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Assisted living ideas
Old 11-08-2019, 04:48 AM   #1
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Assisted living ideas

Hi All,

My parents are rapidly declining in health and we are considering several different options, including assisted living. They would prefer to stay in their house, however I cannot continue to provide care and rides to appts etc continuously, as I have to work! How does one pay for assisted living? Is it covered under Medicare or is purely out of pocket? Forgive the naive questions, but this is all new to me at a very stressful time. Thanks, Tetto.
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Old 11-08-2019, 06:39 AM   #2
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Not Medicare, but Medicaid.

https://www.aplaceformom.com/plannin...ior-care-costs
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Old 11-08-2019, 08:01 AM   #3
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Just an opinion, but if you’re not broke and not so ill that you need a nursing home, you’re going to be paying for this out of pocket. If you’re being taken care of by Medicaid, you’re not going to be getting good care. Maybe acceptable care, but I hope I never have to find out.
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Old 11-08-2019, 08:23 AM   #4
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Just an opinion, but if you’re not broke and not so ill that you need a nursing home, you’re going to be paying for this out of pocket. If you’re being taken care of by Medicaid, you’re not going to be getting good care. Maybe acceptable care, but I hope I never have to find out.
It might differ from state to state. My brother was in a NH for 9 months recovering from a stroke. The entire place was pretty good, excellent in some areas. Nothing close to the horror stories you here about...although I did interview real dumps before settling on this place.

He was self paying at $10K a month but the guy in the next room (as was more than half of the home) on Medicaid (MassHealth in Mass). Same care, food, attention. In fact, his therapists urged me to try and get him on Medicaid as "we could give him so much more therapy and for longer".
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Old 11-08-2019, 08:39 AM   #5
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Out of pocket unless LTC insurance. Won't hit Medicade until all of their assets are spent down to specific number that they can keep. At that point I would say it ends up more of a nursing home versus assisted living
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Old 11-08-2019, 09:30 AM   #6
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Are they getting too frail/needing too much supervision for in-home assistance? Still out of pocket, but they could stay in their home.
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Old 11-08-2019, 09:53 AM   #7
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Depending on the amount of care they need they may qualify for palliative care . Which is visiting nurses or aides .It is covered under Medicare .
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Old 11-08-2019, 10:54 AM   #8
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We had my parents in a luxury apartment 3 miles from my sister--with a full time maid looking after them. It still put too much pressure on my sister just scheduling doctors' visits, etc. And later my father had to go on dialysis.

Later, my mother paid $170K deposit and it was $2050 per month in a CCRC with 20 meals monthly. We had to pay $12 per hour for 24/7 care to watch her and take her to appointments. My sister never has recovered mentally--12 years later.

Our aunt was in a very nice assisted living 1 bedroom apartment, and it cost about $2K per month including meals. We had to pay $500 extra monthly for them to dispense her meds, as she didn't have the mental facilities to attend to such details. She later went into full nursing home care which was around $5K per month--cash out of pocket.
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Old 11-08-2019, 12:09 PM   #9
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You could look at what in our area is called adult foster care, in other communities "board and home". They are licensed homes with 24-hour supervision and assistance with dressing/bathing. They rarely provide transportation but your local transit agency may offer door to door transportation for those who qualify as disabled. Much cheaper than assisted living.

Agencies such as Visiting Angels could help in their home. You have to commit to a minimum number of hours a week.
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Old 11-08-2019, 12:17 PM   #10
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Hi All,

My parents are rapidly declining in health and we are considering several different options, including assisted living. They would prefer to stay in their house, however I cannot continue to provide care and rides to appts etc continuously, as I have to work! How does one pay for assisted living? Is it covered under Medicare or is purely out of pocket? Forgive the naive questions, but this is all new to me at a very stressful time. Thanks, Tetto.
You many not need the expense of assisted living. I'd contact your Elder Services in your area (or similar state/social coordinators); if in doubt start with your local Visiting Nurses and they should steer you.

They might determine that having a PCA/driver/companion at home is a better option. Depending on the state they live in and income a lot of it might be free or at a discount.

"Aging at home" is the current trend so I'd start there. At the very least you might be able to delay large expenses for a few years or more.
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Old 11-08-2019, 12:25 PM   #11
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Agree with @Marko. Every state has a Board on Aging that, among other things, dispenses federal money on various programs. Our state Board has a phone "Senior Linkage Line" staffed with people whose job it is to help you find answers to some of @Marko's questions. Almost certainly your state has something similar.

