# Senior living AND assisted living



## Zac495 (Aug 21, 2011)

I am currently trying to help my parents find a senior living situation. My mother is FINE at 81 but my dad needs assisted living - memory etc - and for the socialization. Mom still works.

I am looking at many places in this area (Philadelphia/Main Line) but how do I find reviews? How do I know what's good? Any advice during this difficult search.

I feel so overwhelmed - with Zac looking at colleges and parents looking at senior residences and the little one just being a teenager and needy....
OY


----------



## bogey21 (Aug 21, 2011)

I was in your situation years ago.  One thing I learned was how difficult it is to find the right place with availability when you are under the gun to do something in a compressed time frame.  

After agonizing with this I determined not to put my kids through the same drill with me.  What I did when I turned 65 and retired (I am now 76) was set myself up in a CCRC (Continuing Care Retirement Community).  I found the place I wanted and furnished it the way I wanted.  

I go there often for meals, to pick up my mail and socializing, but I probably sleep there only 4 or 5 times a month.  Yes, it costs more than just a few bucks but I am content spending the money knowing that my kids will never have to go through the agonizing months I went through with my Father.

George


----------



## glypnirsgirl (Aug 21, 2011)

When making this decision for Ian's dad, we used the services of a hospital social worker. She was very knowledgeable of a great many of the places, she had opinions of the strengths and weaknesses of each - it really cut down on the searching. We were able to winnow it down to 2 or 3 and pick from there.

To help us with our decision, we visited during meal times to see whether the residents appeared happy and sociable. We were also able to tell whether or not they were enjoying their food.  And whether or not they were visiting with one another or sitting there glum. 

As long as your parents are communicative and there is no long term contract, this should not be an agonizing decision. They will simply tell you whether or not they are happy. Once y'all have shed all of the unnecessary furniture and personal belongings, moving is easy. So, if you have made a bad decision, change it.

elaine


----------



## loafingcactus (Aug 21, 2011)

My employees subscribes to an employee assistance plan that provides consultants for this.  You mint want to check if you or your husbands' employer has an employee assistance plan.


----------



## Zac495 (Aug 21, 2011)

The biggest committment is the buy in fee. One place is around 100K per person and that's the cheaper one.

I like the idea of going during social times . THANKS!!!
Makes me think about buying that long term care insurance soon.
My folks are lucky - they have great pensions and a house that's worth plenty, so they'll be fine.


----------



## ronparise (Aug 21, 2011)

Here in Fort Myers/Cape Coral there is a large selection of assisted living choices. aside from the first consideration...are the services needed being provided; there is an important financial consideratiom. i dont mean , can we afford it? but more than that...*how* is it paid for. 

I see these facilities using one of 3 general models

1) rental, ie pay as you go
2) ownership, ie you buy the real estate and pay a "condo fee" that includes meals, on duty nurses, etc
3) for lack of a better term "membership" These require a large up front cash buy in. The facility pays for itself with the interest and dividends earned from this pile of money. And when the resident dies or moves out, the money is returned. making room for a new resident

There are two facilities here that I am aware of that are "lifetime" facilities. They have housing available with next to no services. and other housing available with assisted living services and they have an attached nursing home. As your needs increase you move from one residence to another


All these facilities have a sales staff that will give you a tour of their facility and explain their finances


You and your parents have work to do...good luck


----------



## Pat H (Aug 21, 2011)

My dad was also the one who needed more care. We visited a few places with different options. My mom originally wanted to go into a facility where you had to pay a large ( I think it was over $300,000) fee which was returned if they left or died. No interest was paid on the money. However, they wanted my dad to go into assisted living which my mom didn't want to do.

My sister and I visited more places and found one that had independent care, assisted living & a nursing home. No upfront fee but a hefty monthly rental. My dad died 5 months after they moved in. Mom still lives in the 2 bdr apartment. Her biggest complaint is the food. She cannot cook since the apartments don't have kitchens. She does have a microwave. The day we stopped in without an appointment happened to be Grandparents' Day and they had lots of activities for families. We talked to several people who all recommended the place.

Another one of her complaints is that people are always dying. Mom is 89. She has been there 4 yrs. We feel that this was the right choice for her although she doesn't always agree.

The place she lives is in NJ and was featured in the Sopranos since the producer's mom had lived there prior to her death.


----------



## rapmarks (Aug 21, 2011)

re long term care insurance.  both aunts have had it for over 30 years.  they live together in assisted living.  the one aunt's is paying out, she needs more assitance.  the other aunt doesn't meet the crriteria.  she is over 89 and not only does she have to pay everything out of pocket, but she still has to pay the premium on her long term insurance.  so really read that policy carefully. neither aunt can take care of herself, and every caregiver tells me she is mentally diminshed too, but she can dress herself and groom herself.
anyhow, eat at the place.  My aunts are very unhappy with the food, and when my sisters visited and ate there, they said it was the worst food and the smallest portions.  i know they have to get so many calories a day, but they get a big dessert.


----------



## bogey21 (Aug 21, 2011)

rapmarks said:


> re long term care insurance.  both aunts have had it for over 30 years.  they live together in assisted living.  the one aunt's is paying out, she needs more assitance.  the other aunt doesn't meet the crriteria.  she is over 89 and not only does she have to pay everything out of pocket, but she still has to pay the premium on her long term insurance.  so really read that policy carefully. neither aunt can take care of herself, and every caregiver tells me she is mentally diminshed too, but she can dress herself and groom herself.
> anyhow, eat at the place.  My aunts are very unhappy with the food, and when my sisters visited and ate there, they said it was the worst food and the smallest portions.  i know they have to get so many calories a day, but they get a big dessert.



This is why you all should consider the CCRC alternative upon approaching age 65.  Yes, I paid them $65,000 up front  back in 2000, and yes, I have a monthly payment which started out as $1,500 and is now $2,000.  The monthly payment includes rent, maid service, food, utilities including cable TV, laundry, etc.  In exchange for the up front fee and monthly payment they are contractually committed to providing service for me even if I run out of money (unless, of course, I piss it away on purpose).  The fact that I choose to sleep there only 4 or 5 nights a month is immaterial.  It is there when I need it and it takes 100% of the burden off the shoulders of my childern. Incidentially, the food at my CCRC is Outstanding (yes, with a capital "O").  I probably choose to eat there 15 or 20 days a month.   

The alternative "feel good" alternative sold by the insurance salesmen is the above.  Pay 30 years for insurance which (1) only pays benefits for a few years and/or (2) has policy provisions that make it next to impossible to claim benefits.


----------



## pgnewarkboy (Aug 21, 2011)

Zac495 said:


> The biggest committment is the buy in fee. One place is around 100K per person and that's the cheaper one.
> 
> I like the idea of going during social times . THANKS!!!
> Makes me think about buying that long term care insurance soon.
> My folks are lucky - they have great pensions and a house that's worth plenty, so they'll be fine.



When it comes to assisted living a major factor is the quality and variety of meals. Be sure your parents will like the food.


----------



## Passepartout (Aug 21, 2011)

I really do like the idea of continuing care facility- especially when you have one able-bodied parent and one not-so-much. One can help with the care, and as their health deteriorates (it will), the level of care can increase as needed.

Both of us have had to place a widowed parent in assisted living. We found that the best places all have wait-lists. Only those that you wouldn't put your pet in have vacancies. That's just the nature of things.

It's good if the facility can be close enough to where the parents lived that their friends can visit. Remember, their mobility will likely be impaired, too. Eventually no one visits. 

After you narrow your choices down to 2-4 establishments, drop in unannounced for a meal. Usually the noon meal will be the 'big' one of the day. Eat there with the residents, and get a feel for the interaction with staff- how long staff has worked there or if there is a lot of turnover. It tells a lot about a residence.

Food, companionship, scheduled activities, all of these make the place seem more like a resort where they want to be rather than the 'Heaven's waiting-room' that so many assisted living places are.

Choosing can be a hard thing. Most of us will(or have) done it. Hope when the time comes, I have the where-with-all and good sense to do what Bogie21 has. It'll sure save someone some trouble, and that's my aim.

Jim Ricks


----------



## bogey21 (Aug 21, 2011)

Passepartout said:


> We found that the best places all have wait-lists. Only those that you wouldn't put your pet in have vacancies. That's just the nature of things.


