"Aging In Place" and the "Forever Home"

chisue

Some replies to Jenn's post about our satisfaction with our current homes touched on future ones.


What does "Aging in Place" mean to you? Do you assume it means staying where you were raised or where you raised your family? Would you move to another home, or build one? Would you move more than once? What do you think you'd want or need at 65, 75, 85, etc.?


What is a "Forever Home"? Where do you think you will live after you are unable to "Age" in a "Forever" home?


(I don't know who coined these phrases. Is there some 'whistling in the dark' going on here?)



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marilyn_c

It's a concern, even as I plan to move farther out into the country, with a husband, who still tries to be active, even though he has a chronic illness. I have no choice...I must move from here. I could not find an affordable place that would accommodate my horses. Be that as insane as it sounds....I feel like if we have a few good years there, it would be worth it.


I do know that good health can be deceiving. It can be over in a flash. However, I can't sit around and wait to die....I might as well be dead already if I do that.


Sometimes I have to put animals down. I am very good at it and I hope I can do the same for myself when the time comes. I used to talk about this a lot with Ken, my friend that I took care of for 8 years. He said the problem with that is you have to do it while you are still able....and that is more difficult. He didn't have to resort to that and I hope I won't have to either.

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sushipup1

"Aging in place" means staying in your home for as long as possible. Meaning, having no impediments in the property, as well as having services. For example, mu mother moved from Arizona to be close to me, and chose a senior complex that stressed 'aging in place',meaniing that she could stay in her apartment and add personal services as needed (assisted living), short of nursing home type care. By contrast, some people move into life care places and if they can no longer stay in their apartments, they are moved to another section that offers assisted living services, then moved again to a nursing home when needs were too much for just assisted living.


When we moved to PA three years ago, we found a wonderful home in a great neighborhood, but it's not suitable for aging in place, since it is two story. Should either of us not be able to manage the stairs, we're forced to move. OTOH, a neighbor recently passed away who have 24/7 nursing care in her home. But I can't see us being able to afford that!


By contrast a "forever home" just means that you have not plans to move in foreseeable future. Not "we'll move when we have kids/have more kids/the kids are all gone."

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jim_1 (Zone 9A)

Having worked in a nursing home for several years AND being married to a Geriatrician gives me a different sort of feeling for some terms.

Once in a nursing facility (more often than not, because multiple chronic medical conditions cannot be addressed appropriately otherwise), many folks are accepting of the situation that might be referred to as 'aging in place.' That had to be altered due to the inability of the person to have all of those chronic conditions dealt with in their 'forever home.'

Many, but not all, are accepting of the fact that there is a need to be somewhere other than their regular domicile. If the facility is large enough, there is a wide assortment of people there, one or more whom might become friendly with the person.

150 years ago, it was accepted that, at a certain age, staying in that 'forever home' was an inevitability (whether wanted or not). However, today's society has determined that regular professional health care is better in one spot rather than having providers drive all over the territory to hope to begin to give the proper treatments to folks who really want to 'age in place' in their 'forever home.'


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maifleur01

Both of those terms are advertising terms for the same or similar things. While they sound good unless you have lots of money and can afford 24 hour special care including IV's for most unless they die before the need arrives it will not happen. As happened with my husband on his last hospitalization I was told that he had to go to a nursing home. If the family is the caretakers they often become ill and die taking care of the family member. Another part not often discussed is that many family caretakers do not know enough about how to care for a bedridden person so that they do not develop other medical issues. It also means especially if the caretakers are within their working years those caretakers will be on reduced incomes the rest of their lives.

Many seem to visualize living at home means having care to make certain someone if fed and clothed with help moving around. They do not visualize about when lifts are needed and how their house would effect their usage.

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susanwv

We’ve been in our home here for 50 years. I’d like to be able to stay here with maybe home health care, or whatever. BUT, who knows what’s next?! !

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Uptown Gal

Interesting questions. I don't know the perfect answers, of course, but I guess

we all are thinking (hoping) that we will just stay in our homes of later years and age and things will just progress until we die. Of course, that is sticking our heads in the sand. :) In my Mom's generation and before, there was always a Grandma, Great Aunt, Grandpa, etc., living with the next generation

when they became aged. My Mom said she grew up with a Grandma

living with them, and when I first remember my Grandparents a Great Aunt

lived with them. She was widowed and had never worked and had no outside skills to take care of herself, so relatives (my grandparents) took her

in. My Mom remembered that over her young years They helped out with the chores as long as they could. Of course, the life expectancy was much shorter then too. Very seldom did you hear of a husband taking care of a sick and aging wife without outside help. Wasn't the man's job, I guess. I did

have an Great Uncle who was a very successful farmer and when he became too

old to farm or live alone, his sons farmed the land and my Uncle was well off

enough to be able to pay for a housekeeper who came in by the day to take

care of the house. He later went to one of the boy's homes for a couple of

years before he died. An entirely different busy, on the move World today,

I guess.



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OklaMoni

I am reading the book: "Being Mortal" (by Atul Gawande) for the second time. There was to much truth in it, that I want to retain, as well as ideas/options to be able to stay put in your present house as long as possible. First time I read it on my ipad, now I have my own copy, so I can underline and highlight sections I find super helpful.

My plan is to stay put here. I really don't want to go in a nursing home, EVER!. Hopefully when I need it, I can get Home Health care to come in every other day or as needed instead.

