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Assisted living- where to start?
Old 08-02-2016, 09:37 AM   #1
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Assisted living- where to start?

Looking for resources to learn about assisted living choices for DM. She's 87 and in fantastic health. Lives about 2 hours away from us now. She has wanted to stay in her home for as long as possible, which I understand totally.
There will come a time when she will need some assistance and she has decided that she should move to where we live when that time comes. I am thrilled with that decision because the little town she lives in has only 2 choices and neither is where I would want to see anyone's parent live out their final days.
I know I will need to visit many of the area assisted living communities in person and will begin that process.

BTW... DM's income is 40k (pension, SS, some dividend income). Owns a home worth about 30k. She has LTC insurance that will pay out only $83 a day when the time comes. I'd like to get her situated while her health is good. There are no CCRC's in this area, only assisted living facilities.

What I'm hoping for with this post is for some direction by members of this community who have been through this process with their parent. I'm hope there are resources (online and otherwise) that I should be using along the way and pointing those out will be appreciated.
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Old 08-02-2016, 09:48 AM   #2
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We took MIL and FIL to a few assisted livign places near where they lived - MIL eventually picked one out. FIL decided to tough it out at home, which worked for him.
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Old 08-02-2016, 10:02 AM   #3
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We had my mother in a luxury apartment close to DS for 2-3 years with part time help. We later moved her to a new generation asst. living apartment with full time help--to the tune of $110K per year. Fortunately, we never had to put her into a full care nursing home, and she was down to her last $5K when she passed away.

Realistically she may be needing that change of lfe at 87 years old. We've seen so many friends parents do well up to about that age only to go downhill like the Titanic.

You might want to make the move now.
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Old 08-02-2016, 10:05 AM   #4
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My DW and I have been working on exactly this for the last couple of months. To summarize, you have a tough road.

I can just tell you what we have found, and assume you will find similar costing, etc. here we go:

His Financials
FIL is just now 91. He was in pretty good health up until MIL passed away a little over a year ago. As it seems these things go, he has started to have problems. His income is about $30k/year, and he may qualify for VA benefit of another $20k/year. His home is in trust, he has limited other funds and no LTC insurance.

Assisted Living
What DW and I have found is to be in a place that we would feel comfortable to place my FIL, for Assisted Living, is $4500-$5500/month. Problem is, that you must have an assessment done for entry. This assessment resulted that my FIL requires Skilled Nursing, not Assisted Living. Skilled Nursing is $9000/month.

Right now, DW has taken 12 weeks FMLA from work, and we will assess whether she can return or must quit after that 12 weeks is depleted, assuming some other remedy does not happen earlier.
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Old 08-02-2016, 10:08 AM   #5
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I'd try looking for an assisted living set-up that can transition to full nursing home care if needed.It makes the move to full nursing home a lot easier for everyone. Often they will be relocated to another part of the facility but can have some contact with any friends that are still on location, and they know the routine of the place which can be comforting.
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Old 08-02-2016, 10:23 AM   #6
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This is the best resource guide I've been able to find regarding a thorough review of housing options (with pros, cons, and considerations of each) as we age (includes assisted living):

http://newageofadvice.com/files/5313...plications.pdf

I've posted also these links before on the subject of caregiving for an elder:

Sharing 23 years of Frugal Retirement

and these as well regarding long term care (including assisted living):

https://www.genworth.com/about-us/in...t-of-care.html

https://www.senioradvisor.com/

https://www.fidelity.com/bin-public/...Well_Guide.pdf
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Old 08-02-2016, 10:29 AM   #7
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All of these are good advice information, but you just don't know until you get in to it. Paying for this for elderly that rely on pension, SS for living is damn near impossible. At least if you want to keep them out of a depression pit, shared room, waiting for your time to die environment.
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Old 08-02-2016, 10:36 AM   #8
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When we researched this for Dad I visited 4 Assisted Living Facilities in the area. Three were affiliated with large companies (Sunrise, Kindred and Emeritus) and one was an independent local facility.

The name brand ones were very comparable and kind of standardized, which actually was a good thing. The apartments were about the same sizes, dining rooms similar, activities along the same lines. The independent local one was an older building but the atmosphere was lovely and the place felt very warm and personalized. All the facilities were open about their apartment options and prices for room and board and add-ons (medication administration, LifeLine, personal care, etc) as needed.

I visited by just dropping in and asking for a tour. I was greeted by the Director or someone under them if available. Usually I was given a visitor packet with information to take home. All of them followed up with an email or call. I felt like they were very open to questions.

Dad decided to visit the Kindred facility closest to him. We went with him and got the tour and info. He looked at it as something to think about down the road......

