How to know when your parent needs assisted living?

I know someone mentioned this however there are AL facilities that accept Medicaid payment once your dad’s ability for private pay runs out. I would check into this. My brother and I visited several places that accepted Medicaid when funds ran out.
On another note,as much as my mom did not want to go to AL, she loves it there and thanks us every day for all we did to get her in there, and looks and feels much better. In other words, it may have a better outcome than you think! I stressed, and was so depressed during this transition, but it worked out for my mom. I hope it turns out well for you and your dad, and will keep you in my thoughts.

Initially, it sounds like you are already doing way too much.
Can you / he hire a caregiver to lessen your daily responsibilities? It seems like this is essential for you, at least for now - until other arrangements may be made. How are you working full time and managing four acres? I can't imagine.

I would not recommend he be living alone. The things that are happening now could be very dangerous and his forgetting / brain changes will likely mean other situations will occur that could put him in danger.

If I were you, I would contact an attorney. I don't know what 'could' make an irrevocable trust 'revocable' - it might be something to discuss with the family or whoever / however this is now set up.

Visit AL facilities w/o him initially. Find out what they offer in AL as well, discuss what changes you observe and your concerns. I believe once a person is in an AL facility and ends up with not enough income to pay that they automatically (with the required paperwork) move into a shared room perhaps in memory care. These are things you need to ask about.

Its a given he won't be happy nor want to move.
What I am unclear on is his cognitive abilities (aside from what you tell us).
Has he been tested for dementia?
Does he understand he is leaving burners on ?
Can you talk to him about these things?
Is he in denial?

If he doesn't agree and most people needing these living transitions won't want to go, you will need to decide based on your legal rights to make decisions on his behalf. If you do not have this documentation in place now, you need it - for when you do need to make these decisions.

Start with hiring a caregiver.
You cannot keep going as you are.
You will burn out and it will affect your full time job and your mental / emotional and physical health. You have to make changes soon or 'now.' with more care support. Even if you have someone checking in on him every other day - this gives you a HUGE BREAK from stopping by every day / night.

Sounds like he needs someone there a few hours a day - perhaps even though he is able to cook and do his own laundry. He is in a transition stage.

My mother burned the kitchen counter and it had to be replaced. She lost her entire security deposit (rental). It can / could have been much worse. You do not want to wait until something more serious happens to make needed changes.

He seem(ed) to have agreed to not driving although that was at a major huge expense. Perhaps he will be able to listen (agree) with you again.

At possible AL facilities, talk to the dept that manages finances and ask them the procedures. Our healthcare system is in major flux right now so we really do not know what coverage any of us have moving forward. Still, it is important you talk to professionals in this field to help you sort it out.

You could also contact Medicaid or MediCal and see what they say.
His situation is very common although the irrevocable trust likely isn't common and you'll need to find out how to proceed.

I do think AI / facilities do not require a person to move who doesn't have the funds, but that might not be true for all over the country, all facilities, and a person's individual legal-financial situation need to be taken into consideration.

Gena / Touch Matters

When you ask this question, it's time. The real question is will he consent to going.

Who is in charge of the Trust?
A Trust can be set up so that there is a manager of the Trust and when the person needs money the manager of the trust will transfer funds.
or
There is a beneficiary that the Trust will be paid to once the person has died.

I think you need to talk to the attorney that set up the Trust and find out exactly what it says as to how it is managed.

Who are the beneficiaries of the irrevocable trust? It it’s family, they should be involved in looking at these options. If it’s a charity, you should approach them and be prepared to give them very very bad publicity if they don’t help.

Hi,
Are you able to get a nice housekeeper/nurses aide to help you out? Are you living in the house with him? I moved back home with my mom when she had problems walking etc… It is much nicer for the parent to be home than to be in an assisted or nursing home. They get one on one company and care as long as you get a kind caring aide. I have observed in both assisted and nursing homes that because of shortage of staff, patients can wait forever for any kind of help whether to get to the bathroom, go to their room. I have observed as a volunteer, relative and friend. If you can find someone good, You could eat with your dad at night or have someone be with him if you are going out. I had one person while I taught school until about 4 o’clock. I did night duty but sometimes you can find an aide to spend the night if he needs help with the bathroom etc. I had twin beds in my mom’s room and the aide would sleep in the other bed and give her the bed pan etc… Residents at the assisted living/ nursing home are quite often left in their room and no one bothers with them because staff is busy. I have heard residents say what am I doing here - waiting to die. The home environment is so much more loving. You are able to supervise and see what is going on and talk to your dad nightly. Best of luck.

