer for $1200/month per trailer. Amazing.

I know of a guy in Hampton has a crappy little single story 4 bedroom house with 10x10 bedrooms that he rents out for $200/week per room. Same situation, sex offenders and other cons that have no choice.

https://investingnews.com/daily/life-science-investing/genetics-investing/anti-aging-companies-invest/

CBOEtrader says

MrMagic says

Medicaid requires you to have zero financial assets, and does a look back over many years,

A LTC policy allows you to spend down the policy money rather than your own assets. However, yes the spend down into expensive end of life assisted care is the point. 80% of seniors (and there are millions) are requiring anywhere from assisted living to hospice before they die. If medically necessary, medicaid pays for it after the senior pays down their own assets.

By end of life 60%? of seniors have paid down their assets and are living recieving medical care from medicaid.

This money flows to private care taking facilities. How do we place ourselves downline of this cashflow?

We need to invent an ETF for this if none exists. Perhaps Rin can help.

CBOEtrader says

By end of life 60%? of seniors have paid down their assets and are living recieving medical care from medicaid.

This money flows to private care taking facilities. How do we place ourselves downline of this cashflow?

Actually, I went looking because I thought that 60% sounded high for Medicaid. This is what I found:

..."Over the final year, total medical spending is $59,100. Of this total, $42,100, or 71%, is covered by Medicare,
while $5,900, or 10%, is covered by Medicaid, and $1,040 is covered by other government programs. "



Looks like Medicare pays the most, not Medicaid.




and this shows where it's being spent.

Here's the link, lots of data for Senior healthcare.

https://www.nber.org/papers/w21270.pdf

CBOEtrader says

ex-sex-convicts. Because they had no choice they were packing 2 of these guys into a trailer

Man, I cringe at what the beer summit must be in these. It's a living!!

I'm honestly surprised there aren't more takers for a remote cheap 3/2 house and 15 year old pickup. I'd actually go all in for pre-smog era '72 Buick Electra 225 and do oil changes with Wesson, replace the belts with pantyhose twisted in a rope, and remove the deck lid for hauling. What an easy life.

MrMagic says

Looks like Medicare pays the most, not Medicaid.

Your stat is in regards to final year medical expenses. Medical expenses will always be covered by Medicare first for anyone on Medicare.

The stat I am recalling is specific to long term care facilities, but I need to go find it. Medicare only covers 100 days of LTC, so we are talking a subset of seniors in multi-year nursing home situations where the only options are privately paid (or via LTC insurance policy) or paid by Medicaid. I need to go find the stat and report back. However here's the rules for medicaid paying for it : https://www.nolo.com/legal-encyclopedia/when-will-medicaid-pay-nursing-home-assisted-living.html "Most states have more flexible income guidelines for Medicaid reimbursement of long-term care. In most states, you can make up to 300% of the SSI income limit and still qualify for nursing-home-only Medicaid (300% of the SSI limit, $750, is $2,250 per month in 2017)."

There is theoretically a large pool of Medicaid covered LTC nursing home patients, the housing room/board provider for whom would receive some monthly amount from Medicaid just as an example.

Booger says

CBOEtrader says

MrMagic says

Medicaid requires you to have zero financial assets, and does a look back over many years,

A LTC policy allows you to spend down the policy money rather than your own assets. However, yes the spend down into expensive end of life assisted care is the point. 80% of seniors (and there are millions) are requiring anywhere from assisted living to hospice before they die. If medically necessary, medicaid pays for it after the senior pays down their own assets.

By end of life 60%? of seniors have paid down their assets and are living recieving medical care from medicaid.

This money flows to private care taking facilities. How do we place ourselves downline of this cashflow?

We need to invent an ETF for this if none exists. Perhaps Rin can help.

