How much to save for retirement

[glennds]

I could write volumes on the issue of tort litigation, but cutting to the chase, the idea of huge jury verdicts in nursing home cases is a myth. The one plaintiff's case in which I was involved led me to do a comprehensive review of past jury verdicts in care facilities, and the awards in even the most egregious cases are so low as to make a case hardly worth pursuing.

This has not been my experience at all. The majority of nursing home cases do not go to trial, but many of those that do result in staggering verdicts. The top five in the US (in recent years) resulted in jury awards of $200MM, 90MM, 45.5MM, 19.2MM and 11MM. If those are not big awards to you, then you're a high roller. To me those are huge awards.
Look up a notorious firm called Wilkes & McHugh. They helped pave the way in this area, realizing that the voluminous amount of regulation involved in the nursing home industry could be used for litigation purposes (in the same way that environmental attorneys figured out they could use EPA and other regs for their purposes also). Wilkes reviewed the statutory landscape in each state, picked those states with the most favorable remedies, set up (I think) 10 or 12 offices, started buying copious TV commercial time, developed a boilerplate Complaint form, and went to town.
Several years ago, they flew all their attorneys to Las Vegas on private jets, booked out an entire floor at one of the hotels, and bought nearly all the ringside seats at a Floyd Mayweather fight.

Facilities and physicians used to use photos to document and track wound healing. Not any more. An attorney developed a technique of taking a wound photo out of the medical records, blowing it up to 6 ft big, and using it to scare the shit out of the jury. So industry practice became to create written documentation only so as to not arm lawyers with ammo.
With luck, a good lawyer can channel the embedded guilt a jury member might have over not having had the $4 million to provide their own loved one with private duty 24/7 care. Or harness the fear we all have of aging.

And as for the majority of cases that do not go to trial, there is usually quick settlement money from the facility's insurance carrier. I have direct knowledge of probably 30 cases, not one went to trial, but not one walked away empty handed either i.e. they received settlement money from the insurance carrier. Usually $100-$500K. Most were defensible claims, but the insurance company held the settlement consent rights and the plaintiff lawyers knew it. They usually made us produce the insurance policy before producing the medical records! In these contingency fee deals, the attorneys take anywhere between 40 and 60%.

If tort law is your area of expertise Maddy, and you really believe what you wrote above, I don't know what to say. You don't need to believe me, you can just google it for yourself for god's sake.

[ochotona]

The article is NOT from a commercial webpage from advisors. The magazine is aimed at articles to Financial Advisors for them to better assist their clients.

You proved my point, Vinny. Financial Advisors are in business, and articles for them "to better assist their clients" are by definition commercially oriented. I'm not saying it's bad, I'm just saying there is a slant, and the slant is to sell product and earn commission. That's how Financial Advisors eat.

[Maddy]

I could write volumes on the issue of tort litigation, but cutting to the chase, the idea of huge jury verdicts in nursing home cases is a myth. The one plaintiff's case in which I was involved led me to do a comprehensive review of past jury verdicts in care facilities, and the awards in even the most egregious cases are so low as to make a case hardly worth pursuing.

This has not been my experience at all. The majority of nursing home cases do not go to trial, but many of those that do result in staggering verdicts. The top five in the US (in recent years) resulted in jury awards of $200MM, 90MM, 45.5MM, 19.2MM and 11MM. If those are not big awards to you, then you're a high roller. To me those are huge awards.
* * *
If tort law is your area of expertise Maddy, and you really believe what you wrote above, I don't know what to say. You don't need to believe me, you can just google it for yourself for god's sake.

I can only tell you only what I gleaned from my own comprehensive review of jury verdicts. They are reported, along with a brief synopsis of the facts, in virtually every jurisdiction, so no googling or surmisal is necessary. I would have loved to find otherwise, but the awards were shockingly low; as I recall, many at the low end of the five-figure [EDIT: Intended to say "six-figure"] area. And I was looking for cases that were roughly analogous in terms of the quantum of damages--which in my case involved full body burns that ultimately led to a patient's death and circumstances that reeked of negligence.

When you refer to "the top five in the U.S.," I don't know what you mean. Are you referring to the five highest verdicts nationwide? If so, you're basing your conclusion on a very few outliers at the extreme end of the normal curve.

