Hi all. I'm based abroad and my family are in Texas. My mom is quiet late-stage Alzheimer's and has been looked after at home by my father. It's all too much now, he's found a place that will take her but it's an assisted living. My mother is quiet young and physically in good condition, but her mental decline is shocking and rapid and I honestly can't imagine how a assisted living situation will be of much use for long. However, the only nursing home that my father will consider is a private care home. My parents are very rural and there are not many options for them. The nursing home of his choice has a waitlist but he is refusing to put his name on the list. I'm worried and wondering if anyone has any tips for gently talking about his with my father? They are also paying privately. My dad has said that medicare won't pick up any cost. I've been out of the US for years, is this correct? They are fully insured, how is all the expense of this not covered at all by insurance or Medicare? My mother was always the one that handled the administrative stuff, so I'm a bit concerned that my father may be missing information or confused about how all of this works.
1. There are two ways to get insurance to cover long-term care in the United States. The first is through a long-term care insurance policy. This is a specific policy underwritten for long-term care and no medical care. It is a policy written for room and board at an assisted living facility that takes their insurance. This is not a part of Medicare or Medicaid. The policy must be purchased years in advanced. The second way to get insurance to cover long-term care is through Medicaid. Medicaid is a government program that requires extremely limited assets and income. It is a program set up for the poor and only reimburses when the patient is at a certified skilled nursing facility, also known as a nursing home. The government has very specific rules on how the assets can be spent for the previous five years before the patient qualifies for Medicaid. A married couples' estate can be divided to allow for Medicaid coverage, when one spouse has medical needs, including a diagnosis of dementia. The government does expect reimbursement, if assets are available, upon the death of the surviving spouse. If neither of these insurance policies work for you, then it will be private pay and memory care is very expensive. The cost can range from $4000-$15,000 per month, depending on the level of care needed and where the resident resides.
2. The majority of assisted living residences across the US have dedicated wings for residents with impaired cognition/memory loss, also known as memory care. These are usually locked facilities and offer 24-hour care and activities to stimulate and engage their residents. The facilities are locked for the protection of the resident as wandering away unaccompanied from a memory care facility can lead to injury or death. Many assisted living facilities have Medicaid dedicated memory care rooms. Memory care rooms can be private or shared.
3. Many states have group homes, known as board and care or adult foster care, that are licensed for 5 to 6 residents. These group homes are usually attached to a private residence and offer the same standards of care as the larger facilities. They typically don't have the same level of activities as the larger assisted living residences, but they offer a closer relationship with the caregivers. Some of the board and care homes have memory care dedicated rooms.
4 Skilled nursing facilities are typically only used when the patient has co-morbidities that require specialized nursing care or the patient is on Medicaid. A doctor MUST write a prescription for skilled nursing for a patient to enter the facility. The skilled nursing facilities typically have the least desirable amenities and more limited activities for a patient needing memory care.
I hope this helped.
Your dad is correct that Medicare will not pay for custodial care. He can protect his half of income and assets by arranging for a division of assets through an elder care lawyer. Once mom exhausted her half, she’d go on Medicaid. Which in my state reimburses mostly SNFs only.
Dad prefers the AL environment because that’s what Dad would want for himself, but dad doesn’t have dementia and mom does. Mom is likely at the point where less is more in terms of socialization. My friend’s mom did very well in a small group home where there was constant individual attention without too many names to remember.
If Mom needs LTC then Dad needs to try for Medicaid. If they have any assets together, he needs to see an elder lawyer to have them split. Moms split going to her care and when almost gone, Medicaid applied for. Once Mom is on Medicaid, Dad can remain in the home, have a car and get part or all of tge monthly income to live on. He needs to see an Elder Lawyer.
Your father is doing well and doesn't sound confused at all. Why not come for a visit while you still can, and see mom for yourself? I hope that's a viable option for you.
My mother received wonderful care in a Memory Care Assisted Living facility for 3 years until she passed peacefully with hospice on board in 2022. AD is a terminal disease in and of itself, and Memory Care ALs keep a patient until death. When hospice is on board, no heroic measures are taken to prolong life, and the resident is kept out of the hospital and comfortable where they are. Extending the life of an AD sufferer is cruel and unusual punishment.
Best of luck to you.
Maybe your mother needs to be medically assessed to see what option is needed
having your life’s funds taken so to speak is a scary thought especially when you’re also worried about your own health & concerns and know family aren’t a stone throw away - it’s understandable really ..
prob the first course is to be assessed and see what they say
maybe she doesn’t need it now
the answer may help prepare for the future- maybe you need to work out a health plan for your father so he knows he’s taken care of or will be?
best
You can put your mother on the facility waiting list. You do not need to wait for your father to decide. Put her on and keep having the conversation with him. If/when there is finally a bed available. Your father will can then make a decision. This will take months and by then things probably will have changed so rapidly for the worse that he might be more agreeable about placing her in a nursing home.
If the assisted living your father has chosen offers memory care, and/or continued care, that may be appropriate for her.
A private care home seems very nice, but I would caution that the caregivers may not have adequate training and skills to meet her needs as she declines. Often, it's just a homeowner who sees an opportunity to "rent out" a room in their home to someone's elder grandmother, and keep them company, and provide food, but may not be able to provide personal cares or understand complex memory care needs.
Medicare does not cover long term care in any type of care home, and health insurance does not unless they purchased a long term care plan.
Medicare will cover a short term stay, rehab, after a hospitalization, with the intent of sending the patient home after a given amount of time, and only if they are making progress.