deteriorating health in my parents! Advice needed.

[48Fire]

Quote:

Originally Posted by Mulligan Wow sure leaves this option open when talking to offspring..... Do you want to see $600 k plus 50k a year wasted on a fancy nursing home, or do you want to move in and help take care of me until I die and get the money instead? Sent from my iPad using Tapatalk

So if you have three children, one does 95%, one does 5%, and one of them barely picks up the phone to call, how should you spread the money?

[MichaelB]

I do not like the options that have large upfront lump sum costs. The problem is not the math, it's the risk. If the facility should fail for any reason and be unable to refund the money, DW or I might be unable to afford a similar or even decent option from that moment on. These operations do not have the financial transparency or scrutiny needed for this level of financial commitment.

[target2019]

Costs for a changing situation at CCRC for the last three years.
There is no down payment, and lease is month-to-month.
This is for a recently-built private entity in the Delaware Valley area.

Independent Living IL
1 bdr/1 den apartment w/ two residents, two meals each day
2012 - $52,000

Independent Living IL
1 bdr/1 den apartment w/ one resident
2013 - $42,000

Assisted Living AL
1 bdr apartment w/ one resident, three meals each day
2014 - $85,000

Memory Care Unit
1 room w/one resident, three meals each day
2014 - $90,000

In 2011, a similar facility had entrance fee:
-90% Refundable $275,000
-50% Refundable $210,000
and the lease was yearly. The monthly cost was higher at the time than what was chosen and described above.

[Mulligan]

Quote:

Originally Posted by 48Fire So if you have three children, one does 95%, one does 5%, and one of them barely picks up the phone to call, how should you spread the money?

Well for me, since it would be my money, and my desire to stay out of the home I believe you answered the question.


Sent from my iPad using Tapatalk

[Bestwifeever]

Quote:

Originally Posted by MichaelB Based on experience, I'm not confident DW or I will either recognize or accept the "right time".

Ditto--for us it can be payback time to the kids for the teenage years. I am most definitely making a joke.

A CCRC decision for oneself starting while still in the independent living stage of life (and I applaud everyone for their planning!) is very different than needing to move the parents into care from their own homes when they are too frail to be in any lower level of "assisted living", I imagine. MIL's small immediate town did not offer anything other than "nursing home" anyway when she was wheelchair bound after a stroke.

In a CCRC, there must still be some decision-making about when to move to different levels of care, which I imagine will still be difficult.

Tough times for all.

[target2019]

Quote:

Originally Posted by Bestwifeever In a CCRC, there must still be some decision-making about when to move to different levels of care, which I imagine will still be difficult. Tough times for all.

What we've seen is that a medical crisis pushes you (or decision maker) to the next stage. That is not to say it is easy. It is very difficult for all.

[W2R]

Quote:

Originally Posted by MichaelB I do not like the options that have large upfront lump sum costs. The problem is not the math, it's the risk. If the facility should fail for any reason and be unable to refund the money, DW or I might be unable to afford a similar or even decent option from that moment on. These operations do not have the financial transparency or scrutiny needed for this level of financial commitment.

I have had that thought as well. It seems like many/most of the more established, reputable places around here have long waiting lists of people eager to fork out six figure upfront lump sums, so they require them.

IF (and that's a big "if") I ever decide to move into a CCRC, I'll probably have to just consider the upfront lump sum as money spent and any promised refund as an unexpected bonus, if/when received.

[Brat]

Let's get back to the OP's situation. His father is in very bad health, his mother is depressed. They need help he and his wife can't provide long term. Other family members cannot provide the care the parents evidently need.

I found that parents in that situation are more willing to accept a temporary (2-3 month) stay in a care facility if they can stay together. There are options short of assisted living apartments such as what is called in our area 'adult foster care'. These residences are licensed and inspected by the health department, all have 24 hour staff.

Were I you I would contact your local licensing agency and obtain a list of these residences. Note those closest to your parents home address then look at their inspection reports. Visit the ones that appear acceptable to determine if your parents could be adequately cared for and content in that environment. Yes it is a lot of work but a lot less work that providing care yourself.

Don't skip the review of the inspection reports of ANY facility you are considering. Fancy doesn't insure better care. When my Mother needed care after breaking her hip the facility with the best care accepted Medicaid and thus many of the residents and the facility itself looked warn.

