Advice needed regarding moving an elderly relative into assisted living

Hi all. We're faced with moving my father to assisted living. He can no longer take care of himself and there are no relatives close enough to check on him. If anyone has any experience with this I'd appreciate any advice you can give.

He's a WWII veteran and we're trying to figure out if the VA has a program for assisted living or if Medicare is the only option. What needs to be done for either VA or Medicare to get him into an affordable yet acceptable situation? Or are affordable and acceptable mutually exclusive in regards to assisted living?

Thanks for any advice you can give.

If your father was wounded in battle during his service, I believe more of the cost will be covered.

My father was very well cared for in a VA hospital before his death a couple years ago. I regret that my brother handled all the financials - but he did say that because dad was wounded - something about being a combat vet and wounded helped pay more of the fees. You need to confirm that.

Contact the VA and sorry to say, but "patience and persistence" are the watch words toward success.

Best to you and yours and I'm sorry to hear about your dad. :hug:

He was not wounded, as far as I know. We're going to consult an elder care attorney and see what they recommend.

One way or the other we're going to move him closer to us so we can check up on him and make sure he's doing ok. 1000 miles is too far. He had quit returning calls, answering emails or even responding to letters so we had to do something. He'll be better off, but he's not going to like it. He's been on his own for many years and has a bit of an anti-social streak so living in an assisted living home will probably be his idea of Hell.

I'm working on veteran's benefit paperwork as she is a surviving spouse. Here's a link to the site I've found the most useful.

http://www.vetassist.org/

him with paperwork to comply for Vet. assistance. This will, allegedly, provide a certain amount monthly for his 'rent' at the facility.

My brother is nearby; its important that the resident have an advocate to steer through the maze.

Good Luck to us all

I strongly recommend looking at assisted home-care as an option...it's often the best and least expensive option. You and Medicare pay someone to be there whatever he needs (4, 8 or worst case scenario 24 hours a day), do the sorts of things that he needs done (housework, make sure he's clean, cook meals for him, basic medical, etc.) and to check in on him. And he gets to live at home...which it's been my experience is all many older Americans really want. The sort of residential-care that Medicare will pay for is the sort for people who need constant-care in a monitored medical environment (The mentally-ill, Alzheimers or Parkinson's patients, people with medical conditions requiring constant monitoring and/or care beyond a level which can be provided at home such as congestive heart failure, emphysema, cancer or in some cases diabetes.) usually; think less community and more hospital or worse-case a warehouse.

The biggest thing I remember qua affordability was that Medicare will basically force him to spend pretty much his life's savings on his residential-care before they'll begin to pay for much of anything as far as any sort of residential-care (home-care gets better coverage as they'd prefer to not be responsible for housing the elderly.) will be covered.

So if you decide that he does need to be in a residential care situation, you need to make him as poor on paper as you can before you apply, otherwise the patient-contributed share will make him poor...if he's ever wanted to give money to charity or buy nice things (it's been my experience that WWII vets (like my paternal grandfather) also tend to be Depression-era kids and they wouldn't spend a needless dime on themselves ever.) or take a trip to Greece or a cruise to the Caribbean (you'd be amazed to find out how easy it is to hire a caretaker or nurse to go on a cruise with a client. I knew a guy who decided that it was cheaper to book around the world tours on Carnival for him and a live-in nurse than to go into an assisted-living facility. He'd truly been everywhere...about 8 times.) or splurge on loved-ones or himself...now's the time to do it.

The smartest thing my maternal grandfather did when he got sick was arrange through probate for the immediate disbursement of his will. He owned nothing...the house, the cars, the land, the stamp collection, even his clothes (he was worth millions)...had been inherited by my mother and uncles. If he had ended up in residential care, he'd have been a pauper either way.

