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I think you're asking the wrong question. It's not whether we for the most part have spent time in a LTC facility. We are mostly < 75. It's whether our parents or inlaws have. In my case - my late FIL spent the average 2.5 years in a LTC facility before he died. He was in his early 80's. My late MIL was in and out of them after various hospitalizations in her late 70's (she died with home hospice at age 79). My late mother needed LTC - but got it at home (not at all cheap). In her early 80's.
My father is still alive - and not yet in a LTC facility (although he does live in a "senior" facility). He is 95. The average age in his facility now is about 84 (just about no one < 75 - many people in their 80's). Just about everyone he knows has spent at least some time in a LTC facility (he's been living in his current place for about 8 years now). It is often the last place people live before they die.
So - based on what I've observed - the critical age isn't 90. For most people - it's closer to 80.
Also - statistics can lie to a certain extent. Because many people have too much money to qualify for Medicaid and not enough to pay for LTC. So their families struggle to take care of them at home when LTC would be a better solution. Robyn
Robynn I am confused (as usual). What is the difference, in service and cost, between:
in the long run ltc premiums may be the cheapest route. divorces are quite expensive. many families blow apart over taking care of a parent.
usually one child resents the fact they do more or gives more than siblings . but worse than disgruntled siblings in when the spouse of one of the children becomes annoyed at the time and money given by their spouse into taking care of the parent but the other siblings give little.
that can lead to quite a lot of resentment and can destroy families.
i think it happens so often that if the parents can't afford the premiums all the kids should chip in and pay it. it will only cause them loads of grief and or money down the road if they don't.
my dad was in a ltc facility for 5 years after a stroke at 65.
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Interesting post. Could you elaborate a bit more based on family/friend experiences?
My husband and I have been blessed that when our parents needed this kind of stuff - they had the money to deal with it. Although - to be honest - our fathers - who both outlived our mothers - were cheap in terms of dealing with our mothers in a variety of ways. The money was there - but we didn't have control over how it was spent (e.g., no handicap bathroom for late MIL when she needed one).
My husband and I have been/are in control of our parents' money since our moms died. But not before then. We don't need their money - and have always put their interests first.
Still - I can understand the potential for resentment in a variety of circumstances. Like Mom/Dad has to move in with us because he doesn't have the money for a SNF. Or like my Dad thinks when he needs a SNF - I really think he thinks he should move into our house and I should take care of him - like one of his sisters did with his father, No way that's on my dance card, Robyn
we had it happen in my own family and my ex wife really resented the fact i gave more than my sister. it was a major source of fights after a while.
another issue is of course it can be quite grueling 24/7 on anyone. most folks who think they are going to take care of someone incapacitaded never tried to lift a 200 lb man with flacid muscles. try that one at 2:00am every night .
My grandmother (92) is living in our home essentially because her sons (my father and uncle) are not willing to pay for the appropriate placement, which would be an assisted living facility running about $5500+/month. We love having her here in many ways, but for a family with 4 children and an active lifestyle, it has been a major shift in our lives.
I have to say that even with the best and most loving of intentions, and given the fact that at 92 my grandma still does most of her own care (I prepare meals & put them on the table for her--she is unable to do this with the walker, I do her laundry and give her a bath twice a week while she takes her own meds, washes up daily, handles her own bathroom routine, etc.) I can still see where resentment can build for myself and moreso for my husband.
She can't be alone anymore (should not have been alone in her house for the 5 years before coming to live with me, but my father and uncle were not making a move until she fell and ended up in a physical therapy/rehab facility at which point no one but us seemed to have a plan), but doesn't need constant care. "Retirement home" "nursing home" "assisted living" all mean the same to her and she's terrified by her own vague conception of what any of those would mean. I know she hoped to die in her own home, but it's just not realistic. The truth of a LTC facility is that she would really love socializing with others her age and having a set schedule every day with activities available and meals provided. On the other hand, she seems to love having my children around her every day and we are enjoying this time with her.
It has definitely caused major tension between my father and me, as he still thinks he should make all the decisions and is doing so, and still has power of attorney while I do not, though I am responsible for her daily care in my home (hear the hint of bitterness there? lol. Oh yes, it causes stress and resentment within the family!)
She has nothing but a half of a house held in common with my late great-aunt, which will be in limbo for years, likely. So, too much to qualify for Medicaid with the house as an asset is what I'm told, but almost nothing besides that--a few hundred a month in SS.
