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Dad has gone to assisted living and is insisting on leaving on Friday. He was only released to assisted living, not to home and actually, it is going to be a wash with what I'm paying for in-home care but the difference is that we were only doing 6 hours per day of in-home care and with assisted living, they keep their eyes on them more often than that. There is socialization, better food, beverages offered all day (he is already consuming my liquids than he was at home). I can call anytime and they will tell me when they last saw dad and how he is doing. He wants to stay at home but when he heard that it would be over $20,000 per month, he is finally having second thoughts. He has been told he needs to be someplace with 24 hour care, whether that be at home or at a facility. His 'move' papers have been filed with the court, he is going to contest, we will go to a hearing, and then the judge will decide where he is to live.
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Not in my neck of the woods, easily runs 12-15K a month for 24/7 care and it keeps a person isolated no social interaction, which is detrimental to the patient.
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When making the "home with care vs assisted living" decision you need to keep in mind your mom's ability to make friends and join into the activities if she waits too long to make a move. If she remains at home with care until she "has to" move she may no longer be eligible for assisted living and be forced to a nursing home. Once you are in assisted living and are doing well the facility will generally work with you to add levels of care as needed. At my father's facility I can even hire private caregivers in addition to their services if he needs more than they can provide. Until you actually need more than they can legally and safely provide you will be able to stay. You may not be eligible to enter the assisted living if you need extensive assistance, even if you could stay there if you were already living there. Also, as my dad found, he wishes he had moved earlier so that he could have made friends and gotten involved in more activities. He waited so long he can no longer enjoy much of what they have to offer.

As someone else mentioned, my dad lives in his own apartment, makes his own decision as to when to get up, go to bed, what to watch on TV, keeps food in his kitchen for breakfasts, and snacks. At 98 and blind still is in control of his day. The nurse comes by each day and gives his meds, and the concierge downstairs keeps an eye on his comings and goings (unbeknownst to him). (Oh, and my dad loves the food!)
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Babs75 Sep 19, 2019
Dad has been living on his own but had some sort of breakdown problem in the middle of the night Monday and is in the hospital. He does NOT want to be there but as guardian, I have been waiting for an opportunity to get him moved to a facility that can better meet his needs. His house is dark, depressing, he hates being there, but has refused to move. One of the facilities is doing an evaluation this afternoon but he is definitely not at his best because he is angry about being in the hospital. I would really hope he would not have to go directly to memory care from his house, having lived on his own for 35 years but we'll have to wait and see what the assessment shows.
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Bethin, in-home care is very expensive depending on how many shifts are needed. My Dad was a major fall risk, so he asked for 3 shifts each day. It was costing him $20k per month here in my area. The caregivers were wonderful and worth every penny.

I know some people would rather use a live-in caregiver, but that caregiver would be doing the work of 3 full-time shifts, thus would burn out very quickly. Then back to square one looking for a replacement.

Dad being the frugal person he is decided it was time to sell his house and move into senior living as the house was getting too big and too much responsiblity. He used the equity and it was costing him around $5k when he first moved in. Quite a difference in cost. He loved the place, liked being around people of his own age group :)

Later down the road he needed to move into the facility's Assisted Living/Memory Care section and the cost was around $7k. We joked that Dad was back in a college dorm room once again.

When my Mom was in a skilled nursing home, it was costing my parents $12k per month.

So, this should give you a ballpark idea on the costs.
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Doing a follow up here as many people over the past year have heard stories about my 93 year old dad.

