I need practical (not legal) advice on dealing with parents in assisted living.

In My Humble Opinion
21

Having lived through this very situation, I second this wholeheartedly. You are embarking on a thankless job & every decision you make will be criticized by some arm chair quarterback.

My recommendations:
-Liquidate ALL of their assets as you will need cash.
-Have their mail sent to your house, so things don’t fall through the cracks
-Cancel their credit cards & get new ones (we didn’t do this & ended up regretting it as all sorts of recurring expenses kept getting billed–newspapers, utilities, etc)
-Do not give your mother access to credit cards (my MIL with dementia spent $$ on ridiculous things)
-Take care of YOURSELF

22

Wow, that’s pretty sweet! Glad I was wrong on that.

A couple more things just came to mind:

  • A few folks have mentioned power of attorney and power of medical decisions (or whatever that’s called). I’ll reiterate those - they make things WAY better. But don’t just leave it at that - make a point to get that info to banks & docs & anything else. It’s a major pain in the ass to wait until something is wrong and you need to talk to the bank or the doc and they won’t talk to you until they get the paperwork. Especially if you’re not local.

  • Figure out a way to get their email; for me, that’s been a mix of getting my Dad an email address that I have access to and/or changing his account so any communication goes to my email address. The only reason I made him an account was for things like local utility bills, where they are technologically in the stone age and couldn’t handle two accounts for two different physical addresses going to the same email address.

  • Same thing for phone; my Dad is both hard-of-hearing and forgetful, so I’ve changed all his doctor contact info to go to my phone. He never listens to voice mail on his phone, so I changed the greeting to say “if you need to talk to <Dad>, call Athena at 555-222-3333. Don’t leave a message, nobody listens to them.”

Good luck!

23

One thing you might consider - get in touch with a local church (particularly if they were affiliated with one) and see if their home-visitation “crew” will visit your parents. Our church has a regular round of shut-ins that we visit and check-in on. It’s coordinated by our parish nurse, who briefs the rest of us on who needs visiting. Over time we develop relationships and bring the more mobile folks to our homes for holidays, etc. We have some folks who bring pets (or children) to visit and for many of the elderly this is refreshing.

24

This one is totally covered. My parent’s church has been great to help. Also, my dad was high up in the Gideons and their devotion to each other is nearly cult-like. Whenever I’ve needed something from a local business, someone would say “John Smith is a Gideon with a car dealership. I’m sure he’ll be glad to help.” And sure enough, “John Smith” always is.

25

I want to echo what Dinsdale said about the commitment level. It is a slippery slope. It’s possible they are not telling you the full extent of their health issues, and the only way to learn what is really going on is to start going to their doctor appointments with them, then you start to get involved with their care, and their prescriptions, etc. If you are one who wants to know everything and be in control, be prepared to be sucked-in. You may be better-off letting them manage their own health issues with their doctors.

I agree with most of the suggestions so far. I would add that you should get access to your parent’s bank accounts, especially the checking account, if they have one. It only takes a few minutes for them to provide that by filling out a form at the bank. This will come in handy when some expense emerges for them and they are unable to take care of it. I was able to write checks from my dad’s account (rather than using my own money). It is important to keep your finances and theirs separate. I learned after he died that any and all debts he had are not my responsibility (I did settle-up his consumer debt before closing his credit cards, as that seemed like the right thing to do - using his checking account).

Another financial tip: my father was living off his investment portfolio when he moved to assisted living. I told him not to bother saving anything for me, and to spend and enjoy. Unfortunately, he did not die broke. But, he did me a favor by designating his accounts TOD (Transfer On Death). After he died, I provided the death certificate to his adviser, and the funds transferred directly to me and my brother per his instruction - no probate, no paperwork and this took precedence over any prior will. This is another way to avoid paperwork and hassles later. As someone mentioned already: know where all the paperwork is, where all the accounts are, and who is their financial adviser: now.

26

As many familiar things as possible. If you can hang up a favorite picture or something like that, it can help.

27

I did this the second or third day and you’re right. It made a big difference.

