I think my elderly mother has to go into assisted living...
November 28, 2019 6:20 PM   Subscribe

I'm going through a lot right now: new job, moving to a new city, AND my 74 year-old mother has been hospitalized since last week. From talks with her doctors and nurses, it really seems like she'll be ending up in some sort of assisted living facility. I'm moving in a WEEK and my head is spinning, I don't know where to begin. In particular, I'm worried about the money aspect of it all.

First of all, we're located in Alberta, Canada.

honestly, my mother probably SHOULD be in an assisted living facility (or supported living, as Alberta Health Services calls them). She's been unwell (particularly mentally) for a long time. I would say that my mother, due to years of neglecting her health, is an OLD 74. She's not a senior who goes out and does stuff, she's pretty much become a recluse, doesn't visit with people, doesn't do her errands, barely does housekeeping/chores, etc.

Everything has been so sudden, though, that I don't know what decisions I should make. Knowing that she's also safe and in a facility would allow me to live my life without worrying about her so much... but there are sooooo many things I'm worried about, but two in particular stick out. The hospital is going to have a geriatric physician conduct a capacity test on her, if she passes (which I doubt) I guess she'll be able to make her decisions and this is all a waste of time, but if she doesn't... I'm her next of kin and become her decision maker. Part of me, would honestly consider let her stay in the house, under the condition that she gets homecare, BUT ugh that would probably be a bad choice.

A) Her house. If she's put into an assisted living facility, what am I supposed to do about her house. Would it be okay if I don't sell it IMMEDIATELY? I'm moving out of our current city for just under 1-year. I was planning on driving in visiting my mother every 2 weeks anyway, so I would have been staying at the house. This is something I would probably still be doing to a) visit her and b) see friends/hobbies, etc., so I'd be staying in the house when I visit. I can ask a friend or two to check on the house when I'm out of town. My mom's neighbour leaves the country during the winter-time, so I can ask him how he does it (or just figure out what other snowbirds do).

This home is my childhood home and there's A LOT of my stuff there too, because I'm moving to a town for just 1-year i'm only renting a room, so I cannot bring everything with me anyway. When I'm back in town after 1-year, I think I could begin to go through the house, sort everything, organize any needed repairs/upgrades, and then look into selling it. Eventually, it would have to be sold (I'm sure) to cover her costs in assisted living. I just feel like I have no time to process this and I can't imagine IMMEDIATELY selling the house. The thought of also selling the house as-is and getting a really poor price for it, when we could do moderate repairs/renovations and "increase" the value also kind of worries me.

2) Her money. Assisted living is sooooo expensive. She has CPP/OAS (about $1270 combined (she gets her CPP pre-taxed for some reason), an ok amount of savings+ RIF (about $400K-ish), her home could probably be sold for maybe around $315K with some repairs (who knows, the housing market right now isn't that hot). With that in mind she does have an ok amount of money, not rich or wealthy by any means.

I can't even BEGIN to figure out the costs of supportive living, or what kind of facility they'd refer her to (public or private). It sounds like a room could cost her anywhere from $2500 to $8000 a month! On the low end with her pension and savings she could do pretty well. In the middle if the facility cost around $4000/mo w/ her pension she could live there for about 11 years (longer if she sells the house). However, at a higher end... WTF... with her pension included, she'd have enough for maaaaybe 5 years? And then 3 more with the sale of her house? What the HELL would she do if she ran out of money!? Who knows where I'd be in 8 years career wise, or life-wise. I'm freaking out. There's no organized place I can go to research these costs. It would probably be cheaper to get a shared room, I suppose, so that's one option.

I know that in the US in certain states Medicaid will pay for a senior to live in a facility if they've spent their assets. That's not something that happens in Canada. I guess if all of her money is spent on care for her... she could get the Guaranteed Income Supplement (GIS) in addition to her CPP/OAS, but then what? It doesn't sound like there are facilities for low-income seniors, or if there are I have NO IDEA where to find info about them. Who knows if these facilities will even exist in Alberta due to the shitshow that's going on with the provincial budget for the next 4 years. This might sound awful, but what if assisted living perks her up and she likes it and she gets healthier... I'm sure she'll live for longer, if that's the case, but how would she pay for it all?
What if I have no money to support her?

This has been all I'm thinking about since she's been in the hospital. I've been barely able to even plan for MY OWN move and my new job or anything, because everything is so uncertain.