Two weeks later my sister took him back for lunch and a visit. He realized what a nice change it would be for him. The best thing for him was the three meals a day. He was recently widowed and using a walker after a broken hip and he just could not manage in his kitchen. They had a 1 BR unit on the first floor near the dining room and he asked if he could leave a deposit that day. The cost was around $4000/mo and there were yearly increases of 3%. He did not have LTC insurance but he had an IRA that he withdrew from to cover the amount above his SS of about $1200.

The Kindred place was excellent. He loved the food and he liked how he could be with people or just be alone in his apartment. At first he took part in some of the social activities but did not go on the outings. Later he would go out in the public areas just to people watch. As he declined his care increased. He spent some time in the attached rehab/nursing care facility and was able to return to his apartment.

After 3 1/2 years they let us know that he needed a level of care that they could not provide and we moved him to a hospice facility.

We look back at his time in Assisted Living as a very good choice.

Good luck with yours.
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Old 08-02-2016, 10:39 AM   #9
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...
Assisted Living
What DW and I have found is to be in a place that we would feel comfortable to place my FIL, for Assisted Living, is $4500-$5500/month. Problem is, that you must have an assessment done for entry. This assessment resulted that my FIL requires Skilled Nursing, not Assisted Living. Skilled Nursing is $9000/month. ... .
I'd need to 2x check my numbers, but that sounds about in the ballpark for what I found for my Mom. Costs will vary by general COL for the area I assume.

One of the things I learned matches what I bolded above (but check for yourself in the places you are considering). We couldn't get Mom into Assisted Living after her surgery and weeks of recovery and hospital re-hab. She was still considered a "two person assist", so Assisted Living could not accept her under that label, and she had to go to Skilled Nursing.

I could not find any Skilled Nursing centers that were as nice as the Assisted Living places we looked at. Maybe you will have better luck if you need Skilled Nursing, but the places we looked at were pretty 'institutional' feeling, meals not so good, shared rooms, etc. Kinda bleak.

The Assisted Living places were much nicer (and cheaper than Skilled Nursing if you have to pay out-of-pocket). We were able to get her to Assisted Living as she was approaching her 100 day Medicare limit on Skilled Nursing - by that time she had improved to a "one person assist" level.

Key Point - Once we were able to get her into Assisted Living, she could live there even if she degraded to a two-person assist. The key is to get in while she can, and then she is set. "Aging in place" is what they called it.

But again, check all this, it might vary by place and maybe State regs?


But Assisted Living, most costs are really considered personal costs (same as renting an apartment), so I don't think much is covered by Medicare, etc. Check about your insurance. She may need to tap the principal from her dividends, depending on costs and how long she may be there. I don't think Assisted Living places will let you stay under Medicare/Medicaid if you run out of money. They need their 'rent' payment, and that's just a different category. At that point, you would probably be moved to a Medicaid facility, if the family can't come up with the $$$.

But check all this out for yourself.

-ERD50
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Old 08-02-2016, 10:40 AM   #10
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I have found this site very helpful: Aging Services and CARF-CCAC - nursing homes, retirement living, CCRC

In Oregon, Washington and California there is the option of home certified residential care facilities. In Oregon and Washington it is called Adult Foster Care. It is much less expensive than other options. One cared for my SIL all the way through hospice care once she could not be safely cared for at home by her husband. Because most of these homes only have 2-3 residents there isn't much in the way of activities offered.
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Old 08-02-2016, 10:40 AM   #11
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This is true of anything (you never know until you get into it), which is why it's imperative to remain flexible as circumstances change. OTOH, without a good base of knowledge to start from, you're simply shooting in the dark and at a disadvantage, much like a one-legged man in an ass kicking contest (to paraphrase Charlie Munger).
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Old 08-02-2016, 10:52 AM   #12
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Key Point - Once we were able to get her into Assisted Living, she could live there even if she degraded to a two-person assist. The key is to get in while she can, and then she is set. "Aging in place" is what they called it.-ERD50
I am not sure if it is different by State, but, they told us that a Skilled Nursing level person can't be in Assisted Living area. Another person in an earlier post mentioned "Life Care" which is what a lot of the places here are pushing. Basically, you go through Independent Living area, to Assisted Living Area, then Skilled Nursing area and finally to Hospice. All of this is supposedly based on 1 price for the whole time (I am thinking with a COLA increase). I thought it was a crazy concept until I saw the $5500 and $9000 per month costs! One quote I heard for the Life Care was just over $3000/month. Not sure what "young age" you have to start that at though....
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Old 08-02-2016, 11:52 AM   #13
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What I'm hoping for with this post is for some direction by members of this community who have been through this process with their parent. I'm hope there are resources (online and otherwise) that I should be using along the way and pointing those out will be appreciated.
One thing you will want to look into is the LTC agreement, to see what conditions must be met for them to pay. If it stipulates that your DM must need assistance with certain activities of daily living, your search for an ALF narrows somewhat.

