Moving Dad to Assisted Living

[MichaelB]

I do hope assisted living is a really positive experience for Dad.

The research shows that life expectancy is longer for residents of continuing care facilities vs living home alone. Increased socialization and better nutrition are important for seniors, and if one can adapt to the loss of independence, there is a chance for increased quality of life. Hope it works out for your dad and also that this helps you with your own planning.

One aspect of CCRC living that is under-appreciated is that the adjustment from independent to institutional / community life is more difficult because most people only make the change when they have no other alternative. Relocating from home to CCRC while one still has both mental and physical independence makes the transition much easier.

 

[athena53]

The research shows that life expectancy is longer for residents of continuing care facilities vs living home alone. Increased socialization and better nutrition are important for seniors, and if one can adapt to the loss of independence, there is a chance for increased quality of life. Hope it works out for your dad and also that this helps you with your own planning.

I agree- the woman from the home health care agency we're using for DH says they have clients in their 90s, living at home with the help of people who come in and clean, fix meals, etc. It sounds very isolating to me unless they have family nearby who visit often. A cautionary tale of a friend's father sticks in my mind: after her mother died he moved into an apartment near her brother, who was supposed to look in on Dad regularly. Brother didn't. With nothing else to occupy his time, Dad took up drinking, It created a permanent rift with her brother.

 

[Lsbcal]

I do hope assisted living is a really positive experience for Dad.

We think he has been getting bored living at home, and this should help alleviate that.
....

Sounds like your Dad has made a very positive change. More to occupy his mind, better nutrition, more socialization. Hopefully he can get in some exercise too like even just walking a mile or two a day.

This is an interesting thread as I sometimes dread thinking of the distant future for us. Probably best to just take it one year at a time. In the future we will have perhaps more services like Uber and grocery delivery in large to moderate size towns. But probably not in very rural areas. Then there are forums like this one for those of us willing to keep up with tech. Maybe someday I'll be the IT expert in assisted living?

We visited an upscale assisted living facility. A friend was having an art show there. There was even an auditorium where the artists gave short talks about their work. The folks living in the facility attended too and there were a lot of people there. I thought it was pretty nice and located near a regional park, good for those who could get out and walk. I looked up the costs and one could go from a small condo up to a much more elaborate unit. Priced to fit fat wallets.

 

[Tadpole]

I moved my mom into an independent apartment a month ago with plans to empty and sell her house next spring. I'm a snowbird and will do take care of this when I return next April. Now my sister has decided she should move from the east coast and live in mom's house rather than sell it. I'm not getting all warm and fuzzy about this arrangement. Sis is somewhat lazy and I see her squatting in the house hoping to inherit it someday. I sure don't want to own it with her. But if mom agrees to it, what can I do? Sis had no interest in moving here until the house became vacant.

I hope your mother will never need the money from selling the house. It might be hard to move your sister out, especially if your mother becomes frail and/or develops dementia. Are there any "squatter rights" type considerations for these circumstances; any other legal implications?

 

[rodi]

Maybe someday I'll be the IT expert in assisted living?

We visited an upscale assisted living facility. A friend was having an art show there. There was even an auditorium where the artists gave short talks about their work. The folks living in the facility attended too and there were a lot of people there. I thought it was pretty nice and located near a regional park, good for those who could get out and walk. I looked up the costs and one could go from a small condo up to a much more elaborate unit. Priced to fit fat wallets.

I have a friend who lives at Vi La Jolla - a CCRC. She's a retired university administrator and former professor. She runs the "all things Apple" class - teaching her neighbors how to do stuff on their Ipads, Iphones, and Macs - and ends up doing all sorts of tech support.

The facility has a theater and an auditorium for talks, debates, etc. I've seen a few political debates there where local candidates for city council were doing a town hall style debate.

My former FLL robotics team presented to the residents - and there were some pretty technical/aware questions asked of my middle school team. I was impressed.

But yeah - fat wallets (or a good pension) to live there.

 

[growing_older]

Are there any "squatter rights" type considerations for these circumstances; any other legal implications?

You likely need a lawyer familiar with local laws to help understand the situations that can develop. As a resident of the house, your sister would at least establish a tenancy, which would mean you might need an eviction to force her out if she doesn't want to go. If she is also part owner, such an eviction might be nearly impossible, then you would have to petition the court to allow you to separately sell your interest. Selling half interest in a house with an established tenant in it is likely difficult to do and not worth much. In some cases you can get a court to force the sale of the entire house and split the proceeds, but you probably need legal help familiar with your local laws to consider such a thing.

