How do you mange your parent's care and finances?

I don't blame your wife for not being happy with you saying you would go back to work to fund your parents expensive care. Whose going to take care of you and your wife if you are in the same position down the road?

I am in Northern VA and both of my parents were moved near me into assisted living. I also got their LTC insurance started etc. I got Power of Attorney and we also had Trust Agreements done.

dad has since passed but I have handles all their affairs both financial and health wise.

i would be happy to share where I placed my parents. It is a newer facility with care levels going up to memory care. My parents started out in a two bedroom apartment. Dad and Mom were level 2 care and Mom went to level three soon after. Compared to other facilities the cost was reasonable for their needs due to them wanting separate rooms.

when Dad passed last year I moved Mom into a lovely efficiency apartment and she is very happy. I would be happy answer any questions you have in terms of cost etc. It is overwhelming at first. I had to fight with the insurance company. They love to take the premium but hate paying out.

I placed mom where I knew they have a Legacy” private fund to pay rent when mom goes broke. It is a non profit community. It is a beautiful facility. She had to be able to pay 24 months out of pocket. She had enough money for 4 yrs. She will run out of money at 91. She is now 89. If all fails my back up plan is to have her moved to the nursing facility where medicaid will pay the costs after her monthly income is used up…..good luck.

If either of your parents were veterans contact the VA social worker in your area. They paid for diapers hearing aides dressings a bed a lift a wheelchair. Great benefits

Novaman: You should retain an elder law attorney. However, for all intents and purposes, it appears that your parents are well situated financially for facility living, but it's best to receive expert legal advice.

Mom was 87 when dad died and had memory issues which came more apparent to me after dad was gone. I sold her house and her car as I knew she would not be able to take care of herself. After researching Medicaid it was not an option I wanted for my mom and I certainly did not want any liability with it.

In Florida her memory care rent was $4750 a month and was all inclusive and she was in a very nice place. Her out of pocket was $2000 a month for rent. Above that count on medical expenses which go up and down and monthly incidentals. I would recommend looking out of state if you can and avoid Medicaid at all costs. It seems that you could use your parents income to visit out of state and pay less than where you are.

Look for a facility that has the licenses so your parents can age in place. This means you can hire Hospice and your parents can live there until they die. Most people will not have to go to a nursing home. My mom did not have much money, but what she had was enough to last her until she passed away which was nowhere near what your parents have. I looked up the life expectancy for Dementia at her age and figured she would be all right.

Have three facilities evaluate your parents for admission and maybe a fourth. There evaluation will tell you if they can go to assisted living or need memory care. Remember your parents have to want to go to a facility you cannot force them.

Yes, the costs do look rather bleak when you put it all together (I personally have gone through the shock also.) Have you added in the OTC stuff also, like Depends, OTC meds or meds that you may need to provide when they are in AL?

Instead of selling the house, would it be a better financial decision to rent the house/condo? How much rent could it pull in? Do they pay taxes each year? Would the rental of the house decrease the amount they would have to pay in taxes due to depreciation?

Look at their tax situation. If they are currently paying taxes, is there a way to reduce the amount that they pay?

My Mom's MC cost is about what yours is. However, after you add in all the incidentals like OTC meds and Depends, etc, it is near the upper end of your estimate. Once we get her condo rented, the out-of-pocket cost will drop about 25%.

As someone posted, I would start researching facilities now as well as talk to an elder attorney/accountant. In addition, I would look to see if a neighboring state might be a way to reduce the sting of state income taxes, gasoline taxes, retirement income, etc. It does no good for a senior to get a free bus pass, if they can't ride the bus.

I'm glad you are looking into this now. I'm sorry for the "shock," however, at least you have time to prepare for the future.

Maybe you just let the piggy bank empty and then they qualify for Medicaid? Please make an appointment with an Elder Law Attorney to get strategies that don't force you to come out of retirement.

My wife's 2 caregivers cost $83- $85,000 a year in Orlando FL. You might consider moving. The $400 K should deliver 5% so that is $20K a year. What ever you decide, that is the right answer.

