deteriorating health in my parents! Advice needed.

[rodi]

We are in the throes of this with MIL.

My parents were both independent till the end. My dad fell in love again after mom died - and my step mom is astute enough to recognize she was starting to need help. She sold her house and moved to an independent apartment in an assisted living community last year. She's 89. Only the year before (at age 87, at the time) did she give up teaching nursing students.

My MIL was caregiver for my FIL after he had mobility and brain aphasia...This worked for about 10 years. We built a small casita in our backyard that was wheelchair friendly - but MIL didn't like to live in San Diego -so they stayed here only 6-8 months of the year. He definitely became harder to care for with age. It became too much for MIL - but she would not admit it. Dementia was also an issue for her - so she was less able to recognize that the bedsores, his loss of weight, etc were an issue. Unfortunately, she was adamantly refusing to allow for in home care (didn't want "strangers" in her home) and social service got involved. Social service insisted a family member become guardian, or the state would. DH became guardian of both parents. It was an awful situation because his mother fought it and still things the doctors that dx'd her with dementia are part of a conspiracy. DH moved FIL to a nursing home the day after court. He died 9 months later at age 90. But he had less pain and had regained weight and most of his bedsores had healed.

It's now at a crisis point with MIL. She wants to be "in an apartment" in Philadephia. Currently SIL is checking on her daily, handling her shopping and errand running.. but she's burning out with the daily care. MIL is also getting more frail and the dementia is far worse in the past year.

MIL is originally from Philly and has 3 sons that live there. None of the sons are willing/able to do daily help for MIL so the only option is assisted living. DH is taking her to two assisted living facilities when they are there in May for a wedding. Both facilities have memory units that have small 1br apartments. She is dead set on an independent apartment... so it's going to be a HUGE fight when she is not given an option for a regular apartment....

It could be worse. My BFF is dealing with declining parents who are destitute. The dementia and physical issues are still manageable... but the writing is on the wall. She's currently contributing about $1k/month to their budget.

I joke (and it's truly a joke - I'm not serious) that my parents had the decency to die solvent and mentally intact. (They also died younger than my in laws and BFF's parents.)

[48Fire]

MikeP good luck to you! Really hard dealing with two parents! I may weigh in more later, but currently with MIL and dealing with her issues, so can only use phone. My advice would be get PROFESSIONAL help - lawyers, doctors, etc. Don't try to do this without the experts.

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[Calico]

Quote:

Originally Posted by Walt34 So much depends on the facility, the staff, and the individual. For sure there are rotten homes out there and that is in part why we want to be the ones to pick ours while we are in a position to be picky. <snip> Thirty years ago I would definitely have agreed with Amethyst and fully intended to stay in my own house for "the duration". But the experiences of the last few years have made me aware that that is almost certainly unrealistic and improbable. So we're trying to come up with an exit strategy that lets us do as much as we can for as long as we can and still makes assistance readily available when that time almost inevitably comes.

This is exactly my plan. I am single, so don't have the option of "becoming a burden" to any offspring in my eventual decrepitude, even if I wanted to.

There is a very nice CCRC about 35 miles from my current home. It is affordable, and has very high ratings in all the areas that matter. They have independent apartments & homes, assisted living units, an Alzheimer's/Memory Care building, and full-time nursing home care for those who need it. Pets are allowed in independent living and assisted living units.

I have been researching all the CCRC's within 50 miles of here for several years, because I want to choose while I am still independent and of sound mind.

The best case scenario is I will move there in my late 70's or early 80's and remain in independent living for the rest of my days. But it will be a huge comfort knowing that all the other levels of care are available right there, with no need for further moves, if I require that. Not to mention that by that age, if not before, I will be very glad not to deal with the maintenance and repairs for the house and yard.

I have one much younger, extremely responsible, financially independent cousin who lives locally, and I have already instructed her that if I get the timing of the move wrong, and she notices me wandering into walls and/or spouting gibberish, she has my permission to bonk me on the head, pack my bags, and move me to the aforementioned place.

Her parents moved into a similar (but much pricier) CCRC down the road two years ago, after two adverse health events. It was a huge relief not only to them, but to us as well. They have no more responsibilities of home ownership, and are so busy we have trouble reaching them on the phone most days. We sleep better at night, and they too wish they had made the move years ago.

