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My mother is 84 and has been in AL for 5+ years and she currently pays just over 7k a month. This includes everything - all ADL help needed, medication management, apartment cleaning, and all laundry including bedding that she wets every night. We live in a hcol area so this is the general rate for this type of care. She is very happy there and is well cared for.


Shes been in rehab for a month after another COPD flare up and while we plan to have her go ‘home’ next week I’m very aware that she may need more care than they can give her there. Which leads me to decide what do do next?


I could hire someone to stay with her during the day, every day but after crunching numbers that would come very close to full time nursing. She could go back to the rehab/SNH and we would self pay but I believe the rate is 15K per month. She had 4 years of LTC insurance that just ran out (unbelievable policy that doesn’t come close to even existing today) so I believe if she close SN it would be 100% private pay.


She is fairly comfortable and could self pay for a number of years - it just seems like such a crazy amount. It it common to self pay? Are there better options to care for her and maintain a good quality of life?


Living with me or my brother is not an option.

Depending on her assets which sounds like she has plenty, LTC will take SS & then apply for Medicaid. Here in Virginia, you can’t even get into an AL unless you have LTC insurance or cash. They won’t take Medicare or Medicaid. It’s a mess! That’s why mom has to go to LTC, she only had SS. Sad to realize your parent didn’t plan well. That’s our situation.
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Reply to Lostinva
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GrannieAnnie May 18, 2019
Some people didn't plan well because they couldn't afford to.  My Dad was on Disability for awhile.
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My mother has been private pay in a nursing home for about 7 years. Fortunately, this is only a bit over $73,000 a year (for a shared room), and her SS, deceased father's pension and stock dividends cover over half of it, so her portfolio is essentially unaffected (due to the wisdom of my father and a rising market). I assumed there were few there who were private pay, but I saw a breakdown of the residents, and it was at least a fourth of the residents (although I assume this includes some who will relying on Medicaid in the future).
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Reply to jacobsonbob
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Vegaslady, her mother is already in AL. Her choices are between staying in the AL with more assistance or moving to a NH. Cost is a facor, and Medicaid probably won't be available for the NH care. So staying at home at FullCirlcle's home with almost constant care is not an option. And if it were, as it's been pointed out, that could well be the most expensive option. FullCircle, I would add that in looking at costs, since your Mom is OK financially, remember that if she is able to itemize her medical deductions, the cost of nursing care, whether or not it is delivered by a nurse, is a deductible medical expense. You need to check with the IRS on this, but my recollection is that when I researched the question, I found that all aspects of care in a nursing home may be deductible.; i.e., including the monthly room and board costs. In an AL, that's not the case. You can check on this yourself online; you do not need an eldercare attorney to find out! You can also call the IRS (ask for a supervisor!), but with the budget cuts for IRS support, you may have some long waits and/or talk to someone who is not well trained.
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Reply to caroli1
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My aunt was able to get in a small non-profit, hospital owned MC nursing home.  This year it is about $11,000/month.  They quote by the day around here, and others are more expensive.  It was semi-private, and very good, self-pay. 
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Reply to GrannieAnnie
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My mother was in NH care for 5 1/2 years after an unsuccessful broken hip repair, and the costs totaled almost $1,000,000.
That amount was the accumulation of her frugal life style and my father’s decent salary.
It was all her money and used for her care.
In home care was much cheaper, but not nearly as successful for her as a wonderful experience in her NH.
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Reply to AnnReid
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If she has the money, then she will need to self-pay.

Medicaid will not cover her NH until she is essentially broke. It is for people that truly cannot afford to pay for their care.

Transferring any assets at this point will not get her approved for Medicaid, it will throw up red flags and cause problems.

Have you done a new assessment to be certain what her new status is? This could help you figure out how much additional assistance she requires and go from there. She may not need someone all day, maybe a couple hours in the morning and afternoon.

If she is doing well where she lives and you can keep her there, I would recommend that. Yeah, she may run out of money and then you are forced to make different decisions, but she may die before that happens. If you can give her the gift of stability and some quality of life, that is the most you can hope for at this point.
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Reply to Isthisrealyreal
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I can only answer the part of question about how common it is to do private pay. I believe it is quite common. It seems to be rare when anyone has coverage for this on their insurance plan.  If they do, it is more like as you describe where it is limited in time or costs.  If you outlive those parameters, then you private pay.  Also, someone in my extended family owns a Home Care agency, and he talks about that issue all the time with his clients.  I know my parent's insurance has no coverage at all for LTC.  They don't even have the option to add it, but would need to pay a different carrier for it.  Even then, I was told by that carrier that there were numerous conditions under which they still would not cover costs.  I guess this is a topic where it really does pay to research the options.
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Reply to GingerMay
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My parents at one time lived in an apartment near me and both had dementia and needed 24/7 home care.. which was either I hired someone or I did the care myself..it was a mixture. I moved them to a memory care where they shared a room.. 2 years later my dad recently passed but mom still in memory care.

Anyway.. the home care was way more expensive then even the memory care.. and that is with me taking a shift every day.

So cost is one option to think about as well.... even though both options are expensive.. I found home care way more expensive.
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Reply to katiekay
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If I am to understand, "home" for your Mom is AL? If so, i found that paying for AL is about the same for private pay in Nursing home. We just made the switch with Mom. It seems like, with her health challenges, she might soon require more medical treatments/ management which AL is not equipped to do.

I would consider moving her to a Nursing Home to minimize the inevitable transition again ...and hiring private care in the AL can be challenging. I tried that, and sometimes it decreases the amount of care that the AL is doing because they see someone there all the time. It is like "double paying" for services.

I moved my Mom from AL/MC to a semi-private NH (we are in NC) and the private pay rate is half what you are quoting. I would also consider consulting with an Elder Care Attorney who could help you explore the possibility of filing for Medicaid so you won't have the fear of running out of funding for her care.
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Reply to carytocalcutta
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Stay at home with help, around familiar surroundings and friends or go to a nursing home? Why is this even a question? That is what my 93 year old aunt has been doing for years. If it's affordable what is the downside?
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