Help me understand assisted living
March 19, 2020 9:59 AM Subscribe
This is turning out to be very hard to google, because it's all sales pitches. My recently-widowed mother needs to get out of the huge house/yard my father refused to ever downsize out of, and none of us really understands what her options are.
(Let's just assume that 6-12 months from now the world will work in a way that bears some resemblance to last month, though hopefully improved in some ways. We are keeping "build a compound in the middle of nowhere" in our back pockets for now.)
She's in her early-mid 70s and in about average health for that age - mobile but occasionally wobbly, some memory issues appropriate to her age but no signs of dementia and no family history, recovered well from a heart attack a few years ago, COPD that isn't as severe as it should be, given that she smoked until the heart attack, but it's certainly a thing that is looming in the future.
The house is paid for long ago, they saved decently for retirement and dad had more life insurance than we realized, but she's by no means wealthy, just padded okay.
She has very little social attachment to the part of Texas she lives in, hates the weather there. She's open to moving to southern California where I am, but we're both worried that the cost of doing so would eat through savings that would last her far longer somewhere else. She's also open to buying a condo, but doesn't want any kind of lawn or outdoors to take care of. Moving in with us is on the table, but not anybody's most favorite option. (She could help us buy a house and live with us, that's a thing on the list and we could choose property that accommodates two separate Adult Entity Units, but I worry about not being able to get her nursing care down the road if we do that.)
I can't imagine a future in which she isn't going to have increasing need for assistance. I would like to not be her entire social circle and for her to have independence as long as possible, but be able to be involved. I would like her to be able to smoothly transition though mild-moderate levels of assistance, and be at least somewhat closer to help manage her life and care.
I would love to hear from people who've dealt with the assisted living/step-up care arrangement themselves or with a parent or grandparent to get a better understanding of what that actually looks like, financially and quality-of-life-wise. It seems like lots of people talk casually about that being a thing their family members have done, but it never went down that way with any of our relatives so I have no exposure. Are there scams? Is it bad? Is it financially inaccessible to the not-wealthy? What kind of care options should I be concerned about?
And I assume the same places that are hotspots for retiree/snowbird living might have higher concentrations of options for assisted living as well? Should I be thinking about Arizona and Nevada as more affordable options that I can still drive to in one day?
She's in her early-mid 70s and in about average health for that age - mobile but occasionally wobbly, some memory issues appropriate to her age but no signs of dementia and no family history, recovered well from a heart attack a few years ago, COPD that isn't as severe as it should be, given that she smoked until the heart attack, but it's certainly a thing that is looming in the future.
The house is paid for long ago, they saved decently for retirement and dad had more life insurance than we realized, but she's by no means wealthy, just padded okay.
She has very little social attachment to the part of Texas she lives in, hates the weather there. She's open to moving to southern California where I am, but we're both worried that the cost of doing so would eat through savings that would last her far longer somewhere else. She's also open to buying a condo, but doesn't want any kind of lawn or outdoors to take care of. Moving in with us is on the table, but not anybody's most favorite option. (She could help us buy a house and live with us, that's a thing on the list and we could choose property that accommodates two separate Adult Entity Units, but I worry about not being able to get her nursing care down the road if we do that.)
I can't imagine a future in which she isn't going to have increasing need for assistance. I would like to not be her entire social circle and for her to have independence as long as possible, but be able to be involved. I would like her to be able to smoothly transition though mild-moderate levels of assistance, and be at least somewhat closer to help manage her life and care.
I would love to hear from people who've dealt with the assisted living/step-up care arrangement themselves or with a parent or grandparent to get a better understanding of what that actually looks like, financially and quality-of-life-wise. It seems like lots of people talk casually about that being a thing their family members have done, but it never went down that way with any of our relatives so I have no exposure. Are there scams? Is it bad? Is it financially inaccessible to the not-wealthy? What kind of care options should I be concerned about?
And I assume the same places that are hotspots for retiree/snowbird living might have higher concentrations of options for assisted living as well? Should I be thinking about Arizona and Nevada as more affordable options that I can still drive to in one day?
I was going to write my anecdotal story regarding my mom, but assenav said everything consistent with my family experience and assenav has direct knowledge and experience. I would take them up on their memail offer.
posted by AugustWest at 10:32 AM on March 19, 2020
posted by AugustWest at 10:32 AM on March 19, 2020
I found this blog post about the differences between nursing homes, independent living facilities, and assisted living facilities (including how there is often a continuum of need and they sometimes co-depend) to be useful.
