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Old 08-03-2016, 01:22 PM   #21
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The other point I would make echoes some of the others on this thread - start looking early and be prepared to enter relatively early; most places do physical and cognitive/psychological assessments as an entry screen and you don't want to wait until you 'need' to go in order to do so if you want to be able to select the best place for you; if so, you may end up w only the place(s) that will 'take' you vs what you want.
After experiences with my mother and FIL that is our observation too. We have already put in an application at one place; I'm 66 and DW is 59 and we are not nearly ready to move but we wanted to be high on the waiting list when we do. They really don't want you there before age 70, there is a surcharge for anyone under that age.

My mother waited six years to get in, FIL got lucky. The place where he went had had a ten-year waiting list but they had just completed a several-hundred-unit apartment building that wiped out the waiting list and had about six empty units left, so he got one of those. The backup generator was just outside his windows but since he had hearing loss anyway we figured it wouldn't matter much if at all.
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Old 08-03-2016, 06:54 PM   #22
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I retired Dec. 31, 2015. In January, DM who is 85 and widowed had a mild stroke. She'd lived independently in her home and the Dr. insisted that she needed a full time caregiver in the home. For about a month my two sisters traded off watching her - they both live a few miles away. I live across the country and they ask me to stay with her for a couple of weeks in March. During that time, she visited an independent living facility, that has adjoining assisted living and a memory care unit.

While she'd had memory problems before the stroke, they got worse afterwards. I moved her into the facility in March and put her house up for sale. It sold in June and I went back for the closing. While she sometimes complains that she enjoyed her home better than the facility (national chain - Brookdale), all of us recognize that it would not have worked otherwise. We'd visited the facility about 2 years earlier, so she had some idea of the amenities beforehand and I think that helped. We'd rate the facility as A+ for care and amenities. It costs her about $3300 a month and that covers breakfast and one other meal daily. They have a 24 hour nurse on site and provide transportation, etc. Her income is just slightly more than her living costs presently, but she has some savings, and a few investments to carry her forward, she'd make it in a nursing home a few years (5-6) before being completely out of money. Assisted living is almost $60,000 a year and memory care is around $90,000 annually. There is an option in independent living that she's in to have someone check (nurse's aide) on her 2X a day to make sure she's eating and is OK, etc. This costs $500 a month and would be significantly less than full time assisted living.

On a personal note I've had to put off some plans for retirement projects and trips, and other family needs because of the need to care for mom. It's been a very stressful and difficult period for me to watch her deteriorate and a lot of time and energy to get her affairs in order. I am really glad I was able to be there for her. Don't know how it would have been done if I'd not retired when I did.

Good luck. I think you're wise to begin the process before it's absolutely necessary.
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Old 08-04-2016, 05:40 AM   #23
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Haven't been to look at any places, but have seen some photos of units posted on other forums. They look exactly like cheap motels minus the swimming pool: grim little front door, flimsy shelving, small windows, tiny fridges, and a "courtyard" in the middle with round tables and umbrellas. In such a place, I would die quickly of aesthetic deprivation.

I am not sure whether the low-rent look is is merely to keep costs down (and thus, more elegant places might be available for those of greater means), or if the assumption is that the old dears don't know nice from nasty these days and thus there is no need to make the units attractive.
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Old 08-04-2016, 08:53 AM   #24
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Haven't been to look at any places, but have seen some photos of units posted on other forums. They look exactly like cheap motels minus the swimming pool: grim little front door, flimsy shelving, small windows, tiny fridges, and a "courtyard" in the middle with round tables and umbrellas. In such a place, I would die quickly of aesthetic deprivation.

I am not sure whether the low-rent look is is merely to keep costs down (and thus, more elegant places might be available for those of greater means), or if the assumption is that the old dears don't know nice from nasty these days and thus there is no need to make the units attractive.
At least in my neck of the woods, the ones like you're describing are true assisted living only, basically starting around $3600/month. The Life Care where you start as Independent and work your way through AL and Skilled nursing are much nicer. Starting directly in AL will cost about $5100/month, but if you do the Life Care Plan, you pay about $3000/month all the way through the levels. Not sure what age or health condition you have to be to get the start at $3000/month, but I have a friend whose parents are recently started at that rate.
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Old 08-04-2016, 08:57 AM   #25
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Still do not see why they have to be so depressing and cheaply finished. They remind me of some cheesy apartments I could not wait to get out of when I was in my early 20's. What a joke on me to have to go back to such accommodations after a lifetime of striving!

