Elderly Care - The choices we've made

[maxrandb]

I am not an expert on Medicare, Medicaid, Nursing Homes, etc., but considering what is going on with my mom, I think I will get quite an education over the next several months.

My mom is in her early 90's and is beginning to decline quickly with elderly dimentia. She lives alone, and has for many years. I live out of state, and flew in recently for a few weeks due to an ER visit my mom had for stomach pain. It appears she ate something bad out of the fridge. There are some grandchildren in town that occasionally stop by to check up on her, but they all have lives of their own. Everyone from the doctor to the social worker, to the occupational therapist say that my mom needs 24/7 supervision. She may have dementia, but she knows that she does not want to go to a nursing home.

So, my mom has my dad's Social Security and a small pension from a company she worked at for 30 years. Combined, she brings in $2100 a month. She owns a very small two-bedroom ranch, and has about $30K in checking and savings.

I'm not an expert, but I am going to guess that my mom is in better shape financially than about 80 percent of seniors in this country.

We have started a home-health aid with one of the private companies that do this sort of thing. I am starting the process through the family courts to declare her not capable of caring for herself so that we can get her into a nursing home. That takes about 7 months.

At $360 per day for a live-in aid, that would deplete my mom's savings in about 3 months. The Social Worker tells us that's a "good thing" because the sooner we can get my mom's money below $2000, the sooner she can qualify for MEDICAID.

Once we've blown through her savings, if we're lucky enough, a Nursing Home will put a lien on her house, and if she lives long enough, they can take any proceeds from the house to pay her bill.

My mom worked all her life. She raised 3 good men that made great contributions to America. 2 have passed on, leaving me. She's got 7 grandchildren and 5 great grandchildren. Despite that, she is going to be sucked dry because of the choices we've made as voters.

What one space-cowboy makes in a half-hour, could fund 10 years of quality nursing home care for my mom at $10,000 a month. Thank god the wealthy have used their tax breaks to invest in wages and healthcare, and not in launching themselves into space in penis shaped spaceships.

So, consider that my mom and my family are in better shape financially than most seniors in this country. We'll be fine. As much as I'm sure that my mom would love to leave some of what she's got to her grandchildren, we don't need the money.

Maybe the 1% don't need it either, but they sure are going to get it

[abqtommy]

1. Thanks for this personal information. 360 dollars a day for a live-in health aide sounds like

an awful lot. I admire you for doing the best you can for your Mom.

[h2ebits]

28. That is only $15/hr.

[Blue_true]

33. You can put your Mom in assisted living here in Florida for $4,000 per month.

Her Social Security payment would cover half the amount.

Basically she would live in an apartment in an elderly care complex. Attendants would check on her several times per day and night. Staff would also regularly clean her home, clothing and linen.

You should talk to an estate Attorney. You may be able to sell her home and direct the money toward paying for her assisted living. If the proceeds are decent and the process is managed, using Social Security and her cash assets, you could provide ten year or more of assisted living for her.

Just my suggestion.

[h2ebits]

38. Good advice/suggestion/info

What I also remember is that the cost of assisted living is the base and there are a lot of extras added on--simple stuff like having a hairdresser wash and style hair; medicine and the distribution of it, etc.

[Blue_true]

40. A person needs to do research on the present and future costs.

One of the grandkids can come by to do her hair.

[MLAA]

39. I had to pay around $22 to $24 dollars an hour for home health care after husband

had heart surgery and broken hip. That was through a service. The caregiver typically gets somewhere between $12- $17 an hour based on my research. After a week of thinking I could do it all, I realized I needed help. Plus I’m only 94 pounds so physically I couldn’t safely handle all the help he needed.

Thankfully he is doing pretty well now.

[Faux pas]

2. ...

If you have your name on her house with her, then it can't be used to take all that she has left. That's what we did with my mom who had Alzheimer's. Good luck vibes.

[maxrandb]

5. Only if you plan better

The state she lives in has a 5 year "look back". We have to keep receipts for everything and prove that the funds were used for her care.

If she put my name on the house now, Medicaid will come for any proceeds from the house for 5 years. She can't even gift a couple thousand to the great grandkids, because everything for 5 years prior to qualifying for Medicaid must go to paying for her care.

