Nursing Home or Stay at Home

[Rianne]

+1

The only problem with some of the CCRC discussions, is the part about cost... and any idea that all CCRC 's require large upfront costs...

From personal experience, not always the case, as with our CCRC. While financial responsibility is a part of any vetting process, there are no upfront costs here, except for the normal one month refundable security deposit. Here's a link to post #85 that outlines the basics of our community.

http://www.early-retirement.org/for...s-of-frugal-retirement-62251.html#post1267535

We moved in 13 years ago, when we were 68, into a villa... (regular home)... while we were still spending 6 months a year in Florida. It was a good move for us... the price was reasonable, and we are well integrated into the community, and will be content to move into the apartments, when the time comes.

In effect, we have 6 campuses... Villas, Apartments, Assisted Living, Bounce Back for temporary housing while undergoing rehab, Nursing Home, and Memory care.

What valuable information! I'm looking up all your posts. Since we're in the baby boom retirement era, my guess is CCRC's becoming the new housing industry. About 15 years ago, a friend of mine had a CCRC in a Chicago suburb. Our gathering used to meet there about once a month. After a time, meeting the residents, investigating the "restaurant" that was optional for meals, talking to the staff, I thought, "I'm only 45 yrs old, I want to live here." The balcony was lovely overlooking a superb garden and the apartment approx. 1500 sq. feet. They bought the unit and when they passed, the unit was sold. I would think appreciation would be beneficial to the community if they kept up the quality of living.

This concept takes some investigating, as you say. I would want to visit the facility several times, maybe meeting some residents and staff. I'm reading Jimmy Buffet is opening a "Margaritaville" in Florida, I think Destin area. The more properties built, the more competition, the more affordable. The 2013 thread opened many doors and links to current websites that give valuable info into the future regarding cost. And you are right, contracts need to be read thoroughly and that's what our lawyer is for LOL.

 

[Mdlerth]

Limited, but disturbing, data

I won't attempt to claim expertise, because I don't have a lot of experience in this arena. But since I'm facing the painful problem today, the limited data I do have is imprinted on my brain in big letters. So I'll share it, and you can just add my story to anecdotes you have already heard.

As of about three weeks ago, my own parents are in a nursing home in a tiny town hundreds of miles from any relatives. In their 80s, they are the last survivors of their own families, so no siblings or cousins to call on. There's only my two brothers, two sisters and me.

Mom and Dad are mentally on a steep slope downward. My father also is physically disintegrating rapidly due to suspected series of mini-strokes. There is no chance, short of divine intervention, that they will ever leave that NH. Sad but true.

Now comes the part that might be useful to you readers of this thread. The biggest reason leading to their installation in the NH was their own stubbornness in refusing to move out their house even after it was obvious they couldn't care for themselves any longer.

They were sent there under doctor's orders "to rehabilitate" after the nth time they called 911 and got ambulanced to the emergency room. As the five of us are only now learning, M&D have been practically commuting to the local hospital via ambulance, several times a week, for a year. All the while denying that they ever had any problems at all.

Since they live far away each of us can only see them in person a couple times per year. At least once a day one of us called them on the phone. But we would (naively) believe them when they assured us they were doing fine.

When we did visit in person, we'd routinely volunteer to fix meals and do assorted maintenance and repairs as a matter of routine. But unbeknownst to us, what that did was simply camouflage their crumbling. We could not see that, between their children's visits, they were "failing to thrive" (a medical term I had not been familiar with before).

Their ailments snowballed. They didn't feel good so they wouldn't bother to eat. Poor nutrition led to dehydration, weakness and confusion, so they'd forget to take their meds. Failing to stick to their Rx schedule meant they didn't feel good. Repeat.

Probably nobody can calculate exactly how much of their deterioration or its velocity was an inescapable product of their age and genes. But it's obvious that a significant component was self-inflicted.

It didn't have to be that way. We (the children) have for years tried to engage M&D in conversation about moving out of that faraway house. We offered suggestions for moving in with any of us, or to an assisted living environment where the three "M"s would be reliably provided: meals, meds and movement. Each time our parents would reflexively shut down the discussion. "We're fine here. We're not going anywhere. Change the subject."

Two years ago M&D would still have been healthy enough to be admitted to assisted living, and are in good enough financial shape to afford a high level of luxury. They could have spent the last few years in comfort instead of in denial. Had they made the move then they would undoubtedly be in better health today. Alas, now it's too late to move them anywhere. They are too fragile to survive the journey.

The lesson I'm learning from my parents' mistakes is this: "While you can still think clearly, plan early for the next step - and the following one, too. When the time comes for that next step, take it. Be realistic. Don't delude yourself that you're going to be healthy forever. Pretending things are fine doesn't make them fine."

Of course, it's easy for me to say all this now. I can only hope that when it's my turn I'll face my declining years with courage. We'll see.

This post went longer than I thought it would. Thank you for reading this far.

 

[Walt34]

Now comes the part that might be useful to you readers of this thread. The biggest reason leading to their installation in the NH was their own stubbornness in refusing to move out their house even after it was obvious they couldn't care for themselves any longer.