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At least in my neck of the woods, the ones like you're describing are true assisted living only.
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Old 08-04-2016, 09:25 AM   #26
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Still do not see why they have to be so depressing and cheaply finished. They remind me of some cheesy apartments I could not wait to get out of when I was in my early 20's. What a joke on me to have to go back to such accommodations after a lifetime of striving!
Not all ALF's are cheaply furnished. A lot depends on when they were built. My (limited) experience is that not a lot is spent on upgrading furnishings once the facility is up and running, so no matter how nice it looked when new, 20 years later it looks old and worn.

Depressing is a different matter. The ALF's are, by definition, full of people that are old and in poor health. If they have memory care units, there are probably a fair number of residents suffering cognitive decline as well. Cheerful, healthy and relatively fit seniors are still living in their homes.
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Old 08-04-2016, 09:53 AM   #27
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The photos I saw were of the inside and outside of the units, unfurnished, nobody in them. Not dirty or unkempt; just the lowest possible quality, not even a bit of molding around doors/windows. And so incredibly cramped. No storage, just a few flimsy standing shelving units. As I said - looked like a cheap roadside motel.

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Not all ALF's are cheaply furnished. A lot depends on when they were built. My (limited) experience is that not a lot is spent on upgrading furnishings once the facility is up and running, so no matter how nice it looked when new, 20 years later it looks old and worn.

Depressing is a different matter. The ALF's are, by definition, full of people that are old and in poor health. If they have memory care units, there are probably a fair number of residents suffering cognitive decline as well. Cheerful, healthy and relatively fit seniors are still living in their homes.
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Old 08-04-2016, 10:14 AM   #28
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I retired Dec. 31, 2015. In January, DM who is 85 and widowed had a mild stroke. She'd lived independently in her home and the Dr. insisted that she needed a full time caregiver in the home. For about a month my two sisters traded off watching her - they both live a few miles away. I live across the country and they ask me to stay with her for a couple of weeks in March. During that time, she visited an independent living facility, that has adjoining assisted living and a memory care unit.

While she'd had memory problems before the stroke, they got worse afterwards. I moved her into the facility in March and put her house up for sale. It sold in June and I went back for the closing. While she sometimes complains that she enjoyed her home better than the facility (national chain - Brookdale), all of us recognize that it would not have worked otherwise. We'd visited the facility about 2 years earlier, so she had some idea of the amenities beforehand and I think that helped. We'd rate the facility as A+ for care and amenities. It costs her about $3300 a month and that covers breakfast and one other meal daily. They have a 24 hour nurse on site and provide transportation, etc. Her income is just slightly more than her living costs presently, but she has some savings, and a few investments to carry her forward, she'd make it in a nursing home a few years (5-6) before being completely out of money. Assisted living is almost $60,000 a year and memory care is around $90,000 annually. There is an option in independent living that she's in to have someone check (nurse's aide) on her 2X a day to make sure she's eating and is OK, etc. This costs $500 a month and would be significantly less than full time assisted living.

On a personal note I've had to put off some plans for retirement projects and trips, and other family needs because of the need to care for mom. It's been a very stressful and difficult period for me to watch her deteriorate and a lot of time and energy to get her affairs in order. I am really glad I was able to be there for her. Don't know how it would have been done if I'd not retired when I did.

Good luck. I think you're wise to begin the process before it's absolutely necessary.
We just had to do similar with my parents. Actually my Dad started the ball rolling and my brother and I had to jump into action to make sure he wasn't over-committing. In 30 days we sold their things, packed and moved them, and sold their home. Fortunately my wife, who hasn't actually had a salaried job for five years now, was free to help and made all the difference.