If she were wealthy enough, she could hire some high priced lawyers to shield her property. That's an option of the 1-5% only.

Some states have a 10 year look back, but I think 5 years is pretty standard

[former9thward]

21. This is why having cash in a safe deposit box is always a good option.

It is probably too late in your mother's case but cash can't be traced. And checking accounts pay next to nothing anyway.

[flying_wahini]

25. Yes, we have a 5 years back in Texas.

I know a lot of people hold onto the family home for too long.
Everybody should consult a estate tax attorney early in the game.

[Faux pas]

49. That's

interesting. We were in Oregon.

[appleannie1]

36. If he is not already on the deed, that might not work.

The greedy cover all the bases to get their hands on things. It is just one of the reasons I cared for both my parents and my father in law in my home. I had worked in a hospital many years ago so had some qualifications on bed care etc. So they managed to be able to stay with family. Not everyone can do that though.

[Faux pas]

48. I

wasn't on the deed originally. I was after I was living with her to take care of her, and before she was eligible for medicaid. I was the only one I trusted to take care of her.

[Croney]

3. Has there been an actual diagnosis of dementia?

You say she does not want to go to a nursing home. Is she able to bathe and feed herself, and take care of the basic household chores? Maybe there is a friend or relative who would visit once a day for a couple of hours, for pay. Just trying to think of options.

My mother is 98, but has a younger husband who looks after her. One day soon that dynamic will change and we'll be looking at options too.

[maxrandb]

7. We are trying to use home health aids as a stopgap

Yes, she had been diagnosed with elderly dimentia, but from what the Social Worker is telling us, I still need to go through the courts to get guardianship.

What is probably going to happen is that she will have another hospital stay, and at that time we can say there is no 24/7 family care possible and they will send her to a nursing home.

Medicare will cover 21 days of that which will give us time to find a permanent home for her.

[Ilsa]

18. Depending on which state you live in,

your state government may declare the oldest living child residing in your state as guardian by default. Then you wouldn't need to go to court.

[Hoyt]

4. Sadly, Medicaid - whether in red or blue states - has always been that way for nursing home care.

Fortunately, I guess, less than 10% of elderly end up in nursing homes.

Hope your mom does as well as possible. Sorry you are going through this.

[XanaDUer2]

6. America never gave a shit about average people

in the past, generations lived together. We've had 40 years of this financial disaster. Many made their choices with their votes. Here we are.

Wishing your mother and family the best

[maxrandb]

9. Thanks

If we could, we would have her live with us, but even we can't provide the 24/7 care that she needs.

[XanaDUer2]

12. No, and if we lived in a decent first-world nation

there would be proper care for everyone from birth to death.

[Mysterian]

8. Thank you for your post

We live in a sick society.

[3Hotdogs]

10. First, an elder care lawyer costs a couple of $k. Since she has 30K, it will come out of that. Not

out of your money. It can be money well spent. Also, an initial consultation to see if there is anything that can be done is usually free or around $25.00. Call your county Bar Association to see if there are are elder care lawyers near her.

Regarding her getting sick off food in the 'frig, her sense of smell is probably diminished or gone.

If she or your father were combat veterans, contact the local V.A. and set up an appointment. VA assistance can mean a world of difference.

[maxrandb]

11. Thanks for that. I will look into it.

[Maru Kitteh]

52. I'm a veterans' home nurse & former home health

For sure check out an established home health agency that works with the VA. Vets & spouses have access to some extraordinary benefits.

[Jilly_in_VA]

13. Have you considered

either assisted living, a "board and care" home, or 24//7 in-home care?

We were able to keep my mother in her home with a live-in caregiver from an agency which provides such (they were trained and bonded) for the last 3 years of her life, despite the fact that she declined to the point where she was incontinent and had no speech. Her caregivers (2 of them) genuinely loved her and she them, and we considered them part of the family. We still do, despite the fact that Mom has been gone for 8 years now!

Assisted living is kind of a hybrid, and depending on the facility, they may or may not have a "memory care" unit for those who can sort of care for themselves but don't remember where they are all the time. This may not work for your mom.

