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Assisted Living - oh my, it's expensive.


Spryte
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A couple close to us needs to move to assisted living. They are currently in a faculty that offers it, though they are in the independent section. But their facility will no longer offer assisted living after June 1.

 

We have been calling and visiting homes in our area, and everything is just slightly out of reach financially. It is doable, on their income, but they have some loans to repay that make it not possible. Their income is too high to qualify them for the lower income facilities. They think they won't qualify for Medicaid to get the nursing they need because of the loans. Is that true? They can pay for their current needs easily, it's when we look at the cost of assisted living that it becomes insurmountable. They could do it for a few months, maybe even a year or two, but it creates a bleed that will eventually leave them with nothing left.

 

They both need assisted living, though their actual day to day needs are vastly different. I don't know how to help them.

 

What do people do if they can't afford the care they need?

 

A suggestion we heard was to have them move in to a facility, run through their money, and then hope Medicaid kicksin. But that feels dishonest to them, like they'd be tricking the facility into thinking they can afford it when they can't. Is that really what people in this position do?

 

They will not move in with family. Their care, from a distance, is becoming difficult. They have a lot of needs, so getting them closer to someone who can help (us) would be good. Easier than 3 - 4 hours in round trip driving on top of whatever help they need every week.

 

Any experience here? We need help.

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"A suggestion we heard was to have them move in to a facility, run through their money, and then hope Medicaid kicksin."

 

Honestly, this is what most people do. It's probably the most common modus operandi. Most nursing homes will take you in, suck up all the available money, then switch the person to Medicaid without a change in care.

Edited by Kinsa
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"A suggestion we heard was to have them move in to a facility, run through their money, and then hope Medicaid kicksin."

 

Honestly, this is what most people do. It's probably the most common modus operandi. Most nursing homes will take you in, suck up all the available money, then switch the person to Medicaid without a change in care.

Wow. Ok. Good to hear this from another source.

 

They do have long term care insurance as well, which will cover 3 years in a nursing facility. What they need right now is really assisted living without all the services a full nursing home offers.

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"A suggestion we heard was to have them move in to a facility, run through their money, and then hope Medicaid kicksin."

 

Honestly, this is what most people do. It's probably the most common modus operandi. Most nursing homes will take you in, suck up all the available money, then switch the person to Medicaid without a change in care.

 

Yep, that IS what they do. 

 

I think it is inevitable unless the person is extremely loaded. 

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Yeah, for my husband's grandmother her teacher retirement and social security from her dead husband wasn't nearly enough to cover the facility. Her money did run out and my husband and I just supplemented it. She had a 200 acre farm which we were strongly advised not to sell until after she died for tax reasons. So we just paid the difference as well as all of her medical and extra supplies. We just kept a running tab and got paid back when she died ( at 102 ) and we sold the land. I know that is not financially feasible. My guess is that medicaid won't cover a decent assisted living facility. It will only cover a true nursing home I think. Prayers. It is definitely a hole. We have long term care insurance for ourselves so our children won't have to do that. I realize that is not financially feasible for everyone.

They do have long term care insurance (see post above).

 

They won't accept any supplementing from other family members. Adamant about that, so unless they get to the point that we can do it without their knowledge, it won't fly.

 

It sounds like you were advised to protect your DH's grandmother's assets (re: not selling farm) which makes sense as I think the value of that probably greatly exceeded what she may have received if farm was sold to pay for care and then have Medicaid. So I think that's a different scenario and while it was best for your family, doesn't really apply to our dilemma. I'm glad she had good care, though, and lived a long life.

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It's also better in my limited understanding to get where you want to be because then many states have age in place laws that can protect you even apart from medicare. The mistake, as I understand it, is waiting until you no longer qualify for assisted living because your needs have become too great. You want to get in while you can.

 

I'm sure this varies greatly depending on state laws and individual circumstance, of course.

 

My grandmother is about to face running out of money in her assisted living. It's unclear what will happen. They got her in thinking she could get certain benefits from the VA that they denied her, in part because her income and assets were too great. Well, in the next year, they'll be zero. So, maybe she'll qualify then. 

