Assisted living and nursing homes are so expensive, does anyone have any suggestions for alternative places?

Why is it the "Government's job" to find answers? Government is just people in offices that think they know everything, but they're just as human as the rest of us. In fact, I suspect that there are other answers out there that aren't possible because of the regulations and systems now in place. I've seen enough to know that it's a tough situation for many families, and modern medicine is more expensive than what was available and done a generation or so ago. If a caregiver costs $15/hr (including taxes, etc), a standard work week is $360; a month is $2580. And that's just one shift! Add facility cost, food, etc .... there's nothing cheap here. I recall my nephew saying about 15 years ago that having my brother (who had Parkinson's) in a small condo next door, with one live-in caregiver, was costing about $14K per month. We do need some creative--but realistic --thought about this.
Currently I'm 76, still working, live with a daughter, take care of myself, health reasonably good. We sold my long-time house, and some investment properties, but money in the bank isn't making anything lately; even investing well is not magic. My kids, which include an accountant and a lawyer, are watching my assets, but hoping that my physical and mental health hang in there. Ideas, anybody???

I share your frustration KarenP...nothing but a kick in the ass for working hard all your life & being punished for getting sick. I get nauseous every day for what my Mother is going through & I am responsible for her now. I am my Mother's Mother now. My Father never took sick days off & saved $$ for what? They didn't get a chance to enjoy it. Life is not fair. Gov't has got to find answers to taking care of sick & elderly.

Back in the good old days, before women started working en masse, daughters and grandaughters took care of the aging parent or grandparent, who because preventive care was not common, usually didn't live as long as our seniors do today. I hope all the caregivers on this board either have or plan to buy Long Term Care insurance when they are around 60. I certainly have it--it isn't cheap, but that plus my pensions, savings and social security should take care of me when I need it. Medicare was not designed for people to live as long as they do, and it has never pretended to provide custodial care. Let's just hope we can hold onto its medical benefits!

Churchmouse had said something that suggests an additional possibility (no, not leaving someone in a car park!)--has anyone here considered nursing care or AL overseas? For someone who has essentially no family (or won't by the time they are old enough to need such care) or has no particular place they consider home, perhaps this might be an option. I've thought of this as a possibility, with an additional consideration that the food overseas might be more interesting and appealing than that offered in facilities in the US, particularly if one especially likes a particular cuisine. And I suspect that in many countries such care would be much less expensive than in the US, just as health care in general is generally less expensive overseas.

I don't have a tv so I didn't watch last night's Panorama programme, but apparently one Californian family chose the solution of flying their elder to a small city in England and leaving him in a car park here with no ID.

!!!

I think it turned out okay for the elderly gentleman himself; several months later, he's now safely back in America. But perhaps more by luck than judgement? Plus investigations into the family are ongoing I gather, so I'm not actually recommending this.

It depends on what your loved ones needs are so this would be a challenging question to answer with out knowing if your loved one has dementia, can live independently still or if they need 24 hr care?
If they need 24 hr care then those are you alternatives, assisted living homes and skilled nursing. Assisted living homes are economical if you do a shared room and stay under 15 bed facilities where the rates are lower. If they are not needing 24hr care try senior apartments where you can have a call bell assistance when needed and they also clean the apartment and assist with transportation via shuttle bus. Senior community housing is a great way to go and is affordable since it is based on their income. Check your local area on aging agency they will be able to assist you!
Also you can do a live in in exchange for room and board and have them help with care, cooking and cleaning for a stipend say of $1000-1200 per month thats often a good way to go just make sure they are Background checked and are safe to care for your loved one.
Best wishes!

once there in a place it's possible that then she would be able to get Medicaid if funds were gone, it is considered a difference group. my brother owns his home has navy pension and S.S but is able to get Medicaid because he in in a nursing home check it out never know

Here in the Cincinnati area we are getting nursing care for $6200/month (in a "care center"). I'm mentioning this because an early responder to this post mentioned paying over $7000/month for assisted living. My impression is that AL starts around $3000/month although it may be somewhat lower in some south central states.