Board and care is often a very nice option, again depending on the home. My friend in Texas had her mother, who was in a similar condition to how you describe yours, in one. It was run by a very capable woman and her daughter and had, I think, 5 or 6 elderly residents. All of them got around to some degree, some with walkers or canes. She provided meals and there was someone who came in to help with bathing etc. I'm also familiar with some larger ones which are not quite nursing homes as they don't provide skilled nursing care, but do provide excellent care for their residents. I applied at a very nice one here but ultimately the owner told me that although she would love to hire me, she could not afford me. If you can find a good board and care home, that may be better than a nursing home for your mom.

My first serious boyfriend's mother did board and care in her home while she had three kids still at home...two teens and one just post teen. They had three elderly residents who I still remember well after all these years, their faces and names. Jim was a tall, lanky man who'd lost one leg. George was a little old guy perpetually looking for something. The other one was a woman we all called "Grandma"; I never did know her real name. Grandma was a Jewish woman who suffered from dementia--most of the time. Sometimes she was quite lucid, however, especially around Jewish holidays. Right before the first Passover she was there she got into a cleaning frenzy, but Mama L. learned to roll with that and appreciate the help. In fact, she learned to let Grandma take the lead and she and her daughter followed and the house shone when they were done, never mind that they did all the work. When Grandma got the idea that my boyfriend and I were engaged, she buttonholed me in the kitchen and started trying to teach me the finer points of keeping a kosher home "even though Clara doesn't," she whispered to me, "but she is a good woman." Memories....

[Delphinus]

32. Oh my ...

thank you for sharing your story! It put such a smile on my face.

[modrepub]

14. Listened In On A Long-Term Care Insurance Pitch

It was put on by my workplace and discussed the ins and outs of buying long-term care insurance. On the cost side, you could buy insurance that basically pays in multiples of $100/day to cover the cost of long-term care. The nice person said that you'd need to buy as much as you could afford since good care for an Alzheimer ward was on the order of $300 a day so you're numbers aren't that far off.

On the morbid side, the person told us the average stay in a nursing home was about a year. My wife's Grandmothers didn't last that long. I suspect neither of them liked being there.

The warning from the person explaining the ins and outs of long-term care insurance was not to buy a policy too early (late 50s). There was always a chance you'd never use it with no refund. The company can cancel or change your policy without recourse or worse the company can go bankrupt if they miscalculate their premiums (more people than they plan go into assisted living situations). In the end I passed (but I was in my 40s when I investigated this).

So even if you plan properly and buy long-term insurance it could all be for naught.

As we've all heard many, many times...growing old ain't for the of heart...or more susinctly...life's a bi*!h.

It's good that you're there to help your mother. As a friend once said, as we grow older our roles become reversed. The child becomes the parent, and the parent becomes the child.

[maxrandb]

15. A friends mom had long term care insurance

She bragged about it.

It ended up paying about $800 a month toward. $7500 a month nursing home.

Still, I guess it was better than nothing

[Ilsa]

19. My MIL had long term care insurance while she

was working, but couldn't afford the premiums after she retired. So, everything she put into it was pretty much wasted for a few decades.

[JanMichael]

16. Makes me think of "I Care A Lot"

Options for most elderly people are super limited. In a decent country there would be several options that don't break the bank. We are not a decent country or economy.

Oh call her local Area Agency on Aging or AAA Program. They should be able to provide guidance.

[forthemiddle]

17. I'm sorry you are going through this long distance

I know how tough it can be. We will be going through the same scenario in the near future with my husband’s mother.
Presumably, we save all our working lives to provide for our future care, or as much of that as possible, without becoming a burden on our families.
I honestly hope I didn’t misunderstand, but your Mom’s “fortune” will care for her in the short term so that you at least have a little time to make plans for her. Since it seems that she will probably need long term care start looking now. Look for a nice place that has blended financial residents ( both private pay, and Medicaid).
Make her home as attractive as possible for the inevitable sale, so that money can give her the nicest possible placement. If and when she runs out of money for her care (from the profit of her home), many nursing homes will then switch her to Medicaid payments, but not kick her out.
Many realize that continuity of care is so very important.
Remember, the house, and her $30,000 savings, are her assets, and will be used to care for her.
Your inheritance, or lack of, isn’t a consideration in long term care planning.