If you do end up needing assisted living, it is absolutely mandatory that you visit as many facilities as possible. If there is state regulation it is going to be minimal and probably infrequently policed. So it is up to you. I'd make some kind of checklist to rate the facilities on things like food, cleanliness, staff/client ratio, activities programs, transportation for shopping, comments by existing residents, etc. You'll have a list pretty quickly after the first couple of visits.
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Old 11-08-2019, 12:29 PM   #12
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I'm enjoying this thread a lot, because it is giving me some good ideas.

Personally, as you all know, I'm a rather extreme introvert and wouldn't care if I never saw another human being other than my dear sweet Frank who means the world to me. So, although I could afford it, I might not be a very good fit to a CCRC or assisted living facility or other group living arrangements.

We are planning to age in place and help one another which will be utterly ideal as long as it lasts.

But what happens when one declines faster than the other, or dies? Then the other is left in an untenable position. That person could call for a visiting assistant, but who knows if such a person could be trusted, or would be stealing everything in sight, or would turn out to be unreliable. But at that point, there might be no choice for a while due to the often lengthy waiting period for getting into a CCRC.
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Old 11-08-2019, 12:59 PM   #13
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You can't be the only person who feels this way. I wonder if it's something CCRCs know how to deal with - the Elder who'd rather Not "benefit from socialization," lol.

I'm always reminded of Bilbo Baggins, aged eleventy-one (111), telling Frodo that he loves life at Rivendell because he has the run of the place, but is basically left alone, "and there are Elves if you want them."

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I'm enjoying this thread a lot, because it is giving me some good ideas.

Personally, as you all know, I'm a rather extreme introvert and wouldn't care if I never saw another human being other than my dear sweet Frank who means the world to me. So, although I could afford it, I might not be a very good fit to a CCRC or assisted living facility or other group living arrangements.

We are planning to age in place and help one another which will be utterly ideal as long as it lasts.

But what happens when one declines faster than the other, or dies? Then the other is left in an untenable position. That person could call for a visiting assistant, but who knows if such a person could be trusted, or would be stealing everything in sight, or would turn out to be unreliable. But at that point, there might be no choice for a while due to the often lengthy waiting period for getting into a CCRC.
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Old 11-08-2019, 01:24 PM   #14
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. That person could call for a visiting assistant, but who knows if such a person could be trusted, or would be stealing everything in sight, or would turn out to be unreliable.
IME, "unreliable" is an issue mostly due to an overall shortage of people to do the work; someone calls in sick and the agency has to scramble to cover everyone's bases.

As far as trust/stealing the common agencies have vetted their staff pretty well and I've found them to be good, hardworking, honest people; they know they'd be the first to get blamed. Having said that, keeping temptation out of sight (or even better: offsite) puts everyone in a much safer position. Too many old people claim to have had something stolen by a visitor when after poking around it turns up in the refrigerator where they left it.
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Old 11-08-2019, 02:17 PM   #15
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A few thoughts in general re: assisted living... not all relating to the OP's situation.

First... LTC policies... not all the same. While ours provides for $100/day, the actual cost of assisted living in a facility, is closer to $200 to $300 per day. In our case, the LTC policy goes for a maximum of five years. As an alternative, the total money can be used for home care... up to $150/day up to the maximum payout.

Home care assistnce. In our area, both of these services charge $22/hour. If fortunate enough to have reasonable health, private personal help is usually closer to $10-$15/hr. Live in help is another possibility... not easy to find.

I Believe that medicare pays for three months care... but this must be ordered by a doctor.

About medicaid. One thing to be careful of... the five year lookback. Medicaid is available when assets are depleted to a certain level. Before this kicks in, there is a five year lookback to be sure thatwhatever assets that were available 5 years ago, were not unusually reduced by means of a gift of dollars or property. This is a very serious violation of the law.

One possibility.... that we've seen used in our CCRC... Children of those who will be expected to need assisted living in the immediate future, have contacted our assisted living facility, and been placed on the waiting list... paying one month's rent to assure a reasonably short wait. The size of our facilities means a reasonbly fast turnover.. people going to other parts of the
CCRC... rehab, Alzheimers or nursing home. So far, management has been very flexible, if there is no waiting list.

Most important...that has been discussed... not to wait. Do the homework about facilities, upfront. This means spending some time in the prospective facility to see the cleanliness , the food, the staff, and long enough to talk to some patients.

What with all of the warnings, an upside... We have lived in our CCRC for 15 years in a regular home, but have no fear of moving to whatever part of the campus that maybe necessary.

One possibility that hasn't been discussed here. Nearby, there is a "home" named "Simple Comfort... that offers housing for about 8 to 10 older persons.