Moni

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maire_cate

2 years ago we downsized to an over 55 community that is only 8 miles from where we had lived for 36 years and raised our 3 kids. I already had friends who lived here before we decided to move and I've made many more good ones. There is a different vibe here that I really appreciate. Neighbors are definitely more 'neighborly' - of course that's partly because we're all over 55 and our lots are small so we all see each other more often. I love it!

DH had entertained the idea that we would stay in our much loved and improved family home forever and simply move the master BR down to the first floor library and hire whatever and whomever we needed to care for us.

Then he wised up when he developed serious health issues and reluctantly agreed to this move. Odds are that I will live long enough to be alone and this new home is perfect. We do consider this to be our 'forever and aged" place. It's 2200 sq ft and there is a second floor with a large bedroom, full bath and a loft. We could hire a live-in caretaker if necessary and provide them with a wonderful and private living area. We could even convert the loft into a kitchenette if need be. Everything else is on the first floor and we remodeled the master bath and to make it fully handicapped accessible.

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Raye Smith

I'm of the baby-boomer generations and few members of prior generations from my family are left. All that are gone stayed in their homes to the end (except a few had a short stay in hospice) with little issues. I've remodeled so that I have a full downstairs bathroom/bedroom in case either of us has a time of not being able to go upstairs.

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Jakkom Katsu

I have little/no interest in the concept of "forever" homes. Having moved around a lot, lived in apts, not bought a home until my 40's and now can hardly wait to get rid of it in my late 60's, I have never had sentimentality about the box we live in.

It's a nice box, and customized to our wants/needs. But it takes an enormous amount of upkeep, improvement, and $$$$. We're retired, and traveling is hard because we cannot be comfortable leaving the house empty for long periods. Casual crime abounds in the city (any city) and leaving a home vacant for several weeks is a hi-risk scenario.

I've never been comfortable with the idea of house-sitters and all our friends already have homes, so they can't leave their places empty to come baby-sit ours. We have an alarm system, but burglars can clean you out in 3 minutes flat. Plus, I'm more worried about them trashing the place for the fun of it - it's been known to happen often enough one can't ignore the possibility.

Alas, our home is impossible to modify for "aging in place." We are halfway up a hill and our lot slopes both front-to-back as well as side-to-side. When I broke my leg it was four months before I stopped sleeping on the LR sofa! A friend built a temporary ramp to the front door - I could not even manage 4 shallow stairs and a single half-step up to the front door, at first. I was shocked how weak I had gotten in just a few days in the hospital - and I was only 54 at the time, still working!

We do love our location. The weather, the culture, the conveniences are all perfect. Thus, we intend to move to either a senior living facility or just a luxury 2bd/2ba condo with an elevator, within the next 12-18 months. We still drive, but are happy that Uber and Lyft now exist, for the unknown future.

One thing we learned with my MIL - moving SOONER is much better than moving TOO LATE. Frankly, I have seen little evidence that Boomers are being any more realistic about the limitations of becoming elderly, than our parents were.

I can say that multiple moves for the elderly are very stressful and upsetting for them, especially if dementia enters the picture. For that reason and others, we would rather leave our SFH now when we choose to, rather than because we must and are "under the gun".

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Anglophilia

I'm facing this as of yesterday. Got new oxygen equipment. Pulse oxygen with new $3000+ concentrator is not working for me. Constant flow portables only go up to 3 liters - after that, it's all pulse. There are no portable continuous flow portables that aren't so heavy one must use a cart. Getting a cart up and down the stairs is unsafe and difficult.


Unless this is a temporary situation (high pollen count), I will be looking a home health care aids until my house can be sold.


It just breaks my heart..,

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Uptown Gal

I am sorry Anglophilia.....I hope things can work out for you, and you can stay

in your home. I am glad that you can stay here at the "Table", and hope you

always can. :)

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Fun2BHere

Anglophilia, I'm sorry to hear that you might have to relocate.

We've been looking for a single level home in our desired neighborhood for about a year because I would rather move while we are still active and able. We love our house, but there's no way to enter it without using stairs. While we might be able to modify it somewhat, it would never be a good house for someone on a walker or in a wheel chair.

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Lucille

Anglophilia, I am sorry you are having to go through the situation with your oxygen. That is indeed a critical issue.

I downsized to a smaller house some years ago but even that was not enough. I just do not want to cope with yard, maintenance, insurance, taxes, etc. anymore, although when I was younger it was no problem. My gardens were beautiful but it was getting to be a dreaded chore to do the necessary weeding and mulching. The misadventures with yellow jackets, the inevitable plumbing/ac type of events, I resented as intrusions into my time. My decision to move to a small apartment would not be for everyone but it certainly has made life easier and happier for me.

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blfenton

We'll stay in our current home for as long as we can. We've already been here 30 years and raised our kids here. If we are forced to sell it I won't begrudge the decision and I won't look back. It's been a marvelous home and a great area in which to raise kids and there will be a home for us should we need another that will meet our needs of the time.

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maifleur01

One thing I had not considered until I saw my niece clean out her mother's stuff after she died you might think about in deciding on remaining in your current place or moving to something smaller, assisted living, or nursing home is the ease of your family. That includes clean out, selling, or simply walking away from a nursing type situation. Much easier to end a rental agreement or lease immediately vs. waiting for a house to sell which could be months or more depending on where you live.

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chisue

Thanks, all, for sharing your thoughts. I learn so much from this forum.

