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To my knowledge, and my past experience, Medicare provides visiting Nurses to do this.
They did it for my Mother in law. If the person is younger than Medicare age, I am not sure how that works. there seems to be many here who are not really familiar with nursing homes, especially what transpired during COVId where so many lost their lives to sitting in their own feces being starved to death as no one showed up to work to cook the meals. Then the receptionist blocked people from entering the facility. As she left, I snuck in and saw a horrific site from the hallway. Of course asked if I could go help feed them but there wasn't food. One caregiver to like 35 people, many in wheelchairs. At least I could keep them hydrated. They looked awful. Receptionist said no. I pressed but realized she would likely only end up mentionig she'd have to call Cops as this torture is legal in facilities. Of course it wasnt anyone's fault, that one Angel who stayed to help everyone is a hero. Yet Do this at home and there is legal consequences. I wondered why she was posted by the door and not helping keep them alive and lcean in the other room. These places are petri dishes of diseases and filth anyhow even if they are well cleaned.
I would hope most people have higher standards, if possible, for their loved one than a Nursing home though some are probably pretty good I imagine. Imho, most are not. No reason why you cannot plan for much better care unless the person has severe medical issues where at home care is not an option.
So many in Nursing Homes would do quite well at home with help.
We hired a few agency caregivers for my in-laws. They needed 24/7 help and we worked. They were good robots but really didn't take charge with anything. Privately hired people make suggestions regarding nutrition, health, etc. These folks were not friendly, they were trained to be servants, only cordial. Made small talk then when nothing to do, sat a distance away from my in-laws as if they didnt; want to get to know the. They are trained to not rock the boat. it was difficult to understand them as English was not any of their first languages so the language barrier concerned me. They misunderstood a few problems. I learned they were paid a pittance so if you are wiling to pay lets say, $10 more per hr, you still save a ton of $ yet should get a better quality person, especially if you follow my suggestion above. Strangers are so risky. They also sent in many different care-givers, there wasn't much consistency so it was odd for my mother in law. Amateurs can be trained to be good caregivers, everyone had to start somewhere so that wasn't an issue. My in-laws both needed assistance, it was hella expensive !!! We could not afford to chip in much so I just worked a 24 hr shift per week, stopped by at other times, and monitored many of the caregivers. So sad that my MIL was so lonely, she loves to socialize but none would actually carry on a conversation with her. It was as if they were trained not to joke or just be normal. At best, she was felt like she was bothering them when making small talk. . I have a philipino neighbor named Stephanie who is an excellent caregiver, they are friends of ours. She;s the only care-giver in our small town but very fluent in English Not best friends but we do have dinner together about 3x a year. She helped me learn the ropes with my in laws yrs ago by stopping by. I had to pay her to show me while the other caregiver just stood there. These robots certainly weren't willing to help me learn, pretty much just flat out refused. Today I would have fired that company for that and hired a different agency but I felt it wasn't my place at the time. To hire strangers over someone you've spent time with, someone who likes you back so an emotional bond is forming, is always better. Planned enough ahead of time, this seems very possible.
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LTC works with Medicare or at least they use to depending on which Company we go with. As far as Covid yeah that was a freaking nightmare. They had to lock the doors to keep people from getting Covid or giving Covid. It was a nightmare trying to keep the sick separated from the nonsick. They see people come in and eventually die from old age or their medical condition so I figure it has to be hard to get close to them only to see death take them again or they leave because the family took them out for what ever reason. My guess is the reason we took our Mother out they weren't' as good as we thought they were. She learned her lesson do what the Doctor tells her to do and do the PT so she won't need to stay there and stop refusing to allow a stranger into her home. We did find a wonderful woman we hired from a company who was so good I would hire her for myself. She sat with my mother and had real genuine conversations about each others lives. She came Kenya and was a blessing to us as we all tried so hard to help her, our Mother. She was so kind to us strangers that she was hired again with another relative. A state run nursing home is what I perceive to be what you were looking in. A private one I think would be better but not always by much. Like the one my Mother was in.
Last edited by staystill; 12-05-2023 at 06:57 PM..
Reason: added the word Mother
70% of people 65 and older will require long-term care, with an average length of care of 3.2 years. 20% will require care of 5 years or longer. See research in link below:
So what are the data actually saying? HHS is the source for the figures, although I'm still not certain both come from the same dataset. HHS is a pretty big place! The Administration on Aging within HHS (mentioned in A Place for Mom) did state in its April 2019 study on the topic:
"Seventy percent of adults who survive to age 65 develop severe LTSS needs before they die and 48 percent receive some paid LTSS [long-term services and supports] over their lifetime." Severe LTSS needs are those that require assistance with 2 or more ADLs. Since the OP references money, it's worth mentioning severe LTSS needs are "much more common" among lower-income than higher-income populations.
