Options after leaving nursing home - assisted living vs home/family vs other ?

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Wannaretireearly
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by Wannaretireearly »

TN_Boy wrote: Sun Jan 16, 2022 11:16 am
Wannaretireearly wrote: Sun Jan 16, 2022 2:17 am I sometimes wonder, is it much cheaper abroad? Say Mexico. Is this a good reason to move to a warm/cheap location in your 70s/80s with decent healthcare and cheaper elder care (Mexico, Panama, Thailand etc).

OP: sounds like you’ll figure this out, and money is not a major issue. Best of luck to you and your family.
The problem with someone moving overseas for cheaper elder care facilities (and, they are cheaper in many places) is that it makes it pretty close to impossible for family to monitor the care unless they move also. Someone actually in a care facility needs outside help from friends or family.
Fair point. I was thinking this too. Grandparents in their mid nineties are going thru familiar challenges. Such a hard time for them and the supporting relatives.
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TN_Boy
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by TN_Boy »

JoeRetire wrote: Sun Jan 16, 2022 1:40 pm
TN_Boy wrote: Sun Jan 16, 2022 1:37 pm
JoeRetire wrote: Sun Jan 16, 2022 1:16 pm
fsrph wrote: Sat Jan 15, 2022 10:02 pmWe asked is going home an option? Response was no Doctor would authorize that unless there was 24 hour care at home.
So he has the option of going home, provided he pays for 24 hour care. Seems like an option that might please him.
Well at, 200k+ a year for 24x7 help. If he'll accept the care takers ..... it goes back to how much money he has. Full time care at home is fantastically expensive.
No doubt. It's his life. It's his money. It's his choice.

I'm guessing the care would please him, but the cost would not. We all have to make tough choices at times.
Very true. We have no idea if he can afford this level of care or not. But if he has the money, and is only a one-person assist, that would work.
remomnyc
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by remomnyc »

Do not take your father unless you're willing to care for him indefinitely. Don't go down this road. You will end up resenting him and it will take an unimaginable toll on you and your family. If you and your siblings were all retired, you could take turns moving into his home and caring for him for weeks or months at a time, but caring for a stubborn, full-grown adult is exhausting.

If your father is competent, he decides what he wants. Based on your description, it appears his choices are a live-in caretaker (much cheaper than cobbling together hourly help 24/7) or assisted living, assuming he is physically eligible. I assume he has the money to pay for care. If so, this is the best use of his money, rather than becoming a burden on his children. When the money runs out, he will be eligible for Medicaid.
Point
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by Point »

There’s a huge difference with a sibling helping out as much as they can, when they can, and saying I will take M/S/S as my days and do XYZ. Top that off with not having POA and you could end up with a dependent.

As others have said, facilities that range from assisted living to skilled nursing, with communal eating facilities are a great option. This way there is 7x24 staffing and good interaction with one cannot do effectively by themselves. The last thing your parent wants to do is be a burden on their kids.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by fsrph »

BarbBrooklyn wrote: Sun Jan 16, 2022 6:26 am
fsrph wrote: Sat Jan 15, 2022 10:02 pm
galawdawg wrote: Sat Jan 15, 2022 3:22 am
Sorry for the dose of reality, but if he is a competent adult, where and how he lives and where and how he spends his money are his decisions to make, however unwise those decisions may be. While the nursing home may opine that his going home, as he has decided he wishes to do, "isn't possible right now," they do not get to make that decision. Your father does, even if contrary to the best medical advice. While none of us want to see any harm or adverse consequences befall any senior, particularly our loved ones, a person does not lose their freedom of choice, their ability to live their life as they choose, and their right to spend their money as they see fit as a result of old age, infirm condition, or unwise decision-making.
A few replies asked about the going home option. Want to clarify what happened. My father has mobility issues but improved quite a bit with physical therapy. He was classified as a one person assist but physical therapist told me he is right on the cusp of needing no assist. Family had meeting with social services director at nursing home. He explained options like assisted living. We asked is going home an option? Response was no Doctor would authorize that unless there was 24 hour care at home. We asked what if the family was willing to spend a lot of time helping him at home. They stated that would be considered taking him home against medical advice (AMA) and if anything happens to him, like a fall, we could be accused of elder abuse.

Francis
In other words, the discharging doctor won't sign off unless there is round the clock supervision for your dad?

1. I would ask WHY he needs 24/7 supervision-- is it because of physical limitations or because of poor judgement, i.e., shouldn't be cooking, wouldn't leave in case of fire. Pin them down.

2. " Dad, this is out of our hands. We could be arrested if we take you home".

3. If you hire aides, will he tolerate them? Or will he fire them and place you and he at risk.

4. Spending money on care is NOT spending on himself. It's giving YOU the gift of being his kids, not his caretakers. It's paying his own way, not enslaving you by his increasing needs.
Here's how the going home conversation will go:

Dad, where do you want to next?
Take me home.
Ok, but the Doctor said you need aides to help you at home.
I don't need aides. I managed at home before and I'll manage again. Take me home.

(So to answer your question I doubt he will tolerate aides because of the cost)

Just a little about my father. He's not trying to be difficult. He was around during the Depression era and his family went thru very tough times. He saved his whole life and knows savings can mean security. He just told me last night that his savings are for leaving something for his family.

Francis
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JoeRetire
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by JoeRetire »

fsrph wrote: Sun Jan 16, 2022 3:27 pm Here's how the going home conversation will go:

Dad, where do you want to next?
Take me home.
Ok, but the Doctor said you need aides to help you at home.
I don't need aides. I managed at home before and I'll manage again. Take me home.
I'm not sure why you are having this conversation with dad.

Let the doctor be the bad guy/gal and break the news about going home directly to your dad.
That worked with my dad and not driving.
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BarbBrooklyn
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by BarbBrooklyn »

Francis, (((hugs)))).

So many of us here know how hard this is.

As I've previously mentioned to you and to lots of other posters, there is a great forum at www.agingcare.com. Not limited to the financial stuff as we are here.

Gently, this is not JUST about what your dad wants. It is about:

1. What his funds will support
2. What he can tolerate
3. What you (all) can and want to do

He can't go home alone (per docs).

You can't be his aide 24/7 (you are too old, don't have the training) As Lady Geek wisely points out, transferring a frail elder is a skill not to be sniffed at.

Requires training, equipment. Is your dad going to allow YOU to use a gait belt or a Hoyer lift?

So there are limited choices and you need to present him with what is ACTUALLY on offer. Not what he "wants". The conversation is "Here's the deal, Dad".

With my mom on her 90s, the day I realized that there were no GOOD choices, just the least bad ones, I regained some peace.

End of life decisions, financial and otherwise are not easy.

