Looks like my 86 year old widowed father is going to move to an assisted living facility (a sunrise). Toured the place and it was very nice, location is pretty and convenient (not too far from where he has lived forever), although expensive. What are people’s experiences with assisted living for their parents, what things should I know, andy tips suggestions?
It wasn’t for my parents but I did have my aunt, for whom I had POA and financial oversight, in an assisted living facility for the last year of her life. She passed at 92.
One thing to check is whether things like pill giving, laundry, etc. are included. At the place my aunt was out, they administered meds as part of the charge but a couple of other places had a sliding scale of x amount for one set of pills a day, etc. The base cost was cheaper but when you added in the extras, it wound up being more. Plus, I liked knowing how much it would be each month consistently.
Make sure the facility allows 24 hour visits. Sometimes, my aunt would be restless and H and I would drop by late to see her. Sometimes, we would just stop by to see how the staff was doing and not disturb my aunt.
The OP didn’t say whether the father has family members living nearby.
I wonder whether this is an issue.
Do people in assisted living need support from nearby family members, or is it fine for them to be in a facility that’s distant from where other family members live?
The OP said that the father who’s moving to assisted living will be staying in the geographic area where he has always lived, and that sounds great – it will make it easier for him to stay in touch with friends. But what if there are no younger family members in the area? Would it still be OK for his to make this choice, or would he be better off moving into an assisted living facility near some younger family members even if it means leaving his home town?
Well my father is adamant about being near his various doctors (and hospital of choice). He usually has at least one doctor visit a week (which he gets to using either free public accessible van service or by paying for a car to get him there - which will be the same from the facility).
He is at a point in his life where his friend circle is very small and I believe those friends will be able to visit him at the new location (and take him out for dinner etc. as they do now.) I do not live near and don’t visit that frequently, this facility may add 15-20 minutes to my trip, so that is not really a factor.
His decision is driven a lot by loneliness, having people around him (both the other residents and the staff) to socialize with is important to him. He feels isolated in his current living situation as it has become increasing difficult for him to manage getting in and out of his home.
How timely. I rarely post, but this has become an issue for my mother as well. I would love some help understanding how finances work for situations like this (medicare coverage)? My mom does not have very many assets. Also curious about pet accommodations.
She is in GA, where there is some family to help her, but could move closer to New England or NY/NJ area where other children live. Based on my very early research, I don’t think we can afford the nicest facilities, and we won’t put her in a bad one, so we’re at a loss. She’s 84 with likely several years in front of her (hopefully)!
Secondarily, is in-home care (not live-in) covered by any elderly insurance?
Thanks, and I don’t mean to hijack your thread.
Happy to share the thread with others with similar issues. For my father the value of his house (which he would sell when he moves) will cover many years of care in this facility. The basic needs he has (laundry, cleaning, food, etc.) are included in the costs. He may need more care in the future (like the medicine stuff) and that would be a la carte added to his monthly payment.
He is currently paying for many of the services that will be included (cleaning service, 24 hour emergency call button, laundry service, etc.).
As a vet, he is looking into a monthly amount they will pay - otherwise looks like nothing is covered by his insurance, medicaid, etc. If he got any medical care there (PT or OT), that would be covered by his health insurance (as it is now).
I kept a senior family member at home as long as possible with aides. Her insurance did not cover any of this but she had the investments to do so. When she ultimately needed 24/7 supervision I moved her to assisted living which was less expensive than in home care but her insurance did not cover this…only nursing homes. Eventually she required nursing home care and her insurance covered half the cost. Nursing home care was double the cost of assisted living for her and alittle less than in home care. She passed alittle over a year after moving to the nursing home. Read the insurance carefully if your senior has a policy.
Glad to share some thoughts based on 6 year history of elderly parent in two different Assistant Living Facilities:
-
Have never heard of any health insurance covering any form of assisted living other than the usual medical care they would receive if they were in their own home.