I know no one can predict the future, but holy shit, how can I plan for this and not lose my mind?
posted by VirginiaPlain to Human Relations (9 answers total) 4 users marked this as a favorite
I forgot to mention that, I have spoken to a hospital social worker, and am going to follow up with them tomorrow about everything. I should have mentioned that. Also, how the fuck am I supposed to do everything from a distance? I can't tour facilities while I'm in another town 5 hours away. I'm her only family.
posted by VirginiaPlain at 6:26 PM on November 28, 2019

Having been through this with my mom a year ago (when she ended up in the hospital for the 4th time that year on Thanksgiving), I'm sorry, this is tough. Most things don't have to happen immediately. Mom still hasn't sold her house, and neighbors have been great about helping with checking in on it, etc. It's not super-cheap to have yard maintenance, heating, etc, but if money isn't an immediate worry, the house can stay put for now.

Mom's doctor was great at helping recommend an assisted living nearby. People from her church were great about helping with info about places to stay until she could move in. An elder services social worker was a life saver for all kinds of questions like you have (found through the local seniors services org).

I know a lot of decent assisted living places in the States are $4000-$5000/month, depending on the level of care needed. But also, you don't have to find the perfect place for your mom right away. It stinks to move around at that age, but if she had to go to one place for 6 months to a year and then move somewhere cheaper, it could be ok. You don't have to solve everything at once (which is good, because it's still a lot).

Would any local friends be willing to stop in and visit a place? I visited the one place she moved to while in for the hospital visit, and luckily that was all I had to do (for that parent). So if there's a recommended place, hopefully there isn't too much "shopping" to do, and a trusted person could help.

And you're good for looking at this stuff. Mom is safer for moving, and is coming to even appreciate it in some ways, so I'm very grateful she's doing better with good care.
posted by ldthomps at 7:13 PM on November 28, 2019

Do you have power of attorney for your mom? (Specifically in Alberta: EPA, enduring power of attorney?)
posted by Iris Gambol at 7:13 PM on November 28, 2019 [1 favorite]

I’ve just gone with something similar with my mom. Can you find a senior living consultant? When my mom had to leave her independent living facility (they had no available assisted living space available) they recommended a woman who helps find senior living situations and is paid by the chosen facility, not by the senior. She did a good job for us.
posted by lhauser at 10:12 PM on November 28, 2019 [3 favorites]

First, I've been seeing your posts; you've been going through a lot of life changes (congrats on the new job!) and you have a lot of stress, and I've been wishing you well.

You have a ton on your plate, so taking things off when you can is very important. You have family with a medical issue (and I'm assuming housing needs) now; you have a move and a new job in a week; the holidays are coming. Even your worst case scenario anxiety over the money is about eight years from now. I'm not saying that you shouldn't worry about the future, but I promise you can not worry about it until January or February or even in the spring and you will still have the exact same outcome in 2028.

The house can absolutely wait; it could easily wait a year. In fact, given your situation, I'd plan to not sell it for the year you're out of town. If you make that decision, that reduces the number of balls you have to keep in the air. Ask your neighbour who clears his snow and get them doing yours; turn the thermostat down a little. If you can have a friend check in once in a while, the weeks you're away, that's good, but if you're coming back every two weeks, you're probably fine. (People go on holidays for two weeks and leave their houses all the time.) Most renovations don't increase the value of a house, and in any case, you can think about them in the next year, you don't need to worry about them now.

Pay as little attention to politics as possible in the next month. There are a million people in this province who are appalled at the government; one more person is not going to tip the scales. A more productive use of your time would be spending an hour going through your childhood things every time you come home, so next year when you revisit the house there's a lot less to do.

Regarding your mom's housing, here's some resources from the Alberta Senior's Housing group, including a directory. Lean on your hospital social worker; make them earn their salary, and take a lot of notes. Senior's housing seems expensive, but once she's there, she's not going to have a lot of other expenses to deal with. And if she does wind up with a low income, there are a lot of income-based places.

And ldthomps has an excellent point; she needs housing now, but that doesn't need to be her housing forever. If it's not a good fit and she has to move in a few months, that's unfortunate but not the end of the world. It might be helpful to think of this as finding her someplace for a few months; if it's good and affordable and can be a long term solution, that's great. If it's not, you have a few months to visit other places, figure out the finances and move her again when you're not also moving yourself and starting a new job.

I know no one can predict the future, but holy shit, how can I plan for this and not lose my mind?

Ask yourself whether you're thinking about a problem that you need to solve or answer in December 2019. If the answer is no -- and with kindness, for a lot of what you've posted, the answer is no -- then it's not worth thinking about until you've run out of December 2019 problems to solve. Once the rest of your life has calmed down a little, you will have a bit of breathing room to think about the medium term and long term.
posted by Homeboy Trouble at 12:19 AM on November 29, 2019 [14 favorites]

she needs housing now, but that doesn't need to be her housing forever. If it's not a good fit and she has to move in a few months, that's unfortunate but not the end of the world.

