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Nursing Home or Stay at Home
Old 08-10-2017, 09:43 AM   #1
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Nursing Home or Stay at Home

It's so nice to be healthy and FIRE. We can travel easily, work out, drive...Just cannot be more grateful that we FIRE while healthy and active.

My mom lived to be 93. She lived in her house independently until small strokes started happening. She swore she would not go to a nursing home ever! It got to a point she had to go to nursing home and lasted less than 2 weeks there. She passed.

I keep thinking about this, hopefully won't happen for another 30 years. If my portfolio increases nicely, I plan to pay a nurse or CNA to either live with me or take care of me full time if needed, in my home. I figure I could cover living expenses and provide a decent salary. Then, I had the thought of Independent Living in a nice 2 bedroom apartment. Meals if I wanted or kitchen to cook. I priced out this situation and in Florida there are some very nice places inland for @ $70K a year.

Any thoughts on this topic?
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Old 08-10-2017, 10:00 AM   #2
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We maintained my parents with round the clock care for years. You need someone overseeing you . The pitfalls with inhome care relate to the fact that sometimes home care workers are not all we wish- unreliable, dishonest or good hearted but lazy. What if the worker is ill or has an emergency?

If you have a trusted nearby person it should work we had all the above but mostly gems. However there is no way it would have worked without us intervening as needed

My parents disintegrated simultaneously. My mom mentally and my dad physically.
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Old 08-10-2017, 10:21 AM   #3
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You mentioned Independent Living facilities; are they continuing care retirement communities (CCRC)?

We are planning to enter a local CCRC fairly early...around age 75. You must start in an independent living apartment, but as care needs increase you can receive assisted living services, and then skilled nursing services...all in the same facility. The "Life Care" contract we will use locks in the cost for the rest of your life, so at least that should be predictable. There have been several threads here about CCRC's, if that is of interest.

CCRC's are pricey. There is an initial buy-in amount, then a move-in cost, and then monthly apartment rental fees. I live in Florida, and the average buy-in is around $250k, move in fee around $15k, and average monthly fee around $5k, but there are less expensive ones around. All of the CCRC's I have visited have long waiting lists, so people must be able to afford them.

Just another option to try and stay independent as long as possible, but with a solid back up plan.
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Old 08-10-2017, 10:26 AM   #4
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Originally Posted by Rianne View Post
It's so nice to be healthy and FIRE. We can travel easily, work out, drive...Just cannot be more grateful that we FIRE while healthy and active.

My mom lived to be 93. She lived in her house independently until small strokes started happening. She swore she would not go to a nursing home ever! It got to a point she had to go to nursing home and lasted less than 2 weeks there. She passed.

I keep thinking about this, hopefully won't happen for another 30 years. If my portfolio increases nicely, I plan to pay a nurse or CNA to either live with me or take care of me full time if needed, in my home. I figure I could cover living expenses and provide a decent salary. Then, I had the thought of Independent Living in a nice 2 bedroom apartment. Meals if I wanted or kitchen to cook. I priced out this situation and in Florida there are some very nice places inland for @ $70K a year.

Any thoughts on this topic?
We had our aunt in assisted living for $2050 per month. Had to get them to handle her meds at $500/per month later. At 98 years of age, she went to a large nursing home at $4500/per month. We're thankful to have relatively inexpensive late life care--and the quality of auntie's care was wonderful.
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Old 08-10-2017, 10:33 AM   #5
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My dad began exhibiting symptoms of vascular dementia at 90. My mom remained in good health and they stayed in their home of 60 years, with help from me to do many of the things my dad used to do. (I live 10 minutes away.) Then around his 94th birthday, my dad had a major stroke and required 24/7 nursing care at home. He lived for 8 more months before dying at home. The skilled nursing care through an agency cost $135K for 8 months in a high COLA area. The nurses were excellent, and it was probably more important for my mom that my dad was able to stay at home.

About 6 months after my dad died, my mom started exhibiting dementia at age 93. That was 2 years ago. (My mom started calling me multiple times every evening because she couldn't find my dad.) She continued to live at home, and I became my mom's caregiver. I brought her groceries or took her food shopping, paid her bills, fixed things, took her to doctor's appts, etc. She had still been driving until that point. I estimate that I received well over 1,000 phone calls because she couldn't find my dad. She would not consider moving out, nor would she accept outside help. Then last December she fell and broke her pelvis and wrist. She did well in rehab but needed a caregiver when she first returned home. She now accepts the caregivers. It's somewhat cheaper than my dad's caregivers because my mom doesn't need an RN at this time.

I was fortunate to have great parents. My mom is very appreciative for what I do, but if she did not have dementia, she would be horrified at how this has affected my life. I FIRE'd 5 years ago around the time that my mom started to need more help with my dad and their house. The caregiving hasn't completely consumed my life, but it has prevented me from doing quite a few things I would prefer to be doing. I'm not angry with my mom, but I am very resentful toward my brother who also lives just 10 minutes away and refuses to help.

