deteriorating health in my parents! Advice needed.

[W2R]

Quote:

Originally Posted by Walt34 Good suggestion to look ahead of time. At least for the ones we looked into all have waiting lists as well so it isn't like being able to move whenever the mood strikes. Very few have vacancies for long. As far as heath requirements I suppose that varies. When FIL moved to the independent living apartment (for one day) the facility required a physician's certification that he was capable of independent living, and I suppose he was in that setting at the time. But he was pretty marginal on that and I thought there was a good chance they wouldn't take him. Another issue is that some don't really want you there too early - one has a $2k extra fee for every year each person is under 70 years old. So a 65-year-old would pay an extra $10k entrance fee more than a 70-year-old. But they also won't kick you out if resources are exhausted so I guess that makes up for the risk that a 68-year-old will stroke out and be a full time nursing care patient for 15 years, 12 of those on Medicaid. For the institution that would be a hefty financial hit.

I had no idea that some charged extra for being too young! Thanks for that information, too.

That physician's certificate is what I was talking about. I had forgotten the details until you mentioned it.

As for waiting lists, my mother was on one for 2 years before she got her apartment and it wasn't the size she wanted (so she moved in, was on the waiting list for the larger apartment, and then moved again when it became available). I'd think the waiting times would only become worse if/when the baby boomers start turning 70.

[rodi]

Quote:

Originally Posted by Walt34 I've wondered how that works if there are no relatives around - do they just wheelchair the old lady to the curb? Realistically I guess they just take the person to a warehousing facility that does take Medicaid only but I'd never consider a place that would be so harsh on someone. It shows where their priorities lie.

Many of the big corporate CCRCs are like this - but they fully vet your assets and income stream prior to approving your moving in.

A good friend's aunt lives in a place near us - and my kids robotics team met with the staff there when their theme was "senior solutions". I (as a nosy adult) asked the director specifically about medicaid... they definitely do not take it. But their screening process makes it less of an issue. Many of their residents are retired academics with very nice state pensions that cover their expenses. There's also a "buy in" in case there's a shortfall in the future. I haven't heard of anyone being kicked out - but they have definitely denied residency to folks who might run low on funds before they die.

It's a nice place - but out of my price range. Even though it's the same zip code that I live in - it's got "La Jolla" in the name - which adds $$$ to the price.

[Brat]

Back to OP's situation. It may be that Mother is depressed because she can't adequately care for Father. Perhaps he could find a place for him where she could stay so that she could 'care for him' with help, at least for a couple months. Then reassess the situation.

[imoldernu]

I'm not sure that everyone who has an interest in continued care communities, has a good understanding of what a full service community really means. While I've described our current community, I realize that there a many different levels of care and varied services. While I understand that we cannot "advertise" here I will not use a link, but our community is called Liberty Village of Peru. I have no vested interest in this and, in fact there are no "villas" (regular homes) for sale at this time. It seems to me that we may provide more of a variety of services than one sees in most areas.
The concept of a unitary, full service community is growing. The Parent company of our community currently operates 17 different communities, from many here in Illinois, to some retirement communities as far away as Nevada.

A recent update of the living facilities available for occupancy shows these numbers. The community began in 1999.
Villas - (freestanding regular homes) 74 (BTW... in the "Villas" section, that's a pic of our home)
Apartments - 68 2BR
Assisted Living - 68 (beds) 48 units
Nursing home - 102 (Beds)
Alzheimer's unit - 28 units
"Bounce Back" is the rehab center, with advanced state of the art exercise and rehabilitation equipment. Anyone in the community can use at no charge.
Electronically programmed machines that guide you through a workout designed for you prescribed by the professionals who work there. You receive a coded card which goes into each machine, which then regulates the time, speed and effort required for your "prescription".

So... you won't move here to Illinois just to join our community, but it seems to me that some kind of a yardstick for what may be available in your area could help in making a selection of a senior retirement community.

An internet search for Florida "continued care" retirement communities will bring up many more of these unitary services. For us, it was a tug of war, but being near the kids was important.

