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

It may sound strange coming from someone who has chosen to keep my mother with me in her final years, but I would choose the assistive living arrangement. The main reason for this is it would offer structure, socialization and activities to keep her interested in the world outside herself, whereas living in a separate granny flat would limit her world to you and whatever family would bother to visit. I've stated elsewhere that I think we made an error in not encouraging my mother to move to a more senior friendly environment when we lost my dad at 75 and she shortly after lost her ability to drive due to macular degeneration. I think the isolation contributed to her eventual decline.

Ephesian.....you don't mention your age or circumstances nor those of your Mother....still, some good and considered replies to your inquiry. Must say I weigh in w/the majority here: find a really good ALF....deal w/the situation, as may be, 4-5 years down the road....In my personal experience, Mom was able to live in her condo, independently until 91. At 89, after I took her for testing and she was dx'd w/MCI, we started hiring caregivers so that she could continue to live independently in her condo. Worked well until she had a series of sudden, catastrophic falls, breaks, surgeries. She is now very happy in a beautiful ALF.....and yes, this is a very smart, active, stubborn woman who, when I tried to speak w/her about plans for her future, for several years before "the crises", even as she existed in the state you describe for your Mother, insisted that "she would never leave her condo....ever".....well.....the sudden, catastrophic falls and subsequent fallout changed that. Also, her dementia progressed and she no longer remembered her beautiful condo....(shocked me, but I was quite grateful that leaving her condo ceased to be an issue). Point is......you just CANNOT PREDICT anything when age and dementia are in the mix. I also must say this, w/all respect: #1. Although you ask for input/opinions re: the 2 options in your original post, you frankly, sound to me, in your subsequent posts, as if you are primarily seeking validation for building the separate residence (as opposed to the ALF alternative you offer). That's cool. It's a terribly difficult, emotional and personal decision. I applaud you for caring enough to seek out info and opinions and trust you will make what you feel is the best decision, for you and your Mom, ultimately. But since you have asked here, understand that you will get frank, down-to-earth answers #2. Your Mom, who you describe as confused, etc. is still driving??? Oh, plz, this seems to me a more immediate issue. Plz, deal w/this, for everyone's sake. #3. This has already been addressed by previous posters but....I will add a gentle reminder: Your Mom has dementia, says she NEVER wants to end up in a Nursing Home......BUT.....she no longer has the ability to make these decisions....yet, you feel what? Responsible? Guilt-ridden? Obliged to follow her wishes?.....plzzzzz......do not do that to yourself....she is no longer able to reasonably make those decisions.....your obligation to her is to, best as can, make sure she's safe and secure.....I sincerely wish you luck, no matter your decision.

Ephesian, my mom has been in assisted living for 4 1/2 years now. She was in one facility for almost two years, and in the current one for 2 1/2 years. I admit that I didn't do enough research when I selected the first facility, but in my defense, she had fallen and broken her ankle, and the independent living facility where she had been living said she needed to go to AL, and I didn't have a lot of time. The first facility was part of a national corporation, had very high employee turn-over (there were three directors of nursing while mom was there), charged extra for every little thing and raised the rate almost 10% each of the two years she was there. They also didn't make much of an effort to get her out of her apartment and involved in activities, a situation I blame at least partly on the turnover and lack of continuity. The second facility is a non-profit, owned by a church denomination, so there are no stockholders to satisfy. The staff is much more stable, they do a great job, and the rate is almost $1,000 per month less than I would have been paying by now at the first place. Fortunately, my parents saved money, so there are still funds available for a few more years of AL. If she would need a higher level of care the money would be depleted faster. Her current facility has a wing called "Advanced Assisted Living" for residents who need more help, and recently opened a new memory care wing. Mom's dementia has progressed over the past four years, but she still knows me and is able to dress and toilet herself. Her physical health is good, so at nearly 89, she could need care for several more years. I hope that by the time the money runs out she is to the point that she is not really aware of where she is. She didn't remember the first AL less than a month after she moved to the second. I will cross that bridge when I come to it.

Is your mom in need of care now, or are you just looking ahead? Does she have any income coming in that would stretch her savings further such as SS, or a pension? Is she the widow of a wartime veteran? If so, the Aid and Attendance payment for a widow is now about $1,100 per month after her assets are down to a certain level. There is info about this on this site. Does she own her current home which could be sold to help pay for care?