<snip>

Two years ago M&D would still have been healthy enough to be admitted to assisted living, and are in good enough financial shape to afford a high level of luxury. They could have spent the last few years in comfort instead of in denial. Had they made the move then they would undoubtedly be in better health today. Alas, now it's too late to move them anywhere. They are too fragile to survive the journey.

The lesson I'm learning from my parents' mistakes is this: "While you can still think clearly, plan early for the next step - and the following one, too. When the time comes for that next step, take it. Be realistic. Don't delude yourself that you're going to be healthy forever. Pretending things are fine doesn't make them fine."

To add credibility to Mdlerth: This is exactly the scenario that played out with FIL, and the opposite of what played out with my mother, who moved into a CCRC years before she absolutely had to. My mother was in independent living for ~11 years and loved it there, and was in assisted living for 6 months before passing.

FIL refused to face the reality that he couldn't stay in the house until he passed. We were fortunate to get him into a good CCRC, but he only stayed one night in the apartment when a diabetic episode forced him into full-time nursing care until he passed. Had he gone into the CCRC earlier, both of us are certain that his last year would have been much better than being bedridden.

This is why we are already on a waiting list for a CCRC even though neither one is even near 70 yet. We've seen that movie before and we know how it can end.

 

[Travelfreek]

So many variables! Both my parents wanted to stay at home, too, when the time came they needed help. My dad had multiple strokes (he had no long term care insurance) and they burned through $90k in cash (their life savings) for the 2.5 years he stayed at home w/ 24 hour care. At first there was an agency providing the CNA's. The cost was too much for that so they got connected with some folks who did it much cheaper ($75 per 24 hour period vs. $125). This worked out fairly well but there were some issues trying to cover a day here or a day there. Kind of nerve wracking. My Dad was 82 and sharp minded. My mom was 73 and not able to lift his weight (he was paralyzed on one side).

It worked out w/ 4 of us kids in the general area but it was a hassle (mom didn't drive). My sister often took them to the doctor (she had a job with much a more lenient policy than the rest of us adult children). My Dad ended up in Skilled nursing for just 2 months before he passed and we found a great place that he actually liked. My Mom got dementia shortly after our Dad passed (she was 9 years younger). She wanted to move because she was so lonely in the house where she and my Dad lived for 50 years. She went to a senior apt high rise apt. She was lonely there too because she was not good at making friends. She fell and broke her hip shortly after moving there and from there went to assisted living in a residential home type place (6 patients in a home in neighborhood setting). Luckily, she had long term care insurance and this policy provided "free care/rent" for almost 3 years (cost of care was $2500 a month including meals). My mom was fine with this arrangement even though in her earlier years, she was adamant about having in the house care. She became so lonely being alone in her home and she hated the isolation (she didn't drive either due to eyesight and her 4 kids were all busy in their careers and the grandkids were in daycare. Getting a long term care policy that provides for both facility and home care is a great way to handle changing needs and circumstances.

Also, my mom-in-law died at 81 from lung cancer. She lived at home till she was hospitalized and then placed in rehab until she was going downhill. That's when medicare stops paying for the room and board. At that time, we had to either find caregivers to take care of her in her home (I priced it out and it was $13,000 a month to have 24 hour caregivers who could give her breathing treatments every 4 hours around the clock) or move her to Assisted Living facility (luckily her needs qualified her for assisted living and she didn't need the skilled nursing facility level (all depends on what's required like catheter or IV etc. and the doctor determines this). So, we found a great assisted living facility that was able to provide her with breathing treatments every 4 hours around the clock (had LVNs on staff) and the cost was $6000 a month - less than half the cost of the in home caregivers and it included all the meals in a gorgeous setting. But, she lasted and actually thrived there for only 12 days before she passed away peacefully. This particular assisted living environment was really, really nice. She was so happy there and all her friends came to visit daily. All her friends said they wanted to go to the same place once they required that type of care. She was as sharp as a tack till the very end. She didn't have long term care insurance but she had assets and also would have qualified for the Veteran's Aid and Attendance benefit if she had lived long enough. That pays about $1000 a month for widowed spouses of war-serving veterans as long as their assets are below a certain level (may have been $60 or $70k at the time).

 

[Amethyst]

Oh, Mdlerth, what a heartbreaking discovery. I guess it is just impossible for some people to admit to themselves, let alone others, that they are dying. Imagine if they had no kids to worry about them; no, don't even imagine that scenario.

 

[Scuba]

My DM went into an ALF (with a moderate cognitive decline) after we (some of her children) determined she could no longer care for herself. Prior to that she had in-home care, one shift, for 3 years. Her social life had completely faded and she spent the day watching tv. She was unhappy with the move, but there is no doubt her social life has recovered, she is eating a more balanced diet, and most importantly, she takes all her meds.

Any care, be it in home or ALF, needs oversight and supervision. The recipient needs an advocate to ensure the care is always given as needed. He / she also many need help protecting assets, either financial or personal, as Moemg can attest.

100% agree - care oversight is critical, even in a CCRC.