Anglophilia -- I'm sorry the supplemental oxygen need has caused a crisis and hope you'll find a solution. We know you are *resourceful*! Your situation reminds me of my own vulnerability to having 'one small problem' require huge changes.

We've been in our one-floor, one-step-up, wide doorways, no thresholds home since 2001. I've recovered from two hip replacements here, with only in-home PT -- thanks to the aid of my healthy DH. Last year I was diagnosed with multiple myeloma, and DH has been my 'rock' as I battle weakness from the chemo I will require as long as I live.

I am aware, as Jim points out and as Anglophelia's situation illustrates, that our current status *will* change. We are 78 and 80. Despite famous outliers from the norm, we are unlikely to both remain *ambulatory* and *mentally sound* for long.

Yet, yet...we are reluctant to take 'half-steps' now, to 'Independent Living' facilities. What would we gain that we couldn't replicate with some non-live-in help? It will be as difficult or easy to find and retain help as it is for a facility, and we would have control over the personnel. What factors am I missing with this plan -- as long as we can still shop, cook, perform personal care? We enjoy our SFH and peace and quiet (more than socializing).

Do we wait until we need 'Assisted Living" -- and where does that exist that doesn't mix mentally sound and *unsound* residents? (Says she, optimistically thinking we will both somehow escape severe mental deficits!)

We've set up our own "Forever Home" right (before we'd heard the phrase), but...what to plan and hope for next, provided we can afford some options?

(We consulted with the advisor at our Senior Center last year...who had no clear directives. She is knowledgeable, but said that the elder care situation is constantly changing. Advice was largely to play it as it comes!)

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blfenton

I think in your set-up you can probably stay a long time if the only concern is physical issues. The problems become compounded when mentally unsound issues are introduced.

My mom went into an assisted living with some mental impairment as a result of Alzheimers but they have a seperate floor with a higher ratio of carestaff to resident. At the first sign of issues for the resident, usually more confusion or increase levels of anxiety as in my mom's case, the resident is moved.

When looking at assisted living, if it ever comes to that, that's what I'll look for - A facility that has multi levels of care where you can die in place.

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Feathers11

Chisue, I've been following this discussion with interest. I'm still young-ish but with an empty nest soon, thinking about where I want to spend my upcoming aging years.

A friend recently went through similar circumstances to you, and she found there is no "right" answer. Every professional, every friend, every advisor she talked with had a different perspective based on their circumstances and the facilities available.

In her case, it was a matter of going from her home, to assisted living (an apartment in a community), then to a "Level 4" more round-the-clock care. I watched her transition to each... and frankly, in hindsight, she should have skipped the assisted living and stayed in her home longer. Assisted living was a major adjustment for her, but it was so temporary because she soon required more care.

But... those were her circumstances. Others remain in assisted living for years and years and the initial adjustment is worth it.

These choices are never easy and come with a great deal of heartache. My thoughts are with you, and everyone in this thread making these difficult decisions.

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maifleur01

When I thought my husband was eligible for Assisted Care several of the places allowed significant others to live with the person that needed care for an additional fee. Most in this area were around $1,000 additional some higher some lower. The one we looked at in Minneapolis was one of those that you purchased an apartment and supposedly the staff came in and checked depending on need. Chisue even at your ages both would be eligible to stay in assisted living if one would pass away before the other based on the Activities Of Daily Living standard that most areas use for placement. Those are things like difficulty in cleaning, cooking, etc. As several have mentioned find a place that has all phases of care for when the time comes that either of you need additional care the other one still has a place to live.

Interesting thing I found in this area with dementia patients was that unless the person needed sedation there was no need to go to a alzheimers unit as most of the people in the nursing wings had mild to moderate dementia until they lost total use of their bodies. There is a large difference in cost between the three types of care, assisted, nursing home, alzheimers units.

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Elmer J Fudd

It's hard to know what to do and what not to do. Some can afford having alternatives and making adjustments, others are stuck where they are to make do as best they can.

Everyone is different but what we all share is despite plans and preferences, things change unexpectedly and those changes often can't be anticipated or planned for.

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Feathers11

Yes, same here, Maifleur. It's called memory care around here, and the cost is significantly more.

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maifleur01

Here memory care was 5-15 thousand more a month than a nursing home. I felt really sorry for the ones that only had early dementia being placed there rather than in assisted living or the nursing home.

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Michael

When it comes time, don't forget to check for benefits available for veterans and spouses.


Aid & Attendance Veteran Benefits

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Elmer J Fudd

I hope you noted, Michael, that the site you linked to is a commercial business that charges fees for filing for benefits.. Also, I note that anyone whose net worth plus annual income is over $127 K isn't eligible.

I understand there are many folks with limited means and these benefits should be taken advantage of by those who qualify but for those who own their homes, even in low cost areas, it's quite likely they will not qualify.

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maifleur01

One of my brothers in law was pushing me to sign up for that veterans program until I suggested he look at what the qualifications would be for him if he became ill. I never heard a word about the program after that. You can go directly to the VA to apply but the hoops needed are not worth it if you are on the borderline. httpsbenefits.va.gov/PENSION/aid_attendance_housebound.asp

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Anglophilia

Better today! Realized last night that I was experiencing "oxygen toxicity" and that supplemental oxygen is totally different for someone with bronchiectasis than for someone with COPD - we react differently to everything as it's two totally different diseases. Unfortunately, most oxygen companies and respiratory therapists are not aware of this, and most doctors don't know a lot about various oxygen concentrators.


