cost of assisted living

[Anonymous]

Anonymous wrote:If your Dad can transfer his assets to you and your sibs and whoever else is line maybe he can get his net worth down to where he will qualify for aid. What is the tax liability for you and him if he gifts more than allowed amount which is ??? I want to say $16000/year? Maybe it is worth it to take the tax hit in order to qualify. Am I completely out in left field with this line of thinking? I want to know because I'll be in your boat in the not so far off future.

Even if this worked (it won't because of the look-back rules), the only "aid" he would qualify would be Medicaid, IF he qualified for nursing home care, for medical reasons.

Otherwise he would be out on the street or in the care of his children.

[Anonymous]

I'm surprised at some of the misconceptions on this board- especially when folks state something firmly, when it is not fact.

Generally, assisted living is (as you'd expect) more expensive in the DC area than a lower cost of living area.

Also, as a general matter, dementia care is MUCH more expensive than the standard assisted living for an elderly person without dementia. If a person has advanced dementia, they'll find the cost of care to be EXTREMELY expensive- at Sunrise in Northern VA, dementia care will start at around $5k per month, but can go all the way up to around $12k depending on the person's specific situation. As a comparison, Sunrise for a senior without dementia can be ~$3000 or under per month.

Assisted living costs vary will vary widely, even within the DC metro area. Cost does not necessarily correlate with quality.

Medicare DOES NOT pay for long-term care. (Medicare will only pay for a very short-term stay associated with very limited medical condition recovery.)

Medicaid is a program for the poor, and there are very strict resource and income limits- to qualify, it requires exhausting most other assets and also having a very low income. There is a 5-year lookback to prevent folks from transfering assets right before heading into the nursing home. Depending on the circumstances, Medicaid *may* pay for care. Some conditions require a waiver, sometimes there are waiting lists, sometimes the requirements differ by area-- it is difficult to generalize. To find out based on your parent's specific situation, you should contact your State's Office on Aging.

I'd recommend the elderly father live at home as long as possible- you'd see him more often. If he is relatively healthy, that could work nicely for all of you.

[Anonymous]

Anonymous wrote:I'm surprised at some of the misconceptions on this board- especially when folks state something firmly, when it is not fact.

Generally, assisted living is (as you'd expect) more expensive in the DC area than a lower cost of living area.

Also, as a general matter, dementia care is MUCH more expensive than the standard assisted living for an elderly person without dementia. If a person has advanced dementia, they'll find the cost of care to be EXTREMELY expensive- at Sunrise in Northern VA, dementia care will start at around $5k per month, but can go all the way up to around $12k depending on the person's specific situation. As a comparison, Sunrise for a senior without dementia can be ~$3000 or under per month.

Assisted living costs vary will vary widely, even within the DC metro area. Cost does not necessarily correlate with quality.

Medicare DOES NOT pay for long-term care. (Medicare will only pay for a very short-term stay associated with very limited medical condition recovery.)

Medicaid is a program for the poor, and there are very strict resource and income limits- to qualify, it requires exhausting most other assets and also having a very low income. There is a 5-year lookback to prevent folks from transfering assets right before heading into the nursing home. Depending on the circumstances, Medicaid *may* pay for care. Some conditions require a waiver, sometimes there are waiting lists, sometimes the requirements differ by area-- it is difficult to generalize. To find out based on your parent's specific situation, you should contact your State's Office on Aging.

I'd recommend the elderly father live at home as long as possible- you'd see him more often. If he is relatively healthy, that could work nicely for all of you.

This is an excellent post.

[Anonymous]

Anonymous wrote:OP here In terms of hiring someone to come into the home, does anyone have a recommendation of an agency that helps supply such things? In his current town in the midwest, where we're also looking into options, a nurse is $42/hour. In the same ballpark here?

Word of mouth or through an agency. Agencies will typically cost you more but you won't have to worry about the administrative side of things. But if you do your due diligence and hire someone on your own, it could be a win win situation. Good care, lower costs than thru an agency. I'm not sure what agencies charge their clients but I know that the aides are paid less than $42 an hour. A relative that works as an aide through an agency makes about $20/hr.

[Anonymous]

My father lives in an assisted living apartment in DC. He pays $150/day ($4500/month). For this price, he has a small but pleasant 1 BR apartment including all meals (in the dining room downstairs or brought to his place), as well as medication management. Oh, and the use of a car and driver to take him to medical appointments. Those are the only services provided. Well, a moderately helpful social worker as well. I don't love the place but he is used to it.

He needs more support than that, so we pay for a home health aide at $15/hr for 12 hours per day, 7 days a week. In short, it is expensive. But $42/hr sounds way high unless someone needs an actual skilled nurse at home. You can get a CNA or other aide for much less. If your father is in good health, he would not need as many hours (but may eventually).

[Anonymous]

I would look into the VA if he is a veteran who served in wartime. DH's grandfather gets the VA to help cover a lot of the expenses of his assisted living facility due to his service during WWII.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP here - thanks for the book reference. I also have understood that for public aid to kick in you have to make yourself destitute, essentially. (I don't disagree w/ that.)

In terms of hiring someone to come into the home, does anyone have a recommendation of an agency that helps supply such things? In his current town in the midwest, where we're also looking into options, a nurse is $42/hour. In the same ballpark here?

To qualify for Medicaid, you must have essentially no assets AND you must have a condition that requires medical care. A condition that requires custodial care, e.g., dementia, and, I would assume, blindness, does not qualify.

Dementia is a medical condition.

But yes, you are correct, other than that.