[Bestwifeever]

Here is an article I just read today--an interview with a consultant in Chicago who helps families in their nursing home search: What to Look for When You’re Looking for a Retirement Community | Chicago magazine | April 2015

She says about reluctance to move:

Quote:

What do you tell your clients when a parent is reluctant to go into a home? I worked for a long time as an admissions director at St. Andrew Life Center in Niles, and whenever I saw a child force a parent in against their will, the outcome wasn’t good. So I tell them to see if the senior can do a trial stay. They can see what the other people are like, taste the food, try the activities. I’ve had seniors come back and say, “Why didn’t I do this sooner?”

[braumeister]

Quote:

Originally Posted by Brat Don't skip the review of the inspection reports of ANY facility you are considering.

An excellent point!
The top rated nursing home around here (according to several prominent lists) had the absolute worst inspection reports of any within 100 miles.
My mother had spent several weeks there a few years before I learned this, and even then I could tell it was on a downward slide.

[Walt34]

Quote:

Originally Posted by MichaelB I do not like the options that have large upfront lump sum costs. The problem is not the math, it's the risk. If the facility should fail for any reason and be unable to refund the money, DW or I might be unable to afford a similar or even decent option from that moment on. These operations do not have the financial transparency or scrutiny needed for this level of financial commitment.

That's the part that makes me cringe too. While the CCRC will of course want a look at my finances, I'm going to be taking a hard look at theirs, with the assistance of an accountant and attorney.

This article is about five years old now but it does have some suggestions and warnings. The good news is that no one has been thrown out to the curb. Yet.

Quote:

Increasing numbers of older Americans are seeking out the security and comfort of a continuing-care retirement community. But a new report from the federal Government Accountability Office warns that such assurances often come at a steep price and "considerable risk."

Family Value: The Risks of Retirement Communities - WSJ

[Amethyst]

At the mention of "adult foster care," I couldn't help thinking of this short story by Patricia Highsmith...a suburban couple in their 30's "adopt" an elderly couple for a short stay, and it doesn't go as well as they had hoped. It's an implausible story, but there might be some cautionary notes of value:

Tales of Mystery and Imagination: Patricia Highsmith: Old folks at home

Quote:

Originally Posted by Brat LThere are options short of assisted living apartments such as what is called in our area 'adult foster care'.

[imoldernu]

Re: the matter of "choice".
Yes, choice, in advance of need... but the choice of 'whether or not', in my experience has never been that of the person needing care.
For our CCRC apartments, there is an absolute requirement that those living there as individuals, must be able to perform all normal life activities without outside help. In fact, in cases where it has become evident that a resident cannot care for him/herself, employees are not allowed to offer assistance. Necessary for insurance purposes, but also in respect for others who are living there.

I cannot recall a time when anyone that we've known has opted to go into a nursing home or assisted living only because it has been easier. In fact, while either facility often sounds like a dead end, very often it is not. Quite commonly, many of our neighbors... from the apartments or villas, will enter these facilities for periods from a week or so, after an operation or pneumonia. In other cases, a fall or broken hip may require a more extended stay, but still result in full recovery.

One of the reasons for our choice of moving into the villas, was to avoid the back and forth travel from a distant permanent home in order to visit. This became more obvious recently, when our neighbor, who was DW's best friend went into the nursing home in December for recurrent cancer. Her husband was able to visit with a 2 minute walk from his house to the center. It was a comfort for her to have him visit regularly, before she passed away two weeks ago.

When we are healthy, it is easy to look at assistance as something that would be optional... health aide, assisted living or nursing home.... I have never seen this, even from the strongest, most self sufficient people.

A word on cost. In our area, the cost of a non (medically) certified home health care aide is $18/hr, which works out to $432/day, or $158,000/yr. This, without any medical degree. Something to think about. Continuing care facilities operate on the basis of the economies of scale. Perhaps, at some future time, technological advances may enable lower costs, via refined monitoring and better human engineering, but until this hapens, and unless longer life is coincident with much better health in the future, the outlook for change is hazy at best.
.................................................. .........................
A reiteration of our plan... buying a home in our CCRC. Should either of us have to go into the nursing home for an extended period, that depletes our assets, the survivor will be allowed to keep the house, if and when medicaid has to take over the nursing home costs. Costwise, this looks to be more advantageous than a reverse mortgage.

