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Both parents have dementia and do not need to be living alone. They do not make a lot through pension/social security but make plenty to survive living in their home. Children have been appointed guardian and conservator, but even with the sale of their home and vehicle they'd only have enough to pay the high prices of assisted living facilities for a few years. Without the sale of those assets they have enough for 4-6 months in the facility.

I'm sure there will be a price increase yearly for the facility.....so how does everyone afford it? Or is there another option? Plus what if one of them gets kicked out....or both? So much to think about.

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ConeyCat: Please come back on here.
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more health care aids considering tennent live in more personal atmosphere. Some opt for 4day week live inallowing for 2care taker aides . many work a 2or 3 day on shift at regular jobpositions. lets family have a more family enviroment of care. .better handle on needs assesment.
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ConeyCat: Please respond to my questions. I think they were all very good and valid concerns.
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dcoach -

"The person likely will not be passing on money to heirs but this is understandable as the tax payers will be footing the bill for their care, possibly for many years."

You express that so well! Of course people want to leave money for their children, but all of us need to pay our way as long as we can. If I won't use my assets to pay for my care, why should I expect someone else to pay for it?

I'm a liberal all the way, but, like most liberals, I take responsibility for myself as long as I can.
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ConeyCat:
Question #1 Have they put in place an investment advisor so that their funds can be earning them some money?
Question #2 One of two things will happen-they will age forward or they will decease; I apologize for it being such a blunt, but factual consideration, but have you given that some thought?
Question #3 Is it wise to pay out large chunks of change for each of them to an AL?
Question #4 Should you start the Medicaid process now for them to potentially move into an NH?
Question #5 Have you considered the "living in place" option for them, whereby they get to stay in their own home with home health aides coming in?
Question #6 Have you considered getting a reverse mortgage for them?
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My dad had early to moderate dementia when he was in AL (assisted living). The facility we chose (a small CCRC) had a certain number of AL rooms that would accept Medicaid for after 1 year of private pay (we were paying ~$5500). Other facilities I visited ranged from 1 to 3 years of private pay before accepting Medicaid but only a few had provisions for AL Medicaid rooms. Because of a decline in his heath, my dad was moved to the nursing wing (~$9000). He has moderate/severe dementia now but does not wander, so is not required to be in the dementia wing.

The guardian must decide what is in the best interest of your parents, not how to keep the money for future inheritance. You said they should not be living alone. My dad was in a similar situation. He lived comfortably on pension and SS before the move to AL, but has gone through his savings and the money from his house over the last 2 years and we are in the middle of the Medicaid application process. I knew moving in that his money would be gone in less than 3 years. My dad so very strongly wanted to leave an inheritance, but it would have been a detriment to his health physically and emotionally to put off moving to AL. It's not about what I might get, but about what kind of a steward and caregiver I am for him in his final years.

Here in Ohio, the process of applying and getting approved for Medicaid can take up to 5-6 months, so please contact a lawyer long before you think you may need it. To do again, I would have gone to one when my dad first moved into AL, 2 years ago. Most elder care lawyers here offer a free consult. Ask around and get references or get several consults.

Why would your folks get "kicked out"?

In response to other answers…It is true that moving is difficult for dementia patients, but the longer you wait to move the harder it will be on them…and you. I waited about a year too long because I did not want to "make" my dad move when he did not want to and stilled "seemed" capable.

Please do your research on facilities. Visit unannounced at various times of the day and stay for an hour if you can. Find an out-of-the-way chair and/or walk the hallways and watch - discreetly - the residents, aides, and nurses. Initiate and listen to the conversation with/amongst the residents. Take notice for smells. "Our home" is expensive, but we've been there 2 years, and I can say that all residents get treated with respect and dignity, even those who do not have family or friends visiting. I visit 5-7 days a week at various times of day and night, and stroll through the entire facility every so often to be sure all is up to par.
Sorry for the length...
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The two ALs near me have two year private pay at least and medicaid takes over if a medicaid room is in the facility.
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The assisted living place with a memory care floor that I found for my friends said that after 18 months at the regular rates, they would accept public financing. Between their monthly retirement and social security income, their IRAs, their long-term care insurance and their savings, I can manage the 18 months easily. I will add the proceeds from selling their condo into their savings account. When their assets get low enough, the husband is eligible for veteran's benefits which should pay some $2200 a month to help out. So, it depends on the facility, I guess. I visited about 9 AL places and the one I chose was the only one with memory care apartments large enough for two people, with two-bedroom, one bedroom and efficiency apartments to choose from. They had to go as a couple as the wife was lost without her husband. When she passed, the husband has been quite content to stay in that same apartment, thank goodness, and the staff sees to his needs. I check at least once a week, visiting at different times.
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Look into a Adult Care Home. They are sometimes less expensive than AL. If your mom or dad is a vet might help. If you are going to keep them at home for awhile longer until they (or one of them) can be eligible for NH, get a lot of help. Do get good elder law help to make sure you don't negate their ability to qualify for Medicaid when they need it. An attorney who can help with guardianship may or may not be up on Medicare law for your state. Good luck.
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If you are not facing an immediate health crises then take time to do some thoughtful planning - do you have financial and health power of attorney papers in place ? If not then start there and seek elder care advice