Yes, I realize that this is a very old thread, but, wanted to respond since its had recent action and I have input on this matter.

I don't know what Veterans benefits that allow a person with income over $2205.00 per month to get Medicaid. (I read the max for Medicaid LTC is $2205. for 2017.) Does this mean their veteran's retirement is exempt? I have read about the option of a Community Group Nursing Home for Veterans. I would be curious to know more about it. Having a home doesn't normally disqualify you from Medicaid LTC, but, their income would. Does anyone know the details on this as it relates to veterans?

When people apply for Medicaid long term care or other state benefits for long term care assistance (Medicaid like programs that cover AL and MC), there is a very intensive search by the Medicaid or state representative for assets and income. Every dime is explored and it's not just handed out without qualification. They require written documentation, bank statements, deeds, insurance policies, income verification, etc. They leave no stone unturned, so, I don't think that rich people are getting this benefit. Plus, the person's financial situation is reviewed annually. And if they do qualify, all of their income goes to the facility, with a modest amount left for them to cover all of their personal expenses, like $66.00 per month.

Medicaid is not for people who just want to get LTC to have a place to live. Most medically qualify as needed medical care and assistance with their activities. So many recipients are disabled or ill.

Even with savings and retirement benefits, many seniors will not be able to afford long term care for very long. It's very expensive. And eventually those who can afford private pay, will not be able to.

I would suggest if cost is of concern, you seek out small, rural facilities. You may even wish to research average costs online to see what states have lower costs. Though no one wants to relocate, some states have significantly lower costs for LTC. In the the state of NC, some LTC facilities that are located in rural and low populated communities have costs that are much lower than large cities. Some are as much as one-third the costs of some found in larger cities.

I'm sorry but I don't agree with the original poster's rant. Why should every other hard-working American have to pay for your mother's care?! She should sell her home and stocks and use that money to live on until it's gone. THEN, she can get on Medicaid. What you want is for her to leave all her hard-earned assets to you. It doesn't work that way. Be glad she has assets to use!

I thought my brother wasn't able to get Medicaid he is 92 has a home with mortgage gets a navy $1,900 s.s $826 a month and he can't outside. My brother was put in a Nursing home and there can get Medicaid now, reason GROUP. Now from what they tell me is if your home you are in a group that can't always get it, but put in a nursing home makes it's a different group and income don't matter. I am trying to move him now closer to me the nursing homes know they can bill three months back also to Medicaid.

Medicaid only began in 1965. Before then, families took care of their parents. Medicaid is a privilege that is designed to help thise for the less fortunate and predominantly with out families. It costs our country huge amounts of money and is abused by many who indeed have assets and wealthy offspring who can take care of them.
Perhaps changes should be made so that families who take in their aging parents and arrange for in-home care receive subsidies from the government to do so.
I think it would strenghten family values rather than abandoning parents to impersonal "care-giving" institutions.

Visit an eldercare attorney in your state ,to see the specific facts that pertain to your family. The first consultation is usually free.

I read often on this forum that in-home (hired) care is the least expensive option. My mom had 24 hour caretakers, and it cost $12,000/month. And this was in Texas where it is actually cheaper. I can't imagine what it would have cost in New Jersey or California. We finally found an excellent diaper that allowed her to make it through the night, and that let us stop one shift, which reduced the bill to $8,000/month. Still not inexpensive. A nursing home would have been cheaper.

To answer your questions: she is 81 years old and doesn't qualify for medicaid because she has a few bucks in the bank. You have to basically be destitute to qualify for medicaid. My dad working his butt off so she could have a few bucks and now she does, she is punished because of that. She is currently in AL now and it is costing four grand a month. When she has run out of money, that's when medicaid kicks in. Thanks US government for greedily taking our taxes, overpaying yourselves and stiffing elderly folks. Good job!
Wiling to relocate, but Mexico is too far. Thanks anyway!

