<p>Cardinal Fang, thank you for replying, but can you elaborate? If I/we do not follow the course of action I am pursuing, if I am reading other parties’ ideas of options, the only alternative is for my mother to go to a nursing home, and while she is feeble, she is sharp as a tack. I visit my MIL in the nursing home about twice a month, and the residents there are pathetic and they all seemed to be in some way intellectually impaired. You may know from your own family circumstances, but these places are profoundly sad. When I visit I have to bring my (approved) dog to keep from going mad. If I am following correctly, others are advising assisted living. When I investigated independent living (cheaper than assisted) about 8 years ago, the monthly cost was about $4,000, and thus the money would go just as fast, seeing that prices are certainly higher and she would need “assisted” to say nothing of her resistance to moving and the amazing advantage it is that I live two doors down the street, a matter of a few steps? Are you saying that it would be better for her to grasp sooner than later what her situation is? As I wrote, given her condition, if I wait…a while…this discussion may never need to come up? Am I missing some other care option? Medicare does not offer enough. I look forward to your response as I respect your opinion, and at this point I am thinking you are advising that it would be better for her to"face up to" the facts (I think she is smart enough to “know” them although she might be hiding from them). My own inclination is to disagree to an immediate confrontation of the facts, given that she has 3/4 years to go… Oh, I just thought to add: to manage her manic-depression, (or should I say pseudo-manage) my mother has been seeing the same psychiatrist for–can you believe it?–almost 40 years. The man must have been fresh out of med school when she started with him. Despite her challenges, he has been very kind to her and very caring to me when I have had to step in at crisis points. He knows her very well. Given the strange nature of things, I suppose he might know her better than anyone. I am her daughter, but we are “cordial,” not close.i I wonder if I should talk to him about my mother’s future and ask him to draw her out and for him to ultimately help her see what a short time her money would last and her likely next situation? If he agreed, don’t you think this would be preferable for all in that both my mother and myself would be spared?"</p>
<p>As I understand what you have said, your mother is in pretty good health, mentally and physically, for her age, and could reasonably be expected to live more than three years. If she follows the course of action she is now pursuing, she will have home care for about three years, and then will be out of money and will be forced to move to what I understand from other posters to be a lower-quality facility than what she could be in if she entered while she still was able to pay for her care.</p>
<p>As I understand it, you are asking whether you should tell her that. Yes, you should tell her that, because it’s true, and because she should be making her decisions on the basis of what is true, not what she wishes were true. She apparently thinks that she can stay indefinitely in her home. You should tell her the truth: she can’t. If she chooses to spend down her money now, she won’t have it later, and she will lose her house as well. If she doesn’t have any money later, she will be forced to enter a facility for people who don’t have any money.</p>
<p>What we are trying to tell you is that the house is her biggest asset. If you get a reverse mortgage, you will have only a fraction of that asset. If you sell the house for it’s full value, you will have more money for your mom’s care. Moving the asset to cash also allows you flexibility as your mom needs transitions of care. </p>
<p>In addition to what GTalum says, we are also trying to tell you that paying for round-the-clock care in home costs more money than getting round-the-clock care in some facility. So if your mother gets the reverse mortgage, not only will she end up with less money to spend, but she will also be spending it faster.</p>
