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Assisted living plan; do you have one?
Old 09-17-2018, 07:06 PM   #1
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Assisted living plan; do you have one?

My dad, widowed and living with me, has mild Alzheimers/Dementia. He's been living here with me for about a year and a half. A victim of elder abuse regarding his finances, he had maybe $5,000 in cash when I took him in. He wasn't diagnosed at the time and resented anyone telling him how he should be spending his money. He had a soft heart for anyone, women especially, who had small children who were coached to call him grandpa. I was able to get him to a Neurologist under the pretext of an annual physical exam. I now have his power of atty for medical, my brother has for financial. Since he moved in, I've been able to get his pension, social security straightened out and got him a military disability pension for serving in Korea and now needing full time care. All total, he has almost $6,200 income take-home and about $50,000 in the bank. (I cashed in his life insurance policies, researched his wife's policies and paid, liquidated his property other than what he can use living here with me)

If not for me and my brother, I'm sure he would have continued to been abused financially by other family and those closest to him he should have been able to trust.

My brother and I feel that we have him now in a good place medically, physically and financially so that he is able to afford an assisted living facility. Researching for a facility that will be the best fit for him has not been easy. Seems every time I tour one, ask questions, I learn more and need to review the previous places with this new found intel. We are very close to choosing a place and have been grooming him for the day he'll be moving to a facility.



All this begs me to ask about my and my wife's situation; what if we were in his mental situation? Would we have someone who we could trust to take over all our assets, make all our financial and medical decisions, decide where we will live and how? I've talked to both my sons and, while good men, they pretty much said they would find us a good home and move on with their lives. In one sense, I'm glad they won't stress over what I and DW have been dealing with since we were aware of Dad's financial and medical issues. But it also really drives home to me that I need to very proactive in putting together a plan that protects me and DW in such an event.

My brother and I have no need for our dad's money. We have more than enough of our own, so situating him isn't going to be a financial hit to either of us. Can I say the same about my boys? Even subconsciously, would they make decisions on my behalf in my or DW's best interests and leave their own self interests out of it? Who knows for certain?



So what's your plan for this sort of contingency? I do not want to be a financial or any other kind of burden to my kids. I also don't want to be warehoused in a rat hole, sleeping in my own mess, eating garbage or otherwise, a compromised quality of life either. I hope my own actions set an example for my kids to follow when and if the time comes for them to make these sorts of choices or not.


****EDIT****
I want to add that I have funds bankrolled to cover expenses for DW and I if we are in a similar medical/mental condition as my dad. But I read so much on here about spending down net worth so as to leave as little as possible, enjoy as much as possible, the assets earned over a lifetime. These two things don't jive; being responsible for all contingencies financially in our lifetimes and maximizing the enjoyment of a life of LBYM.
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Old 09-17-2018, 07:58 PM   #2
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Not sure what we’re going to do. Of course, we will try to not spend down our money, but Alzheimer’s care is expensive and $75K to $100K and up for assisted living is not uncommon. We’re dealing with DW’s mom right now and trying to keep her from the negative, but all to common, conditions you so eliquently described above. It’s no joking matter that euthanasia has come up in the discussion. We’re in the early stages with MIL, but we’ve seen it with others and fear it for ourselves. I guess the only saving grace might be that by the time you’re warehoused, you won’t know it. Hopefully by then, you’ll also be close to the finish line.
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Old 09-17-2018, 08:03 PM   #3
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Assisted living in a communal situation with some basic care services, cleaning, room, board and laundry, is not particularly expensive. It's less than $2K a month for my Dad.

I guess it depends on how much assistance is needed and how fancy the facility.
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Old 09-17-2018, 08:13 PM   #4
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Not a popular choice on this forum, but one can set up an irrevocable trust and thus not spend down assets and leave assets for the heirs.
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Old 09-17-2018, 08:14 PM   #5
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We have no children. I have 3 younger siblings, and a sister-in-law 20 years younger.

