Home health care, or assisted living with eventual nursing home?

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If you had the choice between using mom's funds to put her into an ALF (that offered care for dementia patients), with the understanding that her funds would be depleted in about 4 years, and she'd be transferred to a Medicaid facility until her death (which in the case of her mother was over 10 years)...or use a portion of her funds to build a small home on your property, (with the construction geared towards providing comfort and ease til her end of life at home), investing her remaining funds to continue to build equity and be able to provide hired home health care for her once it became necessary for 24/7 care, and become her caregiver, which would you choose? And why?

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When mom was in Independent Living, we kept her in a place that was close to her old home, so that friends could visit (I think that happened once) and so there was a possibility that she would know some of the folks there ( also happened once, a person that none if us could stand).

So mom had a stroke and was taken via ambulance to the local hospital. It took each of us more than an hour to drive there. By which time mom had nodded agreeable to many questions, including "do you have diabetes?" ( she didn't and doesn't. But it took us a while to get the order for insulin dc'ed).

We decided shortly thereafter that mom was going to need to be 10 minutes from one of us. She's now in a nh near one brother with the most financial resources, the most flexible job and PoA.

As to the money, there are certainly continuing care communities that you can buy into that will guarantee lifetime care. There are states where ALs have Medicaid beds, especially after several years of private pay. When mom was discharged from hip surgery, the discharge folks took a careful look at her Financials with us and recommended for rehab a place that was also a long term care facility that accepts Medicaid after private pay. Mom has been there for 2 years now, and at 15,000 per month, her money will last about another 2 years after we sell her house. It's all working out so far. It's a two hour trip each way for me to see her and 5 hours for our youngest brother, but it was a good decision.
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AgingYogi, you express perfectly the tumultuous tug of emotions we all feel. If only I'd known then what I know now.
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We built a mother in law apartment almost 13 years ago for my mom. She's a loner and has never had any interest in socializing. Now she's really deteriorated, confused, and physically challenged. She chose to spend most of her time in bed watching TV for years. I'm beyond exhausted (only child) and can't even leave the house because she's afraid something will happen to me and then what will happen to her. I agree will the above comments. They are more engaged in an environment that is suited to them whether they think so or not. Also, impossible to imagine how difficult it can become and the toll on your personal life. I said I'd never place my mom in a home but as I see her deteriorate, I'm not sure I'm going to be able to keep that promise. Days can turn into years and sometimes into decades. Hindsight is 20/20. Now she says to place her in a home and I just can't. If I took her out of her familiar surroundings, it would be the end of her. Sorry for the rambling, it's just a lot to take on the role of caregiving knowing the only place it's going to go is downhill. Find a way to make your mom happy without letting your life pass you by.
Best of luck and light to you.
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When the money runs out, the elder goes on Medicaid and is allowed 2K in assets.
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First of all, if you are going to be the primary care provider, I agree with the senior agency about moving her to your area. My mom was two hours away for four years and the driving got really old in a hurry. Each trip required a day off from work. I had to deal with winter weather and spring hail storms. I moved her to my town, and although she talks about moving back, in reality there is no one back in her home town to take care of her or even to visit her. I can see her once or twice a week instead of once or twice a month.

Don't spend a lot of time worrying about what will happen when her money runs out. There are so many possible scenarios for five years in the future. She could develop health problems requiring a move before that, or her dementia may progress to the point that her surroundings have no meaning for her. There is enough to worry about now without trying to figure out something that may never happen!
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All the answers were heartfelt, and appreciated. No one has explained what happens when the money runs out, and mom is told she needs to move to a Medicaid facility. From what I've been told, those can be detrimental? In choosing an AL, our local senior agencies have all suggested we move her to our Ares (vs an hour away), so as to be able to tend to her growing needs on a daily basis. Any thoughts? The siblings (who live out of state) don't agree.
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I just calculated what it would cost, approximately, for an agency nurse 24/7 at 20an hr. (Cost in my area) 480 a day, 3300 a week. At $5000 a month or a nice AL, I'd pick the AL. I know people who have voluntarily gone into AL's because they are so nice. You get a nice room or small apartment. Rooms have kitchenetts. You have freedom to walk around, socialize and join into activities. Three meals a day and snacks. If still able to drive, you can have your car. Family members can still have their lives and visit often.
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Honestly, "living in place" is the best option for your elderly parent, with hiring home health aides. Your loved one knows her home.
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Sorry, just couldn't read all the responses. If Mom had the money, I'd have herbin an AL facility. She is bored here and being in a split level doesn't help. The one near us requires 2 years of private pay then will transfer to Medicaid. This way residents keep their room and stay in the facility.
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I am keeping my Mom with me as long as possible after 3 experiences with rehab in 3 different nursing homes. The money they ask for is outrageous and shameless for the small amount of attention they seem to get and the injuries that occur. Either way is not easy, but it was more exhausting having to police the situation in the NH daily and having to deal with Mom being dropped by aides getting her into the wheelchair causing a broken leg, and being neglected so that a stage 4 bedsore happened in the first 5 star medicare rated place, than for me to just care for her myself with one nurse and aide, and she is not allowed to fall or be dropped or just left to lie there for hours without turning or changing. The service you get in my experience does not justify the money they ask for. Aides in nursing homes are not paid well and someone must be pocketing all that.
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