My wife's father L. and step mother M. are needing to transition into some kind of long term care. They are both in their early 70's. L. has vascular related dementia that has come on suddenly, He also has a heart condition. M is mostly in good health but we suspect has early Alzheimer's (not herself and asks the same questions every day) but she can still drive and care for herself.. But she failed to contact anyone when L was clearly having paranoid delusions and needed help. L is in much worse shape. The indications we are getting from LTC facilities is that he will need more care than is typically provided in an assisted living setting. They also have a small/medium sized dog that M is reluctant to part with. We became aware of the situation only a week ago Saturday and had not given any of these issues consideration prior to then.

The plan at the beginning of today was for L to live in a nursing home and M to live in an assisted living unit in the same complex, so she could keep her dog. That plan fell through when the room for L disappeared, but they also said that they didn't have enough money.

Their resources:

He served a full career in the military including the Vietnam years. Veteran's benefits for long term care are supposed to be $2000 per month but may take a year to come through, so we've been told.

Combined income of around $7K per month

Savings plus home equity of about 2 years worth of income, plus or minus

They are moving from the state where both have lived for the last 30+ years to neighboring state to be closer to my wife's sister.

M's family is only nominally involved in the whole process, M's sister finally came to pitch in on the transition after a week of pleading. M's daughter doesn't seem to want to be involved.

My questions:

What is the most economical living arrangement, assuming L needs a nursing home type environment? I'm sure we could persuade M to give up her dog if necessary. Is having L in a nursing home and M in assisted living nearby the most economical or would them sharing a room in a nursing home be better?

Are their resources enough to care for both of them now and potentially when M's condition degrades? Based on average costs I have seen online, it seems like their monthly income is only enough to cover L. M's living would come out of savings.

What happens when they run out of savings? Would their income, plus veteran's benefits, plus Medicaid be sufficient to care for them? Do we specifically need to be looking at facilities that accept Medicade?

Are there any consequences related to them changing states of residence?

Are there impartial counselors or social workers available who can walk us through the best options? We're on a short time schedule due to L being released from the psychological hospital on Friday, my wife being away from home, and my SIL missing work. It seems like we are having to find out everything the hard way and have been stumbling around making false starts. We kind of need a road map to work through the process. Any suggestions would be much appreciated.

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There are several assisted living facilities, some more expensive than others, that will accept a pet as long as the resident is able to care for it. Vet assisted living facilities are popping up all over the country which are way over due. I am not familiar with these, first hand, as the one being built near us will not be available until 2015 and don't know what they will accept and what they will not.. It appears most are near base towns. Nursing home insurance companies will only cover from 2 to 5 yrs no matter how long the policy has been maintained. Keep that in mind. Good luck to you.
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It is a lot to crunch, since L is a vet there are many services available to them that may help you through the transition. We have a new vets hospital and senior living of all kinds here that is absolutely beautiful! They are all over the country. When he is released from the hospital will he go to rehab? You can and should advocate for that. There should be a case manager at the hospital that will help find an appropriate facility. Medicare will pay for up to 100 days in rehab which will give you time to figure the rest out.
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There are social workers at L's hospital but they are never available when my wife and SIL are there. Now wife and SIL are in SIL's town looking for a facility. We will see if there is an aging agency there.
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Is there a social worker at the hospital that L will be released from? If so, I would start there. They have information about what type of facility would be able to accept L, and can contact facilities to ask about available beds and costs. Their information about facilities in the neighboring state may be limited, but they may be able to connect you with someone in the new state.

Since Medicaid is a state program, and the rules vary, there probably will be consequences of a move. Again, the hospital social worker may be able to direct you to the appropriate agency contact.

Depending on your location, there may be private "senior care managers" who can help you for a fee. If there is an aging agency in your location, they could also be a good starting place for information on facilities and financial help.
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