[braumeister]

Quote:

Originally Posted by Calico I have been researching all the CCRC's within 50 miles of here for several years, because I want to choose while I am still independent and of sound mind. The best case scenario is I will move there in my late 70's or early 80's and remain in independent living for the rest of my days. But it will be a huge comfort knowing that all the other levels of care are available right there, with no need for further moves, if I require that. Not to mention that by that age, if not before, I will be very glad not to deal with the maintenance and repairs for the house and yard.

I get the impression this is the plan for many of us here. It certainly is mine.

I've already tired of the work required of a homeowner (we have over two acres, mostly wooded), so we are in the process of buying a wonderful condo to simplify our lives. Total square footage is about the same as current house, so not as much downsizing as I would like, but that makes DW happy so it's worth it.

We want to live there as long as possible on our own, but eventually we plan to go to a CCRC to finish out our span of years. No specific age target for that, just whenever we start noticing that one of us is slipping.

[MichaelB]

Quote:

Originally Posted by braumeister We want to live there as long as possible on our own, but eventually we plan to go to a CCRC to finish out our span of years. No specific age target for that, just whenever we start noticing that one of us is slipping.

Based on experience, I'm not confident DW or I will either recognize or accept the "right time".

[REWahoo]

Quote:

Originally Posted by MichaelB Based on experience, I'm not confident DW or I will either recognize or accept the "right time".

+1

It's never the right time - until you run out of time.

[braumeister]

I understand that hope is not a strategy, but you have to start somewhere. Giving up a standalone house is enough of a step for now.

[Idnar7]

My MIL was living in an apartment in subsidized housing unit. Then she had a couple falls and hurt her back vacuuming. She went for rehab at a nursing home. DW started talking to her about AL. There was one nearby where several of her friends were already staying. DW took her to see it and she agreed that was a good idea. A couple days before her release from rehab, she said she had changed her mind and wanted to stay at the nursing home. She said they treated her well and she felt safe there. She also didn't want to move to AL and then back in the future. She spent the next 4+ years there contented with her decision. Her only fear was running out of money and being "thrown out on the street". Her last four months there she was out of money and on Medicaid. To their credit her care and treatment never changed.

[HFWR]

Quote:

Originally Posted by Calico ...wandering into walls and/or spouting gibberish...

Since this is normal behavior for me, I'll have to come up with "different" criteria...

[Walt34]

Quote:

Originally Posted by Idnar7 Her last four months there she was out of money and on Medicaid. To their credit her care and treatment never changed.

No surprise there. The hands-on caregivers usually have no idea and don't care who is or isn't on Medicaid.

The problem for many (most?) in getting into the nicer ones is being able to show that they have enough financial resources to pay their own way for a reasonable amount of time. The place where FIL stayed said they lost about $100/day on Medicaid patients. That has to come from somewhere.

[rodi]

Quote:

Originally Posted by Walt34 No surprise there. The hands-on caregivers usually have no idea and don't care who is or isn't on Medicaid. The problem for many (most?) in getting into the nicer ones is being able to show that they have enough financial resources to pay their own way for a reasonable amount of time. The place where FIL stayed said they lost about $100/day on Medicaid patients. That has to come from somewhere.

This makes sense. When I was shopping for NH's for FIL I would ask if they took medicaid. Several responded that they required new patients to show 2 years of resources before admission - but that they did take medicaid. So by doing some financial vetting on the intake, they were able to keep longer term residents in place... even when the money ran out for them. I'm ok with that model.

[Calico]

Quote:

Originally Posted by HFWR Since this is normal behavior for me, I'll have to come up with "different" criteria...

You make an excellent point!

A couple of weeks ago I was chatting with my 35-year old neighbor about this and that - what we paid for our respective houses (both 70's ranches), when I planned to pay off the mortgage prior to retirement, etc.

I warned him that I planned to spend at least the first year of retirement in my jammies, doing as much of nothing as I possibly could, until I perfect the art. I repeated the comment about "wandering into walls" and asked him to keep his eyes peeled as the years go by, and to get on the phone to notify my cousin if he sees me slipping.

He responded (while laughing) "how will I be able tell the difference from what you do now?"

Cheeky little b@stard! That's the last time I lend him my snow shovel, or petsit for him.