[Deminpenn]

20. The information about losing your house to medicaid isn't true

There is a ceiling of assets a resident can keep that's higher than you were told, at least based on my experience.

What will happen is the nursing home will get your mom's pension/social security payments directly, but she will be able to keep $50/month for her personal use. Medicaid will pay the rest.

It's possible to have your mom's house put in a trust, too. If your mom is in good physical health, assisted living with a memory care unit is a better bet than a nursing home.

I would second the suggestion to find a good Elder Law attorney to discuss all your options.

[Tomconroy]

24. The rules vary, sometimes substantially,

From state to state, and they are very different if there is a surviving spouse. Best to get good legal advice.

[Tiger8]

35. This is good advice, and plus...

I experienced this role 10 years ago, so I'll add my 2 cents, even though some of the policies have changed.

- If she enters the hospital and stays for 3 days, then she qualifies for up to 120 days of rehab, paid 100% by Medicare. --- And a good Geriatric doc will find PLENTY of reasons to extend her hospital stay - testing for cardiac, neuro, kidney, etc. But the caveat with the 120 days is that she must do physical, occupational and speech therapy and keep improving or they will discharge her before the 120 is up.

- If either of your parents are veterans, the VA will kick in a large chunk toward an ALF (Assisted Living Facility) some of which will have a locked memory or dementia unit. ALF's offer more homey surroundings and activities - and their levels of care can range from 100% independent to "laundry, meals and transportation" to more intense levels that include bathing, dressing, toileting, medicine, feeding assistance. They're less costly than nursing homes because they cater to people who can do some things. But if the resident can no longer get out of bed, then many states say now they the nursing home.

- The VA may now cover for home aides in addition to ALF's. "Aging in place" is the new buzzword.

- The local community may have a meals on wheels program.

- Ask about hospice. It's not just for people a few weeks from death. They offer many benefits, including home visiting CNA's and nurses, and people can remain in hospice for years.

- You can hire the CNA's directly for less money than going through an agency. But do a background check please. I think there are Uber type apps that connect people nowadays.

And finally - don't forget to have fun with your mom!

After my parents died, what I remember most fondly was the small every day stuff....the trips to Starbucks and Whole Foods for a coffee and people watch, car rides, etc. A trip for ice cream. The mall or a small local clothing store. One of my mom's favorite things was a trip to Barnes & Noble - she'd find a book or magazine and then a little snack or comfy chair to read.

It's the least they deserve, considering how they gave us life.

[maxrandb]

41. Medicare covers 21 days of "rehab" following a 3+ day hospital stay

after 21 days, you're on the hook.

With less than 10% of elderly folks going to a Nursing Home, why Medicare doesn't cover Long Term care is beyond me.

I guess we can't afford that, but we can give Dick Cheney a $3M a year tax cut.

Again, this is fixable, but only if our votes reflect better values

[Tiger8]

46. Well, that shows how worse off we are now

In 2006, my 83 year old mom went into rehab on a stretcher after 10 days in the hospital for surgery, and she was able to walk unassisted 3+ months later, thanks to dedicated rehab therapists.

Same thing with my dad in 2008. When many people get to their 80's or 90's....just a few days of illness causes a big drop in mobility.

These are the benefits Republicans love to gut. And it's not even fiscally wise, since more people will need nursing home care when therapy can put them back in their home, or at least an ALF.

Curse every goddamned Republican - I hate every one of them.

[maxrandb]

37. In her state, you don't qualify for Medicaid until you have less than $2K in liquid assets

Not counting the home. When she gets below $2K, Medicaid will kick in.

If in a "Medicaid accepting" Nursing Home, her $2100 in monthly SS and pension will go to the home, minus a small amount for personal use.

A lien will be placed on her home for the rest. We then have 1 year to sell the home. Her home is valued at about 180K. That's about 15 months based on current monthly cost of nursing home care. We are prepaying the funeral expense as part of the buy down to get her below the 2K asset threshold.

It's really not about the inheritence for me. My bride and I are consulting an estate planner this week. We will be fine, but it's a deeper question than whether or not my mom's grandkids might get 10K or so in inheritence.

The single most valuable asset and familial wealth building things we have as Americans is our homes.

We made a choice that the 1% were never going to have to deal with losing the assets they can pass on.

