My view is colored by my parents who, on the one hand, planned ahead by building a Universal Design cottage on my farm when they were in their 60’s. They spent summers there for 20 years. But on the other hand they then didn’t plan. They couldn’t pull the trigger to move to the cottage when they both needed more care. I think this is typical. It ended up being a huge amount of work, and stress, organizing their affairs and getting them cared for. (ETA this is a massive understatement-- it destroyed our family)
As a result: I try very hard to do everything right, to control what I can, given that both parents had/have dementia. But also, I don’t want to burden my kids because I couldn’t face my own mortality (and probable decline). I am a strong proponent of putting things in place in case you need care. And then if you don’t need those things, great!
As much as some say that’s living in fear, I think the flip side is that some are living in denial.
I want to challenge the assumption that moving when elderly is a simple thing. I know many of us have seen parents age at home and then Something Happens and it’s a mad scramble to find another situation. But in our 70’s, we are still all insisting that WE are different and have no need to move in anticipation of Something Happening in our 80’s. Is that optimism? experience? Was I “living in fear” when we bought this house, with its downstairs everything that seemed like it ensured our ability to stay here longer?Why do people wait so long?
My 90 yr old mom lives alone and the laundry is downstairs. No way to put in a lift or a second handrail. We don’t want to make her move, but we know the stairs are a big risk. But the idea of moving overwhelms her completely.
My 84 yr old in laws live in a contemporary multi level home you cannot access without climbing multiple sets of stairs. FIL says he has good genes and will live into his 90’s and they just won’t go anywhere if one of them can’t do stairs. The idea of moving overwhelms him completely.
I expect anyone blithely saying they will move when they need more care in their 80’s or 90’s has never actually moved someone needing more care in their 80’s or 90’s.
There’s a concept in dementia, anosognosia, which is when the person with deficits cannot recognize they have deficits. I think this kind of denial happens with many elderly people, even ones without dementia.
I agree that there is a “sweet spot” for moving. I’d put it around mid 70s, if there is at least one person relatively healthy, based on my experience with my family. Later than that, adult children will be doing all of the moving logistics and probably dealing with lots of resistance along the way.
Our older family, when they hit a crisis in their 90s, seemed to know they had no choice but to move. Still someone else dealing with all those logistics, and often the facility they would have chosen in the past, didn’t have a bed when it was emergency.
I think that part of the equation often gets lost too. Communities with different levels of care want the majority of their residents to be independent. If you are looking to move when you need a lot of care, you may not get a bed because they prioritize their current residents for AL and MC. So then you are forced to look at back up places you might not like as much.
Also not to be overlooked is the cost of various levels of supervised care. My mother, before she passed, was in assisted living and paying $6000 per month (disclaimer: my sister and I had NO say in her care or financial decisions as she entrusted all of that to her stepchildren). Luckily, she had a long-term care policy which picked up the bill for the first 8-9 months and after that, her monthly pension and savings covered it - but the costs were ridiculous, IMO. $500 per month extra if she chose to have meals brought up to her room instead of going to the dining room.
My aunt (mom’s sister - never married) REFUSES to go into any end-of-life care center or hospital situation. She has an “exit plan” in place, which a few of her closest friends have knowledge of, and written directions on what to do with her home, possessions, estate, etc.
We paid close to 10K per month 11 years ago for “memory care”, augmented by private nursing (it was then $25/hour, I have no idea of current costs) after each hospitalization for something or other. I have friends who have not had to move a parent into a facility who assume it’s “3K a month or something for a studio, right?”. And you ask “Why was Blossom so dumb to pay for private nursing care when rehab would have been covered by Medicare?”
NO REHAB FACILITY would accept a post-hospitalization patient with Alzheimer’s, that’s why. They are set up for wound care, cardiac care, mobility, dialysis, intense PT and OT… but not if the patient also has dementia.
My mother happily moved to an assisted living apartment after my dad passed away (mom was 84 yo at the time). She was in early stage dementia and realized it was not safe for her to live in the house thay had had for 30 years (multi level, isolated location, etc). She had no particular emotional attachment to the house (it was actually my dad’s dream house) or much of the stuff in it.