[bmcgonig]

Quote:

Originally Posted by rodi Many of the big corporate CCRCs are like this - but they fully vet your assets and income stream prior to approving your moving in. A good friend's aunt lives in a place near us - and my kids robotics team met with the staff there when their theme was "senior solutions". I (as a nosy adult) asked the director specifically about medicaid... they definitely do not take it. But their screening process makes it less of an issue. Many of their residents are retired academics with very nice state pensions that cover their expenses. There's also a "buy in" in case there's a shortfall in the future. I haven't heard of anyone being kicked out - but they have definitely denied residency to folks who might run low on funds before they die. It's a nice place - but out of my price range. Even though it's the same zip code that I live in - it's got "La Jolla" in the name - which adds $$$ to the price.

Can people please give an idea of the cost of all these places they have looked at? Thanks!


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[braumeister]

Quote:

Originally Posted by bmcgonig Can people please give an idea of the cost of all these places they have looked at?

There is enormous variation in pricing from one part of the country to another, and even within local areas. I don't think numbers would do you any more good than asking the cost of houses people have looked at.

[rbmrtn]

Quote:

Originally Posted by bmcgonig Can people please give an idea of the cost of all these places they have looked at? Thanks!

Here's a link with national average and by states but it probably varies a lot by location and amenities.

Assisted Living Costs - Assisted Living Facilities

From what I have read Nursing home is 2-3x assisted living

[imoldernu]

Quote:

Originally Posted by braumeister There is enormous variation in pricing from one part of the country to another, and even within local areas. I don't think numbers would do you any more good than asking the cost of houses people have looked at.

Cost was one of the driving factors for our choice. Villas (regular home) range from about $160 to $220... With senior exemption and Illinois tax freeze, our taxes are a little over $2500. HOA costs... all outside lawn and shrub and tree care and winter snow removal is $150/mo... but this includes ancillary services, such as a few years ago when they replaced our house and garage wooden door frames with no-care aluminum. It also pays for twice a year picnics for residents, and two dinners at our two homeowners meetings., as well as automatic rplacement of our exterior lighting, and common area maintenance. We aso have a substantial reserve for anything like lawn die off's.

The Apartments - as mentioned, we are rental, with no front load except a one month refundable deposit. Studio, single and 2BR. the 2BR monthly rent is $2500/mo., with 2nd person anothr $500. That includes all taxes, utilities and full maintenance,, plus Cable TV and internet access and two meals a day in the rather elegant dining room. In addition twice a week "excursions" for shows, meals, and special events such as boat tours or casino trips. In addition there are three times a week sign-up trips to the Mall or for grocery shopping, and anytime transportation to doctors or hospital visits. The first floor of the Apartment building is quite beautiful, with libraries, meeting rooms, quiet rooms, a beauty parlor and an outdoor patio for sunning, walking, barbeques etc. There is also a large room which doubles as a lecture/music/theater and general entrtainment for about 80 persons. The building is four stories, with multiple elvators... short access to downstairs and outside. There are a limited number of closed garages and an equal number of open individual grages for cars. There are numerous company van/buses and cars.

The assisted living is very nice and comfortable, with college dorm type rooms in the doubles, with a central "sitting room". No hospital white coldness, but warm colors and a home-like atmosphere. I am uncertain about the cost as it depends on the services required.

There is a separate rehab apartmetnt section that I failed to mention earlier. Short term stay, associated with the rehab fitness center.

The nursing home base cost is about 70K, but varies according to needs. Both the assisted living and the nursing home are constructed as wings around a central core. At the ends of the wings, are formal dining rooms, where residents who are able come to eat, and associate, with cards or bingo after some of the meals. Visitors are welcome here too.

The Alzheimer unit is state of the art, with an activity room for patients who can socially interact, and has planned adaptive activities.

The staff makes the center a friendly place to be. They work as a team, and are uniformly caring and understanding, both for the residents and visitors. While it is physically and financially impossible to have 24/7, one on one care, the cross training and attention to needs is remarkable. DW and I have been to numerous CCRC facilities, and count this as the best. For those who are making a decision for parents or loved ones, this alone may be the most important part of the vetting process.