My mom had a TIA/stroke a few years ago and is struggling with memory issues. They both have neuropathy and walking problems. But they wouldn't have been able to afford the $4300/mo. at their Brookdale facility without the generous Veteran's benefit. Lifesaver, that one.

They probably should have made this move six months or more earlier, but it's really difficult to self-assess that you need to do so. They are getting much-needed help with socialization and meals (3x day free) and have people onhand to assist with medications, showering, etc. Their best friends are also there, which makes a big difference.
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Old 08-05-2016, 03:43 PM   #29
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OP here with update...

Visited independent living facility that is being built..opens end of the month so they are taking refundable deposits for priority place in line. 120 apartments ranging from

$2,650 for studio/460 sq feet
$3,200 for 1 br/599 sq feet
$3,600 for 2 br w/study / 675 sq feet

Note that we are in central Texas close to Austin...not too high COL but getting there.

No buy-in, lease only, 60 days notice to move out, pets allowed, includes $300 credit for meals (cafeteria and bistro). Hair salon, pharmacy, concierge, 24 hour staff.... attached to ALF and Memory Care F.

I think this is a great deal for my DM, who at 87 and healthy, has a life expectancy to 93, according to SS table. The 1 br fits her budget, although a tight squeeze with other expenses. When she's ready for ALF, her LTC and VA survivor benefits kick in to bring her income up to be able to afford it.

2 other ALF's in immediate area have waiting lists of about 1 year.

Now, the hard part is getting DM and I on the same timetable.
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Old 08-05-2016, 03:50 PM   #30
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Now, the hard part is getting DM and I on the same timetable.
When my mother sold the house she'd been in for 40 years she cried a bit but knew it was necessary. Six months after moving into her studio apartment at the CCRC she said "I wish I had done this ten years ago!"

Since there are no other current residents for her to talk with, perhaps taking her to other similar places and talk to residents there.
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Old 08-05-2016, 04:30 PM   #31
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Your Mom is 87 and healthy so I don't see any type of timetable for her to move to AL. My Mom and 3 of my 4 grandparents lived at home until a week or so before dying. They lived alone and took care of themselves. They all were in their 80-90's. She may never need to go into a home. I was reading that only about 20% of people ever end up in a nursing home. It is one thing to be on a waiting list if she wants to be and when her name comes up she can refuse if she wants to then I see that as ok. I know it can be difficult to find a decent place for someone who truly needs it. I am the guardian for a friend that had no family left and her DH died and she had to go into a home at 64 due to dementia which was really sad. At age 62 my parents sold their family home and moved into a 2 BD apartment. Her sister is alive at 91 and lives alone in her own apartment and does everything for herself except she can no longer drive. It is not inevitable that everyone needs some type of care.
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Old 08-05-2016, 08:25 PM   #32
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Hi, have been through the move with my parents over the last 18 months. DM had serious health issues, enough to finally get them to agree to move to a CCRC close to me instead of staying in their house 3 hours away. They got an independent living apartment in the CCRC, and it greatly improved their lives. Social interaction was finally a real part of their days again, meals are very good, and the apartment has a full kitchen so they can eat in if they prefer. Mom passed away several months ago and Dad is now on his own, but very near me so I see him often. I would not be able to be so helpful or to see him (which I do, multiple times a week) if they had not moved close. While he's more of an introvert than she was, he does like having people around in case he wants to share a meal or interact. But again, if he wants to be in his apartment, that's ok. I think he wants to know they are there nearby, but doesn't want to have to interact if he doesn't feel like it. And that is fine in his community.

Parents were in their 80's when they moved to the CCRC. Their neighbors have a wide spectrum of health, some travel regularly or still work, others are terminally ill but still able to live alone. Others are just elderly and manage with various issues. The assisted living unit is also nice, and there is skilled nursing (which Mom used for 2 months post-hospitalization before moving back to their apartment) and memory care if needed.

I plan a move myself to a CCRC, finances permitting, at age 75-79. I want to move early enough to enjoy it and make friends, but probably many years after I retire. I currently work full time. Mom enjoyed the time there immensely, said she wished they had moved years earlier. That is a common, but not universal, sentiment there. Dad would rather have never left his house but the truth is he really isn't ok without a little support, and while he utilizes services available to him in the CCRC he would never have permitted anyone to provide him that kind of help in his house.

