Wow, lots of experience here on CC (as always). This is totally my father’s decision as he is in perfect mental health to make up his own mind. At this stage, he is also mentally able to do all of the things you guys worry about (he will get on Amazon and buy a new remote for his TV if he loses one). When we toured the place, I would say half the residents were in wheelchairs and the other half with walkers (my father has a walker) but they all seemed mentally fit. They have a memory care section which is kept totally separate from the other patients. All of the patients seemed like they had a similar socio-economic background as my father as well as similar ethnic backgrounds (which I think will make it easier for my father to make “friends”.) I was there when they were setting up for BINGO (my father is not interested in BINGO but it was one of a dozen activities for the day.) They have a “council” that helps decide where to go on their weekly bus trips and which activities to run. I think they do have a doctor in house (but I don’t think my father would use this service except in emergencies as most of his doctors know him for many years.) Same with having a hairdresser come in twice a week (it will be hard for my father to give up the barber who has cut his hair for the past 25 years.) Transportation is not a huge issue as there is free accessible van service provided by public transportation (although they are not very prompt). I do have a sibling who is closer than I am and currently does the runs to take care of little stuff (but most of this little stuff would go away now as it was things like put out the garbage, change a lightbulb, etc.). The provide a lease which you can break with 30 days notice and will provide care up to hospice if need be (so if you can afford it you are there for life.)
Wanted to add, he will be having a lawyer review the lease (he won’t sign anything without a lawyer’s review and has a trusted family lawyer he has used for many years.).
Since your father doesn’t have memory issues, make sure and spend some time attending a meal in the dining facility. Are the residents cognizant and verbal? Are they sitting together talking and laughing? One of the key social functions are meals. You should see groups that come at a certain time to meet together for a meal. Some even stop at each other’s doors to go to meals together.
Some facilities even have Ambassador residents that invite new residents to eat with them, etc
My 96 year old mom has been in assisted living for nine years. The food sucks and I hate that; as it is, her appetite is very light anyway so she manages. Other than that, she has had every need met, the place is clean and she is content there. It could be fancier but my mom is not a fancy person so in that respect she is fine with it. My brother and I each live 300 miles from her in opposite directions and we are very pleased with it. She has been hospitalized twice while there, both times due to the attention of the staff. So we know they are on top of things. She has several relatives in that town who look in on her regularly and some of her fellow residents are people from her childhood! (she moved back to where she was from).
Thank you from this poster for all the info, especially AboutTheSame. I am sufficiently intimidated and overwhelmed! (Dysfunctional family dynamics add more complications). In my mom’s circumstance, she’s kind of a loner and really would not appreciate the social aspect of many places, it seems. She is also very high functioning and alert, and will never leave her (several) pets. But her body is betraying her. May need to come up with the funds for in-home care for awhile, but don’t know from where 
. Thanks again.
That is a real issue. My family is full of INTJs who do not appreciate the “social” focus. The last place I put my most recently deceased senior somehow got it and pretty much left her alone except for the essentials she needed help with. They also allowed her to choose to eat in her room or go to the dining room. They figured out just how much interaction she could tolerate. It is a struggle to find the right place for someone who does not need to be social and really doesn’t want to be social.
I hear all of you, and every situation is different. Mom would have liked to stay in her apartment (her home of 40 years, which was a real change for a Marine wife who spent her marriage moving every 3 years), but my brother and I were too worried about her falling and her driving and maybe forgetting to turn the stove off and … Each family has to decide when it is time to make a change and what you can afford. Mom is in a place with good food and has found a circle of friends. She still misses her apartment and her car [no way was she driving any more], and I have to deal with that resentment on a regular basis. I am very fortunate that she’s only about 30 minutes away [she moved to my area when she and dad divorced in '75] but let me tell you that assisted living does not mean you are off the hook. But, heck, she raised me. I can pay back a few years.
