View Full Version : Nursing homes/assisted living

Mar. 17, 2012, 10:34 PM
How can a family with minimal savings afford a nursing home? My mother's need for in-home care has depleted nearly all of her savings except her home. Now she has home care folks in 24/7 at a cost of $600+ per day! Her money will last less than two months at that rate.

My sisters do most of the care and decision making for her; I am on the opposite coast, awash in questions and guilt. I don't know where to start in terms of figuring out what's best. My sisters are nearly to retirement and are worn out and overwhelmed. Who or what can any of us turn to?

Mar. 17, 2012, 10:40 PM
Oh jeez...such a tough situation JoZ.

Her home...mortgaged? Free and clear? Some care facilities will work with families and have the home signed over to them for covering costs. (instead of having mom at home)

Is it possible to have mom move in with you or a sibling? And then pay for care while you/sibling works and no care costs after work day is over and you/family are home?
Sell the home for help with costs?

Hopefully someone with better advice chimes in.

Mar. 17, 2012, 10:44 PM
What about MediCare??
My Dad needed nursing home care for a while and Medicare paid for it.

Comes Around
Mar. 17, 2012, 10:53 PM
Talk with a social worker about eligibility for both Medicare and Medicaid. The latter may cover long term nursing home care.

Mar. 17, 2012, 11:10 PM
If your Mom, or her Husband(s) are a Veteran that served at least one day during wartime, there is a benefit that will help:


Good Lord, $600 a DAY? Might be cheaper to go into a nursing home. :(

Mar. 17, 2012, 11:11 PM
There are usually Senior Services who offer free counseling and placement services. Once an elderly person has burned thru their own money, Medicaid will kick in, in addition to Social Security. It won't be fancy, and it won't probably pay for Assisted Living, but get on the internet and search for the place I mentioned above. I feel for you, but thankfully, my mom has a lot of estate to use up before she'll need public or family assistance.

I did a quick Google search and they have a number of senior services in your end of the Puget Sound. Good luck!

Mar. 17, 2012, 11:28 PM
I am in roughly the same position.
Last year we were weaning an elderly family member off a ventilator and the insurance had farmed her out for 30 days to a specialty hospital. When it came time to release her she was in no state to be released and needed continuing care so I was getting call after call about her Medicare (MediCal) eligibility. She had way too much money to qualify for MediCal - you basically have to be destitute, BUT it's easier to find a placement if you can private pay for a period of time (while you run out of money). MediCal stated that she couldn't have given away any assets within three years and that her spouse only could retain the home and $104K - which is probably not precisely correct but an odd number sticks in my mind.

Bear in mind that MediCal seeks to recover from the estate as well.

This explains why a couple of friends from my youth opted to care for their parent/disabled loved one - it was the only way to pay for it or recover the value of the estate by paying themselves plus it gave them full knowledge and control of how their loved one was treated. They were able to be paid by Medicare IIRC.

I don't know exactly how it works out in other states, how they administer their programs, but I suspect it's similar. As I said, the specialty hospital did put me in touch with someone whose sole job was to determine eligibilty so there are people out there who can advise you whether to move her now and private pay, then when the money dries up she continues on in the same facility but now paid by Medicare, or wait. I had gotten the impression it was much better - more selection and less waiting time, to move to the nursing home sooner rather than later.

My family member ended up with an abcess and the primary took her back
into the ICU, then we had her transferred home and I was lucky in that a different family member had an independently retained medical advocate so we were able to retain her also and she interviewed and selected a home health care aid(s) for six months of convalescence at home. There was plenty of money to pay for all this, my inheritance is shrinking by the day. I'd laugh but it isn't funny. Until I was able to convince the family member to spring for the advocate I was sick with worry about how the bills were being paid - if anybody was remembering - etc. Lots of money is no good if no use is being made of it while the power gets turned off.

It's really hard being out of state - the time difference for one kills me - I'm wide awake and they are asleep, etc. You can support your family members by doing research online, bill paying online - if you are West Coast you can make phone calls in the dawn hours so they don't have to try to call from work.

Try googling elder care and elder ombudsman for the area to see what resources you can come up with.

Good luck. I have two in poor health far away and no siblings - I've contemplated taking the early retirement they are pushing on us if I can just hang on another year - then I'd have to negotiate with DH as well. No easy answers and every situation is different.

Mar. 18, 2012, 05:10 AM
You family should also consider an Adult Family home. They are typically much cheaper and more personal than a nursing home.

Mar. 18, 2012, 09:49 AM
Just went through this for the last 5 1/2 years.
Basically, we had to raise cash for her care, which meant selling her home to subsidize to cost of assisted living (more than her annual income).

Medicare does not cover assisted living, but does cover nursing homes -- but she wasn't ready for that (big difference between nursing homes and assisted living). We really wanted a good quality of life and some feeling of dignity for her. It took a ton of time and research to find the best situation (on a walker with dementia)>

Medicaid is only available if her annual income is less than a certain amount. My Mom's was around $36,000 so there was no Medicaid coverage. Was a tight spot.

