Assisted living and nursing homes are so expensive, does anyone have any suggestions for alternative places?

Windytown, just a thought. The 1 to 2 percent pay most of the taxes. Check it out on the IRS website. My oldest daughter is a corporate lawyer with the biggest firm in Boston. A tax lawyer. She is disturbed at what she see. Even with big tax loop holes the mega wealthy are getting richer and richer. Please don't think I am a socialist, whatever that really is, but if you know someone who actually deals with the monied ones in American you would be shocked at what is going on. America was built to give everyone oppptunities, not to build kingdoms. Many in Washington are looking out for the kingdoms.

Karen get the information that's specific for your state so that your mom & you can make a logical, sound decision on her finances and paying for AL & NH. Most states Medicaid programs do not pay for AL but some states have AL waiver program that do. Some facilities that are "tiered" (that go from IL - AL - NH) often have a bridge program between AL & NH that will accept Medicaid for existing residents. Every state has it's own spin on NH Medicaid, but in general, an individual must show that:
1) are 65+,
2) medical condition requires that level of skilled Nursing care,
3) monthly income is less than their states max (about $2,020.00),
This is the “income test” – how much $ do you make.
4) countable assets are less than $2K
This is the “asset test” – how much $ do you own.
5) not gifted away anything of value during the look-back period.


The eligibility $$$ are different if there is a community spouse.The max look-back is 5 yrs. Most states require 3 – 6 mo. of financials with Medicaid application. Can require more financials if something pique’s interest.A “transfer penalty” can happen when items are gifted below value. Penalty different for each state.

All assets are counted for the asset test, unless the assets fall within the short list of "noncountable" assets, which in general are:
- personal possessions,
- a vehicle,
- their principal residence, provided it is in the same state in which the individual is applying for coverage & the house with no equity limit if the "community spouse" lives there; otherwise the equity limit is 500K (750K in some states)
- prepaid funeral plans (irrevocable, no cash value/NCV)
- small amount of life insurance (usually $1,500 & NCV)
All other assets (savings, stocks, whole life) are counted.These must “spend down” to get to their states asset max to qualify for Medicaid.

Is the system fair? Probably not as it rewards those that do advance planning to make themselves poor, or exempts those that have the financial acumen to do a Living Trust. But thank goodness it is there because if you live long enough you will eventually run out of $ to pay for care unless you are truly wealthy.Medicaid is designed as a safety-net for low income who can show both financial and medical necessity for long term care.Because Medicaid is needs-based, doing a 5 yr look-back on the applicants assets is critical for the states to operate the program. If everyone was able to transfer all of our parents assets, empty out their accounts today, spend monthly retirement and SS on nonNH stuff and put them into a NH tomorrow paid 100% by the state, the system couldn't afford it and they wouldn't have any NH to go to.

Medicaid is all about either doing planning OR spending your $ until or unless you are impoverished. Medicaid gets to the heart of the issue of who should pay for long-term care -- the public through the tax-supported Medicaid program, or users of long-term care through their personal resources, including those remaining after death via MERP (Medicaid Estate Recovery Program).

In almost all states, the elder's homesteaded property is an exempt asset. They do not have to sell it to qualify for Medicaid. There are a few exceptions, like for example the property is assessed at over 500K (or 750K in some states) so has to be sold, or the property is income producing (like it's a duplex and 1 side is rented out) or if the elder has/is end of life stage disease where they really truly have no "expectation" or ability to ever return to the home.

The whole issue of keeping mom's empty house and why, imho, most sell it is because the family cannot afford to maintain the house for mom. Once they are in NH on Medicaid, all mom's income less the personal needs allowance must be paid in toto to the NH. So there is no $ to spend on the house by mom. If there is a mortgage or property tax & maintenance is high, often the family can't afford mom's house. So the house gets sold. But you can have her keep it and you pay for all (taxes, insurance, utilities, maintenance) and then in probate you dispose of the home as per her will and you file your own detailed claim against the estate for the $ you paid. The state might do a claim for the $ the state spent on her care paid by Medicaid (MERP) but MERP rates are low in most states for homes that have valid claims for expenses paid for the homestead, empty property.

