Elder Care

[Southernmiss]

It's becoming a concern for so many now, it leaves me with a lot of questions and worried about the future of the American society.

People are living longer, the quality of expected care is higher than before, costs are rising, people don't live with extended family in generational settings like they once did.

What are the answers? What will care look like in 40 years or so? Expenses, medical help, etc.

I have long term care insurance through my employer. But dh doesn't. We will probably look into it for dh. Only in our 40s now. So sad to think of us in 2 separate facilities, if the time comes.

Our parents are in their 70s, while not 'old' they do have some health issues. My grandmother is 96 and has a full time in house sitter- paid for by my uncle. She's very fortunate. I don't know if we could do the same for our parents. And it's so physically demanding to care for someone all the time.

I work in a church and so many members need help at one time or another and their families often ask for recommendations of care givers or volunteers. But we don't have much to suggest.

I know people go into nursing homes and if they have savings or assets those are depleted and then federal/state aid kicks in. Seems so sad that all of their life savings goes away, but then again, thank goodness they had it.

So many dilemmas. It's just something I'm pondering on my lunch break today...

 

[mjkacmom]

And the money gets depleted quickly. My dad has Alzheimer's, so he will need to go into a nursing home. We want to get him into one when he still has enough money for a paid bed, so that a few years later, when his assets are gone, he is on the list for a Medicare bed. He has a live in now.

 

[Bilberry]

It is sad in many ways about the dilemma of elderly care.

I had a grandma who's body gave out on her. Her mind was more of less gone. She was in a wheel chair unable to easily move around, get into bed or onto a toilet. As first we did the best we could to let her remain in her condo. She was alone and lonely most of the time, but we made daily efforts checked on her as often as possible. She was to fussy to allow someone outside of the family to check and help her.

Eventually her body deteriorated to the point that she needed assisted care. A new, very nice in appearance facility had opened up in town. We were able to obtain a room for her there. Grandma was not happy being in the assisted living home. She took to biting and yelling at staff. But full time care was required at this point. Prices were reasonable at first, but ridiculous toward the end. I think they realized they had us over a barrel.

I don't mention these stories to be crude, but later it came as a surprise to me at some of the activities going at the elderly home grandma was in. Grandma by this point didn't communicate well. She was hard to understand. I remember though her mentioning that some people were having sex down the way. Well, I didn't give it to much thought. I passed the mention onto my folks and left it at that. Later I learned the head of the elderly center had been having sex with her boy friend at the facility. She was fired from her position over that. It was only this past spring though that news came out of an arrest of a worker at the retirement home. The sick pervert had been paying friends to have sex with and take pictures of elderly patients with Alzheimer's and severe dementia.

I am familiar with other lesser actives going on there too. And this is considered a nice place. It makes me feel bad for the run down facilities I've heard about.

As I told my parents, stay healthy as much as possible. We need to keep you out of the retirement homes as much as possible. Looking back I wish something different could have been done for grandma.

 

[Praying Colonel]

Kind of reminds me of the Social Security thread from a day or so ago. It's no secret we'll get older someday (hopefully). What's our plan for that?

So many people want to pretend the day will never come when we might need assistance. Denial is not a plan.

 

[tvguy]

I dealt with this 4 years ago when my healthy 89 year old mom got a cancer diagnosis and suffered a stroke in the same week. The final year of her life she required full time care. Fortunately, she had purchased long term care insurance, and for decades had made he wishes known to me if something happened.
I have long term care insurance as should everyone. My kids, who are in their 20's watched all this, and came to fully understand how important is is for them to be putting away money NOW, for their senior years.
In caring for my mom I was shocked how many physically able 95+ year old dementia and Alzheimers patients there are in care facilities. Even more shocking, how many of those people had no living relatives to help care for them. Ran into more than one patient whose CHILDREN had already died of old age.

 

[crjack]

People are living longer, the quality of expected care is higher than before, costs are rising, people don't live with extended family in generational settings like they once did.

Unpaid caregivers provide a huge amount of support in this country and I think it is destined to reach crisis proportions for all of the reasons you listed. Care for memory impaired patients is often not covered the same way other illnesses are (custodial care needs) so it falls to families, friends and private resources.

That is going to be harder and harder for many to do in the not so distant future. I am living it now with my dad and it has taken it's toll on all of us and he is rapidly depleting all of his financial resources. He will most likely outlive his money despite 40+ years of hard work and living a very modest life. We ration the amount of hours of private care to help stretch his money but all of the hours that we cover is also time away from our careers and retirement funds.

Also, none of us has as many children as my parents had so I can't imagine this burden on the next generation when they will have fewer family members in many cases.