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Assisted living is $3000 a month here. My mom's monthly income on social security is only $1100.00 and due to paying medical bills for my dad's cancer that were not covered by Medicare, she has no savings. The house is worth $15,000 because the market has dropped to the bottom here. (My brother's beautiful 2000 sq ft farm house , two acres, and barn are worth the sum total of $45,000.00 so it is really bad here.) No one can sell property in order to pay for help.

 

We are really struggling with being the sandwiched generation. At some point we will dump her place, pay for five months of assisted living, and then she will have to go to a nursing home on medicare/medicaid. It has become obvious recently that she cannot live with us. We were prepared to take her in, but with all that has transpired, it is not going to work. It would destroy my marriage, and my relationship with my children.

 

This country has a very pathetic system for helping the elderly that is for certain.

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They do have long term care insurance (see post above).

 

They won't accept any supplementing from other family members. Adamant about that, so unless they get to the point that we can do it without their knowledge, it won't fly.

 

It sounds like you were advised to protect your DH's grandmother's assets (re: not selling farm) which makes sense as I think the value of that probably greatly exceeded what she may have received if farm was sold to pay for care and then have Medicaid. So I think that's a different scenario and while it was best for your family, doesn't really apply to our dilemma. I'm glad she had good care, though, and lived a long life.

Some states will not pay anymore if one still has assets. Michigan changed its law in this regard. You have to sell your house and land and run through every last dime you have in order to get assistance. They go back several years in your records to make sure you did not try to hide assets.

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An elder law attorney will be able to tell you what to do with their assets and know current Medicaid laws. Consult should not be crazy expensive.

 

Yes! This is vital. It's what we did with MIL and basically we ended up having her house transferred to us, with permanent right of residence for her, as payment for all the care my husband had given her. This protected it and let her go on medicaid. 

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"A suggestion we heard was to have them move in to a facility, run through their money, and then hope Medicaid kicksin."

 

Honestly, this is what most people do. It's probably the most common modus operandi. Most nursing homes will take you in, suck up all the available money, then switch the person to Medicaid without a change in care.

 

This is how it works in the UK.  You pay fees until you have no more money, and assuming you are in a conditiona to require a nursing home, the government steps in to pay the fees.  You are required to sell your house, unless there is a spouse or dependent living in it, and use most of that money, before the government will start paying.  

 

Nursing homes start at between £600 and £1,000 per week around here.

Edited by Laura Corin
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Yes, we're finding that the very cheapest of facilities (which according to our friend who works in elder care is an old facility and not desirable at all) starts around $3K and goes up with fees added on for various care models (assistance with 2, 3, or 4 or more necessary living activities are extra and different costs, medication assistance is extra, etc).  That is for a shared room with a bathroom shared between 2 shared rooms (so four people using the bath).  For a couple, there is no break for living together.  So we're looking at a minimum of $6K plus we already know there will be $500 for one resident needing med assistance and I haven't even added all the other a la carte options yet.  It's just too much for this couple, if they have no assistance.

 

Of course, the more desirable facilities, that are rated better have a broad range but mostly start in the $6K per resident range.  Ouch.  

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I agree with the suggestion to consult an elder care attorney. I don't know all the details, but when my MIL needed to move from assisted living to a nursing home and was starting to run out of money, some sort of trust was created that allowed her to keep some money above the normal Medicaid amount, but after she died, anything left had to be paid back to Medicaid.

 

We were also told that it is typical for residents to start out as private pay in the nursing home and change to Medicaid as the money is used up. My MIL's very nice facility had a small number of Medicaid rooms that were just for current residents who had to change to Medicaid so that the residents did not have to leave when they ran out of money.

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Be aware that medicaid does not have an assisted living facilities, but they do have nursing homes.  The quality of the nursing home will be very poor compared to a well run assisted living.  If they are being able to afford independent living, does the facility offer additional services they can use.  Here, assisted living is $5000 a month.  This includes all meals, an apartment, transportation, all utilities, help with administering medications, reminders to shower and reminders to walk down to the dining room for meals.