My dad was in a CARE HOME. It was a neighborhood house in our vicinity. The owner of the home put a bunkbed in the living room for the care takers. They put two residents in each of 3 bedrooms and provided care for 6 residents. They had two employees all day (1 cook and 1 LVN) and 1 LVN person each night. The math for them worked out good and their charge was less than a nursing home. The owner was an RN and she would stop by most days. The house had a small backyard, a piano, Big screen TV, a pet cat and a cage of birds. My kids would bring a soccer ball and we all would play in the back yard while Dad watched. He was able to stay their through his death.

Karen, I certainly know that is not my business. You stated that it was his mother's fault and all I asked was how was that anyone else's fault? As a mother myself, I would have done almost anything to make sure my son's insurance policy wouldn't lapse, especially if he had a serious medical condition. In other words, the onus was on her to make sure that happened. It was HER responsibility and I don't see how that's the taxpayer's responsibility.

As far as the Occupy Wall Street 1 percenters thing, I guess you have your own ideas. Mine differ than yours.

You confuse me because you seem to think a socialistic society is a good thing, then in the next post you confirm that government does run our lives, it's messed up with Medicare, yet MORE government would be a good thing???

I send you lots of good vibes and wishes in your situation with your parent. It's one of the hardest things we will have to do in our lives and we all come at it from different perspectives. I'm turning off my political switch now....

brandywine, thanks for your comment!

windytown, not getting into how it's his mother's fault. Not your business.

Piffle? Really, piffle? The 1% is piffle?

And you really don't think that people have died in the US? Be for real. The government DOES tell you how to live your life. Wake up and smell your surroundings.

Karenp,

You say that the mother of your daughter's boyfriend is the one that allowed his insurance to lapse. How is that anyone else's fault? Should not his mother be responsible?

A lot of us don't think you have to be Oprah or Beyonce' to be living the American dream. That 1% stuff is piffle.

100 million people throughout history have died from living under the various "isms" you mention. Our system may be far from perfect but I'd rather live free than have the government tell me how to live my life.

Sorry this is off-topic, but I can't help but respond to a post like yours.

I know there is an independent living center in Powell, Wyoming called the Rocky Mountain Manor. It is relatively inexpensive compared to NH and AL. But you have to be able to take of yourself completely. Having someone live with her parttime sounds like an answer, if parttime would be acceptable.

madge1, I could not agree with you more! You are right. We have all been led to believe we all have the potential to achieve millions, a mega mansion, a yacht, whatever we want. All we have to do is work hard. Lies. Most of us do not achieve that. Sure there are a few Oprah's and a couple of Beyonce's, but most of us are living paycheck to paycheck. Americans have been led to believe that the word "socialism" is akin to "fascism" or "communism." It ain't. Why on earth should people die because they can't afford insurance or medication. We just had a major scare from my daughter's boyfriend who is epileptic. His insurance lapsed (his mother's fault) and we BEGGED agency after pharmacy after social service agency for help. No one would. I ended up having to lend him the money or he would be having a seizure right now. The American dream is the reality of the 1%. Short sidebar rant.

Well, my take is this. In America we have been told we need to work hard, save our money, pay our own way, don't pay alot of taxes and keep the government out of our business. But wait, the government is really us or should be. I have a best friend who is Dutch and a sister-in-law who is French. Yes, neither of these people knew many who could afford the Mega-houses some Americans can and the fancy cars "some" Americans buy. Or the grand vacations (wait a minute most of us don't get those either). But neither one had to worry one day about the care of the their elderly parent. It was paid for by a system that makes sure all have adequate health care and elder care. Sometimes I just think we have been sold an idea that only benefits a select few. I think our country gives us more opportunity than any other. But there is room for improvement and we should not be afraid to look at the options "for the good of everyone", not just the ones who have all the money to afford it. And that is my rant.

