Help! Need a primer on elder care (assisted living, in-home care etc)

[ObviouslyNotAGolfer]

My wife and I are both only children, and so between us we have four aging, declining parents (late 70s, early 80s). (Yet another reason to thank god we have no kids!) My parents especially seem to be going downhill quickly. Two months ago my dad seemed really sharp, on top of all the bills, driving my mom to her appointments, helping her sister, and articulating his horrible political beliefs (will just leave it at that). However, the last few times I talked to him, he seems to have slowed down mentally quite a bit and was forgetful of some very basic recent events. His brother/my uncle died of Alzheimers two years ago, so this is a concern of mine for him at this point. Now that my mom is helping her sister who just got out of the hospital (yet a fifth source of concern), my dad is alone for a few days. I'm at the point where I'm wondering whether he has food in the house, whether he's paid the bills, etc.

Anyway, my parents both are collecting Social Security and seem to be very happy with SCAN and their doctors. However, I am wondering when I will need to step in and try to set up some type of in-home care, or possibly assisted living. I live about an hour away, and I absolutely hate driving over there because I viscerally hate Southern California where my job is keeping me. Nevertheless, I am resigned to the need to start doing it a lot more frequently. But, I certainly can't do it every day or even every other day!

Also, my mom has excruciating pain in her lower jaw. Shitbag endodontist lost no time in doing two root canals, only to proclaim that it was not her tooth after all--just go see a neurologist! (Sounds like an issue with the nerves in the lower jaw!) Now she has a bottle of tylenol/codeine and an appt for the neurologist over a week from now. Even assuming the neurologist can do something for her, what is she to do in the mean time?? What if she can't take it and calls 911? I am guessing they will throw another bottle of pills at her and tell her to GTFO--after all, she's just some poor, whiny old lady!

What does Medicare pay for assisted living facilities? Nothing? Just enough to get them into some horrible rat-infested facility where they will be ignored? I understand a good facility will start around 25K per month? I can't even afford one tenth of that.

Just wondering what to do and where I should start. What can I read and who should I be talking to at this point??

Thanks

[jodelino]

I'm not a lawyer or a doctor, just a person on the internet, but: Medicare does not pay for assisted living facilities. If your parents enter a facility and exhaust their assets, then many facilities will continue to care for them, accepting their SS and Medicaid payments. Visit a lot of facilities and find out what their policies and prices are. $25K/month sounds like way too much. Maybe $8,000/month?

Any chance your parents have longterm care insurance? You might ask them about that. Fingers crossed that they bought a policy a long time ago and kept up the payments.

Sounds like they are still able to live independently, but could perhaps benefit from a paid helper who comes in a few hours/day or week to help with housekeeping while you start taking over the bills and paperwork. Plenty of people and agencies offer this. I was able to hire two wonderful people to help out my mom, enabling her to stay in her home until the end. Cost: $20/hour (several years ago).

Try your state office of aging, and see what resources and guidance they offer.

Start talking with your parents about getting Power of Attorney, Healthcare Power of Attorney, living wills, end-of-life plans. Ask if you can meet their lawyer and accountant (if they have them).

Good luck. This is a tough phase of life you are entering.

[Cranky]

I'm sorry to tell you that even if your parents are in assisted living, they will still need substantial help from you.

For instance, when my mom refused to take her medication, the young woman who brought them to her, who was pretty much a minimum wage nursing assistant, never really was able to insist. My sister was there pretty much every day.

[jim555]

Medicare doesn't pay for assisted living.  Medicare will pay for 100 days of skilled nursing.  Medicare will pay if the condition will get better and needs rehab.  If the condition is something like a permanent condition that won't get better then Medicaid will pay, but in order to qualify for Medicaid it requires a a spend down of almost all resources.

[Papa bear]

Sounds like you don’t need medical care for your parents, just a competent “adult sitter.” 

There are probably a lot of private pay home care companies that would bring someone over for 4-8 hours 3-7 days per week. You could look there to start.


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[Murse]

I grew up in a fa,ily that runs adult care homes. Some thoughts- 25k is insane, in my slightly above MCOL costs range from 2.5k to 8k per month dependending on the services provided and how sick the individual is. For what you are describing it would likely be 2500-3000/month for a live in facility.  25k/month would be for a highly specialized patient that is on a ventilator and requires 24 hour nursing care.

My understanding is Medicare pays around 2.5k per patient per month as a base then up from there. The 8k number is high, the situation I saw that in was a lawyer was paying 8k cash per month to an RN in exchange for the parent to be the only patient in the home.