My 93 yo sharp-as-a-tack mother is considering moving to an AL facility near my sister in Memphis. She saw two places. One requires no buy-in but rent is about $5500 per month and includes a certain number of meals. One requires a buy-in of $300K but the estate gets back $270K upon her death (assuming no bankruptcy). The monthly payment on the second one is $3500 to $3900 depending upon the size of the unit. Her current rent in NJ is $3500 per month (we sold the house I grew up in a couple of years ago). This too would cover many of her meals. So, the net cost is probably comparable to her current living expenses but probably less (except for the foregone appreciation on the $300K).
Each place then has facilities that you move to if your physical health or cognitive health worsens. She had meals with residents at both places. they were very friendly and welcoming and many pretty were with-it. The food is better at the second place, as are the facilities and, in my sister’s and mother’s judgment, the management.
Have you had experience with this kind of buy-in contract ($X in and $90%X back to the estate)? What are the key contractual issues I should be looking for?
Given the sale price of her house and the other assets my father left, her money will outlive her. So, we won’t be worried about Medicare.
My sister has one college-age kid but two who are at home (a third grader and a 10th grader) who have very close relationships with my mother). She could play a meaningful role in their lives (especially the third grader). I think it is a good move, though with some real non-financial costs. But, we are not up to speed on senior assisted living facilities.
Since July, my folks have been living in a buy in independent unit where estate gets 90% back place plus monthly expenses. They were late 80s, early 90s when they moved in. Meals are in a dining room at tables if 4. If you want more than 4, you have to make reservations at least 24 hours ahead. They also have casual dining. It includes housekeeping once/week plus valet service and some meals. It has independent living to memory care and nursing home. There are activities and shuttle buses, but you need to make reservations 24 hours ahead.
My folks had thought they’d engage a lot with the folks there, as they know many of them (same country club), but they really rarely interact with anyone and are pretty isolated except for all of the family members making frequent visits. My folks have never used the shuttle or participated in most of the activities (perhaps if they had moved in a decade ago they might have been more interested).
We feel it is safer for my folks to live there than living alone in a house that is way too big with just the two of them (and no one wanted to move in with them). I wish they interacted more with the other residents but don’t think they will. Fortunately, their new SR community is a 5-30 minute drive from from any of us, their kids, so we all go and spend time with them and get them to events (MD, sports, plays, opera). Fortunately, they could afford the buy-in plus monthly expenses. It was the only SR community they were interested in.
@aboutthesame excellent overview of the “process” - helpful post
MIL 90 just moved to assisted living.
She said after meals a pianist comes into dining room and there is a nightly sing along of beloved “oldies”. She loves this
Make sure heat / cooling are working in the room. Her neighbor’s heat won’t turn off - miserable for that woman.
Attend a Medicaid program sponsored by local assisted living. We attended a program presented by a company who does all the paperwork for families. It was an educational seminar and they answered all questions while marketing their services.
Consult with elder attorney about setting up family trust.
Alas, a lot of experience in this area. Both parents now gone, but were in & out of several Assisted Livings for 6+ years. The last one was wonderful - a smaller private facility with no “surprise” charges where my mom could stay until the end (they bring in hospice if needed). The staff there was wonderful and very caring.
The Vet program you reference is most likely Aid & Attendance - it’s applicable for both the vet and a surviving spouse. It took awhile to apply when we did, but was retroactive to the date the application was filed. If I recall correctly, it was about $1200 a month for my mother. They were lucky to have medical insurance (Tricare) through the military, too.
Things to be on the lookout for are “extra charges.” Some places will charge you extra if a resident doesn’t go to the dining hall one day and requests “room service.” Or up the fee for giving meds if prescriptions change. Find out about how much more it will cost you if your parent needs to move to the next “level.” The jumps can be steep. And if a parent deteriorates to the point where the facility can’t accommodate him/her, nursing homes are ridiculously expensive and can drain any remaining assets very quickly. We went through that with MIL - not fun.
Sending good vibes to all dealing with this issue.
