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Elderly care?

ace2000

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My in-laws are starting to need extra assistance, and even though we're not closely involved (due to the fact they live 10 hours away), we'd like to make sure they're making the right choices.

First, financially they are doing ok, but are not super wealthy. My FIL has dementia and he is going to need to go to a nursing home very soon (or some type of assisted living). They recently sold their house (in a different state) to move to their current location - an apartment. The house was fully paid for. They hate their current location. My MIL believes that they need to buy another house soon and put the money into that, in order to qualify for extra assistance. Is this how it really works?

I know they are getting some advice from some senior-type organizations, but want to make sure they're asking the right questions. To me, it appears that you need to be very poor or very wealthy to ensure you get proper care as you get older. Any truth to this? Any help out there from anyone that's gone through something like this would be appreciated. For one thing, I'd like to know what we need to get prepared for as we get older. :ponder:
 

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Now is a good time to get a list of good assisted living places, and tour them!
Maybe start out even where you live just to get an idea of what they are like.

My inlaws (age 90) went to one and it is a blessing! The costs was like $6,000 a month but they were in bad physical shape. In that same assisted living home they had much lower rates if you didn't need much assistance ($3,000) a month. Basically they had a one bedroom ap't with a small kitchen.

My aunt and uncle (age 90) went the other route where they paid for someone to stay with them 7 days a week (8+ hours a day). My uncle had a very bad case of dementia and my aunt was legally blind. The costs was probably the same.

Honestly, out of the 2 scenarios above the assisted living route is much better. For my inlaws we looked for an assisted living homes that was new.

How old are your parents?
 

ace2000

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How old are your parents?

Thanks for your reply. They are in their 80s. He is getting really bad and it's extremely hard for my MIL to take care of him (leaving the apartment, not knowing where the bathroom is, can't make a sandwich, etc. etc. etc.). She is on the oxygen tanks and has trouble getting around herself. It's starting to become very clear that she does not want to be a caregiver either. Something will be done very soon (as far as putting him into some sort of care), I'm sure of that.

I think $3000 would be manageable for them, but $6000 would be a lot. I'm not sure though and don't know the exact details about their finances. We'd rather they spend all their money on themselves, rather than leave anything behind.
 

Passepartout

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It looks like it's time for a responsible family member to step in and research assisted living facilities either near where they live, or nearer where the family member can look in on them more conveniently.

Prices for these facilities are all over the map, and if they didn't buy long term care insurance, it will all be 'private pay'. There is no requirement for 'mom' to buy another house in order to fund care for 'Dad'. When the time came for me to take on the role of caregiver for my mom, I liquidated her assets- estate sale, house on the market and all that. It was hard, and didn't happen overnight, but as I explained it to her, she'd cared for her house and 'stuff' for decades, and now it was time for the house to take care of her.

My sympathy if this responsibility has fallen to you. It isn't easy. Be strong, enlist the agencies that your (or their) state has in place to guide you. You need not do this alone.

Jim
 

theo

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My $0.02 worth...

My in-laws are starting to need extra assistance, and even though we're not closely involved (due to the fact they live 10 hours away), we'd like to make sure they're making the right choices.

First, financially they are doing ok, but are not super wealthy. My FIL has dementia and he is going to need to go to a nursing home very soon (or some type of assisted living). They recently sold their house (in a different state) to move to their current location - an apartment. The house was fully paid for. They hate their current location. My MIL believes that they need to buy another house soon and put the money into that, in order to qualify for extra assistance. Is this how it really works?

I know they are getting some advice from some senior-type organizations, but want to make sure they're asking the right questions. To me, it appears that you need to be very poor or very wealthy to ensure you get proper care as you get older. Any truth to this? Any help out there from anyone that's gone through something like this would be appreciated. For one thing, I'd like to know what we need to get prepared for as we get older. :ponder:

Individual situations (and underlying finances, as well as state laws) of course vary. The one broad but consistent observation I will offer here is that the expressed logic of buying another house to "qualify for extra assistance" may very well be badly flawed and completely unfounded. More specifically, any and all owned real estate is an asset which could (and surely would) be attached (via lien) in a Medicaid eligibility situation once other more liquid assets are spent down.
Assisted living might very well be a better choice and a much more appropriate option than buying another home for their particular situation and available funds.

