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If you had the choice between using mom's funds to put her into an ALF (that offered care for dementia patients), with the understanding that her funds would be depleted in about 4 years, and she'd be transferred to a Medicaid facility until her death (which in the case of her mother was over 10 years)...or use a portion of her funds to build a small home on your property, (with the construction geared towards providing comfort and ease til her end of life at home), investing her remaining funds to continue to build equity and be able to provide hired home health care for her once it became necessary for 24/7 care, and become her caregiver, which would you choose? And why?

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It may sound strange coming from someone who has chosen to keep my mother with me in her final years, but I would choose the assistive living arrangement. The main reason for this is it would offer structure, socialization and activities to keep her interested in the world outside herself, whereas living in a separate granny flat would limit her world to you and whatever family would bother to visit. I've stated elsewhere that I think we made an error in not encouraging my mother to move to a more senior friendly environment when we lost my dad at 75 and she shortly after lost her ability to drive due to macular degeneration. I think the isolation contributed to her eventual decline.
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I agree with cwillie about the socialization benefits of assisted living. My mother is currently in an AL facility. I also question your calculations. My mother's AL facility costs about $40,000 per year, so four years would be $160,000. After building a small house on your property, and paying utilities, taxes, insurance and upkeep, how much would be left to pay for in-home care when it becomes necessary? 24/7 care at $20 per hour works out to over $14,000 per month. If Medicaid becomes necessary in the future, they may look at the cost of the little house as a gift to you that increased the value of your property.
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Facilities by me for memory units start at around $4,000 per month. Based on her current financial status, that will last her a Max 5 years, and when her money is gone, it's gone. To be more specific, night nurses would need to be hired, someone would be home with her at other times. She has stated, vehemently over the years that she does Not want to spend even one night in a nursing home, however if she moved into AL, that's where she will end up. She is to the point where she has given up 99% of her social life already, so not sure what benefit sitting in a studio apartment will be in an AL?
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The better ALs have daily activities, and make a good effort to get the residents involved. My mom's AL has music programs or sing-alongs a couple of times each week, BINGO, Wii bowling, art activities, cooking activities, sitting exercise classes, card games, puzzles, church services and a daily "walking club". My mom cannot remember when any or these things happen, but the staff goes to her room to remind her and take her to the activities. It is far more stimulation than I could provide if she was living with me. If you are looking at facilities, ask to see the activity calendar and ask if they will encourage your mom to participate.
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I too wonder about the practicality/legal implications of building a second home on your property. Where I live the municipality would not allow us to put up a second home, although semi permanent structures (trailers) can get approval, but they have to be removed when the occupant moves away. And a totally separate home means she would essentially be living alone, even if your are right next door. When the time comes that she needs more help you would have to be in charge of the upkeep of two homes, as well as helping with ADLs. Realistically even those on hospice are not getting 24/7 help, and to private pay that level of care would be crazy expensive.
Why not opt for an addition to create an apartment in your own home and charging your mom a reasonable amount of rent as compensation?
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If I had a choice for my parents I would choose some type of retirement facility, that way my parents would be around people of their own age group.... there would be meals in the main dining room..... the facility would offer transportation to doctor/dentist/hearing aid/you name it..... and there would be employees and caregivers around the clock to check in on them should the need arise. Plus quick access to local EMT's and a quick trip to the hospital.

As of last month my parents were in their own home, alone, with Mom trying to do all the cooking, cleaning, laundry at 97 years old, she refused any type of outside help be it caregivers or cleaning people. With her stubbornness came falling. The last fall was very serious and she is now in long term care.

Dad now has 24-hour caregivers at my parent's home because he is a fall risk. I am a senior myself so I am limited on what I can do. It is costing Dad $20,000 a month for licensed bonded caregivers from an agency. If I had hired independent contractors, my Dad's home insurance would need a workman's comp rider which isn't cheap. Dad is now asking about the cost of Assisted Living which would be close to half the cost of around the clock caregivers.
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How long has any of your loved ones lived in their ALF? Again, mine has funds for 5 years, hopefully. After that, she would be transferred to a nursing home. She's very forgetful now, no longer cooking, nor is she able to do her financials, yet still driving...how do I explain to her 5 years from now she has to go into a semi private room in a nursing home? (we were surprised to learn she didn't have long term insurance, especially knowing her own mother had this disease for over 10 years)
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Ephesian, where does your Mom live now? Still in a house or condo? If your Mom is very forgetful now, chances are in 5 years she won't have any short term memory..... sadly trying to explain anything to her might be fruitless.