As noted, the slight majority of the LTSS care was unpaid, probably by family members. When it comes to duration:
"Most spells of severe LTSS needs and paid care are relatively short. Four out of ten adults who develop severe LTSS needs experience such disability for no more than two years, and only about one in four of all 65-year-olds experience more than four years of severe LTSS needs before they die. Lengthy spells of paid LTSS care are even less common. Only 24 percent of older adults receive more than two years of paid LTSS care, and only 15 percent spend more than two years in a nursing home."
A Place For Mom (along with other nursing homes and insurance sites) simply use an uncited point estimate for the average length of care (3.2 years); U.S. News & World Report used the same figure but included a cite to this HHS summary I'd found along the way. Ergo - this is the best I can do:
Opening it helps because the impact of its relatively simple presentation (a table) differs from looking only at TWO figures: the 3.2 years and the 70% shown in A Place for Mom. At least it does for me. No one specific care category reaches 70%. Rather, care needs/costs are a combination of events that can progress over time to where in the end 70% have been impacted in some way for differing periods of time.
For example, it's not unrealistic to expect something like this: 1 year of 2 or more ADLs an unpaid relative helps with ... that gets to be too much and so let's hire a caretaker for 6 months ... the caretaker isn't working out so time for an ALF for a year ... finally, a bed in a SNF for 6 months, perhaps paid for by supplemental insurance under its Hospice care benefit.
Note.--I'm not only irritated at the seeming lack of transparency at A Place for Mom but also find a lack of clarity in the text and notations of the HHS documents. For example, it's not always clear whether a percentage is of the 70 percent who will have severe LTSS needs or ALL adults 65+. For that it would be necessary to look at tables. Also, medians are more helpful than averages and so on.
So what are the data actually saying? HHS is the source for the figures, although I'm still not certain both come from the same dataset. HHS is a pretty big place! The Administration on Aging within HHS (mentioned in A Place for Mom) did state in its April 2019 study on the topic:
"Seventy percent of adults who survive to age 65 develop severe LTSS needs before they die and 48 percent receive some paid LTSS [long-term services and supports] over their lifetime." Severe LTSS needs are those that require assistance with 2 or more ADLs. Since the OP references money, it's worth mentioning severe LTSS needs are "much more common" among lower-income than higher-income populations.
As noted, the slight majority of the LTSS care was unpaid, probably by family members. When it comes to duration:
"Most spells of severe LTSS needs and paid care are relatively short. Four out of ten adults who develop severe LTSS needs experience such disability for no more than two years, and only about one in four of all 65-year-olds experience more than four years of severe LTSS needs before they die. Lengthy spells of paid LTSS care are even less common. Only 24 percent of older adults receive more than two years of paid LTSS care, and only 15 percent spend more than two years in a nursing home."
A Place For Mom (along with other nursing homes and insurance sites) simply use an uncited point estimate for the average length of care (3.2 years); U.S. News & World Report used the same figure but included a cite to this HHS summary I'd found along the way. Ergo - this is the best I can do:
Opening it helps because the impact of its relatively simple presentation (a table) differs from looking only at TWO figures: the 3.2 years and the 70% shown in A Place for Mom. At least it does for me. No one specific care category reaches 70%. Rather, care needs/costs are a combination of events that can progress over time to where in the end 70% have been impacted in some way for differing periods of time.
For example, it's not unrealistic to expect something like this: 1 year of 2 or more ADLs an unpaid relative helps with ... that gets to be too much and so let's hire a caretaker for 6 months ... the caretaker isn't working out so time for an ALF for a year ... finally, a bed in a SNF for 6 months, perhaps paid for by supplemental insurance under its Hospice care benefit.
Note.--I'm not only irritated at the seeming lack of transparency at A Place for Mom but also find a lack of clarity in the text and notations of the HHS documents. For example, it's not always clear whether a percentage is of the 70 percent who will have severe LTSS needs or ALL adults 65+. For that it would be necessary to look at tables. Also, medians are more helpful than averages and so on.
If you and/or your spouse need extensive and specialized LTC for 10+ years, like my father-in-law did, interpretational differences of statistics won't matter. The best thing is to do your best to be prepared, in the unfortunate case you need LTC for an extended period.
