Are you thinking about having a home healthcare aide instead of moving to a retirement home?

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CULater
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Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by CULater » Thu Sep 05, 2019 7:16 am

In discussions on the forum, I've often heard that people are thinking about having a home healthcare aide when they reach that point, because senior residence and assisted living are so expensive. But having home healthcare aides isn't really less expensive, and there are other issues to consider:
Four out of 10 people will opt for paid care at home, and the median annual cost of a home-health aide hovers at $50,000, according to the U.S. Department of Health and Human Services’ Administration on Aging. Most people over 65 will need help with daily living tasks. Men will need such assistance for an average of 2.2 years, while women will need it for 3.7 years, the government data found.
https://www.marketwatch.com/story/heres ... 2019-08-20

On top of that cost, you have to consider the costs associated with remaining in your home to provide a roof over your head, the cost of food, etc. You won't be able to sell your home for funds; although you could get a reverse mortgage. All-in-all, I'm not sure remaining at home and depending on home healthcare aides is a more economic solution, and you're also faced with managing the people who come into your home as an elder citizen who may not be playing with a full deck and/or is physically infirm.
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stan1
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by stan1 » Thu Sep 05, 2019 7:22 am

$50K is probably about 40 hours a week through an agency in a LCOL area ($25/hour), absolutely not 24/7. So maybe it will extend your ability to stay in your home a bit or help cover short term needs. 24/7 home health care is much more expensive than assisted living or nursing home care if that's what you really need. The reliability of workers in these thankless jobs is low. They are on demand hourly workers with little schedule flexibility.

HomeStretch
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by HomeStretch » Thu Sep 05, 2019 7:37 am

40 hours per week for an aide is a viable interim step for seniors needing assistance with personal care, home cleaning, transportation and daily chores and who can afford it.

But for someone requiring more assistance (mobility issues, daily medical care, dementia), a home healthcare aide might be needed for more than 40 hours per week (expensive) or the needs might be greater than an aide can take care of. Assuming one can find reliable competent aides.

This scenario also assumes that the home set up is conducive to remaining in it. One floor living and possible extra bedroom for aide.

Going through this with parents now and in-home care is not easy to set up in a non-friendly-aging home plus one parent with dementia who gets agitated with strangers in the home.

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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by dodecahedron » Thu Sep 05, 2019 7:44 am

NYT had article with in-depth coverage of homehealth live-in aide who is on duty 24/7 for 27 days a month caring for an elderly man with dementia and Parkinsons. A colleague provides relief four days per month. Her life seems exhausting and unsustainable. Theoretically she is supposed to have at least six hours of uninterrupted sleep but since his condition now requires that he be turned/moved in his bed every two hours, she doesn´t even get that.

Family says they are paying $75K per year for his care.

https://www.nytimes.com/2019/09/02/nyre ... -aide.html

A more humane schedule (i.e., multiple shifts of caregivers each day) with more reasonable compensation would cost more.

I would personally feel awful about imposing such an exhausting toll on another human being as described in this article.

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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by CULater » Thu Sep 05, 2019 7:46 am

stan1 wrote:
Thu Sep 05, 2019 7:22 am
$50K is probably about 40 hours a week through an agency in a LCOL area ($25/hour), absolutely not 24/7. So maybe it will extend your ability to stay in your home a bit or help cover short term needs. 24/7 home health care is much more expensive than assisted living or nursing home care if that's what you really need. The reliability of workers in these thankless jobs is low. They are on demand hourly workers with little schedule flexibility.
Having an aide 4/hours per day (4 hours is often the daily minimum) for 365 days @$25/hour would run $36,500. You pay extra if the aide transports you in their car for outings, shopping, doctor visits, etc., and if they do shopping for you, etc. Pretty sure you can get close to $50K without much trouble, and that leaves you alone most of the time, especially at night. My mother has been in decent ALFs that ran about $60K per year, and that includes your food, meals, around-the-clock assistance, housekeeping, med management, doctor/nurse checks, transportation, activities, etc.

