My uncle has been living in AL for about 2 years now. He pays $8K/month. His problems are mainly mobility - he spends most of his time in a wheelchair and needs assistance to get on/off toilet and into bed and with bathing. He doesn't have any complex medical issues that require management by a nurse (he only takes 3 prescription drugs.) Mentally, he is OK - there are some early signs of cognitive decline - such as forgetfulness, but he seems to know what is going on.

So, at this point, I'm getting concerned that the lockdowns of AL are going to affect his mental health. There is no one who can tell us when it will end. For example, they just tested everyone in the AL and found 3 positive staff members. This pushes all plans for outdoor visits back a month. Who knows when they will get to a normal situation where we can visit with him, where group activities resume, where he can travel, etc.

The more I think of it, the more the value proposition gets weighted in favor of leaving AL. So, he pays $8K in AL. Lets say I can rent a 2BR condo for $2000/month. 24 hour live in care costs $300/day. So, we are talking $11K/month. The problem is that I am not accounting for meals. That is where I'm not sure this works. Can I give the caregiver a food budget and expect them to have a car and do grocery shopping and make meals? What if my uncle needs help when they are shopping?

So, then I thought maybe we could try an Ind Living community where all meals are provided, but this raising living costs and we would still need the caregiver.

Has anyone made this switch? The value of leaving AL is quite high right now. I mean, right now, he is essentially in a prison. Even trips outside the building a limited - they have be monitored by staff and they get 30 minutes a day and I am not allowed to visit him when outside. For what he is paying, his quality of life has declined dramatically. I don't think he can tolerate another 6 months of this. Before, they would do lots of group activities. He had lots of friends visit. We could pick him up and take him to our house for meals and trips. If it costs an extra 3K a month, I'm starting to think it's worth it. The other thing to consider is that being inside an AL probably puts him at far more risk of contracting COVID than if he lived in a condo with a caretaker. The other thing to consider is that he was not happy in this AL even before Covid and wanted to move to another. So, leaving really isn't losing much. I imagine after 6 months or so, we can just resume a search for a better AL.

Anyway, curious about others in this position. Thanks

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My LO moved to AL in Oct 2019. She likes the AL; they provide meals, housekeeping, laundry, and manage her medications. I considered bringing her to my house when Covid started. I am relieved I didn't. Even though we have been limited in how we can visit, my LO's world would have become significantly smaller had she moved in with me. She has a community of people at the AL - their activities have been reduced, but there are groups that play cards each day/evening, and there are other social distanced activities. If she had moved in with me, her world would have been reduced to three people.
I have noticed a decline in my LO's cognitive status, but I don't know that I can blame that on the Covid isolation.

Just some thoughts...
Does your uncle require a two person transfer for toileting/bathing/getting into bed? That will impact how you staff.
What is the medical condition that has him in a wheelchair, and how will this affect the skills and background of the people you hire?
What will be your back up plan if any of the caregivers are sick?
If you give the caregivers a "budget" for food, etc - what kind of checks and balances will be in place that the meals are nutritious, balanced, appropriate, etc? If your uncle has limited ability to manage these kinds of things will they become your responsibility?
Will your uncle be happier in a setting where his primary interaction is only with paid staff - there will be no peers in an apartment setting.
Tough choices - and they are made even worse if you feel that someone you care for is very unhappy in their current living situation. But you are doing good research before making any decisions. Best of luck to you!
Helpful Answer (1)

He is getting older so of course he will decline in strength, whether in AL or home. My mom has been in lock down for 5 months with no face to face visitations. Sure she has declined a little but she is still safe and healthy
I have a few concerns (all cons).
You are disrupting a life which he has adjusted to him to something new where he may be a fall risk for the first month.
Being home alone instead of in AL means no social interaction, physical exercise or entertainment such as arts and crafts.
One person cannot be relied upon if he falls on the floor. How heavy is he?
Food will be an issue since those 24 hour caregivers have a list of rules.
If there are medications that contain opiates or require skilled nursing, the caregiver may not be able to give them according to state laws
You mention that he needs only a little assistance but you say he needs 24 hour care which is why he is in AL.
Also look at his contract. Is there a 30 or 60 day notice? You get an apartment then you are paying for extra months there, You have to pay for moving furniture however he probably only has a bedroom set and the apartment needs furnishing. When he is reenrolled in AL, there may be a wait list but there will certainly be an enrollment fee of 1000-3000$

I once hired one of those type of caregivers for my aunt in hospice care. Even though she only lasted less than a week, I was horrified to see how these people were treated by their agency. The caregiver had no car, she was dropped off after she was brought to a store to purchase her own groceries. She seemed to me like she was under contract as an indentured servant. I was not allowed to offer her any help to find another type of job to better her life. Hiring a real caregiver actually costs 25 to 30$/ hour. The employee gets to work under state laws such as overtime over 40 hours and 1 day off per week. So think about what you are hiring her.
An agency is paid $300 daily. Take off a third to the agency for insurance, taxes and administration for usual and customary costs. That leaves the caregiver paid $8.33/ hour. Compare with the cost of living except you are hiring a slave.
Really think about if this is an ethical means to an end or end to a means.
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Helperson, I've just read the other posts made while I was typing mine.  I see some issues have already been addressed, so I apologize for the duplication.    But I'm too lazy right now to rewrite the post!

