What to do when your parent does not meet ADL requirements, cannot afford assisted living, and is not safe living alone?

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What to do when your parent does not meet ADL requirements, cannot afford assisted living, and is not safe living alone?

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The national median cost of assisted living is $3,495 a month. Medicaid won't pay for assisted living, only for an aide in the home, which has recently become much more difficult now that 3 ADLs are required to be eligible and there is a longer wait time for processing (as in months) than before because of the new 2.5 year lookback. The other option for coverage by Medicaid is a nursing home. I have a parent who is 95 and there is no other money beyond social security at this point, which leaves a $1495 gap for assisted living. I can't assist with that financially. He has diabetes and is losing his ability to walk, uses a walker, can't feel his legs (but still drives!). He has nerve pain in his hands now too. He lives alone in the middle of nowhere. Those medic alert buttons don't work out there, no cell service. Anyway, at this point he would not be eligible for a Medicaid aide since he can do everything on the ADL list - just barely. I really don't want to move in with him, but I don't see another option. My husband and I live about 2 hours from him now. Where he lives there is very little support for seniors, it's the middle of nowhere. You cannot find a housekeeper, for example. I go up there once a week to clean. And I cannot imagine helping him with the bathroom, if it comes to that. The house is in horrible shape, very neglected, ugly inside. Needs a huge amount of expensive work. And I hate it there, so I am very worried about eventually (probably within the next 6 months) having to move in there. We live in a one bedroom in the city - moving to a two bedroom is not an option and he would not come here anyway. I have two siblings living within one mile of him who cannot help in any way, financially or otherwise. I only mention them because I am sure to get questions about siblings - so just consider me an only child. We own his home, having bailed him out of the loan he had on it, so he cannot sell that and we hope to get our money back eventually after putting a lot of work into the house. Any advice? I'm stuck with having to move in, I believe.

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Sadly, your father’s condition will worsen and he most likely will need increasing amounts of help including with bathing and bathroom needs. It’s rare to reach his age and maintain all those skills, not his fault. When a person can’t live on their own and care for their needs, it’s on them to figure out what to do next, or if not competent, it’s on their POA. It’s not on you to change your life and move to accommodate him. Looks like his choices are limited by location and income, and a nursing home with Medicaid paying for it may be what’s coming. I’m sorry you’re faced with this, but please don’t move and put yourself in a position you already know isn’t good

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Reply to Daughterof1930

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This is a good point to consider: the elder has to make the accommodations, not the caregiver. Just simple fairness.

(5)

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Yes, you have it right. The cost of living, and even caring for people who will live to almost 100 years of age will not be supported well or easily in a system that now has most of the money in the hands of the 1%; and those earning low wages will not be able to save for their own care. This will get worse, not better.
You say "we own his home". Hopefully you bought it for fair market value, but if he still had a loan on that home, the profits from it will last only a very short time.
Medicaid WILL pay for his care in a nursing home. But you may not be well satisfied with that nursing home and it certainly will not be on a par with a good ASL place.
So here you are. The choices are as you say. A nursing home and medicaid. Or move in with you and be cared for by you. Your parent is 95 so that would last at most 5 years in normal circumstances. Some are looking at this with parents in their early 70s so they are looking at two decades of caregiving. There are no other choices now, at this point, when it has come to this. And given that in our nation some are paying Federal Student Loans they were lured into when they are on Social Security, I can't see things getting better.
I suspect your family may not want to give up their own lives in the care of an elder. So you are down to Medicaid and the kind of care it pays for in a Nursing home. This varies widely across our country.
And I am left with the helpless words we who answer anything on Forum are often left with. I wish you the best of luck. I caution you against using your own money, as you are going to need every single penny you can save for your own time in this position.
I am so sorry. But you got it all, and you got it right. And like so many things, there is no "fix-it" and there is no answer.
I caution you against "moving in there" as well. Often the people we see do this, sacrificing years of their lives in care, end up homeless, jobless, without job history and penniless as well as ending mentally unstable from attempting 24/7 care. You can read their stories all over the Forum.

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Reply to AlvaDeer

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Thank you. We bought the home more than 5 years ago, so it's not an issue.

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First, are you his durable PoA? If not and he is of sound mind, this needs to get in place right away. This can be done by downloading the forms for his state off Legalzoom.com or Rocketlawyer.com. You will need 1 copy for him, 1 for each PoA so that everyone has a notarized original. You may need to have witnesses when notarized. Banks and hospitals have notarys. So do UPS Stores. Or you may need to find a mobile notary in his area. Digital notary services are becoming a thing as well.