There is a huge financial impact to this issue with no easy answers I'm afraid. I think local, state and federal officials will continue to "kick the can" as long as possible.

 

[DizBelle]

It's becoming a concern for so many now, it leaves me with a lot of questions and worried about the future of the American society.

People are living longer, the quality of expected care is higher than before, costs are rising, people don't live with extended family in generational settings like they once did.

What are the answers? What will care look like in 40 years or so? Expenses, medical help, etc.

I have long term care insurance through my employer. But dh doesn't. We will probably look into it for dh. Only in our 40s now. So sad to think of us in 2 separate facilities, if the time comes.

Our parents are in their 70s, while not 'old' they do have some health issues. My grandmother is 96 and has a full time in house sitter- paid for by my uncle. She's very fortunate. I don't know if we could do the same for our parents. And it's so physically demanding to care for someone all the time.

I work in a church and so many members need help at one time or another and their families often ask for recommendations of care givers or volunteers. But we don't have much to suggest.

I know people go into nursing homes and if they have savings or assets those are depleted and then federal/state aid kicks in. Seems so sad that all of their life savings goes away, but then again, thank goodness they had it.

So many dilemmas. It's just something I'm pondering on my lunch break today...

Re: bolded - that's why they have the savings. If there's anything left after they're gone to leave to their loved ones, that's great. But it isn't necessary at all.

 

[xlxo]

It's a scary and complicated mess....

• government cutbacks... cities declaring bankruptcy
• living older.... but vulnerable to more diseases (eg cancer, Alzheimer)
• care home costs... some thousands of dollars per month
• families having less children. Sandwich generation

Best advice is to research what's available locally where you live and build a plan for it.

With politicians.... ask them what they will do for your senior concerns to get your vote.

 

[crjack]

Re: bolded - that's why they have the savings. If there's anything left after they're gone to leave to their loved ones, that's great. But it isn't necessary at all.

I don't disagree but I think the big issue is who pays once the savings are gone?? It's a struggle for nursing homes and state and fed gov't already and I expect it will get much worse.

I live in greater Boston and average price for a shared room in a memory impaired facility is $14,000+ per month. It's easy to see how someone in their 70's or 80"s now could quickly deplete their assets based on how much they earned back in their working years.

 

[Tinkerdreams]

I don't disagree but I think the big issue is who pays once the savings are gone?? It's a struggle for nursing homes and state and fed gov't already and I expect it will get much worse.

I live in greater Boston and average price for a shared room in a memory impaired facility is $14,000+ per month. It's easy to see how someone in their 70's or 80"s now could quickly deplete their assets based on how much they earned back in their working years.

The bolded is one of the most asked questions we've been discussing lately. As the baby boomers age and more of them enter elder care facilities and run out of money, Medicare/Medicaid won't be able to sustain what it will cost to provide for them (and I'm one of those baby boomers!). I believe it will come down to 2 alternatives - family members will be expected to financially pay for their care - maybe not all, but a good chunk - or the option to take their loved one in and get a stipend each month to bring in a health care provider to do some basic care such as showers, preparing food, etc.

There is no easy answer to this but it's coming and coming quickly!!

 

[NotUrsula]

The vast majority of now-retired elderly saved their butts off and did without very many things, just because they were saving for this contingency. My MIL, who mostly worked as a records clerk, had 20 years' salary saved up when she retired, and she thought that she would be fine. She WAS fine as long as she was able to stay in her paid-for home, but once she had to go into assisted living, the safety net started to fray at lightning speed. What she thought would last at least 15 years was all but gone after 15 months (and her space was not luxe by any means; it was a 250 sq. ft. studio with a kitchenette, in a building with no special amenities beyond a basic gym.) In the last year of her life she went to the ER 9 times, and her federal retiree insurance didn't cover those charges without an inpatient admission. Her medicines also cost a fortune, and were mostly also not covered.

The upshot of all that was that she descended into depression and essentially willed herself to die before the money ran out (she had about 3 months' rent left in her savings when she died.) That particular response is getting more and more common among elderly former wage-earners; they sacrificed so much in the belief that putting away what to them was a massive sum of money for retirement would allow them to live comfortably (not lavishly), and avoid becoming a burden to their children. It demoralizes them greatly when the funds disappear so much faster than they had anticipated.