So, yes. There are legal implications.

 

[Lsbcal]

I have a friend who lives at Vi La Jolla - a CCRC. She's a retired university administrator and former professor. She runs the "all things Apple" class - teaching her neighbors how to do stuff on their Ipads, Iphones, and Macs - and ends up doing all sorts of tech support.

The facility has a theater and an auditorium for talks, debates, etc. I've seen a few political debates there where local candidates for city council were doing a town hall style debate.

My former FLL robotics team presented to the residents - and there were some pretty technical/aware questions asked of my middle school team. I was impressed.

But yeah - fat wallets (or a good pension) to live there.

I looked up the pricing and some details are here: https://sandiego.viliving.com/how-vi-works/pricing

Our son is in San Diego now. Who knows, maybe such a living situation is in our future a decade or so down the road.

 

[kcowan]

There are legal implications.

The best you could hope for is to settle up affairs now. Value the house and get an equivalent "cash" settlement in return for both siblings agreeing to pay for half of her LTC right away. That way she has no financial worries and anything left over can be donated to charity. If the numbers don't work out, take a mortgage on the house to cover part of your share.

 

[Teacher Terry]

Every time I read one of these types of threads if seems like most people assume that they/or their parents will end up in AL. That has not been my experience at all. Many people can stay home forever and if some support is needed they receive it in home. With Uber seniors need not be isolated if they can't drive and Uber is very reasonable. The older people I have known did not get isolated but went to senior centers, bingo, movies, etc even once all their friends had died. I have had a few friends that were about 10 years older then me decide to go into a senior apartment building for instant friends and activities which is another alternative. Of course these are people that are taking care of their own needs. The seniors often willhelp one another with rides, etc.

 

[youbet]

The CCRC we applied to has single family houses (one floor of course, no stairs) apartments, and both assisted living and full nursing care if needed.

Which type of contract (I, II or III) are you looking at? We've visited some CCRC's in the past few months just to start learning about them and have found that the decision as to type of contract is as complicated as the decision to buy LTCI or not.

 

[braumeister]

Every time I read one of these types of threads if seems like most people assume that they/or their parents will end up in AL. That has not been my experience at all. Many people can stay home forever and if some support is needed they receive it in home.

That's certainly true for many people, but it assumes they retain their cognitive powers intact. That's the part that many others are not so confident about.

I knew a guy who happily lived at home with minimal assistance at the age of 100. He walked to the bus stop every weekday morning and rode the bus to his old office downtown where he read the newspaper and chatted with people.

But people like that are the exception. We all hope to be that exception, but few of us will actually get there.

 

[youbet]

I have had a few friends that were about 10 years older then me decide to go into a senior apartment building for instant friends and activities which is another alternative. Of course these are people that are taking care of their own needs. The seniors often willhelp one another with rides, etc.

As DW and I have started to investigate possibilities for our future (we're 69 and in fairly good health), we have come to the conclusion we're too young for a CCRC at this time. The ones we visited would offer LTCI type security of knowing where you'll be and how you'll pay for SNC if needed, but we're completely independent now and the folks we saw were predominantly looking and acting older and less independent.

While no final decision has been made, we're more likely to move to a high tier senior apartment building or a 55+ condo complex as an intermediate step. We do have family nearby who would help if we had a sudden need to transition to SNC. I understand completely for those who don't have family, already being in a CCRC the day the big stroke occurs would be a blessing.

 

[youbet]

That's certainly true for many people, but it assumes they retain their cognitive powers intact.

Of course your mental and physical health are the key factors in the surroundings you choose. But it seems it would be as much of a mistake for a 70 yr old couple in excellent physical and mental shape to move into a care community too early as it would be to try to stay independent when you're not able.

I knew a guy who happily lived at home with minimal assistance at the age of 100. He walked to the bus stop every weekday morning and rode the bus to his old office downtown where he read the newspaper and chatted with people.

But people like that are the exception. We all hope to be that exception, but few of us will actually get there.

Isn't the question "when" do you want to give up some independence in a trade-off for more services and security? As we do our research, we're discovering it isn't easy to know or decide.

 

[Teacher Terry]

I really don't think that people with their cognitive abilities intact as they age are the exception. People have always gotten dementia, etc but most don't. For couples the healthy one usually provides care and when that person dies if the other one needs help there are tons of services out there.

 

[MichaelB]

But people like that are the exception. We all hope to be that exception, but few of us will actually get there.