28

Bumpdate: It was a long and involved process but I finally have Medicaid paying for my parent’s assisted living. They got approved just as their long term care insurance maxed out. They’re happy and doing well. Mom took longer to adjust because she just couldn’t understand why they couldn’t go home. Dad has been solid as a rock.

If you’re curious how much paperwork is involved, it looks like this.

29

I missed this thread during it’s earlier run, but since it’s bumped I’d like to say, for any other latecomers who might be reading this:

My wife and I managed my late mother’s finances both before and after she went into Assisted Living and then to Nursing Care. As my mother and I INTENSELY disliked each other for all of my adult life, 27 years of managing her $$ was a nightmare. She died 18 months ago, age 90.

At the same time, I’m also covering nearly all the costs of my disabled adult sister’s Assisted Living care. She’s helpless, blameless, and I’ve always adored her; wonderfully, the AL lifestyle has brought her real happiness for the first time in her 60 years (it’s the type of environment she should have been in all her life). So my financial “sacrifice” is money very well spent.

Dinsdale’s first post (#7) is spot on correct, says everything I would have.

30

Yes. It can get rough. It sounds like you’ll be pretty much on your own caring for your parents.

I’m kind of in the same boat. I recently (at the beginning of this year) moved my father into a memory care facility. It’s brutally expensive, and there’s a real chance he’ll outlive his money. I don’t know what I’ll do then.

Up until about seven years ago, my father was working at a very intellectually (but not physically) demanding job. He was a federal judge. He took inactive status when his wife became terminally ill, and spend about a year caring for her before her death.

Her death hit him hard. It was tough – his first wife, my mother, died very young, about 30 years ago. Bad luck, to be a widower twice.

After that, his decline was rapid. Physically, diabetes took its toll, and he ultimately because housebound. Mentally, he slid into dementia.

Financially, things were, and still are, a mess. He was very good at concealing his declining mental state, and assured me that everything was alright. After a while, I came to doubt this, and started surreptitiously opening his mail. Jesus. I discovered that not only had he not filed a tax return in about five years, but that his wife and stepsons had pretty much robbed him blind. He is to this day paying a mortgage on his home (an apartment in Greenwich Village) that went to redo, refurbish, fix up a vacation home in the Hamptons owned by the stepsons (who, since their mother died, have not been to visit him, or even called him, once). Stock holdings were cashed out and given to the stepsons. Same with retirement accounts. It was all done legally – the wife and sons are all lawyers, they got him to sign stuff while he was presumably competent, my lawyers tell me it’s a sad story, but nothing can be done.

After a while I was spending all my time caring for my father. And believe me, I don’t have a lot of time. I have a demanding job and two small children. It was clear he could no longer live on his own. But he was refusing to move out of his home. I was on the verge of getting legal help to have him declared incompetent, and myself appointed as guardian.

Fortunately, sort of, he was hospitalized in November of last year for complications resulting from diabetes, and the hospital simply refused to release him to his home. So I found a care facility, and there he is today. He never returned home from that hospitalization.

His apartment is being sold, which is good, because he needs the money. The above-mentioned step-family took everything he had. Even so, I worry that he may outlive his money. Given the cost of memory care in NYC, that’s not a baseless fear.

I’m in New York City, so the car thing isn’t an issue (and my father never had a driver’s license in his life, anyway).

I have three siblings, one of whom has gotten very helpfully involved in my father’s care. He came late to the party, but better late than never, and he’s very involved now. Another sibiling does not live in NYC and has washed his hands of the whole thing. There’s a sister who lives very far from NYC, hasn’t even visited my father in years, but is very, very, *very *interested in his estate planning, and not much else. She calls very frequently to demand accountings of his money, what’s being spent, how much is being spent on his care, etc. Fortunately, there’s nothing she can do. I have his power of attorney. She will be very disappointed that there isn’t going to be anything left when he dies, and I’m expecting some trouble from that quarter.

So, here’s my advice, for whatever that’s worth:

Your geographical distance from your parents may be a blessing, sort of. You can’t be expected to see them every day, or even every weekend. That was a bone of contention with my sister (the one very interested in estate planning). She would get irate if she heard that I’d rescheduled a doctor’s appointment or something, and call me and scold me. Her kids are grown, her husband is retired, and she hasn’t worked a day since she got married. But she would rake me over the coals for not spending enough time caring for my father.