Please understand I am strictly talking about adult care homes- these are places where you take a class and have to get the property evaluated prior to being able to take these people in. These small businesses typically have anywhere from 3-8 patients with someone there 24 hours a day.
It does not sound like your parents are at the stage of requiring 24 hour nursing care. It sounds like they just need someone to check in on them daily and drive them around. I would look into hiring a CNA for a few hours a day a few days a week and go from there.

Another thought- while I was in nursing school there were a couple of opportunities presented to us students in which an older adult needed some help and they were willing to provide free housing in exchange for that help. Consider calling local nursing programs to inquire.

Let me know if you have any other specific questions.

[Pigeon]

I would start by looking at the website for the town and the county they live in and see if there's a section on senior resources.  They may be able to connect you to good sources of information and let you know if there are any services available to you.

As others have said, assisted living is generally not covered by Medicare.  Medicaid regulations are state-dependent, but generally require that the individual's assets are used for this purpose first.  It gets tricky when you are talking about a couple.

The costs for assisted living varies tremendously.  It depends on the level of care needed and whether or not both members of the couple need care.  If memory care is needed, that can also be pricey.  Costs vary locally.  You need to get them assessed by a professional and start looking around.

My father was private pay in a mediocre Catholic nursing home and it cost about $12K/mo.  Care was not good.  He had medical needs that made assisted living not an option.  My MIL was in an outstanding memory care facility.  I can't say enough positive about this place.  She had very few medical needs other than the memory issues and her's was bout $9,000/mo.  At one point, before my FIL died, we were looking at  a facility where he and MIL could both live.  At that point, he needed assisted living with an enhanced license, some additional aides, and she just needed regular assisted living.  That would have been about $23K/mo.

If they need to move into an assisted living facility, I'd look at moving them close to you.

[wenchsenior]

As pointed out, Medicare doesn't cover assisted living, nursing homes, in home care etc., except for very specific circumstances.  Medicaid covers these things once assets are essentially exhausted. Typically, you can spend down to a few thousand dollars in assets and some set amount of income is allowed; if there is a spouse remaining in the home, they are allowed to do so as long as necessary. Upon death, the house also defaults to the state.

It is important to note that Medicaid is administered state-by-state, so eligibility and coverage differs depending on what state you live in. You should try to get an appointment with an appropriate state employee who specializes in Medicaid and elderly care benefits, and any other state programs your parents might qualify for, and start learning to navigate the system (ideally before any sort of crisis appears).  In your parents' case, a daily in-home visit to help with medication and basic cleaning, etc., might be sufficient for now.
 

[lizzzi]

Not a Golfer, I would call their local Office for the Aging (may be called something different) and see how you can get an in-home assessment done. You want it done by a public employee--like a county public health nurse, social worker, or case manager--because they won't have a financial agenda. They can scope out the situation and make recommendations.

I was a county public health nurse in NY for 20 years, and my job was really elder care management--I would go out with one of the county case managers and help to figure out situations like yours all the time. (No charge, of course.) We were paid the same salary whether we had 20 or 200 patients--so could be very objective in either putting some help in place or advising the clients and families how to access what they needed. We had lots of in-depth and inside knowledge about what was available in our county and what would work best for the clients based on their individual situations. It is wise to be thinking ahead--knowing what is available and doing some planning is the key...for sure.

[AMandM]

Agreeing with those who say call the office on aging (or senior services, or eler support, or whatever they call it) in the town where your parents live. Services vary by locality, so you want to start where they are and you will get referrals as needed to higher-level (county, state) services.  For example, my city has an "Aging in Place" program that specifically helps people who don't really need assisted living or nursing home care.

[SimpleCycle]

Hi @ObviouslyNotAGolfer, I'm sorry you find yourself here, it is something our parents have gone through with grandparents and we are probably only a few years out with our own parents.

You don't mention your parents financial situation.  Do they have assets, or are they living on just Social Security?  It makes a big difference in what options are available.  A lot of what is available is state and community specific as well.  I second the recommendation for talking to your local Office on Aging, they should be able to help with what resources are available locally.

Do you think your parents are the type who would admit when things are getting too hard, or will they hang on until they are in danger living on their own?  I might drop by unexpectedly mid-week and see if there's food in the house and things look relatively kept up.  Then talk to your dad about the bills - is it becoming too much, is there anything he needs help with, etc.

There's a long continuum of things you can do before it's time to move them to assisted living.  It sounds like at this point you might want to look into someone stopping by a few times a week to help out, bring groceries, possibly prep some food, check that their meds have been taken, etc.  If your dad is okay with it, you could take over paying the bills and stop by once a week.

