How do you determine what level of help your parents need? Meaning, I think my parents are somewhere between independent living and assistive living. We live in different states - over a days drive - so it is difficult to be available for such things as driving to appointments. Driving is the major issue at this point. as well as keep up of the house. I know assistive living facilities have the ability to get my parents to appointments but right now, an assistive living facility sounds expensive for such small services. With that said, my father is hearing impaired and blind due to macular degeneration but is still trying to run a rental business which he cannot do any longer and my mother has a history of strokes and is just weak, and well, old.

One of our thought processes is to sell our house (at a loss due to market) and buy a single story with in-law quarters so they can move in with us. They have a comfortable lifestyle and would help us buy the house - which I guess could be diverting assets for when the time comes for assistive living or nursing home. The other thought process is to go into assistive living so it will already be in place as their physical condition deteriorates. I am just overwhelmed and don't even know where to begin. Any thoughts or recommendations is appreciated.

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As you will find in visiting the different AL communities, they all have various levels of care that are in addition to the standard housing expense. I've tried for the last few months to find how how these time allocations are determined, to no avail. The AL explained to me that it is like taking your auto in for repairs - there are standard time allocations. But what are these allocations? Dad has assistance daily with showering and dressing..that's it. He was on a care level 2 that provided him 5 hours of care a week for an additional $600/mo. That care level, however, only allowed for showers two - three times a week; then daily dressing. No how many of us only take two to three showers a week? Well, we went to seven days a week showering and they said that would take him to a level 3 care, a total of $900/extra per month and 10.5 hours of assistance weekly.

Dad has parkinsons but has wonderful computer skills. We communicate via iPad and email. For the last 75 days he has emailed me daily with the time the aide arrive, when they left, who it was and any problems incurred. Surprisingly enough, the average daily time to shower and dress him is 18 min per day; a little over 2 hours a week. So, why is Level 3 with 10.5 hours a week necessary? Seems like a logical question to me....yet one the AL has not been able to answer. It's hard to be an advocate for your parents in AL when questions such as this result in a Notice of Lease Termination. Yup, that's what we got on Friday. Ridiculous! Here I thought I was working things out with the Exec. Director only to be blindsided in what was to be the quarterly Care Level Meeting.
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Consult with both their doctors and maybe invest in a geriatric care manager for initial assessment and evaluation. Your local senior center or center for aging can refer you to a couple. At your stage, this would be a wise investment ($700 or less) and then they can also help direct you to the right services for now. Depends on your parents health state and age, sometimes if you can get some in home assistance to start, that might work or be cost effective for now. Certainly, if they are old, two moves might be too traumatic, so you want to research any AL or other senior care facilities to make sure they can offer the care services needed in the long haul.

It can be costly, but if you look at it as a "total daily cost" it can really be cost effective, factoring in lodging, maintenance, meals, grounds maintenance, property taxes, insurance, etc. and aides to keep them in their home.

Also the healthier they are going in the facility the more they can enjoy and adjust to the amenities. Also, once in the facility, they can't be thrown out once they go thru their assets, the facility has to find them a bed and keep them there -- they can't kick them out, and Medicaid will take over. Double check any contracts and make sure you understand all the nuances for this.
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Only you can really decide which one your parents really need. But if they are "starting" to get to where they need more help - understand that this will only increase. So unless you and your family are willing to take on more caregiving roles in the future, I suggest you look for alternatives. Caregiving can be many things - satisfying sometimes and frustrating as well as exhausting - both mentally and physically other times - so make sure you are up for the challenge before having your parents move in with you. You may want to check into home health care help instead of moving them if that would work. But I suggest you research and ask LOTS of questions of the assisted living and independent living facilities - such as what they offer and what they don't do. Assisted Living is more expensive, but there is more care involved - which they may not need yet. And some independent living facilities provide transportation to places. So do your research and talk to your parents and find out what works best for you and them. Unless your parents really objected, if possible, I would look for a place near your home so you can be more involved with their caretaking. And if your dad's rental business is getting too hard for him to handle, it may be time for someone else to take over or sell the property to help pay for their care. Just a thought. Good luck!!
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Hi Pierce,

My dad helped me with a house in which I could care for him and we lived like that for 5 years until the care got to be too much for me. He went from the hospital to a rehab facility and just never really got any better. Then I was stuck with this house I couldn't afford and had to move out in, like, 2 weeks. It was a mess. I hitched myself to my dad financially because he needed my care and we needed a place to live so that I could give him that care. It was a huge mistake financially and I worried about it everyday I spent in that house. I knew that all it would take was one fall, one little incident and I'd have to unload that house.

That was my experience. I see a lot of caregiving situations as I work in healthcare. I see adult children trying like hell to keep their parents at home and the parents continue to age, of course, and it just takes one little mishap like a fall or an infection and major life decisions have to be made in one day under stressful circumstances. Parents refuse to move even if it's in their own best interest and the adult children are left to pull their hair out in frustration about what to do with mom and dad.

If you can, buy a house you can afford, not one that is affordable taking your parents income into consideration because at any time their income may have to be given over to a facility. Maybe not today but if dad takes a fall or mom comes down with pneumonia you may find yourself in a situation where you have to make alternate living arrangements. It can happen that fast.

But until then, good for you for looking out for your parents and wanting to get an idea on what options are out there for them and for the 3 of your with you as their caregiver. I hope I didn't scare you. I share my own mistakes hoping people might choose better than I did.
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