Urgent help needed on nursing home costs

[ilovedolphins]

I am to the point where I may have to think about putting my dad in a nursing home.  I know nothing about the costs, what assets they can have if my mom is still living in their house, etc.

Does anyone have any experience with admitting a parent to the nursing home?

[bobosensei]

no experience with this, but just wanted to say take care of yourself.  If there are any specific nursing homes you have in mind perhaps they have information online?

[Blonde Granny]

I parents can't provide self pay for a nursing home, your only option will likely be MediCAID. Each state has it's own laws and requirements regarding Medicaid.

With my Mom, we contacted the state offices that dealt with Medicaid, or you can find a certified Elder Law attorney who can & will walk you through the entire thing. Just be aware, regarding any money your parents may have, there will be a 3 to 5 year look back on their spending.

This is not a "DIY" situation....best of luck, I know how difficult this all can be.

[NomoreDramaQ1015]

What about A Place for Mom?   According to their commercials they are supposed to have trained staff to help you navigate finding a place.  I'd try that and see if they can help you get started.

[hoops902]

Jul 2, 2019 0:28:12 GMT -5 ilovedolphins said:

I am to the point where I may have to think about putting my dad in a nursing home.  I know nothing about the costs, what assets they can have if my mom is still living in their house, etc.

Does anyone have any experience with admitting a parent to the nursing home?

You need to try to separate out two things.  1.  The nursing home.  2.  Social programs that help pay for things like this.

Your mom can have any assets she wants still living in her house in terms of specifically the nursing home.  The nursing home doesn't care, they care about getting paid.

Your mom may have some kind of asset limits to get on Medicaid, which often helps pay for nursing home care for those who need financial assistance.

If you know where you want your dad to go, go talk to them.  They almost definitely have someone who understands a lot of this stuff already.  We had to put my dad in a nursing home for some assisted living/hospice, they had a person on staff (in a very small town even) who knew this stuff.  They cared about income and assets a BIT, but just to ensure we could pay for his care since we weren't going through Medicaid.  

The answers to things like financials is going to be wholly dependent upon whether he is on Medicaid, and that's an issue whether he's in a nursing home or not.  Don't intermingle the 2 ideas any more than you have to.  The first step is probably to figure out where you'd like him to go if you have a preference...we did because there's a nursing home in a our small town and it was a lot more convenient to have him close.  Next step was going to talk to them and letting them help figure that stuff out.

[countrygirl2]

Don't try moving assets to save them, you are to late.  They will look back 3 to 5 years depending on state. 

Is he a veteran? I got help for MIL but took over a year, but now she gets $1100 a month toward her assisted living.  One problem if they have Medicaid they cannot get help from VA.  It's now a 3 year look back and I believe their house can't be worth more then $80k.  If he has health insurance don't drop it yet, wait on Medicaid. Contact your local VA rep, should be one in your city that can help you understand if he is eligible for any benefits.  They need to only serve 1 day in a combat zone to be eligible.

The nursing homes can help you a lot with this, but an elder care attorney can too that's who I went too.
Also if your dad is ill its easier to transition from a hospital setting to a nursing home.  If he is admitted for more then 3 days, then he can be moved to a nursing home and have 90 days of coverage under medicare, but that's all.  They DO NOT pay for a nursing home, that just helps them transition into Medicaid if he can get it.

An attorney is your best bet, there are so many missteps you can take that will cost you so navigate it carefully.  

[Tiny]

Hospitals usually have social workers who are there to help facilitate the movement from hospital to nursing home. Check with the doctors handling your dad's medical needs - they may be able to get you to the hospital staff who can help you -even without your dad being in the hospital.

[garion2003]

I was looking at assisted living options for my parents. For basic (albeit VERY nice) the cost for a couple was $6,500 and up. They don't have that kind of income (and never did).

In my state (MA) there is a program called PACE (Program of All Inclusive Care for Elderly) and with certain income requirements the costs may be covered. Since they don't look at joint assets, we believe my mom can qualify now. So we are just starting the process. I believe if she qualifies she can get some in home services which may be all she needs for now. Hopefully they will also assist in the transition as she needs more and more care.

Totally agree about the lookback period for other programs. We will be meeting with an elder law attorney soon. My town has an elder services agency which came out to the house and gave them some good info. They actually gave a "referral' to an elder law agency that will do a free consultation.

Good luck to you!

[The Walk of the Penguin Mich]

I can tell you that the month of rehab that I had several years ago was also a nursing home.  I was told that the room rates were $300/day.  This was a full service nursing home in an expensive city.  That might give you a ballpark.

