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My 92 year old Dad has been my 82 year old mom's caregiver for many many years (stroke and vascular dementia) but dad's automobile accident has forced us to move to the next phase. I have taken over their finances and currently have part time nursing aide help that comes into their condo for 8 hours a day in split shifts to cover the mornings and evenings.


Dad continues to decline cognitively over time, and I'm starting to look at Assisted Living facilities for the potential/eventual move that will need to happen.


The costs have been eye opening. I am in the DC metro area and AL is going to run around 130K-150K a year for the two of them. If dad predeceases mom, mom will need memory care which will run 130K a year and up just for herself.


My parents have LTC ins. that I have started tapping and still have a collective 400K balance left, and all told they have about 700K in assets (including the sale of their condo). Between my dad's pension (which includes survivor benefits) and their SS, they also have about 62K coming in per year after tax.


As it is right now, with the in-home nursing care, housing, transportation and food, they are already spending around 110K a year, so at this point the cost to go to Assisted Living would not be that much more.


If I look at the actuarial tables, they can afford to move into an Assisted Living Facility and they should be ok. But if they deteriorate rapidly, requiring much higher levels of care, or if they live longer than expected, they could run out of money.


How do you plan for this? My wife is super concerned (she's a worrier). I told my wife that if we moved forward with Assisted Living and a black swan type event happens, I would be willing to go back to work to cover their expenses (I retired 4+ years ago) but she wasn't happy with that answer.


How is everyone else dealing with all these unknowns?

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Go sit with an Elder Care attorney and get some answers. If I were you, I wouldn't worry. With their income AND $700k in assets, with dad being 92 and mom 82 with dementia at play, they have plenty of money to last them in Memory Care Assisted Living for the rest of their lives. My mother lasted for just under 3 yrs with vascular dementia in Memory Care Assisted Living at $6800 a month which included everything but incontinence supplies, doctor copays and meds which added up to about $300 a month more. Find a memory care facility for mom that's all inclusive and doesn't keep padding the bill every month as they see fit. And remember that Medicare is capped at certain amounts for out of pocket payments. PLUS they have LTC insurance which my folks did not have, a pension which my folks did not have....all they had was Social Security and VA Aid and Attendance benefits of $2032 a month while dad was alive, then $1091 for just mom, plus savings of about $400k. Their monthly income was $1100 not including Aid and Attendance....so nothing. Meaning I made their savings last 8 years plus before mom died at 95 and dad at 92. Vascular dementia normally has about a 5 year lifespan to it.

I tell you all this to say.....don't worry. See the EC attorney. He'll set you straight about Medicaid in your state SHOULD the need arise for you to apply for it for long term care for mom. I had the app ready to go for my mom, and a SNF picked out too, but she passed before her funds ran out. There was NO WAY I was going back to work to fund her extreme old age in long term care, and neither should you. And with their funds, you shouldn't have to even consider it.

Take your wife with you to the attorney visit and set both of your minds at ease. No point borrowing trouble. Good luck.
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Nova, you are right to be questioning their ability to get Medicaid. Not everyone qualifies, not all income can go into a Qualified Income Trust aka Miller Trust and not all states allow a QIT.

From what you have shared, an AL may be a very short stop gap. Change can cause a sudden drop in ability when dementia is involved, moving your parents could very well increase their care needs.

I was faced with a similar financial situation for my dad, except, he couldn't afford to set up a Miller Trust, see a CELA or afford a nice facility and had no insurance. I looked outside the box and found board and care homes. They don't offer all the amenities and activities of large facilities but, my dad wouldn't use that stuff anyways. Some of them keep the residents through hospice, they are prepared for care needs increase, if you choose the right facility.

I would not go back to work to cover their expenses. I would look around, even into different states and find the best facility that meets their actual needs and can keep them together or as together as possible. Enrichment activities are cheaper on an as needed basis, so forget about in house, unless your parents are social butterflies and will be utilizing these services daily.

