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Reminder...Many seniors do not have the financial resources for ALF. Also ALF means you must be somewhat independent to begin with. Otherwise the person must go into a PERSONAL CARE facility to the tune of about $6000 a month. Meaning you will need to turn over all assets to the nursing facility.
ALF is not a solution for MOST lower income seniors.
Reminder...Many seniors do not have the financial resources for ALF. Also ALF means you must be somewhat independent to begin with. Otherwise the person must go into a PERSONAL CARE facility to the tune of about $6000 a month. Meaning you will need to turn over all assets to the nursing facility.
ALF is not a solution for MOST lower income seniors.
Wonder if they look at total assets OR is it just income? or both?
Not to be a wet dishrag, but I am shocked at the decline of my mother in the last five years, between ages 79 and 84. At 79, my mother was active, both mentally, physically and socially. She took care of herself and her home (with a bi-monthly cleaning crew for the heavy stuff), drove to shopping, lunches, theater, church. At 81, she had a crazy little accident where leg popped out of its artificial hip (10+ years old). That one trigger started a cascade of unexpected health issues to the point where now, she is in a wheelchair and has declining memory issues, recurring UTIs, and other issues such as time and date distortion, etc. I cannot emphasize this enough -- the difference between my mother now and 5 years ago is day and night.
I hope that this will not be the case with your mother, but at 79, I certainly didn't envision us dealing with the issues that we are dealing with right now. We went through the occasional home care, to more regular home care, and frankly, by the time we got to the point where she needed 24-hr. round the clock care, the ALF was cheaper than home care. My brother even took the extreme measure of moving himself and his family to my mom's house for an entire summer (left their house to their college-age kids for the summer) to try to give her a chance to recover and be able to evaluate her ability to live on her own. Then they moved back to their home and Mom had caregivers -- but regardless, caregivers have their own lives, too, and something was always coming up to 'work around'. When I finally put my foot down and insisted that we investigate ALF, I told my brother that it was as much for his own sanity as it was for mom's safety. He was getting phone calls at 2 am from Mom to remind him that she had a hair appointment, and he was there every day for 2-3 hours, while also having a full-time job, an active family and a strong volunteer commitment to an organization he's worked with for 15 years. (I live 500 miles away -- she adamantly refused to move near me, and away from her friends.) At one point, she was flying down to stay with me every 6 to 8 weeks to give my brother a break, or I was flying up there. The last time she visited, I called my brother and said, "This isn't working,", because I work 50-60 hrs. a week as a real estate agent, my husband has a demanding job, our house layout was not conducive to her safety, and we had no caregiver backup, so he and I would split our days depending on our meetings, etc. to make sure she was never alone more than an hour at a time -- and even then, it was like babysitting a toddler who would pretty much do whatever popped into their heads, plus due to her sleeping patterns, I was exhausted, too. :-)
I guess the moral of the story is: Don't think that some nice person working 5-15 hours a week running her to her hairdresser and the supermarket is going to cut it if your mother starts experiencing health challenges.
I've noticed, especially watching my grandmother decline and about ten of her siblings all decline in similar fashions and end up in ALF then SNF, is that there is often a profound social expectation that the younger generations keep the elder in their home longer than is really feasible. Of course, it may all be financially driven as well.
Not to be a wet dishrag, but I am shocked at the decline of my mother in the last five years, between ages 79 and 84. At 79, my mother was active, both mentally, physically and socially. She took care of herself and her home (with a bi-monthly cleaning crew for the heavy stuff), drove to shopping, lunches, theater, church. At 81, she had a crazy little accident where leg popped out of its artificial hip (10+ years old). That one trigger started a cascade of unexpected health issues to the point where now, she is in a wheelchair and has declining memory issues, recurring UTIs, and other issues such as time and date distortion, etc. I cannot emphasize this enough -- the difference between my mother now and 5 years ago is day and night.