My greatest concern would be my ability to manage the people coming into my home. Often low-paid, lots of turnover, etc. I'd hate to be a vulnerable elder in that situation. Would really need a trusted person or family member to oversee this, IMO.
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by TomatoTomahto » Thu Sep 05, 2019 7:56 am

We are finishing up a home renovation that has a side benefit of making our home suited to such a setup, hopefully years away (or not required).

Our bedroom could be moved to a downstairs bedroom with an en-suite bathroom with walk-in (or ride-in) shower for one floor living. Stairless access from the garage could easily be provided.

Our current bedroom suite would be a great place for an aide or couple to live when we can no longer use the stairs.

We wouldn’t be doing it to save money. We love our house and property (lots of birds, frogs, wildlife) and would really want to remain there as long as possible.
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by Sandtrap » Thu Sep 05, 2019 8:03 am

MIL is 97, in her own home, 24 hour home care.
She's happiest in her own home. So, that's the priority for now.

DW and I agree that we would want the same if it's a viable option at the time.
Cost is not a factor.

j
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by Swansea » Thu Sep 05, 2019 8:06 am

In my immediate neighborhood, I see two homes with health care aids. One is 24 hours daily, the other seems to be about 12 hours.

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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by TomatoTomahto » Thu Sep 05, 2019 8:07 am

Sandtrap wrote:
Thu Sep 05, 2019 8:03 am
MIL is 97, in her own home, 24 hour home care.
She's happiest in her own home. So, that's the priority for now.

j
If you know and are willing to divulge, how much does this cost for her care, and in LCOL/HCOL area?
Okay, I get it; I won't be political or controversial. The Earth is flat.

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Sandtrap
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by Sandtrap » Thu Sep 05, 2019 8:10 am

TomatoTomahto wrote:
Thu Sep 05, 2019 8:07 am
Sandtrap wrote:
Thu Sep 05, 2019 8:03 am
MIL is 97, in her own home, 24 hour home care.
She's happiest in her own home. So, that's the priority for now.

j
If you know and are willing to divulge, how much does this cost for her care, and in LCOL/HCOL area?
M-H COL area.
8-10k/month. Total expenses for everything including home upkeep and home expenses, car for the caregivers to use and expenses for that, etc, etc. Insurance covers medical visits and nurse/RN if needed.

MIL's husband (passed) was a Boglehead. So expenses come from annuity, pension, ss, IRA, etc.
The home was modified as needed for safety, etc.
j
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NotWhoYouThink
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by NotWhoYouThink » Thu Sep 05, 2019 8:16 am

It's a continuum, and it depends on what your other support elements are. If there is family in town that can manage your doctor's appointments and other health needs, then a few hours a day from a health aide might be a good substitute for moving into a retirement community. But if your only interactions during the week or month are with the health aides, it can be socially isolating. One thing you get from moving into a retirement community is socialization.

If you need more than just a little care, then you will also need someone to manage that care. Maybe your kids can and will do that, or maybe you need to move to a more structured environment. If your health is failing and you have plenty of money to pay for care but no one to help you manage that task you are a prime target for theft and fraud.

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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by lthenderson » Thu Sep 05, 2019 8:27 am

Four out of 10 people will opt for paid care at home, and the median annual cost of a home-health aide hovers at $50,000, according to the U.S. Department of Health and Human Services’ Administration on Aging. Most people over 65 will need help with daily living tasks. Men will need such assistance for an average of 2.2 years, while women will need it for 3.7 years, the government data found.
Both my grandparents opted for renting an apartment in independent living facilities for seniors with attached assisted living and nursing homes. Their rent was $25k per year so half that price. For that they had access to nursing staff, cleaning staff, dedicated drivers, fitness centers, activities, meals cooked for them by a chef, etc. Based on the three years they lived there, they were extremely happy and contented. I don't think I would a home-health aide that would provide less services that costs twice as much money.

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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by TN_Boy » Thu Sep 05, 2019 8:36 am

NotWhoYouThink wrote:
Thu Sep 05, 2019 8:16 am
It's a continuum, and it depends on what your other support elements are. If there is family in town that can manage your doctor's appointments and other health needs, then a few hours a day from a health aide might be a good substitute for moving into a retirement community. But if your only interactions during the week or month are with the health aides, it can be socially isolating. One thing you get from moving into a retirement community is socialization.