This is exactly why I set myself up way in advance in a CCRC.  Although I don't spend many night there, I eat there often and spend a lot of time socializing with residents.  The residents know what is going on.  Communicating with them and getting to know staff gives me a warm fuzzy feeling.

George


----------



## bogey21 (Aug 21, 2011)

Passepartout said:


> After you narrow your choices down to 2-4 establishments, drop in unannounced for a meal. Usually the noon meal will be the 'big' one of the day. Eat there with the residents, and get a feel for the interaction with staff- how long staff has worked there or if there is a lot of turnover. It tells a lot about a residence.



A great thought.  In the CCRC where I am established I find about 2/3 of the residents eat their main meal in the evening except on Sunday.  On Sunday almost 80% or so eat at noon.  It has a lot to do with church and visitors.  Because of the large number of visitors the Sunday meal is usually a feast.  My suggestion if you are going to get a feel one of these places is to show up unannounced once or twice for the noon mean and once or twice for the evening meal.  Avoid Sunday.  My CCRC also serves Breakfast but I'll bet only 5% too 10% eat Breakfast in the dining room.

George


----------



## falmouth3 (Aug 21, 2011)

Although I worked with "A Place for Mom" and they gave me some very good advice and help, my sister ended up doing the legwork near her home in Delaware.  Mom is in a Sunrise facility in Wilmington, DE, 19 miles from the Philadelphia airport.  The people there are unfailingly sweet, helpful and watchful.  Mom is very forgetful so they give her guidance, but she isn't senile.  The meals are smaller portions than I would like, but since they have 3 full meals and several snacks a day, including a bistro where they can help themselves to coffee, tea, juice etc. and cookies and fruit, I don't think anyone there is hungry.  They can also order a "hearty" portion if they are hungry.  My sister often drops by both around lunchtime or in the evening.  She has no complaints about the staff.  I get there much less frequently, but I am just so impressed with everyone there.  

When I was looking around for Mom, I found that a few people in assisted living still have jobs and they drive.  Residents at Sunrise have told me that the van will take them wherever they want to go.  People also have brought their pets to Sunrise and they have a house dog, which my mother loves.  They have frequent outside entertainment.  There are a number of couples at Mom's place too.

It's expensive, but we are very happy to have Mom there.


----------



## MelBay (Aug 21, 2011)

Ellen, sounds like you're in a large metro area, so I'd seek out a Professional Geriatric Care Manager.  Google it...

And, my state has an Elder Care advocacy group and they also "rank" nursing homes.  Very helpful as well.

We used one with my mom and it made me feel like the burden wasn't all on me. I'm an only child, and had a teenager at the time, so I feel your pain.

Hang in there, this too shall pass.  I frequently told myself "that which doesn't kill us makes us stronger".  I feel like I can take on anything after going through all that.


----------



## rapmarks (Aug 21, 2011)

something else to look at, medication policy.
my aunts are not allowed to have any medication in the room.  you have to order through the drugstore the home uses, they order in one week supplies, no ordering three months at a time to pay one copay.  everything is ordered, need an aspirin, a cough drop? plus then they pay $16 a day for the delivery of their medicines.  That is close to $500 a month each and their perscriptions are costing sometimes up to $650 a month with perscription coverage.


----------



## MuranoJo (Aug 22, 2011)

bogey21 said:


> I was in your situation years ago.  One thing I learned was how difficult it is to find the right place with availability when you are under the gun to do something in a compressed time frame.
> 
> After agonizing with this I determined not to put my kids through the same drill with me.  What I did when I turned 65 and retired (I am now 76) was set myself up in a CCRC (Continuing Care Retirement Community).  I found the place I wanted and furnished it the way I wanted.
> 
> ...



Sounds great, but, honestly, how many can afford this?  Not my Mom or Dad, or close relatives could do this.


----------



## pgnewarkboy (Aug 22, 2011)

rapmarks said:


> something else to look at, medication policy.
> I
> 
> Need
> my aunts are not allowed to have any medication in the room.  you have to order through the drugstore the home uses, they order in one week supplies, no ordering three months at a time to pay one copay.  everything is ordered, need an aspirin, a cough drop? plus then they pay $16 a day for the delivery of their medicines.  That is close to $500 a month each and their perscriptions are costing sometimes up to $650 a month with perscription coverage.



Medication policy is dictated by State and Federal rules. Drugs are dispensed in dosage packs to avoid medication errors.


----------



## suesam (Aug 22, 2011)

Ellen,
I work for an assisted living management company in Iowa and dementia care is one of my responsibilities. One thing you want to do is look at the survey results done by your state licensing agency of any assisted living you are considering for your parents. 
Another thing I would do is make sure you know what good memory care is, and is not. Memory care is much more difficult and complicated than traditional assisted living. You will want to make sure the staff is well trained....find out what their training requirements are and what their curriculum is. I would want to read it or go through it myself. I would also want to know what the staff to resident ratio  is in dementia care. Also....what is their security system? Do the residents with memory issues have a lot of opportunity to exercise and get outside at least daily? Is there a nice outside space? Fresh air is so important. 
Also...will your parents stay together or will your dad need to go to a dementia unit? Many couples stay together in the beginning and then the person with the dementia may need to move to the memory unit. Mostly for the sake of the spouse who does not have the memory problems.  Memory care is much more expensive than regular assisted living. Find out the process and cost of one person being located in one section and the other person in memory care. 

Even if your dad does not need a specialized memory care unit at this time he more than likely will in the future. My best advice is to make sure you research that prior to making any decisions. 

If you ever want to talk in more detail just pm me. Memory care just happens to be one of my passions in life! 

Good Luck!!

Sue


----------



## rapmarks (Aug 22, 2011)

muranojo said:


> Sounds great, but, honestly, how many can afford this? Not my Mom or Dad, or close relatives could do this.


 

I agree, anf i think i would rather have them give me that monthly amount now, and when the time comes i will find them a place.


----------



## lvhmbh (Aug 22, 2011)

We got a recommendation from our family doctor - he visited patients in the facility and liked how they were treated - for the place my Mother chose here in Florida.


----------



## bogey21 (Aug 22, 2011)

muranojo said:


> Sounds great, but, honestly, how many can afford this?  Not my Mom or Dad, or close relatives could do this.



I started saving to do this about 20 years prior to retirement after having to find a place for my Father.  It wasn't very hard.  I found out what a top of the line Long Term Care Policy would cost and set aside that amount times two.  When it came time to retire the money was there.

George


----------



## Passepartout (Aug 22, 2011)

muranojo said:


> Sounds great, but, honestly, how many can afford this?  Not my Mom or Dad, or close relatives could do this.



Cost is certainly an issue, but Bogie21's solution isn't as far out of line as you may think. A large percentage of the elderly population, especially those who are widowed, have the family home paid for and don't have a desire to be a burden on their children. They may find it makes sense to sell the home, finance the ccrc with the proceeds and live there with the understanding that as they proceed through assisted living, then to full-time care to memory care or whatever the future holds, they can stay under the same roof. I find this a lot kinder to the kids, who may be scattered, have lives of their own, and who have little or no desire/need of inheritance. Or, frankly to people like me, who have no blood heirs. What I have is mine to spend as I wish and provide for myself. It will just be to a few charities and causes that will profit by my departure. They don't care if my final years/months or whatever time is spent in relative comfort in a retirement center or huddled in the former family home eating cat food so I can leave them more. 

My $.02.

Jim


----------



## loafingcactus (Aug 22, 2011)

bogey21 said:


> I started saving to do this about 20 years prior to retirement after having to find a place for my Father.  It wasn't very hard.  I found out what a top of the line Long Term Care Policy would cost and set aside that amount times two.  When it came time to retire the money was there.
> 
> George



Similar here.  Though I am young, i looked in to Long term care insurance because I want to do everything "right" to protect my assets and people said I should (anything could happen, right).  Well, what I found maxed out at 5 years!  What good is that!!  And, it is well within the normal range of saving for retirement anyway. So if I have a bad car wreck or a young stoke or who knows what and need 20+ years of care, guess my heirs are out of luck, and insurance wouldn't have done aything to help.


----------



## rapmarks (Aug 22, 2011)

starting to pay at age 65 for a home you might not need until your 80's is what surprises me.  i know lots of people who are doing that, but they are probably over 80 and the youngest would be 75.


