Assisted living and nursing homes are so expensive, does anyone have any suggestions for alternative places?

Thanks so much for all of your posts. Here are my answers to your questions:

I live in Roanoke, VA. I was told that if she were to share a room with someone at AL it would be $3,500 per month. If she had a room of her own, it would be $4,700 a month. Although I appreciate all of the responses about how "inexpensive" this is, it's not. It's ridiculously expensive. To only provide a room and 3 meals a day for that price is crazy. It does not include anything like medication monitoring etc. It's extra for that.

Neither her nor my wonderful father are veterans.

When I say she doesn't qualify for Medicaid I say that because my dad working his little tiny butt off and squirreled away every penny he got. He worked very hard to accumulate a small nest egg for my mom. She owns her own house and I'm pretty sure that that may qualifies as an asset that would need to be sold.

she probably gets about $1400 in SS and a few hundred more from a couple of pensions from my dad working.

She also has some stocks. And I am guessing that stocks count as assets also?
And now....be prepared for my rant. Hey, you were warned!

I find it DISGUSTING that hard working folks like my dad who worked for decades and gave THOUSANDS AND THOUSANDS AND THOUSANDS of dollars to the US government through taxes, get screwed at the end. What the hell is the point of working so damn hard and saving and saving and buying a house and paying your taxes like a dutiful American if at the end of it all the woman who you did all this for (in this case, my mother) has to sell the home and become poverty stricken in order to get any assistance? So either way the greedy ass government gets theirs, right?!!

I have another family member who does nothing with her life. Accumulated nothing. Owns nothing. A big giant lazy ass. And when the time comes for her to go to AL, she won't have to pay a dime. Great incentive to work!

Oh, I feel SO much better now. Thanks!!

Wow that NH/AL is a bargain. Most NH for basic services & R & B is 65K annual.

Why doesn't she qualify for Medicaid?

If it is that every month she is over her states's Medicaid income limit BUT not enough to pay in full for the NH and she qualifies for NH in every other way?? Then she can see an elder care attorney to do a "Miller Trust" or a "Special Needs Trust". Say mom gets 1K from SS and 1,500K from retirement every month. Her monthly income is $2,500. So basically she is $ 500 over the state's ceiling for monthly income. No matter what she does is always is $500 over. So this excess $ 500 is what funds the trust. The beneficiary of the trust is the state or the state's Medicaid program and upon death reverts to the state. Miller really has to be done by an attorney who does elder law as it needs to be flexible/adaptable and meet the criteria of each state's law on probate (death laws) & Medicaid rules.

Medicaid is a federal/state needs based entitlement program (and very different than how Medicare & SS are done as they are federally structured entitlement programs).Because it is needs based what was done with assets in the 5 yr window prior to Medicaid application is central to qualifying. Medicaid is designed as a safety-net for low income who can show both financial and medical necessity for long term care. The monthly income & asset ceilings and how assets are dealt with after death is set by each state.

Because Medicaid is needs-based, doing a 5 yr look-back on the applicants assets is critical for the states to operate the program. If everyone was able to transfer all of our parents assets, empty out their accounts today, spend monthly retirement and SS on nonNH stuff and put them into a NH tomorrow paid 100% by the state the system couldn't afford it and they wouldn't have any NH to go to.
Medicaid compliance is all about either doing planning OR spending your share until &/OR unless you are impoverished. Medicaid gets to the heart of the issue of who should pay for long-term care -- the public through the tax-supported Medicaid program, or users of long-term care through their personal resources, including
those after death. Good luck!

Well, my take is this. In America we have been told we need to work hard, save our money, pay our own way, don't pay alot of taxes and keep the government out of our business. But wait, the government is really us or should be. I have a best friend who is Dutch and a sister-in-law who is French. Yes, neither of these people knew many who could afford the Mega-houses some Americans can and the fancy cars "some" Americans buy. Or the grand vacations (wait a minute most of us don't get those either). But neither one had to worry one day about the care of the their elderly parent. It was paid for by a system that makes sure all have adequate health care and elder care. Sometimes I just think we have been sold an idea that only benefits a select few. I think our country gives us more opportunity than any other. But there is room for improvement and we should not be afraid to look at the options "for the good of everyone", not just the ones who have all the money to afford it. And that is my rant.