So, the "hoards are not at the gate" today but in late July, I am going to start exploring what is available out there. I will go NO WHERE where I cannot at least take my 13 year old dog; the 6 year old one can go back to his breeder. I love him dearly, but if it comes to "Sophie's Choice", the 13 yr old will win. If no place locally allows a pet, I will stay where I am an hire a lot more help if I end up in trouble again.

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Elmer J Fudd

I hope things continue to go better for you, anglo, and that what you experienced was just a blip.

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Michael

Sorry for the commercial link. Yes, the VA is the best place to seek advice. Hundreds of thousands may qualify.

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chisue

I asked my DH to read this thread. We are both grateful for your input.

(Thanks, Michael, but DH was a reservist -- no VA benefits.)

Unless we are missing something, an Independent Living facility doesn't make sense. The advantage of dropping SFH responsibilities doesn't outweigh the loss of privacy and self determination.

I'm also uneasy that the option we might take today might not remain as desirable. Senior facilities are businesses that are bought and sold; investors want to see profits. There are few legal requirements for Independent Living facilities, and most public health departments are stretched too thin to provide adequate oversight of even Skilled Nursing facilities.

We could sell our home and rent an apartment. We'd be scaling back, but in our own Independent Living 'facility' -- with fewer (or only different?) hassles than as home owners. We could sell when we *choose* to sell, although that is always 'buyer dependent'.

We might manage until one of us requires skilled nursing care. I read that few 'people like us' spend more than a few months or years there. OTOH, the healthy body of a person with dementia can go on and on. (I at least have the 'out' of stopping chemo for my multiple myeloma.) If we skip the interim Independent and Assisted Living options, we'd have more funds for nursing care in a good facility.

That's as far as I think we can plan. Remain in our house. Look at apartments. Vet nursing homes. Pay for live-out help as needed until that fails to suffice. Then...consider Assisted Living where there is also Skilled Nursing. (Can you get into such a Continuing Care operation at the Assisted Living stage?)

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dedtired

Although I am old enough to be thinking about these issues for myself, I am, incredibly, in the role of caretaker for my super old mother. She will be 102 soon. The burden on me is enormous, although she does not require a lot of physical care. Still, I have to handle all her finances, the upkeep of her huge house that she refused to leave and her medical needs. How I wish she would have moved years ago. Instead she stuck her head in the sand and so it all falls on me. When I should be enjoying my prime retirement years,I am burdened with worrying about her.

i am posting this to encourage everyone to consider how your decisions will affect your family. Will aging in place mean that your children will have to oversee your affairs? Will they be put in the position of finding an appropriate place for you to live? Please, do these things for yourself while you can.

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blfenton

Good point about being responsible for yourself instead of making your kids doing everything for you. I know that many love doing things for their parents but I watch my DH take care of his mother who is living "independently" and the stress is becoming unimaginable for him as it was for me before I found care for my mom.

She is 92 (DH is 66) and he has to drive her everywhere, does all her finances, has to run over (30 min, drive) when she screws up the computer or the remote control to fix it. Has to go over if she can't open the can of soup that she wants for dinner and she can't leave her apartment because of her mobility issues unless she has someone to help her i.e my DH. She is becoming a shut-in and her world is getting smaller and smaller but she won't move into assisted living. She has fallen 3 times in the past 4 months and if she breaks a hip she's done for.

So yes, don't leave that situation for your kids. I refused to allow my mom to play any sort of guilt trip or you owe me trip on me. She's better off in care than living with me or having me take care of her. I don't have that much of the caregiver gene in me and freely admit it.

This is selfish but between the two moms we haven't had a holiday in 6 years because one or the other couldn't be left alone. Not how I envisioned my retirement years. I won't do this to my children.

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maifleur01

Most people that go to nursing facilities have health problems so they would naturally only be there for months or years. However at my husband's facility there were also those that could no longer manage living on their own but had been there 10 or more years. Of those two were over 100. There was one who was dumped by his family after a health episode where he lost his leg but most needed constant supervision that families can not provide. Burying your head in the sand and not looking at what is available only means your loved ones will be in crisis mode when the need arrives. You also need to be aware of the burden you place on family members similar to dedtired mentioned above especially if you want constant contact even once a week.

Visit what is available in your and your loved ones areas always being aware that family may move and the friends that you want to stay near can die. I have heard so many mention staying with friends without that realization and the realization that the friends will eventually be less mobile and you would only connect via phone.

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maire_cate

When we moved to this over 55 neighborhood we definitely thought of our 3 kids as we made the decision. My father lived with us for 4 years after my mother died and that made it relatively simple to keep track of his finances. And I am so lucky that he was fairly self sufficient (although we didn't let him cook anything) up until his final week.

But that did make me realize that I didn't want my kids to deal with our home or health care as we age. Obviously we can't predict what will happen but we've always lived below our income and we have saved enough to see us through.

So with my kids in mind we emptied a 5 BR, 4000 sq ft home that had 35 years of stuff in it. We weren't hoarders but we did have an attic, basement and utility area so it was easy to "save it in case we need it again - or in case the kids want it" . It was just as easy to put all the Matchbox cars in a plastic tote and shelve it - along with the Lincoln Logs, jigsaw puzzles, board games etc. The kids took what they wanted and the rest was donated or tossed. We offered furniture to our kids, our neighbors kids and then gave the rest to Habitat for Humanity and Goodwill.

We treated ourselves to new bedroom, family room, a kitchen table and chairs. We kept the dining room, the living room sofa and 2 chairs. We also have 2 guestrooms - one on the first floor and the other upstairs.