If you and/or your spouse need extensive and specialized LTC for 10+ years, like my father-in-law did, interpretational differences of statistics won't matter. The best thing is to do your best to be prepared, in the unfortunate case you need LTC for an extended period.
Absolutely on the being prepared, and I'm just now about to renter the topic (updating documents, financial decisions etc). It was a pain tonight pouring thru health stats - and I really really looked at quite a bit. Still, helpful.
Per your comment, the policies available to me when I last evaluated LTCi only covered 3 to 5 years of LTC. For sure, a policy purchased many many years ago would have had an unlimited benefit period and perhaps lower cost structure. No longer practically available (during the last window I looked).
I'm also single, which changes both my LTCi costs (higher) and risk profile (lower, no spouse to protect).
As mentioned earlier in this thread, I really ripped the then-actual costs apart several years back to find (for me) LTCi functioned as increasingly less valuable insurance up to about age 82 - at which point I'd prepaid the sucker (payments invested). Again only true for a single, only true for the policy evaluated, only based on how assets organized.
I decided for having unknown (depends on the market) assets in hand at age 82 instead of a policy of unknown sunk costs for which I still need to pay each year. For example, I'm not uninterested in CCRCs and although there's a role for LTCi and a CCRC it's arguably less important for a type A contract.
Originally Posted by TruckeeTami View Post
IMHO, the wisest approach is to make friends with genuine, honest, poorer people.
This to me means poor and broke people.
You are confusing me. I am referring to your post about going to someone from church or a friend to come into my home presumably without any knowledge of or training as to how to pick you up from bed, a chair, get you into the bathroom and wash you, wipe your rear end and dress you without hurting you or dropping you. Plus they need to drive you to all your doctor appointments. There is much more to this than you realize even with your experience. Yes Medicare helps and they will help find someone. I still say going to a friend is creepy and risky. There is no one to check in on me who will not be the employer of the person hired to assist or change bandages.
How and what people did years ago is what I believe led to needing nursing care facilities and/or hiring home health aids and certified nursing assistants. I am not talking about going into a nursing home.
I personally wouldn't want to chance a person from church or burden them with caring for me personally. Especially if they didn't go into that profession to begin with which tells me it's not what they normally want to do. It's always different with family than a stranger I agree with that but a friend from church to me is the person who could come visit and bring a few groceries I pay for not do all that personal hygiene and them some. A person from church is not always the close friend you think everyone has in a church. Most people today go to church and look for do gooders who will bend over backwards for people to please God it doesn't mean they are a right fit to do so many very personal physical care.
I would not want to be close to someone who later plans on asking me to do all they need that is so much more than getting dinner, shopping and some cleaning for them. It would make me feel like we were never really friends. Then comes the offer of paying me to do that or me paying them to do all that it goes from friendship to something more of a contractual agreement and dependence for in home care with no real guidelines or anyone to go to when/if something goes wrong. I am glad for you that you have such good experiences but I would not care for that nor would I suggest it because so much can go wrong. This is why I agree with ChessieMom it is not to say it isn't for you I just agree with her on this
Thanks for this reply. It's probably my fault you are confused. There are so many presumptions I'd be writing a book to address them. Most of what you typed never occurred to me. However, in our area, there are a ton of athletic folks. World Class Ski area so most people are pretty healthy and wealthy. Imho, Most people will not need intimate assistance (certain ADL's) and as you stated. Medicare does provide (hopefully) some help for that, thanks for verifying that. I don't understand this burden idea, if they do not want to do it, then they won't. No one should feel compelled to do such. No one should make anyone carry a burden like that. Either take the job because you want to or don't
The intimate ADL's you covered, that could very likely be for a real caregiver. My guess is only about 25% progress to needing such out of everyone who needs LTC. Example: I care for a lady w/dementia right now one 48 hr shift for $25 per hr. I only work 50% of the time because she watches tv until about 10pm and I go to bed at 9pm. She's okay for 1 hr because she's fairly drunk about that time. Her behavior becomes to extreme for me so i just leave her at that time each night. Period. If she bothers me, I remind her to only come down in an emergency. She never feels bad, there is no guilt, just a quick fake I'm sorry BUT...then she goes on to whatever issue she created to fret about. Nothing iis ever her fault. She's up about 9am each morning, on average. I *think* I am willing to learn how to do intimate ADL's for her only in the future but who knows. I enjoy her, doing puzzles with her is fun, it's what's left she can do... and have bonded but I know what she is. No conscious. I would always be paid ot be with her, if only at night. Sure, she won't get cleaned at night but she eats very little and dinner is at 4:30pm so she doesn't hardly eer et up at night to use the restroom anyhow. I could work 9pm-9am or until Noon max then they could hire real caregivers from 12pm-9pm. I'd pay them $15 cash myself since they would have to change her immediately, it's a bit unfair. It surprises me her 3 glasses of wine, which causes her to become beligerent, doesn't have her using the restroom much at all after 9pm
I am *IN* with this family. However I am more of a companion to a lady with dementia than a caregiver. I lightly cook, clean and assist her putting on a coat but she does the rest. She has a 1.5 million dollar home and i get the entire downstairs to myself-, living room, deck multiple bedrooms and baths. I sleep better there than at home. The bell dings if she opens the front door upstairs but she is so afraid of being cold, thank god, right now, i feel she would never run out. She's still on her game enough but panics when alone. She has that Narcissistic Personality Disorder so feels entitled to have a companion with her at all times.