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Medicaid doesn't cover assisted living, only true skilled nursing facilities, and even then only for the cost of a semiprivate room. As I understand it, an individual must also qualify medically to be admitted to a skilled nursing facility. I believe most elderly people have something that would qualify them, like being at risk for a fall, but a healthy 70yo who has simply run out of money might be up a creek.

 

Medicaid will conduct a lookback to examine how any assets were acquired and dispersed during the 60 month period prior to the application date, and will penalize (require payment before kicking in benefits) in any amounts that are determined to be funds given away or hidden to evade paying for one's own needs prior to asking for government assistance. It's brutal, but there is so much fraud in the system, I suppose this is the government's way to prevent it. It's so complex, people who aren't downright destitute for a number of years (so a simple application) often require an attorney to prepare the application (ime at a going rate of $250/hr). It's a shame, because those 5 years leading up to a person's need for a skilled nursing facility are the ones in which a cognitively impaired or cash desperate elder is most likely to make a mess of their personal finances, which can have a serious effect on their eligibility for Medicaid. Furthermore, though it is a federal program, it is administered at the state level. Each state has its own level of "challenging" for getting through the process.

 

The sandwich generation should really be more like the Cuban sandwich generation, by which I mean it is not just sandwiched, but steamed and pressed in the process. Every person with parents who aren't independently wealthy and every person who has children really needs to learn the ins and outs of Medicare & Medicaid (they are NOT the same thing!), and have a solid plan for finances in aging, a good decade before the need for long term care arises. I believe firmly that I have the responsibility to make adequate plans for myself so that my children won't be burdened to the point of making them ill.

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Can they just hire someone to come in once or twice per day to do what they need? That should be a lot less expensive than a nursing home.

That is one of the options being considered. I think their care needs are reaching a point at which they need quite a bit of assistance. In home nursing here starts at $28 per hour, and one person will need it a minimum of twice a day, I think, the other may need more. We are also looking at a history of falling, and calling the EMTs to get up frequently.

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That is one of the options being considered. I think their care needs are reaching a point at which they need quite a bit of assistance. In home nursing here starts at $28 per hour, and one person will need it a minimum of twice a day, I think, the other may need more. We are also looking at a history of falling, and calling the EMTs to get up frequently.

When my grandmother started having some issues, but not enough to merit full need of assisted living, my Mom hired someone to live with her during the week. Then on the weekends my Mom or her sister would look in a couple of times a day. Even with 24/7 care it was cheaper than assisted living and got my grandma another 6 months of being in her own home, which was very important to her.

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As noted above, many facilities will accept private pay residents with the expectation that they will eventually roll over to Medicaid. However, as part of applying for admissions, the facility administration will need financial info. This helps them assess their financial risk. There are laws in place that protect a person from being immediately evicted should they run out of private pay funds but then not qualify for Medicaid. Nursing homes are businesses. If they anticipate a resident will need Medicaid in the foreseeable future, they can ask for a completed medicaid application to be submitted at the same as the residency application.

 

The "easiest" admission route into a nursing home (aside from bountifully adequate financial resources) is when there is a medical emergency and the elderly person goes straight from a hospital stay into a skilled nursing facility. In that scenario, there are case workers/social workers to assist in the process and Medicare covers the cost of the nursing home hopefully long enough for family members to work through the financial situation and construct the Medicaid application.

 

Please know that the info I share is based on my own experience and many hours of tears and banging my fists and head against a hard surface. Your mileage may vary, and I hope your trips are easier, but my advice for every person my age and younger is to prepare for the journey by having hard conversations now, before your folks are really wanting to talk about it.

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I wonder, can they get a roommate who is not a caregiver but who could reliably call for help if needed?

 

My inlaws were that for each other until my FIL suddenly passed away.

 

Now we are in the tough position of MIL wanting (fiercely, as most elderly folks do) to stay in her home, but not really being safe alone, but not really needing facility-based care.  It's a conundrum for sure.  Thankfully a more or less long lost relative has stepped up to stay there for weeks at a time, but she is 80ish herself, so that is not a longterm solution.  And she has a life, and can't do this continuously.  We are still figuring it all out.  (FIL died last month, so it's all pretty new.)