[garion2003]

The assisted living facility I just toured offers "respite" options, basically you can rent a room on a short term basis. She had one guy staying a week, and on person staying 4 months. The cost? Only $275 per night! But I think it included all meals and activities.

[Deleted]

The only info I have was my experience with Medicaid and my late-DH.

If someone goes into care under Medicaid, they find a bed wherever they can and that's what they will pay for. Period.

They were sending my DH to somewhere in rural NV because there were no beds in CA. 

[busymom]

I'd be willing to throw some numbers at you, but then the cost of a nursing home depends on the region of the country you're in, and how much assistance the resident needs each day (are they in a wheelchair, etc...).  The full price, per month, of the nursing home one of my relatives is currently staying in, is $7,921 each month (this is someone who needs quite a bit of help).  This is a Midwestern, mid-priced nursing home.  Now, this is someone who has no assets, so, the county takes the majority of his SS check each month, leaving him with a small amount for everyday stuff, like telephone service, or cable t.v.    Since your Mom is still living, and will be staying in the family home, I'm not sure how that plays out.  As others have already suggested, definitely talk to an attorney who specializes in Elder Care.


Best wishes!  I had to first move my Mom into assisted-living, and then as her health declined, into a nursing home.  It's truly a marathon, not just for the patient, but for the family.

[Blonde Granny]

I don't know about other states, but Nebraska has a Medicaid program called "Medicaid Waiver"" It is for people who can no longer live alone and on their own, but don't need the level of care as a nursing home. My Mom was granted the Waiver, she had $3k to her name and was moved into a beautiful AL facility when she was 92. The monthly cost was $3k, so my Mom paid that and on the 2nd month the state took over.

She received her Social Security, and out of that was able to keep $60 per month. She also paid for her MediCARE from that SS. The state then took over and paid the rest, including any drugs she might need.
When she was 99 (jan. 14, 2019) she was moved into another facility that was capable of giving her the level of care she then needed....again, the state paid for everything. At her death 2 weeks ago, she was receiving hospice ( paid by MediCARE.)

All this confusion is why I said you need someone in your corner who is capable of handling this for you and your family. This is not an easy situation to control let alone understand. And one simple mistake could end up to be very costly.

[countrygirl2]

Honestly, you are better off to have no money when you need care.  I don't know what your parents have but there will be spend down involved I would imagine.


Here we are fortunate, our assisted living runs around $3k a month including MIL's insurance premiums so between SS and VA she has enough to cover her.  We sold her car which gave us $10k more, we were about to run out and she got her $10k back VA pay.  So far she is getting enough to pay for her, here assisted living is all private pay, Medicaid doesn't pay for it varies from state to state.  I know in  Texas a nursing home for mom was around $6k a month.


Also you cannot just put someone in a nursing home, there has to be so many self care items they are no longer able to do.  They will evaluate them.  Hospital to nursing home is still the easiest.


There are to many variables state to state to be much help, an elder care attorney, Medicaid office, and social workers can guide you.  It's a cumbersome process, wish it were easier.

[happyhoix]

We were able to Mom the extra 1000 per month from the VA, which helped.

There's a difference between assisted living and full nursing home care, both in cost and amenities. If you have a facility near you that offers both options (some offer 3, independent living, assisted living, and nursing care) see if you can get an appointment for a tour. That would give you an idea of what type of facility would be best for your dad, and what the cost might be.

At the time when my Dad was going to go to an Alzheimers facility, my Mom was told she could keep her house, her car, but would have to spend down her savings until she got to 20,000 - then Medicare would kick in for my Dad. That was in Ohio, it's different in different states, so you should try to find an elder care attorney to help. We talked to two different ones, and it was very helpful.

For my mom, she had a pension, SS and the VA money that would have just barely covered a shared room at her assisted living facility, if her money had run out. They didn't accept medicare, though, so she would have had to move out if she couldn't cover the cost. As it turned out, she spent down her money but still had about 80K left when she died, so she had enough she was able to live out her days at a nice facility.

[hoops902]

Jul 2, 2019 12:49:37 GMT -5 countrygirl2 said:

Honestly, you are better off to have no money when you need care.  I don't know what your parents have but there will be spend down involved I would imagine.


Here we are fortunate, our assisted living runs around $3k a month including MIL's insurance premiums so between SS and VA she has enough to cover her.  We sold her car which gave us $10k more, we were about to run out and she got her $10k back VA pay.  So far she is getting enough to pay for her, here assisted living is all private pay, Medicaid doesn't pay for it varies from state to state.  I know in  Texas a nursing home for mom was around $6k a month.