One factor that strongly influences verdicts is the availability of punitive damages under state law. In my experience, it is oftentimes punitive damages that account for verdicts that far exceed the amount of actual damages. You'd have to look at each one of the five verdicts you cite and analyze them, as I did in my case. Unless you do that, your conclusions could be wildly wrong.

[glennds]

I could write volumes on the issue of tort litigation, but cutting to the chase, the idea of huge jury verdicts in nursing home cases is a myth. The one plaintiff's case in which I was involved led me to do a comprehensive review of past jury verdicts in care facilities, and the awards in even the most egregious cases are so low as to make a case hardly worth pursuing.

When you refer to "the top five in the U.S.," I don't know what you mean. Are you referring to the five highest verdicts nationwide? If so, you're basing your conclusion on a very few outliers at the extreme end of the normal curve.

One factor that strongly influences verdicts is the availability of punitive damages under state law. In my experience, it is oftentimes punitive damages that account for verdicts that far exceed the amount of actual damages. You'd have to look at each one of the five verdicts you cite and analyze them, as I did in my case. Unless you do that, your conclusions could be wildly wrong.

Here is a link to the law firm that summarized the five cases I mentioned. The article title says "Five largest" but the body of the article says "Five of the largest, with an emphasis on Arizona". There should be enough info for you to research them further. https://www.knappandroberts.com/largest ... -verdicts/
Note there is an emphasis on Arizona because this attorney is marketing to the AZ market, another indicator that it is a lucrative area. One of the verdicts is his. He provides names, jurisdictions and dates; enough info for you to research further if you like.

Less detailed, here is another law firm that provides a list of twenty cases with large awards, most in the millions or tens of millions. https://www.schupakinjurylaw.com/recent ... nd-th.html

Again, if you google nursing home jury awards you will get lots of news hits of various awards that will have enough information that you could run with if you wanted to do a comprehensive review.

We've been focused on jury awards. Here is a link to an organization that apparently tracks settlements. They claim the average settlement (in the United States) is $406,000. https://www.nursinghomeabusecenter.com/ ... or%20more.

Maddy, the only cases I have seen settle for five figures in my own experience were total nuisance cases that had no merit but the carrier was willing to pay out to make them go away quickly. I still don't understand how your research conclusion was that large jury awards in nursing home cases is a myth. But at this point if I haven't convinced you otherwise, let's agree to disagree.

[Maddy]

If you wanted to determine what a typical jury verdict would be in a particular case, you would need to do it systematically, based upon a review of ALL relevant verdicts in a particular jurisdiction. By "relevant verdicts," I mean verdicts arising from cases that are at least roughly comparable, both legally and factually, to the one at issue.

The sources you cite, Glennds, are the on-line advertisements of law firms who are attempting to attract clients by touting their supposed success in obtaining sky-high recoveries. That's about as biased a source as one could possibly imagine. Their featured cases are undoubtedly cherry-picked. They don't tell you about the cases that didn't pan out so well. Nor do they provide anywhere near the amount of information that you would need to determine what particular features of the case drove the verdict.

If I advised a client based upon the five most lucrative awards I could find, I'd probably be guilty of malpractice. The reason, again, is that you're focusing on one extreme end of the normal curve and ignoring what happens in most cases--including the handful of cases at the other extreme where the plaintiff gets nothing.

And even if you went to the trouble of looking at all of the relevant verdicts, you would still need to evaluate them based upon the idiosyncracies of the particular case. What were the underlying facts? What kinds of damages were at issue (medical costs, pain and suffering, disability, disfigurement, loss of earnings, loss of earning capacity, loss of consortium, loss of life, etc.)? What was the plaintiff's expected lifespan and his pre-injury level of functioning? How clear was the element of negligence? Was intentional conduct a factor? What other aggravating circumstances were present? Did the applicable law allow for exemplary damages? Was contributory negligence an issue? How sympathetic were the plaintiff and the defendant? What other attributes of the case were likely to have ignited passion or prejudice on the part of a jury? When you look at an on-line advertisement of a law firm (or of a "center" supported by law firms), you have no way of knowing the answers to these all-important questions.