-
Double rooms (most often two twin beds with partition in between) can be slightly less expensive and provide needed socialization for the right person. Some parents definitely need to be in a single room, though.
-
I’m familiar with a basic level of care covering laundry, weekly cleaning of room, emergency alarm, three meals a day and usually a small kitchenette in the room. Basic phone and limited cable sometimes included . There are then anywhere from 1 - 5 add-on levels if meds are to be distributed or administered, help is needed with bathing or dressing, help is needed with getting to dining room, assistance with meals etc.
-
Expect to spend anywhere from $4000/month to $8000/month at the some of the nicer places in major urban areas. Even at these fees, there are frequently waiting lists for the nicer communities.
-
Easier if the facility provides physicians on site or reliable transportation to medical appointments (usually for an additional fee). As much as parent wants to continue with known doctors, this is sometimes impossible due to time constraints, help with ambulation, needing to have a family member accompany them to hear the information, etc.
-
My final suggestion - move parent to the location that is CLOSER TO YOUR HOME OR WORK. Really, I can not emphasize this enough. Even with what is supposed to be 24 Hr care - you will be called on to do so much - help with a problem, drop something off, get meds straightened out, fix the tv, bring a favorite snack, find a lost article of clothing. Even 20 - 25 minutes from you is almost an hour round trip and if you’re doing that multiple times a week it really adds up.
The parents supporting parents thread has many comments on pros and cons of AL places, but they are scattered as the topic comes and goes. Lots of good links buried in there as well so worth a look.
Specifically to AL places, my mom was ever so much happier there than home alone and lonely, even though we had to trick her into it and tell her she would be going home as soon as she was better.
Ask about staffing ratios, patient to caregivers. Ask how many hours RN is in house. Ask if there are med aids as well as just caregiver aides. Ask if there are any male aides to help with showers.my moms friend got kicked out of their al place because he got combative being asked to shower with a young girl watching. Yet he needed the help and support.
Long term care insurance might help, even in AL care, mom got 60 percent of her daily max.
Expect stuff to go missing, clothes, pictures… just be prepared to let it go. The last three months of moms life I bought her 36 pair of socks and when I cleaned out her drawers she had six or so…
Your dad sounds like a really astute person. I think that a lot of people don’t realize the social advantages of being in a senior community of one sort or another.
My now 90 year old aunt is in a similar place. She’s totally “with it” and in relatively good health. She moved to the facility several years ago and it was great. Good food and staff. Decent social circle. It was never meant as a health care facility and clearly stated that upfront. If you needed nursing care then you’d need to look elsewhere.
Over the years as cost cutting and competition has increased the food quality has decreased, the staff hours have been reduced (making it difficult for 24/7 visitation). I think security and safety of the residents have been reduced in case of fire or break-in as a result. The over all feel of the place has gone from “younger” seniors to almost nursing home vibe with walkers, wheel chairs etc. and much nursing care as the clientele has gotten older (but not my aunt). She’s gone from living in a great social place to an almost nursing home vibe.
She does fine (she’s got a great apartment and has always been a bit of an independent loner) but if she wanted to move I’d be the first one in moving her. If only from the social aspect.
She does have transportation to doctors, shopping etc which is nice. Everything is very close by. I doubt at this stage she would move even if there were the greatest thing on earth near me.
My now 90 year old aunt is in a similar place. She’s totally “with it” and in relatively good health. She moved to the facility several years ago and it was great. Good food and staff. Decent social circle. It was never meant as a health care facility and clearly stated that upfront. If you needed nursing care then you’d need to look elsewhere.
Over the years as cost cutting and competition has increased the food quality has decreased, the staff hours have been reduced (making it difficult for 24/7 visitation). I think security and safety of the residents have been reduced in case of fire or break-in as a result. The over all feel of the place has gone from “younger” seniors to almost nursing home vibe with walkers, wheel chairs etc. and much nursing care as the clientele has gotten older (but not my aunt). She’s gone from living in a great social place to an almost nursing home vibe.