Karen, Concerning your "rant". You mentioned that your folks saved and saved and worked hard. Keep in mind, they did all of this for a rainy day. This is your Mom's "rainy day." Visit all of the places that are near you and do a true cost comparison. This involves getting the true cost for the level of services your mom needs. Since most ALs charge on level s of services, they might each vary in these charges. Pick the place that makes the most sense for your Mom and for your family. Yes, you will have to sell the house, it's her house and no one else will be using it. Yes, the pension checks and social security checks will go towards your Mom's living costs and yes, some day, you may have to liquidate the stocks to pay for services. The alternatives are you providing 24/7 care, a home health aide or allowing her to fend for herself. The difference between how your Mom lives at this point of her life or your family member who hasn't done much to save is that your mom will be in an AL that provides the level of care described in their list of services. Your family member will not be in an AL --- I don't know of ANY AL that takes medicaid residents. They are all private pay and once you run out of money you HAVE to get out. Your family member will be in a nursing home that accepts medicaid. The ones near me that accept medicaid are mostly run down and I wouldn't put my Mom in any of them.

Karenp, I salute your rant with all my heart. My parents are in a very similar situation. My dad is a WWII veteran too and you ain't seen nothin' until you've tried to figure out the VA run around.
I mean it is all so ridiculous. And the post is that they are looking to me to help them figure it out and I can't. I can't help them when they need me to the most. For all they have done for me all I can do is keep searching for answers and worry right along with them.
Hang tough...

I wish there was a federal standard for Nursing home care. In our state, AL just provides 3 meals a day(dining room only) and room, no medicines or help. This sounds rather independent to me and our state does have independent facilities. If they give medicines or help dressing, they charge extra. If they require even a little extra help(they give points), they want to move them into NH. The next state over provides help dressing & undressing, breakfast in the room among other things in their AL. If I had known this sooner, I would have put her in another state as it was cheaper too. I don't see how a facility can claim to be AL when they do not provide any Assistance. I really thing federal regulation is needed.

Thanks so much for all of your posts. Here are my answers to your questions:

I live in Roanoke, VA. I was told that if she were to share a room with someone at AL it would be $3,500 per month. If she had a room of her own, it would be $4,700 a month. Although I appreciate all of the responses about how "inexpensive" this is, it's not. It's ridiculously expensive. To only provide a room and 3 meals a day for that price is crazy. It does not include anything like medication monitoring etc. It's extra for that.

Neither her nor my wonderful father are veterans.

When I say she doesn't qualify for Medicaid I say that because my dad working his little tiny butt off and squirreled away every penny he got. He worked very hard to accumulate a small nest egg for my mom. She owns her own house and I'm pretty sure that that may qualifies as an asset that would need to be sold.

she probably gets about $1400 in SS and a few hundred more from a couple of pensions from my dad working.

She also has some stocks. And I am guessing that stocks count as assets also?
And now....be prepared for my rant. Hey, you were warned!

I find it DISGUSTING that hard working folks like my dad who worked for decades and gave THOUSANDS AND THOUSANDS AND THOUSANDS of dollars to the US government through taxes, get screwed at the end. What the hell is the point of working so damn hard and saving and saving and buying a house and paying your taxes like a dutiful American if at the end of it all the woman who you did all this for (in this case, my mother) has to sell the home and become poverty stricken in order to get any assistance? So either way the greedy ass government gets theirs, right?!!

I have another family member who does nothing with her life. Accumulated nothing. Owns nothing. A big giant lazy ass. And when the time comes for her to go to AL, she won't have to pay a dime. Great incentive to work!

Oh, I feel SO much better now. Thanks!!

Wow, the NH my Mom is in is over $ 12,000. a month. She had money in the bank and we are using it to pay the NH each month. Once it gets down to Medicaid standards we will be paying someone to apply for her. It is not an easy process here in NY.

excellent answer igloo.

Wow that NH/AL is a bargain. Most NH for basic services & R & B is 65K annual.

Why doesn't she qualify for Medicaid?