As has been suggested, look for facilities that have MC on their campus but more importantly, have medicaid guaranteed beds when a resident"s private funds are depleted. You want that guarantee written into your contract (which should be reviewed by an attorney) because some facilities have only a certain number of beds available to be designated for Medicaid. If your loved one runs out of funds and all those beds are already occupied, you will have to move to another facility. You also want to go into a facility as a private pay resident because you will have a greater number of facilities from which to chose.
Remember also that any signed agreement or guarantee can be tossed out the window at the end of the lease agreement (usually a year long contract) should the facility be sold to a new owner. Yeah.... the whole picture kind of sucks.

Start researching now. I personally have found that the well established non-profit facilities sometimes offer better service than the corporate entities. While you are projecting your annual costs, don't forget to add in the annual rent increase and make sure that you find out what the annual increases have been over a 5 year period when you are taking your facility tours.
I recommend at least two visits to any facility you are interested in.... the second one unannounced. Plan your visits around lunch time or slightly before dinner time. Get a list of the planned activities and of the menu. Try to take a second set of eyes with you.

Good Luck on this journey

Look for a continuing care facility if there are good ones near you. Some of them have "insurance" policies that keep the monthly payment stable (except for cost of living raises). You have to pay for the policy, but in my mother's case, it was well worth it because she didn't have long term care insurance and was in memory care for more than 6 years. If your parents run out of money they can go on Medicaid. Not all senior facilities accept Medicaid. Look for those that do, if needed.

Lots of great advise, if you do decide to go the AL route ,absolutely find one that has a memory care and does accept Medicaid. The one thing I did not know, a lot of AL that accept Medicaid require a period of self pay. Your ahead of the game knowing this, if they tun out of money, they stay…If I have had my mom in one earlier, it could have been a nicer place. My mom had almost a year of self pay funds and our choice was limited. I was fortunate to find it. It was a struggle with staffing issues along with management issues.



if you go with AL , Google care advisors. They are a realtor of sorts. Paid by the facility with placement. An invaluable service. Get someone local who will meet you for tours and arrange everything. They know the ins and outs of it. Availability, cost amenities, reputation… I used a franchise called care patrol.

absolutely do not go back to work

It is stressful, no doubt. Your parents have more money than most folks at this stage and LTC insurance! You're ahead of the game. If you move them into assisted living, it will streamline everything your managing. Most have physicians that come in for their dr. visits, podiatrist, assist with bathing, dressing, giving meds, ect. Not cheap but very convenient. You need to find one that has memory care on site as well so that should their needs change, it's an easy transition. Obviously, start using the LTC insurance before tapping into their assets. Things can change quickly at this age/stage. You might consider renting their condo to get some cash flow coming in to supplement their retirement income. If you don't want to deal with that, you could sell it and put the funds in a trust for their care.

If your parents end up living to be 100 like my mother in law and happen to run through the LTC benefits and their assets, they will have to apply for Medicaid. I think you're a ways away from that though....

I agree with your wife that going back to work is not the answer. Running yourself down physically and financially is not going to help anything. Utilize the LTC insurance as much as possible.

There is no easy answer to this.
I ended up moving my Mom out of assisted living in Florida back to her apartment in NY and went from two-12 hour shifts to full time live-in care givers (more economical and consistent). I managed her health care, hiring (and firing) full time care givers and shopping and cooking. After 2 years, Mom passed away (99 1/2),at home with Hospice care the last month. She was surrounded with one on one care, attention and love. It comes at a high cost financially and emotionally.
Mom passed away almost 5 months ago. It was a gift for her and for me.
I’m so glad I did it. I had a team of medical specialists that advised me for two years ( neurologist, palliative primary, gastroenterologist , I couldn’t do it without them.

Yes. First, I really would bag looking at Assisted Living. You will have to pay a community fee, which isn't refundable. They'll accept your parents until they become too much work, then they will kick them out with barely a 30 day notice. They'll tell you they'll offer this level of care, then you'll find out that they don't. And yes, AL will be much more because you'll move them in at one price and the AL will tell you, you have to pay more because now they require more care.

Here's what I would do.