She was an outlier, I admit.
I don’t want to derail (haha, no pun intended) the larger discussion, but you might consider a stackable washer/dryer combo that could fit into a closet on the main living level. The house we live in (one story) has a water hookup in a hall closet next to the bathroom. The previous owner (elderly) had a washer in there. We have ours down in the basement, but our plan is to eventually put a set in there if the stairs become challenging.
For seniors who need temporary assistance after a short hospital stay due to mobility issues, how is this typically handled by insurance?
I have a family member who recently fell, and broke a few bones. They cannot live without assistance. So at least for a temporary time, they will need rehab care (either in a setting, or with home aides).
The hospital stay was a few days, but “coded” as observation rather than admission, and they were told Medicare will not cover any rehab facility or assistance. In this case long-term care would not apply, since most LTC policies have a waiting period.
Is this temporary aid always self-pay? If Medicare does not cover, the Supplement does not either. Yet it can be VERY expensive, depending on time needed. Is there gap insurance to cover such scenarios?
I am sorry about your family member’s fall. I am not aware of any gap insurance to help cover temporary aid. When Dad went to the hospital after his fall, he was eventually admitted for 5 days and was approved for rehab facility for a short stay. For this particular fall, we decided to bring him home instead and hire private care even though it was expensive bc of his dementia. Previous hospitalization and rehab stay was very stressful on him and family because he didn’t want to stay and wandered too much for the staff.
The lessons I learned from his experience and my FIL’s:
patients have to be admitted for a minimum of 3 days in order to qualify for rehab assistance;
hospitals generally don’t like to keep patients long to qualify for rehab stay esp if they have dementia or Alzhemizer’s. Every doctor always stressed dementia patients do better at home;
better rehab facilities don’t always have space for dementia or Alzheimer’s patients;
rehab facilities strongly prefer patients with traditional Medicare, not Medicare advantage at least in my area or pay premium out of pocket;
having financial resources is key;
having a spouse and adult children nearby to help (daily esp the first few weeks) is very helpful.
Dad died in his home, which was his wish as well as mom’s. He had 24 hour care the last 2 months of his life which was $10k per month. FIL (91) started at an assistance living facility after a fall ($4k per month) and now is at the highest care level at the same facility ($14k per month). It has been about 2 years since his fall. Dad had and FIL has financial resources to make these tragic transitions possible.
That always stinks when hospitals don’t code a medicare admission as just that- and admission! The hospitals get dinged by medicare if there is a re-admission within 30 days, so they play with the codes to avoid that (and call one an “observation”). And who gets hurt? The patient.
We have a long term care policy that is supposed to cover in-home care without the 90 day waiting period. So when we both broke bones within a day of each other, I looked into it. Turns out it is only for an injury or illness that will last longer than 90 days. “gotcha”. so annoying. while we were still on crutches/a cane (respectively) after 90 days, we wouldn’t have met criteria for needing the level of assistance. That’s just wrong
I completely agree with this. It’s esp hard for patients if they don’t have family or someone to help advocate for the patient’s needs. Often patient doesn’t want to stay in the hospital so they are glad to hear that they won’t be “admitted.” This sometimes hurts the patient.
I figure if my knees hurt in my 40s that I shouldn’t count on great mobility in old age. My dad is 80 and is still working pretty much full time. Both of my parents are cognitively pretty good, but my mom has back pain (which I must get from her) that limits her mobility some.
We are in the process of trying to move the laundry upstairs, but there’s no obvious place and then trying to find a contractor/plumber…
LTC , in our case, reimbursed months later after tons of paperwork and phone calls. The money for hospice was out of pocket initially; luckily my parents had the 15K cash the 6 weeks cost.
we were warned by the hospitalist that full time care would be difficult to find – there just aren’t lots of caregivers for that. We decided as a family against it anyway, as it didn’t resolve all the issues.