If you already have DPoA, great! If not and he refuses to take this step then you will need to enlighten him to the reality called Ward of the County or guardianship. Please do not move in with him. This gives the false impression that he is still "independent" and able. He is not. You may want to consult with a reputable faith-based facility near you (if you will be managing his affairs going forward). Faith-based facilities are more flexible and understanding. They may allow him in to LTC and therefore he may qualify for Medicaid. They did this for my MIL. In my state the look-back is 5 years. My advice is to resist moving in with him. If you need to call APS then so be it, it will get him placed sooner. Also, please go into his state's DMV and anonymously report him as a dangerous driver so that he doesn't hurt others (this happened in my own family -- my uncle went through a red light and it killed his own wife and dog and injured the other party). Remove his car physically if that's what it takes. I wish you much success and peace in your heart as you move through this transitional time with him.

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Reply to Geaton777

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Wow. That is so sad and frightening. I think the DMV reporting might vary state to state. True story: My father had always been a terrible driver, reckless, speeding tickets, had his license revoked twice when younger, numerous accidents and fender benders. Never his fault of course (yea right.) No one would ride with him. It only got worse as he got older and more inattentive. In Florida, we had sent in the report to the DMV (he was in his 90's by then.) We heard nothing for months. One day I met his PC doctor who came to the Independent Living apartment do to a checkup. My father had smoked non filter cigarettes for 65 years, had half the right lung removed at age 80 and was supposed to be on oxygen but was too vain to be seen dragging the tank around. Doctor told him straight up his lungs were shot. Dad had the nerve to tell the doc that it wasn't from smoking, his lobe was removed because it was revenge by someone he knew in NY who told the surgeon he was a sex offender! (Yes, he was also paranoid delusional and a sociopath. Whenever he felt slighted or didn't get his way, that's the story he told to anyone who would listen.) Afterwards, I pulled the doc aside and he filled out the same form, signed it and mailed it to the DMV. Lo and behold, my father finally got a letter from the state capital that he had to go get tested or surrender his license. I took him to the DMV personally and he surrendered the license. We finally got his keys away from him and sold the car. Lost count of how many vehicles he totaled in his life time. I could fill a book with the insanity that was my father!

(3)

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The answer is a Nursing Home paid by Medicaid. You do not have to move in, in fact I would advise against it. You can contact APS, they will check on him and monitor his status, and when he is unable to be alone anymore, and meets SNF requirements, that's where he will go.

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Reply to mstrbill

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But what if after that Medicaid has some problem with his finances? And I end up having to pay for the time he spent in the NH?

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If you do not call APS they can claim neglect.

Right now it is self neglect but, as time passes and he needs more help than he is getting and you know this, that is when it becomes a situation for you and your siblings.

Call now so that he is on their radar and you have proof that you have been trying to help him with the situation. They also know about and can implement services that the public can not. They can also force issues that you can not. Call APS today. He is a vulnerable senior that needs help.

You dealt with Medicaid for your mom, what do you know about your dads finances that you are worried about? You can see a certified elder law attorney to get advice on fixing whatever you are concerned about or find that it is nothing to worry about.

Best of luck finding the best solution for your dad.

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Reply to Isthisrealyreal

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Yes, his finances need explaining and back-up documents. It's kind of a nightmare to get together as I saw when I did this for my mom several years ago. There may be substantial penalties as well.

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I don't believe that you should be moving in with him, into a house that is in "horrible shape, very neglected and ugly inside". He shouldn't be living in those conditions either. It sounds like he is probably ready to be put into a nursing home, since he can't afford an assisted living facility, and you know that Medicaid will help cover that. Sometimes the decisions we have to make aren't easy, but they should always be made with the best interest of the involved parties in mind. And in your case, the nursing home makes the most sense. That way you will know he is safe, and taken care of, instead of worrying about him out in the boonies, in a house that's falling down around him, with no cell service and no medic alert service either. It's really a no brainer.

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Reply to funkygrandma59

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JoLo, you basically have to let the State take over. DO NOT move in with him, it will make it harder to get him placed. If you are not able to provide care for him, you tell the social workers you are not able. You are under no obligation legally to take care of him. You likely will not be able to provide a safe environment anyway. The State social workers will find a facility for him if necessary.

