Author Topic: Do Retirement Facilities Take All of Someone's Money to Enter?  (Read 12454 times)

coppertop

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Do Retirement Facilities Take All of Someone's Money to Enter?
« on: January 03, 2023, 08:38:24 AM »
Long story short:  My MIL is having serious memory issues.  We have seen this coming for years, but certain family members were reluctant to act, and now it's become critical for her to be placed somewhere where she will be safe.  She currently resides in a multi-story condo that isn't meeting her needs and she also has a car, which is scary because she refuses to stop driving.  Her oldest son, who is not my spouse, has power of attorney and he's finally come to the conclusion that something has to be done and is asking the other siblings for assistance in getting her on board and making decisions.  One of his concerns in getting her to move is that she will balk at what he describes as a facility making her sign over all her assets before admitting her.  Does anyone have experience or knowledge in this area?  She's been very tightfisted with her money, even to her own detriment sometimes.  Signing over a large chunk of her money will cause her a lot of anxiety and fear.  She's going to be 88 next birthday.  She's a difficult personality, stubborn and had a mean streak even when she was fully lucid.  Any info would be appreciated. This is going to be a very difficult process, and we are not even sure if one of the siblings will get involved or agree to whatever everyone else decides needs to be done.

slappy

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #1 on: January 03, 2023, 08:49:11 AM »
Following. I am in similar situation, except my MIL should at some point be on Medicaid. Not sure how it all works when it comes to selling her home, etc.

Turtle

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #2 on: January 03, 2023, 08:56:03 AM »
Limited experience here - but I can tell you what one set of grandparents did.

The facility that they moved to had a large flat fee buy in and annual expenses.  However, the annual expenses were capped at the rate you paid when you moved in, unless you swapped to a bigger unit at some point and then they reset.

The buy in money went to cover any expenses over and above due to medical issues, and any unused amount was returned to the family/next of kin upon death.  My grandmother ended up being moved to a memory care ward within the same facility for several years after my grandfather died, but there were no additional expenses because it came out of their buy in money.

Those sorts of things vary greatly depending on the facility, though, so I'd recommend doing research.

In my grandparent's case, there were other people that they already knew who had moved to the same facility.  That greatly eased their transition. 

Zamboni

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #3 on: January 03, 2023, 09:38:09 AM »
^One set of my grandparents went to a nice retirement community with a similar set up. It had surrounding cottages and a central building with apartments, a nursing care facility, and large dining/recreation room. They sold their large home but it did not require them to sign over all of their assets. I'm sure there was some sort of buy in, and they were required by contract to eat a certain number of meals per week in the dining room (not all of the meals as they initially had a kitchen in the cottage). After they moved there my grandfather protected some of their money in a trust for his children to inherit so that my grandmother wouldn't give it all away after his death (which she would have because she was very generous.) My two unmarried great aunts eventually moved into the same facility after my grandparents died, and they were both quite poor and they had small apartments there. I am not sure how the great aunts afforded to move there unless the community also accepted medicare, as one of them never worked at all during her life as far as I could tell. Or it relatives had willed or given them money to be able to do that, which is certainly possible.

My Mom is in a similar situation. She is losing both her marbles and gradually her mobility, and she still drives. Argh! Where she lives there is not even a suitable facility available due to how rural it is. All of the retirement home deaths and visitation lockdowns during COVID has made her even more resistant to such a set up (if that is even possible; she has always been adamantly against retirement homes.) My brother and I are not at all sure what to do. She lives near him and is pretty much driving him up the wall with her antics.

All of this makes me vow to do it how my grandparents did it: find a nice retirement community I like and move there before I lose my marbles or mobility.

Good luck with your MIL! You certainly have my sympathy!

BFGirl

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #4 on: January 03, 2023, 09:49:06 AM »
My parents plan to utilize a buy in community when and if necessary.   However, most facilities are pay by the month.  There are nursing homes if the person needs 24 hour care and there are assisted living homes if the person is able to handle their activities of daily living but need some help and medication assistance.  Research is key.

Dicey

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #5 on: January 03, 2023, 09:56:35 AM »
There are many types of care facilities.  You may be conflating the "spend down virtually all your money to qualify for aid requirement for government assistance*" with "this fancypants place costs a fortune, including a huge buy-in and monthly fees".



*Typically, Medicare does not pay for assisted living expenses. https://www.aarp.org/health/medicare-qa-tool/does-medicare-cover-assisted-living/

mistymoney

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #6 on: January 03, 2023, 10:17:18 AM »
could those mentioning a "huge buyin" initial payment share what that payment was?

Turtle

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #7 on: January 03, 2023, 10:41:24 AM »
In my grandparents case it was the mid 1990's and low 6 figures but I'm not sure of the exact amount.

Just Joe

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #8 on: January 03, 2023, 02:04:48 PM »
Someone we know is moving to a very nice version. $800K up front... Non refundable. Cottage/condo with a view.

We knew of someone else who moved to the same place, same price. Both members of the couple died within a couple of years. The family is working to get some of the money back. Pro-rated so to speak. No idea if they are having success.

There are other plans at this place. Monthly rentals in the $3K-$5K range. Includes a certain amount of assistance and dining room access. Basically a two room hotel arrangement. One room is the bedroom and bath, other room is the sitting area and efficiency kitchen. Pretty nice and help is a button tap away. Lots of social activities, gym, library, pool, etc.

A relative of mine could not afford care but went into a medicare facility (needed alot of help) and they did take most of relative's money and social security. There was a financial survey to make sure they weren't hiding assets such as property or cars. This facility saw them out of this world into whatever is next. The facility did a nice job.
« Last Edit: January 03, 2023, 02:06:55 PM by Just Joe »

LifeHappens

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #9 on: January 03, 2023, 02:27:56 PM »
One of his concerns in getting her to move is that she will balk at what he describes as a facility making her sign over all her assets before admitting her.
So, Medicare does not typically pay for long-term care. They will pay for short-term care at a nursing home or rehabilitation center after a hospital stay, but if MIL is going into memory care for the rest of her life they will not cover this.

What usually happens is memory care is really expensive and people don't have enough cashflow to cover it. In this case, they are required to spend down their assets for as long as they last, then they are enrolled in Medicaid. It varies from state to state, but usually Medicaid can take all or part of the value of any home the patient owns in compensation for the cost of care.

A common scenario is 1) person goes into memory care and is able to pay from assets for X number of months 2) those assets are spent down, they go on Medicaid 3) Medicaid starts running a tab against the value of the patient's home and either seizes the home or the estate will have a bill to pay upon the patient's death.

This is complex stuff and I would highly recommend you reach out to whichever agency handles senior services in your MIL's county.

geekette

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #10 on: January 03, 2023, 03:00:45 PM »
Many people do conflate Medicare (doesn't pay for LTC) and Medicaid (will pay once your money runs out).