We've always figured on going the CCRC route. Hopefully I can arrange the appropriate financial services before we make that move.
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Old 09-17-2018, 08:17 PM   #6
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Our answer is to "invest" in a CCRC that meets our needs. Lots of discussions in other threads of the pro's and con's. For us, it allows US to make the decision where we were live as well as insulates our only child from having to the challenges of caring for aging parents. It also allows to "lock in" the cost of care should we need care requiring assisted living or worst, memory care.
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Old 09-17-2018, 08:46 PM   #7
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Assisted living in a communal situation with some basic care services, cleaning, room, board and laundry, is not particularly expensive. It's less than $2K a month for my Dad.

I guess it depends on how much assistance is needed and how fancy the facility.

Here in California, within a 20/30 minute drive from the house so we can visit regularly, costs range between $4,500 and $6,500 a month depending how 'resort' feeling the place is.

One thing we've discovered is the difference between assisted living and memory care. With any dementia diagnosis, no matter how slight now, most places insist on memory care level, which runs $1,000 a month more than simple assisted living.
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Old 09-17-2018, 09:09 PM   #8
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I read on another forum from somebody who lives locallly from me and her dad is in memory care for $5000 a month. I thought it must be much higher. I believe my dad was in similar nursing home area after he had a stroke, but wanted to move to a different place because he didn’t like the food there.

But I have two girls and one who lives near us, the oldest child will most likely help us, she is very caring and helpful now. The other one might help financially if we need it, but I doubt that we need her help financially. While we don’t want to be a burden to them, it’s nice to hear that they are willing to help us.
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Old 09-17-2018, 09:18 PM   #9
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When we had to deal with the dementia issue with a parent, we looked at two brand new assisted living facilities within a few miles. The non-memory care rooms were clean and spartan, sort of a Motel 6. More like efficiency studios, with a microwave and a small refrigerator.

The memory care units were another story. The attendants hung out in a room and the residents stayed in their rooms, two to a room. There was a central lounge with a TV going. The smell was not pleasant. People were moaning and a couple would yell. It was the same at both places.

We ended up keeping the parent in the retirement condo with help, eventually round the clock. Things did not always run smoothly, but there were home cooked meals, fresh laundry, and later regular diaper changes. There was conversation, even if not always two-sided. It cost a lot, although we dealt directly with the caregivers and not an agency. One lived in the condo and worked nights. The others rotated through the days.

It cost a lot of money, but less than full time care through an agency and the same people were there every day. Although there were issues that were not handled properly, I would make the same choice again if faced with this situation.
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Old 09-17-2018, 10:16 PM   #10
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These are the 3 we are considering with costs for Dad's level of care needed;

Ponte Palmero $6,150
Home - Gold Country Retirement Center $5,500
El Dorado Hills Senior Care Village is a Senior Home Care Service in El Dorado Hills, CA $4,100


The first is resort style living, the second is a bit rambling/large and I'd guess Dad would struggle even finding the dining room. The third is 6 homes on a cul-de-sac in a bedroom community of expensive luxury homes. We really like the the third one. Each home has 6 residents, private room and bath, common rest-of-the-house. All the rooms have sliding glass doors to the backyards and all 6 back yards are combined into one with walking paths, gazebos, patios, BBQ areas, etc. I'm surprised they are the least expensive.

My neighbor placed his wife there who had Alzheimers. He's a very particular man and loved his wife dearly. Visited her 3 times a week even though she didn't recognize him. He said they would do anything he asked and that they were treated like family. He still stays in touch with the management and staff more than year after her passing. Nothing beats a personal referral.



Finding care for my Dad is my immediate concern. But my personal concern; I'm trying to figure out how to arrange this for myself and wife if we end up this way and don't have family to watch out for our best interests.



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Old 09-17-2018, 10:46 PM   #11
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We moved my mom to an assisted living home about 1.5 years ago. She pays $3500 for a tiny 300+ sq/ft studio apartment. That was the best price we could find in the county that wasn't a total dump. Everything else was way out of her budget. She gets a tiny SS income and the proceeds from the sale of her house. When that runs out we'll have to turn to Medicaid.

