s/o Cost of assisted living or senior care.

[Night Elf]

I'm reading the other thread and I'm shocked at the prices of assisted living. I was trying to research it and found that medicare does not pay for long term care. So how then do people afford such high prices? I wouldn't even be able to pay $1000/mo let alone the over $2000 and even much higher cost of long term care. My mom only has Humana which is a type of medicare that I don't understand. If it doesn't cover senior type living facilities, how do families handle this? I'm assuming she'll have to live with me but if her care gets beyond what I can handle, what am I supposed to do?

[G5052]

Yes, it's very disturbing.

 

When my mother was on the memory floor at her assisted living, it was $9000/month.  They had long-term care insurance that would have covered half of it, but the individual in charge of it never applied for reimbursement.  I don't remember the exact total, but the regular part of the building was about half of that per month.  

 

Medicare may cover a nursing home, but many nursing homes don't take it.  The one my father was in for a few months before he died did, but they frequently don't have any openings.  When he went in, they had to put him in the memory section because that was the only opening they had even though he didn't need that.  Thankfully he was in the regular part for the last months.

[Lawana]

The short answer is a nursing home and Medicaid. Once someone can no longer live independently and has spent down her own resources, she will qualify for Medicaid to pay for a nursing home. The quality of care varies tremendously.

[Pawz4me]

It requires some careful planning.

 

Long term care insurance is always an option, but it's expensive and (like all insurance policies) is something that needs to be evaluated carefully.

 

Medicare only covers assisted living in a few situations and for short periods of time.  Typically it will be for a few days to a few weeks for rehab following a minor stroke, a fall or a joint replacement or something like that.

 

Many people can get on Medicaid after spending down their savings (and possibly selling their home and spending those proceeds, depending on whether or not there is a living spouse) and probably meeting various waiting period requirements.  I hesitate to post much about that because Medicaid can be very complicated, and the rules may vary from state to state.

 

Most seniors who need care will use all of their Social Security to help pay for it.  And then sometimes kids chip in to cover any costs the SS check doesn't.

[Jane in NC]

My father was in a nursing home facility for the last year or so of his life.  In his retirement, he still received an income stream from Social Security and his pension.  Those two things paid for the bulk of the monthly fee; his savings paid the differential.

 

Some people sell their homes to pay for long term care.  My best friend's mom did this to buy into an assisted living facility with independent apartments, rehab and nursing care, a memory unit, etc.  I don't know what her monthly fee is for this type of arrangement.

 

My mom remained at home through her passing with the assistance of a hospice group.  They were wonderful!  But if my father had not been healthy, this arrangement would not have worked.

 

We also have friends who have adapted part of their home for long term care of elderly relatives. 

 

Elder care can be a major expense. Many companies no longer provide traditional pensions, but investing in 401-Ks and IRAs will help pay for one's future care without burdening the next generation financially.

[tm919]

Medicare and medicaid will pay some of these costs for some people, but the laws are so complicated you'd probably need to talk to a lawyer/specialist in your state to figure out if its a possibility. If either you or your husband works for an employer that has an HR department, I'd urge you (or him) to call and find out if they have any programs that will help with eldercare needs that arise. I know my employer offers a type of insurance for consultations with lawyers, including eldercare lawyers  (we are totally going to use that), and other employers offer back-up care.

[City Mouse]

My MIL used her SS, VA pension, and savings to pay for assisted living. By the time she ran out of money she did need nursing home level care and Medicaid kicked in eventually. Luckily, the place where she was was mostly private pay, but had a very few Medicaid beds for current residents who ran out of money. That allowed her to stay at the same facility, but when she died, she had absolutely no money left. The kids split funeral expensive and when her bank account was closed out there was $50 left in it.

[Caroline]

My grandmother sold her home and a few acres to pay for her retirement/nursing home. She lived in the retirement/nursing him for 10 years. She kept the good farm land (500 acres) and the income from that also helped. She died at 101 this past fall. My parents now own and run the farm, although they live 1000+ miles away. They are putting the income into savings to pay for their long term care if necessary. They also have very good long term care insurance, savings, and pensions. They do not have SS because my dad was a federal government employee.

[goldberry]

My friend's parents stayed in a nursing home that took medicaid. The better places have only a few medicaid beds, so you really have to plan it out.  If you wait until the last minute, you won't get a good place.  

 

They had to sell all their assets and use that money first before they qualified.  It's very sad I think for people that have worked all their lives who want to maybe just leave a few thousand dollars to help their kids along, but then have to use EVERY DIME before they can get any kind of coverage.  It's a horrible system.

[goldberry]

Has anyone had experience about long term care insurance?  I've heard some people say it's a scam.  We are considering it though. Especially since we have an only child and she may not be in a position to even help, or if she was we don't want that burden on her.

[Caroline]

Has anyone had experience about long term care insurance? I've heard some people say it's a scam. We are considering it though. Especially since we have an only child and she may not be in a position to even help, or if she was we don't want that burden on her.

My parents have it, but haven't used it, yet. They are only in their mid-seventies.

[Mimm]

This worries me a lot. My mother is terrible with money and I know she's not saving at all for her future care. Figuring out what to do will fall on us, her children. My father? Who knows. After a life time of smoking, drinking heavily, eating poorly and working high stress jobs, I'm kind of not expecting him to live very long. I feel morbid saying that. But his wife is in good financial shape so I'm just less worried about having to afford elder care for him.