Basically, by selling her home that gave us the extra money to subsidize the assisted living cost and the increasing level of care...until that finally ran out. Then and my sisters and I kicked in the difference. She passed away last Thankgiving only a few months after the $$ ran out.

We would have loved to have in home care but the cost was WAY more than we/she could afford. Assisted living was the only option (though I was her caregiver in my own home for about a year until it became too much for me while still trying to work).

It's a tough situation. Hope this helps.

Mar. 18, 2012, 10:16 AM
My father is under Hospice care right now, under Medicare. He was diagnosed with cancer that treatment does not affect, so no 'cure', therefore hospice. MY mom couldn't afford home care any other way.

My sis, who works in nursing homes and knows ALOT about the process, told my mom that, to get my dad into one under Medicare, she'd need to divorce him to do it. I guess because then he'd have no monetary support (she still works to buy groceries and such), therefore qualifying for assistance.

Mar. 18, 2012, 10:39 AM
My mother has no income except Social Security and my dad's pension (my dad passed away in 2003). I think her MONTHLY "income" would cover one or two DAYS of the care she is getting now.

I don't understand why my sisters want to spend down my mother's money on such an expensive option -- and they think that looking for a place to put the remaining money (like a gift to us kids that we'd turn around and use for her care) is "cheating" and "how the rich stay rich". I am very reluctant to make a big stink when my sisters are dealing with my mother and her bills, groceries, etc. day in and day out. But now one of my sisters is fairly seriously ill and the other doesn't drive (never has), so I might be involved more and I just need a way to get started. I guess I'll try searching online for places in Massachusetts I can call or email for guidance.

My mother doesn't want to leave her house of course. I don't think it's really fair that my sisters would have to retire only to move in with my mother and care for her. My parents had over 25 years of pleasant retirement before my dad got ill and passed away -- my sisters look to be getting NO pleasant retirement, and I might not even be able to live where I want, doing what I want, until retirement. This is family, I guess. I'm feeling a bit sorry for all of us right now, but I've been helping out in Boston for the last five days and I'm tired and discouraged. Thanks for listening.

Mar. 18, 2012, 10:50 AM
This organization should be able to provide some great info and assistance for you and your Mom's situation:

My mother-in-law went into an assisted-living facility 4 years ago and requires full 24/7 care since she's confined to a wheel chair and really can't do anything on her own. Her monthly rent is $5,300, which I think is a bargain, and she gets fantastic care in her own 1-bdrm apartment.

Best of luck and positive thoughts for all of you.

My mother-in-law resides at one of the locations of Amerisist Assisted Living, and their financial options page may have some useful info for you:

Also, if your mother does go into a full-care facility, she may well qualify for a complete exemption from her income taxes. While the taxes may still be taken out of her monthly income, meaning she will still have to file each year, she may end up receiving the full amount back. That is the situation with my mother-in-law. ETA (again): This income tax benefit may only apply if her doctor recommends she needs 24/7 care in an assisted living facility or nursing home. My mother-in-law's doctor simply wrote a short letter, and that's all that was needed.

Lastly, if you believe she may end up needing a power chair (i.e., Hover-round, etc.), if her doctor writes a prescription for one, Medicare will cover the entire cost, or at least most of it, but this only applies BEFORE the person enters an assisted living facility or nursing home. Medicare's reasoning behind this is that a person shouldn't need an $8K (or so) power chair if living in a full-care facility. Fortunately we got my mother-in-law one back when she was living in a non-assisted-living apartment, so it didn't cost her a cent.

Mar. 18, 2012, 11:07 AM
While there is still any money left, best to agressively start looking for a place - you have more options if mom has some money to go into with. Yes, you are basically handing the rest of the money to the nursing home, but you may get her in a better place that way. Find one that agrees she can stay after the money runs out (on Medicare or whatever the nursing home name is).

I'm not as informed as some of you on this, as I've only been seeing/hearing about it as my parents have recently had to put my mom's mom in a home, but I remember they felt it was important to take this step while she still had some cash (she had $100K)

My parents took my dad's mom in to live with them for her last decade. My mom is a retired nursing home nurse. Still, it was SOOOOO hard on them. I felt bad as my dad was sick and they didn't really have any kind of quality of retirement life with my gmom needing round the clock attention & care.

We were all sort of relieved when gmom passed & finally mom & dad could have some fun & relax.

When my mom's mom got to needing care, parents suggested they try again to take care of her themselves, to save the 100K for us kids. Fortunately my sibs & I agreed - no way! We'd all rather you continue to have a quality retirement rather than work your 72 yo butts off to save 100K

It is a tough decision with many facets. My dad is very ill, and the women in my family tend to live long. I'm the only unmarried sib, already thinking can I manage to take care of mom... I know having worked in nursing homes, she doesn't want to end up in one. But sometimes it truly is the best option.

