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My dad lives in an Assisted Living, and has an aide with him for 12 hours a day. The costs every month are getting so high, and we are running low on finances. I don't know how to keep up with everything, and he is having more and more episodes where he needs increased care. How do I deal with all of the costs while ensuring my dad has the right care he needs? None of us kids can take him in, and he has no place to go if we cannot afford the Assisted Living.

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"We" cannot afford the Assisted Living? Your father should be paying for it out of his funds. Is he?

Is he Medicaid-eligible? It sounds like he needs a higher level of care than AL, so maybe he needs a Nursing Home (NH)?
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Why does he need an aide 12 hours a day? AL is for those who need some help, not 24/7 specialized care.

Most likely he needs to be placed in higher level service, like NH, if he doesn't have the money to self pay, apply for Medicaid.

You shouldn't be paying for this in the first place, it is his responsibility.
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Kmi7688, I am really surprised that your Dad was even allowed to be in Assisted Living, due to the Alzheimer's/Dementia that is on your profile. The facility should have recommended Memory Care or a Nursing Home. And they should have mentioned Medicaid.

Memory Care or a Nursing Home can be quite expensive. As others have written, it is time to see if your Dad can qualify for Medicaid [which is different from Medicare]. If your Dad qualifies, Medicaid will pay the bill for nursing home care. Call your State Medicaid office to get the ball rolling.
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Kmi7688 Aug 2022
He does not have the specific diagnosis, but we suspect that is something he has. His doctor has not been forthcoming with the diagnosis, and so he is not eligible for Memory Care.
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Hopefully you aren't paying out of your pocket for his care. His funds pay for his care, and when they are gone, you place him in a nursing home paid by state long term care Medicaid. Contact a state elder care social worker to help you if needed.
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First off, its time for a new doctor if this one is "not forthcoming" with a diagnosis for your dad! What's up with that?? Meanwhile, he's in the poorhouse from paying astronomical amounts of money each month for an aide to be with him 12 hrs a day in ASSISTED LIVING! What are they assisting him with that he also needs to pay an aide for 12 hrs a day???? What's wrong with dad that he needs such a level of care? That begs the question, then, why is he in AL if he requires THAT much care??? Something is wrong with this picture. He likely needs Skilled Nursing but not before he's seen by a REAL doctor who can properly diagnose him and let you know what type of managed care community he belongs in. The ALF itself should be assessing dad and letting you know if he even belongs there and if so, why it's necessary to also hire an aide for 12 hours a day.

Seek guidance from an elder care attorney about Medicaid requirements in your state BEFORE dad runs out of money. He can go to a Skilled Nursing Facility under Medicaid when he runs out of money if everything works out.

Wishing you the best of luck.
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Not understanding, the AL facility he is in can identify his dementia, that is why we moved my step-mother from AL to MC, they were concerned about her wandering and getting lost outside.

Your doctor doesn't need to write a prescription for this.

Again, why the aide? In AL, the aides are the employees, if he needs more care he can be moved accordingly.

Since there is confusion here I would seek some guidance perhaps through a social worker, all AL have a referral list.
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No one should have an aide for 12 hours when in an AL. If an aide is needed, they need a higher level of care. No wonder Dad is running out of money. MC will cost even more and I think Dad is passed MC. They are just a step up from an AL.

Your Dad needs Longterm Care. Start looking for a nice facility. Then take whatever money he has left, and pay privately. With my Mom she was in an AL and money was running out, she had 20k left. I started the Medicaid application in April. She was placed in LTC May 1st. She paid for May and June. June I confirmed with her Caseworker that they had all info needed and Medicaid started July 1st.
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Kristen2037 Aug 2022
This is what I recommend as well.
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My SOs nana paid for a 12 hour aide on top of her ccrc. It was convenient in that she got immediate attention versus having to wait for a bit while at the same time, the housekeeping, maintenance, groundskeeping plus meals were handled.

My neighbor got an aide for her dad in a Brookdale because they told her it was that or he’d have to leave.
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PeggySue2020 my parents placed my 99 year old grandmother in an assisted living facility when she became unable to live on her own (yes, she was independent for that many years!). At the time she was suffering from Parkinson's symptoms and related dementia, was incontinent, was unable to cut her own food, etc. Brookdale promised to ensure someone was always available, on call, to assist her to the bathroom and for incontinence care, to bring her meals (with the food cut up) to her room, housekeeping and laundry. It was less expensive than care in the skilled nursing or memory care wing and Brookdale was happy to convince my parents they were doing the right thing. My parents were concerned that the skilled nursing care wing would burn through Granny's savings before she passed away and they didn't want her to end up in some kind of state home.