I hope that this will not be the case with your mother, but at 79, I certainly didn't envision us dealing with the issues that we are dealing with right now. We went through the occasional home care, to more regular home care, and frankly, by the time we got to the point where she needed 24-hr. round the clock care, the ALF was cheaper than home care. My brother even took the extreme measure of moving himself and his family to my mom's house for an entire summer (left their house to their college-age kids for the summer) to try to give her a chance to recover and be able to evaluate her ability to live on her own. Then they moved back to their home and Mom had caregivers -- but regardless, caregivers have their own lives, too, and something was always coming up to 'work around'. When I finally put my foot down and insisted that we investigate ALF, I told my brother that it was as much for his own sanity as it was for mom's safety. He was getting phone calls at 2 am from Mom to remind him that she had a hair appointment, and he was there every day for 2-3 hours, while also having a full-time job, an active family and a strong volunteer commitment to an organization he's worked with for 15 years. (I live 500 miles away -- she adamantly refused to move near me, and away from her friends.) At one point, she was flying down to stay with me every 6 to 8 weeks to give my brother a break, or I was flying up there. The last time she visited, I called my brother and said, "This isn't working,", because I work 50-60 hrs. a week as a real estate agent, my husband has a demanding job, our house layout was not conducive to her safety, and we had no caregiver backup, so he and I would split our days depending on our meetings, etc. to make sure she was never alone more than an hour at a time -- and even then, it was like babysitting a toddler who would pretty much do whatever popped into their heads, plus due to her sleeping patterns, I was exhausted, too. :-)
I guess the moral of the story is: Don't think that some nice person working 5-15 hours a week running her to her hairdresser and the supermarket is going to cut it if your mother starts experiencing health challenges.
This is an amazing and sad story and should be sticky-ed on the Caregiving Forum. A perfect example of a great family who, despite doing everything humanly possible that they could think of for their loved one, finally hit a wall.
It's very classic that one physical event - especially a traumatic one like a hip dislocation - can avalanche into just this scenario at your mom's age.
Thank you for illustrating what "PREPARE" means. We never even know about any of this stuff until it happens to us.
Last edited by runswithscissors; 01-16-2018 at 08:41 AM..
Reminder...Many seniors do not have the financial resources for ALF. Also ALF means you must be somewhat independent to begin with. Otherwise the person must go into a PERSONAL CARE facility to the tune of about $6000 a month. Meaning you will need to turn over all assets to the nursing facility.
ALF is not a solution for MOST lower income seniors.
Do you live in Canada? None of this is correct. (other than the part about many seniors not having resources)
We don't have "personal care facilities" in the USA. Especially running $6000 per month. That is called an ALF here.
The guidelines are very clearly laid out in government standards for admissions (screening done by the ALF or Expanded ALF according to their policies of what they can provide) and insurance purposes, too. IE Identifying Activities of Daily Living (ADLs).
And you NEVER "turn over all assets" to an ALF or even what you are calling "personal care facility". Choosing to live in an ALF is like choosing to check into a hotel. Until the government gets involved.
You're mixed up with Medicaid - governmental taxpayer funded SKILLED Nursing Facility. Or some ALF permutation in a few states with Medicaid waivers/expansion.
Last edited by runswithscissors; 01-16-2018 at 08:55 AM..
Wonder if they look at total assets OR is it just income? or both?
"They" who?
ALF is private pay. Nobody looks at anything except your ability to pay. And your insurance company if you are in possession of a qualified Long Term Care policy which is considered private pay.
You're mixing up private pay with governmental taxpayer funded Medicaid which is a whole 'nother issue. And only rarely in some states will the taxpayer fund a type of assisted living.
If your mother has any assets, it's 100% BETTER to move to a Skilled Nursing Facility BEFORE she's totally broke and needs Medicaid. Because the SNF will prefer taking residents who have some ability to contribute to their care, even if it's only for a coupla months BEFORE they have to take Medicaid. If you do it that way, sometimes the SNF will do all the work for you and you only have to provide the documentation. For example, at that point you're limited to a finite amount of dollars in net worth and then she gets a monthly cash spending allowance from her Social Security check for incidentals...and the SNF takes the balance for her care. Including medical. Sometimes you can find an ALF which also has a SNF affiliated on site which will take her if she has the ability to pay UNTIL such time that she needs Medicaid but they are not common. Only in some states, too.