When looking for a location for my DM I used a database managed by the State (FL) to list all the licensed facilities within a specific area. We then narrowed to ALF with memory care units. That way, if her AD worsens she can remain "in place", the objective being no more moves for her. We then visited every facility in the search area.

There is a profession that assists in choosing care facilities. They have search engines with directories that provide some basic info. AplaceforMom and SeniorLiving are two examples. They charge a fee to the facility, typically one month rent. In my experience nothing beats onsite visits and talking with current residents. As you have no immediate need, you could even do a little volunteer work in a couple of locations that you like, just to get a better inside view.

In this thread Nords describes in great detail the experience he had with his father. If you haven't already read it you might find it informative.
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Old 08-02-2016, 12:26 PM   #14
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All of these are good advice information, but you just don't know until you get in to it.
^This

My DM was able to live out her days in the home, and was fortunate to have in-home hospice for one day shy of one year (Medicare covered all of it) and we were out of pocket very, very little. The care she got was excellent.

My DD is about to turn 89. He's in very good health for his age but does have COPD (as did my Mom) and if something doesn't get him first, that will most likely be his ticket out of here. *If* it progresses like DM's did, he could hang on for several more years. He is still living independently (about 5 miles from me) and we are going to do our best to keep him there. Since I am retired, I will be able to live with him (or he can live with us) and be a care taker. He also has the means to pay for comprehensive in-home care...so that's plan B, if you will. We want to do everything in our power to keep him out of an assisted living (or skilled care) situation...but we do know things happen.

So...plan for the worst, hope for the best.
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Old 08-02-2016, 02:43 PM   #15
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It does not sound like your Mother needs assisted living and it may be awhile before she does .My Mother went from her apartment to an independent living facility that also had assisted living and nursing care if needed . This worked perfectly . She had a small apartment but went downstairs for meals and activities . They even had a chapel .The good thing about this arrangement is when she broke her shoulder she was able to go to the nursing area for awhile and get rehab . I found as she got older any change in surroundings made her regress for awhile so I would suggest that you find a place that makes these moves easy .My Mother lived in the apartment until she was 99 . She did have some help and in the last few months she had hospice .
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Old 08-02-2016, 03:17 PM   #16
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My mom lived in the AL guest appartment for one week, returned home to think it over and signed the agreement 6 month later.
She moved 2 years ago at age 85 and told me frequently since that she should have moved in much sooner.
I am so relieved.
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Old 08-02-2016, 03:56 PM   #17
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I don't think Assisted Living places will let you stay under Medicare/Medicaid if you run out of money. They need their 'rent' payment, and that's just a different category. At that point, you would probably be moved to a Medicaid facility, if the family can't come up with the $$$.
This varies widely by the facility - each has its own policies, at least around here. FIL went to a CCRC and was in independent living one day, then to skilled nursing after a severe diabetic event. The policy of that CCRC was that you had to have the ability to pay for a period (I think one year) but if your money ran out they would not make you move, they'd eat the loss. He was a month or two shy of exhausting his resources when he passed away but they would have kept him even after that point. This was wonderful to know. Cost varied according to services needed, but it ranged from $9k to $14k per month and the care was excellent. He had ~$200k equity in his house (that was sold) and a pension/SS income of ~$20k per year.
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Old 08-02-2016, 04:40 PM   #18
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It does not sound like your Mother needs assisted living and it may be awhile before she does .My Mother went from her apartment to an independent living facility that also had assisted living and nursing care if needed . This worked perfectly . She had a small apartment but went downstairs for meals and activities . They even had a chapel .The good thing about this arrangement is when she broke her shoulder she was able to go to the nursing area for awhile and get rehab . I found as she got older any change in surroundings made her regress for awhile so I would suggest that you find a place that makes these moves easy .My Mother lived in the apartment until she was 99 . She did have some help and in the last few months she had hospice .
An elderly relative was in a similar arrangement and had less income than the OP's mother. She had a small one bedroom senior apartment with a kitchen but the monthly rent included 20 meals a month at the dining hall, weekly housekeeping, a van for trips to the grocery store or doctor's appointments, etc. There was a nurse on the premises at all times and the facility had assisted living and skilled nursing care available although at considerable extra cost. The facility was part of the Good Samaritan network.