+1

I really don't think that people with their cognitive abilities intact as they age are the exception. People have always gotten dementia, etc but most don't. For couples the healthy one usually provides care and when that person dies if the other one needs help there are tons of services out there.

Independent living is easier when one is not alone. In a way, it's a bit of a contradiction in terms. It is much more difficult when one is solitary.

 

[Walt34]

Which type of contract (I, II or III) are you looking at? We've visited some CCRC's in the past few months just to start learning about them and have found that the decision as to type of contract is as complicated as the decision to buy LTCI or not.

I'm not sure what you mean by type of contract. There is a substantial entrance fee that amortizes 10% per year if you want to leave later, or you can pay a higher monthly rent and rent month-to-month, or a hybrid of the two others, meaning a lower entrance fee but lower monthly expenses than month-to-month but not as low as paying the full entrance fee up front. We may go the month-to-month route to start and after we're sure we want to stay we can pay either the full or hybrid fee and get lower monthly expenses.

One characteristic of high value to us is that they will not throw you out if your finances become exhausted because of medical or nursing home expenses. Now, if you blow the wad on world cruises or gambling or such, they will throw you out. Which is of course reasonable.

 

[Teacher Terry]

That has not really been my experience. Most people I know eventually move to an apartment but the only people I know that went to a home either had dementia bad or were dying and not mobile.

 

[youbet]

I'm not sure what you mean by type of contract. There is a substantial entrance fee that amortizes 10% per year if you want to leave later, or you can pay a higher monthly rent and rent month-to-month, or a hybrid of the two others, meaning a lower entrance fee but lower monthly expenses than month-to-month but not as low as paying the full entrance fee up front. We may go the month-to-month route to start and after we're sure we want to stay we can pay either the full or hybrid fee and get lower monthly expenses.

Walt, we've found that some of our friends also researching CCRC's haven't been exposed to the contract type question and that's a concern. It's really the most important part of choosing a CCRC and your choice is driven by your current health, your prospects for needing assisted living or full SNC as opposed to independent living and your finances.

Type A contracts cost the most but if/when you need lots of assisted living services or full SNC, the price stays approximately the same as independent living. That is, it has a bit of LTCI - like features built into it.

Type B contracts cost somewhat less but if/when you need lots of assisted living services or full SNC, you're provided these at a discounted price. But you do pay more than independent living, sometimes a lot more.

Type C contracts cost the least but if you leave independent living for assisted living or full SNC, you pay the full price for those services.

In the price you've been quoted, does it include the possibility of starting in fully independent living and then moving to assisted living or full SNC at no/little additional cost?

Read this:
Three Types of Contracts CCRCs Offer Prospective Residents

Type A or extensive or life-care contracts that include housing, residential services and amenities — including unlimited use of healthcare services at little or no increase in the monthly fee. These contracts typically feature the highest entrance fees. The CCRC absorbs the risk that more residents than projected will need higher levels of care.

Type B or modified contracts typically offer lower entrance and monthly fees. Type B contracts limit the amount of health care services that may be accessed without any increase in the monthly fee. For example, some may offer a limited stay in the skilled-nursing facility with no increase in the monthly fee (for example, up to 30 days every four months). If the resident requires an extended stay, the monthly fee will increase but still be below the average cost of a stay in other skilled nursing facilities in the area.

Type C or fee-for-service contracts include similar housing, residential services and amenities as Type A and B contracts but require residents to pay market rates for any health-related services under an as needed arrangement. Type C contracts offer lower entrance fees and monthly fees but the risk of large long-term-care (LTC) expenses remain with the resident — the risk is not shifted to the facility.

I strongly suggest you get your CPA or, likely better, an attorney specializing in senior citizen issues to review anything before you make any commitment.

We were interested in the Type A contract situation since our future costs would be known and we could more confidently begin gifting to the kiddos and charity. But we found Type A contracts cost more and the facilities, at least the ones we visited, offering them had less emphasis on independent living housing and amenities. That is, at least for the ones we visited, the Type A places were apartment-like living with the SNC facilities often co-located in the same building. The Type C places were more likely to offer single family homes or duplexes on a golf course or other attractive setting. Again, this based on a very small sample.

But the real difference is in what you pay and how willing you are to pay more up front to not see an increase if your care needs increase from independent living.

Also note, the Type A places want you to be in good independent living health/condition to be accepted. The Type C places don't care because you're going to pay full rack rate when and if you need SNC.

Hope this helps.

 

[Walt34]

I strongly suggest you get your CPA or, likely better, an attorney specializing in senior citizen issues to review anything before you make any commitment.