To switch gears a bit here, I saw an article yesterday about a new trend in senior-living communities for aging in place, several of which are being built in Central Florida. Unlike places like the Villages where the entire community is over-55, the new concept designates certain streets in a larger development as over-55, with a few extra amenities just for them centered on those streets. The idea is that multiple generations of the same family will live in the same development, which allows younger family members to conveniently visit and interact with older relatives without actually living in the same household. Of course, these sorts of developments are meant for folks with a bit more money in hand, but I applaud the idea -- I've seen too many situations where older parents have moved away to a retirement community and then have to be relocated after their health fails, because their families are so far away. (I can attest that this type of situation is ideal. The assisted-living facility that my MIL lived in was at the end of our block, and our kids often decided to just walk down and spend some time with Grandma. It was also very easy for us to do errands for her because we didn't have to go out of our way to go to and from her residence.)

 

[Southernmiss]

Thanks for joining in the discussion everyone! It's helpful to read others thoughts and experiences.

I hadn't thought about the size of families aspect--fewer children mean fewer to help as parents age. That adds a burden and makes sense as my cousin cared for my aunt as she was sick and died. Her brother helped, but much of the burden rested on my cousin. That same cousin has no children and I wonder what she'll do in old age.

I love the idea of living in the same neighborhood as elder relatives. It would be much easier to look in on them. If I go to see my Grandmother 12 miles away, I plan for a few hours- travel time there and back in traffic is over 25 minutes each way and time to visit is another hour or more. Not easy when working and having kids to keep up with.

These discussions remind me to put long term care insurance as a priority and to have difficult conversations with my own family.

 

[Pea-n-Me]

We built an in-law addition onto our home about 22 years ago, when my mother was only around 70. Reasons then weren't as much about caregiving, as about cost of living, which is very high here. It made the most sense when we looked at all her options. Now she's 91, so it's relatively easy for us to help her with all of her needs as we're right here. Lots of people do this in our area, including my DH's parents, who built on to one of his siblings' houses. This might be one thing that people could consider doing, but there are a lot of variables, including being able to all get along reasonably well. I also think that one floor living is important for people as they age, as so many things happen that can make it difficult for them to safely manage stairs.

 

[diz8297]

Well, I've worked in a nursing home as a business office manager for 15 years. The fact is that once private resources are exhausted, the resident applies for Medicaid. For the record, in my homes I've worked in, all beds are certified and the same. No one who provides care even knows or care if a person is paying privately or on Medicaid. The care is the same. That being said, the valid question is: how will the goverment pay for more people needing Medicaid? What is happening is that Medicaid is transitioning into being operated by insurance companies instead of by the states. By contracting out to third party payors, the state saves money and the programs are operated more efficiently. For the record: The abuse situation noted above is horrific and appalling. My state has among the best nursing homes in the country. I can assure you that it is a highly regulated industry.

 

[mjkacmom]

Re: bolded - that's why they have the savings. If there's anything left after they're gone to leave to their loved ones, that's great. But it isn't necessary at all.

But the savings goes before the person goes. When my mom died suddenly, my dad had about $750,000 in assets. Right now his live-in is getting about $55,000 a year under the table, his home is paid for, but his expenses still exist. $500 for health insurance on top of Medicaid, food, cable, oil, electric, medications, home insurance, property taxes ($16,000 a year), home upkeep, landscaper... A nursing home will cost over $100,000 a year. He is 76 and in great health (besides the Alzheimer's). He will eventually lose control of his bodily functions, movement, become more confused... He lives in a 150 year old 2 story house, a house he's been in for almost 50 years, and he loves it (grew up walking by it as a child, was so excited to buy it). His next move will be a home, kicking and screaming. My parents did everything right financially, but my mom's death threw a wrench in it.

Honestly, this living longer crap isn't such a good thing. It's funny that getting older and death are the only certainties is life, but no one likes to discuss it.

ETA, the house is now in my name and my sister's (sort of). My mom was afraid of losing everything when my dad eventually went into a home, so their lawyer protected the house. If we sell, the home will get the money because he's still alive. I didn't include the value in his assets.

 

[crjack]

Well, I've worked in a nursing home as a business office manager for 15 years. The fact is that once private resources are exhausted, the resident applies for Medicaid. For the record, in my homes I've worked in, all beds are certified and the same. No one who provides care even knows or care if a person is paying privately or on Medicaid. The care is the same. That being said, the valid question is: how will the goverment pay for more people needing Medicaid? What is happening is that Medicaid is transitioning into being operated by insurance companies instead of by the states. By contracting out to third party payors, the state saves money and the programs are operated more efficiently. For the record: The abuse situation noted above is horrific and appalling. My state has among the best nursing homes in the country. I can assure you that it is a highly regulated industry.

Thank you for your input. I can't imagine finances are easy for any nursing home. Have you seen a decline in your gov't reimbursement for Medicaid patient over the years? That has always been my impression but I don't work in that industry. I didn't think care facilities had any real say in that situation which must create huge variables financially.

