<p>Greatnews momusic! I have several friends with parents that have recently relocated to assisted living. All did so reluctantly, and all are as happy and thriving as can be expected with health concerns. My elderly inlaws are long overdue for a move, but are insistent in staying in their house. Over Christmas, H will FINALLY have a hard discussion about the current situation (failing health, far away from family, home literally falling apart around them, and should not be driving). I think a carefully selected assisted living situation would be a Godsend!</p>
<p>It sounds like most moves to assisted living or skilled care involve the sale of the primary residence to fund the new living arrangements. But what if the monthly income from pensions and annuities is enough to cover the residential care fees? Our mom’s condo is in a resort area, and I’m thinking of asking my siblings if they would consider treating it as a time share (split equally between us) if and when our mom moves to assisted care. I think mom would like the idea of us maintaining her home and garden, but wonder if it’s better to cut all ties when moving to a new residence?</p>
<p>I think it depends on you and your siblings. I have a dear friend that would love to keep her dad’s place at the beach but she knows it would be hard to get a consensus on things like how often to upgrade carpets, how to divide the time, etc. </p>
<p>I think we all need to give our parents an extra hug if they were able to pay for assisted living - it takes one stress away from caring for them.</p>
<p>momsquad, does your mother have a good-sized nest egg? Even if Social Security and pension is enough to cover the Assisted Living fees, there are other expenses which will come up. And the older they get, the bigger the costs.</p>
<p>The only way to be make an informed & educated decision about the pros & cons of selling vs. keeping the family home when the folks relocate is to consult with knowledgable, trusted professionals about the current market value of the home, projected costs for your folks care–now and for the future, projected longeivity, etc. Keeping the family home as a timeshare is a nice luxury, but does require agreement and maintenance to keep it in good shape, as well as utilities, taxes, and other expenses, and someone to check up on it periodically, especially if it’s going to be vacant much of the time. While it may SOUND attractive at the moment, values may decrease while it’s vacant and it may sell for less than you could get now, when you are not in an urgent rush to liquidate and can fix it up a bit to optimize it before it’s sold (sometimes a coat of paint & some yardwork will do wonders to increase curb appeal without much cost).</p>
<p>Another thing to consider is how quickly would you be able to sell the home if your mother does need the money. With my mother, I had to sell stocks even though they were down at the time because my mother needed the money, but I was able to sell them immediately. Unloading a house can take much longer.</p>
<p>Some assisted living facilities and extended care facilities require a substantial deposit. Make sure you have some assets that could be easily liquidated.</p>
<p>My brother is executor, so I guess ultimately it will be his decision. He had been advised by a tax specialist that it is better to inherit the home because the cost basis is adjusted to current market value, lowering capital gain upon selling. I guess I was thinking my mom might be more inclined to consider assisted living if she knew her home and beloved garden would still be in the family. Although initially it appeared the monthly costs would be covered by her stream of income I forgot to take in to account that some of the more desirable care facilities require a substantial “buy in” that would necessitate selling the condo.</p>
<p>Hard to read a lot of the posts here… so close to home. My brother is having another “hard” conversation this Friday, we have been nudging my parents toward an ALF for a year now. Mom has ALZ, Dad not well physically. I have explored all alternatives for us… and the best seems to be a Christian facility with a benevolence fund. We pretty much have to sign all of their assets away but it its worth it for them to be 1. together 2. receive good care always. This place has all levels of care, the hard part is qualifying to get in… they become actuaries. age? health? assets? They have to do it this way or they would have to close. Kind of like buying long term care insurance at age 83. But I know a for -profit would run thru money really fast and the medicaid facilites would separate them. With 2 college educations looming, I cant fill in the financial gaps.