My father has been in his assisted living since the end of October. He will be staying there (went in on a trial basis). He couldn’t be on his own at this point (needs assistance for too many things - on days when his arthritis is bad - getting dressed, showering, and on a regular basis - couldn’t cook or make his bed daily). He is starting the process of selling his home (which was way to big for him).
I am disappointed in the amount of activities he participates in. He has never gone on one of their shopping trips or other excursions and doesn’t use their transportation. He eats his three meals in the dining room with others (whom he has befriended) and does their weekly crossword puzzle activity. He seemed to enjoy the “holiday” special activities - when a musician came in to entertain or they celebrated veterans day. He feels people stay in their room most of the time. However, this is more social interaction than he had at home where it had become physically impossible for him to leave the house.
He has used their extra services - having a nurse or aid come to assist him at various times. Overall, it was the correct decision, at this point there is no way he could live on his own.
@apraxiamom Do you mean Medicare or Medicaid?
(Sorry, I was responding to a very old post.)
I was very glad my late mother had the means to live in an independent senior apartment in a community that also had assisted living and nursing home care attached. She ended up in the nursing home part, but before that was able to stay in her own apartment with 24-hour aides, following a stroke. That worked well, though it was staggeringly expensive.
I did not consider her money as my future inheritance.
Welcome to the club.
Buy-ins are becoming more popular, tho I would like some with 90% returned.
We all have different criteria. I wanted a room for my dad right by the elevator, leading to the dining room.
I wanted a place with good food.
I wanted a place where some people played bridge.
I fully expected to pay more for the ALF doing his laundry and giving him his meds.
The tipping part for me was that I needed the facility to provide transportation for dialysis during weekdays. The driver had taken his 20 y o DD to dialysis for years. I knew he would be understanding,
I never expected my dad to last a year, so I didn’t even look at the buy-ins. When he needed more help, I hired a woman to be with him during the days. In the last month, I needed 24/7 help. The facility let him eat in a separate dining room, where his aide could be with him. We all knew the end was near.
@shawbridge , My mom is in a place with a buy-in that offered a choice - a lower buy-in that has a pro-rated refund for the first 2 years, but after that no refund. Or a higher buy-in with 90% refund. She went with the pro-rated plan, I’m not sure if that affected her monthly payments. Her payments will stay at the “independent living” price even if she moves to Assisted or Nursing care. That price has gone up 3-5% every year she has been there. She’s been there almost 6 years, doesn’t seem possible.
The activities are good, there is bridge and poker and mahjong and movie night and afternoon concerts and chair exercises and … Really whatever anyone is interested in. Rides to appointments, food in the dining room or delivered. Best of all on-site physical and occupational therapy.
The move was harder on her than we anticipated. Help from her kids plus the senior moving company was essential.
This will be a hard transition, even if it’s a good thing. The sister she’ll be moving close to should take charge and you should do whatever you can to help. I think it’s great that she will consider such a major move, and great that your sister and her family will be able to provide some additional support. My mom had to get a private aid, which costs extra, but it makes her life so much easier. It’s really what allows her to stay in the independent apartment and not move to Assisted Living yet.
There will be cliques, but new people are always moving in because, well, because previous residents have moved on. It’s the way things are in those places, and they usually have staff to ease assimilation.
@MomofJandL, thanks for the advice. I need to find out about inflation in the annual pricing. I hadn’t asked about that. I think the downside will be moving from an area in which she has lived and been very active community member since 1956. She lived in the same house for 48 years before we sold it two years ago. She’s currently living in an apartment (pretty nice) and that move was a shock. We’d suggested looking at senior ALFs near her house then but she didn’t really have an interest at that time.
She won’t need a private aide. She’s remarkably capable. But, she recognizes that in her 90s, she is slowing down. She retired from several non-profit boards at age 90 and gave up her car voluntarily at age 91. She broke two hips at age 92 but has fully recovered. This required my brother driving her to a PT a couple of times a week and then to her gym. This would have been a lot easier at the place in Memphis.