Meaning if you wait until your mom has a crisis, and she's completely broke, you or some SNF will have to start the application process for taxpayer funded Medicaid which is a long involved one. WHY would a business want to do that when there is no shortage of bodies to fill beds with some disposable income and residents who aren't at the worst point yet? So when all the good beds are filled, you're relegated to the lower echelon.
The better choices are some Faith Based Organizations that are more democratic about it but you may even have to move to a different state to find one.
Obviously a CCRC is best but I'm assuming your mother can't afford that.
This is what I mean by people waiting too long. They and the family member are in denial and fighting it until there are no good options. Usually one of two events: Chronic hospital visits and going home over and over again OR one big event like a stroke that was completely unexpected because "mom was fine".
The VERY FIRST THING you have to do is obtain Powers of Attorney.
Go to the Caregiving Forum for more info.
Last edited by runswithscissors; 01-16-2018 at 09:03 AM..
My wife and I are both retired, 70 years old. We still have a bit left to pay on our currrent home, lots of equity, no other debts, living comfortably right now for our life style. We've been wondering what to do.
I despise the idea of most senior living communities because I like movies at theater sound level (and have the equipment to do it) I have a loud, obnoxious hot rod and I like shooting guns and I don't care much for people. I don't play tennis, golf and would prefer to live in an un-manicured woods rather than a neat, tidy community. So, if anyone knows a community like that, that would be if interest. I do know about the one in Florida that caters to car/RV enthusiasts....about as close as I've come to something of interest.
Anyway, we've been discussing just staying here and instead having someone move into the house later that could maybe help us out when we're not capable any longer of taking care of things. Our house is large and would be paid off by then and has the ability to configure easily with in law suite, separate kitchen and entrance. My question is, has anyone here tried this? We could provide free room and board for a person in exchange for a few errands and chores. They should have plenty of time to pursue other interests (education, professional development, etc.). Does anyone here have any experience with this, first or second hand? Aside from finding someone compatible you can trust, what sort of issues might be expected? Thanks for any input.
Its exactly what I did for 98 year old mother who recently passed away. We had someone stay in the home at nights. I had someone come during the days to assist her. As she deteriorated, I had to get even more support during the day. It worked out fairly well and she stayed in her home until seven weeks ago, when she asked on her own to go to a nursing home. She died in the nursing home with medical interventions that made her passing easier.
The trick is finding the right people to help. Its hard. The person who stayed nights was a cousin who worked for a religious organization during the day, so we trusted her. The person who came during the day was paid, but she regarded caring for my mother as "her calling". Even so, the cost can become high when you consider that care has to be 24/7 for seniors who are extremely old and enfeebled.
The effort involved should not be underestimated. I did not have to do much in the way of "hands on care". Yet, my contribution was quite significant. I spent countless hours paying bills and constructing different financial arrangements over almost nine years, so that Mom could stay in her home. It is often harder than it looks.
ALF is private pay. Nobody looks at anything except your ability to pay.
You're mixing up private pay with governmental taxpayer funded Medicaid which is a whole 'nother issue. And only rarely in some states will the taxpayer fund a type of assisted living.
If your mother has any assets, it's 100% BETTER to move to a Skilled Nursing Facility BEFORE she's totally broke and needs Medicaid. Because the SNF will prefer taking residents who have some ability to contribute to their care, even if it's only for a coupla months BEFORE they have to take Medicaid. If you do it that way, sometimes the SNF will do all the work for you and you only have to provide the documentation. For example, at that point you're limited to a finite amount of dollars in net worth and then she gets a monthly cash spending allowance from her Social Security check for incidentals...and the SNF takes the balance for her care. Including medical.
Meaning if you wait until your mom has a crisis, and she's completely broke, you or some SNF will have to start the application process for taxpayer funded Medicaid which is a long involved one.
This is what I mean by people waiting too long. They and the family member are in denial and fighting it until there are no good options. Usually one of two events: Chronic hospital visits and going home over and over again OR one big event like a stroke that was completely unexpected because "mom was fine".
The VERY FIRST THING you have to do is obtain Powers of Attorney.
Go to the Caregiving Forum for more info.