[Chris in VA]

I agree with Jane in NC that the model has been to sell your house and use the proceeds to fund your care.

It's outdated, and skewed against the poor, that's for sure.

 

I looked into longtime care at a place that has levels of care, across the street from me. It's a wonderful facility, and I wondered what it would cost.

 

The upfront costs are high--I'm sure they are thinking that there is a house to sell to pay it. Houses around here are very expensive, so the facility entrance costs are not really THAT high for many who are thinking of moving there. And it was first marketed to retired military officers, too.

 

1 bedroom, 1 bath apt with 90% refundability is ~156K, with a monthly fee ~2600. With 0 refundability, it's ~100K with the same monthly. INcluded in that is a daily main meal, security, grounds maintenance, recreation (they have a pool and are on 7 acres with a small lake), and all medical fees--you can go into assisted living or full-time nursing care with no increase in fees, I think.

 

Anyway, yes, it costs a lot. But I would love to have my parents here! They are in their 80s and I really wish they'd move. I think they could get about 100K for their house, and IDK if they could pay most of the fees monthly, but I am hoping I could convince them. I don't think I am enough to lure them here after they've lived so long in NH, though. They did say they will move if one of them dies.

 

I guess you are caught a bit in the financial "trap" of our generation, between kids and parents. Sorry--it's hard.

 

 

[Anne in CA]

I am not too worried about my own parents, all of their parents avoided long term care and both of my parents are in stellar health. My MIL is a heavy smoker with a bad heart and I am shocked she has lived to the age of 70. I honestly did not think she would make it this long and her husband is 8 years younger than she is and takes care of her.  He never planned for retirement because no man in his family has EVER lived past the age of 56. Until now. He has already lived much longer than he thought he would. He works part time from home and takes care of MIL and they have a lovely home they could sell to fund the care they need, so I don't worry too much about my IL's either.

 

My own plan for dh's and my own long term care is to not spend the small amount of saved retirement we have and sell the restaurant to pay for it. I will fund my retirement by leasing the restaurant, not the best plan, but the best one I can come up with. When we have real medical issues we will kill the goose and take the egg, lol.

 

 

[fairfarmhand]

 

They had to sell all their assets and use that money first before they qualified.  It's very sad I think for people that have worked all their lives who want to maybe just leave a few thousand dollars to help their kids along, but then have to use EVERY DIME before they can get any kind of coverage.  It's a horrible system.

 

And what about when one spouse dies YEARS before the other one?

 

This whole conversation makes me sick because we are facing this with a family member. One spouse is decently healthy, but has a chronic condition that would keep her from working. The other is looking at a year or two left, possibly in a situation needing nursing home care due to mobility issues.

 

What in the world is the surviving spouse supposed to do? If she sells it all, what will she have left to live on for maybe 2 decades?

[QueenCat]

And what about when one spouse dies YEARS before the other one?

 

This whole conversation makes me sick because we are facing this with a family member. One spouse is decently healthy, but has a chronic condition that would keep her from working. The other is looking at a year or two left, possibly in a situation needing nursing home care due to mobility issues.

 

What in the world is the surviving spouse supposed to do? If she sells it all, what will she have left to live on for maybe 2 decades?

 

If there is still a spouse who doesn't need to go into a nursing home (or something else), they use a formula to determine how much has to be contributed but they don't take the house or all of the money away from the other spouse.

[Halftime Hope]

We've recently met with two retirement financial advisor types, and in two weeks I'll have a consultation with an insurance agent who specializes in health plans for those with Medicare (medigap and supplemental plans, and whatever else people get or think about getting)

 

The financial advisors have both told us that, at one point, people bought a lot of long term care policies, and many companies were writing them. But now, given the huge cost increases in all medical care and elder care, the number of companies interested in funding long term care is hugely diminished, and the yearly premiums have gone up astronomically.  Apparently many of their clients had LTC insurance but have dropped it.

 

I'm going to ask the insurance agent if she has seen the same thing, and I'll see if she has the same take on it.

 

We have told my dad that he needs to consider the proceeds of selling his house to be the fund for his care.  He is very resistant to the thought of spending it, but the cost of an in-home caregiver, even an unskilled one, is very, very pricey--since Jan, he's spent over $12K on in-home care.

 

You generally can't just hire a college kid to come over and "sit with granny" once you cross into areas like someone needing help for bathing.  And that doesn't even take into account the risk to the family if a caregiver gets hurt on the job if she is an independently hired contractor, vs. an employee of a caregiving business.

 

Sigh. 

[Guest]

I am in the middle of this stuff as re: my parents and my dh's parents, and have watched my grandparents go through the end of their lives.  

 

A couple of things that are helpful to remember.  Medicare pays for assisted living only so long as one is recuperating from an injury or illness.  Eg, my MIL has broken her leg (each of them, now...) and after the 3-4 days in the hospital, she has been moved to a facility where she can be helped to the fullest recovery she could achieve...and that doesn't mean "as good as new!" or even "as good as she was before she broke her leg."  This last time, we were seriously unconvinced she could live alone, so my dh whisked her away to our beach house and they stayed there for 3-4 weeks.  Then her daughter came and stayed with her for 2.5 months.  Now she is on her own again in her apartment, and she is able to get by.  My dh does her grocery shopping and takes her to the doctor appointmsnts and gets her meds for her.  If I were in her situation, I would rather be in assisted living, getting my food cooked for me--it is really an enormous chore for her to make a sandwich at this point--but she's a hermit.  