[Calico]

Quote:

Originally Posted by rodi This makes sense. When I was shopping for NH's for FIL I would ask if they took medicaid. Several responded that they required new patients to show 2 years of resources before admission - but that they did take medicaid. So by doing some financial vetting on the intake, they were able to keep longer term residents in place... even when the money ran out for them. I'm ok with that model.

This is exactly how they work it at the place I have in mind. You have to provide detailed financial info up front, and if your assets are eventually depleted by nursing home costs, they don't kick you out - medicaid takes over. This is provided your assets aren't depleted as a result of large "gifts" to family in the meantime.

I have no problem with this. If I never need the nursing care, my nieces and nephews will get a bit more of an inheritance than they will if some of it is eaten up by those costs. Works for me.

[braumeister]

Quote:

Originally Posted by Walt34 The problem for many (most?) in getting into the nicer ones is being able to show that they have enough financial resources to pay their own way for a reasonable amount of time.

This is such a critical point.
When I was looking for places for my mom, every one of the nicer places I talked to had the same policy. No Medicaid accepted period, and very clear about it up front -- private payment only. When your money runs out, you're evicted.

[Walt34]

Quote:

Originally Posted by Calico This is exactly how they work it at the place I have in mind. You have to provide detailed financial info up front, and if your assets are eventually depleted by nursing home costs, they don't kick you out - medicaid takes over. This is provided your assets aren't depleted as a result of large "gifts" to family in the meantime.

That's the model where we are looking too. I look at it as a prepaid LTC policy.

[Calico]

Quote:

Originally Posted by Walt34 That's the model where we are looking too. I look at it as a prepaid LTC policy.

Exactly!

[Walt34]

Quote:

Originally Posted by braumeister When I was looking for places for my mom, every one of the nicer places I talked to had the same policy. No Medicaid accepted period, and very clear about it up front -- private payment only. When your money runs out, you're evicted.

I've wondered how that works if there are no relatives around - do they just wheelchair the old lady to the curb?

Realistically I guess they just take the person to a warehousing facility that does take Medicaid only but I'd never consider a place that would be so harsh on someone. It shows where their priorities lie.

[W2R]

Quote:

Originally Posted by braumeister We want to live there as long as possible on our own, but eventually we plan to go to a CCRC to finish out our span of years. No specific age target for that, just whenever we start noticing that one of us is slipping.

At my (now deceased) mother's CCRC you had to be pretty healthy just to get in. If you were already failing, you couldn't join. I don't know if this is usual? But anyway, I'm suggesting to look into the ones that interest you before things get too dire.

My mother was pretty healthy when she joined but just tired of all the upkeep on her home, plus her boyfriend was moving in there at that time too. The CCRC provided her with nutritious meals that she didn't have to cook, and housekeeping services, and of course no yard to care for (although there was a pretty little Japanese garden there with smooth pathways and benches if she wanted to sit outside). For the first few years that was really all she needed.

[REWahoo]

Quote:

Originally Posted by Walt34 I've wondered how that works if there are no relatives around - do they just wheelchair the old lady to the curb? Realistically I guess they just take the person to a warehousing facility that does take Medicaid only but I'd never consider a place that would be so harsh on someone. It shows where their priorities lie.

The facility where my FIL spent his last 5 months after having a stroke would not take Medicaid. But, if residents ran out of $ while staying there and went on Medicaid, they did not kick anyone out.

[Walt34]

Quote:

Originally Posted by W2R At my (now deceased) mother's CCRC you had to be pretty healthy just to get in. If you were already failing, you couldn't join. I don't know if this is usual? But anyway, I'm suggesting to look into the ones that interest you before things get too dire.

Good suggestion to look ahead of time. At least for the ones we looked into all have waiting lists as well so it isn't like being able to move whenever the mood strikes. Very few have vacancies for long.

As far as heath requirements I suppose that varies. When FIL moved to the independent living apartment (for one day) the facility required a physician's certification that he was capable of independent living, and I suppose he was in that setting at the time. But he was pretty marginal on that and I thought there was a good chance they wouldn't take him.

Another issue is that some don't really want you there too early - one has a $2k extra fee for every year each person is under 70 years old. So a 65-year-old would pay an extra $10k entrance fee more than a 70-year-old. But they also won't kick you out if resources are exhausted so I guess that makes up for the risk that a 68-year-old will stroke out and be a full time nursing care patient for 15 years, 12 of those on Medicaid. For the institution that would be a hefty financial hit.