This blogger documented her search for a facility for an elderly relative, including questions to ask, in ways that might be very interesting to you, although her relative was much frailer than your mother at the time of the search. Those posts all under the tag eldercare.
posted by gideonfrog at 10:45 AM on March 19, 2020
This blogger documented her search for a facility for an elderly relative, including questions to ask, in ways that might be very interesting to you, although her relative was much frailer than your mother at the time of the search. Those posts all under the tag eldercare.
posted by gideonfrog at 10:45 AM on March 19, 2020
Assenav covered things really well, I just wanted to add that a major factor in my mom moving to an assisted living facility was the complete and total lack of apartments/condos with no steps of any kind. We could not find anything in our area that was ADA accessible and it was a huge problem. Her current building was built specifically to house seniors. Before she needed a walker, we didn’t think too much about how important things like ramps could be but now we’re extremely grateful that she can live someplace safe.
posted by corey flood at 10:48 AM on March 19, 2020
posted by corey flood at 10:48 AM on March 19, 2020
I literally have just gone through this with my mother this month. She's been suffering from mobility issues and early stage memory loss/cognitive decline.
There are three levels you need to be aware of: Independent Living, Assisted Living, and Memory Care.
With Independent Living (IL), the resident typically has their own apartment (studio to two bedroom) in the community, with their own kitchen and can partake of activities in the residential community and even dine in the dining room where meals are served restaurant style if they so choose (or cook and eat in their apartment).
With Assisted Living (AL), the resident again typically has their own apartment (studio or one bedroom), but they need some level of aide and/or monitoring (e.g. medication dispensing, assistance transferring from wheelchair to bed/toilet, etc.). Units usually don't have kitchens and things that could be a fire hazard (coffee makers, hot plates, etc.) are not allowed. Meals are included and residents take meals together as a group in the facility's dining rooms.
Memory Care (MC) is for residents who are at the far end of dementia/Alzheimer's, i.e. a wandering risk, don't recognize their family members, don't know who they are anymore, etc. These are residents who need a LOT of regular care.
Some facilities offer just one of those, two, or sometimes all three. If you can see your mother's health, memory, or cognition is getting worse, you probably want to find a facility where she can transition from Independent to Assisted to Memory, if needed.
Typically rent in such a community includes the apartment and utilities (except maybe phone/cable/internet). For Independent Living it doesn't include meals in the dining room, but those can be purchased in packs. For AL and MC it typically includes three meals a day + snacks. For Assisted Living and Memory Care, where nurses / nursing aides are providing care, there will be a separate charge for care services depending on the level of care the resident needs. This is usuall tiered, not a la carte.
Note that the facility will do an assessment to determine where the resident belongs. They're not going to take a resident in IL that needs round-the-clock medical care. (Unless, for example, it's a couple moving in. In my mom's facility, there's a couple she knows in IL, where the wife is spry and healthy, but the husband is suffering from fairly advanced Alzheimer's. Alone, he'd be in memory care, but since the wife -- who is healthy and independent -- is acting as his caregiver, they live in IL together.) The care evaluation will also determine the tier of nursing & assistance that a resident in AL would need.
The quality and costs of such facilities can vary widely, and there's no way to pick one effectively without visiting in person. I would stay away from online placement services like aplaceformom.com, because their model is just to send your information to all the facilities in your area. You'll get inundated with calls and sales pitches. Instead, see if there is a senior care advocate in the area you & she decide upon). I worked with one for finding an AL facility for my mother. A good senior care advocate will have personal relationships with the managers & sales reps at the facilities in your area, can help assess what sort of place your mother needs/wants, make informed recommendations, and will schedule and accompany you on visits to the facilities. The advocates typically don't charge you; they earn a flat "finder's fee" from the facility, so they're getting paid the same no matter the facility you/your mom choose. (Another reason to stay away from online placement services like aplaceformom.com, is if you sign up with one of those services you're contracting that finder's fee to the online service and a local senior care advocate won't be able to work with you.) Really, working with the senior care advocate was the best move I made in the whole process, because it took a bunch of the pressure off me and, importantly, gave my mother a professional 3rd party to bounce questions/concerns off of, so she didn't feel like I was trying to sway her decision.
