One takeaway from the pandemic ...

[explanade]

Think long and hard about committing to LTC and other nursing home facilities.

In many places, a huge percentage of deaths are from these facilities.

They take a ton of money but they can't protect their customers. In fact, doesn't it financially benefit some of these businesses if the people in their care die earlier?


Unless the people at these facilities are going out and about, the likelihood is they got infected from staff in most of these cases.

I believe that was the case with the one WA state facility which was the center of their first outbreak. It was in a facility where the people interacted with the staff daily, including very closely, like being helped to shower and such.

It would be interesting to compare the infection and death rates of people of comparable age who were still living in their own homes vs. in these facilities.

 

[gwraigty]

Think long and hard about committing to LTC and other nursing home facilities.

In many places, a huge percentage of deaths are from these facilities.

They take a ton of money but they can't protect their customers. In fact, doesn't it financially benefit some of these businesses if the people in their care die earlier?


Unless the people at these facilities are going out and about, the likelihood is they got infected from staff in most of these cases.

I believe that was the case with the one WA state facility which was the center of their first outbreak. It was in a facility where the people interacted with the staff daily, including very closely, like being helped to shower and such.

It would be interesting to compare the infection and death rates of people of comparable age who were still living in their own homes vs. in these facilities.

So you think that nursing homes have an interest in seeing their residents die? That's ridiculous. I don't know what financial benefit you think derives from this. They don't get paid for empty beds. In fact, a friend had planned to put her father in a nursing home last month and is trying to hold off on doing so now, because of the nursing home outbreaks. It's hard on the family because his condition is so bad, it's a struggle to care for him properly. If anything, nursing homes might be losing money as other families might make similar decisions when possible.

People are so quick to point the finger at the staff, especially since these places have been closed off to visitors for the last 2+ months. At the time of the initial outbreak, visitors were still allowed. It could have started with visitors. It could be from staff. It could also be from the fact that residents normally aren't locked down in their rooms. When they have a medical crisis, they're sent to the hospital. They can get infected at the hospital and then they're returned to the facility, bringing it back with them. More mobile and competent residents are allowed to move around within the facility, visiting with other residents and staff. Doctors from outside the facility are allowed to tend to their patients who reside there. They could be infected and spread it around to every facility they visit. Vendors who deliver food and medical supplies, etc. Even without normal visitation, these facilities cannot be fully and completely locked down.

BTW, I read an article in the last few months of the Kirkland WA outbreak. It's believed the outbreak started there with the transfer of a hospital patient to the Life Care Center. That's another way it spreads. Formerly independent people have a medical crisis, wind up in the hospital, and suddenly can't live on their own anymore. It happened to my late grandmother. One day she was at home, the next day she was in the hospital, 3 days later she was transported directly from the hospital to the nursing home. That fast, no time to pack. It wasn't a choice. Who really chooses to wind up in a nursing home?

 

[explanade]

OK, maybe some of my assumptions are wrong but don't you cut a deal with the LTC which is based on your assets at the time and such?

And they take a big lump sum, like over 6-figures?

Would they keep that amount regardless of how long the person stays with them?


But there have been plenty of articles about number of staff infected. And it's more these assisted living facilities, not the places where you would live independently with maybe weekly housekeeping and one or two meals a day.

That is, the staff would be the people with whom the residents would come into contact most frequently.

 

[RetireBy90]

Mom moved to assisted care facility where staff helped when she requested or needed it. She paid a monthly rate and no upfront payment.
I have read about some senior facilities that you buy into but my memory is that the upfront fee is returned as if you were to sell back to management company.
I believe there are different models of operation and how you pay for the place and services of staff. However can’t see how they would get a windfall from empty rooms.
Just one uninformed view

 

[MrLoco]

Problem is many people will not have an alternative. Most adult children do not want/ cannot give proper 24/7 care for elderly parents. Assisted living/ nursing home care becomes the only remaining option.

 

[explanade]

I guess a lot of these facilities will have to refill their rooms in the near future.

So I guess they will be looking at the recent history of these places, how they fared during the pandemic, how they will change their protocols.

 

[audreyh1]

I thought long and hard about it, but it comes down to the fact is that at some point if you live long enough, you will need a great deal of care, and unless you have family nearby willing to care for you and/or supervise caregivers and help with maintaining your home, you probably need to move somewhere that provides that care. Even when you have caregivers visiting you at your own home, you are still exposed to infection. These caregivers are visiting other people as well and have their own homes and families.

Yes, infection control is critical, and nursing homes were horribly unprepared for a pandemic. They are still short on PPE. I really hope this is a big wake up call, and I expect it will be.

Many elderly people have no other option. We still expect to go the CCRC route. By the time we make that move, we will likely be in our mid to early 80s, and we’ll have to accept the risks in exchange for far fewer daily chores and I hope considerably more comfort. So I don’t envision trying to stay alone in a house struggling with no outside help just to live longer.

 

[gwraigty]

OK, maybe some of my assumptions are wrong but don't you cut a deal with the LTC which is based on your assets at the time and such?