As for her own mother having Alzheimer's/Dementia, it doesn't mean that your Mom will have the same identical issues.... she could instead have inherited aging health issues from her own Dad. My Mom developed serious dementia just a month ago and prior to that she was doing pretty good memory wise, it was a head injury that caused her to go into accelerated dementia. So anything could happen in the future.
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Ephesian, my mom has been in assisted living for 4 1/2 years now. She was in one facility for almost two years, and in the current one for 2 1/2 years. I admit that I didn't do enough research when I selected the first facility, but in my defense, she had fallen and broken her ankle, and the independent living facility where she had been living said she needed to go to AL, and I didn't have a lot of time. The first facility was part of a national corporation, had very high employee turn-over (there were three directors of nursing while mom was there), charged extra for every little thing and raised the rate almost 10% each of the two years she was there. They also didn't make much of an effort to get her out of her apartment and involved in activities, a situation I blame at least partly on the turnover and lack of continuity. The second facility is a non-profit, owned by a church denomination, so there are no stockholders to satisfy. The staff is much more stable, they do a great job, and the rate is almost $1,000 per month less than I would have been paying by now at the first place. Fortunately, my parents saved money, so there are still funds available for a few more years of AL. If she would need a higher level of care the money would be depleted faster. Her current facility has a wing called "Advanced Assisted Living" for residents who need more help, and recently opened a new memory care wing. Mom's dementia has progressed over the past four years, but she still knows me and is able to dress and toilet herself. Her physical health is good, so at nearly 89, she could need care for several more years. I hope that by the time the money runs out she is to the point that she is not really aware of where she is. She didn't remember the first AL less than a month after she moved to the second. I will cross that bridge when I come to it.

Is your mom in need of care now, or are you just looking ahead? Does she have any income coming in that would stretch her savings further such as SS, or a pension? Is she the widow of a wartime veteran? If so, the Aid and Attendance payment for a widow is now about $1,100 per month after her assets are down to a certain level. There is info about this on this site. Does she own her current home which could be sold to help pay for care?

In my opinion, your plan to build a small house is much more risky than an AL. What if you spend a significant portion of her money on the house and then something happens to make it impossible for her to continue living there? A sharp decline in her mental function or a broken hip could require either a move or 24/7 in-home care, which would quickly deplete her remaining funds. Then, if Medicaid is needed you may have a problem with the money spent on the house being seen as a gift to you. It is not as if you could sell the little house to recoup the money since it will be built on your property.
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If I had that choice, I would go with the facility. I would, however, look for one that accepted Medicaid after a period of self-pay, so she would not have to be moved. I think this varies a lot by region or state, but here many ALFs do operate that way.

A person with dementia cannot live alone beyond the very earliest stages. Even a house on the same property is "alone" so that may turn out to be a very expensive option -- building the house and then paying for in-home care. I couldn't leave my husband alone while I went grocery shopping. My sister had to get someone to come in to stay with Mother when Sis went bowling.

The other factor is that dementia -- dementia of any kind -- gets worse. It is the one thing you can absolutely count on. You mother may need the level of care provided in a nursing home in three years no matter where she is now. Even if her money holds out to pay for the ALF, her health may not. And it may not allow her to stay in a private home, either. My mother stayed in my sister's home as long as what she needed was "assisted living." That lasted 14 months. Mom is in a nursing home now, and thriving. She, too, wasn't social before going there so we are surprised and delighted she never misses bingo or a sing-along or live entertainment or a baking session or crafts. Sister had a hard time getting her out of the house to even her beloved beauty appointment. Now someone wheels her down the hall where she gets her hair done happily.

My best friend just wrapped up the sale of her mother's town house and she was saying this will pay for her mother's ALF for another 3 years. Her mom is now in the hospital and may never recover sufficiently to return to the ALF. No matter how carefully you plan, you cannot anticipate all future events.