 

I have further observations I could make, but I'm going to stop, and express a couple of experience-based opinions:

 

People who plan ahead end up better off.  That means not just planning ahead financially, but getting ahead of the curve as far as what you are capable of doing.  My parents have done pretty well in both areas.  They downsized a number of years ago and got rid of a yard they could not maintain and were not willing to spend their nest egg having done for them.  My mom scraped together a very good retirement, going back to every single job she had ever had and finding out what retirement benefits she was owed, and securing them.  She gets about 15 checks a month from different sources--one of them for about $35--but she GOT it.  She invested wisely on the sale of their house, and they live on far less than this income, so the nest egg is bigger now that she is 90 than it was when she was 70.  THIS through the recession, dot.com bubble-burst, and everything.  They were careful and they planned ahead financially and *pretty well* living-wise.  The one thing I wish they had done when my dad started to fail a couple of years ago was to go pre-plan and pre-pay for their "final" costs--burial, funeral, etc.  We are in the middle of that effort now, and it is painful.

 

My grandparents didn't do a good job of planning either financially or life-wise, and it ended up being a 3-ring circus keeping up with their demise.  My grandfather DID pre-pay his burial/funeral expenses and that was a lifesaver.   He also pre-planned.  No one knew he had done so until he died, but it was a great help that the family didn't have to deal with all that.  My grandmother ended up at her daughter's home, then in memory care on Medicaid.  The family had to chip in together for the funeral/burial expenses AND for the disposition of all her junk (she had an enormous storage thing of "treasures" she would never part with....and no one wanted a single thing...it was alll junk).  Anyway, that was an example of very bad planning on both the financial and the life capability end of things.  

 

My in-laws did a terrible job of both financial and living and my FIL ended up in memory care on Medicaid, and my MIL living solely on her social security check.  She recently had a surprise windfall which has taken the edge off, but if she had to go to assisted living, it would not get her more than a couple more years before Medicaid...  

 

 

So--plan ahead and get ahead of the curve.  And when you retire (or sometime while you still have your brains in) get the paperwork in order--Power of Attorney, Health Care Directive, and pre-pay your funeral.  If you don't, and you end up on Medicaid, you will leave your family in the lurch.  Medicaid cant touch a pre-paid funeral, like they can financial gifts given to children to pay for funerals.  

[Guest]

We've recently met with two retirement financial advisor types, and in two weeks I'll have a consultation with an insurance agent who specializes in health plans for those with Medicare (medigap and supplemental plans, and whatever else people get or think about getting)

 

 

---SNIP---

 

We have told my dad that he needs to consider the proceeds of selling his house to be the fund for his care.  He is very resistant to the thought of spending it, but the cost of an in-home caregiver, even an unskilled one, is very, very pricey--since Jan, he's spent over $12K on in-home care.

 

You generally can't just hire a college kid to come over and "sit with granny" once you cross into areas like someone needing help for bathing.  And that doesn't even take into account the risk to the family if a caregiver gets hurt on the job if she is an independently hired contractor, vs. an employee of a caregiving business.

 

Sigh. 

  THIS.

 

My dad needed help putting on his elastic socks.  He's diabetic and it matters.  My mom couldn't do it--she's older than he is, although in better shape.  I looked into getting someone to come by and put on his socks.  $60.  It's $20/hour with a 3 hour minimum--that's pretty standard.  And guess what!  He needed help to get them OFF, too!  So $120 a day to deal with SOCKS.  

 

I know there are ways around this...and I'm happy to talk to anyone about it...but you get my point.  

 

My parents resolved the issue by getting a big gorgeous apartment that had enough room for my sister to live in; she paid no rent, and put on and took off socks (and did other stuff).  Her "part" of the rent would be $700.  I'd say my parents got quite a deal out of that arrangement.  It's been pretty good for my sister, too.  But this is not a possibility for every family.  *I* coudn't have picked up and moved to deal with socks.  

 

One way to deal with this is to live in a retirement community.  The community pays for a CNA to come to the community for the 3 hour minimum and the community splits the CNAs time in 15 minute increments, and pays for that portion.  So my dad could have paid for 2 15-minute increments daily, and a 1 hour increment three times a week for a bath...see what I mean?  Heck, my mom could have paid for a 30 minute increment once a week and have been done with vacuuming forever!  

[Guest]

I'm reading the other thread and I'm shocked at the prices of assisted living. I was trying to research it and found that medicare does not pay for long term care. So how then do people afford such high prices? I wouldn't even be able to pay $1000/mo let alone the over $2000 and even much higher cost of long term care. My mom only has Humana which is a type of medicare that I don't understand. If it doesn't cover senior type living facilities, how do families handle this? I'm assuming she'll have to live with me but if her care gets beyond what I can handle, what am I supposed to do?

 

 

It is not unheard of that people spend *years* in the most expensive level of care...but in my family, it has been a very short-term situation.  My dad, it was less than 2 weeks.  My grandmother, less than 2 months.  My other grandmother, 6 weeks.  By the time MOST people are in need of skilled nursing, it is not a long-term situation.  (YES there are exceptions.  But I am speaking *in general*.)  

 

Assisted living can cover a wide range of services.  

 

I know of someone considering this right now.  Income is flat and is $1800/month.  Savings $25,000.  