People may try to "shield" assets to facilitate access to assistance, but ultimately are subjected to a competent "5 year lookback". In essence, any and all assets discovered (and yes, all would be discovered) to have "disappeared" or to have been "transferred into another name" will still be regarded and treated as if still on hand, available and in possession. There is no allowable or achievable "hiding" of assets in that 5 year "lookback" time frame. That "lookback" period was once 3 years, but was changed to 5 years during the George "W" Bush administration (no political commentary intended; I'm merely providing a time frame / point of reference).

People sometimes use the terms "nursing home" and "assisted living" interchangeably, but often inappropriately. Assisted living facilities generally require a certain level of functionality and independence for residency, as well as sufficient liquid financial assets to meet hefty monthly residency payments. If level of functionality and independence declines beyond a certain point, resident(s) may (depending on the facility) not be able to remain there at all, now requiring the more extensive services provided in a nursing home. Some (not all) assisted living facilities (and some nursing homes) have very separate "memory care" (Alzheimers / dementia) sections on site. Many (not sure if all) nursing homes (unlike assisted living facilities, which AFAIK are mostly "private pay") may have beds available for Medicaid eligibility.
Nursing home quality range and / or costs are just all over the map.

This is a complicated and difficult matter for you and your loved ones to tackle. Been there, done that --- some of the most stressful days of my life to date, by far.
Btw, some so-called "senior advice" entities are actually little more than commission based marketing and referral entities. I could name one in particular I came to particularly dislike, but won't --- I'm not looking for a lawsuit. Suffice it to say that some other family member, not just the elders themselves, should / must get directly and personally involved to help identify and separate objective, legitimately senior-helpful entities from commission-motivated (...ahem) "seniors advisors".

My advice would be to have the in-laws at least have an initial (likely free) consultation with an elder law attorney in the state of the elders' residency, preferably with other family members present for clarifications and clear retention of important information and details. At the very least, said consultation will hopefully address and clear up any existing misconceptions or incorrect assumptions. Elder law attorneys deal with these (sometimes complicated) matters routinely --- and exclusively.

I feel for you and wish you luck. It's not an easy road upon which to travel, but it's a part of life. In something of a role reversal, the former child sometimes must become the responsible parent to parent(s). Be grateful that the folks are still here for you to reciprocate and actively show love and gratitude in a meaningful way.
 
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ace2000

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It looks like it's time for a responsible family member to step in and research assisted living facilities either near where they live, or nearer where the family member can look in on them more conveniently.

Prices for these facilities are all over the map, and if they didn't buy long term care insurance, it will all be 'private pay'. There is no requirement for 'mom' to buy another house in order to fund care for 'Dad'. When the time came for me to take on the role of caregiver for my mom, I liquidated her assets- estate sale, house on the market and all that. It was hard, and didn't happen overnight, but as I explained it to her, she'd cared for her house and 'stuff' for decades, and now it was time for the house to take care of her.

My sympathy if this responsibility has fallen to you. It isn't easy. Be strong, enlist the agencies that your (or their) state has in place to guide you. You need not do this alone.

Jim

Thanks Jim. It's really not on our shoulders - since we live so far away. There are other relatives helping them through the process that actually live near them. My wife's sister has power of attorney. However, it's an emotional burden for us, that's for sure. It really has taken a turn for the worse since they moved out of their house.
 

ace2000

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Individual situations (and underlying finances, as well as state laws) of course vary. The one broad but consistent observation I will offer here is that the expressed logic of buying another house to "qualify for extra assistance" may very well be badly flawed and completely unfounded. More specifically, any and all owned real estate is an asset which could (and surely would) be attached (via lien) in a Medicaid eligibility situation once other more liquid assets are spent down.

People who may try to "shield" their assets to facilitate access to assistance are subject to a "5 year lookback" period. In essence, any and all assets discovered (and they would be) to have been "transferred" to another name will still be regarded and treated as if still currently on hand, available and in possession. There is no allowable or achievable "hiding" of assets in that 5 year "lookback" time frame. That "lookback" period was once 3 years, but was changed to 5 years during the "W" Bush administration (no political commentary intended there; I'm merely providing a time frame / point of reference).

Thanks Theo! Very good information you've posted here that I'll look into further.
 

pedro47

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Deminata by itself that's a toll on any one care giver and the whole family(far & near). Someone who is truelly responsible needs to step up, to the plate. A good senior citizen attorney for consultant would be my first step. Good luck to the family.
 