<p>GT, yes obviously I understand she would get more money if she sold the house instead of taking a reverse mortgage.I had the costs of the RM explained to me over the phone and they indeed are formidable. Please forgive me for being dense, but let’s just overlook the costs of the RM for a moment. Putting those costs to the side, I don’t understand what kind of “facility” she could move to to make her assets last longer. If she sold the house and moved to assisted living, yes, her money would last longer because she would have more of it: she would keep what she would lose with a RM. But any assisted living facility within a 100 mile radius of me costs $4,000 a month. Two Polish women 24/7 at $150 a day is $4,200. Slightly more but far better quality of life. If she moved to AL, she would gain financially because (a) she would not pay the costs of the RM (b) AL is slightly cheaper than Polish women and © we would not be paying a payroll agency to do the women’s taxes etc. To summarize, you are recommending AL over home/RM because of the costs of/losses associated with RM. You are recommending to me that these are the options I offer my mother. Am I missing anything? If she chooses AL, she still spends down her assets rapidly because the monthly cost of AL is high. How much would she gain with the AL choice? Another year of funds, even less? </p>
<p>Cardinal Fang,I just realized from 3381 (“mother in pretty good health mentally and physically”) that you might be wondering if she could live by herself again. That is a definite no. She needs a breakfast in bed. She is too weak to get to the kitchen without something first in her stomach. She cannot cook, do laundry, She walks in baby steps with a walker or cane, cannot bathe herself and it takes her over an hr to dress herself. She is very sharp but I guess you missed the happy news that she is manic-depressive --defined as a “rapid cycler”–and is never quite “right.”</p>
<p>Any feedback on my thought of asking her trusted psychiatrist to review her options with her, if he is willing, to give the situation a more professional/less personal dilemma, and to remove the disstressing mother/daughter issue?</p>
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<p>Your mother is presently spending her $2000/month Social Security. None of those expenses go away if she adds caregivers: she still has to pay her health costs and the costs of keeping up house and household. </p>
<p>You’ve previously said that the cost of the caregivers is $170/day, which comes to, not $4200/month, but $5200/month. So she is looking at a total expenditure of $7200/month at home with caregivers, versus a total expenditure of $4000/month in a care facility. </p>
<p>Moreover, a reverse mortgage is a loan. If she takes out the loan, some of her money goes to paying expenses and interest on the loan, whereas if she sells the house, she gets all the money.</p>
<p>It’s a big difference.</p>
<p>Yes, but I later said that when I insisted to the rep that we will not take an"independent contractor"at$170/day but want an"employee"at$150 a day–which he said is standard for what his women get. But I totally hear what you are saying, and thank you again for the useful input. Don’t forget…I’m seeing the lawyer who specializes in eldercare on Monday!</p>
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<p>If the options were AL vs RM another year of funds is kind of a big deal, especially for a woman as frail is your mom is. Frailty is a better measure of life expectancy than some meaningless lab value telling us how good her organs are. Plus, we are probably not talking about the cost of two Polish women for the rest of her life. Your mom will transition in, and possibly, out of different care levels. She may be hospitalized, need rehab services, be total care, and probably more care providers in the home (more Polish women?). Dementia in addition to bipolar may happen. In the case of the RM, it leaves you little flexibility to provide for the kind of care that she may need at the time as all assets (now depreciated) are tied up in the house. Sure, home care with 2 care providers may work for the short time, but if you talk to others in the same situation, it is not likely to last for the long term. Your mom doesn’t think so now, but AL may even be a better quality of life. My in-laws didn’t think so, but loved the AL facility once they moved. </p>
<p>I understand that your mom will never agree to moving out of her home. But, you are the one trying very hard to arrange things for your mom to allow her to do exactly what she wants. Being frail and dependent on others does take away autonomy and you do need to set some limits as to what you are willing to arrange. Yes, I would see if the trusted psychiatrist can be an Ally. </p>
<p>Yes, if your mother dies in a year, all this consideration is moot. But what if she lives 4-6+ years? Planning includes looking at the extremes. Sorry. I know you’ll aim for the best decision you can make.</p>
<p>You need to chart this out. Make the columns with all the cost detail under them. There’s no point where we can just look at one component- caregivers’ salaries versus Al or NH monthly base. The cost category would be better labeled “cost of staying home.”