It's pretty easy for me to identify who is willing to help out thru laundry, housekeeping, cooking, grocery shopping, or offer some paid some level of help. That's if you truly know their circumstance first, know them well enough including their personality traits. The other lady who lives with my client is no caregiver. She has no skills like that, has no understanding of dementia She used to manage a vacation home office so she already knew the lady. In the future, should be possible they hire someone to do those intimate ADL's for her. That may mean just working a 12 hr shift at night in the future, 9pm-9am and a real caregiver with that extensive experience work days. Basically paid to sleep and do some housecleaning in the morning, start coffee, etc. It would be much easier than what i do now.
I still say overall, you are much better choosing a friend, or someone you know well, than a stranger. Maybe we'll agree to disagree
Church is often not a good place, sure. If you are truly saved and a Christian, it's a whole different world. Some churches are full of wonderful folks, saved or not. Pharisees infilter churches all over just like in the Bible so it's good to be gentle as doves but wise as serpents. If you had asked me 6 yrs ago before our experiences with Caregivers, I would have been fine hiring strangers.
I worked in Behavioral Health however, with this job, it intersects. It is a great foundation for this Narcissistic Personality Disordered individual I am paid to be with. It's like Dementia, when it's advanced enough, is so akin to Narcissistic Personality Disorder, they are so close with different motives... it's hard to identify where they intersect in this case and it doesn't matter anyhow.
Imho, most do not need that level of caregiving to be changing bandages, diapers, etc. That's pretty advanced. MY MIL was in a wheelchair, no one knew why. A lady came in to help her shower and I just turned my head when she needed help at hte toilet. She could still do most of it herself. Hopefully this clarifies it a little better but we may need to agree to disagree. I am sure there are wonderful caregivers out there who do a great job
Last edited by TruckeeTami; 12-05-2023 at 11:27 PM..
LTC works with Medicare or at least they use to depending on which Company we go with. As far as Covid yeah that was a freaking nightmare. They had to lock the doors to keep people from getting Covid or giving Covid. It was a nightmare trying to keep the sick separated from the nonsick. They see people come in and eventually die from old age or their medical condition so I figure it has to be hard to get close to them only to see death take them again or they leave because the family took them out for what ever reason. My guess is the reason we took our Mother out they weren't' as good as we thought they were. She learned her lesson do what the Doctor tells her to do and do the PT so she won't need to stay there and stop refusing to allow a stranger into her home. We did find a wonderful woman we hired from a company who was so good I would hire her for myself. She sat with my mother and had real genuine conversations about each others lives. She came Kenya and was a blessing to us as we all tried so hard to help her, our Mother. She was so kind to us strangers that she was hired again with another relative. A state run nursing home is what I perceive to be what you were looking in. A private one I think would be better but not always by much. Like the one my Mother was in.
What shocked me is they were not notifying families of the fatal situation. Families were left in the dark, even those who visited and were turned away. They lied to them, it went way beyond the risk of exposure to COVID. Many of those loved ones families may have been willing to volunteer to keep these folks alive. Communities need to come together during emergencies. It was eerie to walk in and it was so quiet. I had only visited 1x before and it was a loud place, you could smell lunch. There was a separate dining area in this skilled nursing facility. They must have double drugged many of these folks to keep them quiet. This is an evil I cannot comprehend. No doubt they covered up the real reason for their deaths. I saw people being turned away as I entered who had no clue. I would've warned them. I live 2.5 hrs away so was visiting an old neighbor. I don't think we are finished with the Pestilences but being a Christian, I would think that. The bible warns us of this as part of the end times.