Please don't go down with the ship.
Last edited by BarbBrooklyn on Sun Jan 16, 2022 3:44 pm, edited 2 times in total.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by BarbBrooklyn »

JoeRetire wrote: Sun Jan 16, 2022 3:30 pm
fsrph wrote: Sun Jan 16, 2022 3:27 pm Here's how the going home conversation will go:

Dad, where do you want to next?
Take me home.
Ok, but the Doctor said you need aides to help you at home.
I don't need aides. I managed at home before and I'll manage again. Take me home.
I'm not sure why you are having this conversation with dad.

Let the doctor be the bad guy/gal and break the news about going home directly to your dad.
That worked with my dad and not driving.
This ++++1000
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TN_Boy
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by TN_Boy »

JoeRetire wrote: Sun Jan 16, 2022 3:30 pm
fsrph wrote: Sun Jan 16, 2022 3:27 pm Here's how the going home conversation will go:

Dad, where do you want to next?
Take me home.
Ok, but the Doctor said you need aides to help you at home.
I don't need aides. I managed at home before and I'll manage again. Take me home.
I'm not sure why you are having this conversation with dad.

Let the doctor be the bad guy/gal and break the news about going home directly to your dad.
That worked with my dad and not driving.
A very good suggestion.

OP, so even though he needs physical help to get from point A to point B (like, say, from a chair to the bathroom) you believe he will still insist that he can go home by himself? It's tough getting older.....
TN_Boy
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by TN_Boy »

fsrph wrote: Sun Jan 16, 2022 3:27 pm
BarbBrooklyn wrote: Sun Jan 16, 2022 6:26 am
fsrph wrote: Sat Jan 15, 2022 10:02 pm
galawdawg wrote: Sat Jan 15, 2022 3:22 am
Sorry for the dose of reality, but if he is a competent adult, where and how he lives and where and how he spends his money are his decisions to make, however unwise those decisions may be. While the nursing home may opine that his going home, as he has decided he wishes to do, "isn't possible right now," they do not get to make that decision. Your father does, even if contrary to the best medical advice. While none of us want to see any harm or adverse consequences befall any senior, particularly our loved ones, a person does not lose their freedom of choice, their ability to live their life as they choose, and their right to spend their money as they see fit as a result of old age, infirm condition, or unwise decision-making.
A few replies asked about the going home option. Want to clarify what happened. My father has mobility issues but improved quite a bit with physical therapy. He was classified as a one person assist but physical therapist told me he is right on the cusp of needing no assist. Family had meeting with social services director at nursing home. He explained options like assisted living. We asked is going home an option? Response was no Doctor would authorize that unless there was 24 hour care at home. We asked what if the family was willing to spend a lot of time helping him at home. They stated that would be considered taking him home against medical advice (AMA) and if anything happens to him, like a fall, we could be accused of elder abuse.

Francis
In other words, the discharging doctor won't sign off unless there is round the clock supervision for your dad?

1. I would ask WHY he needs 24/7 supervision-- is it because of physical limitations or because of poor judgement, i.e., shouldn't be cooking, wouldn't leave in case of fire. Pin them down.

2. " Dad, this is out of our hands. We could be arrested if we take you home".

3. If you hire aides, will he tolerate them? Or will he fire them and place you and he at risk.

4. Spending money on care is NOT spending on himself. It's giving YOU the gift of being his kids, not his caretakers. It's paying his own way, not enslaving you by his increasing needs.
Here's how the going home conversation will go:

Dad, where do you want to next?
Take me home.
Ok, but the Doctor said you need aides to help you at home.
I don't need aides. I managed at home before and I'll manage again. Take me home.

(So to answer your question I doubt he will tolerate aides because of the cost)

Just a little about my father. He's not trying to be difficult. He was around during the Depression era and his family went thru very tough times. He saved his whole life and knows savings can mean security. He just told me last night that his savings are for leaving something for his family.

Francis
So what can his savings pay for? Of the various options many of us have tossed around, which ones can he afford?
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by fsrph »

InMyDreams wrote: Sun Jan 16, 2022 11:31 am

Caregiver stress is real. Does your father realize what he is asking of his children to take him into their home? What does he want to do?

How good is the social worker at the SNF where he is - is s/he willing to work with your father on some of these ideas? And, even tho he is mentally competent, it doesn't mean that that this specifically is a rational decision, and like you, he may not see the big picture of the effort this will require.
My father wants to go to his home. He never asked to come to our homes (that was our idea). He said he'll manage by himself at his home like he did before. I am aware about what a huge task it is to care for a loved one. It's unbelievably difficult. Honesty, I'm not sure I can do it.

Francis
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clip651
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by clip651 »

fsrph wrote: Sun Jan 16, 2022 3:45 pm
InMyDreams wrote: Sun Jan 16, 2022 11:31 am

Caregiver stress is real. Does your father realize what he is asking of his children to take him into their home? What does he want to do?

How good is the social worker at the SNF where he is - is s/he willing to work with your father on some of these ideas? And, even tho he is mentally competent, it doesn't mean that that this specifically is a rational decision, and like you, he may not see the big picture of the effort this will require.
My father wants to go to his home. He never asked to come to our homes (that was our idea). He said he'll manage by himself at his home like he did before. I am aware about what a huge task it is to care for a loved one. It's unbelievably difficult. Honesty, I'm not sure I can do it.

Francis
Then your father needs to get well enough to get his doctors to sign off on getting home. Or he needs to understand that going home alone (with no helpers, paid or otherwise) is not an option, and he needs to pick one of the other ones. We don't always get what we want. I don't blame him for wanting to go home. But he needs to figure out where to go where he can be taken care of. These conversations aren't easy, and just him saying "I want X" or "no I won't do that" aren't the end of the conversation if the doctors aren't going to release him to the conditions that he wants.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by fsrph »

JoeRetire wrote: Sun Jan 16, 2022 1:16 pm
fsrph wrote: Sat Jan 15, 2022 10:02 pmWe asked is going home an option? Response was no Doctor would authorize that unless there was 24 hour care at home.
So he has the option of going home, provided he pays for 24 hour care. Seems like an option that might please him.
Until we tell him how much it costs.