She does fine (she’s got a great apartment and has always been a bit of an independent loner) but if she wanted to move I’d be the first one in moving her. If only from the social aspect.
She does have transportation to doctors, shopping etc which is nice. Everything is very close by. I doubt at this stage she would move even if there were the greatest thing on earth near me.
I agree with the advice to have a family member nearby. My mom was in a lovely, high end, ALF, but there were so many things (mostly little) that required our intervention…particularly as she was having memory issues. Things as simple as getting a new remote for the TV, noticing she was out of paper towels, having someone else’s ill fitting sheets on her bed, etc. It seemed as if there was always something we had to specifically request at every visit.
It sounds as if he would be resistant to move to one closer to you, but that would be the best option if you could convince him of that. He will not be lonely in any nice ALF, they have multiple activities and really encourage socialization. Yes, you would have to find him new doctors, but having you as his advocate and second set of ears at critical appointments is important.
If he is adamant about staying in his area, you should plan on visiting him once a month for the first three months to assess his situation, and not only call him, but call the nurses on duty and facility director periodically to see how he’s doing.
Some of the $$$$ ALFs in my area have residents with private aides. If not for these aides, the people would be in a nursing home SNF. It is good to have alert people who enjoy eating meals together and being involved in activities I’ve seen residents write a monthly newsletter, fill the card room, go out to movies/meals.
In my area, some ALFs accept Medicaid or Veterans.
I find that friends visit on occasion, then taper off. It really comes down to family.while the facility provides transportation locally, there is always a wait. I wanted to be there to talk with the surgeon. One dialysis treatment was n a Saturday, and that fell to me. Holidays and family meals. Dentist and ophthalmologist, selecting new glasses.
My father was in a nursing home the last 5 years of his life (gradual step downs and then Alzheimer’s unit). Medicare paid for everything. He had no savings or insurance. I was an hour away by car and visited every weekend. I had POA and financial oversight.
OP, your dad sounds like an ideal person for AL since he wants the social contact. Please spend a lot of time visiting possible facilities. You’ve received sound advice about costs and how they vary from place to place and what is & is not included. One of the things that has worked out best for us is having mom in a place close to her church and convenient for her friends. Not so convenient for me but I can still run errands for her. I’d probably opt for keeping him in his community to the extent possible. I’ll post this and then go looking for an email I believe I saved from an old friend who had to look after her mother for years and who became very skilled in navigating the Medicare pathways.
General health insurance does not pay for any assisted living or nursing care.
Veteran’s benefits do not pay for anything of this either, UNLESS you can prove that the resident was a Veteran of an official war AND that assets/income are below the total costs of the care. They usually only count the specific additional costs above the basic room and board, but we passed the threshold somehow. The primary residence is not included in the asset calculation for the Vet benefits. It can take up to 6 months to get approved for this benefit so you better make sure there is money to pay the facility while you are waiting.
Medicare will not pay for Assisted Living, Nursing Home, etc UNLESS you can pass their means test. You have to be really low on income and assets and your residence will count in the Asset calculation.
The only insurance that covers all this is Long Term Care insurance, which is separate insurance that is purchased long before the facilities are needed.
My personal opinion is that you need to find a facility that offers a van service (at no cost) for health care appointments within a reasonable distance from the facility. This is usually offered at set times two or three times a week. They also have outings to pharmacies and grocery stores. BUT, make sure you find a facility that also has an in-house doctor. These doctors are so much better than regular physicians because they specialize in elder health care issues and stay on top of mental decline also. They are always covered by Medicare. I wish I had a doctor that made monthly visits to my house for checkups!
I have to visit my Dad (Alzheimer’s Memory Care facility) at least once a week to fix something, bring supplies, etc. At first I thought my Dad should be near his long time area, but in reality the few friends left in the area are nearing the same situation and are not going to be out and about socializing with someone in an Assisted Living facility. It is critically more important to be near family members that can take the responsibility as Advocate for the resident.