WinniWoman

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My mom had terminal cancer and dementia and after she fell in her home I propelled into action to find an assisted living facility. That was in Feb (2011)- by March she was in. Totally paid out of pocket except for some medical things through Medicare and Hospice. She died in June at age 81. All in all the costs were app. $54,000. We used her money to pay for it. If she would have lived longer, and if we would have used up her all her money, we would have put her home on the market sooner and paid for it through the proceeds.
 
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falmouth3

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My mother moved into assisted living a few years ago. She thought she was doing well on her own, but her health was failing and her dementia was getting worse. We were amazed at her turnaround after she started getting good meals and having her meds on time. She also enjoyed the social aspect of it and being able to return to her "apartment" when she wanted privacy.

There were couples there who lived in their apartments at the assisted living facility. I do know of one couple where the husband moved into the "memories" area and the wife continued to live in the assisted living area, but they could visit as much as they wanted since the memories facility was one floor below the common area.

It is not cheap, and when you run out of money, medicaid does not cover assisted living costs, although they will if the person has run out of assets and needs to be in a nursing home.

Assisted living and nursing homes are definitely two different things. Best wishes to you and your family members.
 

Bailey#1

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Some assisted living facilities do have some units available that medicaid will cover, my MIL has been in this assisted living for over 3.5 years now (she 93 now), she has been paying out of pocket and in the next 10 months she will have gone thru all her savings. The assisted living home told us that they have a couple of rooms available that medicaid will pick up the costs after all her personal funds are gone. Hopefully what they told us is true! She was the first one in that home when they opened.
 
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DEScottzz

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My dad is 83 and has Alzheimer's. After a fall which we suspect was due to loss of muscle control, he fell and broke his hip. He can no longer walk.

His wife tried having someone come into their home to care for him for about 6 hours a day. The cost for that was a little over $2000 per month. She found that she just couldn't manage during the times they weren't there. He will forget that he can't walk, then try to get up and fall down. She wasn't able to get him up when that happened.

It was a hard decision, but we decided to move him to a board and care facility. It's a private home with 6 patients. The care there seems a bit more personal than a larger facility, and the environment a bit more like home.

The cost is about $4500 per month. I know there are places that cost more, and others that cost less. He has a small private bedroom, but during much of the day, he's in the common living room or dining room. He seems to like the people there and they like him, but he knows he's not at home.

Alzheimer's is a cruel disease.
 

ace2000

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Alzheimer's is a cruel disease.

You've said a mouthful there... that's for sure. He was diagnosed with dementia though, and was told he didn't have Alzheimers. To me, and the little I know, it has to be very similar. It was a slow progression for awhile, but it went downhill very quickly after they had to move to the apartment, to be closer to the relatives. It is very small and I'm sure it's driving both of them crazy since they don't get out much.
 

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Some assisted living facilities do have some units available that medicaid will cover, my MIL has been in this assisted living for over 3.5 years now (she 93 now). The assisted living home told us that they have a couple of rooms available that medicaid will pick up the costs after all her personal funds are gone. Hopefully what they told us is true!

We Helped my 97 year old mother in law with a move from a senior apartment building (with some assistance she hired and paid for on her own) into an assisted living building last summer. After a few months her remaining savings will have been used up. Medicaid will pay the portion of her bill that covers the care, etc., and her Social Security will pay the rent portion. There are some units that are priced to be within what her Social Security will cover. It's a whole calculation that the assisted living and the county funding the Medicaid do to determine what portion of the bill is for what purposes and where the funds need to come from. They require her to use all her Social Security except for a small amount, which is to be expected.

The whole spend down process, applying for Medicaid, getting her elderly waiver, cancelling existing Medicare supplement and drug plan (or not, depending upon Medicaid plan) is very complex. My husband has spent hours researching and working on it...and still gets stuck with questions. Just this week, we got 2 letters from the State and 1 from the County with conflicting info about her health plan status. And given how short staffed the agencies are, getting through to someone who knows what info is really correct is a challenge. I can't imagine how difficult it must be for someone without the kinds of skills my husband has to get the right answers.

In her case, her sons will each contribute to the rent, so she will be able to stay in her small one bedroom unit instead of moving to the single room she could afford on her own.

On the plus, she really likes the assisted living, staff is great, and the sociability and friendliness of the other residents means she enjoys living there.
 