How about a $5/week robo funding app to go along w it :)

I envision a summer camp setup for seniors wherein you have very simple accommodations in a beautiful outdoorsy (cheap) location, with central dining/entertainment/nursing/ambulance services for the community, etc... Could build that for fuck-cheap, the giant unknown here is how hard it is to be certified by the state as as a facility that can accept medicaid. Also, does medicaid pay on time? May need to mix in some private clients for cashflow risk.

Regardless, we are still talking about cabins and/or tiny homes in the boonies rented out for multiple thousands$$$ /month each. Sounds good to me

https://www.kff.org/infographic/medicaids-role-in-nursing-home-care/

Found it. In 2015 Medicaid was primary payer for LTC of 62% @ $55 billion spent in 2015. Number of seniors is expected to double over next 40 years, with costs of care/housing/food skyrocketing.

MrMagic says

Where are they going to live?? In their kids basements?? Oh, wait, their kids are still living in their basements

Allow digging "granny basements" under basements - problem solved.

DASKAA says

MrMagic says

Where are they going to live?? In their kids basements?? Oh, wait, their kids are still living in their basements

Allow digging "granny basements" under basements - problem solved.

I will see if I can invest in sump pumps.

CBOEtrader says

The stat I am recalling is specific to long term care facilities, but I need to go find it. Medicare only covers 100 days of LTC, so we are talking a subset of seniors in multi-year nursing home situations where the only options are privately paid (or via LTC insurance policy) or paid by Medicaid.

When talking specifically about LTC facilities, you're correct, the majority of them are paid by Medicaid. That's a smaller subset of the total.

But, if you're looking at the total subset of Senior living, a smaller percentage are in LTC compared to that total population. You also have assisted living (self-pay), home bound (Visiting Angel group), Living with kids group, and LTC. So, I think, the key is to find a medical housing solution that caters to the majority too.

CBOEtrader says

There is theoretically a large pool of Medicaid covered LTC nursing home patients, the housing room/board provider for whom would receive some monthly amount from Medicaid just as an example.

That's a definite guaranteed group of payors, but besides providing the housing room and board, they also require a higher level of medical care, which requires hiring an experienced medical staff. If it's just the housing part you're interested in, then you'll need to find an outsourced medical care provider to handle all the medical services. That could be difficult to split up in the facility. Like with Licensing, accreditation, inspections, insurances, billing, etc.

CBOEtrader says

I envision a summer camp setup for seniors wherein you have very simple accommodations in a beautiful outdoorsy (cheap) location, with central dining/entertainment/nursing/ambulance services for the community, etc... Could build that for fuck-cheap, the giant unknown here is how hard it is to be certified by the state as as a facility that can accept medicaid. Also, does medicaid pay on time? May need to mix in some private clients for cashflow risk.

Regardless, we are still talking about cabins and/or tiny homes in the boonies rented out for multiple thousands$$$ /month each. Sounds good to me

That's kinda of the idea I had with the Senior Barracks. There will be millions of able-bodied people in their 70s who will need a simple place to live with their limited budget. They will be low care. You can get them in when they are independent, and when their medical issues pick up, transfer them to your Medicaid wing.

CBOEtrader says

Number of seniors is expected to double over next 40 years, with costs of care/housing/food skyrocketing.

That's exactly it. Many won't be ready for Medicaid care in their late 60's and 70's, and with life expectancies in the high 80's, these people will exhaust their retirement savings before they turn 70. Where will they live and what can they afford on their $1300./ month S.S. check.?

In fact, I believe this will be such a HUGE issue, when 10's of millions march on Washington demanding help, that the government might come up with some sort of Section 8 program for all these retirees housing. That would be the thing to plan for. The the government will send you a check each month for housing these people.

MrMagic says

There will be millions of able-bodied people in their 70s who will need a simple place to live with their limited budget.

Seniors who do not have a medical referral to a nursing facility? you are talking about the $1200 to 2000 type SSI range? Ugh, so shared or small rooms for 500-800? Could they use their SNAP cards in your mess hall perhaps?