And, my opinion is the move to Assisted Living or Independent Living facilities is the best thing you can do for an elderly person who is living alone. They eat better, medications are administered correctly, laundry and cleaning is taken care of and they have a variety of social activities to get involved in.
I just recently got hired as the activities director of a new AL facility (not even open yet!). A few things to think about - your father might like the doctors that are contracted with the facility, making going out to the doctor less of a hassle. Also, the facility might offer transportation to the doctors & other appointments. Our facility will offer that, along with shopping trips and other outings.
As the activities director, I want to make sure I’m offering the activities the residents want - so make a point of meeting the activities director (I believe Sunrise has Life Enrichment Directors). Let her/him know what your dad is hoping for. It sounds like your dad wants the socialization, so hopefully, he will be getting out & going to the activities. If not, let the act. dir. know what would motivate him to get out. And don’t be afraid to let the staff know what you’re hoping for - we can’t always deliver, but we will try to figure it out. So make sure you check out the activities calendar.
Wasn’t sure CC would let me post something this long, but it seems to be okay. Take all of this [from a somewhat cynical “been through it all” friend of mine] with a gran of salt, but there are some good tips:
A number of decisions. The first is level of care. Sometimes the person can survive well in assisted living. A nursing home won’t take them if they’re too healthy and the quality of life can be very nice indeed in assisted living but will be much more difficult in a nursing home. Medicare and Medicaid do not cover this.
When you’re out of money, what you suddenly need is Medicaid and Medicaid will not cover you in assisted living – only in a nursing home; and not all nursing homes take Medicaid. Furthermore, if you just run out of money, there may not be a “Medicaid bed” available at a decent nursing home near you. What usually happens is the person falls, breaks something, and is apparently out of it enough that their assisted living place won’t take them back (I’ve had that happen) and they can’t stay on their own, but they’re too healthy for a hospital. So if they’re out of money, the hospital discharge planner puts them at whatever available Medicaid bed there is in a nursing home-- wherever in the area that might be.
Here’s the game plan. You put them either in a senior facility that has both assisted living and skilled nursing sections. You make sure it is a place that takes Medicaid, but you move the person in when they still have six months to a year of money to be private pay. Last time I went through this, the law did not permit a skilled nursing facility to throw out someone who had come in private pay but now had run out of money as long as they could shift them to Medicaid. Nursing homes really want to see the assets in advance because they know the game, but they’ll play if there’s a year of private pay money there. What they’re watching for is someone who puts the person in, takes that person’s money, and then says surprise, they don’t have anything left.
If the person is in a senior facility that has assisted living and skilled nursing sections, be aware their financial motive is to say the person is now too ill to stay in assisted living. Financially, they want them to pay at the higher nursing home rate. But sometimes they’re just correct that the person can’t stay independent, and it is convenient for you to just shift them over in one facility rather than move them to a whole different place.
Every county is different, and I suggest you get in touch with the relevant county’s council on aging or senior service center or whatever they call it. They should have a list of every assisted living and skilled nursing facility in the area, and if they’re doing it right, the brochure will indicate level of care, Medicare/Medicaid qualification, and other bare statistics for every facility in their area. You will then have to go through the time consuming process of visiting possible places yourself (involve the parent when it’s down to a potential few) and weed them out. They push for commitment – don’t commit too early. Even if they’re full or only have a room or two available, let’s be honest – their clientele is constantly dying. Rooms will open up. Another good source of info is the doctor for your person who can warn you off awful places and suggest both level of care and places that might be OK. They’ll know what facilities discharge at the drop of a hat, which want to see a lot of money up front, which are generous on Alzheimers symptoms, etc. They’ll know what level your person is at now. Discharge planners at hospitals also have that facility – but they do just stick you in the next available bed if it’s an emergency and that bed might be in a pit in East Palo Alto.