In my town a beautiful new facility opened however it is 100% private pay. Once your personal resources are exhausted you must transfer out. When I looked at it just under two years ago it was $18K month.

My dad has benefitted from great medical care when needed but Alzheimers and any type of cognitive impairment seems to be much different. My mom passed away from cancer and all of her support and treatment was covered. For my dad (exact same insurance since he was the provider) it is much different. "Custodial care" isn't clinical care and I understand the distinction but for so many people who are impacted by cognitive impairment it does seem like a disease that requires help and support.

Best wishes to all of us who are trying to juggle this in our lives.

 

[RAD]

All I can say is get LTC insurance as soon as you can. I got coverage 20+ years ago and pay about $600 per year in premiums. My wife waited until she was 62 and she's pay about $2400 per year for about 1/3 the coverage I have.

My father was wise and got it for my mother, and it's come in very handy since we had to put her in a memory care unit. She's paying $5500/month and her LTC is covering around $4000 of that. That coverag will pay for 4 to 5 years of care before it runs out and we need to start taping the rest of her assets.

 

[tvguy]

Well, I've worked in a nursing home as a business office manager for 15 years. The fact is that once private resources are exhausted, the resident applies for Medicaid. For the record, in my homes I've worked in, all beds are certified and the same. No one who provides care even knows or care if a person is paying privately or on Medicaid. The care is the same. That being said, the valid question is: how will the goverment pay for more people needing Medicaid? What is happening is that Medicaid is transitioning into being operated by insurance companies instead of by the states. By contracting out to third party payors, the state saves money and the programs are operated more efficiently. For the record: The abuse situation noted above is horrific and appalling. My state has among the best nursing homes in the country. I can assure you that it is a highly regulated industry.

But the home had to be "Medicaid Certified". Love how that sounds, sounds like some sort of standard. In reality, it is the willingness of a facility to accept the (lower) Medicaid payments. And not many facilities here will accept Medicaid patients. And many in the industry have said you would not want a loved one in a facility that did accept Medicaid because the level of care would not be as good.

 

[ronandannette]

The vast majority of now-retired elderly saved their butts off and did without very many things, just because they were saving for this contingency. My MIL, who mostly worked as a records clerk, had 20 years' salary saved up when she retired, and she thought that she would be fine. She WAS fine as long as she was able to stay in her paid-for home, but once she had to go into assisted living, the safety net started to fray at lightning speed. What she thought would last at least 15 years was all but gone after 15 months (and her space was not luxe by any means; it was a 250 sq. ft. studio with a kitchenette, in a building with no special amenities beyond a basic gym.) In the last year of her life she went to the ER 9 times, and her federal retiree insurance didn't cover those charges without an inpatient admission. Her medicines also cost a fortune, and were mostly also not covered.

The upshot of all that was that she descended into depression and essentially willed herself to die before the money ran out (she had about 3 months' rent left in her savings when she died.) That particular response is getting more and more common among elderly former wage-earners; they sacrificed so much in the belief that putting away what to them was a massive sum of money for retirement would allow them to live comfortably (not lavishly), and avoid becoming a burden to their children. It demoralizes them greatly when the funds disappear so much faster than they had anticipated.

To switch gears a bit here, I saw an article yesterday about a new trend in senior-living communities for aging in place, several of which are being built in Central Florida. Unlike places like the Villages where the entire community is over-55, the new concept designates certain streets in a larger development as over-55, with a few extra amenities just for them centered on those streets. The idea is that multiple generations of the same family will live in the same development, which allows younger family members to conveniently visit and interact with older relatives without actually living in the same household. Of course, these sorts of developments are meant for folks with a bit more money in hand, but I applaud the idea -- I've seen too many situations where older parents have moved away to a retirement community and then have to be relocated after their health fails, because their families are so far away. (I can attest that this type of situation is ideal. The assisted-living facility that my MIL lived in was at the end of our block, and our kids often decided to just walk down and spend some time with Grandma. It was also very easy for us to do errands for her because we didn't have to go out of our way to go to and from her residence.)

Insightful, albeit bone-chilling. In this country euthanasia has recently been legalized. I fear as your prognostications become more and more a reality, it will give "mandatory retirement" a whole new meaning...

 

[winterman]

When my mom died suddenly, my dad had about $750,000 in assets. Right now his live-in is getting about $55,000 a year under the table, his home is paid for, but his expenses still exist. $500 for health insurance on top of Medicaid,

I really hope that the 'Medicaid' is error. Medicaid is for people with low incomes, not those with $750,000 in assets.