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My parents are currently living in an independent living facility. However my parents are getting on. My mother has Parkinsons which continues to limit her mobility and my father has recently had a recurrence of a dementia episode. The Professional Services firm appointed by their Elder Law attorney has raised the issue that at some point they would no longer qualify to live in their independent living facility and would need to be in a place with more assistance available to meet their needs.

The Professional Services firm has recommended that they be moved to a Not for Profit facility, since, as they say "even if they run out of money they will be able to continue to stay there and receive care."

What is the difference between Not for Profit and For Profit facilities?
Is there a preference for one over the other, or could both provide equal quality of care?

The other issue that concerned me is that the The Professional Services firm was advocating Not for Profit to address the issue of if my parents run out of money. However at last check, my parent's financial state was very good. My father is 83 and my mother is 87. They just sold their home last year for over $500K and have a sizable amount of money in savings, which I would assume could support them for where ever they chose. Is this correct? Is there cause for concern?

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I hope you get better information from yhe profess services firm when you speak to them. Is it possible the facility they are in was sold since your parents entered? Or yhat the original information was incorrect?

You or the firm might want to get guidelines from the IL about what qualifies you to get "the boot". Incontinence certsinly. It's probably a certain number of ADLs. I would think that your parents also need to be able to manage their own medications.
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Hey Babalou
This is a good idea to look into.
On a related note, I was looking back over the emails for the current facility that my parents are in, that the Professional Financial Services noted.
They were in favor of this facility for:
- Good food
- A non-profit company, not a for profit chain
- A nice patio area for your dad to have plants
- a dedicated assisted living unit on one floor

So if its already a Not For Profit facility, and they have the capabilities of providing Assisted Living, why are they telling me that.

Now looking back at the conversation that sparked this concern seemed stranger.
When I called the Professional Financial Services firm, the representative asked, "Is it about the move to another community?"
"Are they moving to another community?" I asked, surprised.
"Well...I had a chat with them, and the community where they are living right now is a FOR profit community, and it only has up to a certain level of care. Once you no longer qualify for that level of care you have to leave."
"They need more care?" I asked.
"No, not at the moment. I am just sharing with them that these are your options for the future. I had this conversation with your Dad, and I thought that he shared it with you."

This is what stirred up my suspicious side. As I mentioned above, I double-checked the initial emails and confirmed that this facility was NOT For Profit, with Assisted Living as well. I then double checked the website which said:
- a not-for-profit company operated by an independent corporation
- Assisted Living residents receive help with dressing, bathing, medications assistance, and other activities as needed. Blood pressure checks and other minor healthcare monitoring is also provided.

After I spoke to the Managing Director of the Professional Services Firm and asked about the possibility of a move. She said that she was busy and would get back to me. I waited 24 hours for an answer. Then I sent a short, polite email with a few of my questions. Still no response.

Having seen other firms dealing with elderly pull some fast moves on my parents, I get suspicious quickly when things start to not make sense.
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One thing you might consider is what is called a Continuing Care Community; this is the type of facility that generally has everything from Independent Living to Hospice care, meaning that you never have to move again, or if you do, it's simply within the same campus, which makes things a bit easier, at least logistically. Also better if your parents decline at different rates (dad needs memory care, mom NH, etc. They are still in the same physical place. Something to consider.
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Hi cwillie,
Thanks! That puts things in perspective. Currently I would like to get more information from the Professional Services firm, so I am putting together the questions to clarify this issue. Like you said, a lot can happen with elderly over the years. You bring in some good questions: how many more years they live, what level of care they need, what type of facility they choose.

On the side of For Profit and Not for Profit, you give some food for thought to keep in mind about either of these options.

I can hear the exhaustion in my parents voice. They lived for 35 years in the same house, then moved into their independent living apartment last year, now they are hearing that its time to consider where to go next.
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Hi Babalou
Thanks. My parents are in Washington State. Currently they are in a For Profit Independent Living facility. Currently they are paying $4500/month for a 2 room apartment and this includes breakfast in the dining hall and programming activities. This facility apparently has strict requirements that when they can no longer function independently, the facility requires them to find a place better suited to assist them.

So far from my parent's Professional Financial Services firm, I have only heard about the concept of moving to a Not for Profit Assisted Living facility. I've dropped them a note for more details about what they have in mind, and if there is a selection of places they suggest and what the prices are.
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Sleepless, I'm not sure that profit va not for profit is the issue here. The issue for me would be does this theoretical facility accept Medicaid down the road. And does the state they reside in fund assisted living with Medicaid. I guess it is true that many "private" facilities do not have Medicaid beds. Is this firm experienced in the elder care management including being savvy about qualifications for Medicaid?

I don't know wheee your parents live. My mom, in Connecticut is private paying $15,000 per month for NH care. She's been there for nearly 2 years. Discharge planning at the hospital told to make sure upfront to be very certain that they'd accept Medicaid after a certain period of private pay so that we wouldn't have to move her.

So imagine both your parents need nh care. That's 30,000 per month. 360,000 per year.
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The issue of having enough money really depends on a lot of things; how many more years they live, what level of care they need, what type of facility they choose, even what part of the country they live in because prices vary from one region to another. We are increasingly seeing our elders live well into their 90's, many on this site are caring for centenarians. If your parents live 10 more years or beyond, each needing a different level of care so they are no longer sharing costs, even $1M could eventually run out. Suppose a nursing home is needed at $10K a month for each of them, add in a loss in their investments and you can see how fast the $$ will disappear. The Professional Services firm is very wise to be considering these scenarios.

The issue of for profit vs non profit is not clear cut. On the one hand the whole philosophy of for profit is to make money. Some places are known for spending on the bells and whistles to attract potential residents but skimping on staffing levels or other necessities of care. Non profits may have a more altruistic focus, but they too need to reconcile their books and operate within their budgets. I think there are good and bad facilities in each category, they need to be evaluated on their own merits. Also be aware that over the long term ownership or administration of any facility can change, and that can drastically change how things are run.
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