 

Over the years I have built up connections in the area where they lived, and I am reasonably confident that I could find her a good placement in a home that would not be outrageously expensive, but I want to respect her wishes to stay at her own place.  She can't drive or safely navigate stairs, so she is housebound unless she has help.  DH is going back there for a week in May, and I'm stopping in for some time in June as a side trip on a trip to St. Louis.  BIL is spending time there as well.  But none of us is close by.  If only we could just pop over every day and do a little shopping and cleaning, and make sure she was OK, that would be so reasonable compared to flying 2000 miles OR driving 3-4 hours each way (BIL) or 7-8 hours each way (long lost rellie.).

 

 

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I wonder, can they get a roommate who is not a caregiver but who could reliably call for help if needed?

 

My inlaws were that for each other until my FIL suddenly passed away.

 

Now we are in the tough position of MIL wanting (fiercely, as most elderly folks do) to stay in her home, but not really being safe alone, but not really needing facility-based care. It's a conundrum for sure. Thankfully a more or less long lost relative has stepped up to stay there for weeks at a time, but she is 80ish herself, so that is not a longterm solution. And she has a life, and can't do this continuously. We are still figuring it all out. (FIL died last month, so it's all pretty new.)

 

Over the years I have built up connections in the area where they lived, and I am reasonably confident that I could find her a good placement in a home that would not be outrageously expensive, but I want to respect her wishes to stay at her own place. She can't drive or safely navigate stairs, so she is housebound unless she has help. DH is going back there for a week in May, and I'm stopping in for some time in June as a side trip on a trip to St. Louis. BIL is spending time there as well. But none of us is close by. If only we could just pop over every day and do a little shopping and cleaning, and make sure she was OK, that would be so reasonable compared to flying 2000 miles OR driving 3-4 hours each way (BIL) or 7-8 hours each way (long lost rellie.).

Carol, I think your situation is a great example of why the Granny Pod thing needs to catch on in the USA. Our culture has grown into one that is spread out, close relatives live distantly, elder adults don't want to move and sandwich generation children can't move... it is a challenge.

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I agree with others that whoever has power of attorney to make decisions for the couple must consult a local eldercare attorney (with the couple themselves) to get answers and the proper paperwork in place NOW.   We went through this process with MIL & FIL when they moved into assisted living, then FIL's expenses skyrocketed when he needed memory care (more care than base "assisted living" but not enough to need skilled nursing care).

 

Qualifying for Medicaid is a long and very complicated process, and they will look at financial records (like gifts to charity and/or family members that may appear to be an intentional effort to reduce assets) for a number (5?) years from the time you start applying.   There is also a waiting list, and the number of beds available for Medicaid patients is limited.

 

Long term health insurance is also very difficult to implement.   Whoever has power of attorney should be familiarizing themselves with the paperwork NOW, before it's needed, because it's a whole new layer of bureaucracy to wade through.   That person, for instance, should have access through HIPAA release of information, to contact the elderly couple's doctors on their behalf, because you'll need letters from doctors to state that the qualifying conditions have been met to trigger the insurance to begin paying.    Again, an eldercare attorney should review the policy and give you recommendations there.    Not everyone who needs assisted living meets all of the qualifications for long term health insurance to pay for anything. 

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Carol, I think your situation is a great example of why the Granny Pod thing needs to catch on in the USA. Our culture has grown into one that is spread out, close relatives live distantly, elder adults don't want to move and sandwich generation children can't move... it is a challenge.

Right.

The new version of the Amish grandparents' house in the back yard.

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Yes! This is vital. It's what we did with MIL and basically we ended up having her house transferred to us, with permanent right of residence for her, as payment for all the care my husband had given her. This protected it and let her go on medicaid.

Great solution, yet it had tax implications for you, right? Just something everyone should be aware of as they plan how to help their elders.

Edited by Seasider
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I'm not sure about legally hiding money that could be used for elder care and forcing the taxpayer to pick up the bill. It's not something we are doing. I don't expect to inherit a penny of my mother's substantial funds. She is paying a strict share of household expenses while she lives with me, that's all. And when she needs further care, that's what her money is for.