----------



## bogey21 (Aug 22, 2011)

rapmarks said:


> starting to pay at age 65 for a home you might not need until your 80's is what surprises me.  i know lots of people who are doing that, but they are probably over 80 and the youngest would be 75.



The math is somewhat surprising.  The buy in fee back in 2000 was $65,000; today it is approximately $125,000.  Approximately 50% of  my monthly payment is tax deductible as prepaid medical expense.  When you cut through it all, my net cost isn't all that bad considering the peace of mind it has bought me and not having to pay for LTC Insurance.

George


----------



## isisdave (Aug 22, 2011)

rapmarks said:


> something else to look at, medication policy.
> my aunts are not allowed to have any medication in the room.  you have to order through the drugstore the home uses, they order in one week supplies, no ordering three months at a time to pay one copay.  everything is ordered, need an aspirin, a cough drop? plus then they pay $16 a day for the delivery of their medicines.  That is close to $500 a month each and their perscriptions are costing sometimes up to $650 a month with perscription coverage.



My Mom's Assisted Living place had a similar policy, but more flexible. The pharmacy was one that mostly provided service to this kind of facility, so somehow you COULD order 30- or 90-day supplies, but they would deliver them dose-packaged to the facility weekly. 

That plan had no additional med-mangement fee. You could also opt to provide your own meds, and that had a larger fee, but it was about $120 a month (this was in 2005).

About CCRCs: not all require a buy-in fee; that's just one payment model.  My parents lived in one and just paid monthly. They did that so that if I had to move because of work, they could follow me. That's something to think about if there's any chance the family could move away.

Some CCRC "chains" would probably let you move to another if you had "bought in" and some will return a pro-rata part of your buy-in if you move on, one way or another, within a certain period, like 5 years.  Usually, monthly fees are less when you have "bought in." And many CCRCs are run by religious organizations or even educational or philanthropic ones; they are a little less expensive and sometimes less grand, by which I mean the cleanliness and service are OK but the dinnerware is not china and there isn't granite in your bathroom.

There is a benefit available to certain veterans and their widow(er)s. It is income-limited, but many qualify.  And finally, part of the monthly fee in an assisted-living or higher level of care place is usually deductible as a health care expense on Schedule A.


----------



## MuranoJo (Aug 23, 2011)

Passepartout said:


> Cost is certainly an issue, but Bogie21's solution isn't as far out of line as you may think. A large percentage of the elderly population, especially those who are widowed, have the family home paid for and don't have a desire to be a burden on their children. They may find it makes sense to sell the home, finance the ccrc with the proceeds and live there with the understanding that as they proceed through assisted living, then to full-time care to memory care or whatever the future holds, they can stay under the same roof. I find this a lot kinder to the kids, who may be scattered, have lives of their own, and who have little or no desire/need of inheritance. Or, frankly to people like me, who have no blood heirs. What I have is mine to spend as I wish and provide for myself. It will just be to a few charities and causes that will profit by my departure. They don't care if my final years/months or whatever time is spent in relative comfort in a retirement center or huddled in the former family home eating cat food so I can leave them more.
> 
> My $.02.
> 
> Jim



Oh, I'm all for it, if you can afford it.  I'm just saying most people cannot afford to pay for long-term care coverage, much less a ccrc.  When you say a large % of the elderly have their home paid for, well, I think that may be optimistic, if they even own a home.  But I admit I don't have the stats to back this up, just my real-life experience with the 'average Joe.'  The TUG community, I am sure, is very different.


----------



## pgnewarkboy (Aug 23, 2011)

As always one size doesn't fit all. I personally prefer to keep and use my money as my wife and I see fit. I simply don't trust ANY organization to take and use a large amount of money for my benefit. Our views may differ over time as to what is best. If that happens I don't want to rely on a ccrc to give me my money back. If I get the money back without earnings I am really not getting it all back. The ccrc may have the best intentions but I think "the road to hell is paved with good intentions. "


----------



## bogey21 (Aug 23, 2011)

pgnewarkboy said:


> As always one size doesn't fit all........Our views may differ over time as to what is best.



You are 100% right.  We all have choices in life.  It just happens I chose a different path.  Good luck!

George


----------



## Zac495 (Aug 24, 2011)

We found the perfect place in this area - called hte Quandrangle - pretty much founded by Penn Profs (my parents are profs). It's a sprawling, lovely area with assisted living and memory care in two different  buildings - the rest is unassisted. Dad will go to assisted, mom to regular.
200 a day for assisted - no buy in.
Special right now 2000/mo for unassisted with a 129K buy in fee - then assisted couldn't go up from 3700 (beyond annual cross the board increases of course).

So I see it would be worth the buy in OR LTC insurance for young people.... I'd have to do the math.

they're happy, yet scared. Dad feels it may be the beginning of the end. It just hit Mom - seeing herself going from her HUGE beautiful home to a senior home - kind of sad - yet way better than the alternative!!

Thanks for all the posts.


----------



## rapmarks (Aug 24, 2011)

my  aunts are twins and they stay in a two bedroom  apt. in asst. living.  one with Alzheimers gets what is called plus plus care, much more asst.  if she gets much worse, the third floor is the Remembrance floor and i believe they will both move up stairs, but the one without A. will still do all the meals and activities fromt he other two floors.   
Zac, are your pareents going to separate buildings?


----------



## bogey21 (Aug 24, 2011)

Zac, sounds great and IMO the price is reasonable.

My advice to others contemplating a CCRC or something similar is plan early.  The CCRC where I live (part time) has a long waiting list.  They also have a program where you can get on the list for $1,000 (refundable anytime).  Paying the $1,000 allows you to participate in activities and to one meal a month.  If you reach the top of the list and aren't ready to make the move, all you have to do is have your name moved down the list.  I think I was on the list for 2 or 3 years before I finally committed.

George


----------



## pgnewarkboy (Aug 24, 2011)

Zac495 said:


> We found the perfect place in this area - called hte Quandrangle - pretty much founded by Penn Profs (my parents are profs). It's a sprawling, lovely area with assisted living and memory care in two different  buildings - the rest is unassisted. Dad will go to assisted, mom to regular.
> 200 a day for assisted - no buy in.
> Special right now 2000/mo for unassisted with a 129K buy in fee - then assisted couldn't go up from 3700 (beyond annual cross the board increases of course).
> 
> ...



It seems like this will be good for your parents and bring you peace of mind. Iam sure that others here on TUG join me in wishing you and your parents all the best in this new stage of life.


----------



## Zac495 (Aug 24, 2011)

Yes, they will be in separate apartments. They can't be in the same even if they wanted because Dad will be assisted living in another building. If they could have been in the same building, 2 apartments would be best for them anyway - not because they don't love each other but because it's hard to live on top of each other.

Thank you all. I think they will be happy though it's so strange to watch my parents go from the huge house to this ... 

Not bad... just so different. Life changes.


----------



## SueDonJ (Aug 24, 2011)

pgnewarkboy said:


> It seems like this will be good for your parents and bring you peace of mind. Iam sure that others here on TUG join me in wishing you and your parents all the best in this new stage of life.



+1 - Very nicely said.


----------



## vacationhopeful (Aug 24, 2011)

Zac495 said:


> Yes, they will be in separate apartments. They can't be in the same even if they wanted because Dad will be assisted living in another building. If they could have been in the same building, 2 apartments would be best for them anyway - not because they don't love each other but because it's hard to live on top of each other.
> 
> Thank you all. I think they will be happy though it's so strange to watch my parents go from the huge house to this ...
> 
> Not bad... just so different. Life changes.



My parents had the 3000+ sq ft house - 6 bdrs for the 5 kids and 4+ acres. My Mom lived for 16 months in a quad room without ever mentioning or noticing her roommates or them her. My Dad who was more aware had a private room and bath, but spent so little time there - esp. after he decided he had 3 new wives to boss around in the common room at the Assisted Living place. Their long good bye seemed to make the world so much smaller for them - but they knew we were their kids even when nothing else seem to matter.


----------



## Fayeoctober (Aug 24, 2011)

Zac495 - I would really like to talk to you regarding your parents.  I live in Paoli and am sorry I didn't see the post earlier tonight.  Not sure if the facility you are referring to is on the Main Line; if so, some things you need to be aware of.  I am going to take a chance here and post my Email address since this could be important to you FayeD1@AOL.com.


