This article first appeared in the St. Louis Beacon, June 17, 2013: My wife is an only child. Her mother and aunt are twins who just celebrated their 89th birthdays. Both were living independently until the mother fell and broke her hip. Neither of the twins has unlimited funds. The mother, who also has early stage dementia, canceled her long-term care insurance without my wife’s knowledge shortly before she granted my wife power of attorney.
We needed a solution that was right for her that made sure she wouldn’t outlive her money. The first step once the mother got out of the rehabilitation facility was to bring her home. My wife would care for her mother while she was still receiving outpatient services from the hospital covered under Medicare.
When the outpatient help ended, the demands proved to be so taxing that caregiving took over my wife’s life. She (my wife) needed help. And my mother-in-law did, too.
We needed a financial review to determine what solutions were possible.
We tried to get the long-term care insurance reinstated given the policy holder’s mental diagnosis. The insurance company said no. We even offered to pay a penalty and the premiums it would have collected for the period following cancellation.
The aunt, who also has some health issues, does have limited long-term care insurance. Most assisted living facilities will provide a reduced rate for dual occupancy.
Would a good solution be for the twins to go into assisted living together. Unfortunately, "memory care" for patients with dementia or early Alzheimer’s is separate from assisted living, with a premium price. The difference in care needed by our two potential residents precluded them from being able to take advantage of dual occupancy.
So could the mother afford assisted living on her own?
We determined the projected annual cost of a moderately priced facility to be approximately $45,600. At 89 and in relatively good health, save her current orthopedic and memory problems, who knows how many years she has ahead of her?
Some facilities will accept patients at full price and then will move them to Medicaid beds in the same facility after their funds have been exhausted. This is certainly not the case at all facilities. And it is a fair question to ask as, in my experience, all facilities undertake a thorough financial review of prospective residents.
My mother-in-law and her sister each owns a two-bedroom, two-bath condominium in the same building. So, both women owned assets that could be a key to finding a solution.
Moving the two together would benefit to both sisters as follows:
- Both could to reduce their expenses by sharing costs.
- Each would have the company of the other.
- One caregiver could provide service to both based on their different needs.
- The service provided by the caregiver would be superior to that provided by an institution because of the focus on only two patients.
- All furniture and fixtures were already at the location and could be combined.
- One of the condominiums could be sold and the funds invested.
- Separate bedrooms and bathrooms would still provide a measure of independence.
- Trips for groceries and supplies could be combined and doctor visits coordinated.
Many services provide everything one could desire in homecare. The good ones are bonded. Most are priced at $16-24 an hour. Many provide 24-hour care with varying degrees of nursing skills available. All that I talked to priced their services in a minimum of 4 hour shifts. There is always a supervisor available in the event of problems.
Fortunately, I "lucked out" on finding a solution to my care-giving need, meeting a woman at the grocery story whose family provided care and who furnished impeccable references.
An unexpected objection came from the aunt, though she decided to "try it." Keeping the second condo for a while was key, so that the possibility of going back remained. About this same time, a new health issue meant that the aunt could no longer drive, which added to the logic of the move.
I also received great assistance from the lead social service supervisor who had headed my mother-in-law’s rehab team. She helped me sell the aunt on both the merits of cohabitation and the design of the physical arrangements. She suggested that both bathrooms be made ADA compliant, which we accomplished with the aid of a contractor.
We are in our fifth month of the sisters cohabitating. And I learned one thing I hadn’t anticipated: There has to be one quarterback, one person who works with the caregivers and makes decisions. A leader with clear authority should be designated from the beginning.
I hope our experience can help others confronted with decisions relating to the care and lodging of older friends or loved ones.