There are entrance requirements, re: finances, however the facility is medicare/medicaid approved, so the worry about being dumped on the streets is a non starter. Much of the overall design of our community is a result of it being relatively new (1999) and incorporating the newest advances in construction, design, technology and human engineering.

One more thing... if you go to the website, check out the community... the town, facilites, shopping, traffic, taxes, and the cost of living. Far away from urbia, but offering every possible convenience and cultural facility, yet within ten minutes of 3 state parks, and 2 miles from the heart of Illinois farmland.

Another time, I'll describe our 10 million dollar YMCA... the absolute ultimate in sport/fitness and aquatic centers. A step beyond the Olympic venues. Yeah... really.

[Amethyst]

This sounds awful, but consider the business's perspective: They are, in essence, landlords who provide services. Over time, if they didn't evict people who no longer can pay, they could end up with more "out of funds" patients than paying ones. Then they would have no choice but to cut the quality of care for the paying patients, or greatly increase their charges.

Amethyst

Quote:

Originally Posted by braumeister No Medicaid accepted period, and very clear about it up front -- private payment only. When your money runs out, you're evicted.

[Mulligan]

This guy has had a house all to himself too long. If someone determines I need to go to "the home" and be put in a doubles college type dorm facility as described by Imolder they better trick me to get me there. Otherwise they will need to plug the new holes in their body before they can haul me off!


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[rodi]

Quote:

Originally Posted by bmcgonig Can people please give an idea of the cost of all these places they have looked at? Thanks! Sent from my iPad using Early Retirement Forum

My husband looked into Vi La Jolla (the one I mentioned)... I think it was $125k buyin (per person), then $4k-6k/month depending on the size of the apartment you start in and how many meals you eat in the dining room. (Apartments have full kitchens so you don't need to eat in the restaurant/dining room.) It doesn't go up in price as you move to more expensive care (independent -> assisted living-> nursing). The large 2 bedroom is $6k. To put it in perspective - the apartment high rise next door runs about $3-4k for a 2 bedroom apartment... So the rents in the area are high, also.

[Cat-tirement]

Quote:

Originally Posted by bmcgonig Can people please give an idea of the cost of all these places they have looked at? Thanks!

The annual Genworth cost of care survey provides some general cost comparisons which might be helpful:

https://www.genworth.com/corporate/about-genworth/industry-expertise/cost-of-care.html

[Walt34]

Quote:

Originally Posted by bmcgonig Can people please give an idea of the cost of all these places they have looked at? Thanks!

Quote:

Originally Posted by braumeister There is enormous variation in pricing from one part of the country to another, and even within local areas. I don't think numbers would do you any more good than asking the cost of houses people have looked at.

Braumeister is correct. I found prices vary wildly, sometimes within the same zip code. A lot of that depends on the range of included services and such. My mother's place included two cafeteria meals per day with the monthly fee; the place we're considering adds an additional $75/month per person for meals, and when that is used up you pay per meal. Of course, in independent living can cook your own but you still have to pay the $75/month. Clearly that is intended to keep the restaurant operational, if not profitable.

The one we're considering in southern PA has an entrance fee of approximately $230k (depends on size of house/apartment) and that gets the monthly rent down to ~$800/month, plus utilities. We also asked for info on one in NC with similar but not identical expenses.

But I've seen others with entrance fees over $600k and monthly rents north of $4k/month. But those offer a lot of services included that the others don't or are in highly desirable areas, like right on the Patuxent River near the Chesapeake Bay. So far about half of the web sites for a particular facility seem to offer their prices online but you really have to dig for it, which is a bit irritating.

Search on "Continuous Care Retirement Community or CCRC + your state" and go from there.