 

Current rent:  $1400/month

Current utilities:  $300/month

Current food:  $250/month

Other expenses:  $200/month (this includes supplemental Medicare, which has been a GREAT decision)

 

OK, so I found an assisted living apartment that would be $3200 month.  They will segue to Medicaid when her money runs out.  She will still have the flat income.  

 

Her current monthly layout is $2150/month.  Call it $2200.  (Easier math.)  

The assisted living monthly would be $3400 (she still would have the "other" category to pay.

 

At the delta of $1200/month, she would use up her savings in about 20 months, and then Medicaid would kick in and pay the delta.  She's 90 years old.  

 

I'm thinking she can do this.  I wish she would use some of the savings right now to pre-pay her burial expenses so that doesn't fall on her children.  It would make Medicaid kick in sooner...  

 

There are better facilities, and there are worse ones.  I'm hoping that my dh and I get off our butts in time to take the steps to be happy with where we land.  I have a feeling that part of that has to do with where one ends up but MOST of it comes from inside, anyway.  

[texasmama]

We encountered this with dh's grandmother in the past several years.  She was in assisted living and then memory care for a total of about 3 years.  Her monthly income covered the costs.  At the end of her stay in memory care, the bill per month was about $4000.  The care was shoddy, though, and we brought her home for the last two months of her life.  She was on hospice care, which paid for most equipment, most medications (but not all), a CNA for bathing, an RN, diapers, and gloves.  We used her monthly income to pay for hired help overnight and for when we needed to leave for short periods during the day.  I cared for her 80 hours a week at no cost to her.  24/7 care in home is cost-prohibitive.  She had income from her home, which was rented, and an adequate monthly income from SS and a teacher's pension.  And she had family who was willing to provide free care.

[Jane in NC]

Patty Joanna--great posts! 

 

One of the greatest problems in dealing with the issue of aging is that none of us really wants to consider it.  My discussions with my parents went along the lines of:

 

"Where would you guys like to be when you can  no longer live independently?"

 

"We'll deal with that when we need to."

 

End of discussion.

 

My parents each lived until they were 87.  My Mom died at home under Hospice care, as I mentioned earlier.  The last year of her life was compromised but with assistance she could at least be at home--even if her movements outside the door were limited.  Here was the deal with my parents though which I think is pretty typical:  they compensated for each other.  My Mom could not reach for things in higher kitchen cupboards, my Dad could not reach things in lower cupboards.  So they assisted each other.  As Mom was dying, Dad was not just losing a companion, he was losing a person who helped him hobble through his own aging process.  (One thing in their favor:  they had downsized to a one bedroom apartment so they did not have yard care, maintenance, or a lot of stuff.)

 

I recently spent two weeks with an elderly friend who lost her husband in the spring.  My elderly friend can no longer drive due to a medical issue, so she lost her driver as well as her husband.  Mentally she is in great shape though.  One of the things that I did was hook her up with an organization that helps seniors stay in their homes.  There is a fee involved but the organization offers assistance like rides, help with toting trash cans to the curb, help with technology.  These are not long term care issues, but ones that may help seniors maintain independence slightly longer.

 

One of the things that my sister just witnessed in her husband's family was a situation involving an elderly aunt who was released from hospital care but could not return home because her home had too many stairs and a bathroom that was not wheelchair friendly.  Downsizing and moving into a home that can be adaptive is something that is challenging for people who have been in place for decades. 

 

Frankly I want to control my destiny which is why I think about this stuff now.  Or maybe I am just reacting to how my parents just did not want to deal with it.  (When my Dad needed a nursing home, there was no shopping for the best one.  It was just a matter of finding one with an open bed!)

[Night Elf]

My mom and stepdad are not in a good financial place. They have about $5,000 in savings and live strictly on SS now. My stepdad did work part-time until March 1st when he had a bad auto accident. He's expecting to go back to work at the end of this month but he can't even go out for a couple of hours without feeling totally exhausted. If they are gone more than an hour, he comes home and sleeps hard for 3 to 4 hours. I think he's being totally unrealistic about returning to work, but I can see why he feels obligated to do so. They'll have hospital and doctor bills start coming in and mom doesn't know how they will pay for them. They do not own a home. They rent an apartment. Mom also takes care of my 92 year old grandmother. If Mom and stepdad can no longer afford to live on their own, I don't know what they are going to do. My grandmother has a 3 BR house but doesn't want anyone to live with her. I know my grandmother is leaving my mom some money in her will but I have no idea how much. What if we took that money and used it to help us buy a new house for all of us in our names only, but she still needed to use medicaid at some point. Will they want her inheritance money even though it is spent?

[Guest]

...snip...

 

Will they want her inheritance money even though it is spent?

 

I don't know but my mom was really up on this issue and she started giving us big chunks of money (for her) 10 years ago, expecting that at 82, she was in her "latter days" and knew that Medicaid can go back and claim "gifts"  up to five years prior to accepting someone as a Medicaid recipient.  She's 92 now and the "gifts" have dried up because she's pretty sure she's in the 5-year limit.  However, she does just pay a bill or two here and there.  :0)  

 

I wouldn't mess around with this.  I'd find out from a lawyer what to do.  If you are seriously concerned that your mother will completely waste her inheritance, you have a couple of options: 

 

1.  talk to Grandma now and see if she will put the inheritance in a trust with a trustee NOT yourself who will make sure that your mom doesn't just throw it all away, or 

 

2.  decide right now, and perhaps tell you mom, that your family doesn't have the resources to take care of her in case she needs long-term care, and that she needs to be careful with any windfalls and with the current cash she has.  And hope that she will be happy with what Medicaid can provide.  It's not nothing, but it's not high living, that is for sure.