Did your dad serve during the Korean conflict? If so he may qualify for a VA financial benefit called Aid and Attendance. An elder care attorney can help you apply.

Stop gap maybe get someone in 6 hours a day to make his meals.
Make his breakfast, his lunch, and have his dinner on a plate he can microwave.
Generally it is easier to find someone through an agency who can work 8-2.

Is the trust more than 5 years old? If so he may qualify for Medicaid immediately as he is only "renting" the house. If it has been less than 5 years, Medicaid will consider that to still be his asset, and he will need to claw it back or come up with some other way to pay for his daily needs and housing, possibly in a AL or somewhere like that.

In any case, the situation is unsustainable and as you say, cannot go on much longer. Act now to proactively address his living situation, before it becomes an emergency.

Another thought, advertise for a caregiver to live in the home with him. This person would also go outside the home for work or school. Changing to a facility could be too big a change when he is used to being alone...which was true when as a heavy equipment operator. OR find a home with men that won't chatter at him :-). Just a thought.

Short answer is yes. If he cannot manage his medicines and forgetting to turn the stove and water off, he may need help.

I suggest going to visit and talk to several AL places ahead of time by yourself to see which ones fit his needs. For example, my mom was going to need a Medicaid waiver, single floor, her own apartment, memory care for when she gets to that point and active residents and lively activities. We found one that had lovely one bedroom apartments with a patio that goes out to the courtyard. She had a hard time adjusting at first, but she's been there over two years now. It's been the best move for everyone.

He is unsafe living alone. Time to get him moved into a facility where he will be safe. At this point he should never be left alone, not even for a few hours. Try to visit some facilities this weekend. Until he is moved out, find someone to stay with him.

The agreement I have with my Mom is that she is transitioned to AL either when she is no longer safe in her home or I'm overwhelmed by her care. You get to decide both of these triggers.

But it's of no help if he resists going. Even if your PoA is active (is it active?) you can't force him.

Some options are:

- you tell him you are burning out and will need to back completely away "for a while". The hope is that he'll see his need for AL..

- He has "...kidney, heart and prostate issues, is diabetic..." and you wait until one of those issues lands him in the ER, then you tell the discharge planner that he is an "unsafe discharge" and have him transitioned directly into an AL, citing that even though you are his PoA he is uncooperative with care. Ask to talk to a social worker to make the transition happen.

- You hire in-home aids (privately or through an agency) and tell him the aids are for you, not him. You hire out cleaning, maintenance and repair for his property (again, for you).

With the numerous health issues you mentioned, I am doubtful he will live another 5 years -- especially if he isn't keeping on top of any of them (like his diabetes). And even if he does, he may need LTC - which, if he qualifies financially, will cover the cost of his medical and SS will cover the custodial cost.

I would consult with an elder law or estate planning attorney or a Medicaid planner for his home state since rules can vary a great deal by where you live. Talk to professionals, and make sure your Dad divulges all his assets to you so you can plan properly.

I am so very sad to hear he put his home in an irrevocable trust, because this is what it gets him. It gets him facing down end of life issues with no assets, and that won't work for assisted living. To me it is a great tragedy when this happens. He worked all his long working life for assets, and now he has given them away just when he needs them most.

As to when is the time? Currently you are enabling his not having to go, so it is a question of how much longer you wish to do all you are doing, and MORE. To be honest, if this home is going to his beneficiaries, in my humble opinion they OWE HIM big time.

IF isn't so much a question, moreover as whether or not you CAN place him. Are you POA? Is he evaluated incompetent? Because if not, you have no power to decide this issue at all.
IF you tell him he needs to go to ALF and he agrees, be certain to get one that will accept Medicaid when his assets run out, and that is rare as hen's teeth.
IF he goes into ALF, and spends down liquid assets, then he will need to apply with your help if you are POA for Medicaid and that will mean he likely will need a QIT (Qualified Income Trust) to take on some of his pension so that he isn't over the monthly limit for qualification for Medicaid. The trust, then will take his pension money, leaving him a low enough income to qualify, and when he dies the Trust will reimburse the government for his care.

I wish you the best of luck, and given the complications of your case I highly suggest that you and Dad see an Elder Law Attorney together to get options moving forward and to make plans together while you are able. My very best out to you.

If you have to keep up his property then it is time. When assisting him becomes a burden to you then it is time. When he stops taking responsibility for himself and expects you to do it, it is time.