advice needed transitioning LO to MC/AL

waywardson

Someone told me that one day I would know it's time. That I would know it was time for me to make the decision to move my mother, from caring for her myself, at my home, to an assisted living facility that can provide the memory care and safety that she needs. She has mid stage dementia and progressive aphasia.

Well, it's not like there's a fine line. Line in the sand. The fact is that ten times a day I think it is time to transition, and ten times a day I think we are still doing fine. What will tip-the-iceberg, ... I still don't know. But I know we are close. Very close.

The question I have is how should I get prepared.

I couple of innocent internet inquiries funneled me right into the "place for mom" super-structure. I'll be honest, my first impression was feeling pressured by them. I felt like I was talking to car salesman rather than a care provider.

I contacted a couple of assisted living facilities close to me, between my house and my brothers. They all desperately want to schedule an visit. Desperately. But what has shocked me most is the cost. I fully understood that this would cost us ... a lot. (mom has too much money for medicaid, moderate savings and wealth) But I did not expect 7k, 8 to 9k dollars a month. $85,000 or more a year? Are people really able to cover that? Does that seem excessive?

I don't want to skimp, I want Mom to be in the best place, but if I sign up for something knowing that it will bankrupt her (and in a way ... all of us) or know that there is a time limit of affordability ... what do I ask, what do I look for, who do I talk to?

Should I keep looking with an eye on budget, further from my home or should I look for help restructuring our finances? 

What should I be looking for on visits?

I'm worried I'm going to talk myself out of the move and keep her here until it's too late.

Ed1937

It sounds as if you or she never contacted a CELA (certified elder attorney). If that's the case, that's exactly what needs to be done ASAP. They can protect certain assets, write up all legal papers that will be necessary, and give you advice on many other things, including how Medicaid works. Unless she is pretty wealthy, Medicaid could be in her future. This is money well spent, and it can likely come out of her assets. The attorney can explain everything. You should be able to find a CELA at nelf.org.

MN Chickadee

Unfortunately those costs are extremely normal. It can be even higher depending on the area of the country. In my area it ranges from $7-10 thousand per month. When you do the math this comes out to like $11 per hour, which you could not hire help for. It's complicated. I don't know how much profit these places make, and any profit off the mess that is our nation's elder care is obscene, but it also seems like it shouldn't really cost less than $10 per hour if you know what I mean. Anyway, I digress. 

Financial planning with an elder law attorney is important. Even if you feel like she doesn't have a lot of wealth, just the medicaid planning alone is valuable. Many people start with assets and run out of money if they live long enough because care is $100k per year, so do the planning up front. An elder law attorney will know the best route for paying for care. There are almost no CELAs in my state, none in my city, so I always recommend people find a reputable attorney who practices primarily in elder law and estate planning. There are many who don't get the NELF certification who are good. Medicaid beds can be hard to navigate. There are often even un-written policies on Medicaid in many facilities. A good attorney will help you figure it out. 

The tours are hard, I know. You get the fancy brochures and the pitch from sales people. On paper they are all the same.  Make an objective list of things you care about and check them off. I called dozens of places and narrowed it down, then toured like 5 places. I got on the wait list at a few so we had options in case of crisis.  Fancy decor doesn't necessarily mean better. It sometimes mean they put all their money into fountains and carpet and not into staff, and the staff are what really matters. A well trained and caring staff in a place with shabby couches is what our first place looked like. They were great for a few years. Thee place didn't weather covid and its challenges very well and then I moved my mom. The second place was a non-profit place; a multi level care complex (IL, AL, MC, SNF) that was part of a Catholic charity. While we are not Catholic they served us very well. They were still not cheap, in fact one of the highest prices in town, but had a benevolent policy of taking Medicaid if a person private paid for 2 years and had a great staff, good training, put lots of resources into quality of life stuff and enrichment activities . You want to look at activities, food, a decent staffing ratio. Talk to other family members when you tour. They usually are the best source of the real deal. Ask if your LO can stay there until the end and what could come up that would require you to move her.  
Hope this helps. 

Ci2Ci

When I was calling around to AL facilities to get prices, I often got their 'sales' department. Got a price quote from one place, then ended up calling back a few days later. Got a different price. Seems that they have some 'wiggle' room?  If you find ones you like, perhaps the price can be negotiated.  Might be the case for the APlaceForMom(s), as they definitely are sales driven. Perhaps others with experience with those can speak to that. 

loveskitties

I found A Place for Mom to be less than helpful.  By the time I called them I had already made my own calls to the local facilities.  Their lists were about the same and did not always cover the issues I wanted addressed.  Some people may have found them helpful, but I did not.

Jo C.

My personal experience with, Place for Mom, was not a positive.  They do not charge a family for placement, BUT they do get a generous fee from the facilities they have an agreement with when they have made successful placement.

NOTE:  They did give us a listing of care facilities BUT the only ones on that list were the facilities that had an agreement with, "Mom."  Other good facilities were not on the list including several of the higher rated facilities in our area.  Some facilities do not need such a business to fill their beds.   After screening a couple of care centers on their list and getting the ongoing, "sell," I decided not to use them and actually did better on my own with the placement being made at an excellent facility that was not on their list.  Your experience may be different, so it is up to you.

Your best move for adequate advice and setting safeguards into place and in making legal shelters for assets would be a CELA attorney.  They can be costly, but they are the experts on such matters.  And yes, sadly that amount you mention is the usual cost of such care per month. Where I am, the cost is about $7,000 to $10,00 per month.  Not every facility accepts Medicaid, some are private pay only.  When a Loved One (LO) reaches the point that they will require such care as mine did, I accepted the fact that their money was their money and not mine and was to be used for my LOs quality of life.   I used their financial assets for their good care which was the goal. If one feels their LO will run out of money, then one needs to place a LO in a facility that has a contract with Medicaid for use after the private pay assets run out; not all do.

Since you are looking at an "Assisted Living" model of care, be sure to ask several times of different managing staff including nursing what reasons would they ask for a resident to be moved from their facility.  Important question as some of us have found.  My LO was admitted to a lovely facility that said they could accommodate all the way to end of life. Not so. Once my LO could not independently get to the dining room for all three meals and could not get out of bed to a wheel chair without a two person assist, we were told they could not keep the resident as it was, "too much care." Huge shock but fortunately we moved to an awesome facility that was of excellent care and was a huge plus.  Eventually assets ran out and Medicaid had to be applied for as the facility did have a contract with them and not a single thing changed in the care or quality of care.

It is a harsh realization when we begin to face all of  this, but we soon begin to adapt to those realities sad as it may be. I wish you the best as you begin your search,

J.

Quilting brings calm

My parents were living out of state in an RV campground. I started noticing mom was a little off on the phone, and we got a call they needed us to come down.  We got through that issue and then about 12-15 months later, mom started talking about selling the camper.  I tried to talk them into coming home.  Nothing doing.  Someone steered her and Dad to a place for mom. Who talked them right into an independent living facility - basically an over 55 community where you could pay to eat at the AL living facility across the street.  And you got housekeeping and a clubhouse.  Within a week, we got called down there for a crisis of confusion on mom’s part. Which the doctors said was delirium from the move,  A month later, we were moving them back home  on an emergency basis.  Mom was in the hospital for a week, rehab for a month and we moved them into AL. 

They should never have been moved into the independent living place because it wasn’t really independent living as it exists in our home state.  A place for mom and the facility worked together to just take my parents ‘community fee’ of $2000 to move  in when it obviously was not the place for them.   The facility also owned that AL and that’s what they should have gone to. Actually what should have happened was a call to us to tell us they needed to be moved home because they weren’t capable of independent living.