And they take a big lump sum, like over 6-figures?

Would they keep that amount regardless of how long the person stays with them?


But there have been plenty of articles about number of staff infected. And it's more these assisted living facilities, not the places where you would live independently with maybe weekly housekeeping and one or two meals a day.

That is, the staff would be the people with whom the residents would come into contact most frequently.

My grandmothers were in separate nursing homes. Neither had assets worth 6 figures, nowhere near that much. The monthly bills were paid as due and when their money ran out, they both went on Medicaid. They didn't have to hand over a lump sum of any kind. If there had been any money left over after their deaths, I think it would have had to be returned to the heirs through some process. Maybe you're thinking of a CCRC? That's where I've read they require a large lump sum upfront.

Isn't assisted living defined as where you get regular housekeeping and meals per day? A facility up the street has separate buildings for assisted living and nursing home care. The facility my sons works in as a dietary aide has assisted living, nursing home, and memory care all in one building. Normal procedure for kitchen staff is hair nets and gloves. Nothing is touched with bare hands. Masks have been required for all staff for the last couple of months as an added layer of protection. Yes, right now, the staff is who residents would have the most frequent contact with, until outside visitation starts up again. There is no good solution currently in the works that I know of.

You can do a Google search to find out some of the problems, one of which is short staffing and low pay among those directly involved with patient care. You'd think the places are chock full of RNs and LPNs, but much of the custodial type care falls to lower paid STNAs and the like. I looked it up recently out of curiosity and was stunned to learn that STNAs are paid only a few dollars per hour more than a dietary aide in my area, even with all the responsibility that comes with direct patient care. That doesn't mean they're not doing the best possible job under the circumstances. I'd guess it leads to high turnover though. There's much less responsibility and liability cleaning up dishes than cleaning up patients, etc. That's an oversimplification, of course, but patient care shouldn't be such a low-paying job, IMO.

 

[6miths]

My mom was about to make the move to a retirement complex (assisted living not nursing home although they did have nurse in house 24/7 and MD during daytimes) for April 1. But all suspended due to COVID. She is 85 and was going to go into a bungalow at a monthly rate with housekeeping and 30 meals a month. She didn't want all meals as she felt it was wasteful. She is still pretty independent and drives. Still works in her yard and shops but my sister and I help her quite a bit. I do most of the yardwork and lawn and sister does a fair bit of grocery shopping. After considering all of the issues her statement was that she figured to be staying in her house for the foreseeable future and hoping to be able to stay there until she left in a pine box. lol. The place she was going was very nice. No buy in just a monthly fee. I expect that facilities that have accumulated vacancies may have trouble filling them for awhile despite waiting lists before the pandemic.

 

[explanade]

Hmm, maybe I'm thinking of CCRs which try to get huge upfront payments.

Of course people who want to sell you LTC policies talk about how you will need thousands if not 5-figures a month.

 

[nwsteve]

Hmm, maybe I'm thinking of CCRs which try to get huge upfront payments.

Of course people who want to sell you LTC policies talk about how you will need thousands if not 5-figures a month.

You may it helpful to read some of the material in CCRC sticky. There are three primary types of CCRCs. The three types (A,B,C) very substantially in costs and benefits. Type A properties aka Life Care do have substantial entry fees but also provide "life care" at no increase in cost to the resident (usually inflation adjusted). Keep in mind, even within a given type of property, the details very a great deal property to property. By definition, CCRCs offer seniors care from independent living through assist living and finally skilled nursing (some also provide memory care but many don't). For non type A CCRC, a residents cost for care rises substantially as more comprehensive care is required. Properties usually offer some "discount" from market rates as you move up the care spectrum. Just moving from Independent Living your monthly bill can easily double. According to a National Center for Assisted Living report, the median cost for assisted living in the United States is about $4,000 per month or $48,000 annually. Huge variations a function of care level and local market costs--eg NY City lot more expensive than Jackson, MS.
There is so much variation between properties in quality, care levels, and staff, much care needs to be applied to not to rely on any generalizations. Here is a cost comparison by state from Genworth FWIW https://www.seniorliving.org/assisted-living/costs/

 

[explanade]

Thanks, yeah I definitely reall the upfront costs aspects.

 

[martyp]

My 90 year old mom is in an assisted care facility. They are protecting the residents as well as possible. I get frequent updates from them. They are doing all the right things. They alerted us when one staff member tested positive. None of the residents have gotten sick with Covid19. There are good places out there. Expensive though!

 

[Retired Expat]

My Aunt and then a cousin both chose to move to Assisted living where more care was available as needed. Both could have kept living in their own apartments but decided they didn’t want it to be something their kids had to do. They got rid of their own stuff and found a place and moved to it on their own. I sure wish my father had done that instead of me having to move him against his wishes as he needed more care... such guilt!

 

[aiken]

My father is in a memory care facility in KY, and they did a fantastic job of locking down visitors well before most in government and business started lock downs....as well as putting in procedures for employees who deal with residents. Don't believe they've had a single case yet....keeping fingers crossed.