Her time there was completely awful. It seemed that about half the residents in her wing were in the same situation. She was left to sit in her own feces because the nurses "were not paid to clean that up". She was covered in crumbs. Her food was not cut up for her. Her like-new Haywood Wakefield bedroom set was damaged from the staff spilling liquids and food on top of it, and the entire space smelled of human waste and trash. Housekeeping -- if there was any -- must have consisted of vacuuming the room she was never in. The only saving grace was that she declined so quickly that she was basically unaware of her surroundings for most of the time she was there, but it was still a few months before my parents finally found a small group home for her where she received 1 on 1 care. Granny died 3 weeks later. Because my mother was her 'caretaker' at the time and I found it too 'uncomfortable' to visit more than a few times (each of which resulted in my placing an emergency call to management because of the state I found her in), I will never forget leaving my own grandmother to spend her last months in that terrible condition.

Beware. Assisted living facilities may well attempt to sell you whatever service level you seem most comfortable paying. While the individual people we spoke to there -- from staff to the manager -- truly seemed to mean well, the low pay and low skill level combined with pressure to profit from their residents placed them in the position of never being able to live up to their promises. You may tell yourself, each time you visit, that it was a one-off, that they were just short staffed "that day". Don't fool yourself. Don't let a family caregiver fool themselves. A caregiver who is exhausted and burned out may not really comprehend the situation for an awfully long time.

I think these places and the financial agreements entered in to with them require open, objective, caring eyes from the family who make the arrangements. I really wish I had stepped as caregiver in place of my mother, who would probably have resisted but appreciated it all the same. Granny would have ended her days in her own cottage with 24 hour care on top of hospice supplemented by our family. It would have been cheaper, and it would have been better for her.
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sp19690 Aug 2022
Totally agree.
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I also ask why an aide is required for 12 hours?

Whether for supervision or hands on mobility assistance, it sounds like AL is no longer enough care.

"He does not have the specific diagnosis"

Parkinson's listed on profile. This awful disease brings cognitive changes as well as the physical.

Are you (or other family) Medical POA? To have the authority to get an up to date medical checkup, diagnosis & updated care plan arranged?
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Hi,

I live in Florida and I visit what is supposed to be the best assisted living in Florida. It is really, really common for residents to have outside paid caregivers. I see caregivers wearing the smocks of agencies accompanying residents all the time in this assisted living facility in Florida.

You are already paying for 1 caregiver 12 hours per day. It may be cheaper to get an efficiency apartment (standard apartment) and get an overnight caregiver for the other 12 hours.
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Good Morning,

There comes a time when the Assisted Living facility is not the right match for your father's needs. As they age, they require more skilled care.

You don't want your dad to remain in a situation where his needs are not being met and you're being charge for everything, including the chocolate mints on the pillow.

Every Assisted Living is different, however, they are NOT government regulated like a Nursing Home--not that anyone wants to place a loved in a NH but sometime they need around the clock skilled care--your insurance should cover this.

Assisted Living in my humble opinion is real estate with everything a la carte. You pay through the nose for everything--laundry, prescription--ordered, filled and dispensed, hair salon, etc.

I am not in that social circle but I read everything and have been a caregiver to many people over the years.

Some AL have the next step which is a Nursing Home.

I don't know too many people who can afford the Assisted Livings. It sounds like he has exhausted this place in more ways than one.

Speak with your dad's primary care physician and do an assessment. Also contact the nurse practitioner at the medical office. They usually know a lot. A social worker or geriatrician if you find one in the area is another good resource.

I hope I was of some help but I try to speak the truth from my own experiences.

You are in my prayers...
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Obviously he is not a candidate for assisted living if he requires someone to sit with him 12 hours a day. But they won't tell you that because it is a lot if extra money fir them. He needs to be moved to a nursing home. That is the solution.
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Good Morning,

I might add the Assisted Livings will often showcase there is an RN on duty. Again, my humble opinion--if there are 80 seniors who can't live alone, chances are more than one will be sick at the same time.

The nurse can only take care of one person at a time. It looks great in the brochures/contemporary websites your "Mom" and "Dad" will be treated like family (until their $$$ runs out).