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Reply to mstrbill

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Bottom line is you need to speak with an elder care attorney specializing in Medicaid. Depending on which state you live in, along with federal guidelines, will give the attorney and you options as to what can be done in your particular situation. You may have to go to court to get legal guardianship of your father in order to keep him in a skilled nursing facility if it comes down to that, even if you are his POA. You need to get your father's primary care doctor to testify that your father cannot be left alone and, possibly, have your father tested for a psychological evaluation if the court doesn't order one. These are all things you need to discuss with your elder law attorney. Yes, it costs a bit of money but, in the long run, you can't afford not to seek an attorney out. I went through a similar situation with my father who has since passed away. I know he was where he needed to be to get the best care possible. I had no alternative as I was also taking care of my elderly mother and my husband, who suffers from dementia, and also suffer from my own health issues. There just comes a time when we cannot do everything ourselves and, even if we have siblings, they may not or will not physically contribute. I am grateful for the help the elder law attorney has given me and continues to give me as my mother is currently in a skilled nursing facility and I am a full-time caregiver for my husband at home. Believe me, especially now with Covid, it is NOT nor has it been EASY. I am blessed to have good friends and family who do have some understanding of what I'm going through but no one really 'gets it' unless you've actually been there and done that. I'm also a faithful Christian and am praying daily, along with others, that I can get through each day and be of service to my husband. I speak with my 90 year old mother daily on the phone since I'm unable to physically see her since Covid restrictions in March of 2020. I wish you well in your journey with your father and hope that you can find answers that will be helpful.

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Reply to forgetmenot77

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She does not have to pursue guardianship, a State social worker can be called to check on his welfare. State social worker can advise and find the best solution for him.

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Whatever you do, do NOT take this person into your home, nor should you move into his house. It is time he be placed into a nursing home where Medicaid does take over. Medicaid will NOT pay anything for assisted living and YOU should NOT under any circumstances be paying the bills. You might need that money for you one day. Get medical help wherever and however and get him into a nursing home. Call the Office on Aging and local authorities as to how to go about this and possibly talk with an eldercare attorney. You can't wait.

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Reply to Lockett2166

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Medicaid nursing home care qualifications are not only financial ones. There must be medical qualifications and OP believes dad is still "too healthy" to qualify. Group home may be workable.

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You should not have to move in with him if this is not what you want to do. Your first responsibility is to your husband, and you're entitled to your life. First be sure all of his paperwork is in order while he's still capable mentally (you may have already done this and may be his POA). If he has no assets, he doesn't need a will, but he should have POAs for financial and medical decisions, a living will that specifies his medical wishes if he becomes incapable of making decisions, and some banks and financial institutions have their own POA forms. Social Security also needs special permissions for you even talk to them about his affairs. If he doesn't have them, the forms should be simple and you might be able to do them without an attorney. Try to get in touch with networks and support services for seniors in his area so that you know the options. A social worker who deals with seniors would be able to advise you. This advice should be free. For this to work for both of you it sounds like he should be living closer to you. would he move to his own small apartment near you while he is still capable of doing everything? You need to have a heart-to-heart talk with him to find out what he will agree to and telling him what you are capable of doing for him. If he agrees to moving, he'll probably need a lot of help with the downsizing and moving. Be honest with him about how much you can do for him and how it is getting very difficult to get aides to help him. You want him to be safe and cared for. Hopefully you can find a good compromise. Good luck and a big hug!

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Reply to NYCdaughter

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"Social Security also needs special permissions for you even talk to them about his affairs."

If it's just to "talk" to them about something, usually the person, dad in this case, can give the okay over the phone. Beware if he has hearing issues!

In order to manage SS, the only LEGAL way, per SS, is to sign up as rep payee. Not sure how it would be handled today, with the virus around, but it's best to start with a local office, not the main 800 number, unless you like phone menus and being kept on hold for a long time!

I called MY local office, which isn't in the state mom lived in, got an appt and filed. They just asked a lot of questions and submit it. They didn't ask to look at anything and I did NOT take my mother with me. They do send notice to both you and the party involved, so the person can object if they want to. By then mom was in MC, so mail was held by the nurse. Mom wouldn't really understand it anyway! I had to have the address change done, as we were selling her condo and you can't forward federal mail.

The LEGAL note is from THEIR paperwork that came with the approval. No one has the right to "manage" another person's SS and POAs don't work for federal entities.