To a positive, so glad to hear your mother was able to learn from her experience in Skilled Nursing to appreciate being out of that place. Doing her PT and following Doctors orders. Positive experiences with in-home paid strangers who did such a wonderful job in both areas- soul and flesh, is heart warming. You made wonderful points which never crossed my mind. It certainly would be painful to get to know your client well, bond, then they pass away. Makes sense they would want to guard their heart. I am lucky, I really enjoy my client but she is so empty, her disorder is so extreme, I just see an awful person though it's not her fault. She once told me "you kind of folks do not like me" I disregarded it but her controlling and bossy nature, the need to be in my shadow 24/7 or a narcissistic breakdown happens, its almost been that extreme for her for years. She has always been very demanding and puts guilt trips on people. People visit and I wonder why. Two just look at her like they dislike her. One finally told me ,I worked for her for 5 years while my husband was a fellow realtor with her. It was hell. She's not much different. She'll kick you out if you don't constantly stroke her ego. Everything she did was for praise. That's when I started realizing the pattern of why people do their duty to stop by, but actually dislike her. So odd. Only former partners have stopped by in 3 months, not one actual friend has phoned her or stopped by. So sad. It makes me think Skilled Nursing is more likely to get these NPD (narcissistic personality disorder) folks as I am told they went thru 10 people before me. Dementia and NPD are so similar it's difficult to tell where they intersect. She's also histrionic personality disordered (an extreme form of NPD) Of course I am diagnosing her, its doubtful she's ever been officially diagnosed. Her daughter is even worse, never seen anything like it but working my former job in Behavioral Health, you don't get to know the clients that well.
Last edited by TruckeeTami; 12-05-2023 at 11:29 PM..
First I'd make sure that whatever you have this poor couple living in in your backyard is approved by your city/county/HOA as a legal residence. You may have to do expensive improvements.
I'd run your idea by an attorney and your accountant because you are setting up a unique tenant/landlord relationship, have them write up a lease. Then you need to ask what you need to do to cover yourself when having them do work for you, how you pay them, how you deal with their taxes, do you need insurance, will your property taxes go up, how do you report their rental income...
Imagine how this kind couple could start taking advantage of you or start feeling that you're taking advantage of them. Because unless you specifically hire them for a certain number of hours per week, neither of you will be satisfied and think it's fair.
You may decide you want them out and they won't move. They're tenants and have rights.
They may decide you're cheating them and not paying enough and file a complaint against you.
They may get better jobs, they may not like living in the backyard. You need a legal exit strategy for both of you.
First I'd make sure that whatever you have this poor couple living in in your backyard is approved by your city/county/HOA as a legal residence. You may have to do expensive improvements.
I'd run your idea by an attorney and your accountant because you are setting up a unique tenant/landlord relationship, have them write up a lease. Then you need to ask what you need to do to cover yourself when having them do work for you, how you pay them, how you deal with their taxes, do you need insurance, will your property taxes go up, how do you report their rental income...
Imagine how this kind couple could start taking advantage of you or start feeling that you're taking advantage of them. Because unless you specifically hire them for a certain number of hours per week, neither of you will be satisfied and think it's fair.
You may decide you want them out and they won't move. They're tenants and have rights.
They may decide you're cheating them and not paying enough and file a complaint against you.
They may get better jobs, they may not like living in the backyard. You need a legal exit strategy for both of you.
Yes of course it is for a specific number of hours. Nothing would be open ended as you imagine it to be. I can pretty much guarantee in the majority of nursing homes you'd see severe issues far beyond what you listed here. Most everyone here is educated, affluent, active and minds our own business. They have enough land so if someone must live in a small backyard, clearly that may not be wise. Need to exercise a little common sense. Overall people here have class. Many even help out when they see others who are doing similar. Sadly there are people who will try to cause strife no matter what but that is for each to judge for themselves. Nothing stated on message boards is a fit for everyone's circumstances.
Last edited by TruckeeTami; 12-06-2023 at 12:06 AM..
There are some very smart people on this forum who offer and have offered excellent advice and suggestions. Of course, everyone’s situation is different, but that doesn’t mean we can’t learn from each other. I agree with the previous poster that having someone live in your backyard to take care of you comes with a myriad of potential problems. This is a very serious issue and should not be underestimated. It should be carefully thought out and planned for while we still have the mental capacity to do so. Even then, there are likely to still be challenges.
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