Imagine the familial wealth that could be built for the middle class if we didn't require folks to bankrupt themselves in old age.

This really is not about me and the small amount of inheritence I might be entitled to.

This is about the priorities and values we have chosen at the ballot box.

Those values and choices mean that, after my mom has been paying into and contributing to America for 90+ years, the last act of this "great" nation will be to bankrupt her.

[Deminpenn]

43. If you have a good elder care attorney, he or she

will definitely help you.

I know in Pennsylvania, residents who qualify financially can get a rebate on their assisted living rent.

[TygrBright]

22. You may be able to accomplish some of this with a Power of Attorney...

...and sidestep the longer process of the courts declaring you her guardian. Rules vary from state to state and I am NOT a lawyer, but my sisters and I have been going through a similar process with my Mom, so it might be worth talking to an attorney about it.

Hang in there... it's a tough time. There may be a local or even an online/remote support group for children providing care for parents with dementia - ask the social worker. My sisters and I have found the group support incredibly helpful.

The hardest part is feeling so alone making such consequential and generally unhappy choices for someone you love so much. The support group helps with that.

encouragingly,
Bright

[Deminpenn]

44. Power of attorney as well as a healthcare power of attorney

are definately worth getting. They'll allow you to make all kinds of decisions for both your mom's finances and care as well as allowing you access to her medical records, which sometimes can get tangled up by HIPPA rules.

[Tomconroy]

23. I hesitate to write in. I can't give advice. All I can do is describe

My personal experience with caring for my mother who died last year. She was 100 and was mentally sharp to the end. But she fell and shattered her hip and was immobile. She lived in an assisted living facility. We live in Connecticut where nothing is cheap. Assisted living was running about six grand a month. Memory care units run about 8 grand a month. She had 24 hour nursing care from an agency which ran ,$25 an hour which I think runs to about 8 grand a month. Of course we would get calls once a week saying there wasn't coverage for a shift and I would run up and be there. After a month or so of that I decided it made sense to move her to a nursing home. That ran about 15 grand a month. She was middle class, had decent pensions and social security and at that point about 150000 in savings. But at those rates he money went fast.
I was looking towards when the money ran out to qualify for Medicaid. I found out that process itself was complicated. I was told that an elder law attorney would charge at least 15 grand to do a Medicaid application. There are non lawyer companies that will do it for half that. There is usually somebody at the nursing home that will assist people trying to do the application on their own. It involves getting five years worth of records for every financial account and some other stuff I would have had no idea of how to get. When I told the Medicaid maven at the nursing home I was hiring a company to do the application she got an enormous smile on her face. I understood that medicare will pay for 100 days of a nursing home if you come from the hospital. I think that's a national rule so I would check on that.
Medicaid planning is particularly important if there is a surviving spouse. The rules vary by state as to what a spouse can keep. There are legal ways to enhance the amount of assets you can protect and there an elder law attorney can help.
I don't know much about insurance that will pay for a nursing home and the like but I have read that the premiums are really only affordable for the true cost of care only if you purchase it when you are in your 30s.

[Dave in VA]

26. Contact the Alzheimer's Association

They have resources to help you find assistance, lawyers, etc.

https://www.alz.org/

They will guide you to a local association to offer help.

Feel for what you are going through. Just buried my mother last month. She was 91. Dementia did her in.

Use the association. They are great people.

[flying_wahini]

27. Do look at other options for her personal care.

We have used group homes twice for elderly parents and was Very happy using them.

You have to go and check them out but it was half of what a nursing home would cost and
They both had personal care they exceeded our hopes.
Just do your homework. Make sure they are licensed.

[Grumpy Old Guy]

29. I'm not a lawyer.

However, it may not be too late for a living trust. Please get some solid legal advice. Don't believe everything you're being told.

[UGADawg]

30. The rest of us need to buy long term care insurance.............

look into it. I bought a policy 12 years ago. It ain't cheap but look at this story.

[Historic NY]

31. Now I wondering if I should have a trust account...

a will leaves everything to a niece. Maybe I'll need to get bumped off..