One aunt went into a memory care place, and paid monthly out of her considerable savings (one of my cousins had power of attorney and took care of the money stuff).  She died last year with about a year and a half's worth of money left. 

My mother's twin recently went into one of those very nice buy in places.  No one likes to talk about money, but from what I gathered, it was mid 6 figures for the buy in, and about $5k/month for her 2 bedroom with kitchen apartment.  Some of that money goes towards meals, activities, and I think rides to appointments, the cost of which is taken from some sort of allowance (she mentioned while we were there that she was taking leftovers home from a restaurant at lunch so she didn't have to "pay" for that evening's dinner).

She showed us the apartment next door, which was undergoing renovation.  Part of the buy in goes toward new everything - the new occupant picks out fresh floors, paint, kitchen appliances, bathroom fixtures.

I'm trying to get my mother to at least look at places here (we live in NC, both aunts live(d) in more expensive north eastern state).  She's said many times she wants to go in "while I can still walk and talk", and she is doing very well for 87, but...she won't go visit.  I think it's just a mortality thing.

reeshau

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #11 on: January 03, 2023, 03:13:06 PM »
This is complex stuff and I would highly recommend you reach out to whichever agency handles senior services in your MIL's county.

Not only the agency, but I also recommend contacting an estate attorney, especially if there is something of MIL's that the family wants to keep.

My Mom has been involved in 2 complex cases, and two simple cases.  Her mother and stepfather went into a nursing home, and were gone after 2 years, within 6 months of each other.  They owned a small home, had cars, etc.  There was a lot to go through, but not too complicated.

She also was a conservator for her older sister, who had some memory issues in addition to longstanding physical issues, and went on medicaid.  Her facility even took her SS payments, and gave her a very small allowance.  It was right for her, as she would often fall victim to phone scams, or try to hire taxi drivers to go get her cigarettes.  It was a sad ending for a dedicated high school teacher, but it was the setting she needed, and most of the time she was content.

I consider this practice for my stepfather, who had a motorcycle accident in 2005 with a TBI, and has been on disability Medicare ever since, in various facilities.  Mom has been planning since Day 1 for him to eventually go on medicaid, after insurance payments ran out (lifetime payouts) and comingled assets are spent down.  In addition to working to protect the house, at least as long as she will stay there, they owned a small business, so she has been moving ownership to my two brothers, who work in it.  Lots of details, lots of pitfalls, lots of chefs in the kitchen.  She still regularly works with an estate attorney, not just to make sure steps are executed, but also to keep on top of what legal changes have happened over time.

You never know how sticky these things will get.  What might seem like overkill in the beginning can be just right, or even not enough.  And sometimes you can't recover from early missteps.

secondcor521

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #12 on: January 03, 2023, 03:30:21 PM »
My Dad lives in one of the nicer retirement places.

They actually offer a number of plans.  Very broadly speaking, you can put down a buy-in of maybe $250K and then have a smaller monthly rent payment, or you can forego the buy-in and have a larger monthly rent payment.  The difference in the rent payments compared to the buy-in worked out to about a 7% rate of return.  My parents chose to forego the buy-in and pay the larger monthly rent payment, putting their house proceeds into the market instead; 15 years later this seems to have been the better choice financially.

But we also considered that the contract with the buy-in was vague about when and how and how much of the buy-in would be refunded, especially in cases where half of the couple might end up in assisted living or memory care.  Although they ended up happy where they were, the buy-in also would have made it more difficult to move out or switch to a different place if they had been unhappy.

Bottom line, though, is that there are lots of different places with lots of different plans.  Do your research, ask lots of questions, talk to the residents, gather as much info as you can.

I do think the prices you hear will vary quite a lot by location and local COL.  Places similar to my Dad's place but in HCOL areas are probably twice or three times the monthly rent and buy in.

Also, since you mentioned cognitive issues, you probably want a place that has a memory care unit attached to it and at least some sort of idea or assurance that she can get into it when needed.  She may need to go directly there and not even stay in assisted or independent living.

FIREin2018

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #13 on: January 03, 2023, 04:30:17 PM »
There are many types of care facilities.  You may be conflating the "spend down virtually all your money to qualify for aid requirement for government assistance*" with "this fancypants place costs a fortune, including a huge buy-in and monthly fees".


*Typically, Medicare does not pay for assisted living expenses. https://www.aarp.org/health/medicare-qa-tool/does-medicare-cover-assisted-living/
People are confusing Medicare (age 65+) and Medicaid (poor).

Medicaid does pay for nursing homes but you have no assets and very little $ to qualify.
States usually have a 5yr look back period so that you dont xfer everything to qualify.

In these govt aid nursing homes, you pay what you can (from social security and pensions) and Medicaid will pay the difference up to a certain point.
the nursing home will eat the amount not paid. (Think doctor/hospital fees and negotiated medical insurance payouts)

When the time comes, i plan to put my mom in a hybrid nursing home.
It takes private patients and medicaid.
care and facilities are the same for both types of people. The difference is that for Medicaid, it's 2 to a room.

Oh wait.. you're talking about assisted living?
hm.. never thought about that option.
« Last Edit: January 03, 2023, 04:41:24 PM by FIREin2018 »

Zamboni

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #14 on: January 03, 2023, 04:57:47 PM »
Here are the amounts and some contract details for the nicest retirement community that is near me:

Entrance Fee Range $97,970 – $615,891

Monthly Fee Range $3,342 – $8,013

Contract Options Modified: Entrance fee and monthly payments cover housing, residential services such as meals and housekeeping, and some health-related services. Health-related services are provided at a greatly discounted rate and are free for a specified number of days.

Refund Options: The Facility retains $10,000 of each person’s entry fee as a health care reserve. The remaining balance of the entry fee, the residence fee, is refundable based on the following plan: 2% of the Residence Fee accrues to The Facility each month. The refund decreases to zero over 50 months.

snic

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #15 on: January 03, 2023, 07:45:47 PM »
Facilities vary a lot in regards to their cost structure. My mother was in a very nice independent living facility (that also had assisted living and memory care options) for a decade, and they did not have any upfront buy-in requirement. That's one reason why she chose it. Just recently I moved her to an assisted living facility that is near me, in a high COLA area on the east coast. This place does have enormous buy-in fees for independent living that depend on the size of the apartment/cottage (high six figures into seven figures). You can opt for higher rent and 100% of the buy-in fee will be returned when you leave, or lower rent and only 80% will be returned. Independent living rents are something like $5k-$10k depending on size, whether you are single or a couple, and which buy-in option you choose.