If it is that every month she is over her states's Medicaid income limit BUT not enough to pay in full for the NH and she qualifies for NH in every other way?? Then she can see an elder care attorney to do a "Miller Trust" or a "Special Needs Trust". Say mom gets 1K from SS and 1,500K from retirement every month. Her monthly income is $2,500. So basically she is $ 500 over the state's ceiling for monthly income. No matter what she does is always is $500 over. So this excess $ 500 is what funds the trust. The beneficiary of the trust is the state or the state's Medicaid program and upon death reverts to the state. Miller really has to be done by an attorney who does elder law as it needs to be flexible/adaptable and meet the criteria of each state's law on probate (death laws) & Medicaid rules.

Medicaid is a federal/state needs based entitlement program (and very different than how Medicare & SS are done as they are federally structured entitlement programs).Because it is needs based what was done with assets in the 5 yr window prior to Medicaid application is central to qualifying. Medicaid is designed as a safety-net for low income who can show both financial and medical necessity for long term care. The monthly income & asset ceilings and how assets are dealt with after death is set by each state.

Because Medicaid is needs-based, doing a 5 yr look-back on the applicants assets is critical for the states to operate the program. If everyone was able to transfer all of our parents assets, empty out their accounts today, spend monthly retirement and SS on nonNH stuff and put them into a NH tomorrow paid 100% by the state the system couldn't afford it and they wouldn't have any NH to go to.
Medicaid compliance is all about either doing planning OR spending your share until &/OR unless you are impoverished. Medicaid gets to the heart of the issue of who should pay for long-term care -- the public through the tax-supported Medicaid program, or users of long-term care through their personal resources, including
those after death. Good luck!

I have been where you are and it is going to be a long road but you can do it.
My father has utilized in home aid, moved on to assisted living and now a skilled nursing care. I have found when we got him placed in a particular facility the staff were more open to discuss options.
If you or another family member is the primary care giver you can "charge" for those duties. Helps to spend down the funds but keep it in the family.

The sooner you get her assets out of her name the better. Speak with an elder care attorney.

Be prepared if you attempting VA and Medicaid. Although they will back pay the process is long and grueling. Try to go face to face with either of those facilities. It helps.

I wish you the best. You are doing the right thing.

Hang in there.

Sorry but I think the average for AL is around 50K a year. So what you are quoting is really not so bad. It all is really expensive. If your Mom has any money it will soon be gone and prepare yourself for applying for Medicaid. I just don't know if there is any cheaper alternative.

I have a neighbor whose wife had a stroke. They are in their 80's and were very active. She went into a nursing home and required rehab. It was 10K a month. She is now home with no improvement. Someone comes into her home. All of this expensive. Just unfortunate. Good Luck to You

Karen, check to see if you have any Adult Foster Care homes in the area. We had really good luck with them, and it's usually cheaper. Not a whole lot cheaper, but still....

Live in help can be more expensive than AL. We experimented with keeping with my mom in her home with Visiting Angels and 24/7 care was $90,000 a year! Needless to say that lasted about a month.

When we moved her in with us, local and good respite care was $15.00 an hour. My parents were 'grasshoppers' socking away every cent, something we've never been able to do with the cost of everything, but mom's got a good nest egg....for awhile.

Her AL place is a little under six thousand a month. She's in relatively good health and only 75 so I expect at some time, we'll run out. We're also very middle class, often living paycheck to paycheck so I understand. We certainly couldn't even approach affording mom's bill.

When you say she doesn't qualify for medicaid, does that mean she takes in too much a month? My mom has SS and a small pension. I look forward to reading other people's answers. This stuff is not easy!

Hi Karen, As a friend always says, getting older isn't for sissies. Nor is the care giving aspect! Tell me where you live - - - $3000 sounds like a bargain. My mom is in a memory care AL and the bill is $7100/month.

The least expensive solution I am aware of is to hire live in help. It provides one on one care and she gets to stay in her own home. That may work for a while and puts off the move to an AL.

If she or her husband was a veteran, there may be benefits available there. As you spend down her assets, she may become eligible for medicaid at some point.

As part of my search, I did find a group home for memory care. 15 residents in the home. I wasn't impressed with the one I saw and it was the only one in the area.

These are the best ideas I can come up with, perhaps others will have more ideas. Good luck.