Now that things seem stable with my mom and the caregivers, I am going to attempt to do some more travel.
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Old 08-10-2017, 10:36 AM   #6
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My Dad still lives independently at home @ 90 and would prefer to stay there. I have made a promise to do all that I can to see that happen, but we know that may or may not happen. His wife spent several years with Dad taking care of her (COPD and dementia) with the help of other family and for the last year, hospice. For the DW and I, we figure that we will move to a CCRC...when that will happen? Hopefully for not a long time.
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Old 08-10-2017, 11:05 AM   #7
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I will look for extensive threads on CCRC. My question is do you have to buy in early? Like we are 60 and don't know when we'll need those accommodations.
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Old 08-10-2017, 11:12 AM   #8
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I will look for extensive threads on CCRC. My question is do you have to buy in early? Like we are 60 and don't know when we'll need those accommodations.
You should look into the CCRCs that you would be interested in and give them a call to see what their policy is, as they will vary. The one I looked into takes a $1,500 fee to be put on the waiting list. You can decline and apartment and stay on the list for as long as you like. That is what I plan to do.
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Old 08-10-2017, 11:54 AM   #9
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Now that things seem stable with my mom and the caregivers, I am going to attempt to do some more travel.
Good for you! You sure earned it!
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Old 08-10-2017, 12:20 PM   #10
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Of all our parents and aunts and uncles, none that I know of went to an actual nursing home. Several, including both my parents and DH's parents were in assisted living places when they passes. My dad had terrible dementia (not Alzheimers we think) and DH's father had Alzheimers. My parents were in a great assisted living place in the reminiscence unit. The assisted living place had a range of prices depending on how much care was needed, but really the cost wasn't so high - probably half that of a nursing home.

Some of the aunts and uncles stayed in their homes. My aunt has dementia but is in her home since my cousin and his girlfriend live with her (and the GF does most of the care, I think - thanks, Beth).

Anyway, we hope to stay at home as long as possible even if that means part time help but then go to assisted living. I think you have to move into assisted living before you need round the clock nursing care so timing may be tricky. Fortunately my parents got in (their place couldn't take any one with open wounds but if you got one while you were there you could stay - my mother had that problem off and on for years because of poor circulation). I think I agree with OP's mother - no nursing home for me.
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Old 08-10-2017, 02:26 PM   #11
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I will look for extensive threads on CCRC. My question is do you have to buy in early? Like we are 60 and don't know when we'll need those accommodations.
It depends on the facility policies as Live And Learn wrote. The one we're on a waiting list for only charged $100 to be on the list, but they really don't want you there before age 70, in fact they charge an extra fee of $2k per year under 70, so someone age 65 would pay an extra $10k for early admittance.
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Old 08-10-2017, 02:55 PM   #12
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I will look for extensive threads on CCRC. My question is do you have to buy in early? Like we are 60 and don't know when we'll need those accommodations.

You can decide when to go onto a waiting list whenever you want, or based on facility policy.There may or may not be a charge to be on a waiting list.

In my experience, at the time you request to be on the waiting list there is first a financial interview to review contracts and fees, and to ensure that the CCRC buy-in and monthly fees can be afforded. All of this contractual information is provided to you in advance. You are asked to bring proof of your finances and they review it with you, and you only need to share enough to ensure that you qualify.

When you have accepted an apartment and are ready to move, a registered nurse will make an appointment with you to do a health interview. The requirements of all CCRC's that I know of is that you must enter the facility as 100% independent and self care. Some will ask that you consent to a release of medical information from all of your physicians. Others do not, but all have the interview with a R.N.. Lots of questions to check for early dementia, such as count backwards from 100 by 7, what was your weight when we weighed you an hour ago, etc. And of course observation of physical capability. That same day there is a final review of finances to make sure you haven't spent all your money while waiting for an apartment. Much of this will vary based upon specific facility policy.

There are also some differences between for profit and non-profit facilities. CARF Accreditation (Commission of Accreditation of Rehabilitation Facilities) is important to me, but may not be that important to others.

We plan to get onto a waiting list around age 74 (nine years from now). At the facility we are most interested in, the average time on a wait list is 18-22 months, and some have been on the wait list for over 4 years because they want a specific apartment floor plan. (I get a mental picture of vultures circling over the current residents.....) I don't think we'll be that picky.
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Old 08-10-2017, 04:11 PM   #13
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Here's a "sticky" thread with lots of CCRC info:

CCRC Reference Material/FAQs
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Old 08-10-2017, 04:53 PM   #14
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I will look for extensive threads on CCRC. My question is do you have to buy in early? Like we are 60 and don't know when we'll need those accommodations.