Oh, absolutely! At the moment our only commitment is the $100 fee we paid to get on the waiting list.

Since there doesn't seem to be much standard language in CCRC verbiage and every organization whether nonprofit or for-profit seems to have it's own setup it is sometimes difficult to make an apples-to-apples comparison.

What you describe as a "plan C" is what that organization uses. But like I mentioned, if your finances are exhausted on medical expenses they will absorb the loss within the organization. That, of course, is one reason for the high entrance fee - to pay for those losses. I think of it as sort of a prepaid LTC policy.

So, the financial worst case scenario is that we move in, three weeks later I stroke out and go to full nursing care and my entire pension, SS, and savings go to that minus what the state Medicaid system allows for DW to live on, which isn't much. She will still have a decent place to live, healthy food, and perhaps even be able to keep the car. Even if she can't, they still offer transportation to doctor appointments and grocery, etc.

 

[haha]

My grandmother used to say- old age is better than the alternative, but not much better.

Ha

 

[youbet]

My grandmother used to say- old age is better than the alternative, but not much better.

Ha

Good one Ha! Yep, geezerhood isn't for the timid, that's for sure.

We've been looking at CCRC's and other senior living accommodations the past few months just to pick up a few clues. Right now, your choice of a condo in an urban environment is looking better, at least as an intermediate step, than a planned senior community where someone else is preparing your meals, etc. But lately, I can vision that on the agenda too.......

10+ years of ER now. It's gone by FAST!

 

[audreyh1]

I agree- the woman from the home health care agency we're using for DH says they have clients in their 90s, living at home with the help of people who come in and clean, fix meals, etc. It sounds very isolating to me unless they have family nearby who visit often. A cautionary tale of a friend's father sticks in my mind: after her mother died he moved into an apartment near her brother, who was supposed to look in on Dad regularly. Brother didn't. With nothing else to occupy his time, Dad took up drinking, It created a permanent rift with her brother.

I didn't want to take the home health care approach for several reasons. Isolation would be a serious issue. On top of that is supervision of the home health care workers. I think it can work if a close family member lives within say 30 mins and can check up on the situation regularly - provide some supervision and feedback. But otherwise, how do you protect the aging individual from unscrupulous home health aides?

So I'm glad Dad decided he should move somewhere rather than ask for someone to care for him at home. My sister kept asking about finding someone to help him at home, but unless I had neighbors/relatives in his town that could totally vouch for a couple of individuals to take on such a role, I flat told her I didn't see how we could manage it since the closest sibling lives 2 hours away and still works. Background checks, references, interviews, then close supervision - how could you do it otherwise for an elderly person living alone?

 

[anethum]

I wish that my mom were willing to move to assisted living from the house she has lived in for 60 years. She is physically OK, but now has dementia. She'll soon be 95. My dad started to develop vascular senility when he turned 90. He gradually deteriorated mentally and physically and then had a serious stroke when he turned 94. He remained at home with my mom but he needed 24/7 nursing care after the stroke. My mom did a great job looking after him and their house, with help from me; I live 10 minutes away. My dad died 8 months after the stroke. (His nursing care, which was excellent, cost about $140K IIRC.)

Last year, about 6 months after my dad died, my mom began showing serious signs of dementia. She's physically OK and can still cook and clean for herself. She thinks she's still driving but hasn't driven in a year. I take her to doctors appointments, grocery shopping, and sometimes to see her few friends who are still alive. I pay her bills, make sure her prescriptions are refilled, handle house maintenance issues, etc. I have been handling most of my parents' finances and taxes for many years. She wouldn't be able to live by herself without my help. My parents were great parents, and my mom did a fantastic job when my dad needed her help. She gets very angry, however, when I bring up the idea of having a caregiver stay with her at least part of the day, and she won't willingly move anywhere. At this point, I don't think she would adapt to new surroundings after 60 years in her house. If she had all of her faculties, she would feel awful about how this has affected my own life.

My mom is not demanding and is very appreciative for what I do. My dad was the same way. I am resentful, however, that I get very little help from my sibling who also lives 10 minutes from our mom.

 

[audreyh1]

+1

Independent living is easier when one is not alone. In a way, it's a bit of a contradiction in terms. It is much more difficult when one is solitary.

Totally agree with this!

And it so depends on the resources available. And some resources may require too much effort to use.

 

[target2019]

I get very little help from my sibling who also lives 10 minutes from our mom.

Have similar situation x3 (no. of siblings in area). Just have to do what you know is right.