Beyond that...define acceptable. It is possible to find very nice homes/facilities on medicare. The fancy assisted-living condo communities you see advertised though (with the pools and the golf and the "dignity to live in your own space yadda yadda yadda". What I am concerned you mean by "acceptable".)...are a scam, don't do it. Most run like this: They get you to buy the condo-space then when you pass-on, they sell your condo to someone else...you don't actually own the condo as a fungible asset. You're not buying the condo, you're buying the amenities. They bill Medicare for the medical care and if you have too many assets, well...go back to the top of this post and read it again...Medicare pays out often on the level of what minimal amount can they pay for and still make sure that you can afford to pick up the difference and get the care. Having nothing is an asset in this case.

The twisted notion that someone worth millions can arrange his affairs so that taxpayers are paying for his retirement costs is, frankly, sickening. The shifting of that burden to taxpayers so that the estate is preserved for family members is surely some kind of sin, if not a crime.

Because of this kind of twisted skirting of responsibility, public money that could be used for services to people who really need help goes to pay the bills for people with money enough.

Where is the shame at this kind of evasion? Are they all Republicans?

paying for end-of-life care. The system should not be designed to work on the premise of bankrupting dying people. (and often their families.)


(Edit: And oh it does need to be said. The point was moot. He died of a heart attack on the bedroom floor. Grandma died 9 months later in approximately the same spot of cancer. They didn't cost you one dime you wouldn't have had to pay otherwise.)

P.S. Estate planning is not evil, nor criminal, it's just smart.

"The system should not be designed to work on the premise of bankrupting dying people. (and often their families)."

What system is that? Do tell.

Is it the same system that locks workers into jobs with no retirement benefits, no health care benefits, and minimum wage?

Is it the same system that runs out of heating assistance for low income families?

Is it the same system that is cutting Medicaid to the poor? And food programs for elderly shut-ins?

Look. There's a pool of revenue from taxation. It can either be used to help people who need help, or to preserve estates of people who don't need any help.

I sure don't understand how a Democrat can think like a Republican.

I'm sure you've seen the irony in your fear of "bankrupting dying people."

get bent.

It's designed to help people who don't have the money for end of life care and with that comes the assumption that those with millions can fund their own care. That some people chose to use estate planning to shift the burden to the underfunded government programs is part of the problem with the poor end of care for those who don't have the money for care.

I'm all for a universally available, fully funded government end of life care benefit, but we don't have it at the moment. Using estate planning to become a paper pauper is fashionable in some circles but such planning is the main reason for the multi-year look back provisions in eligibility determination for Medicaid nursing home applicants.

But we couldn't afford it after that because he needed 24hour care. My brothers and I were paying $10,000 a month for someone to basically sleep there.

He came down here and lived at a really nice nursing home until he passed away. I visited him every day.

Some assisted living places also have nursing home wings. When we selected a place for mom we avoided those--they definitely have that institutional atmosphere and we wanted to avoid that. She was in a wonderful place for two and a half years, the staff were very good, it was a fairly small place, and she got along well with the other people who lived there. The problem was that she eventually needed more care than assisted living could provide and had to move her to a nursing home, and it was a difficult move--the new setting terrified her--by then her mental conditions had deteriorated and she was convinced that the staff was trying to poison her with the medication. We spent a lot of time wishing we had moved her into one of the combination places to start with so that the move wouldn't have been so hard on her, just going to another part of the building and still seeing some of the same people.

Financially the picture changed as well. In the beginning the assisted living place was as reasonable as those things can be, but as mom began to need more care the monthly charges grew--there were extra fees for things like helping her shower--and by the time she left the monthly charge had almost doubled.

Finally, I don't know what your father's mental state is but this can be one of the most difficult things you can face. Mom was convinced she could still care for herself and moving her into the assisted living place was an emotional nightmare. If it's possible, have your siblings there so that your father knows it's not just your decision; try to have some of his things like furniture or photos in the room before he comes in, so there are familiar items he can see. Not trying to make this harder for you, but you need to be prepared for the fact that your dad will likely be angry and hurt, and you (and sibs) will take the brunt of his feelings--the thing that helped us was the knowledge that mom was safe, she wouldn't accidentally forget she left the stove on or forget to eat or fall and lay there without help. Sounds a bit overdramatic, but it was comforting.