Francis
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by JoeRetire »

fsrph wrote: Sun Jan 16, 2022 3:53 pm
JoeRetire wrote: Sun Jan 16, 2022 1:16 pm
fsrph wrote: Sat Jan 15, 2022 10:02 pmWe asked is going home an option? Response was no Doctor would authorize that unless there was 24 hour care at home.
So he has the option of going home, provided he pays for 24 hour care. Seems like an option that might please him.
Until we tell him how much it costs.
It's a decision he gets to make. We all need to live in the real world, whether we want to or not.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by AllMostThere »

Op, temporary care will ultimately turn into 24x7. Having experienced this with my DM, it will be too much for any one individual and nearly impossible for anyone trying to juggle a career at same time. Stress to you will be crushing, just as I experienced. While there may be local in-home personnel care that you can hire it will be expensive ~ +$25/hr. Additionally, many in-home care providers are having staffing issues and are not accepting new customers or providing very limited services. Just make a few calls to the providers in your area to inquire. I would suggest an alternative. See if there are any licensed private residence assisted living facilities in your area. These are usually low density (<10 residents) facilities that provide 24x7 care. Additionally, if your parent has limited mobility Medicare will pay for in-house physical therapy for a period of time. We did this for my DM, prior to her passing, and the facility was awesome. They provided all meals, bathing, dressing, med dispense and provided mental stimulation to all the residents. While she desired to be home, she liked the facility and accepted it well. It was not all that costly considering the cost of in-home care was great. Good luck and keep us informed on your direction.
Last edited by AllMostThere on Sun Jan 16, 2022 4:06 pm, edited 1 time in total.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by fsrph »

TN_Boy wrote: Sun Jan 16, 2022 1:34 pm
Second, as I noted before, the financial situation absolutely has to be understood. If the aging relative can't afford assisted living or home health care, what then? Family pays? Family takes in dad? You have to understand the $$ before you know the options.

Since there were multiple inquiries about my father's financial situation he has about 650k (maybe a bit more) in safe investments plus a house of about 130k. SS + small pension. No debt.

Francis
Last edited by fsrph on Sun Jan 16, 2022 4:20 pm, edited 1 time in total.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by fsrph »

JoeRetire wrote: Sun Jan 16, 2022 3:30 pm
fsrph wrote: Sun Jan 16, 2022 3:27 pm Here's how the going home conversation will go:

Dad, where do you want to next?
Take me home.
Ok, but the Doctor said you need aides to help you at home.
I don't need aides. I managed at home before and I'll manage again. Take me home.
I'm not sure why you are having this conversation with dad.

Let the doctor be the bad guy/gal and break the news about going home directly to your dad.
That worked with my dad and not driving.
Joe, I didn't actually say that to him. I know in advance how the conversation will go.

Francis
"Success is getting what you want. Happiness is wanting what you get." | Dale Carnegie
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JoeRetire
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by JoeRetire »

fsrph wrote: Sun Jan 16, 2022 4:07 pm
JoeRetire wrote: Sun Jan 16, 2022 3:30 pm
fsrph wrote: Sun Jan 16, 2022 3:27 pm Here's how the going home conversation will go:

Dad, where do you want to next?
Take me home.
Ok, but the Doctor said you need aides to help you at home.
I don't need aides. I managed at home before and I'll manage again. Take me home.
I'm not sure why you are having this conversation with dad.

Let the doctor be the bad guy/gal and break the news about going home directly to your dad.
That worked with my dad and not driving.
Joe, I didn't actually say that to him. I know in advance how the conversation will go.

Francis
You are speculating.
I would speculate that his doctor would say "Well you can't go home by yourself and I won't sign off on that. You need aides."
And your doctor doesn't need to listen to your dad for the rest of his life.

Let his doctor do the dirty work. Often, parents respond differently to a source of authority than they do to their children.
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TN_Boy
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by TN_Boy »

fsrph wrote: Sun Jan 16, 2022 4:01 pm
TN_Boy wrote: Sun Jan 16, 2022 1:34 pm
Second, as I noted before, the financial situation absolutely has to be understood. If the aging relative can't afford assisted living or home health care, what then? Family pays? Family takes in dad? You have to understand the $$ before you know the options.

Since there were multiple inquiries about my father's financial situation he has about 650k in safe investments plus a house of about 130k. SS + small pension. No debt.

Francis
Okay, that's excellent. He has the funds to handle most care situations. He is better off than many in this situation. I suggest you take JoeRetire's excellent suggestion of having the medical staff lead the discussion with him on "going home."

Before the staff talks with him, the family can go over the prognosis with his doctors (likely without him present, or maybe two discussions, one where he is present, one where he is not), and come up with options and plans for the short to medium term. For example, option A is him getting a live in caretaker. Option B moving to assisted living, etc. Option last is you taking him in.

Some of the options discussion is likely to be with the social worker type person that most such facilities have on staff; the MDs will tell you what his condition is, and his prognosis, but other staff might be the ones to go over care options that fit his condition. Note that the family will have to vet care facilities themselves; you cannot only depend upon a staffer recommendation.

Then have the facility staff* go over options with him, being sure to recommend the ones the family has decided are the best.

Oh, and yeah, you have to get all paperwork (POAs, etc) done no matter what. Be sure the staff covers that as well.

*you do want the most forceful MD that has worked with him make his needs crystal clear to him.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by TimeRunner »

JoeRetire wrote: Sun Jan 16, 2022 4:09 pm
fsrph wrote: Sun Jan 16, 2022 4:07 pm
JoeRetire wrote: Sun Jan 16, 2022 3:30 pm
fsrph wrote: Sun Jan 16, 2022 3:27 pm Here's how the going home conversation will go:

Dad, where do you want to next?
Take me home.
Ok, but the Doctor said you need aides to help you at home.
I don't need aides. I managed at home before and I'll manage again. Take me home.
I'm not sure why you are having this conversation with dad.

Let the doctor be the bad guy/gal and break the news about going home directly to your dad.
That worked with my dad and not driving.
Joe, I didn't actually say that to him. I know in advance how the conversation will go.

Francis
You are speculating.
I would speculate that his doctor would say "Well you can't go home by yourself and I won't sign off on that. You need aides."
And your doctor doesn't need to listen to your dad for the rest of his life.

Let his doctor do the dirty work. Often, parents respond differently to a source of authority than they do to their children.
Been there. Done that.
Exactamundo. Mom wanted most of all to be home, in her bed, with her artwork on her (somewhat unusually painted) walls, etc. Her doctors and the hospital social worker told her in writing that she could not go home without 24/7 care, and that didn't mean a relative or live-in caregiver, because someone needed to be awake and eyes on in the middle of the night when she wanted to get up and go to the bathroom, unsteady and risking a fall. She basically had to accept that or she would have to be put somewhere other than her home. She was furious but boxed in.

She tried to fire and send home her caregivers at least a dozen times, but they didn't report to her and I was the responsible party. I would remind her when I got calls from her that if she didn't have a caregiver there she would not be allowed to stay in her home, and if she fell with no one there, my sister and I could be liable for elder abuse.

It was not an easy time, but as her dementia became worse and her sleep pattern more staggered, she became more docile and less questioning about caregivers who were now doing everything from cooking to toileting and showering her. At that point, she no longer thought about why she had caregivers or how they are being paid, thankfully.

You will have plenty to do in managing caregiving, ordering groceries, making sure prescriptions are filled, etc., and eventually managing finances. That's plenty.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by rich126 »

My wife and her brothers took care of their parents partly due toa lack of funds for quality 24x7 care elsewhere. They had a daytime caretaker provided by the state so they could work and took turns at nights and weekends.