----------



## Zac495 (Aug 25, 2011)

Fayeoctober said:


> Zac495 - I would really like to talk to you regarding your parents.  I live in Paoli and am sorry I didn't see the post earlier tonight.  Not sure if the facility you are referring to is on the Main Line; if so, some things you need to be aware of.  I am going to take a chance here and post my Email address since this could be important to you FayeD1@AOL.com.



Thank you - I sent you an email!


----------



## Texasbelle (Aug 25, 2011)

Wow, that's a lot of money.  Just told my husband that we should be able to hire in home help instead.  This is if one of us is okay.


----------



## Zac495 (Aug 26, 2011)

vacationhopeful said:


> My parents had the 3000+ sq ft house - 6 bdrs for the 5 kids and 4+ acres. My Mom lived for 16 months in a quad room without ever mentioning or noticing her roommates or them her. My Dad who was more aware had a private room and bath, but spent so little time there - esp. after he decided he had 3 new wives to boss around in the common room at the Assisted Living place. Their long good bye seemed to make the world so much smaller for them - but they knew we were their kids even when nothing else seem to matter.



Linda - Yes - when nothing else seems to matter...
Today I tried to teach Dad how to use email. Again. Over and over with reply and send. He has trouble with typing. He said, "I wrote a book longer than War and Peace. And now I can't type a sentence." It's so sad. He is BRILLIANT - but he's failing.

I just love spending time with them. Tomorrow is bridge -before the hurricane hits haha!! Then we'll swim home. Or stay with them.


----------



## 1950bing (Aug 26, 2011)

I find this topic most interesting.
My mom, soon to be 97 and widowed since '68 has been in assisted living for 2.5 years. I moved her there after my brother passed in '08. She could not be left alone for safety issues. She didn't want to move away from her home and her things. She says she understands why but misses her home which I rent to help her with her bills. Her costs run a little over 4 grand a month plus meds. and tv. Meals and snacks are included. She has some memory issues. It is a new place and I feel it is well run and the food is great. Meals are ava. for only $5 for family member. She has her own room.
What I wonder is at some point in my life will I understand the need of assisted living as I do now. Will I say " don't put me there. " Will I say "when will I be going home ?"   

bing


----------



## vacationhopeful (Aug 27, 2011)

Texasbelle said:


> Wow, that's a lot of money.  Just told my husband that we should be able to hire in home help instead.  This is if one of us is okay.



I did that for over a year for my mom. My dad did not have the contacts nor were the other siblings living very nearby. My sis 3000 miles away was stunned as to who I brought in - a woman who owned me money, a 22yo who I found by asking for a caretaker at a local breakfast dive, and a 19 yo cashier at the 7-11 store who was looking for a different job. My dad had issues with the first one, but he was a control freak - she was very good with mom sitting every afternoon watching her soaps - mom loved it. As for my sis from California, she spent 3 weeks of her vacation time here and found the overnight shift, who watched her from 11PM to 6AM for 6 months. She really liked my team, but we needed more people as mom would wander at night. 

I also had a retired guy who did exterior house work - who my dad spent time just taking to (supervising??).  His wife had MS who he had to escape from (he worked 4 hrs 3X a week). He would tell me every 2 or 3 weeks how my dad would come outside and chat with him while he was trying to work (about an hour each day). He was not getting as much done as he liked to - I told him I knew that about my dad - I had that "lost time" figured in. It was fine and I thought he was doing a great job. And he was, as my dad needed guy time, and I was getting some outside work done, too.  

Wow, that was like 15+ years ago. And it did cost money. But as I told my CA sister, we had 2 parents over 77. And one of my Dad's sisters was 86 last week - living with her 85 yo BF who is losing it. 

How times have changed! I remember those dates as to how old my nephews were during those times. My youngest nephew was borned after my mom had passed; as a 25 month old toddler, he learned the code to escape from the assisted living unit my dad was in (and how to get ice cream from the kitchen staff). The oldest is moving into his college dorm today while his youngest brother is trying to go to Florida with me (still the escape artist).


----------



## Fayeoctober (Aug 27, 2011)

For those whose parent/s are able to live at home with some assistance or those whose parent/s are able to manage in assisted living, be thankful that your parent's don't require a nursing home.  My almost 96 year old Mother was able to stay in her home for about five years after my Father died.  I was surprised she was able to stay in her home that long.  But ultimately she got too lonely and wasn't taking good care of herself and we were able to move her into a two room unit in an assisted living facility not far from where she used to live.  That worked out fine for four years (although she always complained about the food) and then she fell and fractured her hip.  I remember in the emergency room, the doctor saying she might always need a wheelchair and how sad I felt about that because she had always been a good walker.  But then after a few months at a rehab place and another assisted living facility - this time close to us- she was able to manage and ultimately get around her own room without a walker - for another two years.  Then she fell and fractured her other hip and she has never really recovered from that.  We had her in several different facilities after that and she had a fair amount of therapy, but ultimately she fell one time too many and had to be moved to a nursing home, where she has been for almost three years.  Nursing homes run almost twice what an assisted living facility costs and even someone with a fair amount saved, runs through their money fast.  A year later she had to go on Medicaid.  Sad story and I thank you for reading.  About 10 years ago, both my husband and myself applied for Long Term Care Insurance, and after this experience, I am glad we did.  Yes it is expensive, but given how quickly money can run out, it seems to be worth it having some peace of mind.  I hope we never need it but it is nice to know it is there.


----------



## bogey21 (Aug 27, 2011)

Fayeoctober said:


> But  About 10 years ago, both my husband and myself applied for Long Term Care Insurance, and after this experience, I am glad we did.  Yes it is expensive, but given how quickly money can run out, it seems to be worth it having some peace of mind.  I hope we never need it but it is nice to know it is there.



My understanding is that LTC Insurance runs out too.  I assume policies are different but you might check and see what yours says.

George


----------



## loafingcactus (Aug 27, 2011)

bogey21 said:


> My understanding is that LTC Insurance runs out too.  I assume policies are different but you might check and see what yours says.
> 
> George



Exactly.  I wasn't able to find a policy that covers for more than five years.  So it would have run out in the situation given.  I decided to just continue saving for retirement or whatever the eventualities are instead of buying insurance that was really just a pre-payment plan for a portion of what I could possibly need.


----------



## Zac495 (Aug 27, 2011)

Mom was just told by her doctor friend that people who go to these places - even unassisted - become old and die fast. Now she's unsure. This is SO HARD....


----------



## loafingcactus (Aug 27, 2011)

OMG! Obnoxious!! Don't you just wanna go ask "friend" if she'd like to move in and take care of your Dad? 

I'm in pharma research and I frequently have, um, questions, about people's positive feelings about their drugs and unless I am asked (and sometimes even when I am) I Keep My Mouth Shut.


----------



## falmouth3 (Aug 27, 2011)

My mother would have been dead within months if she had not been in assisted living - of that I am sure.  Her body is healthier now than it has been in years because she is getting fed and getting her meds every day.  Unfortunately, her mind is going.  Because her health was never wonderful being obese, having heart and BP issues and diabetes, we all thought she'd be gone in her 60's.  Now she's 84.  She has a strong will to live and she thinks she's "in her right mind" as she tells us at every opportunity.


----------



## Zac495 (Aug 28, 2011)

I know - I'm frustrated that Mom was scared out of moving there - however she seems to agree that dad needs the assisted living. So her new idea is move him into the assisted living and find a regular apartment very close by. She admits that if she doesn't move in very close, she just won't see him again.

I truly believe assisted living will be a blessing for Dad - lots of people around to talk to and play bridge with. He needs the socialization - he's the coolest guy - you would all love him (and my mom). Just awesome people.

Tuesday the man who has been begging to buy  their house for a year is coming over- so let's see if he actually buys it at their price (otherwise she's putting it on the market for a higher price).


----------



## vacationhopeful (Aug 28, 2011)

Zac495 said:


> Mom was just told by her doctor friend that people who go to these places - even unassisted - become old and die fast. Now she's unsure. This is SO HARD....



My first thought is "KILL that _friend_!". As for your Mom's opinion to get a nearby apartment, that might not be a truly bad idea. Check to make sure how much a cab would cost for her to go back & forth. Remember, she would feel better to continue a reasonably normal life as she seems able at this point. Plus, in 6 months, she might welcome moving into their apartments as she would know the routine.

