Trying to determine if my parents can afford Assisted Living

[gindie]

My parents are in their mid 70's and are rapidly getting to the point of needing an Assisted Living facility.

In our area of the country, a good facility will run $50K/year for the both of them, assuming only one of them needs the added medical attention.

I have run their numbers through FireCalc and see that there shouldn't be any problem for 10 years. But, after that, it becomes real fuzzy. That brings me to the issues I'm struggling with.

1) How do I estimate how long they'll need the care? Both are insulin-dependent diabetics. Dad has congestive heart failure, had a stroke 8 years ago, and is for the most part confined to a wheelchair. Mom just doesn't get around very easily any more. My gradparents all lasted into their mid-late 80's, but none of them had the medical problems that my parents have.

2) What if one or both of them need nursing care in the future? That throws all the financial estimates out the window.

Anybody out there dealt with these issues?

[2B]

DW and I have been dealing with her parents for several years now. We are just now getting things "under control." If your parents understand their situation and will cooperate, you are so much better off than we were. They fought the whole process and DW had to get doctor letters and just take over. Because it was this way, nothing really happened until it got real messy.

Understand that neither I nor DW have any formal medical education. Everything I'll say is based on my observations of my in-laws, other people's parents and what I've seen at my in-laws' facilities.

Back to your question -- assume they will live forever when you start this planning. My 86 YO MIL has been "dying" with Pakinsons and a broken hip for over two years and is still going strong other than a slowly progressing degeneration, constant pain and Parkinsons related dementia. FIL is the picture of health for an 86 year old except for his Alzheimers.

Realistically, one of them will die before the other which will greatly reduce the costs involved. You will, however, be amazed at how well the added care at the assisted living facility will extend their lives.

You need to assume that one or both of them will need nursing care. With their diabetes, nursing care is almost a given from what I've seen. This might go on for several years. My MIL has been in one for 2 years. There are other residents of her facility that have been there longer.

When you get them evaluated ask about what is "typical" for diabetics and see if you can get them to give you a more specific prognosis for your parents. They will hedge everything but I believe they will give you better information than their doctors.

All this means you need to be conservative when planning. You need to figure out what their income will be into the future as best you can. Work out a scenario with your father dying first and then with your mother dying first. One or both of them may have enough income on their own (SS/pensions) to cover most or all of their assisted living/nursing care should the other one die.

The "good news" is that at least one of them will likely die within ten years (mid-80's) but you can't really be sure.

You have my sympathy for what you'll be going through. You'll just have to make the best financial decisions you can and hope they don't outlive their money. Definitely price shop the various facilities and look them over carefully.

Remember to not let their conditions consume your own life or destroy your marriage if you are.

[lazygood4nothinbum]

tough questions. essentially there is no way of knowing for how long someone might last, even with seemingly horrible health. you can find general stats, you can look at family longevity, but in the end each person is a different case. my brother knows someone who stayed in fetal position, living on just spoonfuls of food for almost 3 years after everyone thought he'd be dead.

while there is simply no way of knowing 100%, you should be able to find statistics concerning the ages and illnesses you are dealing with which will give you some ideas for general planning. just to try to wrap my own mind around my mother's impending death, i found this calculator which gave me a general idea of the timing of mom's inevitably continuing deterioration. it was fairly accurate considering how general it is bound to be.

if only one requires medical care you might need to consider separating them so that you can continue to afford good medical care for one while perhaps the other can live with you or nearby his/her loved one. i know that sounds horrible but it might turn out to be the best practical solution.

when you seek a care facility, you might consider looking for one which takes private funds but also accepts medicaid patients so that if/when the money runs out they will be able to remain in the same facility to which they've become accustomed.

these are very difficult issues. good luck.

[Meadbh]

Good advice from 2B and Lazy. It's a very difficult situation. I had to deal long distance with a mother who would not give up her independence. Three emergency admissions to hospital later, she was willing to discuss LTC only because she could not physically make it at home. Her time in care was very short, because her health had deteriorated so much before she accessed it. 2B is correct; good care can really prolong a person's lifespan, compared to living independently and neglecting oneself. While researching facilities for my Mom I met one lady with Alzheimer's aged 101 who had already lived for over 20 years in LTC.