Despite what some posters think - it is extremely difficult to care for an elderly parent with dementia in the home especially if you don't have a lot of support

My mom stayed at home til 92 1/2 and after numerous falls and refusal to accept caregivers - which are not reliable anyway - is now in memory care - the decision to move to memory care was done during a hospitalization after a fall while the discharge clock was ticking - in my opinion it has been a disaster - there is no more care than assisted living which is to say none and I now have private caregivers with her 12 hours a day which we cannot afford much longer - I do not know what are next steps will be but it has been a very long and exhausting road and we have many more miles to go

If you do go the memory care route then visit the facility at different times before you make a decision - afternoon lunch time is far different than 7:30 pm
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I agree with ferris1. Many people stay in their own familiar surroundings well. If you are worried about them leaving, the local police will be willing to give you a tracking braclet for free.
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Changing an environment can be detrimental to folks with dementia. You may want to contact the local Area Agency on Aging and see if there are any in-home services available for them and if the services can be subsidized by Medicaid . If either of your parents are veterans, the VA may be able to offer some Aid and Attendance or help with assisted living costs. You have cause to be concerned if one of your parents gets kicked out of assisted living. They may reach the point when they need more care than they can receive in assisted living. So a nursing home may become the best place for one or both of them. When they are in a nursing home, they may become eligible for Medicaid to help cover the cost----along with almost all of their income. You should contact an Elder Law Attorney when it comes to Medicaid planning. In most states, Medicaid DOES NOT pay for assisted living.
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80% of people with dementia are staying in their own home with the help of professional people who can provide the care each needs. Do not sell that home because I doubt if they can afford $5,000 - $8,000 each month for a facility. What if they live longer than you think they will? Stay put!
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You are right to be concerned about yearly price increases and greater costs in care as your parents need higher levels of care. My dad started out at about $4000 a month and by the time that he passed, he was paying about $11000 a month because he needed a day time sitter and night time assistance. In his case, he was only in assisted living for 20 months before he passed away and did not run out of money. He was very worried that he would, even though I promised him that given my own fortunate financial circumstances I would continue to pay for his care when he was no longer able. My advice is to keep your parents in their home with appropriate supports as long as you can before you make the move to assisted living. We did not have that option because my dad's home was damaged in Hurricane Sandy. There is definitely a lot to think about and no one has a crystal ball on how long and a what cost their parents will need care.
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Since you are guardian, get yourself to a qualified Eldercare attorney who understands the Medicaid rules in YOUR STATE. Get your parents a "needs assessment" from their local Area Agency on Aging so that you understand what level of support they need.
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What often happens is that assisted living is too expensive or not an appropriate placement so a memory care facility is a better choice. This setting is very expensive so the person's assets are used until it is clear they will soon qualify for Medicaid. A Medicaid application is completed and submitted and, hopefully, the person will be approved. The rules differ by state as to the financial requirements to qualify. We went through this process with my MIL and she had to have no more than $2000 in assets, not counting her car or home (she did not have a home). The person likely will not be passing on money to heirs but this is understandable as the tax payers will be footing the bill for their care, possibly for many years.
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Would they qualify for nursing home level of care? If they do, you might need to apply for Medicaid. I was just answering another question and telling the poster that Assisted Living isn't always the right choice for persons with dementia. My grandmother was "kicked out" and moved to a locked facility (now called Memory care units or some other nicer name) when she started wandering because she wasn't safe in assisted living. Best wishes!
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