Fortunately, for assisted living, there was no buy-in. Rents start at around $9k for a studio and $11.5k for a one bedroom, but you have to pay extra for some services like medication management. So the monthly cost for my mother is $12.5k and that is going up by 8% in a few months. It's completely outrageous, but my mother has long-term care insurance, a decent pension and survivor's pension from my father, and social security, and rental income from her house. There will be a shortfall that will gradually deplete her savings, but most likely not until she is over 100 (she is 90).

Interestingly, memory care is actually not really more expensive than an assisted living 1BR apartment (around $13k/mo).

flyingaway

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #16 on: January 03, 2023, 08:00:51 PM »
Here are the amounts and some contract details for the nicest retirement community that is near me:

Entrance Fee Range $97,970 – $615,891

Monthly Fee Range $3,342 – $8,013

Contract Options Modified: Entrance fee and monthly payments cover housing, residential services such as meals and housekeeping, and some health-related services. Health-related services are provided at a greatly discounted rate and are free for a specified number of days.

Refund Options: The Facility retains $10,000 of each person’s entry fee as a health care reserve. The remaining balance of the entry fee, the residence fee, is refundable based on the following plan: 2% of the Residence Fee accrues to The Facility each month. The refund decreases to zero over 50 months.

which state (and city if possible to disclose) is this community located? Is this for a single person or for a couple? Do the fees increase if the person later needs living assistance or memory care?

FIREin2018

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #17 on: January 03, 2023, 09:29:49 PM »
Fortunately, for assisted living, there was no buy-in. Rents start at around $9k for a studio and $11.5k for a one bedroom, but you have to pay extra for some services like medication management. So the monthly cost for my mother is $12.5k and that is going up by 8% in a few months. It's completely outrageous, but my mother has long-term care insurance, a decent pension and survivor's pension from my father, and social security, and rental income from her house. There will be a shortfall that will gradually deplete her savings, but most likely not until she is over 100 (she is 90).

Interestingly, memory care is actually not really more expensive than an assisted living 1BR apartment (around $13k/mo).
Which long term care insurance did she buy?

herbgeek

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #18 on: January 04, 2023, 04:28:04 AM »
My mom is in a memory care unit of an assisted living facility.  No buy in and monthly costs are about 7K.  This is in New England.

slappy

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #19 on: January 04, 2023, 06:42:52 AM »
My mom is in a memory care unit of an assisted living facility.  No buy in and monthly costs are about 7K.  This is in New England.

I am in NE as well. My mom recently visited our local VA nursing home and was quote 9k a month.

There is definitely a difference between a nursing home type of facility and the types of facilities that some posters are describing with the buy in. We have a facility like that locally, but we have not explored it yet.

LaineyAZ

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #20 on: January 04, 2023, 07:06:06 AM »
In addition to what others have said, there are For-profit and Not-for-profit facilities, so check that aspect too.

And double-check the refundable policy - a friend's mother passed away after less than 6 months in an assisted living facility and my friend did get a pro-rated refund of the buy-in fees but that's not always the case.

In most situations I'm aware of, the family will sell the person's primary home which funds the initial months/years for the assisted living or memory care. When that money runs out is when they turn to Medicaid for help.  But each state's Medicaid rules are different and not every facility accepts Medicaid so overall best advice is talk to a geriatric social worker and an estate attorney now.

GilesMM

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #21 on: January 04, 2023, 07:12:37 AM »
The up-front payment places are gambling that you will die sooner rather than later and they will profit off that. If you live longer, they will make less.  These places generally have a six figure buy-in fee and monthly fee, but they offer all the services you will ever need to end of life without price increases.    Some offer a partial refund if you die within the first few years.


Other places are pay-as-you go.  You could start off with a nice apartment for $4,000/mo, then need partial care for $5,000, nursing assistance $7000/mo, then full on medical care $10,000/mo.


So, it is all a gamble.  Pay-as-you go can get really expensive and one could run out of money for it.  Up-front payment could be a waste of money if you don't live a long time and need all the services it is intended to pay for.

Cranky

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #22 on: January 06, 2023, 08:43:18 AM »
We moved my mom into a pay as you go assisted living. She started out in memory care and then they moved her to another area because it was quieter and she didn't wander, and then in her last few months they moved her back to memory care.

She had an ancient long term care policy, which tried not to pay, but my bil hounded them until she did. She died just as it was running out - 3 years I think - and then you spend down your assets and then Medicaid takes over.

Some places we looked at didn't accept Medicaid at all, but many of them would let you enter private pay and then go on Medicaid as your money ran out.

People are typically in memory care for under 3 years, so you can run your own numbers.

snic

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #23 on: January 06, 2023, 06:21:46 PM »
Fortunately, for assisted living, there was no buy-in. Rents start at around $9k for a studio and $11.5k for a one bedroom, but you have to pay extra for some services like medication management. So the monthly cost for my mother is $12.5k and that is going up by 8% in a few months. It's completely outrageous, but my mother has long-term care insurance, a decent pension and survivor's pension from my father, and social security, and rental income from her house. There will be a shortfall that will gradually deplete her savings, but most likely not until she is over 100 (she is 90).

Interestingly, memory care is actually not really more expensive than an assisted living 1BR apartment (around $13k/mo).
Which long term care insurance did she buy?

Unum. I've actually been quite pleased with their claims department. They're on top of it, there is a single contact person for my mother's claim, I can reach that person easily by phone or email, and their process has been efficient and their decision-making reasonable. They do follow the policy to the letter, but that's to be expected. I think my parents bought their policies around 1999, and the inflation increases have long since reached their cap. $4800/month for assisted living is less than half of what it costs now (here; in other parts of the country it's cheaper), and the lifetime cap is about 4 years worth of $4800 payments.

coppertop

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #24 on: January 07, 2023, 07:41:22 AM »
At this point, the siblings are still talking about what to do.  Things seem to move so slowly for them that I wonder if anything will actually ever get done.  Oldest son did find a facility with a one-bedroom that I believe she could afford.  I know she is going to balk at the cost, and I'm not sure if they are all willing to be strong enough to stand up to her.  My husband is, but he can't get anywhere alone.  She's always had quite a difficult personality and a master at manipulating her kids no matter how old any of them are.  She really shouldn't stay where she is - three levels and if she fell, it would be a disaster.  And she definitely shouldn't be driving.  The state where she lives doesn't automatically screen seniors for driving, and she hasn't been to a doctor in years ... not for lack of the family trying, but she has dug in her heels.

scottish

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #25 on: January 08, 2023, 09:43:01 AM »
Both my parents, my MIL and my FIL paid a monthly fee.   (Only my MIL is left, and she still pays a monthly fee.)    Figure 10-12K CAD/month for a nice place in a long term care home in Toronto.   Ottawa was cheaper, but also lacking in nicer places.    Retirement homes are also cheaper, but will provide less care.