Can you give more details why she isn't qualified for medicaid? If you really don't qualify for medicaid, how old is your mother? If she is 65 y.o or older, she may be able to qualify for medicare's skilled care program, it may be limited but would be a great help for you and your family. Just remember that medicare focuses on health care and not long term care. And after you exhausted the help that medicare has to offer, you may opt to choose home care, it is less expensive because you do not have to pay for lodging..I also ready a lot of articles stating that the cheapest ALF are in Mexico, you may want to check on that if you are willing to relocate :)

Perhaps you can check out CCRCs or Continuing Care Retirement Communities. This is a residential retirement community that offers variety of medical and living services to patients who require supervision and continuous care. This type of community has assisted living facility, nursing home and independent living under one roof. However, there are three types of contracts for CCRC's and they are Life Care or Extended Contract, Modified Contract and Free-for-Service Contract. Since you're on a tight budget, it's best to consider the latter. It's initial enrollment fee may be lower but the services offered will be charged at their market rates. There's no harm in exploring your options, so might as well check out this community.

I no longer take care of my mom she had a stoke and I guess dementia I've never seen anything like what she has one day she's in bed and so confused taking to people and seeing people that aren their next day she up in the wheelchair still a bit confused its a day to day challenge we talked to a senior care advocate she showed us care homes they have six residents and 24 hour care they do everything including their laundry we found a nice one for 2800.00 a month she's on hospice so the nurses come twice a week we could not afford a nursing home and I don't think the care is better see if you can talk to a senior advocate best of luck

The alternative is reasonable and affordable care which does not exist in this country. We live in a for profit society where shareholders hold all the stakes. Medicaid could be more sustainable if the cost of caring for the elderly was more manageable. If seniors could afford the cost of their care, there would be no need to spend down all their assets to qualify for medicaid. No need for medicaid will sustain this program far into future generations.

YOu need to check the laws in your state and it wouldn't be a bad idea to consult an elder care attorney. My mother in law has the following situation: She and my FIL worked their entire lives very diligently to prepare for retirement. They each had a pension for life -his with a big oil corporation and hers is a teacher's pension. Plus, he had social security. They inherited a bit of money which they gladly shared over their early retirement years with family, taking a cruise for their 50th, stuff like that. Also gifted my husband and his brother (only 2 siblings) and the grandkids occasionally. They also owned some stock in pretty solid companies, and owned their own home which was free and clear.
25 or so years ago, when they were in their 60's they took a trip out of the country and at that time my MIL insisted that both brothers be given POA and DPOA equally, as well as put them on the deed to the house, so all four (mom, dad and the two sons) equally owned the house. My MIL witnessed huge taxes paid on a family farm years ago and thought this was the way to protect whatever happened then from happening, although it was an ill conceived plan because, when her house was sold (which it did not have to be as a home is the only PROTECTED asset) the co owners who didn't occupy the house had to pay capital gains on it. Had she let it go into the estate that would not have been the case (his dad died 6 years ago and she is 92). The reason the house WAS sold is because my BIL lives in the same small town, has said he has not prepared for his own retirement and wanted her out, into a AL asap and all of her stuff sold. He forced this issue and my husband advised against it, but nobody listened to him.
Shortly after the AL, she fell down, necessitating that she move to nursing home. If you don't know, LTC is covered by Medicare while AL is not. Mentally she is still fine and we wish that she had stayed in her own home and used her long term care insurance and other assets to pay for the help she needed so she could stay in her familiar environment. But that was not to be.
She is now 92. The doctors say that she could live to 100! She has incontinence and other 'elder' health issues, but medication is amazing these days. I think she'd rather just 'go' but that isn't up to her. She still has $150,000, still receives her pensions (those total about $2800/mo) and her husband's social security. Her expenses are about $4000/mo and she pretty much covers that with ss and pension $$.
A HUGE issue for her has always been to 'leave something' to her family. Obviously my BIL is counting on that, and he was the one who basically forced her where she is and has been holding her purse strings. The thing she has a hard time understanding is that if she ran out of money she would have EXACTLY the same care she is getting now. Nothing would change if she were to need Medicaid. And she would still have lifetime income.
Nursing homes are experts at helping one go through their money. Since she and my FIL prepared so well, we have been urging her to gift $12,000 a year to family members. Even if it were all gone, we would set aside money for her extras, like massages, hair do's, etc. But she has it in her head that she doesn't want to be 'on the dole'. I am sorry, but it makes me so upset to see her stuck in this horrible place (she won't come live in our state and insists even after she complains that it is "ok" there). She really, I don't think, gets it that she could totally run out of money and things would be exactly like they are.
I would urge you to look into a) not selling your mother's home and all of her possessions in it and b) having her gift up to the allowed limit. You need a lawyer in your/her state, but you can help her have a decent quality of life and make her money work as well as possible for her. Personally, if at all possible I would find a nice assisted living situation and help for her there if she can't stay in her home with help and also urge her to gift her family. Once she runs out of money, she still can be cared for in a nursing home until she passes away. If she has to be in a nursing home due to health complications, then gifting to her family may give her joy to see what the fruits of her labor are going to during her lifetime. And then make sure her will is in place for 'real' property, ie, her home.