Although I think this is a fair point assuming relatively good health, it does sound like your mother may be suffering from medically significant frailty, in addition to her other complex health conditions, so it's worth thinking about a bit.

There are data supporting the view that, for older people in poor health, the very act of moving home or care setting can be associated with significantly increased negative health outcomes. That doesn't mean that the observation that you're not necessarily looking for a permanent solution is invalid, just that you (and/or your mother to the extent she has capacity to do so at this time/ongoing) should seek medical advice about the likely impact of moves, and how they might be managed if needed.
posted by howfar at 2:10 AM on November 29, 2019 [2 favorites]

I went through a very similar situation with my parents - although I wasn't juggling a move and a new job of my own! - and you absolutely can do this. The advice upthread is all excellent: if you don't already have enduring power of attorney and her healthcare proxy, please start that process. Her social worker(s) will be excellent resources, lean on them as much as you can for information about the services that are available to your mom and which assisted living facility might be the best fit for her. They're typically also very helpful in coming up with solutions for people to stay at home as long as possible; for my mom, a combination of home support and getting a Lifeline alarm let her stay at home until she was ready to move to assisted living.

Re: money - honestly, I think you're fine for now and the house can certainly wait. My parents had considerably fewer resources than your mom does and were able to afford an apartment in a private assisted living facility (about $4300 a month for the two of them) for nearly 3 years before their health declined further and they had not run out of money by the time they passed away. They were in BC, but for public facilities I believe all provinces have similar scales based on a proportion of after-tax income. The social worker will be able to help you with these calculations. There are also options for subsidized spaces should your mom's funds run so low that she qualifies for the GIC.

This is a really hard, exhausting time but you don't have to decide everything right now. One tip - start recording everything (names, phone numbers, contents of phone calls, decisions made) in a notebook so you can reference it later. Start with the most immediate needs for your mom's safety and ignore everything else. I hope everything works out for both of you!
posted by aqueousmedium at 8:17 AM on November 29, 2019 [2 favorites]

Additional anecdata to suggest that sometimes moving to an appropriate facility can significantly improve an elder's physical and mental condition.

I'm in the US and have an elderly aunt who has estranged herself for two decades from nearly all her family, including all but one child. She became a recluse and hoarder and sometimes refused to open the door to her son, her one family contact, after he drove 300 miles to see her. She once shot and killed the pet dog of her nextdoor neighbor after it strayed onto her property - and she lived in a very rural part of western Pennsylvania, with the next neighbor at least a quarter-mile away. She refused to see doctors, after having battled over the years with one doctor after another and filing multiple unfounded lawsuits. Eventually word got around about her litigious impulses and few doctors would take her on. Finally, after about 20 years of this estrangement and paranoia she badly injured her knee in a fall and was taken to the hospital by EMS after she called 911. She was so hostile and delusional in the hospital that she was involuntarily committed (302'd in the US) and treated for her physical and mental illnesses.

What do you know, she improved immensely once she received the right medications and was served nutritious food three times a day. It was decided by the social worker and psychiatrist that returning home would be unsafe, and she was transferred to a nursing home, with initial persuasion that she needed rehab on her knee. Rehab transitioned into residential care. She's still difficult and suspicious and refuses to take pills - thus she receives a monthly psych med by injection. She is still estranged from most of the family but now receives visits from her son when he drives to see her. And her son is relieved that she is being cared for, and wouldn't be found dead at home after some catastrophic accident.

So if part of your mother's ill health and confusion is due to not being able to care for herself and her house, and anxiety about how to continue in her home, it would be a good thing for her to move to a place where the basics of life are managed and professional help is available. Returning home with the temporary crutch of home care would probably only be temporary, ending with a possible emergency like a fall. My aunt, with her mental illness is not your mother with some memory problems, but I'm here to say residential care can be a good thing for some people, particularly people who live alone without extended family within easy reach.
posted by citygirl at 10:17 AM on November 29, 2019 [1 favorite]

When I had a very short time to make decisions for several health-related unknowns, I got a lawyer (MeFi Wiki) with a practice that included a focus on estate planning (Findlaw Canada) for a consultation, and I'd do the same for a parent who may need long-term care, especially if they may lack capacity to make financial and/or medical decisions. TINLA, but a little advance planning can go a long way in reducing stress, worry, and costs.
posted by katra at 7:39 PM on November 29, 2019

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