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I'm not sure about legally hiding money that could be used for elder care and forcing the taxpayer to pick up the bill. It's not something we are doing. I don't expect to inherit a penny of my mother's substantial funds. She is paying a strict share of household expenses while she lives with me, that's all. And when she needs further care, that's what her money is for.

Yes. This is where we fall, too. No one here is interested in, even legally, hiding money. Though our case is not like many being discussed. There is no property or home. That's all been sold, as part of their planning and downsizing. They currently live in the independent wing of a three tiered facility, but the facility is phasing out assisted living just as the couple needs it. On June 1. The couple now absolutely needs assisted living, so we need a solution.

 

There are few, if any assets, and nothing substantial. There is a SS payment (x 2), and a pension. I'm not aware of anything else, but this is a hush hush generation about money, so there is probably a retirement account or something that will need to be, I suppose, depleted prior to Medicaid application. There is the long term care insurance, too. My understanding is that the SS and the pension is not enough to cover monthly expenses for both at an assisted living facility, much less a nursing home.

 

I suspect that a doc would agree that both need nursing. One is in a wheelchair with little to no use of legs, the other has severe heart and kidney issues and requires medication assistance among other things. There's more, but you get the idea.

 

I'm really at a loss. I'm encouraging them all to go the elder care attorney route.

 

This is all frustrating because the couple had planned and financed for this particular facility. They had done their legwork, and made their plans. To have it suddenly no longer available is a hardship.

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Great solution, yet it had tax implications for you, right? Just something everyone should be aware of as they plan how to help their elders.

 

Yes, but not too badly as it went into a trust at first or something? I really don't remember, it was a number of years ago. After she died we split the property proceeds with the other relatives. 

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Yes. This is where we fall, too. No one here is interested in, even legally, hiding money. Though our case is not like many being discussed. There is no property or home. That's all been sold, as part of their planning and downsizing. They currently live in the independent wing of a three tiered facility, but the facility is phasing out assisted living just as the couple needs it. On June 1. The couple now absolutely needs assisted living, so we need a solution.

 

There are few, if any assets, and nothing substantial. There is a SS payment (x 2), and a pension. I'm not aware of anything else, but this is a hush hush generation about money, so there is probably a retirement account or something that will need to be, I suppose, depleted prior to Medicaid application. There is the long term care insurance, too. My understanding is that the SS and the pension is not enough to cover monthly expenses for both at an assisted living facility, much less a nursing home.

 

I suspect that a doc would agree that both need nursing. One is in a wheelchair with little to no use of legs, the other has severe heart and kidney issues and requires medication assistance among other things. There's more, but you get the idea.

 

I'm really at a loss. I'm encouraging them all to go the elder care attorney route.

 

This is all frustrating because the couple had planned and financed for this particular facility. They had done their legwork, and made their plans. To have it suddenly no longer available is a hardship.

Are there any provisions in their residency contract that address this "what if" of that middle tier being phased out? That's a crummy thing to happen, but I imagine it was a business decision. Nursing homes are businesses, after all.

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Are there any provisions in their residency contract that address this "what if" of that middle tier being phased out? That's a crummy thing to happen, but I imagine it was a business decision. Nursing homes are businesses, after all.

I haven't looked at their contract, but my understanding is that it's all legal and just a business choice. There is new ownership and they are making a lot of changes - the facility is moving in a different direction, apparently. I do know that other residents have been moving out in droves.

 

ETA: some of the residents are moving to a facility farther away from us, and we are about 75 minutes already. The new place is significantly farther. It makes it harder to assist with doc appts and daily issues. We had moved as close as we could to them, just this past year, so that we'd be as close as we are now. For them to move farther... well, it's difficult. And I'm not clear that they can afford the place where other residents are going.

Edited by Spryte
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My grandmother has a 24-7 care attendant in her home paid for by I assume assistance of some sort.  Prior to that she had to basically deplete most of her savings.  Some of the money was legally diverted, but no most of it is gone and this is where she is at.  It's nice she gets to stay in her own home. 