She will likely live to be 100 given her genetics and family history and current health. 7 more years in my home? Maybe. If I can't care for her any longer, what happens then? Who pays for it? The cost starts at $5500/mo and rises quickly as additional services are needed.
To me this is exactly the situation I'd like to avoid should I live to be her age. I'd like to have options, and choose my care myself if I'm able or at LEAST not leave my family feeling put upon (as my father and uncle do) when trying to figure out how to provide my care. Maybe I'll want to live with a granddaughter, and maybe one will want me there (as I do my grandma) but if not--I don't want to be left in whatever home medicaid will pay for. I don't want my kids feeling resentful toward one another.
I believe long-term care insurance is worth every penny. If I could talk DH into getting some now, I would But we'll definitely be purchasing a policy the minute we hit 50.
Robynn I am confused (as usual). What is the difference, in service and cost, between:
- Skilled Nursing Facility (SNF)
- Longterm Care Facility
- Nursing Home
- Assisted Living
??
A nursing home and a SNF are basically the same thing. SNF is just a more technical way to describe a place. They're facilities where people - as a result of physical or cognitive problems - or both - need some form of pretty much 24/7 medical care. Often delivered by "skilled nurses" - including RNs and LPNs.
A lot of SNFs offer 3 different kinds of care - often in separate parts of a facility. First - traditional or "long term" care for people with all or most of their marbles who just have medical issues. Second - dementia care for people who have severe dementia and often - but not always - medical issues. The latter facilities are often "lock down" facilities for safety reasons (the former aren't).
Then there's rehab care for people who've just been released from a hospital (say for a hip replacement) or have had something like a stroke. People who need rehab to get back to normal (like after a hip replacement) or who have at least some possibility of being "rehabilitated" (like re-learning how to do things after a stroke). Note that rehab care is the only thing that Medicare covers in this area.
SNF accommodations tend to resemble hospital accommodations because of the need for medical care.
Assisted living facilities (ALFs) are for people who can't take care of themselves in terms of ADLs - the activities of daily living (Activities of daily living - Wikipedia, the free encyclopedia). But who don't need much - if anything - in the way of everyday medical care. A prime example would be a person with less than severe dementia who needs help with dressing - eating - bathing - going to the bathroom - taking meds - etc. A lot of assisted living places are now called - euphemistically - "memory care facilities". Most of the care is administered by CNAs - although there is usually at least one RN available for people who need RN care occasionally.
There really isn't any absolute line in the sand between SNFs and ALFs in terms of the care they offer - except at the extremes. It's more a continuum of care. So people with moderate dementia will often start in ALFs - and then wind up in SNFs when their situation deteriorates. When it comes to dementia and a transition from an ALF to a SNF - complete bowel and bladder incontinence is often the condition that will trigger an ALF "eviction" to SNF care. If someone is trying to determine whether a SNF or an ALF is the best choice for them - it's best to be brutally frank with the ALF in terms of what things it will handle (different ALFs draw the line in different places).
ALF accommodations tend to look more "residential" than those in SNFs. Many are small studio like apartments. Because they're not administering medical care.
A long term care facility? Well - to me - that's more a word for insurance policies. As in "long term care insurance". Different policies cover care in different places under various circumstances.
There's another category of "care facility". Independent senior living facilities. These are for people who need/want some help with things - but not a whole lot. A typical independent senior living facility will have a communal dining room where people can eat (but usually aren't required to). Transportation facilities to take people shopping - to doctors' appointments - etc. Cleaning/maintenance services. Organized recreational activities (both on and off premises). FWIW - both my father and one of my aunts live in places like this. My aunt in a 1 bedroom apartment in a mid-rise building in the metro New York area - my father in a 2 bedroom single story townhouse here.
Finally - there are facilities in other states that we don't have in Florida. Like my late uncle was in some kind of Alzheimer's facility in California (that California apparently allows). All the residents had moderate to severe Alzheimer's and there was little evidence of any knowledgeable (much less skilled or compassionate) care. It was the most dismal place I've ever seen (residents just wandered around - were allowed to sleep in their day clothes - were bathed infrequently - etc.). And it wasn't cheap at all. OTOH - good SNFs in California can cost almost double what they cost here. So I guess many people there have to settle for these "warehouses" in lieu of nicer places.