It was the perfect opportunity to start fresh - with fewer things. There are a few jobs that I still need to do - go through the family photos. They are labeled but I need to discard the extraneous ones and I do know that the kids will toss most of them. I need to make a list of what personal items I'd like each child to have. But my financial records are in a file cabinet and I'm hoping that my kids will be able to deal with that - one is an attorney, one is a bank executive and DD is super organized.

There is a list of contacts taped to the front - attorney, accountant, insurance agents, investment broker etc.

My DDIL has been dealing with her father's estate for the last year - the man was a hoarder and had 3 storage units, plus his 3 BR home. He had Harley Davidson motorcycles in one unit that had been there for 25 years. Anytime he couldn't find something he'd buy another. They found 4 Keurigs in various closets.

It was an eye opener for all of us.


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Raye Smith

I have had none of my family live in a nursing home or assisted living situation so I wanted to see what the likelihood of doing so is, turns out it's fairly low. So here is what I found:

"According to the U.S. Bureau of the Census, slightly over 5 percent of
the 65+ population occupy nursing homes, congregate care, assisted
living, and board-and-care homes, and about 4.2 percent are in nursing
homes at any given time. The rate of nursing home use increases with age
from 1.4 percent of the young-old to 24.5 percent of the oldest-old.
Almost 50 percent of those 95 and older live in nursing homes."



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Raye Smith

Marie, scan those photos and pass any you want to family.

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blfenton

Interesting stats, Raye, Except for my DH and one friend, everyone I know who still has a parent alive, that parent is living in an independant housing residence with meals and housekeeping provided or higher level of care.

The friend has her 98 year old father living with them and the situation has come close to destroying their marriage. They did take a 5 week vacation last summer and left one of the sons (30 years old) in charge of grandpa - the son is no longer speaking to his parents or his grandpa because of the way grandpa treated him and his parents didn't warn him. Maybe it's just the neighbourhood I live in but we don't do well with elderly parents it seems. Oh well, I seem to have cautionary tales. :)

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maire_cate

Raye - I know you're right about scanning the photos. I'd love to hire someone to do it - my own personal intern! I am reluctant to send them off to a third party since my brother lost all his VHS taps when he tried that.

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Anglophilia

Many retirement homes have varying levels of care. Many also have have independent living areas, usually patio homes with 2 or 3 BR’s. Many have attached garages. Some require that one take a certain number of meals a week in the dining room. They do have emergency call buttons by the bed and in the bathroom. The ones with whic I’m familiar are quite lovely.

Residents of independent living usually get preference if the time a move to assisted living or skilled nursing Becomes a necessity.

My husband’s aunt lived for about 30 years in one in Williamsburg. She started out in a large semi-attached house, went from there to a large apartment in the main bldg, from there to a smaller one in Assisted Living, and spent her last 2 years in a single skilled nursing room. She was 103 when she died. Her daughter and her husband had moved 10 years earlier to a semi-attached house in the same community,so it was very convenient for all. DD’s husband recently died at age 96 from multiple myeloma. As his heath deteriorated, he moved into skilled nursing with his wife still in the house. They could have opted to hire nurses in the home but chose not to do so. His wife is in her mid 80’s and for now is staying in the house.

Such places are are very expensive but for those who can afford them, can be wonderful.

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Elmer J Fudd

My experience is similar to blfenton's, with most oldsters being in facilities that can deal with whatever level of assistance they need or may need in the future. Many start out starting with some kind of "independent living". Most of us will hope to not die young and will get to that point ourselves, but one needs to understand that as the years go on older people have special needs that family members may not have the time, the ability, or the desire to provide. The alternative, staying in one's own home with home care and nursing care procured and paid for, is also problematic and can be very expensive.

I think there is a socio/economic component to who moves to these places because they're expensive. It varies by state but many states' versions of Medicaid cover the cost for people who can't afford it and have a medical need for care. I can't say how acceptable or not such places are compared to others that may be more expensive.

blfenton, is the cost of elder housing care provided at low or no cost in Canada?



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chisue

Wikipedia tells me that Continuing Care operations require an entrant to begin at the lowest level of care, Independent Living. The model projects that the person will be with them for 12 years, with 9 years in Independent Living and 1.5 years in each of Assisted Living and Skilled Nursing Care. (I'd guess that there is often back and forth between the last two settings.)

The model requires an applicant's finances be adequate to fund his stay for that long and for increasingly expensive care. In 2017, average entrance age in the US was 81. Wait too long...you're 'too old' for the model.

If we run true to the model used by these facilities, DH and I might expect to live independently for quite a few more years, then need to pay out of pocket for assistance (at home or in a facility), then for skilled nursing care for a year or more.

Neither of us will rely on family to provide extensive *assistance* in the first two stages, and certainly not skilled nursing...or *home* hospice. Each of our mothers lived in nursing facilities at the end of their lives: My DM for a few months with leukemia; his for four years with advanced RA. We do expect our family to continue to be involved in our lives...and to keep any facility honest in our behalf.

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blfenton

@Elmer -blfenton, is the cost of elder housing care provided at low or no cost in Canada?

I suspect that the situation is the same in both countries. There is gov't subsidized care that gets capped depending on the level of care required and then there is private care some of which is tax deductible. Some gov't subsidized facilities require that the residence only have a certain level of assets. There is a huge difference between the two in terms of pricing but even within the two levels of paying there are good facilities and poor facilities. The parents of everyone I know, including my mom, is in private care - simply because of socioeconomics.