Once you get to the point of needing a residential option, what is available and how to pay for it will vary a lot depending on their financial situation.  FWIW, assisted living (not nursing care) in my mom's area is about $5k/month.  Nursing care and memory care are more expensive than that, but can be paid for by Medicaid.

Finally, does your mom have a primary care doctor who can get her in sooner?  It sounds like she has trigeminal neuralgia, and a neurologist is probably the right person to talk to, but her PCP could probably start her on the first line medication and give her some reassurance.

[NV Teacher]

We just went through this with my mom.  I'll spare you the details because they are unpleasant.  The best piece of advice I got was from one of the hospice nurses.  Plan on being disappointed in everything.  No matter how nice the place is, no matter how nice the people are many times you will be disappointed.

[SeekingFIRE43]

With my grandmother, regular assisted care started around $3500 to $4000 a month. Medicare and Medicaid don't cover assisted care at all. Medicaid will cover skilled nursing home care once your parents are completely broke. You could look into having a home health aid come check on them a few times a week, but that costs money and isn't covered by insurance or Medicare either.

Can you move your parents closer to you? That would help with the driving and checking up on them. Depending on how much money they have, they may qualify for discounted senior apartment living, but that is only if they can remain independent.

[scissorbill]

Medicare doesn't pay for assisted living.  Medicare will pay for 100 days of skilled nursing.  Medicare will pay if the condition will get better and needs rehab.  If the condition is something like a permanent condition that won't get better then Medicaid will pay, but in order to qualify for Medicaid it requires a a spend down of almost all resources.

You're right.  With a big UP TO 100 days.  It's hard to meet the criteria for skilled therapy for 100 days and even harder for skilled nursing.  Most people transition to needing custodial care (help with walking, toileting, medication including insulin) quickly.  And to qualify at all for medicare to pay you need a three night hospital stay and you must have 60 days of wellness where you don't need skilled care to generate the full 100 days.  Medicaid will pay after a spend down and the states have different requirements. 

[SunnyDays]

Before you assume it's the start of Alzheimer's, check to see if your dad was recently prescribed any new medications.  Statins for high cholesterol, especially, can cause dementia-type symptoms.  He could also be taking too much of a medication, as seniors are more sensitive to higher doses.  Or there could be a combination of meds having said effect.  You might want to ask his doctor for a medication review, or at least run it by a pharmacist.

[marion10]

Every county in the US has an Area Office on Aging.  That is the place to start. Start with their county and I would see what is available in your county as well- your parents may move close to you.

[Lookilu]

Before you assume it's the start of Alzheimer's, check to see if your dad was recently prescribed any new medications.  Statins for high cholesterol, especially, can cause dementia-type symptoms.  He could also be taking too much of a medication, as seniors are more sensitive to higher doses.  Or there could be a combination of meds having said effect.  You might want to ask his doctor for a medication review, or at least run it by a pharmacist.

Before you assume it's the start of Alzheimer's, check to see if your dad was recently prescribed any new medications.  Statins for high cholesterol, especially, can cause dementia-type symptoms.  He could also be taking too much of a medication, as seniors are more sensitive to higher doses.  Or there could be a combination of meds having said effect.  You might want to ask his doctor for a medication review, or at least run it by a pharmacist.

^^This is excellent advice. Ask their provider or pharmacist for a med reconciliation. It's a very good first step, along with contacting the local department of aging as others have suggested.

Is your mom on osteoporosis medication? If so, there's a small chance that the medication could be related to her jaw issues: https://www.webmd.com/osteoporosis/news/20110317/low-risk-of-jaw-problems-with-oral-osteoporosis-drugs#1

Also, breathe. It's very hard to see our parents decline and is very stressful. Once the immediate issues are under control, it may be time to have some uncomfortable discussions with them about what they will want and what they--and you--can afford and provide.

[ObviouslyNotAGolfer]

Thanks very much for all the advice! This forum is such a great source of info with some very friendly members!

My parents (and my aunt) are very independent, and they have very rarely asked me for help, so I am fortunate in that regard. Also my other aunt and her husband (younger, healthier) live close to them, and they have been very helpful as well--so, that relieves a lot of pressure.

Nevertheless, it is very troubling and sad. I am trying to also walk the fine line of helping them financially without screwing my own finances too much. We are doing pretty well on the retirement savings, will both get SS, and I also have  pension, so none of that is getting touched. My emergency fund can be used to help them out. Can't feel too guilty here I guess; it will do no one any good for me to screw my future retired self. I'm sure a lot of you have similar issues to confront.

I could complain about all this endlessly, but it is surely a waste...nearly everyone has to go through this!