Just be thankful she is WILLING to give up the 3,000 sq ft house. My dad was NOT and we spent 3 years keeping that house going even after he wasn't living in it.  There are TAX advantages selling it now, I believe. Does your Mom have power of attorney yet for your Dad? Will need it, as it is unlikely Dad will be competent to sign transfer papers on the house.


----------



## Zac495 (Aug 28, 2011)

vacationhopeful said:


> My first thought is "KILL that _friend_!". As for your Mom's opinion to get a nearby apartment, that might not be a truly bad idea. Check to make sure how much a cab would cost for her to go back & forth. Remember, she would feel better to continue a reasonably normal life as she seems able at this point. Plus, in 6 months, she might welcome moving into their apartments as she would know the routine.
> 
> Just be thankful she is WILLING to give up the 3,000 sq ft house. My dad was NOT and we spent 3 years keeping that house going even after he wasn't living in it.  There are TAX advantages selling it now, I believe. Does your Mom have power of attorney yet for your Dad? Will need it, as it is unlikely Dad will be competent to sign transfer papers on the house.



Mom drives so she can get there easily. Now she wants to keep the house. Now she's worried if Dad goes into assisted living, people will shun him because he can't hear (he's almost deaf) and no one will play bridge with him because he's really forgetting how to play. Her house is about 6000 sq ft!

I don't know about power of attorney. I wouldn't even know how to ask her that right now. If they sold it soon , he could sign. He does as he's told.


----------



## vacationhopeful (Aug 28, 2011)

Zac495 said:


> ...I don't know about power of attorney. I wouldn't even know how to ask her that right now. If they sold it soon , he could sign. He does as he's told.



Get the power of attorney NOW. I am not a lawyer, but we had a DEVIL of a time with my Dad. He would rally everytime we got him to the doctor's office. He knew what day of the week it was; who the President was; who shot Lincoln .... AHHHHHHHH! Get into the parking lot and he was a daffy as Donald the duck. We finally got the doctor to sign off *when he was too pleasant!* It was under the drastic "change of personality" clause. He even decided when in California to move back home on the east coast ... and my "devoted to dad" sister shipped him "home" as fast as she could call Fed Ex and buy 2 airplane tickets (one for his aide to fly) to my sister's house. Local devoted sister (lived 2.74 hours drive to his home) figured out he wasn't there for a visit when the Fed Ex truck delivered 10 big boxes. :ignore: 

As for your Mom, she may decide to take him home - we feared that with our mom. I spent over a year keeping her at home with your dad; mainly waiting for Dad to fully understand the best place for mom was in a nursing home. As I explained to my siblings, there was no way I could tolerate an in & out door for the nursing home with my parents.


----------



## Zac495 (Aug 28, 2011)

She decided not to sell and try in home care. She wants to see if it'll work before she can bear putting him "away" as she feels it could be. She fears the worst and then there will be no going back as the house will be gone.

It makes sense I guess - she can see if it works. If it bombs in 2 or 3 months of in home, she can sell without regret. 

I'll keep you guys updated.

I will broach the power of attorney with her soon - but right now she is completely fine so it's not my call....


----------



## VacationForever (Aug 28, 2011)

I just came across this thread by accident.  I am actually surprised that the discussion is focused on assisted living facility.  Aging in place is really the best situation, i.e., staying at home with home care help from a reliable and reputable home care agency.  Trust attorneys and private fiduciaries will tell you the same.  Home care can get expensive depending on the amount of care (duration of home care).  Planning ahead of time, i.e., while young and healthy can help us get to the goal of spending our final years at home.  

There are very few situations that one should not age at home: Violent form of dementia, continuous skilled care is needed (insulin injections, G-tube, suctioning etc).   

I bought long term care insurance for myself about 3 years ago and it covers home care, assisted living and skilled nursing facility.  My intention is that when it is time for me to need care I will be staying at home, having a home care aide by my side who will fix me meals that I like, ensure I get to the bathroom when I need to and not have to wait several hours before someone comes help me or be forced to use adult diapers.  Most skilled nursing facilities put adult diapers on the patients not because they are incontinent but because there are not enough caregivers in the facility to help them to the bathroom.    

In case you are wondering where I am coming from, I work in the senior care industry and one of my roles is to help educate the public on choices and resources.


----------



## loafingcactus (Aug 28, 2011)

If you were able to get insurance that truly covered long term care (not a policy severely limited in money and years, as everyone else seems to be finding) please let us know the carrier where such a thing can be found?  It will be very useful to everyone else.

The blanket statement seems unusual.  Adults have options in their living choices, I am surprised to hear that for elders there is only one right answer.  I wonder for examples about the person who cannot drive and is isolated at home, and how they may have more social opportunities in a care facility.



sptung said:


> I just came across this thread by accident.  I am actually surprised that the discussion is focused on assisted living facility.  Aging in place is really the best situation, i.e., staying at home with home care help from a reliable and reputable home care agency.  Trust attorneys and private fiduciaries will tell you the same.  Home care can get expensive depending on the amount of care (duration of home care).  Planning ahead of time, i.e., while young and healthy can help us get to the goal of spending our final years at home.
> 
> There are very few situations that one should not age at home: Violent form of dementia, continuous skilled care is needed (insulin injections, G-tube, suctioning etc).
> 
> ...


----------



## Zac495 (Aug 28, 2011)

sptung said:


> I just came across this thread by accident.  I am actually surprised that the discussion is focused on assisted living facility.  Aging in place is really the best situation, i.e., staying at home with home care help from a reliable and reputable home care agency.  Trust attorneys and private fiduciaries will tell you the same.  Home care can get expensive depending on the amount of care (duration of home care).  Planning ahead of time, i.e., while young and healthy can help us get to the goal of spending our final years at home.
> 
> There are very few situations that one should not age at home: Violent form of dementia, continuous skilled care is needed (insulin injections, G-tube, suctioning etc).
> 
> ...



Thanks for your input. Please educate us more. I would love to hear anything and everything you have to share.


----------



## VacationForever (Aug 28, 2011)

Zac495 said:


> Thanks for your input. Please educate us more. I would love to hear anything and everything you have to share.



Let me try to give a few pointers that you may already be aware of...
Meals On Wheels program - depending on the area/county/city, the seniors pay a minimal sum of money and volunteers deliver meals right to their home.  It is intended to be 1 meal per day and it's based on a balanced diet.  Some locations deliver Mon-Fri everyday, some deliver less frequently but will package several meals so that they go into the fridge.  Meals are all meant to be microwaved.  Some elderly love the food and some don't.  It's personal taste.  

For the mobile and still mentally alert, senior centers are great for socialization.  
For the more frail or with mid-dementia, Adult Day Health/Day Care programs may be suitable.  They provide the socialization plus get lunch during the 4-hr period or so and provide some relief to the family caregiver during the time away.  There are usually buses that will pick them up.

Home care: If you are in a state which requires home care to be licensed, great.  If not, you must be even more careful.  Make sure the company is "employer" based, not a referral agency which the latter has no responsibility to anyone.  Company must walk you through how they do their background screening, how far back do they check and does it cover nationally, federal, sex offender registry etc., and what sort of persons would they not hire based on the background check, drug screening etc.. Do they simply hire warm bodies off the street?  Do they pay their employees well, i.e., better than other home care companies - pay more and get better employees?  Liability insurance, dishonesty bond, workers compensation, unemployment insurance etc.  Can the service agreement be cancelled within 24 hours and you get your deposit back? Duration of shift should be flexible to meet your parents' needs, it maybe as little as 1 hour for a bathing service for your father or a 3-4 hr shift to ensure laundry gets done, bed linens get changed, take your parents to doctor's appointments etc, or longer shift if budget is not an issue.  Your parents may hate having a stranger in their home and it IS an infringement to their quiet time together.  It will take adjustments.  One of best lines that I have heard is a son/daughter telling the parent "You have a choice of accepting home care or you must move to an assisted living place."  We have seen that acceptance of home care quickly when the elderly is given that choice.

The difference in your parents' situation makes assisted living places an even poorer choice.  Depending on the progress of your father's dementia, he may ultimately not stay in the same apartment/room as your mother.  

The only other case that I can think of that assisted living may be a good alternative to home is that your parents are very sociable. 