 

Most of the time, the Little Talk won't make a difference, but if it does, yay.  

 

My FIL made his financial plan based on the assumption that he would work until the day he died, and that his house would sell for a million bucks.  Then he got dementia and the housing market crashed.  He couldn't work for the last 7 years of his life (no income) and the house couldn't be sold at ALL and ended up in foreclosure, so zero income from that.  

 

The assumptions make all the difference.  

 

Assume the worst, and make your plans based on that, and then hope for the best!

[Guest]

---snip---

One of the greatest problems in dealing with the issue of aging is that none of us really wants to consider it.  My discussions with my parents went along the lines of:

 

"Where would you guys like to be when you can  no longer live independently?"

 

"We'll deal with that when we need to."

 

End of discussion.

 

My parents each lived until they were 87.  My Mom died at home under Hospice care, as I mentioned earlier.  The last year of her life was compromised but with assistance she could at least be at home--even if her movements outside the door were limited.  Here was the deal with my parents though which I think is pretty typical:  they compensated for each other.  My Mom could not reach for things in higher kitchen cupboards, my Dad could not reach things in lower cupboards.  So they assisted each other.  As Mom was dying, Dad was not just losing a companion, he was losing a person who helped him hobble through his own aging process.  (One thing in their favor:  they had downsized to a one bedroom apartment so they did not have yard care, maintenance, or a lot of stuff.)

 

I recently spent two weeks with an elderly friend who lost her husband in the spring.  My elderly friend can no longer drive due to a medical issue, so she lost her driver as well as her husband.  Mentally she is in great shape though.  One of the things that I did was hook her up with an organization that helps seniors stay in their homes.  There is a fee involved but the organization offers assistance like rides, help with toting trash cans to the curb, help with technology.  These are not long term care issues, but ones that may help seniors maintain independence slightly longer.

 

One of the things that my sister just witnessed in her husband's family was a situation involving an elderly aunt who was released from hospital care but could not return home because her home had too many stairs and a bathroom that was not wheelchair friendly.  Downsizing and moving into a home that can be adaptive is something that is challenging for people who have been in place for decades. 

 

Frankly I want to control my destiny which is why I think about this stuff now.  Or maybe I am just reacting to how my parents just did not want to deal with it.  (When my Dad needed a nursing home, there was no shopping for the best one.  It was just a matter of finding one with an open bed!)

 

After watching my parents go through the Three Ring Circus of End of Life(ETA)with my Dad's parents, I sad down with my mom and dad (end Edit) and told them that I would be really angry with them if they put me through this.  My mom had everything together as re: paperwork, but the downsizing and so on...not so much  I am so thankful they got after it and made their moves.  

 

My parents did the compensating thing, too.  Lately my dad had become less mobile, but for a few years now, my mom has taken him with her as he is a great navigator but a terrible driver.  But that also meant putting his walker and then his wheelchair in the trunk.  Can you IMAGINE????  My mother is ***92*** years old!  I could barely lift those things.  Mom did the cooking, but Dad made sure the stove was turned off...that sort of thing.  Now, it is a good thing my sister lives with them, but she is at work all day.  

 

The problem with waiting too long is that your body is not likely to have the level of energy it has now to deal with stuff.  I am only 57 years old but about 6 months ago got slammed with a protruding disc and a lot of pain and some days I can barely move.  So all that stuff that needs to disappear out of the garage???  Still there.  It's a ball and chain at this point.  We will get it done, but it is a greater cost to our time and experience of pain.  

 

No one ***wants*** to go to assisted living when they are younger.  And REALLY, no one wants to go to a nursing home either.  But by the time my dad was in his last days, he needed the care and pain management of a skilled nursing facility and was GLAD that he had the option, and had not put a burden of guilt on us to "never put him in a nursing home."  He got the pain meds he wanted/needed, the advanced technology care and he got to quit worrying about how he was wearing out my mother and sister who had 24/7 responsibility, and by the way, are NOT medically-trained in any way.  He knew he was safe in the nursing home.  

 

He probably would not have predicted that reaction even three weeks earlier.  His decline was precipitous and I am very thankful that he left his options open both financially and in his attitude.  

[texasmama]

One of the most stressful parts of taking care of my husband's grandmother was that she and her husband lived as though they would never die.  They did have a will, but that is about the extent of it.  I had to become Nancy Drew, girl detective, to locate her financial information.  In the end, I discovered a small life insurance policy that no one knew of.  She never changed the beneficiary of her policies or her pension after he passed.  I typed up a Durable General POA using my dad's as a guide so that dh could manage her affairs.  Some of the issue is that as her situation changed, they changed nothing.  A life insurance policy beneficiary was chosen in 1970.  She expressed verbally to us what she wanted at times through the years, but she never took the extra step to make her wishes official.  There is only so much a POA can do (yes, there are limits).  Or companies make it difficult for a POA to get ahold of the accounts purposefully to avoid people being stolen from.  However, we weren't stealing - we just needed access to her money to provide for her needs.  It was much more of an arduous process than it should have been if his grandparents had made better decisions.

