Should I care for parents in my house with home health aides or use a memory and nursing facility?

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Would home care be too expensive for both? My elderly parents (92 and 95) live in my home. My mother got very sick and is in a rehabilitation center. My father has advanced dementia. While my mother is in the hospital I have had private home health care aides take care of my father at the cost of $30 an hour (which seems to be the norm in a suburb of Washington, D.C.) My mother will probably be discharged in a week or two and she will need extensive care because she cannot get out of bed without assistance. I was thinking of perhaps building an addition to my home (a large bedroom, sitting room, and bathroom) and hiring caregivers to come to the house. I am also researching memory care for my father (about $8,000/month) and a nursing facility for my mother (about $9,000/month) because she needs more physical care. I would like to keep them together but their needs are so different. I am going to get in touch with the county geriatric case manager to help with planning for their care. I am asking for any advice on what factors I should consider in deciding for their care. My mother says she will do whatever I think is best for them. I want to do just that. Thank you.

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Lots of good answers here. My mom is in Arden Courts Fair Oaks, VA - strictly memory care but there is a rehab next door -- so take a look. They have been outstanding. Cost $7900/mo but no issues and came highly recommended.

Consider YOU in your decision making -- what do you need/want for your future? Do you have a family? Friends? Job? -- This will be 24/7 care with increasing skilled nursing care needs as parents age. Are you willing/able to give up your life for your parents as a caregiver -- or do your parents have funds to pay for their residential care and that would allow you to be the loving daughter and spend more quality time with mom & dad?

Home care did not work for me -- mom fired everyone, CNAs, PT nurses, etc. It was a nightmare. Do you have DPOA to make all the decisions: healthcare, financial, living?

I would advise that at this stage you find a place where they can be together or separate --- whatever is best to meet their needs. Hospital social worker should be able to help you figure it out and suggest residential care appropriate. Look forward 3-4 yrs for both parents vs. planning their needs today -- even next yr can look very different and their needs escalate at this age rapidly.
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I was able to keep both of my parents at home.
BUT... they each had insurance policies that paid for 10 hours a day in-home aides..each. And, they were well off enough to afford all the extras that were needed.

They paid for therapy in home out of pocket when Medicare wanted to require outpatient service.

this is an expensive way to go. Not many can afford this!
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Great answers from everyone. I too live in the DC metro area. Can those in the DC are send me a private message? Thank you.
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demstress, my gosh you have your hands full having both parents living with you. My folks were also in their 90's and they were still living in their own house even though they should have been somewhere where they didn't need to climb stairs.

I would think twice about adding onto your house. For every one year an elder advances that is more like 10 years when it comes to physically and mental abilities. I know one day my Mom was doing pretty good for someone in her late 90's, then on her second fall within a week she never came home, she went into long-term-care for 3 months before she passed.

I am also in the Wash DC burbs and the long-term-care was $12k per month. When my Dad had caregivers around the clock [3 shifts] at his house, it was $20k per month. More on the weekends and holidays. And if my Mom was still there before her fall, the hourly rate would have been much higher for one caregiver to handle 2 people.

Eventually Dad moved to Independent Living at a well known nationwide facility and it was around $5k per month... then eventually to their Memory Care in their Assisted Living which was around $6k per month.

There are a ton of places around Washington D.C. Google "Retirement Living Source Book" which covers northern Virginia, DC, and Maryland. There should be some places where both your parents could live together.
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Thank you all for your responses. I very much appreciate being able to ask a question and so many knowledgeable people providing their experiences and insights.
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MsMAdge here in the DC area our MC s ( or at least the ones my dad and my MIL were/are in) are not at all like AL. Both the ones I have experience with are for those with moderate to advanced ALZ or similar diseases. They do all care, meds, bathing and supervision. Plus appropriate activities. They are locked units, and very safety involved and hands on (OK,some more hands on than others,, ,LOL) My dad was very late stage ALZ, and they did a great job with him in the month he was there before he passed away. Perhaps different areas are rated differently?
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Before even considering adding to your house, check with your community to determine if the house size might exceed setback requirements, if zoning laws permit additions of the size contemplated, and what other regulatory obstacles might be involved.