 

[donheff]

The pandemic hasn't affected my decision to continue LTC insurance. DW and I have it to protect our assets so the kids will get a decent estate. The most likely end results is that the LTC expenses will never get recouped but if we lose the health lottery and need lengthy assisted living or home care it will help us avoid spending down the nest egg,

What I have learned from the pandemic is that I would prefer to end my days with in home health assistance if possible but that is a crap shoot, LTC or not.

 

[kcowan]

I hope one of the outcomes of Covid is a thorough reform of how we care for older needy people.

 

[mountainsoft]

Unless the people at these facilities are going out and about, the likelihood is they got infected from staff in most of these cases.

Assisted Living facilities aren't prisons. They're just apartments with living assistance. Residents come and go all the time, either with family or with outings the facility arranges. They also have guests come in occasionally, musical performers, speakers, etc.

I wouldn't think the infection rate would be any higher than any other situation where people live and interact in close quarters. Schools, churches, hospitals, sporting events, concerts, etc. The more time you spend together in large groups, the higher your chances of spreading the disease.

The only reason assisted livings may have worst outcomes is because the residents tend to be older with underlying conditions.

My mom is 73 and has lived in assisted living the last three years. She has never been sick there and as of today her facility has had zero infections of staff or residents. They haven't allowed guests since March and residents are served meals in their rooms to limit close contact. They're still free to move about the building or walk around outside, as long as they wear a mask. If they do leave the building they are quarantined in their room for two weeks to make sure they don't infect others if they picked up something outside.

If anything, the assisted living is probably one of the safer places to be as precautions are taken more seriously than a person living at home who has visitors or other help showing up randomly.

 

[W2R]

For us, "Plan A" has always been to age in place in our homes as long as possible and hopefully until we pass away.

"Plan B" (for me) was to possibly move into a very nice CCRC at some point later on if aging in place was resulting in insufficient care and hardship. But after seeing the horrific effects of the pandemic on even the best of our local facilities, I decided I will not consider this any more.

Back to Plan A. I have no idea what I will do if/when I can't care for myself any more. I do not want a live-in caregiver in my old age, but maybe one could be hired to visit every day.

 

[explanade]

It's good to hear that people here have had good experiences with elderly parents in facilities.

But in some states "nursing home" cases and deaths comprise a high percentage of the cases and deaths.

 

[Teacher Terry]

I hope to be like my mom who lived just short of 90. She lived in a apartment by herself until a week before she died.

 

[audreyh1]

For us, "Plan A" has always been to age in place in our homes as long as possible and hopefully until we pass away.

"Plan B" (for me) was to possibly move into a very nice CCRC at some point later on if aging in place was resulting in insufficient care and hardship. But after seeing the horrific effects of the pandemic on our local facilities, I decided I will not consider this any more.

Back to Plan A. I have no idea what I will do if/when I can't care for myself any more. I do not want a live-in caregiver in my old age, but maybe one could be hired to visit every day.

At some point if you live long enough, you need someone else to take care of you. You are vulnerable whether or not you have caregivers at home or are in an apartment in assisted living. Managing your own household is too much at a certain point. I prefer a facility, because it is obvious to me that at some point I won’t be able to manage a house or my caregivers without help. I can enjoy independent living and have some ability to isolate while I’m able. And at the time I’m decrepit enough for nursing home type care, well, how much longer do I really want to live anyway? Of course, I’ll be sure to choose a place that has decent infection control protocols early on.

 

[braumeister]

At some point, most likely too late for me, someone (I'm guessing the Japanese) will come out with a robot caregiver that can handle many of the necessary tasks. Should be a game changer.

 

[cbo111]

At some point, most likely too late for me, someone (I'm guessing the Japanese) will come out with a robot caregiver that can handle many of the necessary tasks. Should be a game changer.

You mean something like Rosie?

 

[nwsteve]

At some point if you live long enough, you need someone else to take care of you. You are vulnerable whether or not you have caregivers at home or are in an apartment in assisted living. Managing your own household is too much at a certain point. I prefer a facility, because it is obvious to me that at some point I won’t be able to manage a house or my caregivers without help. I can enjoy independent living and have some ability to isolate while I’m able. And at the time I’m decrepit enough for nursing home type care, well, how much longer do I really want to live anyway? Of course, I’ll be sure to choose a place that has decent infection control protocols early on.

If a "Life Care" CCRC is your target, don't forget that most properties will require you to be in reasonably good health mentally and physically before allowing you to enter. After-all, they are agreeing to give you care for the rest of your life. Both of us had to pass a comprehensive physical and cognition assessment prior to our admission at out CCRC.
Timing to enter a life care property is to me is one of the most difficult decisions to make in this option. Early is probably better than later since you wont get in if you are too late. Early also has the benefit of being able to enjoy the benefits while healthy (increasing your return on your entry fee) but then again you may no longer care when you are dead.