Also you cannot just put someone in a nursing home, there has to be so many self care items they are no longer able to do.  They will evaluate them.  Hospital to nursing home is still the easiest.


There are to many variables state to state to be much help, an elder care attorney, Medicaid office, and social workers can guide you.  It's a cumbersome process, wish it were easier.

So I think I disagree, but would be interested in hearing the rationale.  My mom is getting older, why would she be better off having no money than a few million?

It's also a lot easier to get someone INTO a nursing home if you have some money and can choose, as many places won't take you off the street if you can't pay, but lots of places will let you stay once you're there and you switch to Medicaid while already in the facility.

[countrygirl2]

Because with no assets a person has no issue going on Medicaid, if you have some they will have you exhaust those before getting it.  Also going directly from a hospital in is easier.  

Sure hubs and I will have to pay, its hard to watch all your hard earned money go and the other person having to change their whole living situation in some cases. For mom we sold her car, then sold her house, then used up savings.  It was so hard on her to see everything she and dad had worked all their lives for disappear in short order. For a long time she thought she could get out and live again but she was constantly worried about losing her savings.  Yes, toward the end we got Medicaid maybe for a few months but all this took a real toll on her mentally.  

My MIL asks almost every visit do I have money left, she worries so about it.  These are not people with millions they are people with maybe a $100k or so, it doesn't last long.

If you have millions, well sure that is easy, but most older folks may have a $100k, a house, maybe not much else.  And spending down leaves the survivor in a weakened condition financially, they are the ones that suffer.

[hoops902]

Jul 2, 2019 13:58:17 GMT -5 countrygirl2 said:

Because with no assets a person has no issue going on Medicaid, if you have some they will have you exhaust those before getting it.  Also going directly from a hospital in is easier.  

Sure hubs and I will have to pay, its hard to watch all your hard earned money go and the other person having to change their whole living situation in some cases. For mom we sold her car, then sold her house, then used up savings.  It was so hard on her to see everything she and dad had worked all their lives for disappear in short order. For a long time she thought she could get out and live again but she was constantly worried about losing her savings.  Yes, toward the end we got Medicaid maybe for a few months but all this took a real toll on her mentally.  

My MIL asks almost every visit do I have money left, she worries so about it.  These are not people with millions they are people with maybe a $100k or so, it doesn't last long.

If you have millions, well sure that is easy, but most older folks may have a $100k, a house, maybe not much else.  And spending down leaves the survivor in a weakened condition financially, they are the ones that suffer.

But how are they weakened compared to if they started with nothing?  Yes spending down all your money leaves you in a weakened financial position, but having no money to begin with also puts you in a weakened financial position.  

And yes, a person with no assets has no issue going on Medicaid...they also won't have as many choices for a facility as someone who has money to spend on a facility and THEN go on Medicaid once they are there for a while.

[countrygirl2]

The survivor is the one that will suffer, they will take his SS, so wife will lose that, then a lot of their money.  The nursing home person is ok but the spouse isn't.

[hoops902]

Jul 2, 2019 14:09:58 GMT -5 countrygirl2 said:

The survivor is the one that will suffer, they will take his SS, so wife will lose that, then a lot of their money.  The nursing home person is ok but the spouse isn't.

Maybe I'm just misunderstanding what you're saying.  Are you saying it's better to pre-know which person is going to need care and then move all the money into the healthy spouse's name far enough ahead of time that they end up with plenty of money and the person who is going to need care has nothing?  I agree with that, but that seems both obvious and practically somewhat difficult to look ahead that far for most folks.

If we're talking about the couple as a whole though, it's still much better to have money and then spend it down to X than to start with less than X in the first place.

[countrygirl2]

You can't move money to the spouses name, wont' do any good. might work if they got a divorce over 5 years before otherwise they will get it. If  you move it, Medicaid if you qualify, will just make you spend down whatever amount they require before they are eligible.  You can't have more then $2k in Indiana plus own a car and a house I believe, so its not a slam dunk to get it.

Oh sure if you have lots of money of course that is ideal


MIL will eventually get Medicaid, she has $10k left.  Once she goes in a nursing facility that will go in about a month and a half, then her only recourse is Medicaid.


They do have a familial support law in Indiana, they can go  after the family for money.  I haven't heard of it being done yet but I'm sure they will in time. so they will clean out the poor souls needing care then clean out the family too.  Will push everyone on Medicaid eventually I suppose and clean out the families assets too.  

[hoops902]

Jul 2, 2019 14:57:16 GMT -5 countrygirl2 said:

You can't move money to the spouses name, wont' do any good. might work if they got a divorce over 5 years before otherwise they will get it. If  you move it, Medicaid if you qualify, will just make you spend down whatever amount they require before they are eligible.  You can't have more then $2k in Indiana plus own a car and a house I believe, so its not a slam dunk to get it.