Good luck!
posted by gritter at 10:50 AM on March 19, 2020 [4 favorites]
There are three levels you need to be aware of: Independent Living, Assisted Living, and Memory Care.
With Independent Living (IL), the resident typically has their own apartment (studio to two bedroom) in the community, with their own kitchen and can partake of activities in the residential community and even dine in the dining room where meals are served restaurant style if they so choose (or cook and eat in their apartment).
With Assisted Living (AL), the resident again typically has their own apartment (studio or one bedroom), but they need some level of aide and/or monitoring (e.g. medication dispensing, assistance transferring from wheelchair to bed/toilet, etc.). Units usually don't have kitchens and things that could be a fire hazard (coffee makers, hot plates, etc.) are not allowed. Meals are included and residents take meals together as a group in the facility's dining rooms.
Memory Care (MC) is for residents who are at the far end of dementia/Alzheimer's, i.e. a wandering risk, don't recognize their family members, don't know who they are anymore, etc. These are residents who need a LOT of regular care.
Some facilities offer just one of those, two, or sometimes all three. If you can see your mother's health, memory, or cognition is getting worse, you probably want to find a facility where she can transition from Independent to Assisted to Memory, if needed.
Typically rent in such a community includes the apartment and utilities (except maybe phone/cable/internet). For Independent Living it doesn't include meals in the dining room, but those can be purchased in packs. For AL and MC it typically includes three meals a day + snacks. For Assisted Living and Memory Care, where nurses / nursing aides are providing care, there will be a separate charge for care services depending on the level of care the resident needs. This is usuall tiered, not a la carte.
Note that the facility will do an assessment to determine where the resident belongs. They're not going to take a resident in IL that needs round-the-clock medical care. (Unless, for example, it's a couple moving in. In my mom's facility, there's a couple she knows in IL, where the wife is spry and healthy, but the husband is suffering from fairly advanced Alzheimer's. Alone, he'd be in memory care, but since the wife -- who is healthy and independent -- is acting as his caregiver, they live in IL together.) The care evaluation will also determine the tier of nursing & assistance that a resident in AL would need.
The quality and costs of such facilities can vary widely, and there's no way to pick one effectively without visiting in person. I would stay away from online placement services like aplaceformom.com, because their model is just to send your information to all the facilities in your area. You'll get inundated with calls and sales pitches. Instead, see if there is a senior care advocate in the area you & she decide upon). I worked with one for finding an AL facility for my mother. A good senior care advocate will have personal relationships with the managers & sales reps at the facilities in your area, can help assess what sort of place your mother needs/wants, make informed recommendations, and will schedule and accompany you on visits to the facilities. The advocates typically don't charge you; they earn a flat "finder's fee" from the facility, so they're getting paid the same no matter the facility you/your mom choose. (Another reason to stay away from online placement services like aplaceformom.com, is if you sign up with one of those services you're contracting that finder's fee to the online service and a local senior care advocate won't be able to work with you.) Really, working with the senior care advocate was the best move I made in the whole process, because it took a bunch of the pressure off me and, importantly, gave my mother a professional 3rd party to bounce questions/concerns off of, so she didn't feel like I was trying to sway her decision.
Good luck!
posted by gritter at 10:50 AM on March 19, 2020 [4 favorites]
These facilities are regulated and licensed by the state, and each state will have slightly different names/definitions for senior care facilities. Here's a glossary of terms as defined by California.
In addition to Independent/Retirement Living (this can be a 55+ community or part of an Assisted Living community), there is Assisted Living--described above--and something called Residential Care Facilities.
RCFs are a home setting with 3-6 people living there plus a caregiver. These are called Adult Foster Homes or Adult Care Homes in other states. Because these are small and very residential, they vary widely from home to home.
This company is outside your area, but they have a nice FAQ on their website about the differences among the types of facilities.
That company is a senior care referral company. This type of company can be very helpful (some are scammy though). A senior care referral company is familiar with many of the different homes and facilities in your area. They are familiar with which facilities have available vacancies, and they should also be checking on complaints. A good senior care referral company will personally guide you through the transition (a bad one will spam your information to a bunch of facilities and expect you to do all the legwork.)
In Oregon, we have an association of Referral companies. They all agree to follow a code of ethics. Their website has a library of helpful articles. Browse around the site for more information.