The difference between the two is the ratio of caregivers to residence, the fanciness of the residence, size of rooms, services offered, even simple things such as how often the residents get showers (every day for private and maybe twice a week for gov't care).

My understanding however is that the level of compassion and caring from caregivers of the gov't subsidized places is equal to those of the private and not all private are the same. We are very fortunate in the place we found for my mom.

@chisue - I completely agree with staying involved in their lives. I have 3 siblings and we all are a part of my mom's life which are pretty much dictated by our strengths. I'm in charge of all the financial stuff and her investments.


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stacey_mb

I'm very grateful that when DM was diagnosed with dementia and deemed unable to live on her own, she agreed to move out of her house into an assisted living facility and then a personal care home. She said that having to live with in-laws as a newly-wed made her decide not to live with any of her children long-term. Most of her government old age pension went toward her living costs and it was a very satisfactory arrangement. Although DM passed away several years ago, I am currently "baking up a storm" for the twice-yearly fundraising bake sale held at her former home.

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Raye Smith

In all of my family that has died in the past 40 years - I can think of 8 - 10 of them. None had dementia and they were quite able to function in their homes within a month or two of death. By function I mean they were still cleaning house, laundry, dishes and were still taking care of the gardening too.

None of my over retirement relatives are having any issues, they hike, run, bike, etc. frequently.

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marilyn_c

My mother was very active into her '80's, but she fell, hit her head and got 2 blood clots. They were removed....two little holes in her scalp and "vacuumed" out. The effect on her was sort of like a stroke.

She had moved just 3/10 of a mile from me, and I had been helping her. In order to get her to eat better, I cooked supper at her house every evening. I looked in on her during the day.

When she had the accident, the doctor said she needed to move into a nursing home. I had promised her that I would always look after her, but my house was too small and her house was too small for us to all live together. Also, at the time my daughter was about 10 and my first obligation was to her.

My mother lived 6 1/2 yrs in a nursing home, due to her incredible physical strength and strong immune system, I suppose. We moved her 3 times because the level of care wasn't up to par. One of us visited almost every day. God forbid she be one of those poor souls who never got a visit or had someone advocate for them.

It was a nightmare. They didn't monitor her dilantin levels...put her on that due to having to drill into her skull, and she fell out of bed and broke her hip. They lost her false teeth....so they put her on a pureed diet, that she would not eat. I begged them to give her a soft diet...scrambled eggs, cereal....they said they would...didn't. She was put on prednisone for one month, to be re-evaluated, and instead they never did and she was on it for a very long time. Her bones turned to mush. Picking her up, they broke her leg, but didn't want to set it because she only had "a few weeks to live", but she lived 31/2 more years. Thank God, I found a new doctor for her. She was on 10 prescription drugs. My mother who had been to a doctor less than a half dozen times in her life, was being doctored to death. He took her off all the medicine. Those are just a tiny fraction of what she went through. I remember Jody throwing one of his famous Collins' fits and telling them, "if these people were dogs, you would all be in jail!!"

So my experience with nursing homes hasn't been great. It was very hard on me, and I feel awful about how it was for my mother.

I know my daughter wouldn't be able to see after me. I wouldn't want to put that on her. In my mother's situation, one brother was in Indiana, so he never saw her. He called me to get one of her recipes one time, and never asked about her.

My sister...completely unstable....I didn't know where she was most of the time, came to see her twice in the more than 6 years she was in the nursing home. My brother who lived within 5 miles came to see her 4 or 5 times, so everything fell on us. I ran into my brother in the supermarket and asked him to please come see her. He never said a word, so I walked away. Then he came up to me and said he didn't go see her because she didn't know who he was. I said, "well, you know who she is!"


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Zalco/bring back Sophie!

Raye, I've been wondering about the trajectory described here too. In my family, older people do just fine as they age. I've said it before, our old people live with family as a rule. Not out of economic or logistical necessity, but because widows and widowers have a nicer time with family around than all alone. My grandmother had mobility issues for six months maybe. No dementia, even on her deathbed. Being around people might help protectour brain from the ravages off loneliness and isolation. Lending a hand with folding laundry, doing dishes or supervising homework makes you feel useful and not put out to pasture waiting for your demise.

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Zalco/bring back Sophie!

Marilyn, my heart breaks for what you and your mother went through. There are monsters in this world.

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blfenton

@marilyn - I am so sorry that you and your mom went through that unsettling time.

@Zalco - that's the problem that my DH is facing with his mom. The loneliness. One of the reasons we chose the place we did for my mom is that she was a home ec teacher and taught foods and even though it is difficult for her to follow instruction now she "helps" the staff make muffins for snack time a couple of times a week and "helps" set the tables for the next meal.

Anyway - I've taken up enough time here (I could write a book on this subject) but I wish you all good health and hope that you are able to age as you wish.

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Elmer J Fudd

raye smith, neither health nor particular elder maladies nor good luck are entirely hereditary. Some are affected by happenstance. While all of us hope our glide paths to the ultimate end will be gentle and pleasant, reality for most of us will be different than we expect. The likelihood is that It may be for you too. I wish you the best but suggest you not assume anything for the particular path you may take.

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Elmer J Fudd

zalco, everyone is different, even culturally so. While we always had good relationships with our parents, my wife and I decided long ago that having one live with us was something we weren't interested in.