I found a lady who charges 10 an hour she comes four days a week and bathes my mom and takes care of her in the morning and on Saturday she stays all day so we can go out not the best sisturation but we do are middle class mom had some money put away but most of that gone paying her bills and her trips to er not free and NH stays over the two years we have had many people from the agency paying 25 dollars per hour they come in shower her feed her and sit down read a book /or watch tv pretty much all the same except for the price. We pay the lady around 200 a week not the greatest because shes living with us but better then a nursing home where they either sit in a wheelchair or stay in bed and get two showers a week for 7000 a month

the cost of care is incredible I agree... Is it possible to get homecare to help and keep her at home? I know it is not easy but it may be somewhat more cost effective!

Maybe you have someone live free in her home, if they would take care of her.

Hello Karen
If a person is suffering from memory loss or disorientation, it is the care they need the most. When my mother caught herself with Alzheimer’s, we brought her to. I think it was the best decision we ever made. Their activities of daily living supported her very much. All their facilities were just in line with our budget. I hope it will be same in your case too. It was not just a matter of money; she is receiving the best medical care and emotional support to fill her days with precious moments. They adds a special meaning to "assisted living and nursing homes".

When we have had to place family in homes, we never have had to pay the entire bill from savings. In this current example the mother has $2500 in pension and she is being asked to pay $3500. So the cost to the family from savings will be $12,000 a year. Start Slow. Sell her car. There's one month. Sell some jewlery, thats the next month. Rent out her house and try and get $1500 a month....
Just keep breathing. The water will clear and you will see the way through.

I've read a lot of the responses in this thread with interest. It is strange how we can become conditioned to think in certain ways. Throughout history, people have not only worked for themselves, they have worked so that they could leave things for their children. Men would buy properties in hopes that one day they would pass them down to their sons and their families. They accumulated family heirlooms that they planned to pass down to daughters. It is a very natural thing to want to build an estate, so that it can benefit a couple's offspring. This has been going on throughout history.

But now, people are being conditioned to believe that there is no right of inheritance. If the parents build up an estate, it is just a bad break if they live long enough for the health care system not to consume it all. From the looks of things, it will not be long before the health care system becomes the sole legal heir of all estates in the USA for people who are middle class and poorer. I like this thread because it asks the question why is health care so expensive in the USA? My wish is that people would resist becoming conditioned to thinking that the heirs have no rights to an estate their parents built up, but would fight the rising costs of elder care in the USA.

If you think about it -- why does it cost so little to put a baby in childcare, while it cost an arm and a leg to put Grandmother in one?

Some friends of ours have found some wonderful caregivers from Fiji or from the Philipines. They believe in caring for the aged with dignity and respect. You can possibly find some names from AL's, SN's or on the bulletin board at Senior Centers for long-term overnight caregivers. Of course it is good to have a locked filing cabinet for all personals if the person is to be in the home, or what I have done, is buy a new 4 drawer locking cabinet and keep all of my mother's items in a room at our home. I hope you find someone--please keep us updated.

Omg and the sky is falling. What is a person suppose to do with our parents? take them over state lines and dump them ? We do need care from cradle to grave. God help us all,when its our turn.