So, just wanted to pass that along. Maybe a christian facility with benevolence fund would help some of you? Blessings.</p>
<p>Re: primary residence after move to assisted living. As others have suggested, conferring with tax and legal experts in elder care is important. If the home or other assets are to be “gifted”, there are implications should the elder need skilled nursing care within a specific time-frame. The 3-5 year (depending upon date of gift) “look-back” period can create gaps in Medicaid payments to nursing homes, which in some cases are very problematic. If this hasn’t been sorted out pro-actively, there could be decisions made that have unanticipated consequences. Best to all. These situations are complicated and the emotional stakes are high. So happy to hear of positive responses to increased care.</p>
<p>Will also point out that in some states, if a parent goes on Medicaid, the state has a payback provision after the parent has passed away. If you are saving a primary residence as an asset for the estate and the parent goes on Medicaid, you may not wind up with the proceeds after all. (My parents live in GA and there is such a provision there. Makes it complicated because my parents also own the house my sister lives in, and they do not have liquidity for assisted living. As executor, I may have to evict my sister to settle the estate/qualify my parents for Medicaid.)</p>
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<p>Good point! We’ve decided that it makes sense to sell parent’s condo now even though he doesn’t need the money now. He could rent the unit for some positive cash flow, but I have no desire to be a LONG distance landlord (and I would have to take care of the details in the long run).</p>
<p>So glad y’all are on this subject now. We did sell the house, for many of the reasons above stated. Originally were going to rent it, but realized I would be the landlord and couldn’t handle it and mom’s care.</p>
<p>Now, seven years after moving to assisted living, because of Katrina, and one year in skilled nursing, we are out of funds. Can’t believe how quickly it caught up to me. </p>
<p>I don’t know what to do now, as she is in another state, and I’m not sure what the issues are of getting her on Medicaid in that state or in my state. I’ve called many low income elder communities in my state and have always been told that she’d need to be interviewed. Well, she’s in another state, and while driving distance, what do I do with her once I get her here? She’s in a wheelchair, and my house cannot accomodate her. And once she comes back here, her home, she will not want to go back to the other state, where my brother is. (BTW, he is not very involved in her care, only to visit with his children, who she adores and I hate to take her from). </p>
<p>So, while I needed to sell the house to pay for her care, now I have no place to put her. The house was wheelchair accessible, thanks to my renovations, and I never dreamed we would need it again for her, as I thought her condition would only deteriorate and in fact, she would be dead before we ran out of funds.</p>
<p>Assisted living and skilled nursing facilities are not like I grew up thinking, where you would be dead in six months. Nowadays, the residents are very well cared for and can live long lives there. But for those who do not have unlimited funds, it can be a nightmare.</p>
<p>I worked hard to get my mom as many benefits as I could to stretch out her money, but the economy has not helped in that I have not been able to “grow her money”, which is what we had hoped for. Just bad timing, the hurricane, the housing market, (we lost about 80K on the sale of the house, which could have paid for a couple more years), and the unwillingness of the siblings to contribute to the cost of her care. </p>
<p>I’m hoping to get some advice here as to what I should do at this point. Her condition has actually improved in the last year, where I could probably physically drive her myself from Texas to Louisiana, rather than having to use medical transport, which was an expensive option I had looked into when we moved her to skilled care last year, and I suppose I could research short term housing for her at an elder care facility, but I am worried she will be rejected from admittance to any decent elder care facility, or will not qualify for Medicaid because she is not medically qualified for it. She has mental issues, so I think she will be rejected from some facilities, but since she’s able to, at this point, actually get herself from the wheelchair to the toilet, she will be not eligible for Medicaid funding.</p>
<p>Any help would be most appreciated.</p>
<p>Montegut - I have no ideas - just heartfelt sympathy for what you are facing. The money does seem to just disappear once they are in a facility. And yes, they do keep our folks alive - but at quite a price. </p>
<p>Won’t the facility where she is currently living keep her after her funds have been depleted?? It’s not as though they haven’t profited already. </p>
<p>Oh, your story just gives me chills. I am watching my parents’ assets dwindle each month, and whenever I recalculate how long it will last, something happens and a larger chunk is deducted and then I RE-calculate.</p>
<p>Montegut, hugs to you.</p>
<p>Don’t kick yourself for selling the house. The proceeds bought you time. And if it were there now and she could move back into it, someone would have to move in with her fulltime. Who would that be? You did the right thing to sell.</p>
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<p>If you’re worried that she’d be rejected from a decent elder care facility because of memory problems, you may want to talk to a few Assisted Living centers in your area. Almost everyone in this age group suffers from some degree of mental/memory issues; these facilities expect that and are equipped to deal with it. Unless she’s far gone into Alzheimer’s, she’d probably be fine in Assisted Living, if you can find a way to pay for it.</p>