I've never heard of signing over all your assets to a long term care home.   That sounds like a bad idea in so many ways.  (eg fraud, bankruptcy, lock-in to one place, ...)

wenchsenior

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #26 on: January 08, 2023, 10:47:09 AM »
Both my parents, my MIL and my FIL paid a monthly fee.   (Only my MIL is left, and she still pays a monthly fee.)    Figure 10-12K CAD/month for a nice place in a long term care home in Toronto.   Ottawa was cheaper, but also lacking in nicer places.    Retirement homes are also cheaper, but will provide less care.

I've never heard of signing over all your assets to a long term care home.   That sounds like a bad idea in so many ways.  (eg fraud, bankruptcy, lock-in to one place, ...)

It's functionally the only way most people in the U.S. can get/afford care outside having family members care for them. The government only covers LTC here if you are completely destitute, and the costs are comparable to what you describe, which is far beyond the means of most people.  My father is being cared for at home right now and it's costing about 16K/month. His money will run out in about 2 years, at which point in order to qualify for gov't care, the rights to his property and house sale must revert to the state [at least insofar as they offset the cost of his care for as long as he ends up living]).

scottish

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #27 on: January 08, 2023, 02:37:46 PM »
Both my parents, my MIL and my FIL paid a monthly fee.   (Only my MIL is left, and she still pays a monthly fee.)    Figure 10-12K CAD/month for a nice place in a long term care home in Toronto.   Ottawa was cheaper, but also lacking in nicer places.    Retirement homes are also cheaper, but will provide less care.

I've never heard of signing over all your assets to a long term care home.   That sounds like a bad idea in so many ways.  (eg fraud, bankruptcy, lock-in to one place, ...)

It's functionally the only way most people in the U.S. can get/afford care outside having family members care for them. The government only covers LTC here if you are completely destitute, and the costs are comparable to what you describe, which is far beyond the means of most people.  My father is being cared for at home right now and it's costing about 16K/month. His money will run out in about 2 years, at which point in order to qualify for gov't care, the rights to his property and house sale must revert to the state [at least insofar as they offset the cost of his care for as long as he ends up living]).

Wow, that seems crazy - but maybe it's just a matter of perspective.   

I've always wondered why people on the forum don't seem concerned about increased costs for assisted living at end of life.     For example, MMM doesn't seem to advocate for a planned increase in spending as you reach your golden years and need some help to make meals and other essential activites.    Is this the reasoning?    Fallback to public LTC if necessary?

Privately run LTC facilities in Canada are substantially nicer than the public ones.     We plan to be able to afford something nice (assuming there's no fatal misadventure instead).

wenchsenior

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #28 on: January 08, 2023, 04:06:15 PM »
Both my parents, my MIL and my FIL paid a monthly fee.   (Only my MIL is left, and she still pays a monthly fee.)    Figure 10-12K CAD/month for a nice place in a long term care home in Toronto.   Ottawa was cheaper, but also lacking in nicer places.    Retirement homes are also cheaper, but will provide less care.

I've never heard of signing over all your assets to a long term care home.   That sounds like a bad idea in so many ways.  (eg fraud, bankruptcy, lock-in to one place, ...)

It's functionally the only way most people in the U.S. can get/afford care outside having family members care for them. The government only covers LTC here if you are completely destitute, and the costs are comparable to what you describe, which is far beyond the means of most people.  My father is being cared for at home right now and it's costing about 16K/month. His money will run out in about 2 years, at which point in order to qualify for gov't care, the rights to his property and house sale must revert to the state [at least insofar as they offset the cost of his care for as long as he ends up living]).

Wow, that seems crazy - but maybe it's just a matter of perspective.   

I've always wondered why people on the forum don't seem concerned about increased costs for assisted living at end of life.     For example, MMM doesn't seem to advocate for a planned increase in spending as you reach your golden years and need some help to make meals and other essential activites.    Is this the reasoning?    Fallback to public LTC if necessary?

Privately run LTC facilities in Canada are substantially nicer than the public ones.     We plan to be able to afford something nice (assuming there's no fatal misadventure instead).

To be honest, I think this forum skews young enough, and people have often not given enough thought/done enough research, to really plan for it.  Every time the topic comes up, there's a segment of people who have really planned, a segment that hadn't worried about it b/c they think Medicare (gov't health insurance that everyone in the U.S. qualifies for at 65) covers nursing homes or care at home (it does not, except for short stints after a hospital stay), and a segment that simply hasn't given it much thought or doesn't realize how staggeringly expensive it is.

ETA: Lots of people also seem to handwave it thinking they won't need care for long. It is true that in the U.S., most nursing home stays last less than 2 years, but as we've noted, that can easily more than burn up any savings for most people (though many people on this board might have more than 300K available). And my experience with my own family is that nearly all of the people who have ended up needing full time care have needed it for well over 2 years (both my grandmothers required more than 5 years, for example, as did two of my great aunts, and my grandfather who lived long enough needed care for about 3 years).

The other challenge is that if one half a couple needs extensive care but the other doesn't, the healthy spouse is left with almost nothing to live on in order to qualify for state care for the sick spouse. Divorce is a reasonable option in this case, certainly one my beloved and I would consider in that case.

My father's healthy wife, from whom he was separated but not divorced, had to divorce him to protect her own financially security when it became clear he was going to shortly need 24/7 care. Otherwise she would be on the hook to pay down all of her savings to pay for his care.

It's quite a bad situation.
« Last Edit: January 08, 2023, 04:14:32 PM by wenchsenior »

Car Jack

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #29 on: January 08, 2023, 04:51:32 PM »
I've looked at facilities sort of as an aside when one relative was in assisted living where the facility had the option to move into memory care as needed and then while looking at independent living facilities for both my mom and FIL.  Overall, we've seen integrated facilities where memory care residents come for some activities and meals with assisted living and independent living residents.  Some have separate buildings for memory care.  Some have no accommodation for anyone beyond mild need over independent living.

I've also seen entry and pricing all over the map.  Several had full pay for 2 to 4 full years, then they will accept your assets and any income (social security, pension, annuity) to pay.   Others are as has been mentioned with from 1/2 month rent to over $500k buy in, then monthly rent.  One was a city run facility where you needed to qualify with a maximum income and then they subsidized the monthly which at the time was around $10k per month to the patient.  Most places with over 6 figure buy ins did either refund this to heirs upon the patient's death or a portion of it, according to a formula.