My relative recently died at age 91 and in her last 5 years or so paid a lady to come over a couple of times a week to drive her to the store and carry purchases into the apartment, do her laundry, etc. She would never have been able to afford assisted living and even if she had LTC insurance, it would probably have not paid anything. LTC generally does not pay until you have the inability to perform 2 or more Activities of Daily Living (e.g., bathing, dressing, eating) and she died before she got to that point. The independent living was a more affordable choice.
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Old 08-03-2016, 11:42 AM   #19
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I only have indirect experience with this, but do have some hopefully helpful observations about how to start looking at places.

DW's GP's (on both sides) lived in independent living facilities from their mid-80s onwards. on FIL's side, they had means, but sort of UMC/MC $$ and opted for renting a place that had an attached hospital facility. They liked it, particularly the meals and social aspect. The rest of the family sort of thought it was pretty basic and the meals mediocre, but that's kind of irrelevant. The care was good, though both passed suddenly in their mid 90s (her stroke, him heart attack in his sleep) w/o using most of the medical and assisted living/hospice services.

MIL's parents had more $$ (HNW) and opted to 'buy-in' to a life care place that was v nice -- really more like a country club setting. Started off in independent living in a 2 BR/2 BA casita but w/o a car and they loved it. Social meals, bridge, cocktails at 5, golf, lectures, book clubs, music, etc. They eventually moved into assisted living at ~ 95 and remained there. MIL's F went to hospice at 101 and passed quickly, MIL's M lived to 99 in assisted living until the very end.

Based on that experience, I can say that observationally over the course of about 20 yrs, the all-in approach was higher overall quality in terms of social and mental stimulation as well as food and environment. Better amenities as well, including a couple of guest houses on the grounds where family could stay while visiting or in case of a health crisis.

At this point my FIL and MIL (DW's parents and the kids of the GP's mentioned) are in their mid 70s and starting to look at places. Their recent experience with visiting a few in SoCal near us is that all-in or life-care is more stable and better environment (at least for them). As with most things, there is a near linear relationship between quality/amenities/location and cost - so it's key IMO to have a budget in hand and look first at places within that range, and then down select to places you like best on a visit. And visiting, for lunch or dinner, is critical to gauge not only quality of the food, but the staff,level of care and also the degree of interaction and cohesion among the residents. For example, they saw one place with a large contingent of memory care folks - which made dinner a little depressing/chaotic for MIL and FIL to see first hand.

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.
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Old 08-03-2016, 01:07 PM   #20
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My elderly father moved into an apartment not far from our home in 2006 after his second wife died. It was a good arrangement, he had his own space and we had ours. I had coffee with him every morning and he usually came to our house for dinner. By the time he hit 90 in 2013 he had declined to the point where I felt he needed to be in an attended setting. He was deaf and had great difficulty walking even with a walker. We visited two facilities nearby, one was a CCRC which required $250,000 upfront. I didn't like that arrangement, neither did he. The deal was you get the 250 back when you leave, but upon further questioning by me it was revealed that you get it back when they re-rent the apartment. To which I say IF they re-rent the apartment. I found out that in 2007 or 2008 they had to cut their prices to attract residents. People weren't spending. I also read about 2 or 3 CCRC's in Pennsylvania that went bankrupt in the '07-'08 period. The bankruptcy court decreed that the residents would keep their life residency (you still pay a monthly rent, but it was about 75% of the non-CCRC facility's rate) but there would be no refunds of the upfront fees. Anyway we settled on a nearby assisted living facility. He was classified as "independent living" but there was an emergency call button in the room and a nurse and aides on duty 24/7/365. He had a 300 square foot ground floor apartment. Three meals a day in the dining room (or brought to your room for a small fee if you're not up to going out) and one glass of wine every afternoon at 4:00 in the pub. Although he resisted some at first he quickly accepted his new arrangement and it worked out very well for us. The monthly rent the first year was $4,195. (This is Connecticut).

In Oct. '15 he fell in his bathroom and broke his hip. He had the usual surgery and was transferred to a nursing home right near the ALF. That was a big downgrade and he really missed the old place. He never walked again, other issues came about and in January 2016 he passed away. Medicare covered the first 20 days in full, the second 20 with a $156/day copay, and after that he was self pay at $420/day. I'll do the math for you, $153,300 a year. He had LTC insurance that he bought in the 80s that paid $100/day. I'm sure when he bought it he figured that he would be covered if he ever had to go into a nursing home. Anyway that's our story maybe too much detail, but no regrets on the choices we made.
Good luck to you.
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