You're wise to be proactive in planning ahead. You might want to make some calls to private duty agencies to actually cost out what it would cost to have both parents at home, apparently with 24/7 care for your mother. Then compare the costs to a facility, after also doing research to find ones you think are most suitable.

But you also have to address the issue of what's best for your family, for your parents and you, and that's not easily to quantify. I think home care would be challenging for all.

Are you retired, staying at home, or do you work out of the house? What changes would you need to make to have both parents at home?

FreqFlyer had both of her parents in a facility, so she's been through this. I'll PM her and ask her to stop by and offer some insights.

97YearOldMom, I tip my hat to you for handling the complex and challenging situations which faced you. You must be a very strong person!
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I would only add to understand that generally memory care is considered assisted living and may not be able to manage dad as well as you think unless he is a relatively healthy 95 year old to begin with

I've read of some folks who place their parents in the same room in a nursing facility but that would only be good if dad doesn't drive mom crazy

If you do choose placement try not to make a snap decision and visit places more than once and preferably after 3 pm when there are fewer staff about and you get a better flavor for the level of care provided
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Having two parents who need a lot of care is daunting.

My in-laws lived at home together for several years when they should have been receiving more help. They were under the care of their eldest daughter who turned out to be beyond burned out.
They were evacuated in a hurricane and never got to return to their home. This was eight years ago and I'm still trying to recover from the trauma of it.

They were put in an AL where they managed for less than two weeks before MIL became jaundiced and had to be taken to the hospital, leaving FIL alone. He subsequently was over medicated for diabetes went into a coma and was sent to the same hospital for care.
MIL had to have surgery. FIL ended up falling and never recovered. He died the day they were to be transported home, six weeks later. MIL made it home to an AL and died one month later.

I'm telling you all this because it was extremely difficult to take care of two people at the same time who needed a lot of care and I wasn't even there! Burned out SIL had abandoned them at my home.
Second SIL and her boyfriend were in the area of the AL. She had lost her home and everything she owned in the hurricane. She was constantly in her hotel on the phone trying to get information and help with her personal situation and find a way to get the parents home. We had agreed that she would visit them daily and I would handle the doctors.
I was care taking over the phone 800 miles away. MIL had cancer and uncontrolled diabetes. FIL had severe dementia and now a new head trauma. He had spent months in ICU with one several years before. They were both in the hospital rehab when he died. Not in the same room as MIL had developed MRSA. I tell you all of this because you can see that life happens regardless of the decision you make or where they will live and that changes will have to be made. There is no getting around that at their ages. You might not have a hurricane but when things go wrong it will feel like it.

I still would be tempted to choose the home setting. I don't think you have enough time to have a room built (permits, contractors, etc) before your mom would need it unless she is going to be able to go to rehab after leaving the hospital. That would buy you a little more time.
Whatever you choose it will only be for awhile before one or the other could possibly need more care unless you opted for hospice.
Perhaps you could consider re-configuring your existing home? Clear the living area and set it up comfortably for the two of them. Hire a housekeeper, a cook and the number of aids you need for 24 hour care if that is what is needed. This would free you up to manage their care for the length of time this arrangement would work. Well, that's not true. Whichever way you go it will be a long time before you will be freed up.
Picture hospital beds and lift chairs. TV and telephones. Storage for paper products, linens, other supplies and medication. Possibly remodel a bathroom for wheelchair baths. That you might could make happen in a short time frame. Either way, I think its a great idea to get a care manager involved and to work with the best care provider group you can find. Even if they go into a NH that would really help you to have additional staff to be with them in the NH.
Come back and let us know what you do. We care and it might help another make the decision of caring for both parents who are in bad shape.
Needless to say, the sooner we make decisions on how to care for elders in cases such as yours, the better off everyone is. We tend to think it's too soon and I doubt if it ever is.
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I agree with Surprise. I think you have to be realistic. These folks are 90s. An addition set up for elders would break the bank not to mention the hassle of construction. Not to sound harsh but they may not live to see this addition finished.

There are many facilities that offer various levels of care under the same roof.  At some point as the dementia worsens mom and dad probably will have to be in different areas of the same facilty.  I'm likely facing this in the future with my folks as my fathers dementia worsens.
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