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I'm just trying to get a sense of how much of an option it is for my 91-year-old MIL to live in an assisted-living type of situation or care facility. She has some behavior issues that may be a problem, but I don't really know how much these facilities will tolerate. We are trying to put off such a move as long as possible, but if we do go that route, we would probably have to sell her house to help pay for it, so then the move would become irreversible.


Thanks in advance for any insights you can share.

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Have you provided medically necessary care for two years or longer? If so, check with an elder law attorney on the rules in your state to see if you can remain in the home. You would be responsible for taxes and maintenance.

My mom was kicked out of a memory care facility. She was a danger to herself and others. She had a private caregiver that was with her as necessary over a period of a year and nine months. That became very expensive as that cost was in addition to memory care. Mom's agitation was absolutely unmanageable. Going home was not an option, it had been sold. Mom was on hospice at the time and they recommended/suggested a care home. A much smaller facility, a higher level of care, lower caregiver/resident ratio. And imagine, all residents in that home had been kicked out of their previous facility! The care home was less expensive which was a bonus.

They provided very good care for mom and would have been better for her from the very beginning. Mom's agitation? Where did it come from? She was always ready to fly off the handle. Maybe she was undiagnosed bipolar? She was definitely narcissistic. Had a history of depression. Stepdad had passed four months before mom was kicked out. Mom with Alzheimer's was far past being able to remember or understand a death. Maybe she was grieving and just knew something was off. Who knows.
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AuntieAuntie Mar 30, 2019
So many elements of your situation match ours, especially the agitation, narcissism and possibility of bi-polar or something.

On the "medically necessary care," I can't really say that we are directly providing that. There is a home health nurse who comes by each week to check on MIL, plus she has a lady who personally assists her every day for 5 hours. Medically, she's not actually in very bad shape for her age. It's the mental/behavior part that's messed up. She makes more and more horrible decisions, causing hazardous situations sometimes, or at least big messes and repairs for us to deal with (physically and financially). Plus, there are many "vultures" as I call them... circling to see when/how they can take advantage of her vulnerability. There are certain people who can talk her into anything, and they know it. So that is why we felt it necessary to move into her house.
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Your profile says MIL “is 91 years old, living at home with age-related decline, alzheimer's / dementia, anxiety, depression, diabetes, and hearing loss.” These conditions sound a little more advanced than an Assisted Living level of care. My Mom is in a NH and those issues are common there. Her doctor will need to agree that there’s a medical need for a NH. You don’t say what her behavior issues are, but some behavior issues are pretty common at the NH too and are addressed there. I wouldn’t worry too much about her getting kicked out at this point.
If she has income and and some assets those would be used first to pay for her care prior to Medicaid application and selling the house. Hopefully you’re in an area that has some choices regarding NH that you could start looking at. This will give you a better sense of how to proceed and the costs. And hopefully you already have POA.
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Another insight: houses in very bad condition (or even not perfect) don't have to be fixed to sell. Either way, there is a reduction in the net amount. When you consider the hassle factor for an elder's house, it may not make financial sense to try to maximize proceeds of the sale. My mother's 5k sq ft house was a total loss. It was cheaper & more tax advantageous to donate it to the church along with the cash to have it demolished. We cleaned up an eyesore and the church could direct how they wanted the land for a new building sculpted.
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The good side to a geriatric psych unit is that people who need medicines will receive them to control their broken brans so that they are not a danger to themselves and innocent bystanders. Once meds are adjusted, most go to community care. Mthr is in a locked memory care unit which is very similar to a Geri Psych without all the lab coats
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AuntieAuntie Mar 28, 2019
Thank you! Something to think about.
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You’ve been given great advice on placing her in right level of care.

But I have a question regarding her home. It sounds like you do not want to sell her home. Why? Are you living on it? Other family members? Or is it vacant? How are property cost being handled? Is MIL paying all property costs (taxes, insurance, utilities, etc) or are you or whomever is living there.?

I’m asking this cause I’d be concerned that she does not have the $$$ to afford a NH plus her old home for 2 - 3 years, that means she will eventually need to apply for Medicaid. If NH cost like 10k in your area, she would imo need a good 250k - 300k to be private pay. Does she have that? If not then eventually she’ll Medicaid. Medicaid will require her to be impoverished & so down to 2k in assets and then whatever her monthly income basically almost all must be paid as the required copay to the NH. She can continue to own it but no $ to pay its costs.
You really want to look at her finances and your own ablity to deal wWhy th the property costs.
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AuntieAuntie Mar 28, 2019
She is living in her home and we are living with her now, due to her needs. She is able to afford the upkeep costs as she has a number of income sources. She also has some assets. Where we live, the costs are generally lower, but we still have concerns about her money lasting to the end of her life. She's 91 now, but her mother lived to 106, so who knows? If she did need to move into a care facility, we would probably have to sell the house. It would not be rentable in its current condition and we don't have the time to undertake that project. I don't think we could take on being landlords either, on top of everything else on our plates.

Good to know about the Medicaid. Thanks for helping me think this through!
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I think that there are two reasons for getting 'kicked out'. One is that the level of care provided is not sufficient - you chose the wrong level. The other is anger and violence to staff or other residents. This needs a much higher level of care, irrespective of physical competence issues. If it is too extreme, there are psychiatric 'prisons' which usually follow on actual criminal assaults. Talk to the facilities you are considering, and be as accurate as you can about your MIL's behaviour. Good luck!
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AuntieAuntie Mar 27, 2019
Thank you! This gives me a clearer picture.
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If she is having behaviour problems I would not consider an AL. They are not equipped for people like this. I would say a Longterm care facility.
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AuntieAuntie Mar 27, 2019
Thank you! I guess I need to educate myself on the different types of care facilities.
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