Similarly, when you quote a statistic saying that the average verdict in nursing home cases is $406,000, that doesn't tell you anything useful unless you know something about the cases that were used in the statistical sample. It's only when you start matching up particular injuries with particular amounts that you begin to get a feel for whether verdicts are running high or low. So when I say that nursing home verdicts are, overall, shockingly low, I say that having actually looked at the features of the underlying cases and having seen how terribly undercompensated victims often are in the face of serious, and even extreme, injuries or death.

Settlements are a whole 'nother ball of wax. The purpose of a settlement is to eliminate risk and, for an insurance company, to bracket liabilities. For that reason, it may be a whole lot higher (or lower) than what a typical jury verdict would bring.

P.S. When I referred to "low five figures," I was thinking of verdicts in the area of $200K to o$250K for serious injuries involving clear liability and substantial general damages (disability, disfigurement, pain and suffering). I had five zeros on the brain.

[boglerdude]

Juries love sob stories. whats the reason victims would be under-compensated. Insurance company donations to judges? Car accident victims seem well compensated, even when fault isnt totally clear.

Like gun violence, elder abuse cant be cured. And the cure could be worse than the disease. In the case of 2A. . .much worse.

[Maddy]

Juries love sob stories. whats the reason victims would be under-compensated. Insurance company donations to judges? Car accident victims seem well compensated, even when fault isnt totally clear.

It is not judges, generally, who determine the amount of damages in a jury trial. (An exception is where the verdict is so clearly unreasonable that the judge utilizes his limited powers under the court rules of "additur" and "remittur" to revise the verdict).

It seems pretty self-obvious to me that the lowball verdicts in nursing home cases reflect the view among ordinary Americans that the lives of elderly people, and of people with life-altering disabilities, don't have much value. I'm just guessing here, but I think that jurors often take the view that the plaintiff was already so feeble, already so unable to enjoy life, already so close to death, etc., that the injury at issue really didn't change things much.

Of course, a good plaintiff's lawyer would argue that when a person is elderly, significantly disabled, and has already lost much of the enjoyment of life, taking away even a little of what is left is a really big deal.

[sophie]

Sorry I've been away for a bit, indulging in some Mom care....

As per usual, Maddy asks some really good questions. My answers below.

The tenor of this discussion is revealing that it is not saving for retirement that is the problem; it's saving for medical care. <== TRUE!!! The retirement savings aren't the issue; the amount needed to cover medical care specifically for dementia (the one condition that is almost entirely self-pay) is the main issue.

Some questions to ponder:

- Do folks over 65 really need to be on 12 different prescription drugs? <== Absolutely not. It's ridiculous. My mom is on 3 meds and it's all to manage Alzheimer's behavior which is otherwise incredibly destructive and intolerable. And one of them is being tapered off.
- How much of what passes for medical care in the "over 65" crowd could be handled appropriately (or even better) through self-doctoring? <== Most over-65's are severely over-tested, over-diagnosed, and over-treated.
- How much hospital care is the result of poor lifestyle choices, both past and ongoing? <== Almost all of it.
- Do you really want a year of chemotherapy and radiation at the age of 85? <== Hell no. However, that stuff is covered by insurance and isn't the problem.
- Bodies don't last forever. Is it so wrong to accept that there is a point when you should just let nature run its course? <== Exactly!! Nature's expiration date.

In another thread from long ago, we discussed the fact that the medical system is good for one thing: acute care. With respect to the chronic, degenerative stuff, it really doesn't have too much to offer. So why do we continually look to the medical system, with all its layers of expensive bureaucracy, to solve these problems? <== Totally agree. Medicine has very little to offer for chronic conditions. Although I must say that judiciously chosen medications can be very helpful.

As for D1984's little rant....dream on, friend. Who do you think is going to do what you're hoping, and fully fund Medicare to cover not only what it covers now but also dementia care? If anything, the trend is in exactly the opposite direction. Also, Biden tried to slip some elder care funding into one of his massive spending omnibus bills, but it failed to get through. And even if it passed it wouldn't have accomplished much. No one in either party is the slightest bit interested.

