Old patients unsuccessfully clinging to independent living

[Emergent]

I see a lot of fiercely independent seniors who haven't planned well for the next phase of life. In the rural areas, they are used to living on their own, sometimes on properties that are deteriorating due to their owners creeping infirmities, or lifelong patterns of sloppiness.

Some have had hoarding tendencies that have gotten out of hand. EMS will give colorful reports on that.

What a good way to help these stubborn folk, who need to be guided into assisted living, or toward accepting family help? Sometimes adult children are spread out, or alienated from their parents.

[Wuzzie]

7 minutes ago, FolksBtrippin said:

It is for low income elders who meet a nursing home level of care but want to stay in their homes.

I believe many states have programs like this which is great but once again leaves out the average elderly person who is neither rich enough or poor enough to afford help when they get older. My decidedly middle-class parents are shelling out over $6000/month for an ALF they don't want to be in but have to because of my dad's dementia. I don't know what we are going to do when my dad requires memory care and my mom's continuing cognitive slide negates the possibility of her ever living independently again. We are looking at potentially $15,000/month for their care. We can't afford that.

[llg, PhD, RN]

Within the next few months, I will be moving into a continuing care community that has all the levels of care available and "all the bells and whistles." I'll be moving into the totally independent living neighborhood, with my new apartment very similar to my current condo. I have family members who have lived in that same community and one who is currently living there just down the street in a single-family home.

What we are doing (and my parents and grandparents did) was to move into those independent living sections of the continuing care community while we are still young enough to have many years of active retirement life left. We choose to MAKE that our home while we can. Then, as we age and need services to help us stay healthy and safe ... those services are readily available within the homes that we have made for ourselves. Mom, Dad, Step-dad and grandfather all died while still living in their single-family homes in that continuing care community. One grandmother spent the last few months of her life in Assisted Living (died in her sleep there). Only 1, my other grandmother ever needed the LTC section. She had severe dementia.

The trick is to move there while you are still young and fit enough to make it your home -- so that you CAN "age in place" in a community with all the support systems easy to access. You can stay "at home" longer and keep some of those costs down.

[hppygr8ful, ASN, RN, EMT-I]

On 8/13/2020 at 10:10 AM, llg said:

Within the next few months, I will be moving into a continuing care community that has all the levels of care available and "all the bells and whistles." I'll be moving into the totally independent living neighborhood, with my new apartment very similar to my current condo. I have family members who have lived in that same community and one who is currently living there just down the street in a single-family home.

What we are doing (and my parents and grandparents did) was to move into those independent living sections of the continuing care community while we are still young enough to have many years of active retirement life left. We choose to MAKE that our home while we can. Then, as we age and need services to help us stay healthy and safe ... those services are readily available within the homes that we have made for ourselves. Mom, Dad, Step-dad and grandfather all died while still living in their single-family homes in that continuing care community. One grandmother spent the last few months of her life in Assisted Living (died in her sleep there). Only 1, my other grandmother ever needed the LTC section. She had severe dementia.

The trick is to move there while you are still young and fit enough to make it your home -- so that you CAN "age in place" in a community with all the support systems easy to access. You can stay "at home" longer and keep some of those costs down.

I am curious about the monthly rent for the "Condo" you are living in. I know there are graduated care facilities in California that care for you right till the end but cost is still prohibitive.

Hppy

[CommunityRNBSN, BSN, RN]

2 hours ago, llg said:

Within the next few months, I will be moving into a continuing care community that has all the levels of care available and "all the bells and whistles." I'll be moving into the totally independent living neighborhood, with my new apartment very similar to my current condo. I have family members who have lived in that same community and one who is currently living there just down the street in a single-family home.

What we are doing (and my parents and grandparents did) was to move into those independent living sections of the continuing care community while we are still young enough to have many years of active retirement life left. We choose to MAKE that our home while we can. Then, as we age and need services to help us stay healthy and safe ... those services are readily available within the homes that we have made for ourselves. Mom, Dad, Step-dad and grandfather all died while still living in their single-family homes in that continuing care community. One grandmother spent the last few months of her life in Assisted Living (died in her sleep there). Only 1, my other grandmother ever needed the LTC section. She had severe dementia.

The trick is to move there while you are still young and fit enough to make it your home -- so that you CAN "age in place" in a community with all the support systems easy to access. You can stay "at home" longer and keep some of those costs down.

This is wonderful and I agree, this is ideal for many people. Best of luck in your new home.

[Sour Lemon]

5 hours ago, llg said:

Within the next few months, I will be moving into a continuing care community that has all the levels of care available and "all the bells and whistles." I'll be moving into the totally independent living neighborhood, with my new apartment very similar to my current condo. I have family members who have lived in that same community and one who is currently living there just down the street in a single-family home.

What we are doing (and my parents and grandparents did) was to move into those independent living sections of the continuing care community while we are still young enough to have many years of active retirement life left. We choose to MAKE that our home while we can. Then, as we age and need services to help us stay healthy and safe ... those services are readily available within the homes that we have made for ourselves. Mom, Dad, Step-dad and grandfather all died while still living in their single-family homes in that continuing care community. One grandmother spent the last few months of her life in Assisted Living (died in her sleep there). Only 1, my other grandmother ever needed the LTC section. She had severe dementia.

The trick is to move there while you are still young and fit enough to make it your home -- so that you CAN "age in place" in a community with all the support systems easy to access. You can stay "at home" longer and keep some of those costs down.

My mother in law did this and it does seem to be an ideal solution for some. She also paid in several hundred thousand dollars to get started, and pays high rent on top of that.

[DeeAngel]

On 8/12/2020 at 6:32 AM, Emergent said:

OK, so nurses should not try to guide and influence patients towards healthier choices of living, but just "let them die on their own terms". Message received.