[h2ebits]

34. You can spend the money on a prepaid funeral and other "allowed" things to reduce. . . .

her assets for purposes of Medicaid. Sorry, but I can't remember what other items you can spend money on to reduce assets. The social worker that you spoke with may be able to help.

Doing all of this long distance is particularly hard.

I lived half way across the country but was very fortunate in that my brother lived close by and he took care of everything. (I did learn some things that have helped me.)

Did someone tell you that the "nursing home" would put a lien on your mom's house? My recall from my brother after my mom was in assisted living/nursing home with my aunts living in her condo, was being told by him that my mom had enough money to last one more year and then we would have to sell the condo.

Perhaps your best way to take care of your mom is to put a reverse mortgage on the house so she can stay in it until she dies or absolutely needs to be in a nursing home for more intensive care. That would provide funds should she need to move into a care facility. (That does not negate my first comment regarding a prepaid funeral using her funds.)

Also, you should check into the tax consequences of selling the house and what taxes she would owe, if any, from the sale of the house. And I know absolutely nothing about how the government handles reverse mortgages regarding taxes.

As others have said, I think that I would try to find a lawyer to talk to--and they need to be in the state of your mom's residence because laws are different in every state.

[Tomconroy]

42. Getting a prepaid funeral is good advice.

Again the rules on how much you can spend will vary by state. My experience was that a good funeral home will know the rules if you explain you need a medicaid compliant funeral.
Actually a prepaid funeral is a good idea no matter the circumstances. When the time came all I had to worry about was showing up for the service.

[h2ebits]

45. Me too.

It is such a stressful time to have to make all of those decisions. In my case, my parents and aunts all purchased their funeral plots together many, many years earlier. Such a pragmatic group of people. In some cases, they even provided some input into decisions regarding the funeral arrangements. As I said, they were a truly pragmatic group. . . .

[maxrandb]

47. I appreciate all the suggestions and advice...I really do

Doing this long distance and watching my independent and strong mother deteriorating is really hard.

Maybe I could have done a better job, but the minutiae and details of the bureaucracy was not the point I was trying to convey.

It's not about whether or not I'm going to inheritate some funds from my mom. OK, well it might be a little of that. Any funds would be split between my kids and the other grandchildren. That's what my mom would want with all her soul.

Maybe the kids could use that for school. Maybe they would invest it long term. Maybe it would improve their options to get ahead. Maybe it would be a great legacy for my mom.

Despite all that, the real point of my story is the choices we have made as a society.

In a great country, a hard-working middle class woman played by the rules, lived a good and decent life, contributed to society.

Her reward, and the reward of too many just like her, is to live long enough to see everything she built slowly taken away, piece by piece.

I served 29 years in the military. My dad and older brothers died suddenly in their early to late 60's. I'm a smoker. The chance I make it to 90 is "slim to none".

But those Americans that do make it that far deserve better.

That's my point.

[llmart]

50. I agree with you 100%.

I have posted on here several times over the years that as a leading edge boomer, my generation better start planning if they haven't already - and statistics show they haven't - so that they don't wind up like this. I've posted on here before about how we are headed for a retirement crisis in this country when boomers get old. So many of my friends never saved a penny and kept buying bigger houses, fancy vacations, tons of crap they could have lived without, and now reality is setting in for some.

My parents died very young and sometimes I think about what it would be like if they had lived into their 90's. I hear stories like yours all the time and on some level I'm so glad I don't have to deal with all that. Of course I would have loved it if they would have lived at least until they were senior citizens, but that didn't happen. They were always poor and never owned anything of value, so who knows what they would have done if they would have aged.

I really feel for you and what you're going through and I feel for your mother also. I, too get livid about how we love to brag about how we're "the richest country in the world" (yeah, right) and yet our senior citizens have to play these ridiculous games of juggling how to have just the basics that are necessary for the elderly. I get so p.o.'ed when I think of how many tax dollars went to fight those two ridiculous wars under Dubya that wasted trillions of our dollars.

It's why I never have and never will vote for a Republican.

I have very little advice but I would start with your local Agency on Aging. Their advice is free and they also will point you to some free legal advice.

[UTUSN]

51. You're well on your way.

[Tomconroy]

53. Part of the problem may be

That people have no idea of the costs until it's too late. The answer is a lot higher taxes on a european scale but no one wants to hear that.