On another subject, a POA doesn't allow someone to do something the person doesn't want done.  So be careful about that.  And the person can rescind the POA at any time simply by saying so with a witness hearing.  To have control over a person who is incompetent requires a court to order it, so you'd need to subject the person to testing that they would have to fail.  We've gone through that process with someone who sounds like the subject here.  She had the ability to "snap" to being a normal person when forced to and the testing failed, so she was not under DW's control. 

rmorris50

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #30 on: January 08, 2023, 04:53:23 PM »
At this point, the siblings are still talking about what to do.  Things seem to move so slowly for them that I wonder if anything will actually ever get done.  Oldest son did find a facility with a one-bedroom that I believe she could afford.  I know she is going to balk at the cost, and I'm not sure if they are all willing to be strong enough to stand up to her.  My husband is, but he can't get anywhere alone.  She's always had quite a difficult personality and a master at manipulating her kids no matter how old any of them are.  She really shouldn't stay where she is - three levels and if she fell, it would be a disaster.  And she definitely shouldn't be driving.  The state where she lives doesn't automatically screen seniors for driving, and she hasn't been to a doctor in years ... not for lack of the family trying, but she has dug in her heels.
As some who has an extremely stubborn aging mother, it’s not about standing up to her, but at the end of the day I can’t force her to do anything. She has to decide to help herself, and she won’t. So I’ve just accepted the fact she’ll either die alone in her apt, or go broke ( which is very soon) and go on Medicaid, and when she needs nursing care it’ll have to be Medicaid, or come and live with me if she doesn’t quite need nursing care yet. But I refuse to give in to her guilt trips so she paints me as the cold uncaring son. But it is what it is.


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Dancin'Dog

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #31 on: January 08, 2023, 08:22:23 PM »
Beware of places with nonrefundable buy-ins.  What happens if you don't like it, or need to move, etc.?  Circumstances can change.  Your family may get a job transfer.  The facility's food quality may decline.  You may pass away shortly after moving in.  These are all things where you'd hope to receive some kind of refund.  When we were shopping one of the high-end facilities only offered a prorated refund for the first 12 months.  Their buy-in prices at the time ranged from $125-$450K.  Besides that, they only had about 12 rooms in their nursing facility.  So, it was obvious to me that they weren't able to care for the residents as they aged out of the 200+ independent apartments. 


I put a small ($1000) deposit on a nice looking waterfront independent living facility( Williams Place, Davidson) that was under construction nearby which had no buy-in.  It was initially intended for my father but as circumstances changed my mother ended up living there, and my father went in a facility with full nursing care.  So, I learned a lot about elder care in a short time.  (Lake Norman / Charlotte, NC area) 
Mom liked it fine at first & lived there for almost 2 years, but grew tired of the long wait for meals & the management and decided to move. 
In the meantime dad lived at the nursing facility (Aldersgate, Charlotte) for about 12 months until he passed away.  While he was there they opened a brand-new 5-wing, 120-room, single-level nursing facility.  It was about $8K per month in 2018.  The new building was very impressive, each wing has its own dining room, a sitting room with a fireplace, a larger sitting room with a TV, a central courtyard with a screened-in porch, etc.  Their nursing staff was top-notch, very friendly, and always happy to answer my questions. 
A couple of years later mom decides it's time to move back into an independent living facility.  I'd been so impressed with Aldersgate that we decided to see what they had to offer. They do have buy-in, but they offer 3 different levels.  The one we chose offers a 90% refund.  We chose a small one-bedroom that had a buy-in of $140K, and a monthly with includes meals of $2,850 (for 2022).  They just began an advertised special the day after we signed, so the sales agent gave me a $15K surprise refund.  That was cool. 
Mom's been there for about 18 months and is quite happy.  The staff is very friendly, the buildings & grounds are well kept, and most importantly, the food is good.  There is a fine dining room, a cafe, a pub, a coffee & juice bar, and an ice cream parlor.


The campus is 230 acres, and has an area of single-family type homes, cottages, 2 new condo type buildings with underground parking, an 8-floor main building, 3 or 4 condos  adjoining the main tower, a separate single-level memory care facility, and then the nursing care facility, which includes a rehab wing & a hospice wing.  Aldersgate also has 2 Doctors on staff & a health clinic on site.


I recently heard that Aldersgate is partnering with the Jewish Community Center and opening a new facility on Providence Rd.  Which will be opening soon.  I'd expect their rates to be a bit higher because of the its location.


I realize some of my descriptions of Aldersgate may sound like a sales pitch and few of you will need a place in Charlotte, but many of the things they offer are important  things to consider when looking for a place for your loved ones to live. 


The 2 most important things are the quality of their food and whether they have the facilities available to transition into


IMO, it's foolish to move into an independent living facility that doesn't also have assisted living, memory, and nursing care.  It is doubly important for a couple.  Moving a mate totally off-site would be tragic.  (Not to mention a logistical PITA when you visit them & deal with the management(s).)


My inlaws are at a fancier place near Atlanta.  The food is great, but there's not an affordable option on the menu.  They have memory care but there's a wait list for it.  There is assisted living, but I don't think they have full nursing care available.  It feels like living in a fancy hotel (except it's not close to anything worthy of the rates).  It would be a great place for healthy 75-year-olds, but my inlaws are 87, and FIL has dementia. 




















sui generis

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #32 on: January 09, 2023, 10:23:35 AM »
How did you all find facilities to research and visit in the first place?  Was it just pure blunt force searching or is there some sort of aggregator, like Kayak or Expedia, where you can filter by various elements and characteristics?

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #33 on: January 09, 2023, 11:10:02 AM »
How did you all find facilities to research and visit in the first place?  Was it just pure blunt force searching or is there some sort of aggregator, like Kayak or Expedia, where you can filter by various elements and characteristics?

I don't know of any aggregators.

I just googled "retirement homes near me" and the CCRC where my Dad lives was one of the 10 or 15 search results.  You can then go to their websites or call and ask if they have whatever it is you're looking for.  Also, most higher end places have sales representatives who will give you a tour, let you eat a meal there, and go over pricing and availability.  I think it's a good idea also to talk to several of the residents to get the unvarnished reality instead of the curated brochure.

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #34 on: January 09, 2023, 11:47:30 AM »
There are many types of care facilities.  You may be conflating the "spend down virtually all your money to qualify for aid requirement for government assistance*" with "this fancypants place costs a fortune, including a huge buy-in and monthly fees".

*Typically, Medicare does not pay for assisted living expenses. https://www.aarp.org/health/medicare-qa-tool/does-medicare-cover-assisted-living/

The spend down assets is a Medicaid (US state program with varied rules).   
I was unaware of upfront buy-in.   

My experience is assisted living (mobility and slight cognitive issues) is 5000- 6000 $USD / month. 
 Home care for 6hours/day 7 days/ week is 6000 $USD / month.

scottish

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #35 on: January 09, 2023, 03:36:28 PM »
Both my parents, my MIL and my FIL paid a monthly fee.   (Only my MIL is left, and she still pays a monthly fee.)    Figure 10-12K CAD/month for a nice place in a long term care home in Toronto.   Ottawa was cheaper, but also lacking in nicer places.    Retirement homes are also cheaper, but will provide less care.