In my opinion, your plan to build a small house is much more risky than an AL. What if you spend a significant portion of her money on the house and then something happens to make it impossible for her to continue living there? A sharp decline in her mental function or a broken hip could require either a move or 24/7 in-home care, which would quickly deplete her remaining funds. Then, if Medicaid is needed you may have a problem with the money spent on the house being seen as a gift to you. It is not as if you could sell the little house to recoup the money since it will be built on your property.

I agree with cwillie about the socialization benefits of assisted living. My mother is currently in an AL facility. I also question your calculations. My mother's AL facility costs about $40,000 per year, so four years would be $160,000. After building a small house on your property, and paying utilities, taxes, insurance and upkeep, how much would be left to pay for in-home care when it becomes necessary? 24/7 care at $20 per hour works out to over $14,000 per month. If Medicaid becomes necessary in the future, they may look at the cost of the little house as a gift to you that increased the value of your property.

The better ALs have daily activities, and make a good effort to get the residents involved. My mom's AL has music programs or sing-alongs a couple of times each week, BINGO, Wii bowling, art activities, cooking activities, sitting exercise classes, card games, puzzles, church services and a daily "walking club". My mom cannot remember when any or these things happen, but the staff goes to her room to remind her and take her to the activities. It is far more stimulation than I could provide if she was living with me. If you are looking at facilities, ask to see the activity calendar and ask if they will encourage your mom to participate.

If I had that choice, I would go with the facility. I would, however, look for one that accepted Medicaid after a period of self-pay, so she would not have to be moved. I think this varies a lot by region or state, but here many ALFs do operate that way.

A person with dementia cannot live alone beyond the very earliest stages. Even a house on the same property is "alone" so that may turn out to be a very expensive option -- building the house and then paying for in-home care. I couldn't leave my husband alone while I went grocery shopping. My sister had to get someone to come in to stay with Mother when Sis went bowling.

The other factor is that dementia -- dementia of any kind -- gets worse. It is the one thing you can absolutely count on. You mother may need the level of care provided in a nursing home in three years no matter where she is now. Even if her money holds out to pay for the ALF, her health may not. And it may not allow her to stay in a private home, either. My mother stayed in my sister's home as long as what she needed was "assisted living." That lasted 14 months. Mom is in a nursing home now, and thriving. She, too, wasn't social before going there so we are surprised and delighted she never misses bingo or a sing-along or live entertainment or a baking session or crafts. Sister had a hard time getting her out of the house to even her beloved beauty appointment. Now someone wheels her down the hall where she gets her hair done happily.

My best friend just wrapped up the sale of her mother's town house and she was saying this will pay for her mother's ALF for another 3 years. Her mom is now in the hospital and may never recover sufficiently to return to the ALF. No matter how carefully you plan, you cannot anticipate all future events.

Whatever you decide to do, discuss it with an attorney certified in Elder Law. For example, how will Medicaid look at using Mom's money to build a house on your property. You still need to decide what is best for your mother, but make sure your decision is carried out in the most advantageous legal manner.

My parents are both at home with shifts of full time caregivers. My sister and I both live close to them and help. Well said, freqflyer and cwhilly! So true, jeannegibbs! You cannot anticipate future needs. Maintaining their home, high nurse turnover, endless errands and driving. Mom and dad are isolated. Sis and I are exhausted. I'm doing my very best with advise from the greatest people in the world on this site!!

Thank you all. We took care of dad when he had lewy body dementia/Parkinson's for several years before he died with hospice in our home, so I'm not completely ignorant of what to expect. Matter of fact, the reasoning behind a separate little house, vs moving mom in with us is because of the toll of caring for someone in the same house had on our own family. We were only thinking of mom's ability to stay independent longer, as well as the ability to build to suit her individual needs. That plus the fact that she is only in her mid 70's, and in good physical health, much like her mom was. However, listening to everyone's input brings the reality of what we went through with dad, and we are seriously reconsidering our willingness to go that route again. Because of her possible "longevity", we found a nice AL that for an initial $45,000 (plus monthly fee) will guarantee she not be moved to a lesser facility once her funds run out. Thank you again.

Thanks again. We've decided not to build anything. We told mom today, and she understood. We also talked about various AL options, so hoping to be able to take her to various facilities soon. *fingers crossed*

Ephesians6vs2, thanks for sharing your decision with us. Hang around, keep us updated, share your experiences and read about ours!