Welcome to the wonderful world of research. Get those brochures, price things out, and do a few visits, because your person can become unable to stay at home in an instant – one fall, one incident of wandering confused on the street, one incident of having a kitchen fire or locking themselves out of the house and you may have 24 hours to make a decision. I once moved mom on the day before Thanksgiving because of a fall, confusion, wandering at night – when you get that phone call, you have to have your ducks in a row.
Final advice, when you find yourself signing a person into a facility, do not under any circumstances sign as “responsible party” or you may find the bill coming to you when the money runs out. The patient is “responsible” for the bill and you are signing as trustee or on their behalf or as their attorney. Do not, I repeat, sign as “responsible party.”
Also there is an entirely different track sold by lawyers who specialize in “elder law.” They will figure out if you can basically put everything in trust payable at a moderate amount to the person with the remainder to you on their death. The game is to qualify for Medicaid early because the person no longer has access to all their money - just to a moderate monthly amount. Problem is that when the person dies, you don’t get that remaining money without a fight. If the person has gone Medicaid, Medicaid comes knocking on your door to get any money left to you by the elderly person. I am not familiar with this whole path because I spent all mom’s money on her, but it’s out there.
And an addendum on Medicaid. It is, of course, known here as MediCal. They look back for some years at the applicant’s finances and will disallow coverage when they see transfers of money to family or trusts. Therefore if your relative has a lot of money (you mentioned a house), planning has to occur well in advance to protect assets. Again, I didn’t have that problem. Mom’s house was all of $150,000 and her life expectancy was a year or two (for 18 years). But if it is your relative’s intent to transfer assets and if you therefore go the “elder care” attorney route to protect assets, you have to move quickly so that the person gets through something like three years before applying for MediCal. They keep changing how many years that is. Again, it’s a game. If she goes downhill fast and needs skilled nursing earlier than you thought, you could lose because she might need MediCal earlier. If she’s stable for three years or so under whatever new arrangement you make, you win. If you choose not to play, it doesn’t matter.
In either event, keep superb records of all assets, bank accounts, cars, house sales, everything, because MediCal will want to see it all. My attachments to mom’s application were huge – every monthly statement for years from every bank detailing the drop in her assets to zero. Because of that, they never contacted me after her death to get anything I might have gotten in a will or through a trust. There was nothing to get.
One thing to do even if you don’t try to preserve assets – set aside money for funeral expenses. Whenever you do that, money irrevocably dedicated to funeral expenses is not considered part of the estate when MediCal is looking at how much money the person has left. It has to be irrevocable – funeral homes are quite happy to set these funeral plans up in advance. I did do that for mom. (Then the funeral home went bankrupt. No money lost – this was an asset transferred to the new funeral home.) As time goes by, however, you realize the money may not be enough, so again there’s a game. You want enough for a proper funeral but not so much that you’re wasting money on that rather than on the person’s care or the size of the protected assets. I came pretty close – final funeral still cost me $2000 out of pocket for unexpected expenses.
Well happy research. Again, I imagine MediCal has a brochure on all this written in lovely bureaucratese.
My m-i-l is in her 2nd assisted living facility - Dallas area - around $6000/month. We learned that you have to look past the facilities and focus more on the residents and their level of being " with it". The first facility was quite new, beautiful courtyard garden area, lovely indoor pool, movie theater, etc. Just gorgeous. But at 94, she is still pretty mentally sharp and likes to play bridge, canasta, etc., and there was no resident there who had their mental faculties or the knowledge to play. She never used the pool. It was always too hot to sit in the courtyard.
So after a year of non-stop complaining, we moved her to a different AL, slightly less expensive, closer to family, and with some younger residents who have physical issues, but more mental abilities. She still complains, but we think it is a better fit. (So similar to college process - look past the amenities and focus on good fit).
Based on this experience, I also favor facilities that have just a monthly fee vs a lump sum buy-in fee plus monthly fee. They say you will get a percentage of the lump sum fee back upon death or relocation, but there is a lot of fine print and you may not get that refund for months, depending on vacancy rate, waiting list, etc.