Have you spoken to your parents on their wishes?


----------



## VacationForever (Aug 28, 2011)

loafingcactus said:


> If you were able to get insurance that truly covered long term care (not a policy severely limited in money and years, as everyone else seems to be finding) please let us know the carrier where such a thing can be found?  It will be very useful to everyone else.
> 
> The blanket statement seems unusual.  Adults have options in their living choices, I am surprised to hear that for elders there is only one right answer.  I wonder for examples about the person who cannot drive and is isolated at home, and how they may have more social opportunities in a care facility.



On the first question, there are unlimited lifetime policies but they are alot  more expensive. You can check with any of the large carriers, MetLife, Genworth or James Hancock. I do not sell Long Term Care Insurance and in no way do I endorse one over the other.  I bought through AARP which they change their carrier every few years (I believe they have been gone from MetLife to Genworth to a different one this year).  The one I bought is not limited to 5 years but limited to total amount of $ payable. If you bought one that allows claim of up to $300 a day and up to the maximum amount of $540K (equivalent of 5 years at $9000 a month), you stretch it to 10 years if you only use $150 a day.  

On your second statement, please see my reply in the post before this.


----------



## Zac495 (Aug 28, 2011)

> The difference in your parents' situation makes assisted living places an even poorer choice.  Depending on the progress of your father's dementia, he may ultimately not stay in the same apartment/room as your mother.
> 
> The only other case that I can think of that assisted living may be a good alternative to home is that your parents are very sociable.
> 
> Have you spoken to your parents on their wishes?



My mother won't stay in the same apartment with my dad IF they move. She has decided that even if in the end he needs to go to the assisted living, she will move into a regular apartment nearby. She will pick him up every night and take him out to dinner.

They are very social - but Mom is picky in that she wants to socialize with her own friends and other professors (she would be willing to meet new friends if they were academic types - NOT that she is a snot - I mean that certain people have similar interests. She's not interested in hanging out with people to chit chat - unless they're good bridge players - then she'll hang out to play bridge).

Yes - Mom has been totally involved - and so has Dad. I took them both to a few places - clearly Quadrangle was the best choice for them - but now she started having nightmares about becoming a frail old lady to match the other people in an "old age home," even if she is in the unassisted area.

Is PA licensed for in-home?


----------



## VacationForever (Aug 28, 2011)

Zac495 said:


> Is PA licensed for in-home?



Looks like PA is... 

http://www.privatedutyhomecare.org/

Please do look through this NPDA website if you are interested in getting home care for your parents.  Lots of good information.


----------



## suesam (Aug 28, 2011)

[edited] I have worked in both home health care and assisted living management community and both have pros and cons. Some people can not live on their own without 24 hour staff availability. I have never seen a home health agency with the ability to staff a home health aide 24 hours a day for an individual and I have certainly NEVER seen a long term care policy that was willing to pay the cost it would cost to have a certified home health aide 24 hours. In Iowa home health aides cost about 25-30 an hour. 

Having a spouse with dementia is very exhausting. Statistics show that often times the healthy spouse dies first due to the stress. The healthy spouse needs a health professional that gives them their options...certainly not one who is biased. The home is NOT always the best answer. 

I have seen MANY, MANY individuals love assisted living and thrive. They were not eating well at home. Have you actually tasted those Meals on Wheels? I have.  The lack of mental or social stimulation can be very debilitating for people with memory issues or older people in general. I could go on and on about the benefits of assisted living after working in this industry for 9 years. 

[edited] I have people thank me constantly for the great care they themselves, or their parents are getting. I have had grown men cry in my office when their parent had to leave us and go to a nursing home because they felt like they were a part of our assisted living family and were going to miss it for themselves and their parent. Maybe you ought to spend a few hours in an assisted living environment. Surely in California you have assisted living communities that are as awesome as the ones I know of in Iowa! 
Sue


----------



## vacationhopeful (Aug 28, 2011)

As having had parents in a Nursing home, an Assisted Living,with Home health aides in the home on an hourly basis, babysitters, and a 24x7 live in aide ... I can speak from my personal experiences.


NO ONE CARE SETUP WORKS for EVERY PARENT in EVERY SITUATION or EVERY PHASE of THEIR CARE.

And yes, I was shouting!

You have to evaluate each situation for the person who needs the service. And it will change as they become less able to interact, their mobolity, and their awareness of the world around them. Their personality is also important along with their illness and physical capabilities. Can they feed themselves? Can they walk without falling or tripping? Are they continent? Do they fall out of bed? Are they violent? Are they too passive? Do they need a lot of social interaction? What are their other medical needs? Is the spouse alive and a caregiver?

And then there is the spouse and WHAT they want.

There was no way my Dad would place his wife in a nursing home. He needed to be totally convinced that was the best and only place for her. He could not take care or arrange for her safe care at their house any longer. Until then, babysitters worked and then home health care aides and then attendants who kept her in bed at night. Basicly, 20 hours a day of helpers for my dad, all arranged for privately. And as I argued with my RN sister, YOU have 2 elderly parents and both of them benefit by staying together at home.

After my Mom passed on (and 16 months in a regular nursing home), it wasn't long before Dad was slipping on that downward slide. Except he fought us and had his own idea of where he wanted to be and what he could still do. 8 months in 2 different houses with his married daughters and their families. Daytime home health care aides. He was lucky he lived.  Back to his house for 6 months with a live in aide until he decided to stay in bed for a month; then the doctor invoked Medical POA for the family. Assisted Living which he loved for the 4 months before he passed on.

Yes, visit the facility. Check out the food. Read the reports. Ask your neighbors, friends and enemies. Ask everyone who remotely know. Visit the places in the off hours and on weekends. I even HIRED a spy in housekeeping to watch my mom in the nursing home - was very helpful when all her clothes disappeared and other residents were found wearing them (custom made for her skinny, long arms). Image how my Dad felt finding her in a hospital gown and not her clothes. And yes, I was the PIA for my dad while she was there for 16 months (and my spy was very helpful in who to bitch to in management).

So, be helpful and share your expert opinions.


----------



## DeniseM (Aug 28, 2011)

Folks - I have removed one post and edited another.  We all have strong feelings about caring for our parents, but let's not make it personal.  Everyone is welcome to post their opinion, as long as it doesn't violate the TUG posting rules.


----------



## Zac495 (Aug 29, 2011)

Yes, as Denise says, it's personal. There is no one right answer for everyone here. For my mom, trying everything else seems to be what will keep her sane. In the end, it may be best for Dad to be in assisted living, but her fears made mine grow too. He's also so hard of hearing that we worry he will be shunned. It's so hard to say. Or it might be fabulous - he might be happier there.

One thing is for certain, moving an elderly parent with any dementia at all will cause some regression at first. So trying in home first makes sense to me.

And thanks to everyone for their care and kind responses. TUG community means so much to me.
Ellen


----------



## suesam (Aug 29, 2011)

Sorry.....

Caring for parents is extremely hard, as is being the one who is aging. The unknown is very frightening.  I feel it is so  important to know about all options available and the pros and cons of each. 
I hate to see people so in fear of options that can provide great care as well as a great quality of life. Choice and knowledge are critical. 

Keep up the research Ellen. Your parents are very lucky to have you to help them out! Do you have Alzheimer's Support Groups in your area? This might be a great thing for you and your mother to participate in. Or just your mother and you could spend time with your dad while she is at the meetings? Other families will have lots of great, first hand  information about the services in your area. 

Sue


----------



## bogey21 (Aug 29, 2011)

Just remember that one day you will be the one who is wearing out.  Knowing what you are going through with your parents, what are you doing to minimize being a burden on your kids when your time comes?

George


----------



## Fern Modena (Aug 29, 2011)

Ellen,
I am surprised nobody mentioned this (including me).  Get a copy of the book 36 Hour Day by Mace and Rabins.  It is about Alzheimer's, and it is presented in an easy to read format.  Each topic or question you might have is a separate item, and each item is a page or two at the most.  So if you don't have time to read it all, you can skip around easily.  Amazon carries it, and usually has used copies as well.