My sister will really bear the brunt of this. The hard part is that my brother has retired and has never married. He is entwined with my mother – he helps her but she tries to help him as his life decision-making is often weak. Will he move as well? If so, my sister will have to be something of a saint. Not sure what I can do to help with that, but I’ll try.
My parents moved to a place with a big buy in like that. They moved to independent living but then within a year we determined that my dad needed more support and they could not provide it in IL. They had a big IL area and very good skilled nursing, but only a few AL or personal care units. All they could offer was for dad to move to AL and mom stay in the apartment which was not desirable or for mom to move to AL too and they’d both be in single rooms, like dorms.
So I had to move them again to a personal care place where they could live together in a s BR apartment. So I’d make sure you look at ALL the levels of care - it never occurred to me that there would be this interim step. I figured one of them might have a big medical crisis (stroke etc) and then need to live in skilled nursing. I did not realize how little support they could give in IL for my father.
I will get the 90% of the buy in back when their unit is re-rented or after a year passes. It is almost a year so I will be pressing them on this!
When we moved my in laws we were shocked at home much worse FIL was after the move. In his home of 50 years, habits were ingrained, muscle memory and autopilot covered much of the daily basics. In the new place, he had to think about every single thing and he could not do it. He was demoted to AL in less than two weeks. Assume your senior will be worse, not better, in the new place, in terms of ability and energy.
My parents were in a similar situation as @surfcity. I thought they could live forever in their senior community with different care levels. It turns out, my parents had unique needs due to their dementia and the particular levels of service where they could stay together just didn’t work for them. They are now at a personal care home (6 residents) where they can get individualized care. Downside is that they don’t have the activity resources of a larger facility. By selling their condo, I hope to recoup some money. But it hasn’t sold yet and I’m paying steep monthly fees until it does.
AboutTheSame has really detailed good advice about this. I don’t have information at that level, but send my good wishes to everyone who is dealing with this circumstance. I know that it is very hard emotionally and it can also be exhausting physically.
Things that I have seen work well: One retirement community (in Wisconsin) was affiliated with a hospital and an assisted living facility that had nursing care areas as well. There were duplexes for independent living, where the grounds were maintained. When it became needed later, there were aides to help with grocery shopping and cleaning. I would estimate there were 40-60 duplexes all together–so it was like an extended community, but not too far from the hospital. My aunt and uncle lived there together for about ten or twelve years. It was very pleasant. They had owned a large Victorian home, so they could not bring all of their furniture, but they did an amazingly good job of re-creating the atmosphere of their old home in a contemporary duplex. On a few occasions after one or the other was hospitalized, he/she person was in the rehab/nursing section for a short period (a week or two), but then returned to the duplex. My aunt had hospice care in her home (duplex) at the end. A great aunt lived in the assisted living area of the facility for several years. She was able to bring in a lot of her own furniture. Meals were arranged in a dining hall, and they had a lot of activities. She remained sharp and active until she was about 101. We don’t have anything like this around here. This arrangement seemed to me to be about ideal. My aunt lived to be 87, and my uncle died in December, the day before his 90th birthday (leaving a lot of us with plans that could not be fulfilled–I am not quite over this loss yet–actually, I am not quite over any of the losses).
Another arrangement that worked really well for friends’ parents in Ohio: A group care home was staffed by young Mennonite women, who provided meals and cleaning. The people could use all of the common areas of the home, and had their own bedrooms. I think there may have been 4 to 6 people in the home.
My father-in-law was in an assisted living apartment, again with his own furniture and meals in a dining room (or out with family).
Another thought: I would not be too concerned if the dad in the family did not want to go on shopping expeditions. My dad never liked shopping. Sometimes when my mother wanted to go to the local mall, he drove her and then sat on a bench, reading. On one occasion, he took War and Peace with him. The book attracted a lot of attention from other people, who suggested that he might be able to polish it off before my mom finished shopping.