Considering assisted living for my mom

[disneysteve]

My mom is nearly 92 and is slowly failing. She has lived independently her whole life but we really don't feel that's ideal at this point. She's having more and more trouble with things. Of course, she denies it and doesn't feel she needs any help. We did just hire an aid for 4 hours a week and that's been a struggle, but she's slowly getting used to it. We haven't raised the topic of moving to a place with a higher level of care but that conversation is going to happen eventually.

My wife and I went to check out a well-regarded assisted living community yesterday. The place is very nice and very well run. The apartment she'd have there isn't as large as her current one but I don't think that's a deal breaker.

The tough parts would be two things. The apartments don't have kitchens. They just have a small fridge/freezer and a microwave. No stove or oven. My mother loves to cook and bake. Residents get 3 full meals a day in the dining room (and a couple of more casual locations).

Of course the biggest obstacle is cost. It would run over $10,000/month. Her SS would cover part of that. I'm checking on if her long term care policy would pay the daily benefit 7 days/wk if she were to go there. If so, SS and LTC would cover almost half of the cost leaving her to pay $5-6,000/month. She has enough in savings to cover that for about 5 years which would take her to 97. If she's still with us at that point, she would have to apply for Medicaid and move to their smallest studio apartment (unless we were in a position to supplement to keep her in a larger one).

It's so hard to even raise the topic with her because I know she'll get upset and resist the idea that she needs any help.

Have any of you gone through that process with your loved ones?

[srblanco7]

My father in law had dementia and we had to put him into a long term care facility once the family could no longer take care of him. We used his available savings to fund the first few months of his care, and then transferred him to a medicare room at the same facility. He was there for a few years before he passed. Not the nicest facility but it was clean and he was reasonably well cared for.

[kork13]

My grandmother is about 94 right now (I forget exactly), and a couple years ago had most of one leg amputated due to a flesh-eating bacteria following melanoma treatment. Her mother lived to over 100y/o, and while a little frail & now reliant on a wheelchair (still learning to walk on her prosthesis), she remains competent & capable. We expect that she could easily live for as much as another decade.

Her children (my father & aunts) are doing everything they can to help her still live somewhat independent in her small home -- they renovated to account for wheelchair mobility, and one aunt moved in with her to help, and I think they have a medical assistant who comes by sometimes. But even doing those things was a challenge for Grandma to accept, and it took all three of her kids more or less throwing an intervention to highlight her capabilities, limitations, and finances.

I don't know when she'll need to transition to a full-time assistance home, but I wouldn't be surprised for that time to come within a few years. I expect she'll resist the move, but it'll likely be driven by my aunt no longer being able to be her near full-time care taker.

I don't know the full state of her finances, though she obviously has SS, plus a decent LTC policy that's already being put to use, along with some measure of savings that may be starting to dwindle (judging from the concerns from my father about done of her expenditures, like mailing literally dozens of letters to family & friends every month -- they finally talked her into starting a blog instead).

I can't really offer much advice, but only an observation: Aging & recognizing that you're no longer independent is a really hard thing for people to accept. The more open your discussion can be, and keeping her involved in the decision making, and respecting her feelings of loss throughout the process.... That will make it easier for her to accept what will almost certainly be a painful/upsetting transition for her.

[Fishindude77]

Been there, done that.
We went through the progression of Mom failing; gave up the car, sold the house, moved into apartment, couldn't take care of apartment or self so had care takers coming in, a couple falls and EMT visits, eventually to a nursing home that took great care of her as far as I'm concerned.
Her biggest beef with the place was that she had a shared room since medicare was paying. Her mind was still pretty good, but body was shot (smoker), stayed about 3-4 years in the nursing home.

What you are dealing with is no fun at all, but your Mom is lucky to have you taking care of things.
Good luck with this.

[disneysteve]

Her biggest beef with the place was that she had a shared room since medicare was paying.

One really nice thing about the place we just looked at is even when they go on Medicaid (not Medicare), they still have a private room. It's small but private with no shared bathroom. Basically like a large dorm room or a small budget hotel room.

[jenn_jenn]

My grandfather was in assisted living for a couple of years before his death. I don’t know the financial details other than it was expensive but my mom thought it was worth every penny.

My grandfather initially didn’t want to move into an assisted care facility. My mom started taking him there once a week to play cards “just to get a feel for the place” and then he became more open to the idea and eventually moved in.

I used to work as a waitress at an assisted living home in high school. It was a great first job and a popular one for high school students in the area. We basically had an extra 30 grandparents and I think the residents enjoyed having us around too. They always wanted to know the latest teenage gossip and events going on in our lives. We frequently had potential residents join in on activities. Maybe that’s something you can check if the facility you’re looking at will allow and help your mom with the transition?

[disneysteve]

That’s a great idea jenn_jenn.

[Snydley]

My mom is nearly 92 and is slowly failing. She has lived independently her whole life but we really don't feel that's ideal at this point. She's having more and more trouble with things. Of course, she denies it and doesn't feel she needs any help.

I can relate. My dad is 77 and failing as well. What amazes me is his complete denial. He keeps bringing his cell phone to verizon because it's not 'working right'. He says his eyes are getting worse and worse and every time he goes to the eye Dr. they say his vision is fine. He's gone to multiple doctors at this point for his vision; I realized he is just not accepting that his vision is fine for a 77 year old! Also, his filter is basically gone, and he's a real jerk to people. He's having other issues as well he will.not.acknowledge.