If you need more than just a little care, then you will also need someone to manage that care. Maybe your kids can and will do that, or maybe you need to move to a more structured environment. If your health is failing and you have plenty of money to pay for care but no one to help you manage that task you are a prime target for theft and fraud.
Everything you said is true, but I will note that moving to a community does not remove the need for someone to manage the care. It's still the families problem to manage doctor appointments (often the patient needs to be accompanied by someone to hear what the doctor says directly), manage the finances, etc.

Being in a community makes many things easier -- for example, suppose there is a fall and for six weeks the patient needs 24x7 help. Usually easier to turn that on in a facility that at home. Plus there is often an RN available during the day to do checks, etc. Meals are provided and so forth.

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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by dbr » Thu Sep 05, 2019 8:46 am

Our family kept two people in home health care. The key step is that the caretakers were not an agency but particular individuals we found in the community that were willing to work full time only for us. In one case the arrangement was live-in with room and board part of compensation.

I don't have a record of costs at hand, but the total was similar to care at that level at a facility. In one case the cared for person needed to move to a facility because care needs became too severe. The other person passed away directly from home. Fortunately those relatives had enough assets to support the level of care to the end.

In both cases the responsible family member had to become either legally (as custodian in one case) or effectively (by POA in the other case) in charge and hire the caretakers as employees with the full machinery of employing people. That job is big, detailed, and onerous, especially when a person is a legal custodian with all the reporting requirements. In the case of the person eventually placed in a nursing home things got much better for us and the person was happier there than at home. In hindsight they should have been moved sooner.

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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by Broken Man 1999 » Thu Sep 05, 2019 8:59 am

Here is another data point!

Tampa Bay area, I have two CNAs, one for Monday-Friday, one for Saturday and Sunday. Each visit is 2 hours. I pay $20/hr to their agency.

One has been with me a few years, another replaced a CNA that had to retire in her 70ties because of knee issues. She had been with me well over 10 years.

Be very careful when you look for any type individual who becomes a regular visitor to your home. Agencies screen their employees, and have the various required insurances to protect you against liability, theft, etc.

As well, the individuals will have vacations, family emergencies, etc. An agency can send another person with little delay. If you are doing things yourself, not thru an agency, you will need a backup plan.

Broken Man 1999
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by dbr » Thu Sep 05, 2019 9:12 am

I actually have another data point where the resolution was for the person involved to finally be placed in assisted living with some medical support. For a variety of medical and behavioral reasons trying to let this person live at home was a nightmare. They could easily have died there. As things have settled down I have POA for the person's bank account and for health care and that is sufficient to keep things on an even keel for the moment. They are competent in general to make their own decisions.

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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by Speckles » Thu Sep 05, 2019 9:44 am

For your consideration, there are also personal care homes (PCH).These are state-regulated small faculties, typically rum by an individual or family in their own home. Each personal care home accepts 2-5 residents typically.

The PCH provides homemade meals, any needed personal assistance like washing or dressing, meds, often helps arrange appointments and transport. All in their own home. It’s kind of like being an aging parent living with foster kids.

Of course, there are good PCH and bad ones and one needs to look around. The state council on aging usually publishes a list of places.

To me it feels far less institutional because you are in someone’s home with a yard and pets or children or whatever combination of those you want. You’re also helping a small entrepreneur.

Specks

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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by TN_Boy » Thu Sep 05, 2019 12:05 pm

Speckles wrote:
Thu Sep 05, 2019 9:44 am
For your consideration, there are also personal care homes (PCH).These are state-regulated small faculties, typically rum by an individual or family in their own home. Each personal care home accepts 2-5 residents typically.

The PCH provides homemade meals, any needed personal assistance like washing or dressing, meds, often helps arrange appointments and transport. All in their own home. It’s kind of like being an aging parent living with foster kids.

Of course, there are good PCH and bad ones and one needs to look around. The state council on aging usually publishes a list of places.

To me it feels far less institutional because you are in someone’s home with a yard and pets or children or whatever combination of those you want. You’re also helping a small entrepreneur.