I've never heard of signing over all your assets to a long term care home.   That sounds like a bad idea in so many ways.  (eg fraud, bankruptcy, lock-in to one place, ...)

It's functionally the only way most people in the U.S. can get/afford care outside having family members care for them. The government only covers LTC here if you are completely destitute, and the costs are comparable to what you describe, which is far beyond the means of most people.  My father is being cared for at home right now and it's costing about 16K/month. His money will run out in about 2 years, at which point in order to qualify for gov't care, the rights to his property and house sale must revert to the state [at least insofar as they offset the cost of his care for as long as he ends up living]).

Wow, that seems crazy - but maybe it's just a matter of perspective.   

I've always wondered why people on the forum don't seem concerned about increased costs for assisted living at end of life.     For example, MMM doesn't seem to advocate for a planned increase in spending as you reach your golden years and need some help to make meals and other essential activites.    Is this the reasoning?    Fallback to public LTC if necessary?

Privately run LTC facilities in Canada are substantially nicer than the public ones.     We plan to be able to afford something nice (assuming there's no fatal misadventure instead).

To be honest, I think this forum skews young enough, and people have often not given enough thought/done enough research, to really plan for it.  Every time the topic comes up, there's a segment of people who have really planned, a segment that hadn't worried about it b/c they think Medicare (gov't health insurance that everyone in the U.S. qualifies for at 65) covers nursing homes or care at home (it does not, except for short stints after a hospital stay), and a segment that simply hasn't given it much thought or doesn't realize how staggeringly expensive it is.

ETA: Lots of people also seem to handwave it thinking they won't need care for long. It is true that in the U.S., most nursing home stays last less than 2 years, but as we've noted, that can easily more than burn up any savings for most people (though many people on this board might have more than 300K available). And my experience with my own family is that nearly all of the people who have ended up needing full time care have needed it for well over 2 years (both my grandmothers required more than 5 years, for example, as did two of my great aunts, and my grandfather who lived long enough needed care for about 3 years).

The other challenge is that if one half a couple needs extensive care but the other doesn't, the healthy spouse is left with almost nothing to live on in order to qualify for state care for the sick spouse. Divorce is a reasonable option in this case, certainly one my beloved and I would consider in that case.

My father's healthy wife, from whom he was separated but not divorced, had to divorce him to protect her own financially security when it became clear he was going to shortly need 24/7 care. Otherwise she would be on the hook to pay down all of her savings to pay for his care.

It's quite a bad situation.

Less than 2 years?    My mother had dementia and she lasted about 10 years in long term care.    My grandmother was up around 15 - that one's harder to remember, although I do remember it was *not* a good time.   

There are lots of shenanigans in Canada around long term care as well.    Seniors will be left in acute care in a hospital as their kids try to get them into their preferred home.    The LTC people will use sneaky tactics to get you into whatever empty spots they have even if they're not well suited to your needs.    It's not a very pretty picture, and the best individual solution is to be wealthy enough to use the high end private care homes. 

And the private places had lots of problems during the pandemic anyway, so there really aren't any guarantees.

Dancin'Dog

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #36 on: January 09, 2023, 07:07:51 PM »
How did you all find facilities to research and visit in the first place?  Was it just pure blunt force searching or is there some sort of aggregator, like Kayak or Expedia, where you can filter by various elements and characteristics?




Good question.


When I first began searching, the choices available were overwhelming.  I was acting as my dad's caregiver, which involved dealing with his medical providers as well as working towards getting his financial and legal affairs in order.  So, I asked all of the professionals that I'd been working with, and of course friends and neighbors, for recommendations but nobody really had much advice beyond the few places nearby.  They mostly seemed to fear the unknowns of it as much as I did, even the doctors. 


Dad had a sodium imbalance which put him in the hospital.  He needed a place to recover, and since he was on a feeding tube (he'd had throat cancer & couldn't swallow food or water) the choices of facilities that were able to care for him were limited.  Aldersgate was recommended.  I'd also been in touch with a palliative care agency a few months earlier, so gave them a call for their advice.  They raved about Aldersgate, so I went and checked it out. 


From what I've learned, I would start the search by looking for facilities that are equipped to handle the worst cases because life is downhill from here.  It's foolish to shop for a country club lifestyle when your health is already in decline.  I'm not saying that it doesn't need to be a nice place, but their capacity to fully care for your loved one(s) until the end is paramount. 


You do not want to have to relocate your parents as their bodies and/or minds begin to decline. 


I'd contact palliative care agencies and ask for their personal recommendations for local full-care facilities.  Then I'd ask for tours of them and inquire about their capacity for each level of care.  The number of rooms they have in independent living, assisted living, memory care, and nursing care.  Ask about the vacancies and/or waitlists for each.  Ask what the nurse-to-patient ratio is for each, as well as the night shift ratios.  Try their food, of course, it has to be good but also be sure to notice how long it takes to finish.  Ideally, independent living should serve restaurant style, with a window of seating times.  Some places have everyone arrive for meals at the same time, which means it takes forever to serve everyone.  While you're there be sure to chat with a few of the residents.  They'll be happy to tell you what they like and dislike.  If your visit happens to be on a weekend you'll be more likely to also meet their families, who will offer their perspectives.  Chat with the wait staff too if you can.  Do they seem friendly and happy to be there, or do they seem stressed and overworked? 
As you shorten the list of potential facilities, I'd suggest you ask for a tour of the next levels of care, just to be sure they're good too.   


This isn't an easy task.
Good luck

iluvzbeach

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #37 on: January 09, 2023, 07:19:03 PM »
@GreenEggs, thank you for providing such detailed responses.  The information you've shared will undoubtedly be helpful to not only the OP, but to many others of us as well.  Again, thank you.

Dancin'Dog

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #38 on: January 09, 2023, 08:24:54 PM »
@GreenEggs, thank you for providing such detailed responses.  The information you've shared will undoubtedly be helpful to not only the OP, but to many others of us as well.  Again, thank you.


I really feel fortunate to have found the right place for my folks.  Elder care isn't one of those things that we like to think about until we have.   I'm just trying to share the Cliff Notes to make it a bit easier for whoever's facing it next.


 




coppertop

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #39 on: January 10, 2023, 07:54:51 AM »
One thing I'd recommend to everyone is don't wait until you are 87 until you or your loved ones decide you  need to move.  My MIL is going to have a very difficult transition if and when she does move.  My DH and I moved recently to a town where one of our children lives, because all of the children relocated to distant states when they married and accepted new employment.  We would have had no one to help us nearby when we are in our 80s and beyond.  Currently we are in our 60s and retired, and even so, my DH is having a difficult time accepting our new location.  Some people are not as flexible or adaptable, and he is one of them, but he has time to adjust before we are in a situation where we need the assistance of our kids. 

coppertop

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #40 on: January 17, 2023, 09:20:47 AM »
Update:  Family member has been looking into facilities and found a senior complex with no buy-in that will cost about $4,000 a month.  She hasn't been approached yet, and that is planned for later this month.  I predict that she will balk at that $4,000 a month.  The adult kids will lay out what she is already paying for everything to demonstrate to her that she can afford it - everything is included in that place except for internet/cable/phone - but she is very likely to say she can't understand it all and it's way beyond her in an attempt to shut the whole thing down. 