The longer your mom can live independently, the better it will be financially. But, she'll also need an outlet for socialization. Even if you find her an easy-to-enter apartment, if there's no one near her that she knows, that may be detrimental to her health. I'd look for a 55+ community for her, whether it's attached to an assisted living facility, or if it's just a set of apartments, it will be more likely to have some opportunities for socializing. If it's attached to an assisted living facility, it's also possible that she can go there to get some meals so she doesn't have to cook. As her needs increase, you can have in-home care brought in to assist her.
posted by hydra77 at 11:15 AM on March 19, 2020
In addition to Independent/Retirement Living (this can be a 55+ community or part of an Assisted Living community), there is Assisted Living--described above--and something called Residential Care Facilities.
RCFs are a home setting with 3-6 people living there plus a caregiver. These are called Adult Foster Homes or Adult Care Homes in other states. Because these are small and very residential, they vary widely from home to home.
This company is outside your area, but they have a nice FAQ on their website about the differences among the types of facilities.
That company is a senior care referral company. This type of company can be very helpful (some are scammy though). A senior care referral company is familiar with many of the different homes and facilities in your area. They are familiar with which facilities have available vacancies, and they should also be checking on complaints. A good senior care referral company will personally guide you through the transition (a bad one will spam your information to a bunch of facilities and expect you to do all the legwork.)
In Oregon, we have an association of Referral companies. They all agree to follow a code of ethics. Their website has a library of helpful articles. Browse around the site for more information.
The longer your mom can live independently, the better it will be financially. But, she'll also need an outlet for socialization. Even if you find her an easy-to-enter apartment, if there's no one near her that she knows, that may be detrimental to her health. I'd look for a 55+ community for her, whether it's attached to an assisted living facility, or if it's just a set of apartments, it will be more likely to have some opportunities for socializing. If it's attached to an assisted living facility, it's also possible that she can go there to get some meals so she doesn't have to cook. As her needs increase, you can have in-home care brought in to assist her.
posted by hydra77 at 11:15 AM on March 19, 2020
edit: Not sure why the direct link to DSS's glossary doesn't work. But if you go to their Care Facility Search, then click Glossary at the top, that will get you the glossary of terms.
posted by hydra77 at 11:27 AM on March 19, 2020
posted by hydra77 at 11:27 AM on March 19, 2020
When we were dealing with similar issues for my mother-in-law, we found an "eldercare advisor" in the town where she lived (knowing she wanted to stay in that town). It cost somewhere around $800 to hire this person for X number of hours of consultation, and it was the best money we could have spent. This person knew all the options, all the facilities, basically everything we needed to know, and helped us navigate exactly what to do. We ended up saving literally thousands of dollars in the long run.
posted by BlahLaLa at 12:42 PM on March 19, 2020 [2 favorites]
posted by BlahLaLa at 12:42 PM on March 19, 2020 [2 favorites]
At some point your mother is not only going to need more daily care but she will also need more support from family members to coordinations the care and deal with all the little problems. So, it is possible to move her once now and again when things get harder but it is easier in the long run if the current move puts her close to someone who can be involved in overseeing her care as she ages.
posted by metahawk at 6:43 PM on March 19, 2020
posted by metahawk at 6:43 PM on March 19, 2020
This thread is closed to new comments.
The two most basic options would be to have her move to a community/facility that has both independent and assisted living, or to have her move into an ADU on your property and then bring in care as needed when the time comes. A lot of that is going to have to do with how much care it's likely she'll need--if she needs daily care for more than a couple of hours a day, assisted living will probably be less expensive in the long run. If she just needs someone to come in a couple of hours a day or even a few hours a week, in home care will be much cheaper.
Right now in home care is about $25-35/hr in most bigger CA cities. Assisted living starts at about $6000 a month but independent living or an over-55 condo would be much cheaper, and most independent living communities will let you pay for private caregivers to come in (so, this could still be an option similar to the ADU situation but with her having more access to activities and social time with peers).
Nevada and Arizona are both less expensive for senior care, but consider the cost (time, money, and stress) of needing to supervise her care situation from afar. Check flights from your closest airport to the closest airport to those potential locations.
This calculator from Genworth Financial is great, very straightforward, and you can compare different zip codes: https://www.genworth.com/aging-and-you/finances/cost-of-care.html
posted by assenav at 10:18 AM on March 19, 2020 [1 favorite]