You're damn right we get to chose to die on our own terms, my life, my choice. Get over yourself. My mothers nursing home six years ago cost me nearly $10,000.00 a month so she wouldn't go to a hellhole. You know absolutely nothing about the costs of senior care.

[hppygr8ful, ASN, RN, EMT-I]

On 8/12/2020 at 5:32 AM, Emergent said:

OK, so nurses should not try to guide and influence patients towards healthier choices of living, but just "let them die on their own terms". Message received.

"The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge." Virginia Henderson.

[Hoosier_RN, MSN]

12 minutes ago, DeeAngel said:

You know absolutely nothing about the costs of senior care.

How do you know that @Emergent doesn't know about the cost of senior care? They may be paying for a loved one now...I took the comment to mean if we educate and can help with healthier lifestyles, interventions and need for higher care levels can be lessened, often helping to contain costs

[Lenore Chapman]

Is there really such a thing as a well run assisted living facility? or LTCF? I don’t know a single person that enjoyed or benefits from these elder warehouses. We need to find a way to allow our Elders to remain in their own home with dignity. Not an easy task and I do not have the answer. I believe a good start as a nation is to value and utilize our elders in incentive programs to educate our youth. We all need purpose. Pipe dream? I certainly hope not. How do we begin? Maybe reverse psychology before it’s too late with a Significant reduction in tax incentive program if our elders partake in programs to aide our youth.

[amoLucia]

To PP - we freq & STRONGLY advise new members to use an anonymous screen name here. Membership is not closed to just nsg; it's open to EVERYBODY & ANYBODY. They read these postings and you might not be comfortable with that.

Ask the moderators here to help change your name.

[Hoosier_RN, MSN]

13 minutes ago, Lenore Chapman said:

Maybe reverse psychology before it’s too late with a Significant reduction in tax incentive program if our elders partake in programs to aide our youth.

Please explain, I'm not following. To me, this seems to benefit the young, not the elderly, that's why I'm asking for clarification. Also, the elderly end up in these settings when they cannot care for themselves at home any longer and don't have the resources available to do so or hire assistive services. Without a shift in cultural thinking and basic economics, most families can't/won't take care of their elderly at home.

[llg, PhD, RN]

On 8/13/2020 at 11:21 AM, hppygr8ful said:

I am curious about the monthly rent for the "Condo" you are living in. I know there are graduated care facilities in California that care for you right till the end but cost is still prohibitive.

Hppy

The condo I currently live is not a rental situation. I own that condo -- and it is not in a retirement community. It's current assessed value for tax purposes is $220, 000 and the monthly costs are about $1200 per month when you consider the condo association fee to maintain the outer property, property taxes and insurance. Things like new carpeting, appliance repairs, etc. are all added on top of that of course -- as I own.

The retirement community that I will be moving into in a couple of months (in another state, but in a community with a similar "average USA" cost of living index) have units with a wide variety of sizes, styles and prices. I checked the 2019 price list. (I don't have the 2020 price list, which from my extensive experience with this community would have increased by only a couple percent at most.)

The cheapest units (750 square feet, one-bedroom unit that is one half of a duplex building) range from $75,000 to $85,000 depending on the specific unit features. The monthly service fee for those units that includes all maintenance and repairs as well as full access to all the community's facilities and services -- was listed at just under $700 per month. (but that did not include heat/air conditioning).

The most expensive unit is a single-family structure ... 2,050 square feet, 2 bedrooms, 2 full bathrooms, home office, living room, dining room, large kitchen, screened in porch and a large 2-car garage was $400,000. Interestingly, their monthly service fee was only $1500 because the single family structure fees do not include heat/air conditioning, cable TV fees and internet connection. The fees in the apartment buildings are higher (ranging from $1200 - $2500) because they include those things.

Most units are in the $150,000 to $275,000 range and consist of 1000-1500 square feet, 2 bedroom, 1-2 baths, "great room," full, mid-sized kitchen, and a 1-car garage.

So ... people sell their houses and use that money for the entry fee. Many downsize significantly and have some cash left over to add to their retirement savings. The community services are the same (fitness center, activities, fine arts program, discounts on food purchased on site, RN on call 24/7, security, etc. -- even some housekeeping services are all included at no extra charge.) With the average person getting between $1400 and $1500 per month in social security ... that covers most people's monthly fee. 50% of all people get above-average Social Security, so most residents and married couples getting 2 SS checks each month have money left over for basic food, etc.

So most people only have to dip into the retirement accounts, pensions, etc. for some food, clothes, health care -- and any "fun stuff" like cars, traveling, etc. That money can continue to grow as needed for the larger expenses of actual LTC later in life. Most people don't need the Assisted Living section (or at least, not for very long) because they can stay in the independent housing longer with the services available in the community. And when Assisted Living or LTC is needed ... there is no additional "entry fee" because you already paid it when you first moved into the community. Twenty years from now when I may need that sort of thing, I will have already paid that fee -- at 2020 rates. That's where some significant savings comes in. I'll just need to pay the larger monthly fee for those facilities/services.

Of course, I will also save money on 20 years of property taxes and home owners insurance, home repairs, etc. And it 20 years, you can expect to have to repair and replace a lot of items in your home (like the roof, the heating system, flooring, appliances, etc.)

Finally, no one will have to worry about "what to do with old Aunt llg" because I have already made those arrangements.

It's not cheap. People who haven't paid off their houses and/or who don't get more than the average SS payments may not be able to afford it. But the average, middle class person (school teachers, nurses, etc.) can afford it. As the facility's sales slogan goes, they have "options for every budget." You just have to be prepared to trade your full house to an apartment-sized private space with additional shared space at your disposal for use -- and the easy availability and security of all the readily available services.