From what I've seen, the people are happy and seem well cared for, but while old, are probably qualified for "independent living". Meals, washing, housekeeping and basic needs are provided, and there are even a few wheelchairs. Most facilities... living room, card rooms etc are "shared"., and rooms are for one or two persons. "Independent Living" is a formal qualification. Some info here... different for local legislation.
https://www.seniorliving.org/care/admissions-criteria/

The changeover need not be traumatic. Some early research to become famiiar with the options should make the process easier on you and your parents.

Good luck!
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Old 11-08-2019, 03:26 PM   #16
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I have done Asst Living for my mom and the Foster Care as her dementia increased. Foster care was much cheaper and better for a 4:1 or 5:1 ratio. She was not really ambulatory by then.

My MIL is trying to age in place and were at 33 hours on in home care at $30/hr. So about what low level Asst Living is. But, when she had a fall, all sorts of people got involved and weeks of assessment in rehab and home. They can force you out of home care if they feel your parent is at risk. So its
not always their or our choice
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Old 11-08-2019, 03:40 PM   #17
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I helped my Mom care for my Dad for 14 years and we bought the house next door. My 3 siblings and I helped my Mom stay in her apartment when she went through 3 different bouts of cancer from 78-89 despite not living in the same town. We would use our sick and vacation when it was needed. My Mom wasn't safe her last year but she had all her faculties and we didn't blame her for not wanting to go to a home. Then we helped a couple stay in their home 2 years before he died and I had to put her in a home. Another friend of ours was growing more dependent on us for help which we did some but have now nipped in the bud because we are done. If I ever get to the point I will have to go to a home I plan to stop taking my meds for my chronic conditions.
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Old 11-08-2019, 03:41 PM   #18
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A few thoughts in general re: assisted living... not all relating to the OP's situation.

First... LTC policies... not all the same. While ours provides for $100/day, the actual cost of assisted living in a facility, is closer to $200 to $300 per day. In our case, the LTC policy goes for a maximum of five years. As an alternative, the total money can be used for home care... up to $150/day up to the maximum payout.

Home care assistnce. In our area, both of these services charge $22/hour. If fortunate enough to have reasonable health, private personal help is usually closer to $10-$15/hr. Live in help is another possibility... not easy to find.

I Believe that medicare pays for three months care... but this must be ordered by a doctor.

About medicaid. One thing to be careful of... the five year lookback. Medicaid is available when assets are depleted to a certain level. Before this kicks in, there is a five year lookback to be sure thatwhatever assets that were available 5 years ago, were not unusually reduced by means of a gift of dollars or property. This is a very serious violation of the law.

One possibility.... that we've seen used in our CCRC... Children of those who will be expected to need assisted living in the immediate future, have contacted our assisted living facility, and been placed on the waiting list... paying one month's rent to assure a reasonably short wait. The size of our facilities means a reasonbly fast turnover.. people going to other parts of the
CCRC... rehab, Alzheimers or nursing home. So far, management has been very flexible, if there is no waiting list.

Most important...that has been discussed... not to wait. Do the homework about facilities, upfront. This means spending some time in the prospective facility to see the cleanliness , the food, the staff, and long enough to talk to some patients.

What with all of the warnings, an upside... We have lived in our CCRC for 15 years in a regular home, but have no fear of moving to whatever part of the campus that maybe necessary.

One possibility that hasn't been discussed here. Nearby, there is a "home" named "Simple Comfort... that offers housing for about 8 to 10 older persons.

From what I've seen, the people are happy and seem well cared for, but while old, are probably qualified for "independent living". Meals, washing, housekeeping and basic needs are provided, and there are even a few wheelchairs. Most facilities... living room, card rooms etc are "shared"., and rooms are for one or two persons. "Independent Living" is a formal qualification. Some info here... different for local legislation.
https://www.seniorliving.org/care/admissions-criteria/

The changeover need not be traumatic. Some early research to become famiiar with the options should make the process easier on you and your parents.

Good luck!
I am often confused about these elder care things.

For example, when you mentioned $100 (or $300) per day for assisted living, did you actually mean that the person in question will be placed in a room with care? Which I meant is that the person will not live in his/her home, and therefor can sell that home if needed?

Than what are the differences among: assisted living, nursing home, memory care, etc.?
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Old 11-08-2019, 04:09 PM   #19
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  • I would try to sign them up for 'meals on wheels' if it's available in their area.
  • There are Medicare-subsidized 'med rides' available in many places to take folks without the ability to drive to doctor's appointments.
  • In-home health care visits can be purchased less expensively than long term care or assisted living, depending on the duration needed.
  • Several companies make monitoring devices that you can use to monitor the health and mobility of your parents, and that they can use to summon help, should they fall.
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Old 11-08-2019, 04:16 PM   #20
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I had all those services lined up for both my parents and my friends. They can be a great help.
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