Their residential care facility will have to handle the day to day stuff. If you trust them, back off and let them handle stuff. But make sure they contact you about medical matters. I’m assuming you have their health care proxies.

Be prepared for the day when advancing dementia, or illness, may require a move to a more specialized care facility. Know what your options are. Have a plan. It’s quite likely to happen.

Did you know that you can pre-pay for funerals? It’s a good idea, and since you have a power of attorney, you can do it with your parents’ money, rather than having to dip into your own pocket and recoup from the estate, if there’s anything in the estate (sounds like there might not be).

Sorry, I’ve spent more time complaining that saying anything useful. But the three paragraphs preceding this one, I think, are useful.

31

I’m going through a similar process right now. And my strongest advice to everyone who will ever be facing this situation is to plan ahead.

My brother and I tried to push my mother into seeing a lawyer a few years ago in order to make plans for when my father needed assisted living. But my mother resisted; she’s the type who doesn’t want to face harsh realities. So we never made legal plans.

Now we’re being forced into the situation by my father’s declining health and my mother is paying the price for not having planned ahead. A lot of the work that needs to be done to protect an elderly person’s assets needs to have been in effect for a period of several years before you apply for financial assistance. My parents are now going to have to spend a large sum of money paying for bills that they could have been able to hang on to.

32

Another one:

even if your siblings are too far to provide physical care, they may be able to help in other ways. My brothers live in the same town as Mom, I don’t; I’m Mom’s primary psychological caretaker (aka her primary target): she offloads on me all the shit she normally hides from other people, and if I could bag it for fertilizer I’d be rich. When I see that Mom is being particularly off-the-rails I warn the Bros; when any of us feels like we’re about to explode because of high-stress situations wherever our sibs often are the best source of help, because we do love each other and we know each other like we’d grown up together ;). Never underestimate the power of a good rant or an all-caps whatsapp to someone who’ll understand it and be able to make you laugh.

33

I’m currently going through this process as well. And I look at the photo of the binder of paperwork and say “Really? Is that all?”

I had to supply every bank statement and canceled check from every bank and investment account for a 5 year period.
I’ve written about this before but our situation is complicated. Our family home was destroyed in house fire 4 years ago. The fire also trashed a lot of the financial protections we had on the property. It also added several degrees of complexity to our financial situation. I had made several large loans to family in the wake of the fire, and I had to go back and find documentation to prove they weren’t gifts. And a lot of this was stuff I just hadn’t thought to save, like rent receipts from their temporary housing.

Another complexifier was the fact that my brother and his daughter are both legally disabled. This one worked in our favor and allowed us to retain certain assets.

Then a couple of the bank accounts that I needed documentation out of had been closed because of a fraud incident about 4 years ago. I probably spent over 40 hours hunting down the requested documentation.

The other thing I wanted to mention was that some of the previous posts have mentioned liquidating assets to pay the nursing home bills privately. It is my understanding that there are better ways to handle this. The Medicaid rate for the nursing home is substantially cheaper than the private pay rate.

As for the details, ask your lawyer. You need one for a Medicaid application. It isn’t cheap ( probably around 10K ). But that fee is part of the “spend down” process and comes out of money that would’ve otherwise gone to Medicaid or your nursing home. You can also do things like prepay funeral expenses as part of the spend down.

34

My parents both died in their sleep about a month apart from each other 20 yrs ago. They were in their mid-70s. A month and a half before my mother died, they moved out of the home my dad had lived in for 70 years, into an assisted living place. They were completely sentient up until the day before they died.

My parents were older when they started having kids, so my parents died well before most of my contemporaries’. At the time, I was angry, and thought they died too soon.

Now, as I hear of so many people (such as the MANY in this thread alone) having to deal with parents declining yet being kept alive for years/decades, I realize how fortunate I was.

The one thing I urge EVERYONE is to plan ahead so as not to impose such a burden on YOUR family.

35

Following this thread with interest…my set of parents have retired well with pensions, annuities, wills, etc so I can’t thank them enough. Love ya mom and dad!