Fern


----------



## Pat H (Aug 29, 2011)

NOW is the time to have them give you a POA. You don't have to use it but at least you have it if you need it. You can then speak to agencies, banks, insurance companies, etc. on their behalf. I recommend it very highly. Make sure it's a durable POA that is not affected by disability. One of the most important things is to have a POA on file where they have their bank accounts. You never know when something could happen to either one of them and then you are scrambling to be able to take care of things. Many companies will not speak to you unless you send them a copy of the POA. Please don't wait to get that done.


----------



## Zac495 (Aug 29, 2011)

I'll get the book Fern.
Pat - I keep hearing get POA. But here's the thing - Mom is 157% there - way more than anyone I know. It's a King Lear thing - no way would a parent who shows NO signs of any problem need to do this.

It would make her very angry.

If she died tomorrow, there would be a problem - but meantime - she's not dead and not dying and I just don't know how to broach anything like this without totally pissing her off.

We are meeting with an in-home person tomorrow. Wish us luck!!!


----------



## loafingcactus (Aug 29, 2011)

My grandma signed a poa when she was all there... For her it let her give over some of the burden of managing things to a family member she trusted very much.  Then as she got older there was no sudden loss of control, there was the continued collaboration she had always had.

I, at 35, have a poa that only goes into effect if I'm incompetent or temporarily unable to make decisions (thinking traffic accident or some such problem, I have both a medical poa and a regular poa).  I hope that when I am elderly I will be able to poa one of my heirs so that I can go through the same process... The twerp should do some things for me before he gets my money!


----------



## falmouth3 (Aug 29, 2011)

My husband and I just signed POAs naming each other.  I may get hit by a car in the parking lot and he would need to take care of my business dealings for me.  

I have POA for my mother, but it's unbelievable how many hoops some people/companies make you jump through.  I just had to take my mother to a bank to get a medallion signature guarantee because she never took my father's name off of a joint account.  And they wouldn't recognize the POA from a lawyer.  We had to have the mutual fund's forms notarized to get POA.  And what a joy it was to get her health insurance documents mailed to my house instead of the house that she hasn't lived in for 20 months.  

My advice it to get things started sooner, rather than later.

My mother lived in NY and now she's in DE.  Her driver's license expired so my sister is trying to get her an ID so that she can sign these sorts of things.  We needed her birth certificate and a piece of junk mail addressed to her at her assisted living, also a bill for phone with her service address, although the bill comes to my house.  So they get to the DMV, or whatever it's called there, and they get turned away because the last name on the birth certificate doesn't match the license and all the other documents.  No kidding.  So now I'm trying to get a marriage certificate but the site is down.  OK, so how many 84 year old women with the name Hildegard were born on the exact same day?  They have a photo ID on the license too, although it's out of date - and of course the clincher is that it's from out of state.  I understand that they have processes that need to be followed but common sense should prevail, too.


----------



## puppymommo (Aug 29, 2011)

Zac495 said:


> It would make her very angry.
> 
> If she died tomorrow, there would be a problem - but meantime - she's not dead and not dying and I just don't know how to broach anything like this without totally pissing her off.



This sounds like my MIL.  I can't count the number of times she has been dying or near death  over the past 12 years. I know some of it has been genuine but it is hard to not see much of it as a ploy to get DH to come home.  

For example, several times she has told him her "kidneys are shutting down" and that she doesn't want dialysis.  And yet she lives!  Another time it was "all her organs are shutting down".

This summer she was in the hospital with a possible stroke.  DH dropped his physical therapy for hip replacement and flew home.  Turns out not a stroke but complications of pneumonia.  Still serious.  He stayed for a month. She got him to promise to come home for Thanksgiving.  Last year he went home for Christmas break and left at 6am on Christmas day!

He is the only one of 4 children (one now deceased) she has any contact with.  I know he is in her will and his name is on some or all of her bank accounts.  But he has no POA, not even health care POA. He is afraid to say anything about such matters to her.

Sorry I have gone on about myself.  Perhaps you could bring up POA as a way to protect YOUR DAD should something happen to her?  Good luck!


----------



## suesam (Aug 29, 2011)

Ellen, 
Your parents may already have Power of Attorneys set up if they ever see an attorney for estate planning, wills,  or anything else. They are just in existence in most cases only if the person can no longer make decisions for themselves.All of the ones  have seen says the Dr. must make that decision. Power of Attorneys can only be set up when the person has no cognitive issues. If they do not have one for your dad and he has no ability to make decisions for himself it is too late. In Iowa we have one power of attorney for health and one for finances. My husband and I have had the power of attorneys designated just in case, for years. He is my first poa and my sister is my second in case he can not carry out his duties. 

I would be very surprised if your parents have not had this paperwork completed for years and years already and you just do not know it. 

Sue


----------



## Zac495 (Aug 29, 2011)

suesam said:


> Ellen,
> Your parents may already have Power of Attorneys set up if they ever see an attorney for estate planning, wills,  or anything else. They are just in existence in most cases only if the person can no longer make decisions for themselves.All of the ones  have seen says the Dr. must make that decision. Power of Attorneys can only be set up when the person has no cognitive issues. If they do not have one for your dad and he has no ability to make decisions for himself it is too late. In Iowa we have one power of attorney for health and one for finances. My husband and I have had the power of attorneys designated just in case, for years. He is my first poa and my sister is my second in case he can not carry out his duties.
> 
> I would be very surprised if your parents have not had this paperwork completed for years and years already and you just do not know it.
> ...



Good point. It's probably in the "death file," that Mom emailed me a few years ago. EWWWW


----------



## pwrshift (Aug 29, 2011)

*You Could Live a Long Time...Are You Ready?*

I suggest you get this 'out of print' book from Amazon.  I got a 'used' one from them that looked brand new...and the price was right.  It's an easy read and covers all the considerations expressed above.  I should mention it's a Canadian book so the little bits on retirement investing might not apply but the rest is excellent IMO.

http://www.amazon.com/You-Could-Liv...5274/ref=sr_1_1?ie=UTF8&qid=1314667145&sr=8-1

Brian


----------



## bogey21 (Aug 29, 2011)

Those of you who are having these issues with your parents should take the steps necessary to ensure that you have things set up so your kids don't have similar issues if/when you die or become incompetent.  For example, in addition to a will and powers of attorney for health matters, financial matters, etc, I have prepared (and keep current) a loose leaf binder which contains every piece of information (in extraordinary detail) my family and/or an executor would need to wind down my affairs.  Although I am 76, I have no reason to believe that my mind is going to fail or that I will die in the foreseeable future.  On the other hand at age 76 I know anything can happen and don't want to be a problem for my kids.

George


----------



## Rose Pink (Aug 30, 2011)

bogey21 said:


> Those of you who are having these issues with your parents should take the steps necessary to ensure that you have things set up so your kids don't have similar issues if/when you die or become incompetent.  For example, in addition to a will and powers of attorney for health matters, financial matters, etc, I have prepared (and keep current) a loose leaf binder which contains every piece of information (in extraordinary detail) my family and/or an executor would need to wind down my affairs.  Although I am 76, I have no reason to believe that my mind is going to fail or that I will die in the foreseeable future.  On the other hand at age 76 I know anything can happen and don't want to be a problem for my kids.
> 
> George


George, I find your posts and suggestions/encouragement to act spot on. Having gone through this with my FIL during the past years, I can testify to the importance of having a durable POA and a medical POA. I used those instruments many, many times.  

I know DH and I need to get our affairs in order for our own children/grandchildren.  I keep saying it but we don't seem to find time to get it done.  I think I am so burned out at the moment.  But each time I read your posts, it is another reminder to me.  

Thank you.


----------



## csalter2 (Aug 30, 2011)

*Long Term Care Insurance*

I find it very interesting to find this thread at this time. I have not been on TUG this summer. I spent all summer traveling the west with my 78 year old father who is suffering from bone cancer. He was in a skilled nursing facility in May in New York, but was able to get better enough to visit with me in California and for us to go horseback riding and traveling. My dad actually liked the skilled nursing facility and wanted to stay. However, to stay there was going to cost nearly $400/day. He has no long term care insurance, he owns his home outright and has a pension and social security. Thus, he was not eligible for Medicaid because he had too much money, but he has no other assets other than his home and his  income from both his pension and social security only adds up to $2000. As you know that's not much in New York. Fortunately, my niece does not work and lives with him with her children at his house. So she takes care of him as he cannot live alone. 

