<p>Oh Mansfield, so difficult, especially when there’s so little clarity regarding dx and prognosis.</p>
<p>I’m just joining this thread and have read back several pages, will read back more as I have time. My question is a financial one to start with. I’m very new to thinking about long-term care and am trying to get educated quickly.</p>
<p>My understanding is that Medicare will pay up to 100 days of skilled nursing. If there are less than $2000 in assets, Medicaid will kick in after that. There’s a 5-year (?) lookback for Medicaid.</p>
<p>My situation is this: an elderly friend of the family just had a stroke. She’s 90 and lived by herself in an apartment in a city where she has elderly friends but no family. My sister and I flew in to see how she was doing and sort/pack/donate/store everything in her apartment. It’s clear she can no longer live on her own, and in fact had agreed to move into assisted living before her stoke occurred. My sister has POA and Medical POA. After 3 days in the hospital, they moved my friend to an acute rehab center. She’ll be there for approx 3 weeks, at which point I’ll fly back to her city and move her to the next place.</p>
<p>It’s not clear whether she will meet the criteria for assisted living (transfer from chair to bed and chair to toilet seems to be a sticking point). If she is able to get into assisted living, she’d need a lot of add-on services. Cost would be approx $3000/month. Skilled nursing would be $6000/month.</p>
<p>Now to the crux of my question: how can we help pay for this in such a way as to avoid the risk running out of money in the case that she lives another 5 years? Can we count on Medicaid to come through and provide her with top-quality care? What’s the best way to structure her assets at this point, or is the look-back period going to limit what can be done?</p>
<p>She has $20,000 in a bank account and $100,000 in a brokerage account that my parents funded several years ago. The brokerage account is in my friend’s name with her SSN on it. My parents are managing it by investing in value stocks that generate $600/month in income. They are hesitant to touch the principal because once it’s gone, it’s gone. Is that the only option? At $6000/month, the money will be gone in 18 months. What happens then?</p>
<p>Our friend was never married and is estranged from cousins, nieces and nephews so my family is all she has at this point. We want to do the best we can for her, but spending down her savings at such a rapid rate seems like an alarming proposition.</p>
<p>mansfield, so sorry! It is very scary. UTI’s do wreck havoc with dementia patients, I’ve seen it and heard about it so many times. </p>
<p>vballmom, I know it is true that medicare will pay for 100 days of rehab…so long as the patient is making “progress”. (or it could be 110 days?) Some facilities will allow one to go live there and promise not to kick you out if you go on Medicaid…some DON"T. So choose wisely if someone will likely spend down to nothing so quickly. The Medicaid only places vary from state to state, too, so you have to look within your circle…The social services, Elder support state services, etc etc are places to start. It is a very scary place to be. Even with my Mom who should have plenty is running about a $1200 a month deficit and that is only at level 2 care… what will happen when it is level 3? 4? Ah at 5 the stinking LTC insurance MAY kick in. I am still thinking about getting a lawyer on writing a letter to them. It is $3000 a month and that would really make a difference.</p>
<p>vballmom-</p>
<p>Make an appt with an elder care attorney in the state she resides. S/he will advise you on how to handle the assets. Its complicated. </p>
<p>ALso, you can go online and find a certified geriatric care manager, who could oversee what is going on/visit, etc when you are not there (usually its a social worker who has specialized licensure and training).</p>
<p>Don’t try to figure out the rules yourself. Also, just fyi, many facilities will take medicaid patients. The level of care is the same; its more dependent on how good the facility is. The geriatic care manager can even visit places for you in your stead (they usually get paid hourly).</p>
<p>Good luck</p>
<p>vballmom- I agree with san-dee to get some expert input here. A visit to the Medicare website would also help avoid misunderstandings. For example, while Medicare pays for the first 20 days of skilled nursing care post qualifying hospitalization, the co-pay for days 21-100 is approximately $128. This could be covered by a medi-gap insurance policy, but if one is not yet in place, the cost does add up. In my experience, getting all this sorted out is highly worthwhile, but requires knowledge in several fields and some aspects of it may vary by state, including supplemental insurance options.