Specks
I have looked at group homes. The one I looked at the most closely (friend with family member there) was actually very good. More expensive than memory care or assisted living, less than skilled nursing. Much better staff/patient ratio than a larger facility.

It is sort of like living at home. The downside is that your "space" consists of the bedroom. Most of the rest of the house is common area.

My reaction to the one I looked at was that it would be a nice alternative to memory care (though they couldn't handle dementia with aggressive wandering, they could deal pretty well with typical dementia).

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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by carolinaman » Thu Sep 05, 2019 12:56 pm

TomatoTomahto wrote:
Thu Sep 05, 2019 7:56 am
We are finishing up a home renovation that has a side benefit of making our home suited to such a setup, hopefully years away (or not required).

Our bedroom could be moved to a downstairs bedroom with an en-suite bathroom with walk-in (or ride-in) shower for one floor living. Stairless access from the garage could easily be provided.

Our current bedroom suite would be a great place for an aide or couple to live when we can no longer use the stairs.

We wouldn’t be doing it to save money. We love our house and property (lots of birds, frogs, wildlife) and would really want to remain there as long as possible.
This decision is not simply a dollars and cents one. Obviously, it has to be affordable, but living in our homes for the remainder of our lives is something many seniors want very much. Our mother was legally blind (macular degeneration in both eyes) and nearly deaf, but she steadfastly refused to leave home even though we were willing to help her in assisted living. My sister pushed her hard to move to assisted living but I could not push too hard because I will be the same way.

She died at 89, but only spent last 9 months of her life in hospital, rehab and nursing home due to a fall.

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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by rjbraun » Thu Sep 05, 2019 1:00 pm

dodecahedron wrote:
Thu Sep 05, 2019 7:44 am
NYT had article with in-depth coverage of homehealth live-in aide who is on duty 24/7 for 27 days a month caring for an elderly man with dementia and Parkinsons. A colleague provides relief four days per month. Her life seems exhausting and unsustainable. Theoretically she is supposed to have at least six hours of uninterrupted sleep but since his condition now requires that he be turned/moved in his bed every two hours, she doesn´t even get that.

Family says they are paying $75K per year for his care.

https://www.nytimes.com/2019/09/02/nyre ... -aide.html

A more humane schedule (i.e., multiple shifts of caregivers each day) with more reasonable compensation would cost more.

I would personally feel awful about imposing such an exhausting toll on another human being as described in this article.
I also read that article. Sobering, to say the least.

I found a couple of the photos odd, though, and hope that they were simply "staged" for the benefit of the NYT's photographer. In one photo the caregiver is seated at a table with a cup of tea in front of her. She is looking aside, perhaps out a window. Meanwhile, the 77-year old man she cares for, who has dementia and Parkinson's, is behind her walking by himself across the living room. In another picture, she has her back to him as she makes the bed and he is, again, on his own, pedaling an exercise bike.

Not at all suggesting that the profiled caregiver is anything but fully capable and caring, but as it is the pictures sure seem misleading to me as to the attention and commitment required by a caregiver. It would be unacceptable to me if the ones we hire were anywhere but side-by-side to the "cared for" as they walked or exercised.

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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by RetiredAL » Thu Sep 05, 2019 1:11 pm

I first tried in-home care thru an agency. One shift x 7 was about same cost as the ALF, and it became apparent 2 shift was inadequate. 3 shifts would have run 18 to 20k a month. Location was a MCOL in Ca. Ca laws for caregiver employment are pretty tough.

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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by rjbraun » Thu Sep 05, 2019 1:15 pm

Sandtrap wrote:
Thu Sep 05, 2019 8:10 am
TomatoTomahto wrote:
Thu Sep 05, 2019 8:07 am
Sandtrap wrote:
Thu Sep 05, 2019 8:03 am
MIL is 97, in her own home, 24 hour home care.
She's happiest in her own home. So, that's the priority for now.

j
If you know and are willing to divulge, how much does this cost for her care, and in LCOL/HCOL area?
M-H COL area.
8-10k/month. Total expenses for everything including home upkeep and home expenses, car for the caregivers to use and expenses for that, etc, etc. Insurance covers medical visits and nurse/RN if needed.