My father went quickly from hospital to hospice at the hospital to passing away within a week. He had funds and insurance but I was seriously pondering other options since I really wanted to help him and not have him in a hospice. If I still had my single family home that I did in 2019 I would have volunteered my home and hire people to help out. Unfortunately I had sold that when I moved out of state and when I returned I only got a small one bedroom apartment since I planned it to be a 18-36 month stay. I was considering moving to a 2 bedroom unit but sadly he passed away too quickly (I suppose that was both a good thing in that he didn't suffer long but selfishly too quick for me).

Family dynamics can make things harder but anyone who has spent time in hospitals, rehab centers and hospices will quickly realize how lonely and depressed people get in them and ideally you don't want to have loved ones there. My wife spent a lot of time and money helping her parents and have never regretted a minute of it. Now that my dad has passed away I better understand what she meant.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by fsrph »

I believe I have positive news which came about in the most unusual way. Was watching the NFL games with my father at the nursing home tonight. He looked at me and said I'm going to tell you about something. I said OK. He said when you get older (I'm 62) consider assisted living places. They make your meals and help you when you need it. I asked has he considered assisted living and he said, not yet I can still do things myself. This is great because he was upbeat about assisting living and hopefully he'll be open to that option. I think social interaction there will be good for him too. Noticed some improvement in his mobility. He used wheelchair / walker to go to bathroom and bed and did transfers to toilet and bed by himself.

Francis
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by DarthSage »

It's good news that he's open to the idea of assisted living. Many facilities have different areas with different levels of care. My MIL needed to go into one after she broke her hip--she toured several facilities, and found a really nice one that provided meals, but not much else (unless you paid extra for an aide). They had plenty of activities, shuttles to go to the store or local shows, a pool (both for recreation and physical therapy), and it was a very nice setting. Her only complaint, aside from the cost, was that the food was too good, and she was gaining weight! Given that she'd been subsisting on Lean Cuisines for a while prior to that, we were thrilled.

AS to the cost--I understand your dad wanting to leave something to his children. This is very common, even when the "kids" (I know, you're 62!) aren't looking for a windfall. If possible, gently remind him that the best gift he can give you now is the comfort and security of knowing that he's safe and well cared for. He's worked hard all his life, he's entitled to have comfort in his declining years.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by BarbBrooklyn »

Interesting. He's recommending AL for YOU, not for him. But glad his mobility is increasing; it sounds like perhaps the Social Worker has been introducing the idea.

Financially, I think you need to make it clear that you are in no need of his funds and that living with you, even temporarily, is off the table.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by rich126 »

fsrph wrote: Sun Jan 16, 2022 10:48 pm I believe I have positive news which came about in the most unusual way. Was watching the NFL games with my father at the nursing home tonight. He looked at me and said I'm going to tell you about something. I said OK. He said when you get older (I'm 62) consider assisted living places. They make your meals and help you when you need it. I asked has he considered assisted living and he said, not yet I can still do things myself. This is great because he was upbeat about assisting living and hopefully he'll be open to that option. I think social interaction there will be good for him too. Noticed some improvement in his mobility. He used wheelchair / walker to go to bathroom and bed and did transfers to toilet and bed by himself.

Francis
I think at some point most people realize fighting help isn't good. They eventually realize they do need help and accept it. Lets be honest, how many here want to give up their independence? Or want to admit they need help to go to the bathroom? Or need help to make a bed? Or can no longer drive?
It is a very tough thing for most of us to deal with.

I've wanted to be independent since I was very young and my whole goal in high school/college was to get my degree so I could be independent and no longer need to rely on others for money or assistance. My single mindedness caused me to miss out on things that I probably regret now but nearly 40 years later, it would be horrible to give up my independence.

Trying to view these things logically, misses out on the emotional parts of it and sometimes it is best to move very slowly on things. I realize in some cases nothing you do will help matters, especially if memory issues are beginning to occur.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by Sandtrap »

Consider 24/7 home care?

We did this for MIL who recently passed at age 94.
She was determined to stay in her own home and did.
It ran from 8-12,000 per month for all expenses including home and a car in the garage for the caregivers to use to take her where she needed to go such as doc appts etc.

This is a step by step thing.
Baby steps.

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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by LadyGeek »

^^^ For reference, that's about the same cost as a nursing home.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by mkc »

fsrph wrote: Sun Jan 16, 2022 10:48 pm I believe I have positive news which came about in the most unusual way. Was watching the NFL games with my father at the nursing home tonight. He looked at me and said I'm going to tell you about something. I said OK. He said when you get older (I'm 62) consider assisted living places. They make your meals and help you when you need it. I asked has he considered assisted living and he said, not yet I can still do things myself. This is great because he was upbeat about assisting living and hopefully he'll be open to that option. I think social interaction there will be good for him too. Noticed some improvement in his mobility. He used wheelchair / walker to go to bathroom and bed and did transfers to toilet and bed by himself.
Having been through this with a parent, the social aspect of assisted living is definitely worth considering as well - activities, groups of friends, etc.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by BarbBrooklyn »

Here's the thing; as Lady Geek points out, in many places, the cost of staying at home with round the clock aides and Nursing Home Care is about the same, Assisted Living is somewhat less.

What getting into a GOOD facility now may get you--and this is highly dependent upon state law--is the fact that if you private pay for a certain amount of time, they will allow you to stay if you need to go on Medicaid when the money runs out.

Right now, you have what sounds like a good social services/disharge team that is almost certainly very knowledgable about state regs and such. Please take advantage of that.

A good certified eldercare attorney who is knowledgable about Medicaid lookbacks and the like should be brought onto Team Dad; getting a consult could save you much heartache and money down the road, especially if your dad decides that gifting you guys funds now is a way to preserve his legacy.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by Jablean »

My family lost five years of me, plus the sacrifices they made covering for me when I wanted to take a bath or walk the dogs. No going out to family dinners, no family vacations with my DH and kid, no movie going. We didn't leave my dad alone in the house for the first 3 years. He woke me up at least once a night for pain pills, hot pads, just to talk. He was/is mostly wheelchair bound but can transfer etc on his own. Has swallowing problems and doesn't like onions, peppers and other things that my family enjoys in their food so separate meals for him. No "his house" to go to, no "money" other that SS (savings was used up in the stroke hospital - he took out his "retirement" years ago to "play") . I thought he'd get better and back on his own (travel trailer on a vacation lot) but knee replacement and neck surgery later things still did not get better.