Every investment book right now is stating--if you want to make money, invest in Assisted Livings.
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Hi,
I recently moved my mother to a nursing home from assisted living.
Unless you have nursing home insurance the cost is not covered. You apply for Medicaid once the funds run out. Talk to a specialist on this. Good Luck!🍀
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Chellyfla Aug 2022
That only works if he meets level
of care determination.
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I live in a so-called luxury AL place. It is ok. However, it is no place for someone as disabled as your father. The point of
AL is your own place, in my experience, with access to social activities and prepared food. It can be a good arrangement for moderately disabled people (walker, cane, some mild memory problems, etc.).A SNF (and I worked as a psychological consultant for years in ones) accepts disabilities. Often, the people are in groups, or as many preferred, sitting by the nursing station and watching the world go by (and, again, commenting on it as a group). They check on people frequently, they can handle physical care, etc. Be careful, because they have such a dependent population, you need a responsible, well-run place. When my MIL was in one, someone visited almost every day at different times to make sure they were doing their job. Very occasionally, they were not and were informed of it. This was the best in the area, by the way. I have seen quadriplegics in the hallways visiting with people in SNF. I have seen them alone in their rooms for hours in an AL. I doubt the price difference will be two great having seen what AL charges for more assistance. Good luck.
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I live in a so-called luxury AL place. It is ok. However, it is no place for someone as disabled as your father. The point of
AL is your own place, in my experience, with access to social activities and prepared food. It can be a good arrangement for moderately disabled people (walker, cane, some mild memory problems, etc.).A SNF (and I worked as a psychological consultant for years in ones) accepts disabilities. Often, the people are in groups, or as many preferred, sitting by the nursing station and watching the world go by (and, again, commenting on it as a group). They check on people frequently, they can handle physical care, etc. Be careful, because they have such a dependent population, you need a responsible, well-run place. When my MIL was in one, someone visited almost every day at different times to make sure they were doing their job. Very occasionally, they were not and were informed of it. This was the best in the area, by the way. I have seen quadriplegics in the hallways visiting with people in SNF. I have seen them alone in their rooms for hours in an AL. I doubt the price difference will be two great having seen what AL charges for more assistance. Good luck.
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call his medical plan and ask to provide you with the case manager or social worker. There are free options on supplies etc to alleviate costs. The social worker have over 10 pages of options
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So many advice …

Here’s one more: Talk to a certified eldercare attorney in your state for advice. They know all the in’s and out’s of paying for care in AL or NH. Their expert advice is not cheap, but you’ll get the correct info.
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Medicare only covers 100% of nursing home cost for the first 20 days. After that a percentage up to 60 days. If you have a supplemental plan (either private or Medicare part G) they will pick up until you reach 100 days. After that your on your own. If there is no "available money" not secured in a trust; you must deplete your savings until Medicaid kicks in and pays. Mind you that all facilities must take Medicare/Medicaid which usually are not the greatest. Being an advocate for 15 years it breaks my heart to see family's severely suffer financially and mentally. Please voice concerns with your local represent ative. They are there for you.
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More than likely his move is going to be to Nursing Home care. Where he is now, do they also have NH facility or is it only AL? If they do, you can talk to them now about making the move now or give them an idea of when his money for assisted living is going to run out, so he can be transferred at that time. If he goes over there now, he would just be self pay. If his monthly income, after his savings dwindle down to under $2K, he could apply for Medicaid assistance to pay for his NH bed. The facility people can help you apply for that.
The other option is to visit an elder attorney because they understand Medicaid rules ( once he is living on monthly income only), what is counted in the Medicaid process, or if he would even need Medicaid. There are also trusts that can be set up to help with qualifying for Medicaid if he is slightly over income limit, but not enough income to pay the monthly cost of NH.

Bottom line is, the 'right care' is more about 'what he can afford care'. If he can no longer afford hired caretaker, he goes to a NH where all his needs will be met. However...someone needs to be going to visit random times and every day if at all possible. That's how you ensure he gets 'right care'. He needs an advocate at all times.
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Your dad needs more care.
Get out and tour some nursing homes, (some offer memory care, but THEY will decide if appropriate). Put some applications in , make some calls.
You will need to know all his financials. Generally what happens is he might begin as private pay, then when money is dwindling, you apply for Medicaid. They can help you figure when that is. Once Medicaid is pending, you stop paying the gigantic bill and only pay Net Available Monthly Income.

My mom recently had to leave assisted living because she became a two person assist for transfers. The facility sent out a person to interview her to see if she was appropriate for memory care. After a little rough start, she is thriving there. They have more programs/ activities for her and she is getting the care she needs…Not just sitting in front of the TV.
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sgp1038 Aug 2022
What city is that good facility in?
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Please contact an Elder Law Attorney who can assist your Dad in getting placed in more appropriate care and figure out if he can qualify for Medicaid.

Memory Care may be the solution, but he needs to be evaluated. You can call the care advisor here or contact, "A Place for Mom."