My wife and I haven't made any specific plans for our own long term care, but most of our regular retirement income could be redirected that direction if needed. If we needed care beyond that we might be able to do a reverse mortgage, or even sell our house if we're no longer able to live at home (I hope that day never comes). The most difficult situation would be if one of us needs assisted living while the other is still able to live at home. I'm not sure what we would do in that situation.
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Old 09-17-2018, 11:29 PM   #12
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Depending on the part of the country it’s way more expensive than 2k/month.
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Old 09-17-2018, 11:36 PM   #13
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OP-

We have no children & plan to enter a CCRC, probably a “Life Care Facility.” If we had children, we’d still probably take the same route to preclude being a burden to them.

I think there are a couple of ways to approach this, with some generalizations about each:

1. Acquire guaranteed high quality care - better care, more expensive, less anxiety provoking (for residents & family), better quality of life, typically acquired (entered) in advance at the ‘independent living’ stage.

2. Acquire care with the minimum expenses/NW expenditure possible - lower quality care, less expensive, anxiety about quality of care, typically acquired at time of need (assisted living level of care or higher).

You have to choose which route you take. BTW, there is a lot of middle ground as well; one common ‘middle ground’ choice is to find a high quality CCRC (multiple levels of care in a single facility/campus) which will allow you to remain using Medicaid after asset depletion.

Here are some useful links, with quite a bit of California-specific info (because that’s where I am too). Feel free to PM me if you’d like to discuss further.

CCRC Reference Material/FAQs

Life Care in California
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Old 09-17-2018, 11:37 PM   #14
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We have no plans, hopefully decades away from needing any as it is tough to figure out. Even trying to decide which if any family members could be trusted to not fill their pockets and leave us destitute.
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Old 09-18-2018, 05:00 AM   #15
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Here in California, within a 20/30 minute drive from the house so we can visit regularly, costs range between $4,500 and $6,500 a month depending how 'resort' feeling the place is.

One thing we've discovered is the difference between assisted living and memory care. With any dementia diagnosis, no matter how slight now, most places insist on memory care level, which runs $1,000 a month more than simple assisted living.
Similar costs here in the southern Ohio area, so I'm actually surprised your numbers are as low as that.

I was paying almost $6K a month for Mom's memory care back in 2012, and it wasn't the most expensive place in town.
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Old 09-18-2018, 05:56 AM   #16
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Depending on the part of the country it’s way more expensive than 2k/month.
My DM is at a place that costs $2,400 per month. For that amount she receives a room and 3 meals a day served in the dining room, daily housekeeping to make bed & empty trash. More formal housekeeping (ie launder clothes, new bedding etc) comes once a week. There are many daily activities. All in all not a bad deal. She is not paying for any additional "care".

DMIL, on the other hand, is at the same place but requires significant care at this point. She pays on the order of $4,000 /month. She is in a wheel chair so she needs help showering, dressing, transferring to toilet, wheeled to and from dining area, etc. She does manage her own medication.

Bottom line is that when you speak prices of "assisted living" be sure to specify how much "care" is being provided to avoid apples-to-oranges comparisons.

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Old 09-18-2018, 06:16 AM   #17
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I haven't worked this out yet. I'm 65, so I probably need to be more active. In my mind I'm leaning towards something like my Dad did. He was widowed (who knows if I or DW will be?)and he, while still robust in his late 70s or early 80s, got on a waiting list for a retirement living community that would take him from needing no assistance to end-of-life care if that became necessary. He liked it there a lot, except that the attrition rate on his circle of friends due to their passing on was emotionally heartbreaking.

