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Assisted living in New England seems to want $12,000 to start and anywhere from $2500 - $3500 per month until assets are gone. My Dad lives 350 miles away alone. His house needs much repair and cleaning. The neighborhood has changed - it will be difficult at best to sell the place. Assets were spent down two years ago when my mom needed care. She has since passed. Reverse mortgages are too chancy. He shouldn't be alone. What do people do?

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This can all seem so overwhelming. Here are my suggestions & I'm assuming that you are the designated family for him and that you are going to go visit him to do all this.

I'd start 4 notebooks: Housing, Finances/Legal, Medical & Neighborhood.

Housing:
You mentioned AL so I'm assuming that you feel that he would be best moved out of his home.

Go on-line to find both assisted living & long term care options in his area, including board and care homes. Contact his local Area Council or Agency on Aging for resources. You will have to do alot of drilldown as the assisted living or retirement villages (that require a buy-in) will show up first as they pay for advertising or placement.

The general rule for most states is if his assets are under 2K then he qualifies for Medicaid. But you really need to figure out what his assets are (the house & a car doesn't count). Mediciad will pay for LTC but not AL - unless his state has a community based waiver program which pays for AL. If you find you're in the not ready for LTC but can't afford AL then board & care might work. Most of these are hard to find on-line. What I found is that alot of the hospice programs know what's out there as they often have to move a patient to one who gets "better" and has to move out of hospice.

Plan on visiting several AL and LTC facilities - even if he doesn't need LTC now. Things could change in a heartbeat and you'll be ahead if that happens. If there is a tiered facility (IL, AL, LTC/SNF & hospice) I'd look at those first as he hopefully can move along their system so you don't need to find another place for him to live. Be blunt about how they approach Medicaid - most take it but the # of beds may be limited or
they do not take "Medicaid pending" - which means you have to pay their private pay daily rate for the period of time while his application is being reviewed as opposed to paying his anticipated Medicaid rate. The review could take 30 - 120 days
and that can really add up.

Medical:
His medicare card and any other secondary insurance.
All Rx's and your notes on what his health and behavior is like.
Schedule an appt with his MD for when you are there. I'd
set this appt first and work your travel around when this happens. Ask if he needs blood work & chest X ray in advance, so you can get that done before you & him see the MD. Also I'd go to the pharmacy he uses to see if he's been ordering his med's on a schedule that he would do if he was taking them as he should.

Go thru the house looking for all medicines and make a list of what and their expiration date. Especially look for those that
might have been your mom's that he may take......

Also when you go looking at facilities find out the names of their medical directors - if you don't get a good vibe from his MD
then they could be his "new" MD and this helps when you need to place him in LTC or SNF as they will have the clinicals needed and the nursing staff get's their calls returned.

Finances/Legal:
Wills, DPOA, MPOA, warranty deed for house, insurance, all the funeral items from your mom, bank statements, retirement/SS/ other annuity items go into this notebook. Attorney info. Birth certificate too.

You'll need to have this together when you apply for Medicaid so might as well start this now.

Neighborhood:
Plan on visiting him - probably for a week. Weekends I've found are a bust because so much of what you need to do or who you need to speak to are there during the workweek. If you can stay at the house that would be good as you can figure out what's what with his neighbors and old friends. Get a notebook filled with utility statements, property taxes paid, insurance, repair info from the last 5 years. He probably has this all squirreled away. Tax stuff goes into the legal notebook. If you grew up there contact those old friends from the past and find out what's what with their folks - if their your age they are in the same situation. Also go through the obituary sign in form from your mom's funeral to find people to contact who might have insight as to where the elderly can move to in the area. Contact a Realtor - they are an amazing resource.

I found a dependable yard guy and a hairdresser who makes housecalls at one of my mom's neighbor's funeral.

Also one of the neighbors might be interested in buying the property.
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How you do all this really gets involved with the type of relationship you have. I was very no nonsense this is what's what with my mom - she wasn't happy but then she's never been a happy person. But things needed to be changed and done for her own safety, health and security.

I looked into a reverse mortgage. If the property is old or has structural issues or in a historic area - seems it just doesn't work. That was the case for my mom's house. If he qualifies for Medicaid you don't need the reverse mortgage anyway - the state will put a lien on the property for estate recovery so it becomes their problem (this is assuming that no one in the family wants the property).

Another thing that worked for me is that when I went I packed an extra suitcase of stuff I needed on arrival: to spruce up the house immediately (Febreze, cute Kleenex boxes, good garbage bags, Ziplocks); the notebooks and dividers, tape, paperclips, envelopes; something to keep her busy (large print magazines, loose photos and a book to have her put them into, a flower puzzle, movies she'd like); old "work" clothes that you can just throw away; and whatever you need to start & end your day (coffee, tea, Jameson). This all is stressful enough without driving to several stores to get whatever you need just to get started when you could have do it in 20 minutes at home. Also the extra suitcase gets the notebooks when you leave.

If you're real OCD you can make a copy of everything and
leave a whole set of the notebooks there too.

Good luck.
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My mom is displaying signs of dimentia and odd behavior. She is forgetful and physically challenged with walking.
She only has enough money for assisted living that would last a couple of years at most. She needs assistance but not a nursing home. How do we afford this or get financial assistance once her money runs out?
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