Thanks. When I said "they" I guess I meant the admissions of the facility...meaning if you have income of less than $30,000 you are entitled to some type of aid even if your assets exceed $700,000
I have POA already....I need to learn more about this whole process.....bottom line is right now she isn't going to voluntarily move into any home ...shes fully functional..I know that can change any day, but I can't force her into a place
Thanks. When I said "they" I guess I meant the admissions of the facility...meaning if you have income of less than $30,000 you are entitled to some type of aid even if your assets exceed $700,000
I have POA already....I need to learn more about this whole process.....bottom line is right now she isn't going to voluntarily move into any home ...shes fully functional..I know that can change any day, but I can't force her into a place
Interesting choice of words: "entitled".
No, not usually. I think you're thinking of either a very rare type of community that is usually faith-based or that combo-ALF with Medicaid that is only available in certain states like I said. So each state has their own policies. (A good example of this is Florida. We don't have that and I'm glad. Why should I subsidize someone with a net worth of $700K to go live in an ALF on my tax dollars. )
OR low income (income restricted) subsidized housing and most often that's where you pay perhaps 30% (or more, depending) ...of your income on rent. Typically they don't care about assets or some may charge you a surcharge at a certain point. There are MANY types of this housing including non profit AND for-profit and some grants that require the community to provide "supportive services" but they are a far cry from Assisted Living. Like, one required meal a day or having social workers or a small medical office to check basics on site could be considered supportive services. They are targeting what are considered frail individuals. But pretty much anyone who qualifies can move there if the community accepts them. They ration the rentals out by percentages because they can't exist with ALL 100% frail or 30% payers so some people do pay more - market rates. Still very cheap and still income restricted, though. Also, sometimes there are waiting lists.
If your mom is lucky enough to have >$700K in assets she should IMMEDIATELY move to a CCRC. Like yesterday! It provides continuing care for the rest of your life up to and including Skilled and Hospice.
Good you got the POA. That's usually a big hurdle.
Last edited by runswithscissors; 01-16-2018 at 09:40 AM..
ALF is private pay. Nobody looks at anything except your ability to pay. And your insurance company if you are in possession of a qualified Long Term Care policy which is considered private pay.
You're mixing up private pay with governmental taxpayer funded Medicaid which is a whole 'nother issue. And only rarely in some states will the taxpayer fund a type of assisted living.
If your mother has any assets, it's 100% BETTER to move to a Skilled Nursing Facility BEFORE she's totally broke and needs Medicaid. Because the SNF will prefer taking residents who have some ability to contribute to their care, even if it's only for a coupla months BEFORE they have to take Medicaid. If you do it that way, sometimes the SNF will do all the work for you and you only have to provide the documentation. For example, at that point you're limited to a finite amount of dollars in net worth and then she gets a monthly cash spending allowance from her Social Security check for incidentals...and the SNF takes the balance for her care. Including medical. Sometimes you can find an ALF which also has a SNF affiliated on site which will take her if she has the ability to pay UNTIL such time that she needs Medicaid but they are not common. Only in some states, too.
Meaning if you wait until your mom has a crisis, and she's completely broke, you or some SNF will have to start the application process for taxpayer funded Medicaid which is a long involved one. WHY would a business want to do that when there is no shortage of bodies to fill beds with some disposable income and residents who aren't at the worst point yet? So when all the good beds are filled, you're relegated to the lower echelon.
The better choices are some Faith Based Organizations that are more democratic about it but you may even have to move to a different state to find one.
Obviously a CCRC is best but I'm assuming your mother can't afford that.
This is what I mean by people waiting too long. They and the family member are in denial and fighting it until there are no good options. Usually one of two events: Chronic hospital visits and going home over and over again OR one big event like a stroke that was completely unexpected because "mom was fine".
The VERY FIRST THING you have to do is obtain Powers of Attorney.
Go to the Caregiving Forum for more info.
Just to clarify, I don't think you are talking about different quality of care within the same facility. While their may be beds with different levels of necessary care, there is NO difference in the quality of care given to Medicaid and self-pay residents in the same facility.
It IS however entirely possible that facilities with a higher proportion of self-pay residents end up with better employees, etc. and so the overall quality is better, across all beds. Lower quality facilities may end up with more Medicaid residents and then they're stuck in a downward spiral - that again, affects ALL their beds, not just the Medicaid beds.
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