Oh sure if you have lots of money of course that is ideal


MIL will eventually get Medicaid, she has $10k left.  Once she goes in a nursing facility that will go in about a month and a half, then her only recourse is Medicaid.


They do have a familial support law in Indiana, they can go  after the family for money.  I haven't heard of it being done yet but I'm sure they will in time. so they will clean out the poor souls needing care then clean out the family too.  Will push everyone on Medicaid eventually I suppose and clean out the families assets too.  

That's why I'm not understanding what you're saying.  All of the stuff you're saying is based on the healthy spouse being in a bad position, and the idea that you're better off not having any money to begin with.  But with spend-down, you're in the same position either way, so what's the advantage of having no money to start with?

Using your example from Indiana.  How are you in a better position having $2k/car/house than you are having $100k/car/house?  Yes, you will have to spend $98k on the nursing home to get down to Medicaid standards.  I fail to see how you're better off  just having no money to begin with though, particularly when you consider that having the $98k might give you some options on facilities you otherwise wouldn't.  How are you "better off" having nothing?

[Deleted]

I think the point is the person left behind will be left with no savings and a decreased income forever. Try re-roofing that house if you can only have $2K in the bank because your ill spouse needs care. People have no idea what that becomes. 

The person needing care will get it either way, and the spouse gets completely screwed in the process. 

[countrygirl2]

You got it.  It bankrupts basically those left behind.  And its generally when they both are old and vulnerable and can't do anything about it.

None of it is ideal, its just if they have nothing much to begin with, they at least don't have to see it all go.  May put the survivor on food stamps or even if they can keep their house may require them to sell it to live.  I'm not sure if they can and not have to give more to the ill spouse or not.  Again all that varies state to state. I just know it makes hard times for other then very wealthy people.

[hoops902]

Jul 2, 2019 15:20:37 GMT -5 @rockhounder said:

I think the point is the person left behind will be left with no savings and a decreased income forever. Try re-roofing that house if you can only have $2K in the bank because your ill spouse needs care. People have no idea what that becomes. 

The person needing care will get it either way, and the spouse gets completely screwed in the process. 

Yes, all this is true.  My question is...How is it BETTER to have nothing to begin with?

The statement I'm questioning is this:

::Honestly, you are better off to have no money when you need care.::

I get why having a little money means you're eventually going to have no money after the spend-down.  

If we consider that statement to be objectively false in that, actually, you're better off having a LOT of money when you need care...that's fine, that's been acknowledged.

I'm failing to understand why you're "better off" having $2k than $200k when you need care.  That 200k is going to get spent down to 2k eventually, but what is the advantage of starting with 2k in the first place?  If you have 200k, you can reroof that house now seeing what is coming down the road.  If you have no money to begin with, you're in bad shape regardless.

It's not a question of "you're going to be in bad shape because you have to spend it down", my question is why it's better to simply start with nothing to begin with?

[CCL]

Jul 2, 2019 12:11:45 GMT -5 @rockhounder said:

The only info I have was my experience with Medicaid and my late-DH.

If someone goes into care under Medicaid, they find a bed wherever they can and that's what they will pay for. Period.

They were sending my DH to somewhere in rural NV because there were no beds in CA. 

Agree. They may move them at some point, too.

[happyhoix]

Jul 2, 2019 15:20:37 GMT -5 @rockhounder said:

I think the point is the person left behind will be left with no savings and a decreased income forever. Try re-roofing that house if you can only have $2K in the bank because your ill spouse needs care. People have no idea what that becomes. 

The person needing care will get it either way, and the spouse gets completely screwed in the process. 

This is an issue that is only going to get worse, as more people develop Alzheimers as they age, and need a higher level of care for the last years of their life.

My mom died from dementia and lived in a memory care assisted living facility the last five years of her life. We were happy she had enough of a nest egg she could afford a nice facility (facilities that accept medicare only patients around here are not nearly as nice) but she was paying about 5000 - 6000 per month and she did end up spending down almost all her money. If my dad had survived her he would have been broke.

 

[azucena]

I'm far from needing care for myself and hopefully my mom has a ways to go, so I probably shouldn't comment but I'm curious.  I was under the impression that you could pay a one time premium to buy your way into a continuing care retirement community (CCRC).  That premium would be based on age, gender, health - underlying it is an actuarial calculation of life expectancy - and would be in the hundreds of thousands of dollars per person.  These types of facilities have independent living, assisted living, and some have memory care and the premium covers your transition from one type of care to another.  The facility takes care of all day to day living expenses and maybe leaves some out of pocket medical care.  So say my DH and I retire at 65 with $2M, we live on $1M for 10 yrs and then at 75 buy into a CCRC with most of the remaining $1M.  If a couple moves into one together wouldn't that take care of leaving one spouse destitute?