Back to the original question 6 years ago - why isn't there something less expensive? I'm a healthy 76, grateful and appreciative of what I have, have saved, and planned for healthy retirement and the potential of higher care later. I've done a good deal of research on the realities of aging and how it's playing out financially - downsizing, budgeting, and eventually having to cancel Long-Term Care Insurance because it doubled in cost last year. I planned for inflation increases, but with escalating costs of care, it was clear that another increase would have insurance taking half of my fixed income. Bottom line is that we individuals; they (everybody else including many care recipients who never worked or contributed to programs designed to assist the whole); or the government - took into consideration the social change and transfer of wealth that occurred over the last decade virtually destroying the American middle class and their ability to care for themselves.  Sheer GREED has brought us to a point where Seniors who planned to age-in-place are unable to pay escalating property tax on often debt-free homes. My grocery bill has doubled in the last 5 years while my Social Security check (for which I worked and contributed most of my adult life) has increased a whopping $2 over that same 5 years. Meanwhile a teenager who has never worked but birthed a couple of innocent citizen babies feels entitled to (and receives)  housing, healthcare, and further education with the likelihood that those who start life based on irresponsible decisions for which others pick up the cost are unlikely to ever become productive citizens. The family company who owns the grocery where I shop is among the wealthiest families  in the world (billions). As corporations go, they are good guys -  supporting charities worldwide. If they, or the likes of Bill Gates, Soros, the Koch Brokers, big pharma, etc. simply sell their products for reasonable prices based on costs and not costs with obscene profits, then the money we earned, or that our children earn, could be self administered to improve health and elder care.  With grandchildren nearing or in college (where scholarships were based on need and diversity rather than grades and accomplishments), my children struggle to get by on $100K a year and have little time to enjoy life, help with my care, or plan for their own futures.  The problem increases when you consider that each middle age couple (our kids) potentially have four adults for whom they feel some responsibility. 

There simply needs to be other housing models besides aging-in-place (where costs are prohibitive); aging with family (where costs, time, and social needs are lacking); or FOR PROFIT institutional care.  LESS THAN 5% of all over age 65 live in ANY KIND OF INSTITUTIONAL SETTING (independent, assisted, memory or full care).  If you check out the biggest providers of healthcare, you'll find CEOs compensated in the range of $30 to 50 million annually; and CEOs of the biggest providers of Senior are compensated $5 to 10 million while paying actual caregivers $10-$15 per hour. I could  cite more statistics, but the only ones that count are population vs earnings. Those over age 65 are now about 20% of the total population. As boomers and their progeny retire over the next 20 years, Seniors will represent almost 40% of total population. Add children and those truly unable to contribute and there's simply not enough workers to sustain  current models of housing/healthcare or living. There IS NO MAGIC ANSWER - we either change or the system will fail. Meanwhile, our elected representatives twiddle their thumbs, increase their pay and provide higher standards of living for themselves than for those who elected them. 

But, back to reality, how do the other 95% of those over 65 cope with the situation that exists. In the aging-in-place model, there is not only the cost of maintaining a home, but loneliness which is now attributed to be equally as unhealthy as smoking alcoholism, or diabetes. We seek medical care because we are scared and lonely and Medicare/medicaid picks up the tab without our even knowing the cost. A night in the hospital which was excessive at $1000 thirty years ago is now obscene at $10,000-$30,000.

One solution is banding together under the same principles of cavemen and colonists - sharing the space, the work, and the bounties (the basis of Cooperative or CoHousing. For those healthy enough, as little as taking on a housemate could double household resources. If 4 are each struggling to live on $60K annually, if they banded together, household income would be $240K, enough to hire assistance in the form of cleaning, transport, medicine management, keeping the larder stocked and meal preparation. This is a different mind set - but it can be our reality and it has the potential to get us and our kids through the next several decades of a social/health/financial problem that is only going to grow. Among my friends and with help of Social Media (some new technology is helpful!) , we've created a group who are in the process of selling our homes with the intent to buy into a small condo project nearby. We're not planning a takeover - just to have proximity to each other and to the goods, services, healthcare and cultural opportunities that we already know. Sale of our homes will add to each of our assets to be used to supplement fixed income. And that will allow to re-allocate spending to some shared costs (housekeeping, transportation and anything else for which we can collectively bargain). 

We'll have small separate living units, but with the intent of our daily social needs being resolved by being companionable neighbors. One of our otherwise healthy friends is currently in memory care assisted living - which could be any of us within the next decade - whose family has agreed to support her decision to buy with us and ours to include and watch after her. That doesn't mean we are obligated to replace any special care any individual might need (which remains a responsibility of their estates), but we want to include up front a small percentage of those whose care needs are higher than the groups so that we will have an understanding of group dynamics for the time that any of us may need  attention that the group cannot provide. 