Mar. 18, 2012, 11:10 AM
Sorry JoZ. There really wasn't anywhere to put the money that would be cheating, unless I had been able to retire and do the caregiving and pay myself a stipend. MediCal was very very clear on that. You could pay off the house for the spouse to live in mortgage free, but they were going to try to collect from the estate. I've been told some of the specialists can help you maximize your family member's benefit. Usually it means buying a good hospital bed, lift up chairs, motorized wheelchairs, in-home and portable vent equipment, stuff like that.

The research the advocate did on my behalf pretty much said that it's the expensive option or paying under the table-totally illegal, for 24/7 care, unless you do it yourself and live in. I know nothing about Mass law, I haven't any family there anymore, but as someone said a social worker might be associated with your mother's doctor - they had a social worker at the hospital my family member was at last year and a Medicare specialist at the specialty hospital.

You need to sit down with your sisters and discuss what they are doing and why, and sometimes the emotions of the situation just make it impossible - I remember arguing with one family member about how we were going to handle bill paying and it devolved into attitudes about control of money - not keeping the bills paid which was the crux of the matter - it was just awful, but you have to find out what really is the motive behind spending down the savings - getting the Medicare eligibilty ASAP while resting up for the duty that lies ahead or what?

Best of luck to you. My road isn't over yet and I just hope we can string it on a little longer.

Mar. 18, 2012, 11:17 AM
I am in shock over the $600 a day....that is double the standard rate. Are you using an agency or are they private people? I would contact a professional agency. My Dad and step mom had 24 hour a day care in TX for 4 years in their home and we had a contract with an agency that did home care. Medicare paid for therapy when needed and used to pay for a bather until this year. Our daily rate for TWO people was $230 a day. As things got worse and we started looking at nursing homes the rates for each person was $4500 a month.
And this was not any nursing home... it was private house in a mucky muck development north of Dallas in a rich area where they take up to 7 clients in the house and have 2 staff people taking care of them 24 hrs a day. Included laundry and meals. It is a GREAT alternative to a traditional nursing home. They are suited for private pay clients since they do not take medicare.

Mar. 18, 2012, 01:29 PM
Lawndart, thank you very much for your timely posted article. We are now in this situation, and my mother will qualify.

CDE Driver
Mar. 18, 2012, 01:45 PM
JoZ I understand....

My husband and I moved in with my Mother a couple of years ago to help her. It is now at the point that she does need 24/7 care.

I am fortunate in the fact that I have respite care givers that come in 5-6 days a week for five hours, usually about 8:30 - 1:30.

But...I am here seven days a week. And I have those five hours to "do" my life. I pretty much have no friends, no time for that if I want to get anything else done and work my horses.

I do count it a huge blessing to be able to do this and have this time with her. But...I have pretty much put my entire life on hold. I think about the future when she is gone. While I hope she is here with us for a long time I do fear for my future. I will have no savings, a career that has been put on hold. I get a small income from this and we get room and board.

I have two Sisters. One lives about 140 miles away and is the executor of her estate. My other Sister lives in another state. My Sister that is the executor does make things a bit difficult as she holds the purse strings and we do have a history of familial strife.

It is not easy on a day to day basis and I have to say that my husband is a saint. But, like I said, it is a blessing to be here with her and I am so glad I am able to do it.

Mar. 18, 2012, 04:02 PM
My Mom was under hospice care AT her assisting living facility. Medicare covers hospice, it covers medical care...but it doesn't cover "rent".

Forcing my Mom to leave her home was probably one of the most difficult things I've ever had to do. But it was a matter of safety, hygiene, medication managment, nutrition -- all of those things.

Bascially, the child turns into the parent and must make the tough decisions, financial included. It can be exhausting, but that is the bottom line, I'm afraid.

Mar. 18, 2012, 08:59 PM
As someone suggested, did either of your parents qualify as veterans? Retired military? Belong to a religious organization (Catholic, Baptists etc have affordable options in some locations) or social organizations? (Eastern Star, etc have affordable nursing homes, and I believe others do too). Some of the religious based institutions are very affordable compared to for profit homes. And many of the religious based homes aren't just for their own members either.

I also agree with finding out if there is an Elder care social worker or community based social worker who could help put you in touch with local resources where your mom is.

Mar. 18, 2012, 10:35 PM
. . .that is double the standard rate. . .

The standard rate varies according to area. My family member is in the CA Bay Area and OP's is in Boston if I read it right, both of which are not exactly affordable places.

I remember being shocked at the rates I was quoted, but at $11 an hour wages for the cheapest service we could find it was more than $264/day just to pay wages, and it just wasn't what we wanted with me being so far away - too many low skilled caregivers and no continuity.
When we thought we would have to have a ventilator, well that requires an RN and adds up fast! I was seriously contemplating going back to school and taking over partial care if it came down to that.

Mar. 19, 2012, 08:17 PM
JoZ, there is some option in Massachusetts to make an incapacitated elderly person a "ward of the state". I'm not sure if the requirement is physical incapacitation or mental decline, but my grandmother with late-stage alzheimers was placed into state care when her estate ran out of money.