MIL's husband (passed) was a Boglehead. So expenses come from annuity, pension, ss, IRA, etc.
The home was modified as needed for safety, etc.
j
Another data point. For HCOL area, I think the going rate is about $25 / hour for what is reasonable to expect to be quality care. In other words, maybe you can pay a bit less but might need to compromise on experience, certifications, etc. Holidays can cost more, and 24/7 coverage may be more depending on how long the shift lasts and whether the person is allowed to rest.

If you go through an agency, the caregiver will probably only receive about half of what you pay. So, in our experience you might be better off going direct to the individual as that would allow them to see the full $25 rate (pre-tax), assuming that the employer pays taxes and workers comp coverage. Of course, identifying and screening candidates will take time, and it's amazing how much effort is required to juggle the various schedules even if you use an agency, assuming you have a preference for certain caregivers over others.

In our experience, it really is almost a full-time job to find, train, and schedule the caregivers. And what I mean by train is to familiarize then with the particular setup and needs, not the actual professional training, per se.

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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by GJ48 » Thu Sep 05, 2019 2:22 pm

CULater wrote:
Thu Sep 05, 2019 7:16 am
….I'm not sure remaining at home and depending on home healthcare aides is a more economic solution....
Since 2015 my spouse and I are managing with home health aides for her and expect to do so for as long as possible. It'll be either aides at home or a nursing home. Her condition is complicated and her medication schedule is extensive. Neither of us ever seriously considered assisted living for her because there's just too much going on with her throughout the day.

I read with interest the following opinion piece in the New York Times last week:

https://www.nytimes.com/2019/08/29/opin ... iving.html

"The irony of assisted living is, it’s great if you don’t need too much assistance. If you don’t, the social life, the spalike facilities, the myriad activities and the extensive menus might make assisted living the right choice. But if you have trouble walking or using the bathroom, or have dementia and sometimes wander off, assisting living facilities aren’t the answer, no matter how desperately we wish they were....Assisted living has a role to play for the fittest among the elderly, as was its original intent. But if it is to be a long-term solution for seniors who need substantial care, then it needs serious reform, including requirements for higher staffing levels and substantial training."

mgensler
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by mgensler » Thu Sep 05, 2019 2:30 pm

Our experience was 18k - 20k for three shifts through an agency. Also included nurse visits for medication. We are in a MCOL.

TN_Boy
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by TN_Boy » Thu Sep 05, 2019 3:22 pm

GJ48 wrote:
Thu Sep 05, 2019 2:22 pm
CULater wrote:
Thu Sep 05, 2019 7:16 am
….I'm not sure remaining at home and depending on home healthcare aides is a more economic solution....
Since 2015 my spouse and I are managing with home health aides for her and expect to do so for as long as possible. It'll be either aides at home or a nursing home. Her condition is complicated and her medication schedule is extensive. Neither of us ever seriously considered assisted living for her because there's just too much going on with her throughout the day.

I read with interest the following opinion piece in the New York Times last week:

https://www.nytimes.com/2019/08/29/opin ... iving.html

"The irony of assisted living is, it’s great if you don’t need too much assistance. If you don’t, the social life, the spalike facilities, the myriad activities and the extensive menus might make assisted living the right choice. But if you have trouble walking or using the bathroom, or have dementia and sometimes wander off, assisting living facilities aren’t the answer, no matter how desperately we wish they were....Assisted living has a role to play for the fittest among the elderly, as was its original intent. But if it is to be a long-term solution for seniors who need substantial care, then it needs serious reform, including requirements for higher staffing levels and substantial training."
GJ48,

My sympathies for your situation. But it sounds like your spouse is almost needing skilled nursing (versus assisted living).

I don't fully agree with that article. Or rather, it fails to emphasize the major issue, which I'll get to below.

Usually memory care units are basically assisted living, plus, well, locked doors (wandering is a serious issue with some dementia patients), and extra supervision. They vary in quality. Group homes can work well for many people with dementia.