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #41 on: January 17, 2023, 09:34:10 AM »
Update:  Family member has been looking into facilities and found a senior complex with no buy-in that will cost about $4,000 a month.  She hasn't been approached yet, and that is planned for later this month.  I predict that she will balk at that $4,000 a month.  The adult kids will lay out what she is already paying for everything to demonstrate to her that she can afford it - everything is included in that place except for internet/cable/phone - but she is very likely to say she can't understand it all and it's way beyond her in an attempt to shut the whole thing down.
OMG, $4k sounds like a bargain. One concern is how they handle residents who might develop dementia. Many places don't handle it, so the frail person is forced to move yet again. Just something to think about.

kite

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #42 on: January 17, 2023, 02:28:21 PM »
I’m on my 3rd relative with dementia.
First was a childless aunt with Alzheimer’s. She was in a facility that cost $600/day. LTC paid 1/3, SS, Pension & savings paid the remainder. Her memory was good enough when she went in that she was miserable, calling all day to be let out. A combination of physical disability and an inaccessible home meant that in-home care (which she wanted) was not an option. Lesson for me: make my house fully accessible.

Next was her younger brother, also effectively childless.  His memory issues were exacerbated by loss of oxygen to the brain. An internal bleed was suspected but never found. Ultimately, a tumor was ID’d as the cause. He had Medicaid. When he needed a nursing home bed, there was no charge to the family.

Now I care for my mother who is 7 years from symptom on-set,  6 years with a diagnosis of vascular dementia. It is less expensive to keep her at home with family pitching in and 3 aides throughout the week. And while she doesn’t know who I am most of the time, she knows the route from her bed to the bathroom. There are still some memories at work, even if she can’t communicate them.
It’s not like a light switch was flicked off, more like a dimmer. 
My advice, take away the keys. Put in grab bars and good lighting, remove trip hazards. Replace the gas stove with induction. 
Before you shop for a facility to take all your money, get a full physical work-up. Lots of treatable illnesses or conditions present as memory loss: Depression, malnutrition, B-12 deficiency, infection, blood clot, alcohol abuse, medication side effects, etc. Whatever the next steps are, you need to know what you are dealing with and aim to get some kind of a time-line.

Most of my friends in this situation hired live-in help. In my part of the country, many who do live-in come from Eastern Europe. My husband’s step-brother and his wife do live-in care. In exchange for room & board and a salary, they move in and do whatever needs to be done.

If she were open to it, you could suggest buying into a place. But a physical is probably the best first step.


coppertop

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #43 on: January 18, 2023, 08:04:20 AM »
Thank you for your advice about getting her a physical.  My BIL made her an appointment with one of her specialists and took off from work so he could accompany her...he was furious when she canceled the appointment the night before.  We are talking about a very stubborn person, who even when her memory was good didn't much care about the convenience of others when she wanted something.  That's one thing that will make this whole process so hard.  She hasn't been to a doctor in years. As far as the car, if the kids took away the keys, she'd just go buy another car.  She has the cash to do it.  She likes to do what my BIL calls "joy ride," meaning she gets bored at home and goes out driving wherever she feels like it.  She has been lost at least twice and called a friend to come and get her. 

Over the years, she came thisclose several times to moving to a more suitable place, even having put down deposits which she took back within a day or so. She has also had a lot of trouble making decisions and sticking to them.

I have a feeling this is not going to end well. 

slappy

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #44 on: January 18, 2023, 11:46:24 AM »
Thank you for your advice about getting her a physical.  My BIL made her an appointment with one of her specialists and took off from work so he could accompany her...he was furious when she canceled the appointment the night before.  We are talking about a very stubborn person, who even when her memory was good didn't much care about the convenience of others when she wanted something.  That's one thing that will make this whole process so hard.  She hasn't been to a doctor in years. As far as the car, if the kids took away the keys, she'd just go buy another car.  She has the cash to do it.  She likes to do what my BIL calls "joy ride," meaning she gets bored at home and goes out driving wherever she feels like it.  She has been lost at least twice and called a friend to come and get her. 

Over the years, she came thisclose several times to moving to a more suitable place, even having put down deposits which she took back within a day or so. She has also had a lot of trouble making decisions and sticking to them.

I have a feeling this is not going to end well.

You are literally describing my mother in law! We had to have everything routed to us, so we got the confirmation phone calls, etc. Thankfully she has come around a bit, but now that she has, expects us to do everything for her.

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #45 on: January 18, 2023, 03:28:20 PM »
My mom just moved from Independent Living into Assisted Living in a continuing care retirement community. 
For her IL unit, she chose the apartment (nicer than my last 1 bedroom condo, or hers, or anyone's I've known).  The buy-in price was about $420K and the monthly service fee was under #3K/month (increased 4-5% per year).  When she leaves, she gets 90% of the buy-in back.  Or, if she needs more money to pay increasing fees, the facility starts a spend-down of her buy-in money, which is always considered "hers", even though they hold it. 
She started needing substantially more care about 18 months ago and started the spend down, getting about $2K per month spend down.  At that time, the facility said we had underpaid the buy-in amount by about 200K.  They said they had a financial model that includes about 6 years of spenddown care and we somehow hadn't paid that.  It was clear someone on their end messed up! 

A few months ago, she moved into AL and the unit fee is $6K/month and the service fee is anywhere from $3K to 6K/month.  She'll likely be at the $6K level within a few more months, so it will be about $12K/month total.   My understanding is that life expectancy after entering AL is about 3 years, so that will just about work out with her accounts. 

As for spending down your assets to get medicaid, the social worker on site told me that for Medicaid, having Social Security + a small pension means that she'll never be eligible for Medicaid because she has monthly assets/income. 

Once her spend-down is wiped out, there is a benevolence fund within the community that pays for people who can no longer pay.  So she should be good forever.  I have no idea what happens if the benevolence fund runs out.  I guess we pay then. 