Depending on the facility and its packaged offerings, if you choose AL over NH, she may need addl hired help. But all these things get charted, projected. When it’s all down, it’s usually informative. The deal is to anticipate everything. Every penny out in this year, every penny out with home care, then the AL/NH fees and any extras.</p>
<p>Didn’t we cover that, if the matchmaker “finds” you an employee, you have to manage the payroll issues? Add that in. Consider whether there is a good supply of women willing to work for 150- on a 24 hour cycle, it may be less than minimum wage (would be, in my state.) If you hire an agency that you just pay monthly, they build in a surcharge, their profit. I somehow doubt that will add to 150/day. </p>
<p>I know this is emotionally hard, on top of the responsibility. My mother is a problem child.</p>
<p>I don’t understand the $150/day either. How is that not below minimum wage? As I understand it, these are not live-in employees, because there is one living area, but two employees. So each employee would have to have another home to go to when they were off work. Like firefighters-- they sleep at the firehouse when they’re on duty, but they all have homes to go to when they are off duty.</p>
<p>GT your post was very sobering and a real eye-opener. From the useful advice I’m hearing, I can clearly see the benefits of AL. One immediate problem I face is that my mother may be sent home in less than a week and she will need a caregiver in place. My rep says he can get a woman to my home in 24-48 hrs.I know a better woman than myself would move in with mom, prepare meals,do all that needs to be done. But I have two teens and an 11 yr old who need meals, laundry, a lot of listening and parenting. I cannot move in with my mother; I see a caregiver, even if temporary, as my only option. The lawyer may urge us to explore the AL option–I would have to drive my mother to her to have the facts laid out by a professional. At least temporarily we would be paying caregivers(and the agency fee) until,if it so happens, she moves to AL. I recognize from what CF outlined that in fact the savings would be significant going the AL route. I am not a defeatist person, but have known my mother and waited on her faithfully for 57 years, recognizing her illness and becoming an adult myself at age 6, and she will do what she wants regardless of the consequences. She has as her MD defines, episodes of depression, episodes of mania, and psychotic episodes. One fine day in a restaurant when the host was not paying attention to her soon enough, she upended the huge tray of food and drinks he was carrying and sent it crashing to the floor. Thank God I was not there; she reported it to me without emotion as a matter of fact. </p>
<p>If I have it “easy” it wiill be caregivers/RMmortgage/nursing home
If I make the effort to save/salvage as best as possible (but don’t forget my mother may violently veto a move) we will pursue more economical options with the eldercare lawyer, with incredibly more wear and tear on me with one daughter in college and one approaching. But as you kind patient readers can infer, I have–and can–weather through the storms.</p>
<p>Please release yourself from the idea there is some standard that “a better woman” would just manage this in its entirety. Some people choose these career paths, nurses, CNA, etc. The rest of us barely know what’s a trouble sign and how to handle it. This whole thread is about us eeking our way through and the emotions we endure.</p>
<p>Sorry to bang this point, but it may interest others. I just asked my bff about her mother’s care costs. She’s an hour outside DC (an area I believe equates to greater NYC in cost of living.) Are you sitting down? Via an agency, they pay $19.50 per hour, the workers get $10/hour. She said, sure, maybe you can circumvent an agency and get someone yourself for 10-12/hour, etc. </p>
<p>To try to answer your question Cardinal Fang, one woman would be 4days/ the other 3 days. At $150 a day would we be breaking another law about minimum wage? Perhaps naively, the only issue I foresaw was simply changing sheets and towels between the two women’s stints.</p>
<p>At this juncture, it may be interesting to observe from the many hours of research and phone calls I have conducted,many,many people are breaking the "nanny tax"rules and reporting very wrongly on elder care.</p>
<p>Thank you Looking forward, I wish I were as smart as most of the parents here; I am a complete idiot at spreadsheets and what they involve.I am willing to learn but would need the help of my local town’s excellent
“all purpose” agency and would consult them. So nice; we live in a lovely Hudson Valley town with generous service providers of all kinds, but of course, none of it is cheap.</p>
<p>Looking forward, thank you for the kind personal remark, because truly I feel almost viscerally opposed to,e.g.,feeding my mother, guiding her to the toilet,etc. I feel tremendous respect for the Polish women we have interviewed who are graciously willing to take on this kind of thankless job. It humbles me. </p>
<p>What you remarked about costs–agency vs. private pay-- is very interesting because it is so dangerous to flaunt the law and many do. Hey, I am a 1970s Bard College graduate! and as a determined liberal, I am very afraid of doing anything “off the books’” or shady. </p>
<p>Live-in caregivers (and that’s a misnomer because they need their own home too) are paid by the day, not by the hour. The assumption is that they don’t work 24 hours a day. This website seems to describe pretty well what the agency who provided aides to my dad and stepmother charged, although it gives an arrangement of 2 aides per week like Dharmawheel was planning and my dad and stepmother had someone who stayed for weeks and then took a few days off and was replaced by a substitute.</p>