You are really fortunate that they have a decent income, insurance and some assets. You don't have to worry for years or ever, if you can find a facility even outside their area that can accommodate increased care needs, at a more reasonable price, right through hospice. (It is important to verify that ANY facility will accept hospice, not all do.) When a facility becomes a reality, location isn't as important, because their world will largely exist within the facililty and you can create excitement about new adventures outside the home.

Tell your wife that worrying won't change anything except her health, so try not to. Your parents really are positioned okay with some creative solutions.
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mstrbill Aug 2022
If someone medically needs skilled nursing care and long term care and need to be on LTC Medicaid to cover the costs, they will get it, no matter their monthly income. There seems to be misinformation out there, where some people feel they can't qualify for Medicaid. They are reading the guidelines for community Medicaid, not LTC Medicaid. Lets say for example 78 year old James has a monthly income of $5000 between his SS and pension, and will have this for the rest of his life. Lets now assume James gets in a horrible car accident and assume he had minimum insurance (or no insurance). He's paralyzed with brain damage. What would happen? Do you think he wouldn't get LTC Medicaid because his income was too high? NO, he would be taken care of by the state. Each state has different ways to go about it, but everyone of its citizens can get nursing home care if it is medically necessary.
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In DC area, check out costs of facilities in the outlying area, may be a bit less that DC / Bethesda / Chevy Chase. My mother is in memory care in Olney. You can hardly throw a rock in that town without hitting a care facility. Lots of choices are out there. But direct care staff will be immigrants who struggle with written and spoken English, leading to lots of communication problems, and who are generally exhausted during their day shift because they have an overnight shift at someone's home. Even direct care care staff with some type of nursing qualification are not guaranteed to understand what they read on a simple medical test report, and they do not understand literally half of what they hear in spoken English. They will never admit any of their deficits in reading, writing, and hearing English. Their first strategy to avoid revealing their deficits is to get angry at you for asking questions!
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Yes. First, I really would bag looking at Assisted Living. You will have to pay a community fee, which isn't refundable. They'll accept your parents until they become too much work, then they will kick them out with barely a 30 day notice. They'll tell you they'll offer this level of care, then you'll find out that they don't. And yes, AL will be much more because you'll move them in at one price and the AL will tell you, you have to pay more because now they require more care.

Here's what I would do.

Consider either renting out the condo (it's a good renters market and you can get a property management company to handle the whole thing for a cut of the rent). That might bring in $2-4K a month, giving their income a boost up. Or sell the condo if the market is still good and get the money into bonds/CDs and get some income coming in with the proceeds.

Find a nice apartment where they would have no maintenance worries and where the cost is probably 5 times less than AL. Keep the home health care and just up the hours. Your parents will require someone there all the time eventually. An AL is not going to provide them with that. An AL will have maybe 50 residents with 1-3 caregivers. They won't be getting the care they need. They will with home health care. I've had to hire home health care in addition to the little support mom gets from AL, so we're moving out. An apartment and home health care is about $40-50K less a year than AL.

You look for ways to have their money make money. You also look for a ton of ways to save them money. I've been able to reduce my mom's expenses by about $1,000 a month. She doesn't need the ultra expensive diapers, and if I buy them in bulk, I save, a ton of money. We cut cable and went with streaming services that offer their same favorite programs. Coupons! It's amazing what you can do to save money.

You should not go back to work for your parents. There's ways to make that money stretch and work to cover expenses. AL is not one of them.
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Many of us recommend finding an assisted living facility that also has a SNF wing that one can transition to when needed and that will take Medicaid when the funds run out. That is the normal progression; liquidate the assets, buy into assisted living, transition to skilled nursing when needed and finally go on Medicaid when the money is depleted. Most of us don't recommend children funding their parent's assisted living unless they can comfortable afford it. Remember, you need to start saving for your elder years.
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geralDine9 Sep 2022
I agree...but no matter how much you save if you become ill to the point where you need LTC they WILL take everything you have before Medicaid will kick in...
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Novaman, I also live in your area where we thankfully have many choices of senior living available. I am shocked to hear that rentals in senior facilities have gone up that much compared to what my Dad was paying just a mere 4 years ago.