BTW - these are pretty much my personal definitions based on personal observations. Different states have different statutes outlining the legal requirements for many of these places - and this isn't meant to be a legal guide - just a somewhat practical one. Robyn
we had it happen in my own family and my ex wife really resented the fact i gave more than my sister. it was a major source of fights after a while.
another issue is of course it can be quite grueling 24/7 on anyone. most folks who think they are going to take care of someone incapacitaded never tried to lift a 200 lb man with flacid muscles. try that one at 2:00am every night .
My late FIL was only 150 pounds - and even that was a lot for my husband and I to handle just getting him into and out of the car and into and out of a wheelchair. He died almost 10 years ago - and I don't think my husband and I could handle him physically today. Robyn
My grandmother (92) is living in our home essentially because her sons (my father and uncle) are not willing to pay for the appropriate placement, which would be an assisted living facility running about $5500+/month. We love having her here in many ways, but for a family with 4 children and an active lifestyle, it has been a major shift in our lives.
I have to say that even with the best and most loving of intentions, and given the fact that at 92 my grandma still does most of her own care (I prepare meals & put them on the table for her--she is unable to do this with the walker, I do her laundry and give her a bath twice a week while she takes her own meds, washes up daily, handles her own bathroom routine, etc.) I can still see where resentment can build for myself and moreso for my husband.
She can't be alone anymore (should not have been alone in her house for the 5 years before coming to live with me, but my father and uncle were not making a move until she fell and ended up in a physical therapy/rehab facility at which point no one but us seemed to have a plan), but doesn't need constant care. "Retirement home" "nursing home" "assisted living" all mean the same to her and she's terrified by her own vague conception of what any of those would mean. I know she hoped to die in her own home, but it's just not realistic. The truth of a LTC facility is that she would really love socializing with others her age and having a set schedule every day with activities available and meals provided. On the other hand, she seems to love having my children around her every day and we are enjoying this time with her.
It has definitely caused major tension between my father and me, as he still thinks he should make all the decisions and is doing so, and still has power of attorney while I do not, though I am responsible for her daily care in my home (hear the hint of bitterness there? lol. Oh yes, it causes stress and resentment within the family!)
She has nothing but a half of a house held in common with my late great-aunt, which will be in limbo for years, likely. So, too much to qualify for Medicaid with the house as an asset is what I'm told, but almost nothing besides that--a few hundred a month in SS.
She will likely live to be 100 given her genetics and family history and current health. 7 more years in my home? Maybe. If I can't care for her any longer, what happens then? Who pays for it? The cost starts at $5500/mo and rises quickly as additional services are needed.
To me this is exactly the situation I'd like to avoid should I live to be her age. I'd like to have options, and choose my care myself if I'm able or at LEAST not leave my family feeling put upon (as my father and uncle do) when trying to figure out how to provide my care. Maybe I'll want to live with a granddaughter, and maybe one will want me there (as I do my grandma) but if not--I don't want to be left in whatever home medicaid will pay for. I don't want my kids feeling resentful toward one another.
I believe long-term care insurance is worth every penny. If I could talk DH into getting some now, I would But we'll definitely be purchasing a policy the minute we hit 50.
I think you've put your finger on a lot of the "hot button" issues that definitely arise. My late grandmother moved in with us when she had what would now be called mild/moderate Alzheimer's. She was paranoid and argumentative - and couldn't be left alone. I recall one incident where I - at perhaps age 12 - had to stay home and "babysit" for her when the rest of the family went out. I went across the street to visit a friend for a little while. And - when I came back - my grandmother was in a full blown crisis. She yelled at me - and when my parents came home - they yelled at me too. This situation went on for a while. Eventually - my father - after a fight with my grandmother - threw her out of the house. She wound up in her own apartment for perhaps a year - and my mother had to visit about 3 times a week to take care of her (my grandmother insisted on moving back to New York - and the drive was about 1 1/2 hours each way). My grandmother was eventually evicted from her apartment (she accused the landlord of putting poison gas in the radiators). And then she wound up in a "nursing home" (where she died several years later).
My uncle (her son) couldn't deal with the situation at all. And moved to California to avoid any responsibility for dealing with the situation physically (he did however send some money to help care for my grandmother - don't know how much).