Understood!

Ro166-actually I've said on this forum that if they live long enough they will run out of money unless they are truly generationally wealthy. And if that was the case they & their family wouldn't be on this site.LOL.

My mom is mid 90's, could afford IL and the minimum expenses related to her home. Now she is in NH with income below her state's Medicaid income ceiling of $ 2,020.00 a month so she totally qualifies for & is on Medicaid. Her home (empty with homestead exemption) is an exempt asset under her state's Medicaid. She does not have to sell it to be on Medicaid. I've found that social services often recommend that the home be sold because they know it is likely going to be nothing but a problem for the family to deal with and a $$ tar baby in being paid in a timely manner. But it doesn't have to be sold. But someone other than mom will have to pay for all for the home.

The usual story is that mom has a home but now needs to move into LTC facility after being in the hospital with Medicare paying for the stay after a fall.Family is all dither. What to do? Where to get the money? Sell the house to pay for whatever. It can totally make sense to do so but I don't think they can be forced to sell the home in order to qualify unless it's the few exclusions I posted earlier.

Home does not have to be sold to qualify for Medicaid, but has to be under $ 500K in value (some states 750K). What matters is being under the state’s Medicaid financial ceiling for all other assets and income. The Medicaid application states that any assets are subject to MERP if they get on Medicaid. (Yes, I know 500K seems high but you'd be surprised at what property values are especially if your parents bought it in the 1950's and their taxes are frozen so they didn’t worry about it). MERP can then be done on their estate as a claim or lein depending on what your states view and laws are regarding probate.

Say they are in NH 4 years then die. Now after death, MERP can place a lien or a claim on the home through probate (this is how most states do it). So if the executor of the estate wants to transfer real property (house) to settle the will in probate the lien or claim from MERP has to be released in order to do so. But you can do your own claim against the estate for whatever expenses you paid for on the empty house but you need to let MERP know you plan to do this within the timeframe set by each state.

Remember, once they are in LTC there will be no $ to be used on the home as ALL money less personal needs of $ 30-60 a month MUST be paid to the facility. So someone will need to pay for parents house expenses. If the home still has a mortgage, this can be a lot of $$ every mo.

If you do this,. It is CRITICAL
that you keep track of every $ spent. Say you have paid tax, insurance, repairs for 4 yrs @ 8K=32K. Medicaid
paid NH, med’s, therapists, 70K over 4 yrs. House value is 90K which could net 81K max at sale.

But you let MERP know you are filing your own claim for 32K. The most MERP could get is 49K (81 – 32) but only if you did a sale quickly (fat chance) before maintenance and taxes etc continue. MERP declines to do a claim as not cost effective and gives a release to probate court. You finish out probate and get the house 100%. Happiness all around!

Some states have been aggressive with MERP. As states face $ shortfalls, MERP should increase. Imho MERP wasn’t well thought out. What are states going to do with a ton of homes with old people stuff in them that likely has a decade ++ of delayed maintenance? MERP came about 2000-2002 when housing was all a go-go. Totally different real estate conditions now.

Some states have super low MERP recovery rates. Other states are more aggressive. Imho all this is really dependent on each state's view of personal property ownership and probate laws and how the program is managed. Her state just gave out a contract to HMS (they do a lot of state's MERP), so recoup should get more aggressive. I think how it happens is very dependent on what the recovery prospect is - like MERP going after a 300K home rather than 100K home.

Her cognitive abilities really changed in 2010 or so - she probably has Lewy Body Dementia which seems to be quite different in it's run than Alz. There are a couple of others on this site who have family with LBD (and who have great insight in this type of dementia) - in some ways it's super scary because they seem just so competent and normal and then they have an episode that is so unreal but real for them. For her, the LBD episodes with hallucinations and false beliefs got to the point that she flat couldn't function in IL. Her gerontologist was also the medical director of the NH so she went from IL to NH. Bypassing AL. For us, the NH is better than a residential care home or board & care home, as her gerontologist - affiliated with a medical school - and their NP's are on-site regularly at her NH
and get the more specialized understanding of & care for her type of dementia.