<p>For the ALs that want to interview her, ask if they have a guest apartment or respite care apartment where she could stay temporarily. </p>
<p>I’m not an expert on Medicaid, but as I understand it, anyone who meets the eligibility requirements qualifies. The requirements are non-medical (age, income/assets, citizenship). Medical/disability status doesn’t have anything to do with it. [Eligibility</a> | Medicaid.gov<a href=“Someone%20please%20correct%20me%20if%20I’m%20wrong%20about%20this.”>/url</a> </p>
<p>I also found this about Long Term Care under Medicaid: [url=<a href=“http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Long-Term-Services-and-Support.html]Long-Term”>http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Long-Term-Services-and-Support.html]Long-Term</a> Services & Support | Medicaid.gov](<a href=“http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Eligibility.html]Eligibility”>http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Eligibility.html)</p>
<p>You said that the siblings are unwilling to contribute to the cost of her care. Now that she’s out of money, might that change?</p>
<p>Lasma: I think you’re right on Medicaid eligibility. If I recall correctly (my mother went on Medicaid over 3 years ago), she could still transfer herself to the toilet and the bed at that point, but she still qualified for Medicaid because of her financial situation.</p>
<p>Montegut: So sorry you’re going through this. You also have to be prepared that any facilities you look at may have waiting lists, so you may need to come up with an interim solution to finding care for your mother.</p>
<p>Montegut- So sorry for your dilemma. All the complexities of payment may well make it worthwhile to talk to local representatives/social workers at Councils on Aging, elder affairs offices, legals services, etc. Some states have hotlines and offices for free help with such matters. Nursing home residents who are Medicaid eligible have minimal expenses beyond their payment to the skilled facility (typically from their social security) and are allowed to keep a small monthly stipend for “extras”. While she has improved in skilled nursing, I would not want to underestimate how much of that is due to a high level of care, structure, etc. Sometimes, interrupting care impacts payment options, but I am not an expert in the specifics of this.</p>
<p>What is concerning me here is that requiring a year in skilled nursing usually would create a need for a thorough aftercare review. Did the facility offer planning or suggestions? They should know exactly what her status is re:level of care eligibility. She may well qualify for Medicaid or other benefits. In any event, it pays to look into the ramifications of whatever you do next for your mother. I don’t know exactly how this could play out, but it could be harder to advocate funding needs for supervised care settings if she has been navigating what appears to be a completely independent setting for example. </p>
<p>Fiscally speaking, assisted living (vs. skilled nursing)is a much more complex situation in my experience. Some offer no medical care built in and it is hard to get outside help for payment. Some are certified to provide a bit more medical care, dispense meds, etc. In these cases, some states have programs to pay for elder services through “emergency” aid funds or other funds. </p>
<p>Look into non-profit elder facilities (some are church sponsored, some are not) and speak to experts in the areas she may live for advice. She may be to a point where having an involved, responsible family member nearby trumps other considerations. I would start with the people who know her best and also get outside expertise on options. Best to you all; this is so hard.</p>
<p>Montegut: so sorry to hear this news. I have no experience in this area, but have heard friends say that once their parents money ran out, the facility kept them there using medicaid & their SS$$. Best of luck. I’d suggest talking to the social worker at her current facility for insight. </p>
<p>Has anyone had experience with AAA (abdominal aortic aneurism?) Took mom in for her 6 month visit with her geriatric specialist (which is usually a very enjoyable visit as she just reviews what the other doctors are doing & does a general physical) only to see the dr. get a very concerned look on her face & point out to me (and mom) a very visible fluttering/pulsing in the abdomen. Took mom for an abdominal ultrasound Friday afternoon (during which they took extended time on the exam compared to what they’d told us when we walked in.) Mom is NOT a good surgical candidate due to various medical conditions. Trying not to pre-worry…</p>
<p>RobD- Sorry, RobD. My mother also had AAA. She too, was not a surgical candidate. Period. As I understood it, surgery was the only fix and if the aneurysm ruptures, it is indeed a medical crisis with little likelihood of survival. That said, my mother never faced that issue as her other health issues ultimately caused her death. She lived with it for many years without incident. I hope that is the case for your mother as well. Best to you.</p>
<p>RobD - Dad also had AAA about three years ago. At the time, his cardiologist advised against the surgery, however, a surgeon was already involved with dad because of a hernia. My dad was sufficiently scared about the life threatening aspect of AAA, so he opted for surgery. </p>
<p>He DID recover, but it was one of many stops on the way to declining health. I have no advice, but I would be darn sure the surgeon was exquisitely skilled. The cardiologist was concerned that dad would survive the surgery, but be incapacitated in some way. </p>
<p>I honestly think I would have opted not to have the surgery.</p>