Rockhounder and countrygirl are two of my favorite posters mostly because I learn so much from their very different life experiences.  Rockhounder's situation is at one extreme, and I'm proud to watch her work her way upward, and I'm rooting for her every step of the way. 

Countrygirl is another extreme.  And while yes, it must be difficult to spend down life savings - in my opinion, that's what it's there for.  I empathize with her concern for her daughter's care and well-being which clearly complicates retirement for countrygirl.  I also think CG herself is of the generational mindset that family is supposed to care for family.  So in an ideal world, her DS might step in and provide some form of eldercare like CG did for her own mom unless/until care becomes too complicated.  But, since CG has been a long term caregiver herself and is an extremely kind soul, she would never ask her son to do that for her.  So she's left worrying for her future, her DH, and her DD and clearly she's a planner so the unknown really bothers her.  Watching her worry grow these last few months has been troublesome to me, and I wish she would trust a bit more in the preparing and saving that she and her DH have done through the years.

Anyway, that's my two cents.

[Deleted]

Jul 3, 2019 7:16:35 GMT -5 happyhoix said:

Jul 2, 2019 15:20:37 GMT -5 @rockhounder said:

I think the point is the person left behind will be left with no savings and a decreased income forever. Try re-roofing that house if you can only have $2K in the bank because your ill spouse needs care. People have no idea what that becomes. 

The person needing care will get it either way, and the spouse gets completely screwed in the process. 

This is an issue that is only going to get worse, as more people develop Alzheimers as they age, and need a higher level of care for the last years of their life.

My mom died from dementia and lived in a memory care assisted living facility the last five years of her life. We were happy she had enough of a nest egg she could afford a nice facility (facilities that accept medicare only patients around here are not nearly as nice) but she was paying about 5000 - 6000 per month and she did end up spending down almost all her money. If my dad had survived her he would have been broke.

 

After watching my late husband's battles with being terminally ill, I won't hang around long enough to end up in the old people's warehouse of horrors. I value quality of life over everything else in life and when it's gone, so am I. 

[Deleted]

Jul 3, 2019 9:45:23 GMT -5 azucena said:

Rockhounder and countrygirl are two of my favorite posters mostly because I learn so much from their very different life experiences.  Rockhounder's situation is at one extreme, and I'm proud to watch her work her way upward, and I'm rooting for her every step of the way. 

  I empathize with her concern for her daughter's care and well-being which clearly complicates retirement for countrygirl.  I also think CG herself is of the generational mindset that family is supposed to care for family.  So in an ideal world, her DS might step in and provide some form of eldercare like CG did for her own mom unless/until care becomes too complicated.  But, since CG has been a long term caregiver herself and is an extremely kind soul, she would never ask her son to do that for her.  So she's left worrying for her future, her DH, and her DD and clearly she's a planner so the unknown really bothers her.  Watching her worry grow these last few months has been troublesome to me, and I wish she would trust a bit more in the preparing and saving that she and her DH have done through the years.

Thank you. 

The thing I don't think most people realize is how financially devastating illness is, even when you are working and making good money.

Before my DH's first massive leg infection that left him disabled, we were both making 50K+ a year. I was only in my late-20s and worked my way into a tech job with Kaiser. My DH was running an auto center. We had two toddlers. He spent 8 weeks in ICU alone that first time.

I had to leave my job about two years later because we had to move because we couldn't support a family of 4 on SSDI plus just my income and I kept missing work to drag him to appts and surgeries...

Our house payment for a home in the ghetto was more than DH's SSDI income and he was unable to watch the kids, so we also had to pay childcare.

The suggestion was always family should help us watch the kids, etc... so I could work. Every.single.family member we had was already working full time and none lived close to us. And, we couldn't afford to move closer.

My mom is really struggling now because when my step-father passed a couple years ago she lost 2/3rds of her income. Her house is costing a fortune in repairs and her income just can't keep up.

It seriously sucks that she had to give up a 100K+ job to take care of her DH and now she lives a much reduced lifestyle due to lack of funds. And, now she feels too old to go back to working. 

While I agree with spending down assets, it's very hard to live with less than 2K in savings and own a home. I want to sell my $160-180K house and buy something for less than half. While this is completely doable where I want to move and would give me a better vehicle and savings again, it would also mean no access to healthcare.