As for what's going to happen to future dementia patients...no idea and I hope I never find out. It'll be ugly is all I can say. Up until a few years ago, it was possible to find a home care aide for reasonably cheap, like $15/hr. Now the going rates are $25-30/hr, almost always paid in cash so forget about getting a tax deduction. Agencies are charging more like $35-$40/hr. Also note, the statistics on cost of dementia are GREATLY underestimated because they totally ignore these cash-pay aides. I know quite a few people in the home care for Alzheimer's world, and typical costs are not less than $10K/month for partial care, $20K/month for round the clock care. Good luck making that work with just $100K in savings.

[boglerdude]

Some of those 15k/month places will take your estate, then keep you after you've burned through it at 15k/month rate, so it works out to less 15k/month. Also avg life span in nursing home is 2 years.

> the view among ordinary Americans that the lives of elderly people don't have much value

But of course that cant be true. We just had two years of unprecedented and unconstitutional house-arrest, specifically to give our 80 somethings a few more months.

[sophie]

Some of those 15k/month places will take your estate, then keep you after you've burned through it at 15k/month rate, so it works out to less 15k/month. Also avg life span in nursing home is 2 years.

Once you burn through your savings, you get put on Medicaid. If you had a private room you'll be moved to a double, and or you'll be moved to a Medicaid nursing home. It is an advantage already being in a facility though, they can't throw you out while you're waiting for a Medicaid bed.

Average length of stay in a nursing home is 3 years, not 2. There is a large range however, hidden by that average; around half of people die within a year of being moved to a nursing home, and there is a long tail with extended stays ranging up to 20 years. The average for patients with dementia is much longer than 3 years (I remember reading an article reporting that it's 5 years but I can't find it now). Certainly that's holding true for my aunt, who is going into her fourth year in memory care and will probably be there for years to come. She can no longer speak or understand language, and needs help walking, but is otherwise perfectly healthy.

The really critical ingredient here is that you have a fighting chance of minimizing costs if you set yourself up with a dementia-compatible living situation before the dementia sets in. My aunt and her husband had a condo in Florida and a split-level house in NJ, meaning lots of stairs. When my aunt started having cognitive problems, they sold the Florida condo and moved back to their NJ house. IMHO they should have stayed in Florida and sold the NJ house. My sister had to move them to memory care because they kept falling on the stairs, and also because they kept throwing out the aides she tried to send there. I spent a lot of time and effort working on my mom to get her to accept home care, but my sister had no patience for that with my aunt and uncle. If my efforts with my mom had failed, she'd be in memory care now too.

So, two recommendations if you want to minimize your costs and improve your quality of life: 1) Move somewhere without trip/fall hazards, and where it's easy to get help if you need it, and 2) Put a sign on the wall or arrange for someone you trust to tell you to accept home care when you need it.

I have no idea how often people with dementia go to a nursing home too early due to refusing home care, but I bet it's very common. Similarly, someone who insists on remaining in their house with stairs and trip hazards galore will also end up going to a nursing home sooner than they would if they were living in a one story, mobility-friendly home or apartment. An independent living apartment in a retirement community is a great option, but so is a private apartment or one-story house with appropriate modifications. Just make sure there is an extra bedroom to accommodate a live in aide. And, good to move near the family member who will be taking care of you. My aunt in Colorado who is now in the early Alzheimer's stage did that correctly, and her daughter (my cousin) is incredibly thankful for that. She moved to an apartment in an over-55 complex that's about a 20 minute walk from her daughter's place.

[Pointedstick]

Some people like us have a chance of being able to save and invest enough to end up (hopefully!) with $1-3M retirement portfolios that we can then spend down on living expenses and high priced health and nursing care, but this is definitely not the norm. I think it's pretty clear that as a system, "individual savings" isn't working. Most people aren't saving enough money and are having to rely on publicly funded institutions and the charity of their children.

On that subject, throughout history, people's children have been the original old-age/retirement system, and in many ways they still are. This seems to be a big part of what people on this board say they're doing with their own parents. If that's not your plan because you don't have kids, or your kids hate you, you'd better have a ton of money saved if you don't want to be at the mercy of whatever the government and eldercare industries happen to look like after you're 75.