On my father's side - his father lived to 96 and his mother to 103. One of my father's siblings needed money (the others didn't). So the deal was she was the caregiver for both of her parents. And she was supposed to get all of their money (which wasn't a whole lot to start with) when they died. But they lived so long that there wasn't any money left at the end. Neither of my grandparents was a very nice person - and my aunt had to endure considerable verbal abuse from them over the years. Plus - even though my grandmother eventually got an aide (that New York Medicaid paid for) - my aunt's work was physically exhausting. She was the youngest sibling in her family - and predeceased all the other siblings at a relatively young age for her family (in her 70's - one sister died at 90+ - and the other 3 siblings are all still alive and 90+ now). And I think her caregiver work was in part responsible for her early demise.
I think your message is perceptive in recognizing that a good facility can be the best option not only for the immediate family - but for the person in the facility too. In terms of having a set schedule - organized activities - people to socialize with - etc. I can't say that my late FIL was happy in his SNF (most people in his physical shape wouldn't be happy either - anywhere) - but he was as content as possible. He had one close buddy there - John - and a couple of other guy friends too. They had coffee every morning - and "chewed the fat". John died a couple of months after my FIL - I think in part from loneliness.
And your message is also perceptive in pointing out that money - regardless of the source - gives one options. Options that can result in choices that reduce family tensions. I think my husband and I and my late FIL had a lot more "quality time" together because of where my FIL lived. Had my husband and I been 24/7 caregivers for 2+ years - I think we all would have been frazzled - not to mention that my FIL would have received a much lower quality of care.
Anyway - I wish you good luck in terms of dealing with your situation. It is a very far from easy one IMO. Robyn
A nursing home and a SNF are basically the same thing. SNF is just a more technical way to describe a place. They're facilities where people - as a result of physical or cognitive problems - or both - need some form of pretty much 24/7 medical care. Often delivered by "skilled nurses" - including RNs and LPNs.
A lot of SNFs offer 3 different kinds of care - often in separate parts of a facility. First - traditional or "long term" care for people with all or most of their marbles who just have medical issues. Second - dementia care for people who have severe dementia and often - but not always - medical issues. The latter facilities are often "lock down" facilities for safety reasons (the former aren't).
Then there's rehab care for people who've just been released from a hospital (say for a hip replacement) or have had something like a stroke. People who need rehab to get back to normal (like after a hip replacement) or who have at least some possibility of being "rehabilitated" (like re-learning how to do things after a stroke). Note that rehab care is the only thing that Medicare covers in this area.
SNF accommodations tend to resemble hospital accommodations because of the need for medical care.
Assisted living facilities (ALFs) are for people who can't take care of themselves in terms of ADLs - the activities of daily living (Activities of daily living - Wikipedia, the free encyclopedia). But who don't need much - if anything - in the way of everyday medical care. A prime example would be a person with less than severe dementia who needs help with dressing - eating - bathing - going to the bathroom - taking meds - etc. A lot of assisted living places are now called - euphemistically - "memory care facilities". Most of the care is administered by CNAs - although there is usually at least one RN available for people who need RN care occasionally.
There really isn't any absolute line in the sand between SNFs and ALFs in terms of the care they offer - except at the extremes. It's more a continuum of care. So people with moderate dementia will often start in ALFs - and then wind up in SNFs when their situation deteriorates. When it comes to dementia and a transition from an ALF to a SNF - complete bowel and bladder incontinence is often the condition that will trigger an ALF "eviction" to SNF care. If someone is trying to determine whether a SNF or an ALF is the best choice for them - it's best to be brutally frank with the ALF in terms of what things it will handle (different ALFs draw the line in different places).
ALF accommodations tend to look more "residential" than those in SNFs. Many are small studio like apartments. Because they're not administering medical care.
A long term care facility? Well - to me - that's more a word for insurance policies. As in "long term care insurance". Different policies cover care in different places under various circumstances.
There's another category of "care facility". Independent senior living facilities. These are for people who need/want some help with things - but not a whole lot. A typical independent senior living facility will have a communal dining room where people can eat (but usually aren't required to). Transportation facilities to take people shopping - to doctors' appointments - etc. Cleaning/maintenance services. Organized recreational activities (both on and off premises). FWIW - both my father and one of my aunts live in places like this. My aunt in a 1 bedroom apartment in a mid-rise building in the metro New York area - my father in a 2 bedroom single story townhouse here.
