Anonymous wrote:

Anonymous wrote:This is why my plan is to kill myself if I get in this situation. I’d rather leave my money to my kids than burn through it all myself.

A lot of people think this, but the truth is by the time you’re anywhere near needing 24/7 care, you’re well past the point where you could make and execute that decision. Just functionally in most cases, ethics aside.

A cautionary tale: my MIL told FIL years ago that if she would k—- herself if she should ever get a diagnosis of Alzheimer’s.

My FIL was so afraid of her threat that he blatantly ignored her rapidly progressing cognitive decline and waited 2 years to have her see a GP and then insisted that she NOT be told anything about her condition. All the while MIL has agnosognosia - she’s unaware that there’s anything wrong.

MIL is now in mod-severe stage and FIL refuses all outside help. He’s done nothing to help her - no safety accommodations in their home, no enrichment activities, zero insight on disease progression- he’s in deep denial and a bumbling idiot. Meanwhile, MIL rots in front of a tv, wanders around the house, goes without bathing or showering for a week or more…

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yeah what do families do when the money runs out?

The next generation goes into debt?

The elderly person goes on Medicaid and into a Medicaid bed in a nursing home.

Except if you are cheating the system, you have to have basically no money (I forget but I think it was a $2K limit and you can only keep about $75 a month of your social security check). We had to do it for my MIL and it was less than ideal and few good nursing homes take it. It is good when the money runs out but I'd rather spend the money and have someone well cared for.

This blew my mind when I first had to deal with (the prospect of) it. My father lived in Alaska, where the *average* nursing home monthly fee is $27K a year. Assisted living isn't much better. He had a pension AND good long term care insurance AND a small inheritance from my grandmother and we were still realistically giving him around 2-3 years at a nursing home after the LTC ran out before he'd wind up on medicaid. He had a serious medical condition, lived alone, and I lived in DC. He couldn't travel.

He died about a year before we really needed to encounter the Medicaid spend-down period. Trust me, I did not relish the idea of him burning through $27K a month before we would need to move him into one of the rare medicaid beds at the crappier Medicaid facility. And it's not like his quality of life was amazing -- he was basically wheeled from his bed to a television room and back.

And people wonder what happens to "generational wealth."

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:LTC might help if you are considering buying it for yourself. As the PP said, it's too late for your dad.

You definitely need to talk to your dad and fully understand his finances. How long can he pay for full time care? What are his issues? Some progress much faster than others.

You might try at home care and see if he can realistically reduce hours. If not, then he has to be made aware that if he runs out of money he will have to find a Medicaid bed if he qualifies.

We've had to repeatedly talk to our parents about the reality.

Yeah my brother keeps saying he has the money but I realized my brother doesn't fully understand how much money my dad has. My relationship with my dad is so weird since my mom died this all sucks

True, it does suck for everyone. You'll need to wrap your head around that. End of life is hard and it triggers all sorts of past issues. You need to have a detailed discussion with your brother before you talk to your dad so you're on the same page. And he needs to truly understand how much At Home care is. You also need to know how much different types of facility living is. That's not cheap either, but people can sell their homes to pay for that, in many cases.

If I were you, I'd call using your name and the generic "my parent" might need care. And ask about pricing. Find out about the assisted living places close to your brother, including pricing. Find at home care companies and pricing. Get a sense of your dad's options. Then present all of this to your brother, then your dad.

I said this upthread, but these decisions also vary depending on what is wrong with him. Did he have a heart episode? A stroke? Broke something? How likely is it that he will fully recover?

Sorry. I missed the question before. He has aFib and COPD. He was in heart failure but didn't know it because he thought his chest hurt from COPD so he kept taking his steroid which worsened heart issue and put him into kidney failure. He only notified my brother because his legs were too swollen to walk.

He will never but have the Afib but it's otherwise "stable" just with very limited mobility. No stroke. Nothing broken.

He needs the care for mobility issues, self care, meals, driving to appointments, etc.

Anonymous wrote:These costs seem inflated. I know people who care for people who need help that make nowhere near that.

No one thinks the aides make $370k a year! It goes to taxes, and multiple shifts of aides, and improvements to home and vehicle, etc etc. It just….disappears, basically.

Anonymous wrote:If this hasn't been stated already -- even if he were to living in a facility, most facilities would require privately arranged and privately paid-for 24 hour care.

You are conflating someone in independent living who finds themselves in need of more care with full nursing care.

If the independent facility will even allow for additional care, then yes, you have to pay for it on top of the monthly facility charge. Not all will allow outside help. If the person is in assisted living, then they might need care augmentation. But if the person truly needs 24/7 care, then they need to be in a nursing home, which is 24/7 care. Though generally it is not very good care no matter how expensive the place is. I do know of people who have augmented care in memory care, but still, it isn't 24/7.

Seriously if the math you are doing is the base rate for one person times the hours in the day, you’re in lala land. The reason agencies take a huge cut over their aides take home pay is because it costs a lot, not because they’re raking in profit. When you find/poach good people, you can pay them more to convince them to stay, but it doesn’t stop them from getting sick or having a new grandbaby across the country or anything else. It doesn’t make overtime cheaper and good luck staffing 24/7 without it. Etc etc.

I know it's painful, but this is what retirement money is for. It's not meant to be passed down to heirs or fancy trips (although those are nice if you save a lot!), it's meant to provide care for you when you can't care for yourself.