Consider either renting out the condo (it's a good renters market and you can get a property management company to handle the whole thing for a cut of the rent). That might bring in $2-4K a month, giving their income a boost up. Or sell the condo if the market is still good and get the money into bonds/CDs and get some income coming in with the proceeds.

Find a nice apartment where they would have no maintenance worries and where the cost is probably 5 times less than AL. Keep the home health care and just up the hours. Your parents will require someone there all the time eventually. An AL is not going to provide them with that. An AL will have maybe 50 residents with 1-3 caregivers. They won't be getting the care they need. They will with home health care. I've had to hire home health care in addition to the little support mom gets from AL, so we're moving out. An apartment and home health care is about $40-50K less a year than AL.

You look for ways to have their money make money. You also look for a ton of ways to save them money. I've been able to reduce my mom's expenses by about $1,000 a month. She doesn't need the ultra expensive diapers, and if I buy them in bulk, I save, a ton of money. We cut cable and went with streaming services that offer their same favorite programs. Coupons! It's amazing what you can do to save money.

You should not go back to work for your parents. There's ways to make that money stretch and work to cover expenses. AL is not one of them.

First off, know that they are far better prepared than most financially. Second, I strongly feel that no one should have to pick up the cost of care for their parents or anyone else for that matter because that will put you in a bad place when you need care. And finally, once their finances are completely tapped out they can get help from Medicaid to help with the costs.

Sorry you are having to deal with this. This journey with elderly parents is often highly complex and emotionally draining. The good news is, it sounds like your parents have some assets that will help.

First step, IMHO others have said, is find a good elder care attorney licensed in your state (you said you live in the DMV area, but the attorney should be licensed to practice where your parents live currently as each state has different legal aspects of all of this). Your parents should pay for the lawyer. For reference, about 2 years ago when dealing with a similar situation, the lawyer we found in MD charged $7 as a flat fee. Another reputable firm I contacted asked for $12K as the flat fee.

Many legal steps may be need to be completed, such as executing durable Power of Attorney (POA) docs if they do not already exist with you and or other siblings having it. Also "Advance Directive" or "Medical Agent" documents to allow you to serve as your parent's "agent" in dealing with any assistive living, nursing or memory care facilities as time goes on AND to make medical decisions on their behalf if they cannot make such decisions. Obviously Wills, Trusts or any other legal structures to protect either parent when the other passes or is not competent or both are not competent to make decisions.

You may be able to get them into what are called "continuum of care" facilities, but honestly they may be a bit on the older side for that. Most of these facilities prefer two healthy and independent seniors when first entering. These facilities have a large up front fee (often $100K) AND one has to buy a unit. Units may be huge, 3 bed 2 bath down to studio sizes. Typically, folks sell their home and roll over those proceeds to do this, to pay the up front fee and to buy their unit. The facility then guarantees as the folks need more services including up to full on memory care or nursing care; they are guaranteed a bed at the facility. But again, many want folks to "enter" when both are independent and healthy. You can check with a few places or there are services that can help ID them and the elder care lawyer might have suggestions too re: which facilities might consider taking them both.

Other than "continuum of care" facilities which have from independent living arrangements, to assistive living arrangements (which might include a menu of additional services such as "medication management," "help with dressing/bathing," "house cleaning" etc.), to licensed nursing and/or memory care all in one place and ALL licensed for each; others are generally all separate. In other words, most assistive living facilities will NOT have licensed nursing home care (which is regulated/licensed by the federal government and qualified by Medicare and Medicaid and requires things such as RNs all the time). Assistive living is regulated and licensed by each State and many are NOT Medicare nor Medicaid qualified. In such assistive living facilities, one is entirely private pay and when one runs out of money; the love one has to be moved to a different facility that is Medicare/Medicaid qualified. Some assistive living facilities have memory care, others do not.

Given the age of your parents and that dementia is already an issue, IMHO looking for a facility that has Medicare and Medicaid qualified nursing home AND memory care beds would be best. They could go in as private pay (facilities like that) and with LTC insurance, that is another plus for the facility. Sadly, given mom has dementia and likely needs memory care; they may separate them. But your dad can go visit. All things to ask about.