Finally - there are facilities in other states that we don't have in Florida. Like my late uncle was in some kind of Alzheimer's facility in California (that California apparently allows). All the residents had moderate to severe Alzheimer's and there was little evidence of any knowledgeable (much less skilled or compassionate) care. It was the most dismal place I've ever seen (residents just wandered around - were allowed to sleep in their day clothes - were bathed infrequently - etc.). And it wasn't cheap at all. OTOH - good SNFs in California can cost almost double what they cost here. So I guess many people there have to settle for these "warehouses" in lieu of nicer places.
BTW - these are pretty much my personal definitions based on personal observations. Different states have different statutes outlining the legal requirements for many of these places - and this isn't meant to be a legal guide - just a somewhat practical one. Robyn
i worked for a number of years in a skilled nursing facility (maryland ) as a social work director, and these descriptions of the different categories are very accurate, in my experience. i would add that there is , in many assisted living facilities, a real blurring of the lines, as i have seen such facilities, in an effort to keep up census, really take on patients that they do not have the skilled personnel or staffing to care for. skilled nursing facilities are much more heavily monitored by the state, and at least, years ago, assisted livings had little oversight , in comparison. changes in the elderly can happen rapidly, and what was an appropriate placement three months ago, may not be three months later. it often doesn't take long for a person starting out in a level one or two assisted living to need level three.
my mother, thirty years ago when there were no assisted living units, was in a nursing home, and remained there for seven years. her placement there was due to increasing dementia and an inability/unwillingness to care for herself, in terms of dressing, bathing, toileting etc. in her case, she just gave up after my father's death, and, along with the care my husband and i provided, had used in-home care for as long as it seemed to be working. my mother could afford ltc for most of the time she was in the facility, but it certainly used up all of her resources. if there had been assisted living at that time, she could have probably had a year or so in that kind of environment, but , i feel would have still ended up in a nursing facility.
i've had long term care insurance for some years, and, in my situation ( no close relatives ) feel it is insulation i need, whether i ever have to use it. i expect to go into some kind of retirement community- perhaps an independent living facility with back-up dining options, transportation, assisted living component on campus- or a ccrc. i am in the process now of looking at such options and narrowing down those that seem appealing and feasible. i agree with other posters who have said that caring for a family member long term is often more of a commitment and responsibility than a caregiver can envision at the outset.also i agree that 80 seems to be the magic age when independence becomes more questionable and making changes becomes more difficult.
catsy girl - Glad to hear that my "amateur" observations are on target.
WRT ALFs - I have seen the opposite of the situation you describe. Where people with limited means (either in terms of money or insurance) - or people who are just cheap - try to keep someone in an ALF long beyond the time they should be there - to save money. Because ALFs generally cost less - a lot less - than SNFs. And it isn't easy for an ALF to "evict" someone who needs more intensive care.
I witnessed an unfortunate case like this a while back. Where a wife was just plain cheap. And - when her husband in an ALF - even though he needed much more care than it could give him - was circling the drain - his wife transferred him reluctantly to a SNF - where he died 2 weeks later. Don't think the SNF - which is excellent - could have done anything under the circumstances. But - to this day - the widow goes around town bad mouthing the SNF. And I get PO'd.
OTOH - people often try to do the best they can with limited means. My late uncle and aunt in California were in this situation. My aunt cared for my uncle at home as long as one could reasonably expect a woman pushing 90 to do so. And - when it was clear he needed to live in a facility - she got the best she could afford - which wasn't much. I always wondered why their kids/grand kids didn't pitch in to help them out (I have some speculations - but I like to refrain from speculating in writing).
Just in terms of your future - I am skeptical of CCRCs. Because the finances in many are shaky. And - if there are financial problems - you're pretty much an unsecured creditor. Also - a CCRC may be good in certain areas (like independent living) - not good in others - like SNF care. We have a couple of big CCRCs here. Some seem to be doing great. And one has an excellent reputation in all 3 areas of care (independent/ALF/SNF). Others have gone into bankruptcy at least once/have had other financial issues. You have to do a lot of financial homework.
Of course - if you rent in a senior independent living facility - there's pretty much no big deal downside financially. OTOH - you may have to find other accommodations if and when an independent living facility is no longer suitable. Over the last 8 years - my father has stayed in his place by hiring people for more hours. To do more things. Like his laundry - his dishes - make lunch for him - pick up his clothes - those kinds of things. On the third hand - he is in really good shape for someone his age. On the fourth hand - we're kind of transitioning to a new phase now (he's almost 96) - and I'm not sure exactly where the road will lead. Robyn
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But we'll definitely be purchasing a policy the minute we hit 50.