Since CCRC's are partly an insurance product, one has to be somewhat independent to qualify. Otherwise it would be akin to buying health insurance after being diagnosed with a chronic illness. Policies of different CCRC's do vary but most people do not actually move into CCRC's until their 80's. Keep in mind that late 70's to early 80's is the average move-in age. The average person living in a CCRC is much higher as people tend to live for quite a few years after moving in.
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Old 08-10-2017, 05:02 PM   #15
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So if one half of a couple can't remember their weight etc., but the other half can, neither of them gets to move in? I ask because both my Uncles were definitely demented when they moved into assisted living, but my Aunts were not, and the Aunts did much of the caring.

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You can decide when to go onto a waiting list whenever you want, or based on facility policy.There may or may not be a charge to be on a waiting list.

In my experience, at the time you request to be on the waiting list there is first a financial interview to review contracts and fees, and to ensure that the CCRC buy-in and monthly fees can be afforded. All of this contractual information is provided to you in advance. You are asked to bring proof of your finances and they review it with you, and you only need to share enough to ensure that you qualify.

When you have accepted an apartment and are ready to move, a registered nurse will make an appointment with you to do a health interview. The requirements of all CCRC's that I know of is that you must enter the facility as 100% independent and self care. Some will ask that you consent to a release of medical information from all of your physicians. Others do not, but all have the interview with a R.N.. Lots of questions to check for early dementia, such as count backwards from 100 by 7, what was your weight when we weighed you an hour ago, etc. And of course observation of physical capability. That same day there is a final review of finances to make sure you haven't spent all your money while waiting for an apartment. Much of this will vary based upon specific facility policy.

There are also some differences between for profit and non-profit facilities. CARF Accreditation (Commission of Accreditation of Rehabilitation Facilities) is important to me, but may not be that important to others.

We plan to get onto a waiting list around age 74 (nine years from now). At the facility we are most interested in, the average time on a wait list is 18-22 months, and some have been on the wait list for over 4 years because they want a specific apartment floor plan. (I get a mental picture of vultures circling over the current residents.....) I don't think we'll be that picky.
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Old 08-10-2017, 05:05 PM   #16
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Here's a "sticky" thread with lots of CCRC info:

CCRC Reference Material/FAQs
+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.

Sharing 23 years of Frugal Retirement

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.
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Old 08-10-2017, 06:06 PM   #17
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So if one half of a couple can't remember their weight etc., but the other half can, neither of them gets to move in? I ask because both my Uncles were definitely demented when they moved into assisted living, but my Aunts were not, and the Aunts did much of the caring.
That's a great question. I can't say for sure what would happen, and it may be handled differently at different facilities. It sure is a question that needs to be asked at any facility being considered.
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Old 08-10-2017, 06:12 PM   #18
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A close friend of our family wanted to stay home when she got dementia. She hired full time help .Her house was filled with antiques by the time she was moved into a Nursing home the house was stripped of every item worth something and she did not receive good care .You really need someone to oversee your care .
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Old 08-10-2017, 06:25 PM   #19
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+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.
Some CCRC contracts do not require a buy in amount. I can only assume in those cases that assisted living and skilled nursing costs are charged at the going rate when they become necessary, so there may be a significant increase in costs later in life.

The CCRC's I am most familiar with have contracts providing "Life Care", meaning the monthly costs are "frozen" at the time the contract is signed so that costs are more predictable. You pay the same monthly fee for independent apartment living as you do for assisted living and skilled nursing care, and they cannot kick you out of the facility even if you run completely out of funds. They will pursue Medicaid on your behalf so they still get some payment. These contracts are well explained in the link provided by MBAustin.

Although they certainly may exist, I have not found any facility offering a "Life Care" contract, locking the costs for all future levels of care, without an up front buy in. If they exist, that would be really good to know.
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Old 08-10-2017, 07:14 PM   #20
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Some CCRC contracts do not require a buy in amount. I can only assume in those cases that assisted living and skilled nursing costs are charged at the going rate when they become necessary, so there may be a significant increase in costs later in life.

The CCRC's I am most familiar with have contracts providing "Life Care", meaning the monthly costs are "frozen" at the time the contract is signed so that costs are more predictable. You pay the same monthly fee for independent apartment living as you do for assisted living and skilled nursing care, and they cannot kick you out of the facility even if you run completely out of funds. They will pursue Medicaid on your behalf so they still get some payment. These contracts are well explained in the link provided by MBAustin.

Although they certainly may exist, I have not found any facility offering a "Life Care" contract, locking the costs for all future levels of care, without an up front buy in. If they exist, that would be really good to know.
You are correct... Our CCRC does not have "life care", though when the patient's funds are exhausted, it does accept medicaid. For us it was a decision... between our health status, and life expectancy, and our limited nursing home insurance, we figured it would be a reasonable bet. Most of the full service CCRC's in the general area, DO have endowment requirements, as did the one we looked at in Florida.

in some other threads I have suggested owning instead of renting, to protect the surviving spouse in the case of long term nursing home expenses, whereby the state would pay through medicaid, and not take the home, until the surviving spouse would sell (lien on house) or pass away...
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