<p><a href=“Hourly and Live-in Care Services and Rates - CaregiverList.com”>http://www.caregiverlist.com/rates.aspx</a></p>
<p>We’re all idiots on this bus. We’ve all learned in fits and starts, through experience and from each other, even when our tales are not the same. My mom doesn’t have dementia, but I have learned and taken comfort from every tale of a stubborn parent.</p>
<p>A spreadsheet is just columns of numbers. Or you can use separate sheets of paper. </p>
<p>Dharmawheel, you don’t have to do this. You don’t have to dance to your mother’s tune. You don’t have to let her take over your life. You can set limits to what you are willing to do.</p>
<p>You’re far from an idiot, dharmawheel. Most of what I learned in this area was the result of making most of the mistakes it is possible to make, first with FIL, then with mom, then with dad, then with MIL. A very experiential learner am I.</p>
<p>The rules are changing on caregivers. </p>
<p>Caregivers for the elderly used to be called companions, and under the law were not required to be paid minimum wage if they lived in or worked for a household employer. Lots of people had caregivers that worked a 12 or 24 hour shift at a time. No overtime was due. Many were paid at a flat rate. ($150/day, in your example.)</p>
<p>But…the Department of Labor recently rewrote the rules on what duties a companion can have, and intentionally, much of what caregivers do no longer qualifies for that exemption from overtime as of January 1, 2015. </p>
<p>Here are the current rules: <a href=“WHD Fact Sheets | U.S. Department of Labor”>http://www.dol.gov/whd/regs/compliance/whdfs25.pdf</a></p>
<p>Here are the rules taking effect on 1/1/2015: <a href=“Fact Sheet: Application of the Fair Labor Standards Act to Domestic Service, Final Rule | U.S. Department of Labor”>http://www.dol.gov/whd/regs/compliance/whdfsFinalRule.htm</a>
A few excerpts: “The definition of companionship services does not include the provision of medically related services which are typically performed by trained personnel. Under the Final Rule, the determination of whether a task is medically related is based on whether the services typically require (and are performed by) trained personnel, such as registered nurses, licensed practical nurses, or certified nursing assistants. The determination is not based on the actual training or occupational title of the worker performing the services. Performance of medically related tasks during the workweek results in loss of the exemption and the employee is entitled to minimum wage and overtime pay for that workweek.” So – any medically related services (and many caregiver services are considered medically-related) and you’ve got trouble. Time spend on ADL’s that exceeds 20% of the hours worked in a week also causes the exemption to be lost. </p>
<p>Here’s a FAQ, with more explanation of how companionship has now been narrowly defined to mean fellowship and protection. <a href=“Domestic Service Final Rule Frequently Asked Questions (FAQs) | U.S. Department of Labor”>Domestic Service Final Rule Frequently Asked Questions (FAQs) | U.S. Department of Labor;
<p>Also, some states (like NY and CA) have their own rules on overtime, and may also have their own rules on independent contractors that layer on top of the federal rules. It is a mess. (California was the pits to try and work with as a household employer.)</p>
<p>The biggest advice I can give is to make sure your parent – not you – is the employer. I was very careful to word all of the documents that way, as I did not want problems coming back on me. People do sue, and I expect that many, many families will be sued for failure to pay overtime, or failure to carry workers comp.</p>
<p>Having done it all, I rather wish that we’d pushed a lot harder to get MIL into Assisted Living – keeping her at home was astonishingly expensive and consumed massive amounts of my time trying to get problems resolved from 800 miles away. It was also very socially isolated, since most of her friends had died off or couldn’t drive or were in AL or nursing homes. Setting boundaries is critical.</p>
<p>Dharmawheel, it is a good idea to write down the alternatives as you see them, but then give it a rest. See what he lawyer says on Monday. She will know what’s available and typical in your area.</p>
<p>The thing about places with independent then assisted living, then nursing home is that often they will take people who still have assets with the understanding that once they use up those assets, they will keep them on as Medicaid patients in the nursing home. I am sure the attorney can explain the options in NY.</p>
<p>My stepmother’s last caretaker when she lived with my dad had previously cared for a woman who was spending down her assets. She lived in assisted-living with this woman as her personal aide. Once the assets were gone (several years), she qualified for Medicaid in the affiliated nursing home.</p>
<p>Thank you for the link, kind old mom.I will study it tomorrow morning. Thank you looking your thoughts dear Cardinal Fang. How nice to turn in for the night after connecting with friends. My husband is watching TV after a stressfull day at work which is the aggressive truth of the corporate workplace in 2014, he works himself at age 62 to the breaking point… My 11 year old just came downstairs with–in world terms–was a completely meaningless complaint–but thank God we are not in Israel or Palestine or Turkey or Syria or an number of countries in Central America or Africa… Good night frieds.</p>