A relative has been caring for a parent at home for over 10 years. The parent has a neurologic condition and it is tremendously heavy work. What is saved in LTC fees is spent in arranging sitters, respite care, physical aids, transport, and a toll on my relative's physical, mental and family health. Filial love and duty notwithstanding, there is a time to delegate this work without guilt. I wish you luck!

[old woman]

Look at the cost again $50K for two people might only be room and board. All other cost like haircuts, medical care, medicine, clothing, depends are not covered. At least not at the one my grandmother was in until last October.
One thing is they did say if she ran out of money they would keep her anyhow, but she was 97 when she went to assisted living.
Consider a paid caregiver or two to help them live at home longer. My mom is 80 and having hip surgery we will gather around to take care of her. My brother's wife will drive her to all appointments since she teaches school and will be out for the summer. My brother retires in August and may find part time work, I have a few hundred hours of vacation saved. My other brother lives there when he isn't gone for work days at a time but when he is home he mows the lawn and will do whatever she asks him to do. I would put her in a smaller apartment if it was just that she couldn't keep up the house or hire yard and housework done unless she needed personal care that was more than we could handle. Even my boyfriend has offered to do whatever mom wants, I told him he can be in charge of the cat while she is hospitalized, he drives by going and coming for work so can watch the cat, my brother is out of town for work most of the summer but if we all work together we might keep her in her home another 5-10 years.
What would it take to keep them in a non assisted living apartment? Can you stock them up on microwavable meals and come clean once a week or would you need to be there several times a day to help out? Good luck whatever you do.

[2B]

Independent living facilities are good bargains for people that don't need continuing care. Here they can get meals cooked for them. Housekeeping can be taken care of. They are also with a lot of people their own age and have regular activities. Unfortunately, it sounds like this case has passed this option by.

The one truth is that once they start "the decline" it will progress rapidly where extensive care will be needed soon. You can't expect the elderly to continue to know how to cook from scratch, microwave prepared meals or even remember what medications to take.

old woman has an option that was not practical in our case. There were really only us here and the IL's were "too independent" to not come and go as they wanted. Once my FIL's Alzheimers became apparent, the driving had to stop. If you bring them into your own home as an alternative to assisted living, you have signed yourself up to continuing care for the duration. Lazy did that and I can only say he's either a saint or totally crazy. I know it had to have been very stressful.

If you do "professional" in home care, it is very expensive and you run the risk of numerous scams happening to them. You will also have to be extensively involved in all aspects of their care.

My IL's finances were such that DW had to sell their home to pay for their care. Any in home care would have spend all free money in less than a year. Continuing to live in their home would have probably only taken 2 more years before all of their equity was also gone. Now they are financially ok if both of them live another 15 years.

My concern with the "many helpers" approach is that it will wear real thin after a few months. There may be 10 "eager beavers" ready to keep Mom and Dad out of "a home" when it starts but it will soon seem like work. Spending your vacation time, weekends and taking this on as a retirement "j*b" will create resentment and stress. There will also inevitably be differences of opinion in what to do.

I do have a SIL/BIL several thousand miles away who are more than happy to tell us how we should take care of the IL's. It has been so helpful having non-participants telling us how to handle the situation. I offerred to put my FIL on a plane and that has slowed most of the "help."

Your not always doing them a favor letting them stay in their home. When the time comes, it's time to do the deed for their well being and yours.

[old woman]

Quote:

Your not always doing them a favor letting them stay in their home. When the time comes, it's time to do the deed for their well being and yours.

We are lucky mom just finished with her mom so understands what a burden it can be and will do whatever we decide for her. Her mom stayed at home alone until she broke a leg at 96 they tried putting her in assisted living but she was evicted within a day for hitting with her cane and biting, he daughters tried but she resisted. Mom is having trouble with yard work now and I offered to send my guy for the heavy work but she learned she can work 15 minutes at a time she said last year it might be her last year in her house, the minute we tell her we want her to move she will. Last year she said she carried a rake or shovel in the yard to steady herself, I bought her a cane and she immediately started using it.
I watched when my grand parents had my great grand mother in their home in her 90s and I couldn't ever do that, they only lasted 17 months before putting her in a nursing home. I would tell mom it was time for independent living or assisted living when it is right for her she can afford to spend about 40K per year for about 15-20 years and is 80 now but it will cut our inheritance to zero. Inheritance isn't really an issue we are old enough to have our own money, mom was 80 before her mom died and the money didn't mean anything to her, I hope to be the same way.