[flyingpylon]

On that subject, throughout history, people's children have been the original old-age/retirement system, and in many ways they still are. This seems to be a big part of what people on this board say they're doing with their own parents. If that's not your plan because you don't have kids, or your kids hate you, you'd better have a ton of money saved if you don't want to be at the mercy of whatever the government and eldercare industries happen to look like after you're 75.

And along those lines, if you've ignored your children's financial advice and made poor (albeit noble) decisions about how to spend your income during retirement, what obligation do your children have to bail you out when the time comes? No hate involved, just exceptionally poor planning.

[DogBreath]

On that subject, throughout history, people's children have been the original old-age/retirement system, and in many ways they still are. This seems to be a big part of what people on this board say they're doing with their own parents. If that's not your plan because you don't have kids, or your kids hate you, you'd better have a ton of money saved if you don't want to be at the mercy of whatever the government and eldercare industries happen to look like after you're 75.

And along those lines, if you've ignored your children's financial advice and made poor (albeit noble) decisions about how to spend your income during retirement, what obligation do your children have to bail you out when the time comes? No hate involved, just exceptionally poor planning.

I don't know where you guys hang out, but I see the exact opposite problem. It's a bunch of 30- and 40-something adults living with (and sponging off) their parents, causing a drain on the parents' savings and ultimately leading to a less prosperous retirement (of the parents, but prob the 40 yo adults as well cuz now there is also no inheritance).

[sophie]

Yes that's part of the problem. Which children are you going to count on to take care of you in old age, when they're part of a generation that currently can't take care of themselves?

Back in the day, children did indeed help take care of elderly parents, but it wasn't something that could go on for decades. Most people didn't ever even "retire"; they'd stop working and wouldn't live more than a year or two after that. People are now less healthy, but live longer. Not a great combo. This is what's killing Social Security and Medicare, too, it's the same problem.

And, it wasn't "children" who did the elder care. It was women who typically did not work outside the home, and instead played support roles for working husbands and other family members. Obviously that's often not the case anymore; women now have careers and jobs. And, given that half of them are single or divorced, stopping work to care for Mom isn't exactly a viable option.

I agree that the government's idea of having people fund their own ever-lengthening retirements was a really, really bad idea that's going to blow up spectacularly. Dementia care is probably going to be the first major flash point, because that will do the most to expose the problem. Here's a few choice comments from a thread on children taking in parents with Alzheimer's, from a dedicated forum on the topic:

"My mother has lived with me and my son for the last ten years. I have lost my 40s and my son's childhood has been ruined. My mum and my dad went to concerts, held dinner parties, did all sorts of stuff in their 40s and 50s. We've barely been able to have anyone over to the house. As for choice. We have no choice. I've told social services and the memory clinic I can no longer cope and do not want to look after her. Makes no difference whatsoever. So much so, I'm going to have to go to the court of protection and throw myself on their mercy to see if we can be freed of my mother."

"I work full time. I have carers in to help during daytimes. My husband and I haven't had a vacation since 2008. We get to go out for dinner because we pay a carer to be at home while we are out. Six nights a week, I am cooking dinner and feeding my mother. She is not ambulatory, so her every movement, including toileting, is on us or her carers and us (it takes two people). We are up usually once per night, and often twice, sometimes five times a night, because my mother can get restless."

"My Gran has lived with my parents for 10 years. She has needed constant supervision for the past five. It has severely limited (read: ruined) my parent's, my own and my brothers lives and I feel really angry that Dementia has affected our family in the way that it has. The burden of this condition is unbearable and I wish people who do not live with (or regularly care for) people with Dementia understood."

[Xan]

Heartbreakingly tragic.

[Mountaineer]

Heartbreakingly tragic.

Yes. So very sad. God have mercy.

[Pointedstick]

Maddy's "just take me out back and shoot me" comment is similar to a sentiment I've heard voiced many times before by aging people horrified by the notion of losing who they are while becoming permanent burdens on their loved ones. I predict that assisted suicide becomes a major political issue and trend in the coming decades. I know it's what I'll want if I get diagnosed with Alzheimer's or dementia and there's still no cure in sight: give a responsible child power of attorney, estimate approximately how long my personality will be recognizably mine, then write up a contract scheduling an assisted suicide before it's projected that I start to decline and become a real burden, while my friends and family can still recognize me as me. Probably be best for everyone. I don't know whether such a thing would actually be legal today. Can people with moderate to late stage yet not immediately terminal Alzheimer's consent to assisted assisted suicide? So yeah, tomorrow's political issue.