Generally, the pattern is folks "spend down" all their assets (spousal impoverishment rules can protect one spouse, but it sounds like your dad cannot remain in their condo and live independently so this may be moot). Medicaid can pay once the asset limit ($2.5K in total assets, for MD but VA or DC may be different) is reached.

Unless someone currently has around $3 to $5 million in assets, it's likely his money will run out. Depends on how long someone requires higher level long-term care. Elder care attorney is advised.

Just in my own experience...there are options however I've learned that they will get your money no matter what...if AL is your choice you'll pay out of pocket, if skilled is your choice I would assume their Long Term Care ins. would kick in...I don't know how your parents have their assets set up but look into an irrevocable trust or have them relinquish all their assets to you to protect it...again I don't know the history but everything I have been through with my mother as long as I keep her out of a nursing home her assets are protected...I'll be honest I refuse to give my mother's hard earned money to a nursing home...we've spent our lives working our butts off so that we are cared for and they still take all your money...which ever direction you go protect what they've worked for...I am in the process of moving my mom out of her home and into an apartment...I don't know if paying for in home care will be okay or not but I refuse to pay for nursing home care...I'm sure you know most of this and any advice you can offer would be appreciated as well...just protect them and what they've worked for...take care

In DC area, check out costs of facilities in the outlying area, may be a bit less that DC / Bethesda / Chevy Chase. My mother is in memory care in Olney. You can hardly throw a rock in that town without hitting a care facility. Lots of choices are out there. But direct care staff will be immigrants who struggle with written and spoken English, leading to lots of communication problems, and who are generally exhausted during their day shift because they have an overnight shift at someone's home. Even direct care care staff with some type of nursing qualification are not guaranteed to understand what they read on a simple medical test report, and they do not understand literally half of what they hear in spoken English. They will never admit any of their deficits in reading, writing, and hearing English. Their first strategy to avoid revealing their deficits is to get angry at you for asking questions!

Go sit with an Elder Care attorney and get some answers. If I were you, I wouldn't worry. With their income AND $700k in assets, with dad being 92 and mom 82 with dementia at play, they have plenty of money to last them in Memory Care Assisted Living for the rest of their lives. My mother lasted for just under 3 yrs with vascular dementia in Memory Care Assisted Living at $6800 a month which included everything but incontinence supplies, doctor copays and meds which added up to about $300 a month more. Find a memory care facility for mom that's all inclusive and doesn't keep padding the bill every month as they see fit. And remember that Medicare is capped at certain amounts for out of pocket payments. PLUS they have LTC insurance which my folks did not have, a pension which my folks did not have....all they had was Social Security and VA Aid and Attendance benefits of $2032 a month while dad was alive, then $1091 for just mom, plus savings of about $400k. Their monthly income was $1100 not including Aid and Attendance....so nothing. Meaning I made their savings last 8 years plus before mom died at 95 and dad at 92. Vascular dementia normally has about a 5 year lifespan to it.

I tell you all this to say.....don't worry. See the EC attorney. He'll set you straight about Medicaid in your state SHOULD the need arise for you to apply for it for long term care for mom. I had the app ready to go for my mom, and a SNF picked out too, but she passed before her funds ran out. There was NO WAY I was going back to work to fund her extreme old age in long term care, and neither should you. And with their funds, you shouldn't have to even consider it.

Take your wife with you to the attorney visit and set both of your minds at ease. No point borrowing trouble. Good luck.

Nova, you are right to be questioning their ability to get Medicaid. Not everyone qualifies, not all income can go into a Qualified Income Trust aka Miller Trust and not all states allow a QIT.

From what you have shared, an AL may be a very short stop gap. Change can cause a sudden drop in ability when dementia is involved, moving your parents could very well increase their care needs.

I was faced with a similar financial situation for my dad, except, he couldn't afford to set up a Miller Trust, see a CELA or afford a nice facility and had no insurance. I looked outside the box and found board and care homes. They don't offer all the amenities and activities of large facilities but, my dad wouldn't use that stuff anyways. Some of them keep the residents through hospice, they are prepared for care needs increase, if you choose the right facility.