When my Mom needed to go into a nursing home, Dad hired 3 shifts of caregivers for himself as he couldn't live alone in his house. The caregivers were costing him $20k per month. The nursing home was costing $12k per month. Big bite out of the financial pie.

After Mom passed, Dad did the math and noticed it was quite a cost savings to move into a senior facility. He started out in Independent Living full size apartment then moved to Memory Care at the same facility.

Since I was Dad's Power of Attorney for both health and finances, I was able to see how much my parents had saved over the years. They were the children of the Great Depression so they lived well below their means. Thank goodness they did. They saved for that rainy day, and now it was pouring outside.

I, too, was always worrying if Dad would run out of money depending on how long he would live. Dad was already in his mid 90's. In the back of my mind, I knew that there was Medicaid [which is different from Medicare] if Dad should need it. I didn't know if the facility would even take Medicaid. Dad had passed a couple years later. Thankfully he and Mom had their Wills updated at my stern request, as the old Wills were older than dirt, and would have been a logistical nightmare. Plus they had prepared a current Revocable Trust. If you need an Elder Law Attorney, I can highly recommend a firm on Wiehle Ave in your area.
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Just in my own experience...there are options however I've learned that they will get your money no matter what...if AL is your choice you'll pay out of pocket, if skilled is your choice I would assume their Long Term Care ins. would kick in...I don't know how your parents have their assets set up but look into an irrevocable trust or have them relinquish all their assets to you to protect it...again I don't know the history but everything I have been through with my mother as long as I keep her out of a nursing home her assets are protected...I'll be honest I refuse to give my mother's hard earned money to a nursing home...we've spent our lives working our butts off so that we are cared for and they still take all your money...which ever direction you go protect what they've worked for...I am in the process of moving my mom out of her home and into an apartment...I don't know if paying for in home care will be okay or not but I refuse to pay for nursing home care...I'm sure you know most of this and any advice you can offer would be appreciated as well...just protect them and what they've worked for...take care
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Lots of great advise, if you do decide to go the AL route ,absolutely find one that has a memory care and does accept Medicaid. The one thing I did not know, a lot of AL that accept Medicaid require a period of self pay. Your ahead of the game knowing this, if they tun out of money, they stay…If I have had my mom in one earlier, it could have been a nicer place. My mom had almost a year of self pay funds and our choice was limited. I was fortunate to find it. It was a struggle with staffing issues along with management issues.



if you go with AL , Google care advisors. They are a realtor of sorts. Paid by the facility with placement. An invaluable service. Get someone local who will meet you for tours and arrange everything. They know the ins and outs of it. Availability, cost amenities, reputation… I used a franchise called care patrol.

absolutely do not go back to work
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As has been suggested, look for facilities that have MC on their campus but more importantly, have medicaid guaranteed beds when a resident"s private funds are depleted. You want that guarantee written into your contract (which should be reviewed by an attorney) because some facilities have only a certain number of beds available to be designated for Medicaid. If your loved one runs out of funds and all those beds are already occupied, you will have to move to another facility. You also want to go into a facility as a private pay resident because you will have a greater number of facilities from which to chose.
Remember also that any signed agreement or guarantee can be tossed out the window at the end of the lease agreement (usually a year long contract) should the facility be sold to a new owner. Yeah.... the whole picture kind of sucks.

Start researching now. I personally have found that the well established non-profit facilities sometimes offer better service than the corporate entities. While you are projecting your annual costs, don't forget to add in the annual rent increase and make sure that you find out what the annual increases have been over a 5 year period when you are taking your facility tours.
I recommend at least two visits to any facility you are interested in.... the second one unannounced. Plan your visits around lunch time or slightly before dinner time. Get a list of the planned activities and of the menu. Try to take a second set of eyes with you.

Good Luck on this journey
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Maybe you just let the piggy bank empty and then they qualify for Medicaid? Please make an appointment with an Elder Law Attorney to get strategies that don't force you to come out of retirement.
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