Finally found the website that could help me with costs seniorly.com with correct prices that I didn't have to call/visit/sign-up for and more information on levels of care from assisted living which in his case SS would almost cover to up to five levels of care depending on what he couldn't do himself. Because he did live with us, and I didn't charge for not being able to hold down a full-time job, he now has some savings. It was still a long slog getting him to agree to assisted living (desperately afraid of it do to childhood trauma) but since I've been unable to walk distances for the last year and in pain getting up and down, finally convinced him that I could no longer physically take care of him and had to take care of myself.
It's only been two months but the kid, who no longer has to share his bathroom, and the hubby, who no longer has to get him breakfast while I'm trying to sleep in, are much much happier. I'm still down to the center once a week with supplies (he has his own fridge) but my life is once again my own.

So check out the website - I so which I had found it years earlier (A Place for Mom just seems convoluted to find prices).
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by LadyGeek »

Jablean wrote: Mon Jan 17, 2022 5:55 pm So check out the website - I so which I had found it years earlier (A Place for Mom just seems convoluted to find prices).
When I was searching for a nursing home for my late husband, the hospital social worker said that "A Place for Mom" is not a good reference. They get compensated for referrals. The local social workers know the area and can provide recommendations. Don't expect advice saying "here's where you need to go". Expect advice like "here are a few in the area, check these out".

You absolutely must visit the home in person. Walk through as discretely as you can during normal hours and keep your eyes and ears open. Also, your nose for signs of cleanliness. Once you walk through, then ask someone at the front desk to take a tour. They'll show you the better parts of the home. It's difficult to ask the residents, as that will draw the attention of the staff and you'll be quickly escorted to someone who can "help" answer your questions.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by Sandwich »

Another thing to consider is obtaining written documentation regarding your father's ability / inability to perform activities of daily living. If current health care providers are saying he can't return to his home without extensive care, then he may need at least "standby assistance" for activities such as bathing (hazardous slippery bathroom environment) and transferring (risk of fall).

Having the written documentation of inability to perform at least 2 activities of daily living will allow one to take itemized deductions on the costly home health and / or assisted living costs. Since 2022 has just started, these deductions can add up quickly.

An elderly relative has been receiving long-term care insurance benefits for years and during all that time has been able to use itemized deductions (for the cost of care not covered by insurance) to help reduce her income tax liability.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by bhwabeck3533 »

TN_Boy wrote: Sun Jan 16, 2022 10:27 am However, regardless of how competent someone apparently is, if they literally cannot go to the bathroom by themselves (as later posts by the OP make clear) then in fact, no, the person doesn't get to call the shots because they cannot implement that plan. And it's other people that will have to keep fixing things. Sometimes the family has to unite and say, "No, that is not going to happen."
[ quote fixed by admin LadyGeek]

My sister lived with my 95 YO Mom (in Mom's home) till two about weeks ago. Mom's physical frailties were exposed. We moved her into a 1 BR Assisted Living apartment. She's having a tough time adjusting. So we are all newbies at what' is happening. So using your feedback as a "crystal ball":
1. Will the Assisted Living facility require access to her finances/assets? To my knowledge they have not requested this information. My Mom has SS and a teacher's retirement pension which will cover more than half her "rent". My sister has POA to pay her bills. Basically, want to make sure there's a firewall between the AL and her assets.
2. Should we look into a new healthcare insurance policy for her? She's had the same coverage for many, many years and has been quite healthy till recently. This seems to be changing, especially dental care. Has her move triggered a "life changing event" such that she can look for a new policy outside of the typical end-of-year "enrollment period"?
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by clip651 »

LadyGeek wrote: Mon Jan 17, 2022 6:16 pm
Jablean wrote: Mon Jan 17, 2022 5:55 pm So check out the website - I so which I had found it years earlier (A Place for Mom just seems convoluted to find prices).
When I was searching for a nursing home for my late husband, the hospital social worker said that "A Place for Mom" is not a good reference. They get compensated for referrals. The local social workers know the area and can provide recommendations. Don't expect advice saying "here's where you need to go". Expect advice like "here are a few in the area, check these out".

You absolutely must visit the home in person. Walk through as discretely as you can during normal hours and keep your eyes and ears open. Also, your nose for signs of cleanliness. Once you walk through, then ask someone at the front desk to take a tour. They'll show you the better parts of the home. It's difficult to ask the residents, as that will draw the attention of the staff and you'll be quickly escorted to someone who can "help" answer your questions.
In my limited experience, none of the facilities in our area would allow a visitor to just walk in and look around. You're presented with a registration desk before you go anywhere, you have to sign in and tell them why you're there. If you are a general visitor they will find someone to show you around or tell you to make an appointment to come back later if no one is available.

As a resident (theoretically, I'm not one now!) I sure wouldn't want random strangers (the family of prospective future residents) wandering around freely with no supervision.

If you know a current resident, or know someone that does, you might be able to arrange a visit with that person, which could then facilitate a bit of looking around and talking to other residents with minimal supervision. But advising a general idea of "go visit and walk around" a nursing home without checking in with registration seems really odd and inappropriate advice to me. Maybe things are run really differently elsewhere, but even in poorly run places here (I've visited some when looking for a spot for a relative) there is some basic security to prevent people from wandering around to just check a place out on their own.

[edited to fix typo]
Last edited by clip651 on Tue Jan 18, 2022 7:50 pm, edited 1 time in total.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by TN_Boy »

LadyGeek wrote: Mon Jan 17, 2022 6:16 pm
Jablean wrote: Mon Jan 17, 2022 5:55 pm So check out the website - I so which I had found it years earlier (A Place for Mom just seems convoluted to find prices).
When I was searching for a nursing home for my late husband, the hospital social worker said that "A Place for Mom" is not a good reference. They get compensated for referrals. The local social workers know the area and can provide recommendations. Don't expect advice saying "here's where you need to go". Expect advice like "here are a few in the area, check these out".

You absolutely must visit the home in person. Walk through as discretely as you can during normal hours and keep your eyes and ears open. Also, your nose for signs of cleanliness. Once you walk through, then ask someone at the front desk to take a tour. They'll show you the better parts of the home. It's difficult to ask the residents, as that will draw the attention of the staff and you'll be quickly escorted to someone who can "help" answer your questions.
Good points all. I especially second the rejection of "A Place for Mom." They are nothing but a sales organization. Stay far away from them. Because they only recommend places that pay them a referral fee, you could have a situation where the best facility in the entire world was 1 mile from your house and they would not mention it.

To build upon your comment that the social workers provide only general recommendation (still quite helpful, they are likely to be aware of major issues at facilities) it's still the case that the social worker is unlikely to have actually *visited* the various places, at least not a lot.