It wasn't even a remote possibility with my parents, now deceased, but there was a passing inquiry by hers some time ago. My wife responded by saying that she and her siblings (who were of the same view) would of course make sure they were always properly looked after but it wouldn't be by living in any of our homes. That approach has been followed. Maybe that's cultural too?

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chisue

Raye -- I'm wondering how old your independent-to-the end relatives were when 'the end' arrived? We'd all like to fit that description! However, with the exception of a few Christian Scientists I've known, 'modern medicine' prolongs lives for decades past 'retirement' -- an age that was set when many people were dead or infirm by 65. (Some of today's retirees also had better nutrition and living conditions, and less physically strenuous work.)

At 78, I can observe that I was very much 'same old, same old' until 75. My DH only began to decline after 78; he'll soon be 81. We've each lost two inches of height in the last two years!

Forty years ago my mother died of a blood cancer at 73. Mine has been beaten back and is currently held at bay by quite new chemo drugs that I've been on for a year now. People diagnosed at younger ages can even be *cured* with new stem cell procedures.

It would be great if 'living longer' meant living *well* longer, without adding years of dependency.

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Raye Smith

Elmer, in my years of working in hospitals I saw patients that were 50 that were in terrible shape but I also saw patients that were 90's and older that were just there for an overnight surgery stay that were functioning just fine. Many of those young & in terrible shape patients, showed signs that their condition was due to their lifestyle.

I choose to have a lifestyle that I feel increases my ability to enjoy life into my older years such as exercising and maintaining an appropriate weight. I don't feel a need to be pessimistic about my future.


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Raye Smith

Chisue - they were between the ages of 70 to 90 and didn't go for heroic measures of health care, about half died in their sleep of old age.

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Elmer J Fudd

raye, I agree with you about the benefits of a healthy lifestyle. Don't forget many health declines begin following accidents. Or contracting communicable diseases. A healthy lifestyle may help provide a measure of protection but won't prevent slipping in the shower or tub, tripping over something in the dark at night, a car accident, getting a severe case of the flu or pneumonia or other unforeseen event. Nor will it prevent the onset of a genetic disease or some other health problem, which you and everyone else may carry and may or may not know about it. Nor are all genetic conditions inherited.

All I'm saying is that everyone should have several contingency plans thought through and not assume things will go as they wish them to.

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chisue

Raye -- Thanks for the information. We're about halfway between your relatives 70 to 90 'end dates'. We've always been moderates in lifestyle. I'm conscious of monitoring my condition, not willing to witlessly follow doctors orders beyond reason. My major obstacle against 'heroics' will be my DH, who just doesn't want to lose me.

Yesterday we got information on two CCRC possibilities near us. Each is long-established and independent (no publicly traded chain ownership) and a buy-in, with a 90% return of funds when a resident leaves or dies. Entrance fees are $600K and $800K. Each runs about $5K/month in independent living. Personnel tell us that the Wikipedia estimate of 18 months in assisted care or skilled nursing is a good average.

One has two other locations in the US, with a fourth planned. Their facility here has a 2-3 year wait list for 240 independent living apartments, plus assisted living apartments, and private BR/Bath units in the skilled nursing section. It's 'urban'. The other has four locations all in his area -- much larger capacity and all suburban. Each has some buildings under ten years old with nice-looking apartments. We've yet to tour either, but are familiar with both.

Or...we could downsize, buying a condo or renting an apartment.

Or...we could stay put!

You have all been very kind in providing input as I think this through. Thank you.

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yeonassky

I would like a place like this if I had dementia. I know they are setting one up in the states somewhere. I don't necessarily think aging-in-place is always the best but aging in a familiar surroundings or in a familiar lifestyle would be absolutely the best. They model this place on when their short-term memory stopped recording.

https://www.ted.com/talks/yvonne_van_amerongen_the_dementia_village_that_s_redefining_elder_care/up-next?language=en

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Raye Smith

Chisue, have you run the financials to see which option you are most comfortable with? I have friends that did that and quickly decided to stay put and focus their finances on traveling.

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Elmer J Fudd

For many I think location, the quality of the facilities and availability of amenities are far more important than cost. Assuming that the cost of a choice among alternatives is affordable and do-able.

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maifleur01

There are also some independent/assisted living that do leases rather than buy-ins in this area. There is always a chance the "rent" will go up but so could the monthly fees. Many charge additional fees for each level of care in both.

One of the quirks in this state is that you will own property taxes and depending on your insurance company renters or home owners insurance on the ones that have a buy-in. Which was never mentioned at any of the ones I looked at.

When I looking for my husband it made more sense to just pay the fees after a basic monthly charge rather than to buy. We would have paid more than what the rental places were charging for lodging and care after all the add on fees.

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chisue

Raye -- Yes, we are definitely 'running the numbers'. As for travel, we've BTDT when we were younger. At this stage in our lives, the *travail* outweighs the enjoyment.

maifleur -- I'm seeing two options at the two places we've looked into. I should start a separate thread asking for help deciphering the contract-ese.

Elmer -- Re: Location. Beyond staying near family, the two CCRC places we're looking at mean choosing between an apartment in a small city, and either an apartment or a 'cottage' in a suburban setting.

The cottage appeals, but...we're already living in our own almost handicap-adapted house in a suburb! Moving to a CCRC cottage seems like very expensive 'peace of mind' -- just to assure less expensive (?) care in assisted living and skilled nursing, for perhaps two years past independence.