 

My own grandparents were very organized and purposeful.  It made things easy.  My dad is the same, and I have copies of all paperwork.  

 

My dh had to go purchase burial plots when his grandfather passed away four years ago at the age of 98.  I suppose these folks thought they would live forever and never need to be buried???  It is a burden on the family to have to do these things.  In addition, they are expensive.  All of my dad's arrangements are made except for a memorial service (he is donating his body and then being cremated).  One of my ancestors purchased a huge group of burial plots many years ago, so that is where I will go.  

[texasmama]

No one ***wants*** to go to assisted living when they are younger.  And REALLY, no one wants to go to a nursing home either.  But by the time my dad was in his last days, he needed the care and pain management of a skilled nursing facility and was GLAD that he had the option, and had not put a burden of guilt on us to "never put him in a nursing home."  He got the pain meds he wanted/needed, the advanced technology care and he got to quit worrying about how he was wearing out my mother and sister who had 24/7 responsibility, and by the way, are NOT medically-trained in any way.  He knew he was safe in the nursing home.  

 

Having just bragged on my grandparents for being organized and planning ahead with end of life issues, I will now chime in and say that they moved into a three tiered facility (independent, assisted, nursing home) very early, a good twenty years before they passed away so as "not to be a burden" on family.  But then they proceeded not to want to move up to the next level when it was painfully clear that my grandfather was not physically capable and my grandmother not mentally capable of being alone.  They propped each other up until finally we insisted that she go to the nursing home due to advanced dementia.  Family provided all the assistance while they stayed in their independent apartment far longer than either of them should have.  My grandfather stayed in his independent apartment after she moved to the nursing home portion of the facility, but he fell out of his scooter constantly so the downstairs neighbors would hear him fall, call the front desk, and they sent someone to help him.  

 

I think this is very common.  People make plans and then, in the end, who wants to live in a nursing home?  They both ended up there eventually much later than they should have.  And it was a burden on family, exactly the type of burden they were trying to avoid, ironically.  I hope I will choose differently when the time comes, but I have no idea.  Your world becomes small when you are elderly and infirm, and I can understand not wanting to take that last step to the grave.

 

While I am at it, my other grandmother spent all of her money traveling around the world so when she needed care, her kids had to come together and provide it for a couple of years prior to her death.  My uncle spent every night at her house, and my aunt and dad traded off going during the day.  Hospice came in to help at some point, but they only come 24/7 at the very end.  Fortunately, she had family willing to help her, but it forced their hand to do so because there was no good alternative for her situation.

[texasmama]

My dad is funny and completely practical and unemotional.  He told me that when I get his ashes back from the medical school donation facility, to go out under cover of darkness and spread them around the family plot, not to spend the money to have someone dig a hole and bury the box.   :lol:  So I went with it, and told him I would take a cheap engraving kit out there and write his date of death, too.  Why pay good money for a professional to do it???  He suggested just leaving it off altogether, to which I replied that at least I could write it with a magic marker. :lol:  :leaving:

[Orthodox6]

If there is still a spouse who doesn't need to go into a nursing home (or something else), they use a formula to determine how much has to be contributed but they don't take the house or all of the money away from the other spouse.

Who is the "they" referenced? A care facility cares not a speck about how much money a spouse has. Price is price.

 

Thanks!

[Orthodox6]

accidental DP

[Halftime Hope]

Fortunately, we had helped my parents do all the paperwork, i.e., POAs, wills, medical directives, medical POAs, and so on, because my mom had a terminal cancer diagnosis.  What we didn't know when we finalized all of this was that she would only live an additional 6 weeks.  (It was sad in one way, but definitely a reason to be thankful: she did well for many months and then died, did not have months of horrific suffering.)

 

They have a burial plot, but we need to get dad to pre-pay the funeral home so that $$ doesn't have to be spent to qualify for Medicaid.  The way he's thinking now, it's going to be difficult to do. 

[Orthodox6]

All I know are laws for Texas. A person on Medicaid here may not (house does not figure in most of the time), at any time have assets of more than two thousand dollars. Firm requirement.

[Orthodox6]

My mom and stepdad are not in a good financial place. They have about $5,000 in savings and live strictly on SS now. My stepdad did work part-time until March 1st when he had a bad auto accident. He's expecting to go back to work at the end of this month but he can't even go out for a couple of hours without feeling totally exhausted. If they are gone more than an hour, he comes home and sleeps hard for 3 to 4 hours. I think he's being totally unrealistic about returning to work, but I can see why he feels obligated to do so. They'll have hospital and doctor bills start coming in and mom doesn't know how they will pay for them. They do not own a home. They rent an apartment. Mom also takes care of my 92 year old grandmother. If Mom and stepdad can no longer afford to live on their own, I don't know what they are going to do. My grandmother has a 3 BR house but doesn't want anyone to live with her. I know my grandmother is leaving my mom some money in her will but I have no idea how much. What if we took that money and used it to help us buy a new house for all of us in our names only, but she still needed to use medicaid at some point. Will they want her inheritance money even though it is spent?

If money is left to your mother, it belongs to her. More prudent and honest (thinking also of government scrutiny which most definitely occurs) to work with an eldercare attorney. I was surprised by how beneficial to us the lawyer's efforts turned out. Well worth the financial investment.

[Halftime Hope]

Who is the "they" referenced? A care facility cares not a speck about how much money a spouse has. Price is price.

 

Thanks!