Along with this... planning to leave an optimum legacy. If this has been discussed, would appreciate a link. Many of the members have more than enough to pay for their own extended care, but a discussion of how to optimize an inheritance should provide an interesting exercise. The time element... (a five year lookback) puts a premium on early planning, rather than waiting until the government takes their share.

[Amethyst]

An interesting and useful perspective, I think.

I don't know a single person who doesn't think "going to the nursing home" = "to die." Maybe in your community, the difference is that the nursing facility is close by, and going there doesn't necessitate selling the house.

Amethyst

Quote:

Originally Posted by imoldernu In fact, while either facility often sounds like a dead end, very often it is not. Quite commonly, many of our neighbors... from the apartments or villas, will enter these facilities for periods from a week or so, after an operation or pneumonia. In other cases, a fall or broken hip may require a more extended stay, but still result in full recovery.

[Cat-tirement]

Quote:

Originally Posted by LitGal (Mine has a Pre-Residency Life Care Program, whereby I pay 20% of the entrance fee now; but because I have passed the health screening and financial test, I can move in whenever I want, as long as it is by age 75..... even if my health falls apart.)

Interesting - I haven't seen that approach before. Does paying that 20% early lock in the total entrance fee at that point?

[LitGal]

Quote:

Originally Posted by MichaelB I do not like the options that have large upfront lump sum costs. The problem is not the math, it's the risk. If the facility should fail for any reason and be unable to refund the money, DW or I might be unable to afford a similar or even decent option from that moment on. These operations do not have the financial transparency or scrutiny needed for this level of financial commitment.

When shopping for ours, we learned some lessons from dear sister-in-law, who has been an administrator in facilities like these for years. First, she said to check their financials/balance sheets. (The one we chose posts theirs on their website) Then she came and visited it with us, interviewed the administrators, and walked through it the way accreditation visitors do. (And she read the parts of their Joint Commission recs that she wanted to know about.)

Plus, it helps that it's a non-profit and self-owned. It's been popular, filled, and thriving for over 25 years. People move to it from all over the country because of its national reputation. (Plus the place costs less in northeast Ohio than in--say-- Northern California where my mom's room in assisted living runs $4K/mo. But, granted, she pd. only a nominal up-front fee; but, if she runs out of money, she's out. If I run out of money, I won't be.)

But, in many ways, it did feel like hunting for a needle in a haystack!

[LitGal]

Quote:

Originally Posted by Cat-tirement Interesting - I haven't seen that approach before. Does paying that 20% early lock in the total entrance fee at that point?

Yes, it does. But it does not lock in the monthly fee. Since we bought the contract 2.5 years ago, the entrance fee for our particular plan has gone up $10K. But the monthly cost of a 2BR apt. has also gone up. (That's what we contracted for.)

One major reason we bought in is that, at the time, my DH could not get LTC insurance due to disability. We knew we would eventually need to get him help that I could not provide.....and I wanted to go where he went.

However, he recently passed away; so, now I have no interest in going there yet. I'm healthy and independent. But, I still do want to go there when I need the help (or by age 75 at the latest, as per my contract).

Re. DH's early passing: from the hospital, he had gone to our CCRC for rehab and was very happy to do so (because it was a familiar place/"known quantity" he had already chosen for himself). It just so happened that he was admitted into the skilled nursing section of the CCRC.

When his situation deteriorated, he was in a beautiful, sunny room he knew I had chosen for him. When he decided to begin Hospice, he never had to move; simply another layer of excellent care was added.

His peace and comfort in those final days were worth every penny. Granted: he never used his "20% down" contract the way we expected. But what it did provide was a smooth transition to whatever level of care he needed when he left the hospital--- and those levels of care changed over a couple of weeks. Yet they all took place in one room in a place he had chosen.
The sense of control that gave both of us was priceless.

A nice irony: because he turned 65 last year, Medicare paid most of the bills. His stay at the CCRC cost us only about $700, out of pocket.

Bittersweet, of course.

[Brat]

Keep in mind that in home care either involves using a 'service' or screening and hiring the care giver yourself. Unless the person is a known quantity I do not recommend the latter (turnover and neglect).

[48Fire]

MikeP, I am reading these posts with great interest, since MIL is rapidly declining with severe stage dementia. My wife and I are doing everything we can to keep her out of Assisted Living or Nursing Home, but it is getting very challenging. Dealing with two parents and their dynamics at the same time must be overwhelming.