And medicaid nursing homes are a lot cheaper than this. I have two relatives in one. They are 3 beds to a room and they basically never get to leave their bed. They aren't helped to the bathroom and they only wear diapers.

Anonymous wrote:These costs seem inflated. I know people who care for people who need help that make nowhere near that.

Okay well go do it for less and godspeed.

Overtime. Taxes. Constantly needing to replace/fill in for people who are sick or on vacation. The size of the patient matters a lot if they need to be lifted. Everyone involved needs to be fed. A special van to get anywhere. Hospital bed. Stairlift. A mountain of disposables.

If this hasn't been stated already -- even if he were to living in a facility, most facilities would require privately arranged and privately paid-for 24 hour care.

The expectation that you would be able to live in your own home at 90+ with serious health issues is entitled. Unless you have saved enough to pay for that kind of care, you have to either move into assisted living or move closer enough to kids where they can provide care. I know this is not what people want to do and I know giving up independence is very hard. But it is a reality of aging. You aren't independent anyway if you need 24/7 home care. You are completely dependent on other people. Unless you are very wealthy, that likely means accommodating the people who are caring for you.

We are going through this right now with my MIL. She cannot afford full time care and she lives in a house that is not at all set up for eldercare (tiny downstairs with no main floor bathroom, rickety old stairs, plus the house is filled to the gills with stuff and she refuses to get rid of anything). We cannot afford to provide her with 24/7 care nor can we afford to retrofit her house for this purpose nor does that even make sense. We have invited her to live with us in our IL suite, which has two rooms and its own bathroom and kitchenette. We could afford to pay for part-time care here during the day, but would not need to pay for overnight or weekend care, at least not yet. We have also found a decent facility in her current town but it would necessitate her selling her home in order to get in there, and BIL doesn't want her to do this because he's hoping to inherit that home.

She doesn't want to move anyway, not in with us, not to a facility. BIL claims he's taking care of her and doesn't want to hire anyone at all, but she's had multiple surgeries and two major falls in the last few years and I don't think he can handle it. We drive up there every time something happens but it's 4 hours each way and taking a major toll on our family as the incidents have started happening with more frequency. DH has used up all his sick leave for the year already and will have to take unpaid leave if he needs to go up again, which he almost certainly will.

It's so frustrating because everyone wants this ideal situation that is totally unworkable and is not willing to just confront the limitations of the situation. I also think people are being stubborn about change but that if she either moved in with us or into the care facility, everyone would be much happier in about 6 months, including MIL and BIL. No one is thinking clearly. Ugh.

Anonymous wrote:This is why my plan is to kill myself if I get in this situation. I’d rather leave my money to my kids than burn through it all myself.

A lot of people think this, but the truth is by the time you’re anywhere near needing 24/7 care, you’re well past the point where you could make and execute that decision. Just functionally in most cases, ethics aside.

Anonymous wrote:

Anonymous wrote:LTC might help if you are considering buying it for yourself. As the PP said, it's too late for your dad.

You definitely need to talk to your dad and fully understand his finances. How long can he pay for full time care? What are his issues? Some progress much faster than others.

You might try at home care and see if he can realistically reduce hours. If not, then he has to be made aware that if he runs out of money he will have to find a Medicaid bed if he qualifies.

We've had to repeatedly talk to our parents about the reality.

Yeah my brother keeps saying he has the money but I realized my brother doesn't fully understand how much money my dad has. My relationship with my dad is so weird since my mom died this all sucks

True, it does suck for everyone. You'll need to wrap your head around that. End of life is hard and it triggers all sorts of past issues. You need to have a detailed discussion with your brother before you talk to your dad so you're on the same page. And he needs to truly understand how much At Home care is. You also need to know how much different types of facility living is. That's not cheap either, but people can sell their homes to pay for that, in many cases.

If I were you, I'd call using your name and the generic "my parent" might need care. And ask about pricing. Find out about the assisted living places close to your brother, including pricing. Find at home care companies and pricing. Get a sense of your dad's options. Then present all of this to your brother, then your dad.

I said this upthread, but these decisions also vary depending on what is wrong with him. Did he have a heart episode? A stroke? Broke something? How likely is it that he will fully recover?

Anonymous wrote:

Anonymous wrote:These costs seem inflated. I know people who care for people who need help that make nowhere near that.

Right. I think the difference is whether the caretakers have medial training--like a nurse in your house 24-7 or just a person who can help you walk, use the bathroom, bathe, prepare food for you, etc., but not providing actual medical care.

If you're in the DMV or another HCOL, you'll need to pay that person helping you use the bathroom $25-$30/hr.

If you’re living far away from children to stay in your home, you’re running your kids ragged trying to care for you from afar. Dropping responsibilities at home and work to travel to care for you when there’s an emergency. Sleepless nights feeling guilty that they’re not doing enough. Worrying how to manage the next emergency. It’s awful.

Anonymous wrote:These costs seem inflated. I know people who care for people who need help that make nowhere near that.

Not OP, but it is really city dependent. Also, type of care. Do you know women who do this independently and you manage it all? Sure, that is less expensive. But in a HCOL area and using a home care service, you're easily spending 25-35/hour. While Phoenix isn't a HCOL area per se, it is not cheap. My parents live in a LCOL area and it's about 165K/year for (supposedly) fully managed. But there really isn't fully managed at home care. Someone has to be watching over all of this.