He's got a nice pension and a ton of debt and zero net worth, so I'm thinking maybe we could work with an elder care lawyer and he could ultimately just let his credit go, not pay the debt, and use the pension to pay for a decent assisted living place when needed (which could be soon). However, I don't think he'll ever agree to it. Something bad will likely happen, but he won't let me help and it's his choice ultimately. Sucks.

[ua_guy]

I've been part of the discussions and logistics moving various sets of grandparents into facilities and none of it is easy. My mom's family did it the best. Grandma lived independently until 90 and then needed to go to a memory care facility. They involved her in the tours of various places and let her give input. They hung on to her house for a while as she was very reluctant to give it up. They'd always go pick her up and have her over for dinner or do something on the weekends, go get her hair done, and a fair amount of visiting her at the facility itself. She just didn't want to feel alone there. My mom and others took turns being "on call" for the facility staff - they carried a phone, single point of contact. They'd also gather on a conference line periodically (my mom lived out of state, and some of the other siblings were a couple of hours away) to review finances and discuss topics about her care, make decisions, come up with options, etc. She had a lot of love and support.

I'm having to have gentle conversations with my own parents, and my husband with his dad. Both sets of parents are approaching decision points. My parents are still in a huge multi-level house with a big yard. My FIL is on rural property in Idaho (lots of snow) and needs new knees. We keep nudging....what's next?...Where do you want to be?...We want them to be where they want to be, but remind them that "later" is coming and we need to start planning and coming up with goals now. My folks wanted to be in their current place 7-10 years, and we've passed the 10 year mark. My FIL said once his parents passed (now about 18 months ago) he'd like to move closer to civilization and maybe have his knees replaced. Nothing needs to be done right now/today, but we are trying to get them to take the next step...before they have to. None of them need supervision or care yet. There's another step or two before that. They need to downsize and live in places which are more manageable for them, are more accessible.

[riverwed070707]

I've given DD strict instructions that if/when I reach the point I'm not able to care for myself she is to take me to a beach and leave me there. Either I'll figure it out or I'll die and both scenarios are better than being in an assisted living facility or burdening my only child with my day-to-day care IMO. Probably an unpopular opinion but I side with all your parents/grandparents on this.

[QuarterMillionMan]

No one wants to be put in a SNF or assisted living facility. To me the answer is simple if one has the finances. Hire more in-home care and increase it from 4 hours to let's 10 hours. Keep increasing it to 24 hours if needed albeit if the funds are available. As a last result then a SNF or assisted living should be looked at.

[scfr]

I wish I could offer some help other than empathy, but my mom feels about her house the way Charlton Heston felt about his rifle.
Regarding the in-home aides, be prepared for turnover. My mom's change every few months.

[mumof2]

I'm just wondering if it is going to cost around $10,000 per month in assisted living wouldn't it be cheaper to get 24 hr care in her own home...you could put up cameras so you can keep an eye on what is going on...but I have to say putting my mom in assisted living would be the very last resort and that would only be if we couldn't take care of her..she is pretty independent at 83

[disneysteve]

I think several of you are confusing assisted living with a nursing home, which couldn't be farther from the truth. Nursing homes are typically akin to a hospital ward with a hall of rooms occupied by 2 patients and a central nursing station. At least around here at the places I'm familiar with, assisted living is a very nice upscale complex where residents live independently in their own apartments but there is care available onsite to whatever degree is needed. Meals are served in a nice dining room. There are all sorts of daily activities which are included in the monthly fee: a movie theater, exercise classes and a fitness center, arts and crafts, card games, speaker programs, a game room, etc. They have buses that takes residents shopping and provide transportation for medical visits. They run various trips. Monthly fee includes housekeeping services to clean your apartment, laundry service, and at the place we visited, 5 hours/week of personal care (assistance with bathing and such). This place is beautiful, opened 11 years ago. My wife and I were about ready to sign ourselves up once we saw the place. We would feel very good about moving her into a place like that. We know she'd be far happier and get far better care than where she is now living by herself, even with a paid aide coming in a few hours a week.

[riverwed070707]

I think several of you are confusing assisted living with a nursing home, which couldn't be farther from the truth. Nursing homes are typically akin to a hospital ward with a hall of rooms occupied by 2 patients and a central nursing station. At least around here at the places I'm familiar with, assisted living is a very nice upscale complex where residents live independently in their own apartments but there is care available onsite to whatever degree is needed. Meals are served in a nice dining room. There are all sorts of daily activities which are included in the monthly fee: a movie theater, exercise classes and a fitness center, arts and crafts, card games, speaker programs, a game room, etc. They have buses that takes residents shopping and provide transportation for medical visits. They run various trips. Monthly fee includes housekeeping services to clean your apartment, laundry service, and at the place we visited, 5 hours/week of personal care (assistance with bathing and such). This place is beautiful, opened 11 years ago. My wife and I were about ready to sign ourselves up once we saw the place. We would feel very good about moving her into a place like that. We know she'd be far happier and get far better care than where she is now living by herself, even with a paid aide coming in a few hours a week.

Not confused. You said in your OP she will get upset and resist the idea. Surely as a doctor you're keenly aware of the emotional toll losing your independence as you age can be. You said your mom loves to cook and bake and you're looking at places that don't have kitchens. Don't mean to be critical and I certainly don't envy the position you're in to have to navigate this, but if I put myself in mom's shoes, I can understand why that would be an uphill battle. I would think if this is inevitable, the best way you could approach would be to start having conversations with her now about what she wants for the future, what situations might trigger her to consider the need for assisted living and talk through pros and cons with her input. At minimum, is it an option to keep looking to find a place that has a kitchen so she doesn't have to give up something you know she loves?