 

 

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There are few, if any assets, and nothing substantial. There is a SS payment (x 2), and a pension. I'm not aware of anything else, but this is a hush hush generation about money, so there is probably a retirement account or something that will need to be, I suppose, depleted prior to Medicaid application. There is the long term care insurance, too. My understanding is that the SS and the pension is not enough to cover monthly expenses for both at an assisted living facility, much less a nursing home. 

 

I suspect that a doc would agree that both need nursing. One is in a wheelchair with little to no use of legs, the other has severe heart and kidney issues and requires medication assistance among other things. There's more, but you get the idea.

 

Check the paperwork on the long term care insurance.  We were in the process of getting it activated for my MIL when she had a very swift decline in her chronic lung disease and passed away within a week.   But DH and BIL had been working on the paperwork for a month prior to her decline.   Every policy is going to be different, but there were specific benchmarks - cognitive impairment, needs help transferring, needs medication management, needs help with ADLs, incontinence, etc. and a certain # of those benchmarks must have been met in order for the LTC insurance to start paying.   It was a lot of paperwork, phone calls to doctors, letters from doctors, phone calls to the ins. co., and so on.   I would get your hands on the policy and start working on that now, since there are obviously some potentially qualifying needs already noted, but it may take several months before they begin paying.

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Most of the assisted living facilities that take Medicaid take it only after you have been a paying resident for 5 years.  

 

They should get in there now.  If they run through their money, fat chance of finding assisted living when you start out on Medicaid.

 

We have been through this drill.  

 

And I don't know what people do if they don't have a retired and generous son living nearby so they can live in a low-income apartment and have all their shopping and doctor visit rides and so on taken care of.  It is a half-time job for my dh.  

 

 

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Just did some research. It is up to each state as to whether or not Medicaid plays a factor in assisted living. For example, in my state, Medicaid is only available for those with Alzheimers in assisted living who have exhausted their funds but are not ready for full nursing care. Otherwise, you need to be nursing care eligible and below the financial threshold for Medicaid help.

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We are really struggling with being the sandwiched generation. At some point we will dump her place, pay for five months of assisted living, and then she will have to go to a nursing home on medicare/medicaid. It has become obvious recently that she cannot live with us. We were prepared to take her in, but with all that has transpired, it is not going to work. It would destroy my marriage, and my relationship with my children.

 

This country has a very pathetic system for helping the elderly that is for certain.

 

The big problem we found is that the assisted living places and nursing homes determine which one they need, not us the family members, so even though "we" (being the extended family, not me/dh personally) felt a family member should go to nursing after about a year of assisted, said person was just under the requirements and was told "no", not until needs were greater. After another 6-7 months, she finally qualified for nursing and got some financial help.

 

And yes, our system for caring for the elderly is pathetic.

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Just did some research. It is up to each state as to whether or not Medicaid plays a factor in assisted living. For example, in my state, Medicaid is only available for those with Alzheimers in assisted living who have exhausted their funds but are not ready for full nursing care. Otherwise, you need to be nursing care eligible and below the financial threshold for Medicaid help.

.

 

Can you point me to how to find out each state's assisted living/Medicaid guidelines? Easily? I can obviously research but if you have a handy tip, I'd love it. Thank you!

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.

 

Can you point me to how to find out each state's assisted living/Medicaid guidelines? Easily? I can obviously research but if you have a handy tip, I'd love it. Thank you!

Just to be even more confusing, it can vary not only by state but by county.  

 

We dealt with this for assisted living/memory care for my FIL.  There are more spots for Medicaid-funded assisted living when there is an "issue". But the number of rooms available for Medicaid-only is very small.  

 

My MIL has benefited by a relatively small life-insurance policy on my deceased FIL, and she is relatively well.  For 93.  We looked into assisted living for her, and the amount of money in the life insurance would cover her for, oh, 5 months.  The facilities that take Medicaid *eventually* require 5 years previous residence.  

 

Only one facility in the area takes Medicaid from the get-go, so she'd have to spend down her insurance money before they will take her in.  