Karen G

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My advice would be to have the in-laws at least have an initial (likely free) consultation with an elder law attorney in the state of the elders' residency, preferably with other family members present for clarifications and clear retention of important information and details. At the very least, said consultation will hopefully address and clear up any existing misconceptions or incorrect assumptions. Elder law attorneys deal with these (sometimes complicated) matters routinely --- and exclusively.
I heartily second that advice. When my mother-in-law suffered a stroke and went to a nursing home, the social worker at that home advised us to do so and it was one of the best things we ever did.
 

mjm1

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My best wishes to everyone with family members going through these situations.

My 83 year old mom just had a stroke 2 1/2 weeks ago. Fortunately, a friend found her at home and got medical attention to her very quickly. She has been in rehab the past two weeks and we are moving her to a board and care facility that my brother and sister found in the San Francisco Bay Area. The cost will be $4,900 for the basic care. Depending how they assess her care needs, the cost could go up a bit. We hope to get her back in her house with 24/7 care, some of which will be provided by my sister. The cost for someone else to do it is at least $11,000 per month. Amazing how expensive it is.

We are taking it month by month and pray that she improves significantly. Time will tell.

Mike
 

vacationhopeful

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My best wishes to everyone with family members going through these situations.

My 83 year old mom just had a stroke 2 1/2 weeks ago. Fortunately, a friend found her at home and got medical attention to her very quickly. She has been in rehab the past two weeks and we are moving her to a board and care facility that my brother and sister found in the San Francisco Bay Area. The cost will be $4,900 for the basic care. Depending how they assess her care needs, the cost could go up a bit. We hope to get her back in her house with 24/7 care, some of which will be provided by my sister. The cost for someone else to do it is at least $11,000 per month. Amazing how expensive it is.

We are taking it month by month and pray that she improves significantly. Time will tell.

Mike

My heating contractor had a stroke about 4 years ago (around age 60). His stupid bimbo live in GF was ignoring and laughing at the old fart gurgling and drooling in his chair (between breakfast and lunch time) but his best friend (heart attack years ago and disabled) just happened to stop in ... recognized the symptoms and called 911. I visited him in the acute care hospital 5 days later and thought ... his pooch is cooked. Within a few months (after less than a month in a rehab), he was WAY better than I thought he ever would get. Today, he good enough most people would not know he had a stroke.

Wishing you the best outcome for your mother ...

PS His son removed the girlfriend from the house ... explaining to her she would have to take care of him and elder care agencies would be making sure he was properly cared for. ;) as the hospitals would be taking the house for medical bills as he had no insurance. And child protective care would make sure her young children were not caring for him. She fled.
 
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Bailey#1

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We Helped my 97 year old mother in law with a move from a senior apartment building (with some assistance she hired and paid for on her own) into an assisted living building last summer. After a few months her remaining savings will have been used up. Medicaid will pay the portion of her bill that covers the care, etc., and her Social Security will pay the rent portion. There are some units that are priced to be within what her Social Security will cover. It's a whole calculation that the assisted living and the county funding the Medicaid do to determine what portion of the bill is for what purposes and where the funds need to come from. They require her to use all her Social Security except for a small amount, which is to be expected.

The whole spend down process, applying for Medicaid, getting her elderly waiver, cancelling existing Medicare supplement and drug plan (or not, depending upon Medicaid plan) is very complex. My husband has spent hours researching and working on it...and still gets stuck with questions. Just this week, we got 2 letters from the State and 1 from the County with conflicting info about her health plan status. And given how short staffed the agencies are, getting through to someone who knows what info is really correct is a challenge. I can't imagine how difficult it must be for someone without the kinds of skills my husband has to get the right answers.

In her case, her sons will each contribute to the rent, so she will be able to stay in her small one bedroom unit instead of moving to the single room she could afford on her own.

On the plus, she really likes the assisted living, staff is great, and the sociability and friendliness of the other residents means she enjoys living there.

Thank you for sharing this information!
 

bogey21

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I went through this with my Father many years ago. I had two problems (1) convincing him he needed to go and (2) finding a decent place at a decent price in a short time.

I swore at the time I would never put my kids through this. What I did was search far and wide for the best CCRC (Continuing Care Retirement Community) and moved in (sort of). I say short of because I have a condo at the facility, use it for my mail and eat and socialize there 3 or 4 times a week. I sleep there every now and then, mostly when they have an activity early in the morning that I want to attend.