Read more carefully. I didn't say dementia isn't a medical condition, i said it doesn't require medical care. There is no medical treatment for alzheimers other than occasional pills (that are of questionable effectiveness). It requires custodial care, and Medicare will not cover it. I know this from personal experience. Sometimes alzheimers patients will have another medical condition (or the nursing home will fabricate one) that does require medical care, and will get coverage that way.

[Anonymous]

Pp here - I meant to say "Medicaid". Medicare obviously doesn't cover custodial care, either.

[Anonymous]

The cost of assisted living will vary around DC. I believe the last time I looked (and I worked in the industry) it ranged from $3,000-$7,000/month depending on the facility (this was for MD). Nursing homes have medicare/medicaid beds available for short term rehab stays. State run nursing homes are a bit different. So just assisted living will come out of pocket.

OP, does your dad have long term care insurance? If so, you should find out his benefits for the different types of services (aid in home, assisted living, nursing care etc...). Also, I don't know exactly where you are but you may want to look at continuing care retirement communities like Asbury Methodist Village and Erickson Retirement communities. These are places that offer step care. In other words you can start out living alone with no help and move to assisted living and there is nursing home care (short and long term) available. If you need the care, you are moved, when you are able, you go back to your assisted living or independent living apartment. You should research how it's paid for but I think you pay a lump sum when you move in and your care is taken care of off the money that is made when investing the lump sum you pay in. When a person no longer needs the care provided (is laid to rest) I believe the family gets a portion of the money back (if not all of it). It's been over 5 years since I've worked in the LTC industry, so I may have portions of the financial information correct. You should research. A good place to go is: https://connect.computility.com/directory/search.php?id=26369dceff02afdc481b1f85a9d24fb6

This lets you search by type of care (although only in MD). Hope this helps.

[Anonymous]

From the OP - thanks, all. This is very helpful. My dad doesn't have long-term health insurance, and when we looked into getting rid of his assets (which aren't huge) a year or so ago the clawback provisions made it not seem useful. [I actually agree w/ the clawback/lookback provisions.] He very much does not want to go to a nursing home, will see it as betrayal, etc. But my own family situation makes it very difficult to have him here at our house. I'd be interested in any further observations ....

[Anonymous]

I used to work in senior assisted living housing. The PP's are correct in that it can be $4,500 and up (some of our homes were $7K/mo), and remember that it is more expensive in the major metro areas like DC, NY, etc. (If you have siblings in cheaper cost-of-living cities, it might be worth it to check out homes there.) The good homes will generally have asset requirements, like the person has to have X number of years of expenses in the bank. (once they spend it down, they're eligible for medicaid.) Some states (like PA) have state homes for medicaid patients and private homes for non-medicaid. Many/most homes will require medicaid patients to share rooms, since the reimbursement rates are less than the standard rate that non-medicaid patients pay.

You may want to put him in a home that has several levels of care, so you don't have to switch him as his needs change. He may be assisted living now, but down the road he may need more nursing care, or dementia care.

Some Sunrise facilities are not so bad, but they can really vary.

[Anonymous]

Anonymous wrote:From the OP - thanks, all. This is very helpful. My dad doesn't have long-term health insurance, and when we looked into getting rid of his assets (which aren't huge) a year or so ago the clawback provisions made it not seem useful. [I actually agree w/ the clawback/lookback provisions.] He very much does not want to go to a nursing home, will see it as betrayal, etc. But my own family situation makes it very difficult to have him here at our house. I'd be interested in any further observations ....

My recommendation would be to start right away with your State's Office on Aging or Aging Ombudsman to identify some options. If you have siblings in lower cost-of-living-areas, I'd research options there too.

Assisted living is expensive, plus if your father is doing relatively well now, maybe it could work to have him at home for now, and it would be in keeping with his wishes- but know the backup options because you may need them.

If your father lives at home, it may be a short-term inconvenience for your family in a number of ways (I won't try to gloss over that), but could give him happiness and support, and he is 96 after all. Your children could get to know their grandfather better and he can convey his wisdom to the next generation. You'd get to spend time with him. If he doesn't need SO much support, you can identify the specific needs- maybe you get a home health aide to come twice a week to bathe him (not a home nurse). You'd monitor the medication, etc. (I really admire other cultures that give more support to elderly family members- having my 96 year-old relatively healthy father live at home would be far and away my top preference.)

This is something people can be reluctant to talk about, but it needs to be discussed: what are his wishes as far as end-of-life care? Does he want life to be extended for as long as medically possible? Or does he really want to focus on a certain quality of life, and then personal comfort? This is an individual decision that each person must make for himself, based on personal preferences.

Frequently when people reach old age, they can reach a point where they have so many different medical conditions, and quality of life suffers badly. The question becomes how long to keep chasing the different medical conditions, in pursuit of extended life, at the expense of quality and comfort for someone who has already lived a long, healthy life. If your father is familiar with the experiences of others, it is helpful to know that he has expressed "I don't want to die like Mary did" etc. You will save yourself and your father so much grief if you can get his clear, well-informed wishes known to you on the end-of-life issues. (And get all the documents in place- durable power of attorney, etc.)

[Anonymous]

Thanks 10:19. fortunately, my dad has been pretty clear (and it is in the legal documents) about wanting no extreme end of life measures. Sadly, he is psychologically ready to go now. It's just that his body hangs on. I do feel lucky, though, that with both my parents these end of life issues have been out on the table. In my DH's case, nobody talks about it.

[Anonymous]

Aside from obvious abuse and neglect, what are the things to look for in an assisted living situation?

[Anonymous]

Anonymous wrote:Aside from obvious abuse and neglect, what are the things to look for in an assisted living situation?

The book I mentioned above gives good advice. Too much to go into here (and I don't recall exactly anyway).

The non-profits are reputedly better than the for-profits.