My dad is 94 with mild cognitive decline and limited mobility, and needs some help with basic ADLS. He owns a 3bd 2 1/2 bath home in Balto co, and would like to age in place but can’t afford the high cost of live in help, and we don’t even want to consider going into assisted living during COVID. He is also a veteran but doesn’t meet Aid and Attendance Pension benefits at this time. With all the people who need housing and employment, and all the elders with limited income who need affordable unskilled care to be able to stay in their homes, a WinWin Exchanging Needs Solution could be extremely beneficial to all. My dad has local family members who have been, and can continue to provide some help and support but can’t do it all alone.
I have already researched many of the in home agencies and their prices are too high, 4x the monthly cost of assisted living homes, plus still have the costs of your home, food, insurance, etc..
The caregivers have issues as well. Family members of the elder coming in and causing disruption. Coming for holidays as was their custom prior to Covid and putting all in danger. Treating the caregiver like a personal servant, the list goes on and this with ones who are being paid.
Recently there is a post where the arrangement worked so well that the elder has changed her will to leave her entire estate to a stranger who began by mowing her lawn and has since moved in.
So there is that problem to consider where dad with mild issues now deciding he likes the live in caregiver better than his family.
Cameras help, a medialert helps, ordering things in, a housekeeper. Think of it as layers of help.
My DH aunt, 94, with dementia has an aide that comes in threes hours a day to help with ADLS and meals and to get her day started.
She has had HH for several years and therapy. They manage her meds and provide baths. She is now on hospice through the same company and receives more services. She also has MOW three times a week.
Until Covid, I had a couple in the family that came over once or twice a week to prepare food, order the supplies that were needed, replace batteries in the cameras and just check on things. They also paid the helpers. I had them for about three years. It gave me a much needed break. I lived two hours away. I still came in two to three times a month. My motto at that time, the more eyes on the situation the better. Since Covid not so much.
Call the Area Agency on Aging for your dads county. See what services they have available for him. They can sometimes come out to your dad and do a needs assessment.
My personal opinion is that at 94 things can change in a blink of an eye. Whatever help he has will work as long as it works and then you have to rethink, regroup and add the next needed thing to keep him happy and comfortable.
Of course, we often talk of “the event” that changes everything and usually results in hospitalization, rehab and then placement for appropriate care.
Check out the book “Being Mortal, Medicine and What Matters in the End” by Atul Gawande.
There are pros but I think more cons to this kind of arrangement. There have been horror stories where the Caregiver refuses to leave or they move in their entire family.
Since Dad seems to have no money to hire help, I don't understand why he doesn't qualify for Aid and Attendance. The criteria is serving during Wartime. You don't have to be in the fighting. You are allowed a certain amount of assets. You need to prove that the cost of your care is more than your income. Did u actually try to apply? And if you did and were turned down, did you appeal?
You cannot expect a tenant to work for free. You still have to pay minimum wage and can only adjust the hourly wage down by what's considered the **reasonable** cost of providing room and board. And your tenant would have to agree to what he or she considers reasonable for room and board to be deducted from his/her paycheck. For example, you cannot serve oatmeal for breakfast and deduct $10 per day for it. That's not reasonable.
Likely you will find yourself in a situation where the tenant may agree to a certain deduction for the room but not the board given that many people have food allergies and/or food preferences and would prefer to have the cash to buy the food they want. Even then, you still cannot expect someone to work 24/7. You still need to give days off. And paying minimum wage you will be hard pressed to find someone reliable.
- anyone living with him needs to have a thorough background check by a licensed company. There are many creepy people in the world and your father, at 94, is very vulnerable.
- anyone living with him who becomes undesirable can't just be kicked out, they'd need to be evicted, a legal process which takes at least 30 days and then if the housemate won't go voluntarily you will need to call the police, but they'll only help you after an eviction notice (or unless this person is actually making threats to your father)
- "aging in place" is the romanticized notion that your dad will remain at the level of function he is currently at (both physically and mentally). This isn't most people's reality. He WILL need more and more intense help than a random person picked as a housemate may be able to handle. He may need medical help that a random housemate may not be qualified to provide. The housemate may have no idea how to interact or manage someone with memory loss or dementia and may decide it's not for them. They leave and you're back to square one.
- allowing a housemate opens up the very real possibility of financial and/or physical abuse. It is often a crime of opportunity. If your father has never had a diagnosis of dementia or cognitive decline in his medical records, this housemate can literally talk him into making them his PoA and then proceed to drain him of literally everything and will have no legal way to stop it. This would leave him unable to even qualify for Medicaid. Please read the hundreds of posts on this forum whose parents were just such victims and the awful aftermath, which usually has no recourse to recover the money or prosecute the thief.
- for many elders "aging in place" really just means they are living in their homes and everyone else is orbiting around them to keep up the pretense that they are somehow "independent". This is very isolating. Also, newer nursing homes are very nice, not like the horrible ones of prior years. It is important to find ones that are well managed. They are not perfect but neither is staying in a private resident. FYI depending on what type of care your father eventually needs and for how many hours in a day, paid in-home care will exceed the cost of a facility.
It would be a very wise investment to spend 1 or 2 hours talking to an elder law attorney familiar with estate planning and Medicaid qualification. Everything he does with his money now could impact him qualifying for Medicaid. In some states the "lookback" period of the application is 5 years. Many people think they'll never need or want Medicaid -- this is an option that should never be dismissed or ruined. Please take him to an attorney -- there is lots to know so he can make wise and productive choices going forward.