Good luck.  It's hard and it just gets harder.  :( 





slappy

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #46 on: January 18, 2023, 03:46:28 PM »
My mom just moved from Independent Living into Assisted Living in a continuing care retirement community. 
For her IL unit, she chose the apartment (nicer than my last 1 bedroom condo, or hers, or anyone's I've known).  The buy-in price was about $420K and the monthly service fee was under #3K/month (increased 4-5% per year).  When she leaves, she gets 90% of the buy-in back.  Or, if she needs more money to pay increasing fees, the facility starts a spend-down of her buy-in money, which is always considered "hers", even though they hold it. 
She started needing substantially more care about 18 months ago and started the spend down, getting about $2K per month spend down.  At that time, the facility said we had underpaid the buy-in amount by about 200K.  They said they had a financial model that includes about 6 years of spenddown care and we somehow hadn't paid that.  It was clear someone on their end messed up! 

A few months ago, she moved into AL and the unit fee is $6K/month and the service fee is anywhere from $3K to 6K/month.  She'll likely be at the $6K level within a few more months, so it will be about $12K/month total.   My understanding is that life expectancy after entering AL is about 3 years, so that will just about work out with her accounts. 

As for spending down your assets to get medicaid, the social worker on site told me that for Medicaid, having Social Security + a small pension means that she'll never be eligible for Medicaid because she has monthly assets/income. 

Once her spend-down is wiped out, there is a benevolence fund within the community that pays for people who can no longer pay.  So she should be good forever.  I have no idea what happens if the benevolence fund runs out.  I guess we pay then. 

Good luck.  It's hard and it just gets harder.  :(

If having Social Security makes you ineligible for Medicaid, I doubt anyone would have Medicaid. Maybe they think her buy in is considered an asset?

sui generis

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #47 on: January 18, 2023, 04:31:18 PM »
Yikes, $12k per month is more than I thought these things would be and makes me worry about being FIREd. 

I Fat FIREd and I don't have $12k per month for JUST my living expenses (I guess most other expenses would go away at that point [like travel] but I wouldn't even have it if I stopped all of my charitable giving aas well, and I guess I'd have to rely on the kindness of others if I ever needed like new underwear or a t-shirt or something).  This really makes me skeptical, as someone mentioned upthread, about mustachians actually being prepared and some conventional wisdom I've read a few times about expenses going down at advanced age.

PDXTabs

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #48 on: January 18, 2023, 04:40:14 PM »
Yikes, $12k per month is more than I thought these things would be and makes me worry about being FIREd. 

I Fat FIREd and I don't have $12k per month for JUST my living expenses (I guess most other expenses would go away at that point [like travel] but I wouldn't even have it if I stopped all of my charitable giving aas well, and I guess I'd have to rely on the kindness of others if I ever needed like new underwear or a t-shirt or something).  This really makes me skeptical, as someone mentioned upthread, about mustachians actually being prepared and some conventional wisdom I've read a few times about expenses going down at advanced age.

But by the time you need assisted living will you have $432k for the average assisted living bill? That's a rhetorical question of course.

BicycleB

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Re: Do Retirement Facilities Take All of Someone's Money to Enter?
« Reply #49 on: January 18, 2023, 04:54:16 PM »
Thank you for your advice about getting her a physical.  My BIL made her an appointment with one of her specialists and took off from work so he could accompany her...he was furious when she canceled the appointment the night before.  We are talking about a very stubborn person, who even when her memory was good didn't much care about the convenience of others when she wanted something.  That's one thing that will make this whole process so hard.  She hasn't been to a doctor in years. As far as the car, if the kids took away the keys, she'd just go buy another car.  She has the cash to do it.  She likes to do what my BIL calls "joy ride," meaning she gets bored at home and goes out driving wherever she feels like it.  She has been lost at least twice and called a friend to come and get her. 

Over the years, she came thisclose several times to moving to a more suitable place, even having put down deposits which she took back within a day or so. She has also had a lot of trouble making decisions and sticking to them.

I have a feeling this is not going to end well.

Great work finding the $4000 place, @coppertop!

I became my Dad's guardian after his dementia diagnosis, which was later recognized as Alzheimer's. He was stubborn, though not as much as your MIL, and intermittently quite profane. Once he was in assisted living, I was called "asshole" and "controlling asshole" repeatedly in between questions like "When am I getting out of this jail?" or, in more peaceful moments, "When am I getting out of the hotel?"

(As an aside: I learned to view this as the weather obscuring the underlying landscape of care and bonding that was in process, and considered that when I was a baby/ small child, my parents probably found me to be a pain in the rear at times. Nonetheless they grew closer by caring for me, and the same thing happened as I cared for Dad.)

Consider following the physical with a memory test / mental acuity assessment by a psychiatrist or similar professional recognized by your state's courts as qualified to determine an adult's mental competence. Based on my limited experience, which will defer to relevant experts:

1. you (meaning, "your family  - BIL, sis, you yourself, etc") will not achieve control over her affairs unless a court says so.
2. The court won't say so unless a relevant expert (in my state, the psychiatrist, after a 3 hour memory assessment) establishes that she cannot handle her own affairs.
3. This doesn't happen by magic. When you have your evidence together, if she resists, you unfortunately have to petition the court to be named guardian (or whatever the similar procedure is in your state).
4. Unless there is a power of attorney naming one of the children to be in charge in the event of her incapacity, a professional rather than a family member could be appointed in charge
5. If she or her lawyer persuades the court ya'll are grasping sickos who can't be trusted, more likely a court appoints a professional
6. If she admits or you present persuasive evidence of trustworthy caring and competence on the family's part, that increases likelihood of you being the guardian instead of a pro
7. Pros get paid by her estate (her own money, which she loses control of) so in some states there are vultures who file for guardianship, persuade the court the family are untrustworthy, and succeed in cutting off family from even contacting the person while draining the victim's funds
8. Preventing 5 and 7 suggests that if you can get her to sign POA ahead of time, so that you instead of "the court" will take care of her "someday in case a doctor says someone needs to take care of you", you will be better off; after the POA is set up you are then in good position to initiate the mental capacity assessment.
9. Starting now, I suggest keeping a well documented record of all incidents in which she has difficulty functioning - she's lost, fails to implement a plan, etc. This should come in handy in court, but also as a reference to discuss with psychiatrist, lawyer, etc.
10. There are good summaries out there of how dementia progresses. Both these and summaries of common end-of-life patterns were extremely helpful to my sister and I. We were a team even though the paperwork was usually in my name. Take charge if needed but work with all support available, it's precious.

Don't take my advice, get advice relevant to your state by consulting elder care agencies, specialized attorneys, maybe experienced elder-focused social workers, support groups, etc. Remember support groups and agencies can help you while you help MIL. Also Google power of attorney procedures for your state. Learn fast and work together because the clock is ticking.

PS. The poster upthread who said to use the medical workup to sort out possible dementia causes gave you gold, and I hope one of these remediable causes can be addressed, solving the problem. My list above is just to give a framework for addressing the worst (though very possible!) case: progressive dementia that really does require that someone else manage her affairs.
« Last Edit: January 18, 2023, 05:17:32 PM by BicycleB »