Whatever you decide to do, discuss it with an attorney certified in Elder Law. For example, how will Medicaid look at using Mom's money to build a house on your property. You still need to decide what is best for your mother, but make sure your decision is carried out in the most advantageous legal manner.
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Ephesian.....you don't mention your age or circumstances nor those of your Mother....still, some good and considered replies to your inquiry. Must say I weigh in w/the majority here: find a really good ALF....deal w/the situation, as may be, 4-5 years down the road....In my personal experience, Mom was able to live in her condo, independently until 91. At 89, after I took her for testing and she was dx'd w/MCI, we started hiring caregivers so that she could continue to live independently in her condo. Worked well until she had a series of sudden, catastrophic falls, breaks, surgeries. She is now very happy in a beautiful ALF.....and yes, this is a very smart, active, stubborn woman who, when I tried to speak w/her about plans for her future, for several years before "the crises", even as she existed in the state you describe for your Mother, insisted that "she would never leave her condo....ever".....well.....the sudden, catastrophic falls and subsequent fallout changed that. Also, her dementia progressed and she no longer remembered her beautiful condo....(shocked me, but I was quite grateful that leaving her condo ceased to be an issue). Point is......you just CANNOT PREDICT anything when age and dementia are in the mix. I also must say this, w/all respect: #1. Although you ask for input/opinions re: the 2 options in your original post, you frankly, sound to me, in your subsequent posts, as if you are primarily seeking validation for building the separate residence (as opposed to the ALF alternative you offer). That's cool. It's a terribly difficult, emotional and personal decision. I applaud you for caring enough to seek out info and opinions and trust you will make what you feel is the best decision, for you and your Mom, ultimately. But since you have asked here, understand that you will get frank, down-to-earth answers #2. Your Mom, who you describe as confused, etc. is still driving??? Oh, plz, this seems to me a more immediate issue. Plz, deal w/this, for everyone's sake. #3. This has already been addressed by previous posters but....I will add a gentle reminder: Your Mom has dementia, says she NEVER wants to end up in a Nursing Home......BUT.....she no longer has the ability to make these decisions....yet, you feel what? Responsible? Guilt-ridden? Obliged to follow her wishes?.....plzzzzz......do not do that to yourself....she is no longer able to reasonably make those decisions.....your obligation to her is to, best as can, make sure she's safe and secure.....I sincerely wish you luck, no matter your decision.
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My parents are both at home with shifts of full time caregivers. My sister and I both live close to them and help. Well said, freqflyer and cwhilly! So true, jeannegibbs! You cannot anticipate future needs. Maintaining their home, high nurse turnover, endless errands and driving. Mom and dad are isolated. Sis and I are exhausted. I'm doing my very best with advise from the greatest people in the world on this site!!
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Thank you all. We took care of dad when he had lewy body dementia/Parkinson's for several years before he died with hospice in our home, so I'm not completely ignorant of what to expect. Matter of fact, the reasoning behind a separate little house, vs moving mom in with us is because of the toll of caring for someone in the same house had on our own family. We were only thinking of mom's ability to stay independent longer, as well as the ability to build to suit her individual needs. That plus the fact that she is only in her mid 70's, and in good physical health, much like her mom was. However, listening to everyone's input brings the reality of what we went through with dad, and we are seriously reconsidering our willingness to go that route again. Because of her possible "longevity", we found a nice AL that for an initial $45,000 (plus monthly fee) will guarantee she not be moved to a lesser facility once her funds run out. Thank you again.
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I recently took my 85 year old Mom on a tour of an assited living place near her home. She, like many elders, has always said never, never, never to the idea of a care facility, but her memories are of the places she saw many years ago that were basically the county poor farm. She was amazed at this place. It's nothing fancy but clean, we'll run and lots of activities. If it weren't for my stubborn Dad she would have moved in that day.

You should think very carefully about trying to care for your Mom on your own. She could live for many years but the dementia can progress very rapidly. I would hate to see anyone go to the trouble of building a house or apartment for a loved one only to see the person is hardly aware of their surroundings in coming years.

There are long debates on this forum about home vs facility care and you should read through some of them. Most people regret trying to go it alone. I agree with Cwille's first post on this thread. I think she captures the issue very well reflecting on her own experience.
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Thanks again. We've decided not to build anything. We told mom today, and she understood. We also talked about various AL options, so hoping to be able to take her to various facilities soon. *fingers crossed*
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Ephesians6vs2, thanks for sharing your decision with us. Hang around, keep us updated, share your experiences and read about ours!
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The facility my folks are in (independent living with assistance) offers an overnight visit for potential residents. It gives them a chance to have the meals, participate in activities, and get a general idea of what living there would be like. As you look at different facilities, you might ask if such an opportunity exists. My folks' facility does not have Medicaid beds, so if necessary, that will be something I will have to look into. But being around people their own age has been a real boost to them. As my mother (age 96) says, when we talk about "the war" we all are talking about the same war. Shared experiences is very important to them.
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My mom had moderate cognitive impairment before her last fall. The experience at the better nursing home (for rehab) advanced her to stage 6 dementia. This better nursing home costs just shy of 10K per month. Mom cannot be alone at all now. No nursing home in our area provides 1 on 1 staffing. The recommendation was to put her in a psychiatric facility. We chose to buy and remodel a place where Mom has her own apartment in the house. Now that her needs are so great, my husband and I are essentially living in her apartment with her. We are working through the medicaid process to get hired staff in the home. This is a real option in 11 states. At that point we'll have more time for our own lives and Mom will get cheerier care givers with some actual training. Consumer directed medicaid allows you to exempt 1 home and 1 vehicle and there is no look back period. Mom owns the home we live in. It is exempt. Her care will be cheaper than in the nursing home and it is far greater. She has not had to go to the ER since coming home (she did twice in the nursing home) and she is not bruised all over her limbs from battles with staff. She is mostly happy and I am much happier to have this time with her. It is no doubt the hardest thing I've ever done (and my husband too). It is also no doubt the best thing I've ever done.