I would not go back to work to cover their expenses. I would look around, even into different states and find the best facility that meets their actual needs and can keep them together or as together as possible. Enrichment activities are cheaper on an as needed basis, so forget about in house, unless your parents are social butterflies and will be utilizing these services daily.

You are really fortunate that they have a decent income, insurance and some assets. You don't have to worry for years or ever, if you can find a facility even outside their area that can accommodate increased care needs, at a more reasonable price, right through hospice. (It is important to verify that ANY facility will accept hospice, not all do.) When a facility becomes a reality, location isn't as important, because their world will largely exist within the facililty and you can create excitement about new adventures outside the home.

Tell your wife that worrying won't change anything except her health, so try not to. Your parents really are positioned okay with some creative solutions.

Novaman, I also live in your area where we thankfully have many choices of senior living available. I am shocked to hear that rentals in senior facilities have gone up that much compared to what my Dad was paying just a mere 4 years ago.

When my Mom needed to go into a nursing home, Dad hired 3 shifts of caregivers for himself as he couldn't live alone in his house. The caregivers were costing him $20k per month. The nursing home was costing $12k per month. Big bite out of the financial pie.

After Mom passed, Dad did the math and noticed it was quite a cost savings to move into a senior facility. He started out in Independent Living full size apartment then moved to Memory Care at the same facility.

Since I was Dad's Power of Attorney for both health and finances, I was able to see how much my parents had saved over the years. They were the children of the Great Depression so they lived well below their means. Thank goodness they did. They saved for that rainy day, and now it was pouring outside.

I, too, was always worrying if Dad would run out of money depending on how long he would live. Dad was already in his mid 90's. In the back of my mind, I knew that there was Medicaid [which is different from Medicare] if Dad should need it. I didn't know if the facility would even take Medicaid. Dad had passed a couple years later. Thankfully he and Mom had their Wills updated at my stern request, as the old Wills were older than dirt, and would have been a logistical nightmare. Plus they had prepared a current Revocable Trust. If you need an Elder Law Attorney, I can highly recommend a firm on Wiehle Ave in your area.

There are Miller Trusts in some States called Qualifying Income Trusts. You need to find out if Medicaid allows them in your State. In my State the monthly income cap is just over $2300. So if my total monthly income was $3000, I would need to set up a trust and have the access put there. When the person passes, that Trust reverts back to Medicaid.

What you also need to find out is if Medicaid will pay after at least 2 years of paying privately in an AL. Your parents assets should be split. Each spending down their half and when the money is gone, then Medicaid is applied for.

I think in your situation seeing an Elder Lawyer well versed in Medicaid would be a good idea. You can use parents money for this. You want to make sure you do nothing that will jeopardize your parents from getting Medicaid eventually.

Thanks for the responses. One thing that confuses me is how my parents could possibly qualify for Medicaid once their assets are depleted considering their pension income which exceeds the Medicaid qualifying income levels. I’ve done some reading about the matter and attorneys speak of creative tricks using trusts and income diversion but I just don’t see how it is possible with a pension check that is written to my dad.

Many of us recommend finding an assisted living facility that also has a SNF wing that one can transition to when needed and that will take Medicaid when the funds run out. That is the normal progression; liquidate the assets, buy into assisted living, transition to skilled nursing when needed and finally go on Medicaid when the money is depleted. Most of us don't recommend children funding their parent's assisted living unless they can comfortable afford it. Remember, you need to start saving for your elder years.

Look for facilities that also have "Medicaid beds" once someone is "private pay" for several years if there comes a time when they have to apply for Medicaid the facility will often keep them as a resident. If the facility you chose does not accept Medicaid you would then have to find another place and being on a waiting list for Medicaid beds can be long.
If either becomes eligible for Hospice that can help. Hospice will provide all the supplies and equipment needed. It will not pay for the facility they are living in but some other costs are absorbed. And you get another set of eyes looking in on them (also the Hospice CNA does not duplicate what the facility does, if the Hospice CNA is bathing mom or dad the facility staff will not)
It sounds like you have things planned out, a discussion with an Elder Care Attorney might be good just to make sure there is nothing that you might have over looked or not known about.
I am sure you will get a few much more detailed responses very soon....