MC and AL costs

*Ollie*

We moved my mom in with us and she's been with us for a year and has moderate dementia.  We started looking at adult foster homes (weird name for what they are) and a memory facility because my mom is needing more are.   No AL as I think she would need more assistance than what is provided.  The costs were shocking!  5-10K a month.  We've since been able to increase her caregiver's hours and that is a great temporary solution.

How do people pay for AL or MC?   My mom has Medicare and it sounds like Medicaid is only an option way further down the line.   

Are there facilities that you start out by paying out of pocket and then when the money runs out Medicaid takes over?  

CanyonGal

My mother could first pay for Assisted Living and her savings covered other pharmacy and personal expenses. As her dementia worsened, her long-term care insurance kicked in and covered her AL and later, her MC. Her MC is affordable compared to others in the area. 

We sold her home to cover expenses since we did not when the long-tern care coverage would start. I have read some people get second mortgages to pay for care. She has military health insurance, and we get some Veteran's aid. So far, I have not had to touch the money from the house sale.

Medicaid can be used for nursing home once savings are depleted - unknown about MC. 

Look at the financial part of planning ahead for Legal Matters: 

Paying for Dementia Care | Alzheimer's Association

And take the free e-course on managing money:

Managing Money: A Caregiver's Guide to Finances (alz.org)

harshedbuzz

*Ollie* wrote:

How do people pay for AL or MC?   My mom has Medicare and it sounds like Medicaid is only an option way further down the line.   

Some people pay using LTC insurance. When there is no spouse to consider, many families sell the PWD's homes, cars, and other assets. Pensions, savings, investments and social security are often cobbled together to pay the monthly fee. 

My aunt's husband invested well; her care was funded by that. My dad day-traded away $350K in the earlier stages pre-diagnosis which left a shortfall in their portfolio. I moved my parents from 2 fairly LCOL area homes to a higher COL area and put them in a more modest home which left about $125K (about 18 months at dad's MCF) in savings to pay for dad's care. Mom also inherited about $150K from the aunt in the previous scenario.

Are there facilities that you start out by paying out of pocket and then when the money runs out Medicaid takes over?  

This can work, but there are some caveats. For starters, you'd need to live in a state in which Medicaid will pay for memory care and actually have vouchers available IRL. (I do not- dad would have gone into a SNF at that point presuming he needed that level of care. Moot as it turned out; he died within 8 weeks of admission) You'd have to select a MCF/CCC that routinely does this and will work with you. And you'd have to satisfy their funding policies which are often not written down. Where I live it's typically around 2 years before converting to a Medicaid bed.

*Ollie*

Canyon Girl - Thanks for sharing the resources.  Unfortunately, my mom does not have LT health insurance and while she has some savings, it would only last a few years if she is moved to a facility.

harshedbuzz - That's good to know.  I'm guessing I'll have to inquire about the switch from private pay to Medicaid from the facilities.  None have mentioned it to me.  

LicketyGlitz

I second Canyon's advice, only consider MC facilities that will transition to Medicaid when/if she runs out of funds.

I'd also check on things like vet benefits, your state or county department of aging and disabilities for information on financial support on the state level. California has (had? it's been awhile since I checked) a paid family caregiver program, I believe some other states do too.

An elderly law attorney appointment might be super helpful as they know the ins and outs of end of life financial issues.

MN Chickadee

$5-10k per month is very normal. If you do the math it comes out to $10 to $13 per hour, which when you think about how many staff they have at any given time and other costs then it starts to make sense nor could a person hire round the clock care for that price in their home. An elder law attorney in your area can look at her particular finances and advise the best way to pay for care. Medicaid may seem way down the line, but when care is easily $100k per year the funds can go fast, and there are things she can do in the mean time to protect assets (pre-paying funeral expenses for example.) Having that legal advice up front makes it a better process and makes sure there aren't issues, because the government will look back 5 years for expenses and financial moves that would disqualify her.  For many people long term care involves starting as private pay until the funds run out, and then either being in a facility that will accept Medicaid or moving to a a different facility that does. Medicaid does not reimburse as well, and many build their business model on having a mix of private pay to balance it out. But an attorney can plan the best use of her existing money and timing for Medicaid application and tell you what it does or doesn't cover in your state. In my state Medicaid only pays for a SNF, but we have a waiver program that covers other things if a person financially qualifies. These Medicaid Waivers (called home and community based services waivers) are sometimes available so people can obtain care at a lower cost than a SNF. Things like adult daycare, personal care, transportation, and even memory care in a long term care facility. This all varies by state so you need state specific legal advice. Neither facility we had my mom in had a written policy on Medcaid that I ever saw. The first just told me they accepted Medicaid when I asked, and many of their residents were on Medicaid. We were private pay and not there long enough to find out what the change over looked like. The second place made us prove with financial records that we could pay for 2 years out of pocket, and then would let her stay after that if funds ran out and she went on Medicaid. It's often these vague benevolent policies, but for sure having funds up front really opens up your options which is why financial planning matters even if Medicaid seems far down the road. 

And just an FYI - we found adult daycare to be a life changer; it allowed us to keep my mom at home a couple years longer than would have been otherwise possible. Even if you pay out of pocket it is usually much cheaper than a hired staff in the home or living in a facility. She even got her showers there, so between that being off our plate plus the respite from care giving 30 hours per week it made a huge difference. It was kind of a stop gap, like being in a memory care facility part time and therefore much more affordable if the family is able to cover the rest of the hours in a day. It was also really good for her, kept her as active and social as possible. Other folks were rather comatose and they handled all stages of dementia. 

EllisA

Awesome valuable information.  Thank you.  I will refer back yo his frequently for info.  Thanks again!