However, as others have noted, it's hard/impossible to just wander into and around a care facility. Especially in covid times, but even before then. Yes, you'll get a tour with their marketing director. The better places will actually introduce you to a couple of residents as you tour. I visited prospective facilities multiple times.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by BogleTaxPro »

Another good resource is to pay to have a Geriatric Care Manager meet with your dad for a few hours to determine what level of care he actually needs and discuss how what he wants will fit with that. They can then recommend options. We did this with my dad, and the facility they ended up referring us to was perfect for him.
https://www.aarp.org/caregiving/basics/ ... nager.html
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by TN_Boy »

bhwabeck3533 wrote: Tue Jan 18, 2022 7:19 am
TN_Boy wrote: Sun Jan 16, 2022 10:27 am However, regardless of how competent someone apparently is, if they literally cannot go to the bathroom by themselves (as later posts by the OP make clear) then in fact, no, the person doesn't get to call the shots because they cannot implement that plan. And it's other people that will have to keep fixing things. Sometimes the family has to unite and say, "No, that is not going to happen."
[ quote fixed by admin LadyGeek]

My sister lived with my 95 YO Mom (in Mom's home) till two about weeks ago. Mom's physical frailties were exposed. We moved her into a 1 BR Assisted Living apartment. She's having a tough time adjusting. So we are all newbies at what' is happening. So using your feedback as a "crystal ball":
1. Will the Assisted Living facility require access to her finances/assets? To my knowledge they have not requested this information. My Mom has SS and a teacher's retirement pension which will cover more than half her "rent". My sister has POA to pay her bills. Basically, want to make sure there's a firewall between the AL and her assets.
2. Should we look into a new healthcare insurance policy for her? She's had the same coverage for many, many years and has been quite healthy till recently. This seems to be changing, especially dental care. Has her move triggered a "life changing event" such that she can look for a new policy outside of the typical end-of-year "enrollment period"?
One thing I learned about crystal balls is that they work poorly. I had two close relatives who had to be placed in care facilities. One followed a fairly .... linear and unsurprisingly path. A steady decline. Occasional visits to hospitals due to a fall or some other issue. But no ... surprises I guess.

The other .... large declines following a step pattern. Repeated moves; the speed and types of decline caught me (and sometimes the caretakers) off guard and I even had backup higher level facilities already vetted, so I didn't have to redo the facility search every time. Many many dr and hospital visits. It was very tiring for everybody, even though I was doing no hands-on care.

I don't think the care facility needs "access" to assets. They may ask for verification of assets.

Healthcare coverage ... that's one area I had no problems with. Both the relatives I helped in care facilities had medicare and a spectacularly good secondary coverage plan, provided by a state pension organization (which due to years of service even partly paid for the secondary coverage). I'd get all these bills for a lot of problems ... and they never owed anything. Once in a while the provider would forget to bill the secondary provider and I'd have to call them up. But the out of pocket cost for medical bills was literally trivial. The net here is that I personally didn't have to evaluate their medicare options -- what they had when I took over was excellent.

Long term care insurance paid for part of the costs of the facilities.

Neither relative had dental insurance; it's not clear to me that dental coverage for seniors is worth much, but your investigation might yield different results. One of the relatives above was out several thousand dollars for dental work.

[Edited to add]. You want to pay attention to the medicare prescription benefit provider. Different providers may have different costs for drugs mom needs.

I am not familiar enough with the medicare rules to have an opinion on whether you could change plans now if mom was in the same area after moving to assisted living.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by InMyDreams »

bhwabeck3533 wrote: Tue Jan 18, 2022 7:19 am
My sister lived with my 95 YO Mom (in Mom's home) till two about weeks ago. Mom's physical frailties were exposed. We moved her into a 1 BR Assisted Living apartment. She's having a tough time adjusting. So we are all newbies at what' is happening. So using your feedback as a "crystal ball":
1. Will the Assisted Living facility require access to her finances/assets? To my knowledge they have not requested this information. My Mom has SS and a teacher's retirement pension which will cover more than half her "rent". My sister has POA to pay her bills. Basically, want to make sure there's a firewall between the AL and her assets.
2. Should we look into a new healthcare insurance policy for her? She's had the same coverage for many, many years and has been quite healthy till recently. This seems to be changing, especially dental care. Has her move triggered a "life changing event" such that she can look for a new policy outside of the typical end-of-year "enrollment period"?
bhwabeck3533, it might be best to start a new thread?

1) Altho CCRCs usually do a financial review with prospective residents, to the best of my knowledge, ALFs do not. They will, however, quickly work on finding another living arrangement for those unable to keep up with rent. I suspect that with your mother they may have asked for more than just one month's rent to move in?

2) Not sure why she would need new/changed medical coverage. MCare does not cover long term care, so they are not going to pick up the ALF costs. Some MedAdvantage plans have limited dental benefit. You might talk to a SHIP counselor at your local aging office to explore options.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by BarbBrooklyn »

"Will the Assisted Living facility require access to her finances/assets? To my knowledge they have not requested this information. My Mom has SS and a teacher's retirement pension which will cover more than half her "rent". My sister has POA to pay her bills. Basically, want to make sure there's a firewall between the AL and her assets."

None of the facikities that my mom was in (IL, AL or NH) asked for or was granted to mom's financials. I believe that scenario happens when Medicaid is footing the bill for Long Term Care and the resident's share of cost is whatever income they have (SS, pension) less a small personal needs allowance.

This comes as a shock to some; although Medicaid won't "take your home" as many have been led to believe (they simply put a lien on it that needs to be satisfied at death or sale) but the family needs to understand that neither will Gma's income be available to pay taxes, upkeep or insurance.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by TN_Boy »

InMyDreams wrote: Tue Jan 18, 2022 10:25 am
bhwabeck3533 wrote: Tue Jan 18, 2022 7:19 am
My sister lived with my 95 YO Mom (in Mom's home) till two about weeks ago. Mom's physical frailties were exposed. We moved her into a 1 BR Assisted Living apartment. She's having a tough time adjusting. So we are all newbies at what' is happening. So using your feedback as a "crystal ball":
1. Will the Assisted Living facility require access to her finances/assets? To my knowledge they have not requested this information. My Mom has SS and a teacher's retirement pension which will cover more than half her "rent". My sister has POA to pay her bills. Basically, want to make sure there's a firewall between the AL and her assets.
2. Should we look into a new healthcare insurance policy for her? She's had the same coverage for many, many years and has been quite healthy till recently. This seems to be changing, especially dental care. Has her move triggered a "life changing event" such that she can look for a new policy outside of the typical end-of-year "enrollment period"?
bhwabeck3533, it might be best to start a new thread?

1) Altho CCRCs usually do a financial review with prospective residents, to the best of my knowledge, ALFs do not. They will, however, quickly work on finding another living arrangement for those unable to keep up with rent. I suspect that with your mother they may have asked for more than just one month's rent to move in?

