Any suggestions on how to figure this out?

[Anonymous]

Love any insights here from folks who have faced this with their parents"

DH's parents have been living in their one-story home for the last few years after downsizing from where they had lived for 40 years. There is a finished basement with bed/bath and a family room at their newish place, but they do not use it to minimize time on steps. FiL is deteriorating cognitively and has some mobility issues as well as occasional continence problems. MiL, who is a bit overweight, is firing on all four cylinders, driving, etc. The weight affects her mobility to some extent, but she works hard to keep moving.

The one change they've made is having 40 hour help during the week day and are starting to think about it for the weekends in order that MiL can keep up with her activities, etc. I think their LT care covers this kind of expense, but not sure if it is bottomless, etc.

I'm starting to wonder what the next steps here might be, especially as their funds are not endless. They've spent a lot in retirement and appears to be more than what may now be needed for the next phase of living. If she decides that she wants to continue to live at home while he moves into a memory care unit, can they swing it? The challenge seems to be that they planned to live together in a continuing care community, but IDK if a community will allow him to live with her in an apartment if he may been as a flight risk (he really isn't based on my experience with those who are over the last 20 years). IDK if she will want to live in one of these apartments, especially if he requires a 24-hour caregiver. And from what I can tell, MiL is now realizing that they may not have the money to pay for two different units in one of these communities.

Does it make more sense for them to remain in their home as long as possible (paid in cash), maybe preparing for a 24-hour caregiver in their basement? For him to move somewhere when it is time if she wants to remain at home?

How does one figure this out? Grateful for any insights here.

[Anonymous]

If they are already paying for long term care (which I doubt is covered by anything) then they are likely paying about $1000 a week for that, or $4000 a month. Going into assisted living will probably run more like $14-$20k a month. If this is working for them, I would try to let them stay at home as long as possible.

[Anonymous]

Anonymous wrote:If they are already paying for long term care (which I doubt is covered by anything) then they are likely paying about $1000 a week for that, or $4000 a month. Going into assisted living will probably run more like $14-$20k a month. If this is working for them, I would try to let them stay at home as long as possible.

Yes, that's what I say to DH - living at home is the least expensive option at this time. I'm just wondering what's gonna happen when he requires more intensive care - incontinence, diapers, etc. Does that require higher level (and compensated) care? And can one blow through their LTC benefits?

[Anonymous]

I have one acquaintance with 24/7 home care. Their payroll is well north of $300k/year (before LTC reimbursement, which doesn’t cover everything). There are obviously ways to do it less expensively. The main one is loopholes in the law that allow housing as compensation and skirt overtime laws. I think that’s exploitation, frankly, and a recipe for burnout and abuse. But people do what they need to do. If not doing something like that, I would expect 24/7 care at home to be as or more expensive than two units, depending on the specifics.

[Anonymous]

Anonymous wrote:If they are already paying for long term care (which I doubt is covered by anything) then they are likely paying about $1000 a week for that, or $4000 a month. Going into assisted living will probably run more like $14-$20k a month. If this is working for them, I would try to let them stay at home as long as possible.

You can find assisted living for less than that. Especially if she would be with him. He is probably a lower elopement risk when she is around. I’d research assisted living options for them. It’s better to move now before he deteriorates further.

[Anonymous]

Anonymous wrote:I have one acquaintance with 24/7 home care. Their payroll is well north of $300k/year (before LTC reimbursement, which doesn’t cover everything). There are obviously ways to do it less expensively. The main one is loopholes in the law that allow housing as compensation and skirt overtime laws. I think that’s exploitation, frankly, and a recipe for burnout and abuse. But people do what they need to do. If not doing something like that, I would expect 24/7 care at home to be as or more expensive than two units, depending on the specifics.

Thanks for your insight here - helpful.

FWIW, I'm not a fan of burnout and abuse with caregivers. When we had a nanny, we had a separate sitter on Saturday night as I specifically wanted to avoid that situation. That said, DH and his sister will be making these decisions. I can make my suggestions but won't make the final call. (I think a reasonable deduction for housing is okay, but it shouldn't be the majority of the pay. And no skirting OT!)

Thanks again.

[Anonymous]

BUMP

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have one acquaintance with 24/7 home care. Their payroll is well north of $300k/year (before LTC reimbursement, which doesn’t cover everything). There are obviously ways to do it less expensively. The main one is loopholes in the law that allow housing as compensation and skirt overtime laws. I think that’s exploitation, frankly, and a recipe for burnout and abuse. But people do what they need to do. If not doing something like that, I would expect 24/7 care at home to be as or more expensive than two units, depending on the specifics.

Thanks for your insight here - helpful.

FWIW, I'm not a fan of burnout and abuse with caregivers. When we had a nanny, we had a separate sitter on Saturday night as I specifically wanted to avoid that situation. That said, DH and his sister will be making these decisions. I can make my suggestions but won't make the final call. (I think a reasonable deduction for housing is okay, but it shouldn't be the majority of the pay. And no skirting OT!)

Thanks again.

If you need 24/7, OT will really bite you because you need I think 5 people to not go into OT but realistically people will not want to work less than 40 hours/week with overnight shifts and also it becomes too many people to manage. The going base rate is $30 so OT is $45/hour. You’ll also need increasing levels of equipment (like hospital bed, nbd) and skilled nursing (preventing/managing bedsores, etc).