Taking Care of Mom Part III

[chinaco]

We placed my mother in a nursing home this weekend. We had been discussing it with her for a while. Took her on a tour of the facility a few weeks ago to try to get her use to the idea. Still, she was apprehensive. I think she was upset a little. I spent the first day with her. One of my siblings will spend the next day. All we can do from here on out is keep an eye on things and visit regularly (be there for her).

I feel a little relieved now. Making that decision was very difficult. Her condition was not one that was caused by an event (like a massive stroke). In that case it would have been an easy decision. Her problem has been a long drawn out steady decline. It was difficult to judge when to make the move. Ultimately the medical issues were too much for us to handle. The burden of providing the help was starting to get very difficult also. The RN at the Day Care advised me about 2 months ago that we should consider an NH. That discussion with her helped me to make the decision.


The cost is brutal. Aside from the normal room cost (which covers a lot), there are many small additional costs. Plus, due to the state law regarding drugs, I have had some trouble getting them to accept her current Medicare Part D provider. I am working that one.

Anyway the basic cost ex any medical will be about $62k/yr semi-private. We will me her into a Private room if when becomes available... it is about $75k/yr. Because of her health issues, I expect the total cost (not including new medical issues, hospitalization for new complications) to be around $80k - $85k/yr.

Essentially this will take most of the estate. This is not financial problem for her. My father passed away several years ago so she is the lone surviving spouse. I can remember that she was really worried when my father went into an NH because of the costs. She took care of him for a long time. When he went to an NH he only lived about 1.5 years in there (he was in bad shapre).

However, it is a lesson about LTC. Spouses should have it to protect the surviving spouse (if you have a nest egg). There is no telling how long she will be in the home.
Here are some numbers.

*) Day Care for Mom - $40k (actual) - needed for about 4 years prior to NH
*) Home Health for Mom - $20k (estimated since family did the work)
*) Day Care for Dad - $40k (estimated since Mom did it all... used moms cost) - Needed for about 4 years prior to NH
*) Home Health for Dad - $20k (estimated since Mom did it all)
*) Nursing Home for Dad - $100k (actual)
*) Nursing Home for Mom - $100k - $250k (estimated... no way to know yet but she could linger)


This totals to a range of $320k - $470k. The family actually bore the burden in effort of about $120k. That was not too bad on us helping mom, but it was difficult for her to help my father.


LTC is very important because of the toll it takes on the family (in effort) and the basic cost. Many LTC plans would have covered Day Care, Home Health, and NH.


If you look at the cost above in terms of $ and effort (not including the stress which should have a cost)... LTC premiums pale.

Here is my take on LTC: Get it. Use a Highly Rated provider that has a good track record. Even if you do not get a great inflation rider on it, it will help to defray much of the cost and perhaps cover the lesser cost of home health and day care early on. Compare the potential cost of assistance on a PV basis versus projected premiums. It is likely to make sense if you do not have a spouse because of just protecting assets for the estate. If you have a spouse... that is another matter. My view is (unless you have several million $)... you cannot afford to retire unless you have LTC covered. Plus, it will vex your thoughts later if you do not have it.

DW and I have a policy with a reputable company with an inflation provision. It is fairly inexpensive today. As we age the inflation protection provision will step up the cost. But still... It is much cheaper than what I have witnessed. And even after the cost of premiums... I am praying the DW and I will not ever need to use it (My premiums were only bought peace of mind)... I am hoping it goes to some other poor unfortunate!

[lazygood4nothinbum]

i'm a single guy who would not be able to yet retire well with insured ltc but, having no children on whom to pass on legacy, have ample funds to self-insure if need be. i keep this factor in mind when considering even dating, as i don't care to jeopardize either my early retirement or a potential partner's future.

but i really just want to comment here on congrats to you for doing the right thing. that was a tough decision but the only correct one you could have made. may life go as well as can be for your mother there.

[SoonToRetire]

Thanks for that information, Chinaco, and hope the best for your mother and your family. As I've posted before, I'm facing a similar situation for my MIL. The cost is sobering. What did the $40k in day care consist of? Did you have a caretaker coming to the home?

[chinaco]

Originally Posted by SoonToRetire

Thanks for that information, Chinaco, and hope the best for your mother and your family. As I've posted before, I'm facing a similar situation for my MIL. The cost is sobering. What did the $40k in day care consist of? Did you have a caretaker coming to the home?