 

My understanding of how it works:  when an elderly person applies for Medicaid to cover the cost of assisted living/nursing home/memory care, their assets have to be spent down to a certain level, $2K I believe, before Medicaid will kick in.  If one spouse does not need to be in the facility, the house the spouse is living in does not have to be liquidated to get down to $2K cash.  The spouse is allowed by the government, in the form of Medicaid administrators, to retain some money for his/her care and upkeep.

 

http://www.elderlawanswers.com/medicaid-protections-for-the-healthy-spouse-12019

 

They would be the Medicaid bureaucracy.

[Orthodox6]

My understanding of how it works: when an elderly person applies for Medicaid to cover the cost of assisted living/nursing home/memory care, their assets have to be spent down to a certain level, $2K I believe, before Medicaid will kick in. If one spouse does not need to be in the facility, the house the spouse is living in does not have to be liquidated to get down to $2K cash. The spouse is allowed by the government, in the form of Medicaid administrators, to retain some money for his/her care and upkeep.

 

http://www.elderlawanswers.com/medicaid-protections-for-the-healthy-spouse-12019

 

 

They would be the Medicaid bureaucracy.

My father retained all of his money, plus the house. He has lived with us for over three years now. I know I am repetitive, but I cannot too strongly encourage securing the services of a highly experienced eldercare attorney.

 

EDIT: It was my mother who went on Medicaid, not my dad. Also, Medicare and Medicare Supplemental continued to cover her medical needs.

[Guest]

My I-laws were renting at the time my FIL needed assisted living due to dementia. They had zero assets by then, only FIL's SS check. MIL kept getting SS check (less than $2000/month) and lived on that. FIL was 100% Medicaid.

[Orthodox6]

Interesting trivia regarding nursing homes and Medicaid. True for Dallas-area.

 

Here in DFW, nursing homes are moving away from advertising that they have Medicaid beds. You have to ask pointblank.

 

Not every nursing home is dual-certified. Many are certified for Medicare only. If Medicaid may be necssary in the future, hold out for admittance to a dual-certified facility.

 

It s true, and not a myth, that a person already living in a nursing home as a private pay resident receives priority in shifting to Medicaid status within that same nursing home.

 

It continues to be very difficult to enter a nursing home as a first-time resident if you already are on Medicaid. Private pay residents yield greater profits, and business practices favor those individuals.

[Halftime Hope]

My father retained all of his money, plus the house. He has lived with us for over three years now. I know I am repetitive, but I cannot too strongly encourage securing the services of a highly experienced eldercare attorney.

 

EDIT: It was my mother who went on Medicaid, not my dad. Also, Medicare and Medicare Supplemental continued to cover her medical needs.

 

 

This makes sense: according to the link the spouse may retain all the money and the house, if it is under a certain threshold. More money than the threshold would need to be spent down before Medicaid would kick in. 

[Orthodox6]

This makes sense: according to the link the spouse may retain all the money and the house, if it is under a certain threshold. More money than the threshold would need to be spent down before Medicaid would kick in.

It was my mother's assets that needed to be under $2000.00. The attorney removed her name from everything else, including the house. She retained only one bank account because the federal government required it for direct deposit of her social security check. If my father's total assets needed to be under some limit, I don't remember what that was. We definitely are not "millionaire folks". I do not understand or know what all the lawyer did to succeed with Mom's Medicaid application. I am confident that everything was fully legal, because this man's public reputation is both extensive and positive. He can't afford to be "a scuzzy lawyer".

[Guest]

I can vouch for what Orthodix said above, about securing a place in a dual-certified facility first as a private-pay client. Entering as a Medicaid client is harder.

[QueenCat]

Who is the "they" referenced? A care facility cares not a speck about how much money a spouse has. Price is price.

 

Thanks!

 

Medicaid doesn't require a spouse to give up their home or 100% of their cash reserves before qualifying someone.

[Orthodox6]

Medicaid doesn't require a spouse to give up their home or 100% of their cash reserves before qualifying someone.

I had not read whatever was the original post to which the ambiguous word "they" was replied. That post must have specified Medicaid. I thought writer was referring to a care facility.

 

Agreeing with you, as my posts about my parents explain.

 

No fun to go through the process, though!

[StephanieZ]

Self-pay:

 

-Retirement savings.

-Retirement income (social security, pension).

-Long Term Care insurance

-Kids help

 

Usually it is some combination of above factors. 

 

If you are without your own substantial financial resources, then options are more limited:

 

Run completely out of $$ and then Medicaid will pay for a Nursing Home only. They won't pay for anywhere for people who only need Assisted Living.

 

If you are on Medicaid in a NH, they take ALL your income short of a few measly dollars a month. So, your kids will still need to supplement to provide your clothing, hearing aids, etc, etc.

 

Being old doesn't guarantee you a nice place to live. You need income and savings and/or insurance if you want options.

 

Typical retirement goals are to replace 75% of your working-income stream, for life time (so maybe 20-25 years post retirement). So, if you now live on 10,000/mo, you want at least 7,500/mo. BUT, that is NOT enough for the more expensive AL or NH options. So, this is when you want to consider LTC insurance, etc. I'm thinking that unless your assets are so huge as to make it possible to self-pay indefinitely for AL/NH/in-home-care, then you really need LTC insurance . . .