I'm observing that CCRC residents fight leaving their independent living quarters to utilize the assisted living they've paid for. They hire 'assistance' out-of-pocket instead. We could do that without leaving our home or paying over $1M to 'buy in'. We could pay market pricing for skilled nursing care if we are 'average' and only need it for a few months -- or if we were eligible for hospice at that point.

I'm left wondering for whom the CCRC choice is appropriate. Maybe I should start a new thread. (If you aren't all sick of this!)

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blfenton

@yeonassky - They are opening a Dementia Village in Langley

https://www.thevillagelangley.com/

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maifleur01

chisue I can only comment on what I saw when I was looking and what friends who have had older relatives and friends living in various types of senior housing. The ones that are fighting moving to assisted care may have discovered that the costs for care were much more than hiring someone. I looked from 2010 to 2013 so prices are dated. To just give medicines the ones I looked at charged between $500 and $1,200 additional to the base rate. Each increase in care added to that amount. The CCRC ones that I looked at in Minneapolis where my husband has family where you purchased a living area also had monthly charges. At that time I did a quick calculation and for more advanced assistance in the various assisted living places you could easily add $5,000 or more to the base rate. The cheapest base rate was around $2,000 and went to $15,000. I balked at the idea of spending all of the money from the sale of our home plus additional for the "buy in" polite way to say purchase plus that much a month plus all of the additional fees. He became rapidly worse so the move was not made.

Recently it was mentioned that a "low cost" place that recently opened in this are started at $400,000 to $600,000 plus $5,000 a month for basic costs. You still will need to pay property taxes and there was phone and anything beyond basic cable. I cringed because while for some that live in high cost areas that can be a very small amount but not for this area.

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Elmer J Fudd

Yes, it's a quandary of alternatives with unknown outcomes for you. Good luck, I do understand what you're thinking about.

Managing home care can be a rat's nest of problems too. We went through this for home care with a family elder living in another city. Not unlike the recent discussion about house cleaners, we found that the so-called elder care attendants were a very mixed bag of competence and reliability. Even going through an agency as we did, it wound up being an unfortunate parade of changing faces because of suitability, changing availability and personal incidents in the care givers' personal lives that would come up from time to time to necessitate a change.

Skilled nursing for those requiring that would probably be a higher level of competence and reliability but may not address the normal day to day help with household tasks an oldster needs.

Financially, this person had very limited means but a decades long ownership of a house provided a more than adequate source of funds.

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Michael

I know of a few facilities where people are dying to get out of.

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chisue

This is more complicated for a *couple*. In the literature from one CCRC, if one person in independent living moves to assisted living, the rate drops from $7880/month to $4800. Ah, but if one of a couple remains in independent living, the couple would face paying two monthly charges. (The charge for one person remaining in independent living goes down to $5935/month but there's the additional $4800.) And this is on top of paying $1M entry at a 90% rate of reimbursement; down to $680K entry fee if you want nothing back.

There is yet another detail. You can select 90%, 50% or 0% ultimate return of the buy-in. Both the buy-in and the monthly charges go up if you select the 90% return, but maybe there are some tax advantages to 'contributing' to the entity (selecting only half or zero return).

The refunding scheme puzzles me. If you select to get 90% or 50% of the buy-in returned, the institution takes 4% out for your first month of residency, then 2% each additional month "until the refundable amount is reached". Huh? Can someone illustrate this for me using a $1M entrance fee and a 90% 'refund' plan?

Let's say our house is worth the same as the entry fee in a CCRC. There's a wash. But it doesn't cost us $7880/month to live 'independently' in it. We'd still have all the non-house-related expenses like groceries, clothing, tickets to the circus. Maybe I just can't grasp how much 'care' will cost us for the last two years of our lives.

I know all about the 'revolving door' of assistance/caregivers from my MIL's last ten years of life. I'd also like to be able to hire and fire, not be stuck with people hired by an institution -- as long as I'm capable. Seems to me it's the same 'pool' of help. Skilled nursing is different. I would not attempt that or hospice at home.

Thanks for walking along this road with me.

maifleur -- I'm sorry your last years with your DH were so difficult. I appreciate your 'inside' knowledge, but regret you had to learn it!

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maifleur01

If in learning I help someone to avoid some of the things that have happened it was worth it.

A comment on the return of your money. The place we finally decided on in Minneapolis had both buy in and lease. We were going to opt for the lease. One of the things to look for on the buy-in return was that out of that return came gutting the unit and refurbishing. Not certain if that is normal or not. Since the gutting took it completely down to the concrete walls my estimate at the time would be that a person might receive half back if you were lucky. You also had to wait until someone was willing to use the unit so it was not a quick return of your money.

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maire_cate

Chisue - my parents went through this and were ready to sign on the dotted live for a highly recommended CCRC and sell their home. We happened to visit them and my father showed the contract to DH. He read part of the contract and then started asking my father questions about it. We quickly discovered that Dad had not read it but relied on the 'nice lady in the office who explained it to them.'

The facility would house them in independent living. But my mother needed assistance in bathing and dressing and the CCRC would provide them with an aide every morning - for a fee. That is reasonable.

However the administration at the facility would determine if and when one of my parents needed assisted living. Both of my parents would be allowed in the assisted living unit - but they would be still paying for 2 units until the independent unit sold. And there was no incentive for the CCRC to really market an empty apartment, especially since they were still getting paid for it.

They finally decided to sell their home and move into an apartment near me.

I wish you luck with this - it's not an easy decision.

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