Best of luck to you and your father... :hug:

Why should he be in a place where strangers have so much influence over his daily life? The way of most of the world is multi-generational living. Americans really can't afford their retirement habits any longer.

Not only was it good for his son to have the grandparents close but he was also able to care for them until their deaths last year.

I am moving to the house in a year and a half and we decided that we would like for one our kids to take the big house someday and we could live quite happily in the inlaw apt for the rest of our lives.

Not possible or ideal for everyone. But if you have a family that gets along it can work out great for everyone.

We're barely keeping out heads above water financially.

I was only trying to comment on generations living together as being a positive experience for my guy and his son. It would be nice if everyone were able or willing to do it, but we all know it's not that easy.

Please don't think that I was judging anyone on this, I wouldn't do that.

:hi:

My wife and I both work and there would be no one with him during the day. As I think I mentioned he's a bit anti-social and after 2-3 days he'll just pack up and leave. Since we wouldn't be able to watch him 24 hours per day it's not a good option.

We did consider it but it wouldn't work. Neither one of us can afford to quit our jobs to take care of him.

Most families are dual-income families, and don't have somebody around during the day to help take care of grandma/grandpa. Nor can they afford to give up one of their incomes in order to stay home and take care of a parent.

My grandfather is in an assisted living facility. He's 93 years old, and even though he's in relatively good health, he can't see (macular degeneration) and is almost deaf in both ears. He's also go dementia, and can be a real handful to care for, even on a good day.

My divorced mother lives alone, is 61, and works at least 50 hours a week. She holds a high-level position with an international Fortune 500 company. Her job is very stressful, and she is not capable of looking after my grandfather full time, like he needs. Even though she can telecommute, her job requires full-time attention, and she can't be looking after my grandfather full-time.

Not everybody lives in a nuclear family anymore-- especially since the divorce rate in this country is 50%. And most families need two breadwinners to pay their bills. Having an elderly person with round-the-clock needs living with a family is not possible for most Americans.

For the past two years, she has been in a continuing care facility that offers everything from independent living to full care. This is the ideal solution, in my opinion. There is minimum disruption as you move from one level to another, and residents of the complex have priority for openings in the next level of care. If they are hospitalized, they can convalesce in the full care unit and return to assisted or independent living if they are able.

After my mom's last hospitalization, she was in rehab for a month (same facility), and at the end, a team of nurses, social workers, physical therapists, occupational therapists, chaplains, and psychologists decided that she was not capable of returning to assisted living (which is for people who need a little assistance occasionally). This was helpful for us, since we siblings had been wondering this for a long time, and in this way, the staff were able to play the role of the bad guys and get us off the hook.

Wherever you put your dad, be sure that there is someone around who will make unannounced visits. As we learned with other older relatives, they might have good meals and sparkling clean facilities when they know that visitors are coming, but unannounced visitors will find bad food and bad smells.

Unless there will be people visiting him in the area that he lives now - move him to an assisted living facility near you. It makes sense. Once people have been moved out of their homes (and if their friends or other relatives won't be visiting them regularly) then why not have them closer to you if you are going to be the one visiting them most often?

I can't help you on Medicare/Medicaid options (except I think Medicare pays for less than a month of care unless there is a medical need (like physical therapy or on-going blood testing) for the assisted living home. Then the billing goes to Long Term Care Insurance or Self-Pay or Medicaid.

Here's a website that evaluates some of the existing homes:

http://www.medicare.gov/NHCompare/Include/DataSection/Questions/SearchCriteriaNEW.asp?version=default&browser=IE%7C7%7CWinXP&language=English&defaultstatus=0&pagelist=Home&CookiesEnabledStatus=True


Oh, another bit of advice was to observe how the staff members of the facility interact w/each other and the residents when you visit the facility. FWIW