Mrs Gargoyle’s parents, on the other hand, will be a nightmare. They are rigid ‘homesteader’ attitude and intend to die in their rocking chairs on the porch that they’ve sat on their whole lives. They are very poor with tons of dept and zero assets. Their house is decayed to the point where the bank would only claim it as a loss, and their property is in a flood plain. They want their homestead to be preserved as a family heritage and as their dying wish, and constantly emotionally manipulate the three siblings who all infight over ultimately what should happen. They already can’t physically take care of themselves well and are only being supported by weekly visits with groceries, cleaning, handyman fixes, etc.

I just want somehow to have her parents supported in a way that they won’t suffer, while not dragging everyone down into doom with their homestead money-pit boat anchor. I find myself wishing for a major flood so that nature can at least help make the property decision for us.

36

My family was pretty well set financially, except for the lack of a specific long term care insurance plan.

But nursing home bills drained the principal from the the retirement accounts pretty fast. 15 to 20K a month, it adds up fast. I spent a couple of years watching what I thought was my Mom’s financial security spiral down the drain.

37

Depending on the location, social networks are likely to not kick in until private sources are demonstrated to be dry, or will kick in at much-lower levels. After all, the purpose of the social network is to help those who need it, not to preserve inheritances (you hear that, Grandma? Ah no, you’re dead… you bloody well were obsessed with not selling the flat, though).

38

If any of you are acting as a full-time physical caregiver for your aging parent:

If you have to apply for Medicaid, most states give special status to a “caretaker child”. Your parent may be allowed to transfer certain assets (like second cars or the family home) to you without penalty. Because Medicaid realizes that, if not for you, your parent would have been in a nursing facility sooner. So, in a sense, your work saved the state money.

There are a lot of caveats that should be discussed with your lawyer. IIRC, the caregiver has to be the patient’s child, grandkids and nieces/nephews don’t count. And the child has to have provided a certain level of care, just driving mom to the doctor and preparing meals may not be enough to count.

Again, anyone that is going through this should get a lawyer. Try to find one that specializes in Elder Law. I can’t mention this enough. At one point, someone at my Mom’s nursing home handed my brother a 3 page application for Medicaid and told him to fill it out and return it. Luckily (in this case) my brother has cognitive disabilities so he just stuck the paper in a file and forgot about it. I have nightmares thinking about the kind of trouble we would’ve been in if he had tried to do this without the proper legal advice and estate planning.

39

Even though protecting large assets like the family home should be a priority if you have a legal way to do it, that wasn’t what I was getting at.

Say, for the sake of simplicity, the equity in the house is 200K and the nursing home bill is 20K a month. If you sell the house and use the proceeds to pay the bills, you get 10 months of nursing care in exchange for your house.

But the Medicaid rate for the same room may just be 10K a month. So if you keep the house ( I don’t believe the state will seize the house until after your parent dies ) and it ultimately reverts to Medicaid, that same house will pay for 20 months of nursing care.

So if your parent dies 15 months into being Medicaid supported and Medicaid does sell the house to pay the bills, you may get something back. Plus you will have continued to accumulate equity during those 15 months, so the house may be worth a little more.

Again, IANAL. Again, if you are going through this you need a lawyer. But everything I have read and been told suggests it’s usually a mistake to sell the family home to pay nursing bills.

40

Definitely make plans for contingencies. But you never know what the future will throw at you.

For example, my father’s federal government job gave him an option to accept a reduced pension in exchange for having that pension be inheritable by his surviving spouse. He chose this option. Seemed sensible. He was a bit older than his wife, and women tend to outlive men anyway. But his wife died first. So that’s that – he’s receiving that reduced pension for the rest of his life.

When he stepped down from the bench, he had the option to go on Medicare, or continue to receive the health insurance that he had as a benefit while he was working. He chose that option, since his wife was very sick (terminally sick) at the time, and her doctors and hospitals and so on were all covered under this insurance plan. Didn’t seem like a good idea to change horses in mid-stream, so to speak. Then she died, he’s suffering from dementia and various physical maladies, and all things considered, he’d be better off with Medicare. Next open enrollment period, I may be able to get him on Medicare. We’ll see.