An addition though:  If the careperson is an immigrant, be sure that the agency has all the proper documentation for nonresidents.

I would also do as much background research as I can on the agencies.
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Helpperson, addressing first your specific questions:

1.   Meals and shopping.

Would your uncle have support, and if so, at what level, while the careperson went shopping?  Is there an operating Meals on Wheels program in the area of the condo (once it's chosen)?  I think meal prep might be a negotiable issue.    I would investigate though to see if he can get Meals on Wheels, which provides not only food but interaction with caring delivery people.

2.   Emergencies.

He would need some emergency backup, such as a life alert pendant, & lock key box outside the front door for emergency personnel.   Is he comfortable using a senior citizen cell phone, which he'd probably need to have with him at all times?

Being in a wheelchair, the condo probably would have to have a ramp, and he would need to be able to exit himself in an emergency when the careperson is gone.   I believe portable emergency ramps are available, but the condo association By-laws and other governing documents would have to be addressed, to ensure compliance for the ramp installation.   This would result in additional costs.

3.   Condo rental.  

I'm not intimately familiar with condo leases or subleases, so you'd have to do some research to ensure that a unit can be rented for less than a year.  Or if you sublet, you'd need to be sure that it's allowed under the various governing restrictions.    I'm assuming also that you'd have to pay the condo maintenance fees, which aren't cheap.

4.   Caregiver responsibilities.  

I would think any careperson would have a car of his or her own, but would probably also want a private life.   It might be necessary to have a backup for when he/she needs some private time.  I don't think it's reasonable to anticipate or expect someone to spend all the time caring for someone without a break.

5.    Insurance.

You'd have to address liability coverage for a live-in person.   As I've indicated before in other threads, in Michigan this would require a commercial liability insurance policy ($750/annually, several years ago) as well as workers' comp insurance.   There would also be some bookkeeping and tax filing for compensation.   Would you handle this yourself or hire someone?

6.   Veteran's Benefits.

Is your uncle a Veteran?  If so, and assuming he's getting Vet benefits, I would find out who his team's social worker is and speak with her.  The VA may have something to offer.  

7.   Mental health during lockdowns.

I think you're wise to address his mental health.   The pandemic and lockdowns are already affecting health and emotional outlook of those who aren't in care facilities.      My chocolate budget would reflect that.

8.    Condo vs. independent living.

I'm inclined to think there would be more interaction and activities in a senior community, but again, the issues of restrictions, length of time, leasing vs. purchase, and all the other factors come into play.   I would check it out though, because there would likely be more senior level options than in a condo complex. 

9.    General issues.

I wouldn't disagree that living in other than where is now could be much better, and probably safer.  He wouldn't be interacting in an environment which is already known for high rates of viral and infection presence.  

I think the cost, feasibility, location sourcing would be the major issues, but if this were my father, I'd make the effort.
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Food can be delivered and you can offer meals included for preparing meals for uncle. Make it part of the job description.
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You will also have utilities and insurance.

300.00 daily, is that through an agency? If not you have payroll taxes to consider as well.

Have you checked with other Al's in your area to see if any of them are allowing visits and doing any activities? You may find one that is doing well with managing day to day quality of life with covid. That would be my 1st step, finding out what other facilities are doing. Especially since you plan on moving him anyways.
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Helperson132 Aug 2020
300/day is through an agency. I won't have to manage taxes or assume any liability. Thats all on the agency.
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You have tried to work this out, and you have a working plan, but even before beginning you are seeing the problems. I will say, compared to what you SEE there are easily two times more than that.
These caregivers you think will be there so diligently preparing meals and etc? Reliable and there as at the facility, or replaced easily? Not so likely. And you will have caregivers who are exposed to their families and life on the outside coming and going without testing (which many facilities now are doing). Covid will not be denied if it comes through the door.
You say he is in prison. Yes. But it is in fact "protective custody" of a sort. I would not do this, personally, even if money was not a question. It is disruptive to Dad more than you can guess. And I think the problems will come by the basketful. And you will, by trundling Dad around, expose him to covid as surely as he can get it in his facility.
Good luck whatever decision you come to and I congratulate you on trying to come up with all the problems and trying to think it out as well as you are able.
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Helperson132 Aug 2020
Hi. Thanks for the reply. You have given me a lot of food for thought. I should clarify this issue. During Covid, I don't plan to take my uncle out anywhere (except for doctors appts.) I just want the ability to visit and spend time with him in person. Other family member want that as well. I imagine we will try and take good precautions. When the weather is good, most of our visits would be done outside. I've spoken to caretaker organizations. The people we would consider are generally from other countries who want to work and live in one place for a period of time while they save money to send back to their families. The person I hire I would expect to be someone who lives with my uncle 24 hours/day seven day a week for a number of months. It's not likely they would have their own family here. The food and cooking issue is still a problem, though.
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