2) Not sure why she would need new/changed medical coverage. MCare does not cover long term care, so they are not going to pick up the ALF costs. Some MedAdvantage plans have limited dental benefit. You might talk to a SHIP counselor at your local aging office to explore options.
Most places I've worked with -- whether assisted living, memory care, etc -- require about 1 month's rent as a non-refundable "entry fee" to enter the facility. Thus moving in costs at least 2 months rent.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by quantAndHold »

BarbBrooklyn wrote: Tue Jan 18, 2022 10:31 am "Will the Assisted Living facility require access to her finances/assets? To my knowledge they have not requested this information. My Mom has SS and a teacher's retirement pension which will cover more than half her "rent". My sister has POA to pay her bills. Basically, want to make sure there's a firewall between the AL and her assets."

None of the facikities that my mom was in (IL, AL or NH) asked for or was granted to mom's financials. I believe that scenario happens when Medicaid is footing the bill for Long Term Care and the resident's share of cost is whatever income they have (SS, pension) less a small personal needs allowance.
One nursing home dad went to required me to show them a bank statement showing he had the money to pay for X months, in order to get placed in a private pay bed. Until I showed them that, they placed him in a Medicaid bed, which was pretty awful.

The assisted living place didn't require any of that. As long as I stayed current on the rent, they didn't care what was going on behind the scenes.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by KarenPDX »

Just wanted to comment on bringing your dad to your home and taking care of him. I'm a full time caregiver for my husband who has ALS, and also work full time and we are raising a 12 year old. And I'm super burnt out. Caregiving at your home is a hard and exhausting job, and I wouldn't advise it. We do hire caregivers for when I go into the office, and it costs $35 an hour.
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by ResearchMed »

bhwabeck3533 wrote: Tue Jan 18, 2022 7:19 am <snip>
1. Will the Assisted Living facility require access to her finances/assets? To my knowledge they have not requested this information. My Mom has SS and a teacher's retirement pension which will cover more than half her "rent". My sister has POA to pay her bills. Basically, want to make sure there's a firewall between the AL and her assets.
2. Should we look into a new healthcare insurance policy for her? She's had the same coverage for many, many years and has been quite healthy till recently. This seems to be changing, especially dental care. Has her move triggered a "life changing event" such that she can look for a new policy outside of the typical end-of-year "enrollment period"?
We had a different experience with the financials.
All of the facilities we were considering for MIL required financial vetting.
That was so they could estimate approximately how long the money might last.

If it's a facility that will "keep the person if they run out of money, and switch them to Medicaid" (and accept only that limited amount should that happen), obviously, they'd like to estimate the likelihood of this happening, and the length of time they might need to subsidize the costs.
So this all began as the ALF (Assisted Living Facility) stage, given the continuity. It's not a full fledged CCRC, but it's almost like that, once they have verified that one can pay for some length of time, etc.

For facilities that do not make that assurance, they'd want to minimize the chance that they'd be forced to "kick an elderly and frail person out". They'd also then need to be working with a Medicaid facility that would accept the patient.
The facilities that could/would not "keep" the person all stated that they had "relationships" with such facilities. We didn't visit those, as that wasn't an arrangement we found acceptable. At least locally, facilities that will accept Medicaid patients from Day 1 are not... among the most... pleasant...

As for those that will "keep" someone one they are "in", some of those were very nice. One of the top (and most expensive) facilities in the state was near us, and was jokingly and somewhat warmly referred to as "a cruise ship on land". :happy
But if one passes their financial and health vetting, they do agree not to kick you out.
They have no official double rooms in skilled nursing, so the worst is that you'd be moved to a shared bathroom. (But if someone is pretty much bedridden, then it would be more like the other person "sharing" the bathroom would have an almost private bathroom.)
They do have a few rooms that are large enough for two beds in case spouses both need that level of care and want to be together.

But in terms of "access to her finances/assets"... any "access" would only be to the information so they could determine if there was "enough"; they wouldn't have control over the money before it is due to be paid. And they wouldn't have unfettered access to the information, either.
The patient or a caregiver/someone with Power of Attorney would pay those pills as they come due.

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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by TimeRunner »

For reference, for my Mom in a nice part of Los Angeles, a 12-hour daytime caregiver shift is $355. A second 12-hour (nighttime) caregiver shift is discounted to $290. So a normal 24 hours of caregiving is $645. A Holiday daytime shift is $532.50, a second holiday shift (nighttime) is $435. 24/7/365 adds up. While we could hire our own caregivers, going through an agency ensures that all timekeeping, wage and labor, insurance, liability, scheduling, vacation/illness days, training, requirements for vaccines/boosters, substitute caregivers, etc., are handled by case managers, etc.

It's horribly expensive, and doesn't cover groceries, utilities, HOA fee, property taxes, insurance, ongoing condo maintenance, Rx's, etc. Cost for everything is close to $20K/month. The clock will likely run out before the money does, but if it comes to it we can sell the condo and move Mom to a good facility near me. In the meantime, she's living her best life in the way that she made clear before dementia set in. She's very lucky she had money from my Dad who passed decades ago, and Mr Market has performed well during the time of her need.

Medicare covers visiting nurse who sets up pillboxes for caregiver dispensing of meds as well as a weekly patient check. I order groceries and supplies, coordinate condo maintenance, pay the bills, manage investments, etc. I have that dialed in so it's not a huge amount of work, but emergencies do crop up and it falls on me to solve them. That's probably not an issue in a facility where those things are handled. TLDR is that housing at home with agency caregivers can work well, but be prepared for the cost and for managing all the other aspects around someone else depending on you for everything from groceries and incontinence pads to tax returns.
One cannot enlighten the unconscious. | "All I need are some tasty waves, a cool buzz, and I'm fine." -Jeff Spicoli
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fsrph
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by fsrph »

KarenPDX wrote: Tue Jan 18, 2022 4:16 pm Just wanted to comment on bringing your dad to your home and taking care of him. I'm a full time caregiver for my husband who has ALS, and also work full time and we are raising a 12 year old. And I'm super burnt out. Caregiving at your home is a hard and exhausting job, and I wouldn't advise it. We do hire caregivers for when I go into the office, and it costs $35 an hour.
Thank you for your comment. Best wishes for your husband.

Francis
"Success is getting what you want. Happiness is wanting what you get." | Dale Carnegie
Cruise
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by Cruise »

fsrph wrote: Fri Jan 14, 2022 1:34 pm A family member completed short term rehab for mobility issues in a nursing home. Have to decide where he should go next. Nursing home social services spoke to us and stated full care in nursing home is not needed. Mentioned possibility of assisted living or living with a family member. Patients mobility has improved but still needs assistance at times.

Another family member hinted that I should take over all care for my father in my home. I think they said this because I'm financially secure, in my low 60's, and could retire anytime. Other family member can't retire yet. I love my father. But, I see all that was done for him in the nursing home and it scares me very much to take on all these responsibilities by myself .... all day, everyday. The other close family member said they would help "whenever I can, for as long as I can". Not exactly a ringing endorsement that help is on the way. If you ask my father what he wants to do, his answer is to go home. Facility said that's not possible right now. Maybe in the future.