Having said all that, if Mom did not need 24/7 supervision, I might have a different opinion.
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I am keeping my Mom with me as long as possible after 3 experiences with rehab in 3 different nursing homes. The money they ask for is outrageous and shameless for the small amount of attention they seem to get and the injuries that occur. Either way is not easy, but it was more exhausting having to police the situation in the NH daily and having to deal with Mom being dropped by aides getting her into the wheelchair causing a broken leg, and being neglected so that a stage 4 bedsore happened in the first 5 star medicare rated place, than for me to just care for her myself with one nurse and aide, and she is not allowed to fall or be dropped or just left to lie there for hours without turning or changing. The service you get in my experience does not justify the money they ask for. Aides in nursing homes are not paid well and someone must be pocketing all that.
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Sorry, just couldn't read all the responses. If Mom had the money, I'd have herbin an AL facility. She is bored here and being in a split level doesn't help. The one near us requires 2 years of private pay then will transfer to Medicaid. This way residents keep their room and stay in the facility.
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Honestly, "living in place" is the best option for your elderly parent, with hiring home health aides. Your loved one knows her home.
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I just calculated what it would cost, approximately, for an agency nurse 24/7 at 20an hr. (Cost in my area) 480 a day, 3300 a week. At $5000 a month or a nice AL, I'd pick the AL. I know people who have voluntarily gone into AL's because they are so nice. You get a nice room or small apartment. Rooms have kitchenetts. You have freedom to walk around, socialize and join into activities. Three meals a day and snacks. If still able to drive, you can have your car. Family members can still have their lives and visit often.
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All the answers were heartfelt, and appreciated. No one has explained what happens when the money runs out, and mom is told she needs to move to a Medicaid facility. From what I've been told, those can be detrimental? In choosing an AL, our local senior agencies have all suggested we move her to our Ares (vs an hour away), so as to be able to tend to her growing needs on a daily basis. Any thoughts? The siblings (who live out of state) don't agree.
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First of all, if you are going to be the primary care provider, I agree with the senior agency about moving her to your area. My mom was two hours away for four years and the driving got really old in a hurry. Each trip required a day off from work. I had to deal with winter weather and spring hail storms. I moved her to my town, and although she talks about moving back, in reality there is no one back in her home town to take care of her or even to visit her. I can see her once or twice a week instead of once or twice a month.

Don't spend a lot of time worrying about what will happen when her money runs out. There are so many possible scenarios for five years in the future. She could develop health problems requiring a move before that, or her dementia may progress to the point that her surroundings have no meaning for her. There is enough to worry about now without trying to figure out something that may never happen!
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When the money runs out, the elder goes on Medicaid and is allowed 2K in assets.
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We built a mother in law apartment almost 13 years ago for my mom. She's a loner and has never had any interest in socializing. Now she's really deteriorated, confused, and physically challenged. She chose to spend most of her time in bed watching TV for years. I'm beyond exhausted (only child) and can't even leave the house because she's afraid something will happen to me and then what will happen to her. I agree will the above comments. They are more engaged in an environment that is suited to them whether they think so or not. Also, impossible to imagine how difficult it can become and the toll on your personal life. I said I'd never place my mom in a home but as I see her deteriorate, I'm not sure I'm going to be able to keep that promise. Days can turn into years and sometimes into decades. Hindsight is 20/20. Now she says to place her in a home and I just can't. If I took her out of her familiar surroundings, it would be the end of her. Sorry for the rambling, it's just a lot to take on the role of caregiving knowing the only place it's going to go is downhill. Find a way to make your mom happy without letting your life pass you by.
Best of luck and light to you.
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AgingYogi, you express perfectly the tumultuous tug of emotions we all feel. If only I'd known then what I know now.
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When mom was in Independent Living, we kept her in a place that was close to her old home, so that friends could visit (I think that happened once) and so there was a possibility that she would know some of the folks there ( also happened once, a person that none if us could stand).

So mom had a stroke and was taken via ambulance to the local hospital. It took each of us more than an hour to drive there. By which time mom had nodded agreeable to many questions, including "do you have diabetes?" ( she didn't and doesn't. But it took us a while to get the order for insulin dc'ed).

We decided shortly thereafter that mom was going to need to be 10 minutes from one of us. She's now in a nh near one brother with the most financial resources, the most flexible job and PoA.

As to the money, there are certainly continuing care communities that you can buy into that will guarantee lifetime care. There are states where ALs have Medicaid beds, especially after several years of private pay. When mom was discharged from hip surgery, the discharge folks took a careful look at her Financials with us and recommended for rehab a place that was also a long term care facility that accepts Medicaid after private pay. Mom has been there for 2 years now, and at 15,000 per month, her money will last about another 2 years after we sell her house. It's all working out so far. It's a two hour trip each way for me to see her and 5 hours for our youngest brother, but it was a good decision.
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