[Maddy]

My heart goes out to the few who take on this herculean feat. And I have all the respect in the world for those who do.

[Maddy]

I don't know whether such a thing would actually be legal today. Can people with moderate to late stage yet not immediately terminal Alzheimer's consent to assisted assisted suicide? So yeah, tomorrow's political issue.

Isn't assisted suicide presently legal in Oregon? I would think that if a person executed an advance directive while still indisputably competent, which directed that he/she be brought to a jurisdiction in which assisted suicide was legal, it would probably be enforced. Just guessing.

As conservative as I am, it really irks me when the certain conservative factions express opposition to the right to choice. It's one thing to choose life at any cost for oneself (and by extension, the family members who will bear the brunt of the decision). It's quite another to stand in the way of another person who wishes to make a dignified and humane exit.

[ochotona]

I'd get on the KLM bird one last time and fly first class to the Netherlands and get it done there. To heck with Murican laws.

[sophie]

One of the biggest problems with Alzheimer's is that the victims have no insight into their condition. They could be standing in an unheated house with no food in the fridge, poop all over the floor etc, and they will insist they're managing just fine and don't need any help. A trueism in neurology is that anyone who comes in complaining of memory loss and worried about developing dementia, doesn't have it by definition. My mother and her sisters all fought the diagnosis tooth and nail and refused to even go to the doctor to get evaluated. My mom was calling me 20 times a day because she didn't remember she'd just called me, and she would still say "There's nothing wrong with my memory!"

Thus, if you're thinking about assisted suicide once you get an Alzheimer's diagnosis, well, I don't think it will work because you won't think anything is wrong. Not to mention that...who knows if a past document will be accepted in lieu of informed consent. And no, a person with middle stage Alzheimer's cannot provide informed consent. Maybe an unscrupulous MD would accept a signature, but they could get in a ton of legal hot water if it was ever contested.

The incidence of Alzheimer's is projected to double - at least - by 2050. I can't even begin to imagine how all this is going to play out. To say it'll become a social and medical crisis is an understatement. It's just a question of what will be done about it. It's true that no one gives a fig for the elderly - just look at the VAERS reports of mortality following the COVID vaccine, which were largely in the over 65 population. No studies, no reports, no nothing. No one cares. They will care about the plight of family members maybe. Or maybe not; note that no one cares now, and it's already a crisis.

[Maddy]

. . .

[boglerdude]

Gotta do your own reading on certain things, stups. https://old.reddit.com/r/LockdownSkepti ... =top&t=all

You might be able to get a directive to not feed you, then when you start starving/dehydrating, be put into hospice (morphine drip). Hideous. Maybe I should get that Wingsuit.

[sophie]

You might be able to get a directive to not feed you, then when you start starving/dehydrating, be put into hospice (morphine drip). Hideous. Maybe I should get that Wingsuit.

Yes, advance directives are very important and you should get that done. Make it as specific as you can, because many of them are too vague to provide useful guidance in real life situations. Definitely no CPR, intubation, or feeding tubes under any circumstances. I'm thinking to revise mine to explicitly refuse all preventive care (including vaccines) after age 75, and comfort care only after age 80.

[Xan]

You might be able to get a directive to not feed you, then when you start starving/dehydrating, be put into hospice (morphine drip). Hideous. Maybe I should get that Wingsuit.

Yes, advance directives are very important and you should get that done. Make it as specific as you can, because many of them are too vague to provide useful guidance in real life situations. Definitely no CPR, intubation, or feeding tubes under any circumstances. I'm thinking to revise mine to explicitly refuse all preventive care (including vaccines) after age 75, and comfort care only after age 80.

Sophie, are you saying no CPR, feeding tube, or intubation at any age? I guess you mean, from the age you are now (which I don't really know) or would you never have wanted those things?