I think that if a person doesn't miss the society of others and is willing to get some help coming in as needed, that is one thing. Stay in the house. But for those who like to socialize or who enjoy friends, or who need a little help, or who refuse to properly care for themselves out in their isolated house somewhere, a CCRC is a great alternative.


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Old 08-07-2016, 12:09 AM   #33
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Thanks for the mention, MichaelB!

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Now, the hard part is getting DM and I on the same timetable.
You seem to be making great progress, especially if she's willing to talk about it.

Another resource is a local geriatric care manager. Most of them offer a free hour followed by $50-$100/hour (depending on the service). They know all the ratings and the gossip about the local care facilities. They also know how to talk with your Mom using vocabulary that will resonate with her and make her feel like she's in charge of the process.

If your mother is a military vet (or if her spouse was) then you may be eligible for some needs-based veterans services from the local VA center. They may even offer her an Aid & Attendance "pension" (stipend) depending on her income & assets. She's also probably going to be eligible for Medicaid soon. The GCM can help you navigate both of those confusing and frustrating processes.

For you, I'd recommend reading a library copy of "The 36-Hour Day" (skim the parts that apply to you) and "When The Time Comes". Your mother should also consider signing a power of attorney now (ideally for someone like you) to handle her finances when she's ready to turn over that job. In a perfect world she'd give you logins/passwords to her accounts so that you could manage her finances at her direction. Powers of attorney are typically voided when the signer becomes mentally incompetent (whether by dementia or some other physical condition) so it's a temporary measure... but it'll pay the bills until you can work out a long-term conservator appointment.

I've written a dozen blog posts on the subject (and my conservator's financial experience) at The-Military-Guide.com. You can find them by searching for the keywords "geriatric" or "Alzheimer's".

I'm on travel for another couple months with limited bandwidth, but feel free to send me a PM or an e-mail (NordsNords at Gmail) if you have more detailed questions.
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Old 08-07-2016, 03:13 PM   #34
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I tried to get the "aid and attendance" pension for my friend. The good thing was her income was low enough but I had found a place that would take her SS and small pension as payment in full but it is an hour drive for us. To live in our city it would be more expensive and this city is also her home. Anyways, if I had put her in a home she could not afford then they would have given it to her. But I can't move her here and then get it. It is also my understanding that Medicaid pays nursing home care but not assisted living. The rules are so complicated. It was a nightmare trying to navigate the system for my friend. My Mom put my name on her checkbook and accounts so if she could not pay her bills I could. This was the easiest way to handle that. It came in handy a few times when she had extended hospital stays. I actually was very surprised that only 20% of people ever end up in a nursing home. The news makes you feel like it is inevitable.
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Old 08-10-2016, 10:35 AM   #35
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It would be good idea to inquire into stats regarding reported incidents of violence when investigating potential assisted living facilities:

Assisted Living Residents With Dementia Prone To Abusing Others, Study Finds | Kaiser Health News

Quote:
Gilbert Gimm, the study’s lead author, said he was surprised to discover how prevalent resident aggression and abuse was in assisted living. Older residents’ frustration with their declining ability to care for themselves might be a factor that leads them to abuse others, he said.

In a national sample of 6,848 residents at least 65 years old, Gimm and two collaborators found 7.6 percent of residents had engaged in physical aggression or abuse toward other residents or staff in the month before the survey. Verbal abuse or aggression had been shown by 9.5 percent of residents and 2 percent had taken part in sexual abuse toward residents or staff, according to the study.
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Old 08-15-2016, 02:19 PM   #36
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It would be good idea to inquire into stats regarding reported incidents of violence when investigating potential assisted living facilities:

Assisted Living Residents With Dementia Prone To Abusing Others, Study Finds | Kaiser Health News
Absolutely. A woman with dementia shoved my mother to the ground (breaking her hip) in an attempt to escape out the front door. The facility was not equipped to care for such a resident.
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