Every act of care doesn't have to be profitable. I've never been in favor of law restricting the amount a person could "earn." Still, there's something basically wrong with the model in which the actual caregivers in Assisted Living facilities average $13/hour, while the facility Director averages $36/hour and so on through state and regional management to the CEO averages a whopping $480/hour before management bonuses and stock options which bring his/her take to an obscene $3,000/hour. 

Still, if you don't have the time, willingness, or energy to participate in management of the care of an individual or in cooperating with others to manage the direction of an ongoing group with common interests - then you will have to pay for the privilege of others providing services you can't or won't provide. Yes, we'll still have to seek legal and perhaps social guidance to protect ourselves and family earnings/assets from government overreach and  we'll need to lobby on behalf of family and friends being compensated for care-giving. But if lower costs and higher satisfaction are goals with which you can help, there are options. 

Apologies in advance for anything sounding offensive or non caring about the rights or entitlements of others (salaries, welfare, etc), I' m just sick of seeing the assets of what was the middle-class backbone of this country drained off to attorneys, pseudo services such as A Place for Mom who basically gives you a list of housing providers who will pay them a commission if you move there; and dozens upon dozens of governmental offices and non-profits who are in the job-creation/information disseminating business. What we need is affordable housing that meets our physical, social and financial realities. We need to spend our resources on those who are actually helping improve our daily lives.

madge1, I could not agree with you more! You are right. We have all been led to believe we all have the potential to achieve millions, a mega mansion, a yacht, whatever we want. All we have to do is work hard. Lies. Most of us do not achieve that. Sure there are a few Oprah's and a couple of Beyonce's, but most of us are living paycheck to paycheck. Americans have been led to believe that the word "socialism" is akin to "fascism" or "communism." It ain't. Why on earth should people die because they can't afford insurance or medication. We just had a major scare from my daughter's boyfriend who is epileptic. His insurance lapsed (his mother's fault) and we BEGGED agency after pharmacy after social service agency for help. No one would. I ended up having to lend him the money or he would be having a seizure right now. The American dream is the reality of the 1%. Short sidebar rant.

Windytown, just a thought. The 1 to 2 percent pay most of the taxes. Check it out on the IRS website. My oldest daughter is a corporate lawyer with the biggest firm in Boston. A tax lawyer. She is disturbed at what she see. Even with big tax loop holes the mega wealthy are getting richer and richer. Please don't think I am a socialist, whatever that really is, but if you know someone who actually deals with the monied ones in American you would be shocked at what is going on. America was built to give everyone oppptunities, not to build kingdoms. Many in Washington are looking out for the kingdoms.

I agree with the previous poster. I happened to spend a few years working in The Netherlands and experiencing their health care and retirement systems. They have a much better approach to senior care than what we do here in the U.S. They have opportunity to earn and excel just as is claimed here but the citizens are not left to twist in the wind when they have a health crisis. My wife came down with Alzheimer's while there and their system took care of her immediately and worried about payment afterwards. Even then the costs were reasonable and not designed to impoverish me. All this and I wasn't even a citizen. Something is very wrong with our approach to these basic needs.

Hi Karen, As a friend always says, getting older isn't for sissies. Nor is the care giving aspect! Tell me where you live - - - $3000 sounds like a bargain. My mom is in a memory care AL and the bill is $7100/month.

The least expensive solution I am aware of is to hire live in help. It provides one on one care and she gets to stay in her own home. That may work for a while and puts off the move to an AL.

If she or her husband was a veteran, there may be benefits available there. As you spend down her assets, she may become eligible for medicaid at some point.

As part of my search, I did find a group home for memory care. 15 residents in the home. I wasn't impressed with the one I saw and it was the only one in the area.

These are the best ideas I can come up with, perhaps others will have more ideas. Good luck.

I wish there was a federal standard for Nursing home care. In our state, AL just provides 3 meals a day(dining room only) and room, no medicines or help. This sounds rather independent to me and our state does have independent facilities. If they give medicines or help dressing, they charge extra. If they require even a little extra help(they give points), they want to move them into NH. The next state over provides help dressing & undressing, breakfast in the room among other things in their AL. If I had known this sooner, I would have put her in another state as it was cheaper too. I don't see how a facility can claim to be AL when they do not provide any Assistance. I really thing federal regulation is needed.

Karenp,

You say that the mother of your daughter's boyfriend is the one that allowed his insurance to lapse. How is that anyone else's fault? Should not his mother be responsible?

A lot of us don't think you have to be Oprah or Beyonce' to be living the American dream. That 1% stuff is piffle.

100 million people throughout history have died from living under the various "isms" you mention. Our system may be far from perfect but I'd rather live free than have the government tell me how to live my life.

Sorry this is off-topic, but I can't help but respond to a post like yours.