I am 51 and my wife is 37. Seeing my dad's situation made me do some research on long term care (LTC) insurance. I have got to tell you that over this last month I did so much reading on this topic that I bet I am better qualified to to sell it than most of the agents. 

The cost of LTC insurance really depends on a number of factors such as: How much money per day you want to have available; How long an elimination period you want. This is like a deductible in which you my have a 30, 60 pr 90 day period in a facility or home care before you have your LTC insurance beggin paying. Another consideration is how long you want your coverage to last which can be as short as a year or lifetime coverage. You also need to determine if you want inflation protection or not, because $300/day coverage today won't have the purchasing power of $300/day ten or 15 years from now. You can have a choice of not purchasing  or there are per 3% 0r 5% inflation protection increases that your policy can provide. 

All of these variables determine the cost of your policy. Also there are riders that can be purchased such as survivorship in which the policy of your spouse is paid off after the other spouse dies. However, the fine print says that the rider will only be paid up if there are no claims for ten years on either policy.

LTC is not for everyone. If you don't have significant assists or are super wealthy you don't need it. However, in California and some other states there are some definite advantages to owning not only LTC but Partnership LTC insurance. This parntership LTC is between LTC insurance companies and the State of California. They have to meet certain requirements to be a part of the partnership and can only raise prices when the State of California gives them the okay. I like that part because the premiums don't go up too often when your older on a fixed income. The big advantage to the partnership is that it helps protect your assists.  For example, if you own a home, a car and have $350,000 in your IRA and you had to go to skilled nursing facility like my dad you could be in trouble depending on your situation. Lets say you have a pension and your wife had an income/pension too. If your LTC paid for $200,000 of your long term care bill of $300,00 bill then you could protect $200,000 worth of your assets. You could apply for Medical/Medicaid for the remainder of balance of your bill $100,000 without spending down all of your assets as usually is required. This only happens with the partnership plans. Now there is a lot more to the Medi-Cal piece but for those with assets outside of their car and primary home this can be very, very helpful. 

As many of you have learned like I did with my dad care for the elderly is expensive. For my dad to stay in that skilled nursing facility he was in was going to cost about $12,000/month or $144,000 per year. Medicare only paid 100% for the first 2 weeks and then 80% of the next 2 1/2 months after that it's out of the patient's pocket unless they are indigent. 

The bottom line is that because of the cost of LTC is tis better to have it if you can afford it. The older you get the better your chances of needing it. It becomes a matter of not if you are going to need it but when are you going to need it. 

I would advise to buy it younger than older because it is more expensive the older you are and you could become uninsurable as you get older. Also, I would advise that you not buy too much insurance that you can't afford but enough that you can handle in case of a premium increase. 

I know this is long but after reading all of these posts I saw that many people had questions that were not answered thoroughly, especially about not having lifetime coverage. I had a friend who had a stroke two years at the age of 44. She cannot talk and has had limited use of her right side. She has improved over the last two years, but still has a long, long way to go. She had lifetime LTC insurance. Someone is at her house from 8-5 with her every day.

I would be happy to entertain questions. I am not an insurance agent, but school administrator so don't worry about me trying to sell you something.


----------



## Zac495 (Aug 30, 2011)

Carlito,
What do you consider weathly and having assets? How much do you have to have saved/pension/worth of home in order to be "too wealthy" for LTC to be worth it? I'm curious.THANKS


----------



## loafingcactus (Aug 30, 2011)

Zac495 said:


> Carlito,
> What do you consider weathly and having assets? How much do you have to have saved/pension/worth of home in order to be "too wealthy" for LTC to be worth it? I'm curious.THANKS



Im very curious what other people think of this as well.  The typical insurance policy only covers about 500k, and a couple around the 100k/yr level needs 1 - 2 million for retirement... So for your typical middle class person it just doesn't seem to make sense because they can get ahead saving and investing for themselves, and retain the flexible use of those dollars.

And then if you are under that, locking that value into a specific use insurance instead of saving for more general use also seems like a bad plan, because you need every retirement dollar if you happen not to be in LTC.

So from my thinking, LTC insurance is pretty much always a negative financial decision.  But I know there are some others who have thought this through and come to a different conclusion...


----------



## Pat H (Aug 30, 2011)

A POA ceases at death so you cannot do anything once the person dies until the executor/administrator of the will has been validated. Of course, if you don't notify the bank the right away that the person has died, you can still write checks to pay their bills, funeral expenses, etc. :ignore:


----------



## csalter2 (Aug 30, 2011)

Zac495 said:


> Carlito,
> What do you consider weathly and having assets? How much do you have to have saved/pension/worth of home in order to be "too wealthy" for LTC to be worth it? I'm curious.THANKS



That is the million dollar question. What is wealthy? What the government thinks is wealthy and what you and I may think is wealthy can be very different. I know Obama would consider me wealthy, but when I look at the housing, gasoline, insurances (home and auto) and taxes in California compared to other parts of our country, I am far from wealthy and Obama wants to increase my taxes.

However, here's the deal. You have to think about your particular situation because that will really determine if it's important for you or not.  

If you have assets *that you want to protec*t then a partnership policy is good for you.  In California, your primary residence and your car are exempt, but all of your other assets are fair game. So Uncle Sam says you can keep your car and home, but if you need additional funding for your long term care then you have to pay with your assets if you don't have a partnership policy.  

Let's say you receive a pension and you get $4,000/month and you have a spouse and she makes $3,000/month and you have a 401 or 403 accounts equalling about $400,000.  Uncle Sam will look at you as being wealthy. If you don't have LTC insurance you will have to pay for it with your own money. Period. Medicare as I said earlier will not pay for long term care unless you have have had a condition like a stroke and are released from the hospital to the nursing care facility. However, as I stated above they have limits as to how long and how much they pay. Also, you need to be making strides to getting better because those skilled nursing care facilities are for rehabilitating you. If it is determined that you will not be able to do any better or you are able to meet the goals set for you then you will be discharged and you will need to start paying out of pocket. Medi-Cal (which is Medi-Caid but California's division of it) will have you spend down all of your assets as you continue to need care. So the pension, the $400,000 are now all fair game to be used for your care. 

If you have regular LTC, that will pay for your care up to the amount you have, but then your assets will then need to be spent down before Medi-Cal will assist. 

However, if you have Partnership LTC there's  difference. First, your LTC will pay and depending upon the amount of coverage you have it will pay your long term care bills. So let's say you have $200,000. Well, if you need to more time in the facility to pay for your bills then you will more than likely do what they call a Share of Cost. However, unlike the people without LTC or those with regular LTC, because you belong to the partnership, $200,000 in that 401/403 will be protected.  

When you have pensions and social security like the amounts mentioned, you will probably be in the share of cost portion of Medi-Cal in which you would have to a portion determined by Uncle Sam. Uncle Sam only let's you keep about $2000/month and the rest pays for your bed. Married couples get to keep $3000. However, your home is protected and $200,000. Think about the impact this can have on your spouse while you're in a facility. She will not have your income to help sustain herself. 

Yes. One can self insure, but how much money will you be able to save to do so. Look at this link. It gives prices for care in California
www.completelongtermcare.com/states/california/

Looking at those costs would make one wonder if they had to spend a significant amount of time at home or in some facility if they could afford it.  I have looked policies for a 50 year old you can get a modest policy for under $1000. However, as I said this is a very personal and individual decision. There are so many variables. What makes this so hard is that you don't have a crystal ball to let you know when and how long you will need care.


----------



## csalter2 (Aug 30, 2011)

loafingcactus said:


> Im very curious what other people think of this as well.  The typical insurance policy only covers about 500k, and a couple around the 100k/yr level needs 1 - 2 million for retirement... So for your typical middle class person it just doesn't seem to make sense because they can get ahead saving and investing for themselves, and retain the flexible use of those dollars.
> 
> And then if you are under that, locking that value into a specific use insurance instead of saving for more general use also seems like a bad plan, because you need every retirement dollar if you happen not to be in LTC.
> 
> So from my thinking, LTC insurance is pretty much always a negative financial decision.  But I know there are some others who have thought this through and come to a different conclusion...



Here is the link for costs of LTC in North Carolina 

www.completelongtermcare.com/states/northcarolina/

It seems to me that you could go through your retirement pretty quickly even in a state like North Carolina that is cheaper than California. Look at the Nursing home daily rates. The cheapest is $168/day in Greenville.


----------