 

Unless you are cool with going on Medicaid and won't use AL . . . Realistically, that is what most families end up relying on, as the other options require a lot, lot of resources. If you are relying on Medicaid as the fail safe, then I would look to make sure to do "Medicaid planning" well ahead of time to try to safeguard some cash, ideally in the hands of one or more trustworthy adult children, so they can pay for your misc needs (say 1k/mo or more) without using their own resources. 

 

 

[anneinco]

We are in the process of sorting through this with MIL. She has applied for medicaid and we are waiting for that process to start. Her spend down will be minimal. We are not looking at AL (nursing home) yet but it is close on our thoughts as we go through this process.

 

For at home care, she qualifies (in Washington state) for 129 hrs of care a month. Orginally it was 93, so the bump up, while I don't know why, was nice. With at home care she will be allowed to keep something like $980/mo. If she goes into a home, that drops to $60/mo.

 

While it will be best for her to keep her here, we don't know how we will do it long term, especially as she needs more care. I keep telling my husband we need to look at homes and start talking to them now, and he is dragging his feet. Weekend respite care (3days/2 nights) at home would cost around $600.

[SparklyUnicorn]

The short answer is a nursing home and Medicaid. Once someone can no longer live independently and has spent down her own resources, she will qualify for Medicaid to pay for a nursing home. The quality of care varies tremendously.

 

Yup this.

I worked in a nursing home.  Most of the people who lived there were not private pay people and it was Medicare that paid for it.  Medicare doesn't pay what it actually costs though.  To supplement their income the nursing home got into offering short term rehab services because that brings in more money.  So I think as a result the care overall in the place was not bad and bottom of the barrel.  Some of those places are bottom of the barrel though and it's very sad.

[Guest]

And not to be argumentative about how much people need for monthly expenses once they are in assisted living...but in my experience it is nowhere near $1000/month. No car, not enough energy to just "go shopping", not a huge wardrobe needed, food included in the rates, and so on. Haircuts / beauty parlor, cards and gifts for friends, stamps and stationery, that sort of stuff...but the monthly discretionary spend in assisted living is not a lot.

[anneinco]

And not to be argumentative about how much people need for monthly expenses once they are in assisted living...but in my experience it is nowhere near $1000/month. No car, not enough energy to just "go shopping", not a huge wardrobe needed, food included in the rates, and so on. Haircuts / beauty parlor, cards and gifts for friends, stamps and stationery, that sort of stuff...but the monthly discretionary spend in assisted living is not a lot.

Interesting question about this, since we could well be facing it. Let's say they allowed to keep $60/mo. If they have $2000 already in savings, will this be a use it or lose it situation? If they don't have needs that add up to $60/mo can they use it to buy gifts?

[Caroline]

And not to be argumentative about how much people need for monthly expenses once they are in assisted living...but in my experience it is nowhere near $1000/month. No car, not enough energy to just "go shopping", not a huge wardrobe needed, food included in the rates, and so on. Haircuts / beauty parlor, cards and gifts for friends, stamps and stationery, that sort of stuff...but the monthly discretionary spend in assisted living is not a lot.

Definitely. My grandma would ride the bus from her retirement/assisted living/nursing home to Kroger, but she never bought anything at Kroger. She just liked to chat with the bus driver.

 

Her care givers took very good care of her, bringing her doughnuts from her favorite bakery, keeping her company watching Ohio State games... I believe my dad did give them large tips every month or so.

[SparklyUnicorn]

And not to be argumentative about how much people need for monthly expenses once they are in assisted living...but in my experience it is nowhere near $1000/month. No car, not enough energy to just "go shopping", not a huge wardrobe needed, food included in the rates, and so on. Haircuts / beauty parlor, cards and gifts for friends, stamps and stationery, that sort of stuff...but the monthly discretionary spend in assisted living is not a lot.

 

I also worked in an assisted living place.  Depends on the place, but I believe it probably does actually cost upwards of that.  Where I worked they had people on staff 24-7.  All meals were provided including special occasion stuff like parties, birthdays, and holidays.  Someone cleaned their apartment.  If they dropped their remote while watching TV they could ring the call button and someone would come pick it up.  They had recreational activities including trips.  They had a small library, salon services, and laundry service.  They also had some medical staff for stuff like medications.  This was I'd say a middle of the road place, not necessarily posh.  Having these things makes life as close as possible to the life they may have had prior to needing assistance.  They didn't drive, but they had shuttle services and planned outings. 

 

I'm talking assisted living not nursing homes.  Nursing homes are expensive mostly because of the tons of medical needs.  At the assisted living place I worked we didn't even offer special accommodations for dietary needs. 

[Caroline]

So you think people were spending $1000 a month above and beyond what it cost to live there?

 

I also worked in an assisted living place. Depends on the place, but I believe it probably does actually cost upwards of that. Where I worked they had people on staff 24-7. All meals were provided including special occasion stuff like parties, birthdays, and holidays. Someone cleaned their apartment. If they dropped their remote while watching TV they could ring the call button and someone would come pick it up. They had recreational activities including trips. They had a small library, salon services, and laundry service. They also had some medical staff for stuff like medications. This was I'd say a middle of the road place, not necessarily posh. Having these things makes life as close as possible to the life they may have had prior to needing assistance. They didn't drive, but they had shuttle services and planned outings.

 

I'm talking assisted living not nursing homes. Nursing homes are expensive mostly because of the tons of medical needs. At the assisted living place I worked we didn't even offer special accommodations for dietary needs.