[Mulligan]

Quote:

Originally Posted by Walt34 Braumeister is correct. I found prices vary wildly, sometimes within the same zip code. A lot of that depends on the range of included services and such. My mother's place included two cafeteria meals per day with the monthly fee; the place we're considering adds an additional $75/month per person for meals, and when that is used up you pay per meal. Of course, in independent living can cook your own but you still have to pay the $75/month. Clearly that is intended to keep the restaurant operational, if not profitable. The one we're considering in southern PA has an entrance fee of approximately $230k (depends on size of house/apartment) and that gets the monthly rent down to ~$800/month, plus utilities. We also asked for info on one in NC with similar but not identical expenses. But I've seen others with entrance fees over $600k and monthly rents north of $4k/month. But those offer a lot of services included that the others don't or are in highly desirable areas, like right on the Patuxent River near the Chesapeake Bay. So far about half of the web sites for a particular facility seem to offer their prices online but you really have to dig for it, which is a bit irritating. Search on "Continuous Care Retirement Community or CCRC + your state" and go from there.

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?


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[bmcgonig]

Quote:

Originally Posted by Walt34 Braumeister is correct. I found prices vary wildly, sometimes within the same zip code. A lot of that depends on the range of included services and such. My mother's place included two cafeteria meals per day with the monthly fee; the place we're considering adds an additional $75/month per person for meals, and when that is used up you pay per meal. Of course, in independent living can cook your own but you still have to pay the $75/month. Clearly that is intended to keep the restaurant operational, if not profitable. The one we're considering in southern PA has an entrance fee of approximately $230k (depends on size of house/apartment) and that gets the monthly rent down to ~$800/month, plus utilities. We also asked for info on one in NC with similar but not identical expenses. But I've seen others with entrance fees over $600k and monthly rents north of $4k/month. But those offer a lot of services included that the others don't or are in highly desirable areas, like right on the Patuxent River near the Chesapeake Bay. So far about half of the web sites for a particular facility seem to offer their prices online but you really have to dig for it, which is a bit irritating. Search on "Continuous Care Retirement Community or CCRC + your state" and go from there.

Yes. I did some googling today. There are three classes of CCRCs: Class A which offers the full deal, I.e. Independent living, followed by assisted loving then nursing home as and if you need it for one entrance fee and one steady monthly fee. Some call this Life Care. This is the most expensive because in effect you're getting a LTC insurance policy included I guess, as well as assisted living all for one price. Includes some meals, utills, cleaning etc., to,some extent or other.

Class B offers the independent living and a limited number of days assisted living and nursing home and/or a dIscount on those.

Class C is a pay as you go, if you need assisted living or nursing home you pay up when the time comes.

Some of the ones I looked at only offer Class A. Some like imoldernu's seem to be Class C, pay as you go. Others offer a choice.

Some of the Class As I looked are in the region of 100k entrance, and 2k/mo rent. Looked quite nice in fact. Not bad if you really just want to be on your own and not have to live with the kids, or don't have kids.

And yes it's annoying that some have prices in plain view, and others want you to call...boo!



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[HFWR]

Since most of my dough is in tax-deferred accounts, is there a way to pay those up-front fees without the huge tax hit?


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[aja8888]

Quote:

Originally Posted by HFWR Since most of my dough is in tax-deferred accounts, is there a way to pay those up-front fees without the huge tax hit? Sent from my iCouch using Early Retirement Forum

That's an awful good question as I am in the same boat. I suppose we could sell the house and use that cash. But I'm of the same mind set as Mulligan right now.

[LitGal]

Quote:

Originally Posted by HFWR Since most of my dough is in tax-deferred accounts, is there a way to pay those up-front fees without the huge tax hit? Sent from my iCouch using Early Retirement Forum

Yes-- I will sell my house, and that will pay the entrance fee to my CCRC when I move in. (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.) So, since I'm only 62, I'll either stay here, then move over to the CCRC. Or downsize to a condo for a while, then move to the CCRC and sell the condo.

None of this affects the tax-deferred accounts.

[HFWR]

Quote:

Originally Posted by aja8888 That's an awful good question as I am in the same boat. I suppose we could sell the house and use that cash. But I'm of the same mind set as Mulligan right now.

The equity in my house wouldn't begin to cover the fees mentioned in this thread, but I'd have the nicest cardboard box under the bridge...


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[aja8888]

Quote:

Originally Posted by HFWR The equity in my house wouldn't begin to cover the fees mentioned in this thread, but I'd have the nicest cardboard box under the bridge... Sent from my iCouch using Early Retirement Forum

My equity would only cover the least expensive entrance fee.