[2B]

Quote:

Originally Posted by old woman Last year she said she carried a rake or shovel in the yard to steady herself, I bought her a cane and she immediately started using it.

My MIL was prescribed a walker by her doctor but she wouldn't use it because it "made her look old." She was 83 at the time. She fell within a few months and broke her hip. Now she is bedridden and gets put in a wheel chair. Mentally, she's not all there now so I can't ask her if the wheel chair makes her look old or not.

Both of them still talk about moving home when she's "better." My FIL still says he's able to live at home (when he forgets DW sold it) and is still unhappy DW sold his car (when he remembers she did). Fortunately, he doesn't remember very often.

BTW -- I'm an SOB when I decide things have to be done. The only reason my DW has a POA is because I emotionally abused her until she convinced her parents to get a new will, durable POA and medical POAs. Thank God I am or this would be a total nightmare. Her parents were 80 at the time.

[gindie]

Thanks very much for the replies. Some additional information. We live 250 miles away from them and our goal is to have them move down here. My Mom's sister and BIL live 3 houses down the street from them, but they are of the same age and they are gone to warmer climates during the winter. My parents do not have a social circle, so the winters can be very lonely. We travel up there as often as possible.

I am very new to all of this, obviously. So maybe I don't have my definitions of the levels of care straight. At this point in time, the only assistance my parents really want is for someone to cook, clean, and help with the laundry (the washer and dryer are downstairs). It would also give us a little more peace of mind if we knew they were taking their medication correctly. Maybe all of this qualifies for a lower level of care than I have originally thought?

As for the finances, besides the cost of the Assisted Living, I did figure in the cost of their medication (which I assume would still be through their Medicare Part D), their MediGap coverage, and a guess for miscellaneous expenses. I considered their SS and then calculated their shortfall and put that into FireCalc.

[lazygood4nothinbum]

Quote:

Originally Posted by 2B If you bring them into your own home as an alternative to assisted living, you have signed yourself up to continuing care for the duration. Lazy did that and I can only say he's either a saint or totally crazy. I know it had to have been very stressful.

crazy as a fox. mom wasn't with me all week, usually just for weekends. no wonder i'm still single. during the week we kept her working (someone had to keep making money), well, or at least we continued to provide her with the illusion that she was still working (her favorite pasttime). we handled things more like old woman's situation with everyone helping out. i think that is the best way to do it but that only works if the family all live locally and are cooperative.

fortunately, mom had very good financial resources and so we were able to keep her in her home with paid aid plus family effort. we only needed a care facility for what turned out to be the last four years, when safe, in-home care became too difficult for us to manage even with help. it still shreds me some to remember it. i think i will only date guys who have already buried their parents. i can't go through that again. i ain't no saint.

[old woman]

Quote:

Originally Posted by gindie I am very new to all of this, obviously. So maybe I don't have my definitions of the levels of care straight. At this point in time, the only assistance my parents really want is for someone to cook, clean, and help with the laundry (the washer and dryer are downstairs). It would also give us a little more peace of mind if we knew they were taking their medication correctly. Maybe all of this qualifies for a lower level of care than I have originally thought?

My boyfriend's aunt sold her home when she had cancer. She moved to a wonderful apartment where meals were in a formal dining room 3 times a day and they served fruit all day you could take to your apartment and they had coffee and dough nuts at 10 for those that missed breakfast. They had nice halls and elevators rooms for social things like watching tv, exercise and a piano. Her apartment was one bedroom and tiny the kitchen was a sink, microwave and miniature frig. They supplied all linens and came once a week to change the bedding and towels and vacuum. She only had to wash her own clothing and each floor had a washer dryer. She didn't like going to the meals because it took to long to seat everyone so had a cup of soup in her apartment for lunch and kept juice and ice cream in her frig. The residents weren't prisoners they would walk to the store and go places whenever they wanted. It was 2,300 a month and nice because she could keep her own things that would fit and have her own company in the privacy of her own apartment. They didn't help with drugs or personal care but had a beauty shop and you can get visiting nurses if you have money. Some of the people drove little rascals or wheel chairs or used walkers but many were just old and didn't want to be alone in a house or cook and clean.
Mom is visiting a friend in a place like that now and we have a low income senior apartment half a block from my house and several other places, low income apartments don't give you food.