 

Her apartment rent was $100 less than her SS check, but to get into low income housing, which is $500 less than her SS check, she doesn't make enough money because they require 2x the rent in income.  Too poor to afford low-income housing, even though it will be less than she is *already paying* in regular housing.  And they won't count her savings.  

 

We finally got her in by some finagling.  But THAT was a lot of work.  More for my dh to do.  

 

Anyway, he dealt with two different states and with two counties within ONE state, and the rules are all over the map.  Or maybe some offices are just more obnoxious than others.  

 

Good luck to you.  I'm telling you for sure, I don't want to go into my old age without a LOT of money so the options are open.  It's rough out there.  

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.

 

Can you point me to how to find out each state's assisted living/Medicaid guidelines? Easily? I can obviously research but if you have a handy tip, I'd love it. Thank you!

 

I just searched "Medicaid Assisted Living" "states" and came up with several decent links. Didn't save them.

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This is not really a dishonest thing to do. Once you run through your money you will be indigent, and then Medicaid pays. That's the way the system is really set up to work; Medicaid pays when you have no more resources.

"A suggestion we heard was to have them move in to a facility, run through their money, and then hope Medicaid kicksin."

 

Honestly, this is what most people do. It's probably the most common modus operandi. Most nursing homes will take you in, suck up all the available money, then switch the person to Medicaid without a change in care.

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But here is how I would "run through my money."

 

I would get into a decent assisted living place that advances to nursing care and accepts Medicaid after 5 years of full pay.

 

They are much better facilities. And you have the ability to make more of the decisions. If you run through your money first and then have to rely on Medicaid only in your move to assisted living, the facilities are....lacking.

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Following.  I have one relative in a nursing home, put there last year, and it is a mess.  She is alone though, no husband.

And then I have my parents, currently living in a retirement facility but really needing to move to assisted living, and aren't.  I plan to address it more this summer when I go out there.  But their plan has always been to move to assisted living when one of them dies and since they both have lived (mom has lived far longer than we anticipated), they don't see the need because in their minds, the plan was to wait for one to die......they are so set in their ideas!

 

And it is hard from across the country to deal with any of it.  They can't move because they bought into this system at their retirement home and to move would be far too expensive at this point.  AND the weather in AZ is so much better for my mom who has all sorts of breathing issues.

 

We are looking at a move back to CA and part of that is to help with this.  Yes, we will still be 5 hours away, but it is drivable for long weekends, etc....but the move won't happen for prob. another year.

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That is one of the options being considered. I think their care needs are reaching a point at which they need quite a bit of assistance. In home nursing here starts at $28 per hour, and one person will need it a minimum of twice a day, I think, the other may need more. We are also looking at a history of falling, and calling the EMTs to get up frequently.

 

Do they need nursing care? Or would an assistant be adequate? 

 

Usually the sticking point is meds because states often regulate who can give meds---even though we all give them to ourselves and our dependents and our parents if they are around. 

 

It sounds like in your situation, if the parents would agree to moving close to a child who is willing to care for them that that would be an important first step. 

 

Even if they were to need full time nursing care, I strongly believe that people in nursing homes need to be visited very regularly to decrease the risk of abuse/negligence or just simple mistakes. 

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Wow, what happens when one spouse needs assisted living/nursing home and the other doesn't, but the healthier spouse isn't able to care for the other? Do they have to deplete their joint assets?

My grandparents legally divorced in their 80's. I don't know the ins and outs of it, but I do know it was a financial move.

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That is one of the options being considered. I think their care needs are reaching a point at which they need quite a bit of assistance. In home nursing here starts at $28 per hour, and one person will need it a minimum of twice a day, I think, the other may need more. We are also looking at a history of falling, and calling the EMTs to get up frequently.

 

Re: falling: Has the person falling had physical therapy for strength and balance and occupational therapy assessment of their environment and what hazards there are and what devises, etc. could help?  Those professions can make a tremendous difference. 

 

We helped our neighbor up when he had fallen for years before he went into a facility. Having a caring community around is also significant. 

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