The situation is further complicated by my father doesn't want us to have POA for him. The reason isn't that he doesn't trust us, it's more that it cost too much and he doesn't need it. He won't budge. To his credit he can still take care of his financial affairs. He wants to preserve his savings as an inheritance, not spend it now.

What I'm looking for is suggestions or compromises how to handle this. Maybe full time assisted living? I have thought of proposing the following. I'll take care of my father, in my house, for 3 months. Then other family member takes him for 3 months in their house. If they can't do that, they need to set up assisted living for those 3 months. Just keep repeating this cycle. Any thoughts are appreciated.

This is actionable as if we can keep my father out of a facility his savings will not be depleted. He is private pay.

Francis
OP: Sorry that you are in this situation.

I was the POA/Trustee for my father. In our situation, my father was living alone and periodically falling. After the last fall, my siblings and I decided enough was enough, so I flew in to the city where he was living, picked him up from the rehab facility where he was, flew him to another state where my oldest sib resided, and admitted him into a rehab facility there. At the same time, we made arrangements for him to gain admission to a nearby assisted care facility for post-rehab living.

For us, the actionable issue was not how to save our inheritance from being depleted (not saying you are), but to assure that he was well-cared for. There was no way that either of his three loving children could care for him at home. The reality is that for children in their 60s, that is not a burden easily assumed. It is risky to the health of the caregiver.

My oldest sib visited my father several times a week and was instrumental in making sure that the assisted living facility gave him good care. Even that took a tremendous amount of effort and energy by that sib. The other sib and I helped out on other tasks that could be tackled remotely from other states. It does take a village...

Good luck with your father and your own health.
TN_Boy
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by TN_Boy »

TimeRunner wrote: Tue Jan 18, 2022 6:38 pm
....much useful stuff deleted for brevity

but emergencies do crop up and it falls on me to solve them. That's probably not an issue in a facility where those things are handled.
Once someone is in a good facility *many* minor things are handled. And having staff around that sees the resident every day -- and gets to know them, their habits, etc is very valuable.

But it doesn't reduce the administrative burden on the family as much as you'd think.

Resident falls with no one around? Response is likely to be call EMTs, let EMTs evaluate*, and if there is any doubt, trip to hospital to make sure no serious head injury*. You'll get a call. At skilled nursing level, they will handle more (nurse on site 24x7, and doctors on site during the day). But below that level of care, the facility does not have the ability -- and doesn't want the legal liability -- to ignore what seems like a minor issue.

In their (slight) defense, frail people in their 80s and 90s are quite vulnerable to all sorts of problems. Resident gets a skin tear, you'll get a call. Continence issues? You'll get a call to discuss options. Resident is complaining about something the aides did. You'll get a call. Resident misplaces an item (thinks it was stolen). You'll get a call ....... Resident is getting a doctor visit today? You probably want to be there to hear what doctor says.

And so forth. I'm sure it is less work than coordinating home health aides at a house, but if you are doing a good job helping a relative, it's still a lot of work. Relative typically has to make sure the facility staff, drs, resident are all on the same page. Once you get to know the staff at a care facility on a first name basis (and of course you will, since you'll be there a lot) it is easier to work with them and make sure things are running smoothly.

*if they are doing badly -- for example there is a DNR, are on hospice, etc, the EMT/hospital dance might not happen.
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AllMostThere
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by AllMostThere »

TimeRunner wrote: Tue Jan 18, 2022 6:38 pm For reference, for my Mom in a nice part of Los Angeles, a 12-hour daytime caregiver shift is $355. A second 12-hour (nighttime) caregiver shift is discounted to $290. So a normal 24 hours of caregiving is $645. A Holiday daytime shift is $532.50, a second holiday shift (nighttime) is $435. 24/7/365 adds up. While we could hire our own caregivers, going through an agency ensures that all timekeeping, wage and labor, insurance, liability, scheduling, vacation/illness days, training, requirements for vaccines/boosters, substitute caregivers, etc., are handled by case managers, etc.

It's horribly expensive, and doesn't cover groceries, utilities, HOA fee, property taxes, insurance, ongoing condo maintenance, Rx's, etc. Cost for everything is close to $20K/month. The clock will likely run out before the money does, but if it comes to it we can sell the condo and move Mom to a good facility near me. In the meantime, she's living her best life in the way that she made clear before dementia set in. She's very lucky she had money from my Dad who passed decades ago, and Mr Market has performed well during the time of her need.

Medicare covers visiting nurse who sets up pillboxes for caregiver dispensing of meds as well as a weekly patient check. I order groceries and supplies, coordinate condo maintenance, pay the bills, manage investments, etc. I have that dialed in so it's not a huge amount of work, but emergencies do crop up and it falls on me to solve them. That's probably not an issue in a facility where those things are handled. TLDR is that housing at home with agency caregivers can work well, but be prepared for the cost and for managing all the other aspects around someone else depending on you for everything from groceries and incontinence pads to tax returns.
TimeRunner, you gave a very vivid example of how this in-home caregiver process works. As you implied, while the agency does all the scheduling, etc. the family will still be responsible for all the other aspects of caregiving such as bills, grocery and other tasks. As you would agree, while the burden is reduced (at a large cost) the family is never fully relieved due to all the other items. Good in-home care is really hard to find. One thing I experienced that the OP needs to realize is that in the age of COVID on any given day a caregiver may not come in for a variety of reasons (sick, required isolation, etc.). In my case with a parent, this happened nearly every week and backups were not always available from the agency. Additionally, turnover was high causing additional anxiety with my parent. Maybe in the LA area there are more resources to provide the backup, but I would guess you experienced similar.
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TimeRunner
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Re: Options after leaving nursing home - assisted living vs home/family vs other ?

Post by TimeRunner »

AllMostThere wrote: Thu Jan 20, 2022 3:14 pm ...but I would guess you experienced similar.
Yes, certainly. At least with an agency, they may have some part-time/standby resources that can jump in, or a regular caregiver that's willing to pull an extra shift to cover (at an OT rate). It would take more pre-planning coordination for 'hire-your-own' caregiving. Bottom line is like you said, for someone to be able to stay in their home, one or more family members will have an important duty with time-critical tasks like ensuring that groceries and supplies are on-hand when needed, because the homebound person is totally dependent on the family being on top of it every day. For a typical Boglehead that is an organized planner and computer literate, a lot of these tasks can be optimized and streamlined to a point where it's not too burdensome. In a family without that, home living could be a disastrous option for everyone.
One cannot enlighten the unconscious. | "All I need are some tasty waves, a cool buzz, and I'm fine." -Jeff Spicoli
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