Here's how it worked:
1. you had to be self sufficient when you actually moved in. You couldn't wait until you needed assistance.
2. You got a smallish, but nice apartment with your own kitchen, and laundry.
3. you paid a monthly rent, I think it was around $3500/ month (2008), and it included one meal a day (food was pretty darn good), but you could pay more for more meals/day if you wished. He liked to cook, and he liked the one meal per day to socialize.
4. He paid a lump-sum fee, I think it was around 185K, to cover his long term care if it ever came to that. The deal was if he died before 48 months went by, his estate would be returned 2% of that sum for every month less than the 48 that he survived. (As it turned out, he lived exactly 48 months).

In his most declining months, maybe the last year, they took care of transporting him to his doctors, to the hospital, etc. He was just on the verge of needing some care to get him through his days when he died. However, with my brother, and me only 45 minutes away, we were able to keep him going with visits, cleaning his place up etc. It was clear he was going to need some care, however, he passed away instead.

All in all it was a great way for him to spend his last 4 years. He had great friends, he sang with, he traveled with, and he dined with every day. It was a comfort to his kids to know he was well taken care of.
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Old 09-18-2018, 06:48 AM   #18
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Similar costs here in the southern Ohio area, so I'm actually surprised your numbers are as low as that.

I was paying almost $6K a month for Mom's memory care back in 2012, and it wasn't the most expensive place in town.
I always thought memory care would be way more expensive than basic assisted living with minimal care. So I am not surprised at your numbers.
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Old 09-18-2018, 08:24 AM   #19
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Good thread. My thinking:

First... to really understand the subject. From the above, I see five or six different pictures. There's nothing that any one person can do to provide a simple answer. Difficult at it will be, "being there"... visiting, talking, seeing... not just one or two, but three or four options. Care and price don't always go together... and a walk through by a facility person will show just what they want to show. Likewise, the pricing structure can be much more complex that what you'll be presented with.

What you see on the surface, may not be what residency is like. Going in at dinner hour is different than early morning or middle of the night. Staffing is the most important issue, both in number and experience.

Find a family member of a resident to get an honest overview of the good and the bad... and there will be both.

Time for a session with your own family members. Honest and in detail. A look ahead to see what your own interactions are likely to be. Perhaps the worst situation is not to to be comfortable with what your "back up" believes.

We've lived in a CCRC for 14 years, and get a chance to see the good and the bad. At this time, we're likely to move from our villa, to estate living within the foreseeable future.

Be sure you understand the difference between:
Independent living
Assisted living
Nursing home
Memory care

We're very happy with our current situation and have enough experience with all facets of our unitary CCRC. I think, for comparison purposes, that you might take a look at the website for our home... not to live here, but to see the many parts of a full service community. All of the above mentioned levels of living, and an added "plus" not available in all facilities... a complete exercise and full rehab facility. Something we don't think of normally, but from personal observation a benefit that is a "must"for a very high percentage of residents in all of the facilities... for an "in house" recovery from an illness, an injury or unplanned events.

For a look at this type of facility, google "simply the finest" or "libertyvillageofperu". For a description of our lifestyle , go to the "villas" with a short video of what our home is like, and how it fits in with the rest of the CCRC.

FWIW, this is not an "endowment" CCRC. If you choose to go this route, i would very strongly suggest that you review the endowment contract with a lawyer.

On a personal note, we have worked out our plans and our finances with our family and we continually update the plans. Fortunately we're all (four sons and their families) on the same track. Wills and powers of attorney in place.

A work in progress.
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Old 09-18-2018, 08:51 AM   #20
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We had my mother in a CCRC for a couple of years, after she and my father were in a luxury apartment for a couple of years with help.

The CCRC required a $177K security deposit, and it was $2,050 per month for a 1 bedroom apartment and twenty meals monthly. The restaurant was the nicest facility in the city, and they had a Dutch chef preparing the meals. The place was plush.

We ended up having to get 24/7 help for my mother to take care of her needs and make sure she didn't fall getting up nights. While the apartment is reasonably priced, she was burning through $110K per year--well more than her income.

When Mom passed, she was down to her last $5K cash. We were going to have to sell real estate had she lived on. The CCRC is a fine option for future care, but it's often difficult to cash flow for the middle income person.
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