We are trying to look forward in planning, since MIL is in total denial about death and her declining health. She tells the doctors she is fine, walks 1 - 2 miles per day, etc., etc. Reality is that she sleeps most of the day.


While there are great people here offering great advice on planning, we are in complete reaction mode, usually trying to figure out what to have for breakfast. FIL died suddenly 5 years ago, so there was no time to discuss details with MIL. She is completely dependent on us now, and can't pack a suitcase for our trip tomorrow, can't tell the difference between the house key and a credit card, and on and on. She can't be left alone really, without some risk - wandering off, letting the dog out, etc.


In the next few weeks, we will have some hard decisions to make. Good luck in yours as well.

[imoldernu]

Between the rock and a hard place.
If the anwer was easy, there would be a known path to the right decision.

We work out these questions with a full cards on the table with stating the problem first, then "what can't we do", followed by the longest list of possibilities of "what can we do".

Theoretical... from the white bear...

The problem:
Mom is old, physically okay so far, strong willed, independent and with evident dementia. Denial and likely with some paranoia. (If dementia is an uncomfortable term, substitute forgetfulness.)
The fear: Traumatic, damaging crisis, lost, injured, fire, violence or suicide. Worry and fear causing upset at home. Money, depression, uncertainty and general disruption with no clear way forward. Possibility of being held captive for an indefinite period, with periodic crises.

What can't we do?
- Can't continue (longer term) in present home without help or caretaker.
- Can't afford 24/7 care.
- Can't commit to taking mom into our home.
- Can't continue "as is".
- Can't go into an CCRC apartment.
- Maybe can't go into assisted living if dementia precludes this. Need professional assessment in advance of this consideration.
- Can't force the decision. The in-between period of dementia would reuire a court decision, likely not favorable.

What can we do?
- Work out a defined plan to continue in current situation, with some home health care, and an emergency call system. Enlisting neighbors, police or professional healthcare povider to be knowlegeable of the situation. Plan for spending our own time to supplement the care. Schedule our own visits, to fit in with a reasonably normal life.
- Plan for a heart to heart meeting with mom, in a quiet, "listening" talk... non threatening, no recriminations, no suggestions and letting her take time to see herself, with her own thoughts. Not a time for solutions, but quietly planting the seed. Understand her fears.
- Due diligence in review of CCRC facilities... not just for cost, but for the knowledge that the administrators can provide.
- Depending on the situation, consider looking at home style community living. Not to be overlooked, despite the fear that many have over a non-professional staff. Many of these "comfort homes" present a happy, socially involved group of residents. Due diligence, and checking out more than one.
- Recognize that our own decision is not and cannot be legallyl made without consultation and verification by professionals. A very difficult decision to make, but necessary. This will be a benchmark for later decsions for wills, power of attorney, and situations that inevitably happen.

(personal note here):
- Consider looking for a compassionate older person who would prefer living in a "paid for" home with room and board... prefer this to working in the local Walmart.
That would be our first choice... We have seen this work with our across the street neighbor, who had this arrangement for the first 8 years that we lived here. Trust... did the shopping, used the car, managed the household as her own. A gem! After our neighbor passed away, the caretaker went on to the same situation with another person who needed help. Actual incremental cost (pay) was 1/5th the cost of the nursing home.

...............................
Ths list can go on indefinitely, and can be adjusted, but laying out the possibilities puts everyone on the same track. Most important of all.

Yes... every situation is different. My solutions are not yours. Coming here for advice is a start... The personal approach is a good adjunct to books or web pages. None of us see the answers in the same light. Having said this, you may want to read this late breaking article that discusses, in depth the state of seniors in retirement. Both the good and the bad.

http://www.alternet.org/fear-america...iss-full-story

It includes observations by Pew Research, regarding the actual state of retirement in the US as well as observations by those who were born between 1946 and 1964.

Quote:

When asked, sizeable percentages of people under age 65 said that they expected to face all of the following problems as they aged: memory loss, losing ability to drive, serious illness, diminished sex lives, sadness, depression, loneliness, not being needed, trouble paying bills, and being a burden. Yet the prevalence of those problems among people over 65 was markedly lower in every category—sometimes by more than two-to-one. In contrast, expectations that people under 65 had about having more time for hobbies, family, volunteer work, travel and financial security in later life were also unmet. “Getting old isn’t nearly as bad as people think,” Pew said. “Nor is it quite as good.”