I received a call in the middle of the night Monday from my sister. The sheriff had called her because dad had called 911 saying that people were outside his window telling him they were going to kill him. (he still lives on his own - I have wanted to move him for a long time but he refuses to move). I went over there and he was truly freaked out. We turned on the TV and in his confusion, he thought the people on the TV show were the ones trying to get him. I brought him back to my house. It's amazing that he perked right up after that. Of course, I was exhausted! No confusion, talking normally, etc. I swear his house is a trigger for him. So the next day, I took him home. He called his care service and they were concerned so they sent the paramedics. The paramedic said when he got there, there was a lady hiding in dad's bushes! Maybe his story wasn't totally false! Anyway, 2 days later he is still at the hospital and is mad as a hornet. He hates the hospital anyway and now he's not be allowed to go home. His care service would love for me to pay 24/7 care in-home but that's not going to happen (would be over $20,000 per month) but as guardian, my decision is to move him to a facility. I am waiting for a letter from the physician (needed for the guardianship, as I have to notify the court what I am doing). Right now, I don't think he'd pass the test for AL, as mad and unreasonable as he's being (I can't go up there -- I tried on Tuesday night and was only there for a couple minutes - he thought I was picking him up to take him home). But I question the need for memory care so we will see how his plays out. He is on the go too much with activities and does not wander. A new chapter for both of us but one that has needed to happen for a long time.
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We are dealing with the same thing with my father in law. He was discharged from a NH/Rehab about 6 weeks ago. He needs 24hr care at the moment. He can walk with a walker but needs help with all transfers, toileting, bathing, dressing. He is alert and oriented.
We went through an agency and between cost of 24hr care, rent, food, utilities, it would be slightly cheaper to put him and my mother in law in assisted living. If you are talking about only one person in assisted living, it would most likely be cheaper initially.
There are many different types of places with different skill levels of care. I have found one of the key questions to ask the AL facility is, "Can you do two person transfers?" Some can do almost everything, including oxygen, and some don't have that level of certification. Most places have a fixed fee for the room/apartment and then assess the level of care needed and charge a la carte for that accordingly. Some places that have an AL as well as a NH have an exorbitant buy in; $150,000 and up and a monthly fee of a few thousand dollars on top of that.
In many AL places (the ones without a NH) they will assist you with transfer to a NH once the client has higher nursing/medical needs than the facility can provide or if the client has around 3 months left of funds to pay. They can assist client/family with applying for Medicaid if they are eligible.
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So, my mom was in IL/AL.

I don't think she EVER went to breakfast in the dining room; she used to make her own oatmeal or cereal. Woke up whenever she wanted.

Now, in AL, your mom might not be able to keep her meds in her room and self-administer.

Sounds like you have a good list of questions to ask!

My mother was NOT pleased about going to a "facility". She had a lot of preconceptions about what it was going to be like, most of which were proved untrue.

However, complaining about how over-cooked the green beans were could have been listed as an activity, I heard about that so much from mom AND all of her friends.
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BethinPA Sep 25, 2019
LOL about the green beans! Yep - sounds like my Mom. Since I last posted we were able to get Mom in AL, by the skin of her teeth. Her care level is 5 out of 7. They are willing to work w/her to see if mobility improves. She's only been there 6 days and is eating breakfast in her room but will do other meals in dining room. Day atta time!
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What sort of control over her time do you think she wouldn't have in Assisted Living?

Have you toured any AL places?
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BethinPA Sep 12, 2019
Waking up and eating when she's ready. Small thing but it's about all she has. Just starting the facility tour. She is able to retain the bed she has at rehab as a nursing home patient but that place is expensive compared to others in her area.
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I use a home care service for dad and at 6 hours a day, 7 days a week, we are beyond the cost of assisted living. However, even with assisted living, I will still need to hire someone to get him to doctor appointments and such (he can't go on his own even if the assisted living takes him).
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BethinPA Sep 12, 2019
Thank you. Among family we can do errands & doc appointments. I'm mainly concerned about her ability to toilet, feed & clean herself.
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So, just checking your profile, your mother is now back at her own home, living alone, two hours away from you but comparatively close to other family members.

Is she still being a bad patient?

You say she is mentally competent but physically very frail. What are her views on her next steps? And when it comes to budgeting for her care and accommodation and cost of living... is she realistic about the figures or a bit, shall we say, devil-may-care?
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BethinPA Sep 12, 2019
I'm preparing her for her next steps. she will no longer be a rehab patient under Medicare rules as of the 18th so I want to give her the options for her care, either her home or a nursing facility. I don't think she has ever considered the cost, but she is certainly up against it now.
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I had to do this calculation for my aunt. Daughterof1930 is correct. The minute your LO is even a fall risk or needs to be given meds, the service needs to send someone who is "rated" for that scenario and their hourly rate goes up. Eventually, if the LO needs care 24/7 it will exceed the cost of a facility.
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BethinPA Sep 12, 2019
Thank you. I know she would rather be home. She will definetly need help getting to the bathroom and keeping clean and fed. She still has the ability to manage her medications.
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It likely depends on how many hours a day you’re paying for in home care and the skill set required of the person providing the care. If it’s not skilled help and only a limited number of hours a week, less expensive. The picture quickly changes when you need more skilled care and more time.
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BethinPA Sep 12, 2019
Thank you. That's the conclusion I'm arriving at. Although I'm more anxious about home care, I think she would feel better in her own nest and have some control over her time. If it looks like it's not working we could re-evaluate.
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