CBOEtrader says

Seniors who do not have a medical referral to a nursing facility?

Yes, millions will only have minor medical issues, so won't be a candidate.

CBOEtrader says

you are talking about the $1200 to 2000 type SSI range?

Yes, 10 of millions of them. Go do a quick search to see what the median amount Boomers have saved for retirement. It's not pretty, it's like $78K. You're good with numbers, how long will that $78K last if they spend the median amount of $45K a year to live with that level of S.S. payments?

CBOEtrader says

Ugh, so shared or small rooms for 500-800?

Like army barracks or dorm rooms. How cheap can you build these structures?

CBOEtrader says

Could they use their SNAP cards in your mess hall perhaps?

That is definitely an option, or probably a necessity. Would be better than pulling it from the S.S.check.


CBOEtrader says

Ugh,

Exactly.

Easy Peasey.
Pay off mortgage, pay down kids' student loans.

CBOEtrader says

2019 $1 million in cash to invest. What's your plan?

I hear the Nigerians are offering a 40% guaranteed return.

B.A.C.A.H. says

Easy Peasey.
Pay off mortgage,

Why, you can make more investing it than tying it up, not liquid, in a house.

B.A.C.A.H. says

pay down kids' student loans.

Dumb, that an even bigger waste of money with less of a return. It's THEIR college, they pay for it, not you.

Why, you can make more investing it than tying it up, not liquid, in a house.

For most people out there, who are the working Joes and not investment experts, the best thing they can do with extra funds is pay off all credit cards and similar loans, then pay down the mortgage.

HeadSet says

For most people out there, who are the working Joes and not investment experts, the best thing they can do with extra funds is pay off all credit cards and similar loans, then pay down the mortgage.

For credit cards and other loans, who's interest rates are higher than what they can get on their investments, that's what should happen. But, many people have refied their mortgages the last few years, at rates in the 3's, so historically, they can get a higher return NOT paying off the mortgage and investing it. Plus, if they take the MID, it reduces their net mortgage rate even more.

In the event they need some quick cash (like in a job loss), it's a lot easier to sell some investments to raise cash then to try and apply for a home equity loan to pull cash from the house.

I'd actually go all in for pre-smog era '72 Buick Electra 225

I know you are joking, but a '70 or so Buick Electra 225 Convertible is one of my dream cars.

But, many people have refied their mortgages the last few years, at rates in the 3's, so historically, they can get a higher return NOT paying off the mortgage and investing it. Plus, if they take the MID, it reduces their net mortgage rate even more.

I hear you, but remember that MID is more for richer folks. A Joe with a 3.5% $250k loan or less will only pay about $8.5k or so in interest, and the Standard Deduction is $12.7k for married, soon to be $24k. And with the $24k SD, even a $400k loan MID would be around half of the SD. And Joe is unlikely to find a risk free 3.5% tax free investment, so Joe's best bet is actually to pay down the mortgage and keep credit cards on the side for emergencies.

Depending on the state, Medicaid will pay for some of the assisted living costs. Because kids were dumping their folks into assisted living, absconding with their accumulated wealth, and having Joe taxpayer pick up the bill, usually now the senior citizen has to have exhausted all or most of their wealth beforehand, or iit may be applied to pay the cost of assisted living.

So, Medicaid plus the senior hands over their SS check, and if the are lucky, pension check, and the cost may be covered. Yet another reason to stop the flow of illegal gimmegrants.

https://www.payingforseniorcare.com/medicaid-waivers/assisted-living.html

MrMagic says

B.A.C.A.H. says

Easy Peasey.
Pay off mortgage,

Why, you can make more investing it than tying it up, not liquid, in a house.

B.A.C.A.H. says

pay down kids' student loans.

Dumb, that an even bigger waste of money with less of a return. It's THEIR college, they pay for it, not you.

Silly MrMagic,

you know everything that's best for everyone without even knowing them.