[Brat]

Gindie, I agree with others that you need to find a setting where if they run out of resources the facility will coordinate with Medicaid.

Visit an attorney who specializes in elder issues. That person doubtless knows the resources in your community and their policies.

I learned, for example, if either were members in a Masonic Order there are retirement residences that will work with you. Don't know if there are any near you, but worth a try.

Also, if they/you are Roman Catholic sometimes you can utilize their care facilities. Possibly there are other residences for faith groups.

Check out non-profit senior housing in your community. While sometimes the management forgets that they need to have a service level above apartments (had an issue here when we had a wide-spread power outage), by in large they are accustomed to issues of aging in place. Don't move them into an 'active retirement' facility unless you can see support services in place before you move them.

Been there, done that.. my Mom's been in a nursing home for over 6 years!

[2B]

Quote:

Originally Posted by gindie Some additional information. We live 250 miles away from them and our goal is to have them move down here. So maybe I don't have my definitions of the levels of care straight. At this point in time, the only assistance my parents really want is for someone to cook, clean, and help with the laundry (the washer and dryer are downstairs). It would also give us a little more peace of mind if we knew they were taking their medication correctly. Maybe all of this qualifies for a lower level of care than I have originally thought?

If you are 250 miles away, I doubt you are really seeing the whole situation. They will probably work very hard to hide things from you.

Levels of Care:

1. Independent Living - Personal apartment, food service option, housekeeping option, no personal assistance with meds or mobility.
2. Assisted Living - 3 levels of care/cost based on the number of activities requiring assistance. All meds are controlled by the facility.
3. Memory Care - This is the Alzheimers wing for people that need "containment" for their safety.
4. Nursing Care - There are various ways into this but they involve either medical conditions requiring extensive care or the inability to get out of bed by themselves. Many in senior facilities are also suffering from dementia and lack enough mobility for Memory Care.

My suggestion is to investigate facilities near your home. You should assume your parents may need all of the levels listed above. You and, eventually, your parents need to decide if they can be separated as their individual conditions develop.

We looked for a place where my IL's can both be under the same roof even though they are at different levels of care. Limiting ourselves to this option raised the cost because most facilities don't have assisted and nursing in the same building.

The assisted living facilities all have social workers on staff that can give you a lot of information on alternatives. The ones I've talked with are very committed to helping the elderly and aren't "sales people" for their facility. You can also describe their abilities and limitations and get a good idea of their "level." You should also consider having them evaluated. An evaluation will be required before admission to any of these facilities.

If you are worried about them taking their meds properly, that automatically puts them in the lowest level of assisted care. I would question depending on a "day maid/cook" to keep track of their meds. Also, depending on where they live the cost of in home assistance will raise their cost of living to well above the cost of an independent living facility (if they still qualify).

Based on my IL's and my SIL's grandparents, "staying in the home" becomes a big issue with many elderly. If you're not careful, meeting this "goal" will reduce the quality of their care and cost them a lot more money than the alternative.

Feel free to PM me if you want more info.

[Khan]

Quote:

If you are worried about them taking their meds properly, that automatically puts them in the lowest level of assisted care. I would question depending on a "day maid/cook" to keep track of their meds.

Just a data point:

I know someone who works as a home aide for a local hospice. She does not and will not handle people's meds. There is a lock box for meds.

Sometimes home aides steal drugs.

Sometimes relatives steal drugs and accuse home aides.

[Brat]

One of my MIL's first stops was a retirement residence with meals & housekeeping. For residents who needed medication supervision and assistance with bathing (for example) there was an office of a home health provider on site. Residents paid extra for extra services. There came a time, however, when MIL developed dementia and needed close supervision, we had to move her.