Best with your efforts to help.</p>
<p>Mansfield - UTIs wreak havoc with the elderly. Whenever my mother acts more confused than usual I always request they run a urinalysis.</p>
<p>vballmom - At least in my state, Medicaid will not pay for assisted living, so you may have to be prepared to move your friend after her money runs out in assisted living. You should check with professionals in her state and yours to find out the specif rules and requirements for qualifiying for Medicaid and how to handle spending down her assets.</p>
<p>Thanks everyone for your advice. I’ve Googled “certified geriatric care manager” plus the city and have found a couple LCSW providers with many years of experience, so I’ll call one of them tomorrow. I’ll see what can be done from a distance vs what I can do when I’m there in a week. I know my friend is receiving very good care at the acute rehab hospital for which I’m grateful.</p>
<p>Thank you all for your condolences. It was an amazing, modern funeral. Both of my daughters are overseas and I recommended that they not try to get home. My DH set up a Google chat and both of my girls attended the funeral virtually. What a remarkable world we live (and die) in. My mom would have been so happy!</p>
<p>Bonnie, I am glad your daughters could participate in heir grandmother’s funeral via by long distance. Kudos to your DH for setting that up!</p>
<p>Bonnie- So good that your daughters could be there. I am sure it meant a lot to each of you. Best to your family.</p>
<p>Condolences Bonnie and to all on this gracious thread who who have travelled and are still in route on this difficult end of life road with their loved ones. I have followed along here as my 76 y/o mother had Alz (approx 8 yrs) but was relatively stable. I knew I might need the wisdom shared here at some point. Interesting the comments about people having a say somehow in the timing of there passing. My sister & I went to visit our parents in Fla 3 weeks ago with a cruise planned. But when we arrived my mom was having breathing issues. Cruise cancelled, week stay in hospital, dx with adv Lung Ca, home 4 days on hospice and she passed relatively peaceably on Good Fri morning with us all by here side. It was a unexpected, slightly traumatic and heartbreaking two week experience. I can also relate to the sentiment of ambiguity of grief and gratitude. Blessings and comfort to you all for being there the best you can for those you love and for generously sharing your experiences, wisdom and support with me and others here.</p>
<p>Coskat- my sympathy at this sad time. How fortuitous that you and your sister were there when you were. I am sure that it meant everything to your parents and you. I can see how the ways things unfolded would have been a lot to wrap your head and heart around in very little time. </p>
<p>Take good care of yourself.</p>
<p>Good news! Long term care insurance has been approved and should start paying in a month or so. Bad news! Mom is saying she is bored in assisted living. She is still sharp in many ways, but can’t cope with driving, finances, or even having much of a conversation. She is well aware of her situation. It’s like the twilight zone between independent living and assisted in some ways. She’s at level 2 at the place. It’s very nice, but there are some very frail people there. I think what she misses most is being at home and just piddling around. Even though she wasn’t getting out much, it was on her own schedule. She’s started crocheting and reads a lot, but I don’t know how much more I can do for her when I’m not there. They have activities and she has therapists and regular visitors. After 2 1/2 months, does she just need more time? I’m thinking we need to sit down with her and tell her that in this situation that my brother and I are working hard to keep her as independent as we can, but she has a job and role to play also - to find a way to be as happy as she can and tell us what she needs to get there. Any advice?</p>
<p>Preironic- Great news about long term care insurance. There are many factors that could play into your mother’s declaration of boredom, including that what she is capable of has changed and is diminished. Decades ago I worked with challenged and challenging adolescents in a school/day treatment program. When they used the word 'boring", we asked questions to determine what that meant to them. It was fruitful to dig a bit deeper, because sometimes it meant they couldn’t follow the material in class and sometimes it meant they had mastered it 2 years ago. Sometimes it meant that their boyfriend was away over the weekend and sometimes it meant that they had been subjected once again to violence in their home. It’s not always a word that by itself allows you to get a handle on things. </p>
<p>It is also hard for some people to ever just be “okay”. There has to be a bit of a negative, particularly as they cope with aging or other obstacles. Maybe time will help, but maybe your mother will always need to tell you she is bored. It does sound like you have done right by her and just by listening to her, you may be serving an important role. She may or may not be able to fully engage with all the activities available. Not everyone does. I often wonder how I will do in that kind of setting should the time come. While I enjoy people, group activities a la cruise ship and even wearing a Brownie uniform because it was Tuesday weren’t my cup of tea. I hope I adapt, but maybe I will be finding my own way a bit also. While there are people more frail than she is there, she likely has some peers with whom she could have common ground over time. You mention that conversations are difficult for her at times, so maybe starting new relationships is impacted by that. </p>
<p>Best to you. There sure isn’t a cookbook for all this.</p>
<p>I often hear my mother talk on the phone to far away family and mentioning there is “nothing to do here” about the small town where she is. But this is also the woman who won’t go to the senior center, won’t go to the senior exercise classes, won’t go to the Bible study, etc. etc. No matter what I find and offer, she won’t try, but she tells people there is nothing to do. Grrr.</p>
<p>^^^That’s the song that I have to deal with. Mi Madre went to the senior center ONCE, said it was fine & people were lovely. By the next day it was “but they played cards, I don’t like cards” so I offered to take her another day when there was something else to do. Then it was about the lack of transport. By about a month it was “well those weren’t my kind of people. All they do is sit around and play cards and they’re cliquish.” Even though there’s a 4 page listing of all the activities they do. Le sigh.</p>
<p>She admitted about a month ago that she’d rather just sit home & watch TV. Which is fine, but then you’re not allowed to say you’re stuck in the house all the time except for the two evenings a week I take you out. We all make choices…</p>
<p>Travelnut - very insightful and useful observations. Being independent and social “loners” runs in our family. I think in time she will be able to transition to a different idea of what’s available to do and she is trying to participate in activities. It’s just that she’s always been an optimist and it’s hard to see her struggling. When someone has never been a complainer, every slight complaint seems huge. In reality, she has much more to do now than when she was still at home and her world had shrunk. Does anyone else observe that it seems that most of the people in assisted living have lost the art of conversation? They have interesting things to say when prompted but initiating conversations seems hard for most. Does anyone have experience with a parent making real friends in assisted or skilled nursing environments?</p>
<p>Thinking about all this, I wonder if some people would be happier if they just had small tasks to do, to feel useful. Folding laundry or, I don’t know, shelling beans. </p>
<p>When you can’t follow the thread of a conversation, can’t see well enough to read, never liked Bingo, and can’t enjoy learning something new, maybe “piddling around” is just the thing. Only there’s nothing like that in your assisted living situation.</p>
<p>I agree, mommusic. This is all new for us and a discovery period, things you can’t know ahead of time. Her laundry is done and folded, apartment cleaned, food served. A blessing or a curse?</p>
<p>My mother’s in a nursing home where they have various activities during the day. All my mother likes to participate in is exercise and bingo. She complains that she’s bored, but won’t engage in other activities or tell me what else she’d like to do when she complains that she’s bored. I try to encourage her to do other things, but she just won’t.</p>