Nursing home and financial well-being.

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I keep seeing the advice...put him/her in a nursing home


I think if the senior does not have substantial resources...this may be the only advice that makes sense. But, it often does not when there is a fair amount of financial resource


Consider the situation with my parents.
Had Mom put Dad in a NH when the dementia started to drive her a bit nuts (1997) the result would have been..after 19 years (he died in 2016) she would be in poverty with nothing left for herself.


The cost of the Nh would have taken everything except the max. State Medicaid allows....$90,000 and her own social security. Everything else would have gone completely to 19 years of care. That would have meant that today Mom would not be able to afford in home caregivers. Would not have a driving service when she needs it. Would not be able to keep her home (cost of maintenance would have eaten away the remaining savings)


Yes, having a home aide a couple hours a week and dealing with the rest was a hardship for her. But, the hardship of losing all financial security would have beaten her down more over those years.


Mom feels strongly that she will not be in a NH..ever! She has the financial ability to live independent for the presumed remainder of her life. The long term home health policy she purchased in 2000 was expensive through the years...but it is paying off very well now.


I have worked her finances back and forth...she can keep in home health aides for 10 hours a day 7 days a week ...and live comfortably without worry for 10 years.....her life expectancy is 5 years.....hopefully she will outlive her "sell by" date.


The awful reality of the poverty of the remaining spouse has to always be considered. "Put him in a nursing home" may not be good advice when you take into consideration the living situation left behind.

7 Comments

There is no getting around the reality that chronic illnesses are formidable financial challenges!

If your mother had placed your father in a nursing home when caring for him was daunting, wouldn't she have gone to work? I'm not sure your analysis is taking all factors into consideration.

You are assuming that your mother would always be able to function with only 10 hours of in-home care per day. That would not have been true for my husband, with dementia, or for my mother with dementia and mobility problems.

But in any case you are certainly right that finances should be a consideration. The trouble is, we can't foresee the future. Nineteen years is an extremely long time in a nursing home. The average stay is less than 3 years. At the point one needs to make a decision, one can't look into the future and know these kinds of things.

Very well said, katiekate. Your mother was a wise woman. It looks like she passed it on to the daughter handling her finances. Each person has to consider their own circumstances and what care choices would mean. When someone says, "Put him/her in a nursing home," I usually just think of it as saying to take back our own lives. They don't know the particulars of a situation. Only the people in the situation knows what would be best and what would be possible. It would be different if modern illnesses didn't last for years. A person now has to plan for 10-15 years for an illness instead of 10-15 months. I think your mother did a good job planning.
Gone to work? At the age of 72? Having been a housewife all her life? People with advance degrees and an actual career (especially women) find jobs hard to come by at that age. Unless you are talking about the kind of job that will kill a senior..like standing all day at a counter asking "do you want fries with that?" Even those jobs are hard to get for someone that old.

True enough, she may need more care and require a NH in time...but, she will have options...not just whatever she might get into with Medicaid.   I read that being able to self pay for a couple years will get a better placement.   

I have often wondered...if entering a very nice NH self pay...what keeps them from bouncing the senior out when they go on Medicaid?   What guarantees do they have that the self pay provides a nice NH after the money runs out? 

I expect that Mom will remain at home.   I am downsizing her now to something that is much smaller and thus a much smaller drain on her resources.    Between us, we can pay for the monthly living costs...then it just all the extras that will come from savings.   I think we can make it go a lot longer that way.   Or, free up enough to pay the extra 14 hours a day if that is the answer.  

katiekate, I agree with what you say. I think that Medicaid should be a last measure for someone after the money runs out. I think it is a good thing to try to live in a way that Medicaid may not be necessary at all. End-of-life care is so expensive and the government really can't afford to pay for everyone, with costs being like they are. I am careful with my mother's money to try to make sure she'll have enough if she needs to go in a NH. I hope that she'll never need to apply for Medicaid, though I know it is a possibility.
Katiekat, I am really glad that you specified spouse relationship. I've also seen a lot of the "put em in a nursing home" related to parents that expect their children to provide 24/7 care at home with no financial contribution from the elders or concern about the long-term effects on siblings/children/grandchildren's financial standing. My aunt lived with my mother for years, paid no rent and rarely purchased food, and argued about filing for social security at 62 with her severe COPD and NO JOB because it would "reduce her benefits later". Aunt told my mother that "it was her job as her sister to take care of her". My mother delayed her own retirement in part because she didn't want to become a full time caregiver to my aunt. By the way, my aunt had one child, a son that she spent lavish amounts of money on (from my dead grandmother's bank accounts that were not shared with my mother). The son refused to have his mother live with him (he had a 5 bedroom house 25 minutes away from my mother's) and told my mother he didn't have money to bury his mother - she needed to use the money my grandmother left for my mother and aunt (long ago spent on the son). So keeping the elder at home at someone else's expense is not one-size fits all:)
Katiekate, I should have looked at your profile and seen your mother's age. Sorry.

How do you know that a facility will take Medicaid after the self-pay money runs out? You simply ask them when you investigate them. "My mother is self-pay now. Will you accept Medicaid when her money runs out?" Will she get lesser care then? No. But Medicaid pays so much less that if she is in a private room she may have to move to a shared room.

It looks like you are on top of the finances. Good for you!
I am not married to Dave who is a long=term nursing home. They receive his Social Security since August 2016. The business said that medcaid would pay for his supplement insurance policy. Also, medicaid would pay for his prescription D. The business office say they were waiting on medicane to pay for his insurance and prescriptions. We are not married but lived together for many years.
We are buying a house which is not saleable, because of liens. I am living on just my social security, which makes me responsible for paying all the home expenses.

I have received bills for Dave's nursing home. I am asking why me and what should I do?

Dee Worry

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