My monthly cost when I signed up about 15 years ago was $1,500. It is now $2,200. If you subtract the 30% of the monthly payment which I can deduct from my FIT as prepaid medical expenses; the cost of Long Term Care Insurance which I don't need; and the cost of the meals I eat there, the difference is my cost of relieving my kids of potentially having to face this problem. I consider it money well spent.

Another nice thing about this arrangement is I have a relationship with a large number of the residents which will make moving in permanently, if necessary, a non event.

George
 

ace2000

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Some more thoughts... after reading the thread I linked to above, I can't help but wonder that the reason that they decided to purchase the house was probably to protect their assets (at least to a certain degree). They may realize that they're going to run out of money anyway and they'll at least have the house paid for. (more details in my OP above).

Anyway, thanks to all who have replied (including the ones in the previous thread). We may need to start considering the LTC insurance pretty quickly... :)
 

theo

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I went through this with my Father many years ago. I had two problems (1) convincing him he needed to go and (2) finding a decent place at a decent price in a short time.

I swore at the time I would never put my kids through this. What I did was search far and wide for the best CCRC (Continuing Care Retirement Community) and moved in (sort of). I say short of because I have a condo at the facility, use it for my mail and eat and socialize there 3 or 4 times a week. I sleep there every now and then, mostly when they have an activity early in the morning that I want to attend.

My monthly cost when I signed up about 15 years ago was $1,500. It is now $2,200. If you subtract the 30% of the monthly payment which I can deduct from my FIT as prepaid medical expenses; the cost of Long Term Care Insurance which I don't need; and the cost of the meals I eat there, the difference is my cost of relieving my kids of potentially having to face this problem. I consider it money well spent.

Another nice thing about this arrangement is I have a relationship with a large number of the residents which will make moving in permanently, if necessary, a non event.

I sincerely tip my cap to your foresight, planning and unselfish consideration for your progeny, George.

Responsible offspring who love and respect their parents will of course always just do "whatever it takes" in difficult times; that's a "given".
Nonetheless, I couldn't begin to count the number of times I recall my siblings (...with absolutely no resentment, but still honestly) proclaim that "I don't ever want to put my kids through this" during the most difficult and stressful times and decisions.

This stuff may well all be "a part of life" --- but it sure ain't an easy part.
 

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Having been thorough this over the past few years, I have 2 recommendations. Check out http://www.aplaceformom.com/ and fill out their form. They are very helpful and we were able to find a great place for my mother. They can help you find a place that suits your needs and budget. I think they gave me a list of 18 places and I checked out most of them before making my decision as to where we would move Mom.

She was at this facility for 2-1/2 years with her own little Assisted Living apartment and it cost about $5600 per month for all the care she needed when she was in the Memory Care area. (Those are generally higher because then need more care.)

We moved her to a group home in 2014. These are big in the Phoenix area and I wish we had moved Mom there about a year before. There were 9 residents and 3 caregivers all the time. She received better care for about 1/2 the cost. She passed away in September and even when she went on Hospice, the group home caregivers asked to keep her there and one was by her side most of the time.
 

theo

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Having been thorough this over the past few years, I have 2 recommendations. Check out http://www.aplaceformom.com/ and fill out their form. They are very helpful and we were able to find a great place for my mother. They can help you find a place that suits your needs and budget. I think they gave me a list of 18 places and I checked out most of them before making my decision as to where we would move Mom. <snip>

Fwiw, the entity referenced above (by hyperlink) is in fact one which is paid a fee or commission by the facility if / when a "client" ultimately books into a place to which they have been "referred" by this entity, at least around here.

This certainly does not mean that a "referred" facility isn't entirely suitable and / or outright wonderful; just be aware that there may not be complete objectivity in their "referrals". For specific example, we ultimately selected a place which actually chose not to be affiliated with (or pay commissions to) that "referral" entity, so we never even learned of the facility's existence at all from the "referral" entity mentioned above. We actually learned of the place we selected from another family's positive experience; we checked it out for ourselves and ultimately selected it from among about eight other places we also visited.
 
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falmouth3

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I had also contacted A Place for Mom. While we ultimately placed my mother in a different geographic location (closer to my sister), A Place for Mom did provide me with literature and guidance, not only with finding facilities. I found them to be helpful and cordial. Many or most of us are entering new territory when Mom or Dad needs some help.
 
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