Take yourself out of the equation and do not offer to pay for anything. This is a great learning opportunity for you to see what you will need to plan for, for yourself.
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Medicare and Supplemental only pay for NH or Rehab for 20 days if there wad a qualifying hospital stay. They do not pay just to live there.

If your father has no or minimal resources, he may qualify for Medicaid. There will be fewer choices of Medicaid facilities, but better choices require private pay.
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When my husband was in late-stage Parkinson's he did better in skilled care than in assisted living. Even with skilled care, I hired care givers to be there when I left.
It was extremely expensive, but the only way.

If I wasn't so burnt out from years of caring for him, I would have brought him back home and hired in home care providers. I never had peace-of-mind.

Today, facilities only provide the bare minimum of care. CNA's and nurses are run ragged. These facilities are run for profit and that's the problem.
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Cdriver Aug 2022
Agreed. My father, 90, is in late stage Parkinson's. Just moved him to SNF at the beginning of the summer after he had a bad fall at home. I looked into ALs but was told point blank by several of his doctors and by the PT and OT staff that his needs far exceeded what could be provided at an AL facility. It's crazy expensive for SNF, AL would've been much less, and I am having to clean out his big house and sell it to pay for care, essentially bankrupting him so he gets good care. But I never worry now, he is in a very good SNF and I visit almost daily as it's 5 mins from me. At some point, especially with Parkinson's because it is progressive and can get worse quickly, you have to look into a higher level of care. For a SNF, you can apply for Medicaid once you've exhausted all funds. It's a terrible thing that in this country our elderly family members have to go bankrupt to get care.
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Why does your Dad need an aide 12 hours a day? Is the aide that is there 12 hours a day, employed by the Assisted Living Center? What is the per hour charge?

If my Mom used the caregiver services of the Assisted Living area, she would be paying $50/hour for the services. If I hired from outside, the cost is more like $30/hour. At 12 hours a day, that is $240 a day and $7200 in a 30 day month, not including 1.5 cost for holidays.

The fact that I could use outside services for my Mom's care is something that I asked when I was touring facilities. I asked about it only because I wanted to ensure that I could use her same doctor, her same PT, etc. Some allowed, some did not allow. Then when I signed the forms, I saw the $50/hour charge on the price list. YIKES!

Take a look at the smaller homes that provide Assisted Living. Many of their prices are considerably less than the larger facilities and they do provide a better caregiver to resident ratio.

If your Dad is memory impaired and needing help with laundry, food, medication, etc, find out what the cost to move him into Memory Care would be. Then do the numbers. For me, it was cheaper to move my Mom to Memory Care than to allow her to continue to live in her condo and hire from the outside. When she went to respite, depending upon the level of services needed, there was a point where it is more cost effective to use Memory Care rather than Assisted Living.

If you are within reason of the lowest cost alternative, it is time to consult with someone to see about Medicaid. Your definition of "right care" will be different than the definition of the government for "right care". However, if you are this close to exhausting all his financial resources, then Medicaid may be your only alternative left.

Also reach out to your state's Office on Aging and ask for a counsellor. There might be some other alternatives available for your specific situation.

Good luck!
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My mom was in memory care and required a 24-Hour additional caregiver that was paid in addition to the facility. Some of you think this should not be necessary. And, again, I state very strongly, it was necessary in my mom's case. Her agitation was off the charts, hitting, kicking, biting staff and other residents in spite of being on meds to calm her. It was that or take her home, or a zombie by increasing her meds to that point. Heck, some of the meds tried had the opposite effect.

The caregiver was responsible for keeping mom engaged which is what she needed. She was a wanderer and once devised an escape plan with another client at a memory day care she once attended.

Some of those with dementia need the individual level of care. There were other residents in memory care whose care could not be decreased because my mom's care took extra time and attention.

Maybe he is ready for memory care, but he may still need a separate caregiver. Have that discussion with the facility. It could be that assisted living plus the caregiver is cheaper than memory care, and it works for now.
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Kmi7688: As your father's funds are running low, he may have to file for Medicaid. Additionally, it should always be the patient paying for their own care.
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Should he be moved to a nursing home instead of AL? If he requires an aid it may be time for a stepped up facility whose staff can better care for him. AL often will not accept Medicaid clients while SNF are required to have a portion of their beds reserved for Medicaid patients. It may be worth your while to set up an appointment with your state's Medicaid office and get the facts.
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Sounds like he may benefit from moving out of assisted living and into a skilled nursing situation. He can apply for Medicaid if he does not have funds. Start your search now to find a decent one. The good ones have waiting lists.

You will go broke trying to pay for his care out of pocket.
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