4 years of adult day care and Home Health Care. My sibiling only took her to Day care about 3 days a week (worked out of home). Late in the game my sibiling used Home health care recently. It cost about $20/hour. HH came in 4 days a week for 6 hours (cost = $480/week). Adult Day care was $55/day Bathing her was $9 per bath. We started using that when it got ot the point the DW could no longer help her bath. I owe DW a month Trip to Hawaii and Tahiti. If we included equipment and supply cost... It is probably closer to $45k. If my sibling had taken her to day care 5 days a week.... the cost would have been more like $55k - $65k.

The cost is very expensive. Of course, if my mother had no resources, Medicaid would pick up the tab.

[SoonToRetire]

Originally Posted by chinaco

The cost is very expensive. Of course, if my mother had no resources, Medicaid would pick up the tab.

Yes, if they have no resources. But there is a catch 22 in the case where they happen to have an income that is above the medicaid threshold but well below the cost of care. In my MIL's case she has a military pension from her deceased husband of around 23k a year. The medicaid limit is around 21k so she gets $0 medicaid. So she (we) would have to pay the difference between 21k and say 100k.

I wonder what happens if someone just doesn't have that kind of money? Do they wheel the elderly down to the nearest street corner and let them die there?

[chinaco]

Originally Posted by SoonToRetire

Yes, if they have no resources. But there is a catch 22 in the case where they happen to have an income that is above the medicaid threshold but well below the cost of care. In my MIL's case she has a military pension from her deceased husband of around 23k a year. The medicaid limit is around 21k so she gets $0 medicaid. So she (we) would have to pay the difference between 21k and say 100k.

I wonder what happens if someone just doesn't have that kind of money? Do they wheel the elderly down to the nearest street corner and let them die there?

If I understand you correctly... you are saying that shw would have to pay 100k - 21k = 79k

I do not believe that is correct. It depends on income and assets. Each state has slightly different rules, but there is a little consistency. I think it typically works like this. If they have any assets, that and income is used to pay for the service until the asset is spent down. (houses can work a little differently... This depends on the state). But... apparently medicaid will pay for up to 6 months and let the person keep the house (assuming the person will get better). Otherwise all assets and income is spent toward the NH.

In your case... I will assume the MIL has no assets. Her 21k - about 2k would need to be spent to cover the NH, Medicaid would pickup the rest. I think the 2k (may differ by state) is to cover other expenses she may have that the NH and insurance does not cover. You will need to check with your state Medicaid office to get the specific rules.

I do know that some states are better than others about the asset situation for a surviving spouse. But I think most of them require a complete spend down if there is no surviving spouse.

[SoonToRetire]

Originally Posted by chinaco

In your case... I will assume the MIL has no assets. Her 21k - about 2k would need to be spent to cover the NH, Medicaid would pickup the rest. I think the 2k (may differ by state) is to cover other expenses she may have that the NH and insurance does not cover. You will need to check with your state Medicaid office to get the specific rules.

Chinaco, you are quite right, and I'm very relieved. I checked with my county senior services office in Virginia, and what you describe is roughly the way it works here. She is now in Texas, which is an "income cap" state, and it's very different there. In Texas there is a cap which, as I said, is a couple of thou below her income, so medicaid would not pay anything. There is one loophole called a "Miller Trust" in which all of her income would go into the trust. But it's a tricky legal vehicle that has to be set up by a specialized elder law attorney. We called one but they wanted $500 up front just to talk to us.

Thanks for the advice, I feel much relieved, and good luck with your situation.

[chinaco]

Originally Posted by SoonToRetire

Chinaco, you are quite right, and I'm very relieved. I checked with my county senior services office in Virginia, and what you describe is roughly the way it works here. She is now in Texas, which is an "income cap" state, and it's very different there. In Texas there is a cap which, as I said, is a couple of thou below her income, so medicaid would not pay anything. There is one loophole called a "Miller Trust" in which all of her income would go into the trust. But it's a tricky legal vehicle that has to be set up by a specialized elder law attorney. We called one but they wanted $500 up front just to talk to us.

Thanks for the advice, I feel much relieved, and good luck with your situation.

Another option is to Move your MIL to another state. There may be some rules you need to adhere to (e.g. time in state)... not sure. Check with a state Medicaid Ombudsman. You may find that another state has simpler rules. Obviously, your MIL will need family near by to check in on her.