Many people in assisted living need lots of help. At times, they may have to wait for that help. But in many situations, things work okay. They may need help getting to the dining room, but are able to putter about the apartment okay. Meals are provided -- can can be brought up -- etc.

I don't want to pretend that US assisted living facilities are just fine the way they are. Yet they remain reasonable choices for many people.

Back to the major issue I mentioned above. There are many frail elderly, who, due to either mental or physical problems, would greatly benefit from having someone attending to them just about 100% of the time. And that's the problem. There is no universe where that is going to be remotely cost effective. You are essentially dedicating one person to keep another person going.

Here is an article on Japan's solution (approvingly referred to in the NY Times article):

http://theconversation.com/social-care- ... tion-96936

If you read through it, you come to this key phrase (regarding the community model they have):
While the idea of ageing in one’s own home and fostering supportive communities of care is undoubtedly positive in many ways, it is important to recognise – as those in the NGO sector in Osaka have pointed out to me – that it relies on the unpaid work of many volunteers, many of whom have cared for family members themselves and so understand the burden it involves.
There is no magic here. Supporting someone at home means *somebody* -- paid staff, family, unpaid volunteers as noted above -- is there helping.

Let's go back to the NY Times article:
But if it is to be a long-term solution for seniors who need substantial care, then it needs serious reform, including requirements for higher staffing levels and substantial training.
And this will greatly raise the cost of assisted living. I don't know the right solution from a cost standpoint. I know that 1-1 care is very expensive.

shell921
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by shell921 » Thu Sep 05, 2019 4:20 pm

It's not my fondest desire to go into a retirement place one day but it's something I will consider. I don't want to be isolated in my home, depending on whom ? My friends will all be old too. I made a younger friend a few years ago-- but would I want to burden HER-? no way. she has her own life/problems to deal with.

I think it's good to have a plan - but it's only plan "A" .
if your only plan is to stay in your place and age in place, wonderful if you can do it. but you also need to have a plan"B". a fallback plan in case something happens and you can't stay in your place or in case you live to be over age 85 or 90.

How many 90+ year olds do you know who are able to live in their own place without anyone helping them? when people get old they become weaker and more frail. it's just a sad fact of life.


While we would all wish to dance at our 100th birthday parties and die in our sleep soon thereafter, that's seldom how life works.

Most people have NO PLAN for living life if they live past age 85. Most seniors over age 85
usually need some kind of help to stay in their homes. Not all but most.
Here is a list of things I read on-line that you need to think about if you plan to live in your
home when you are old:

People already know how to live at home and they know if they like it – but, in fact, it is the most bewildering choice of all.
What happens when your doctor, plumber, housekeeper all move away?
What happens if your friends all move away?
What happens if you lose your license? What happens to your social life when your friends stop driving at night
(They will and you will )?

How age friendly is your home – could you live there in a wheel chair or walker?

Will you be able to find a reliable person to help with activities of daily living?
If one of you had to move to assisted living or nursing, could you still afford the house? How safe is your neighborhood?

delamer
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by delamer » Thu Sep 05, 2019 5:18 pm

If my health became such that I needed significant care (more than a couple hours per day), I assume that I would need help with managing my entire daily life — cooking, grocery shopping, housekeeping, home maintenance, finances, doctor’s appointments, etc.

I would not burden my children with having to deal with all the above and arrange for/manage my caregiving at home too.

I would move into a facility. Even then, the children still would have responsibilities related to finances, doctors, and any issues with the facility. That’s bad enough (I’ve performed that role for my mother).

TN_Boy
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by TN_Boy » Fri Sep 06, 2019 9:11 am

delamer wrote:
Thu Sep 05, 2019 5:18 pm
If my health became such that I needed significant care (more than a couple hours per day), I assume that I would need help with managing my entire daily life — cooking, grocery shopping, housekeeping, home maintenance, finances, doctor’s appointments, etc.

I would not burden my children with having to deal with all the above and arrange for/manage my caregiving at home too.

I would move into a facility. Even then, the children still would have responsibilities related to finances, doctors, and any issues with the facility. That’s bad enough (I’ve performed that role for my mother).
Your first paragraph is extremely relevant. It is surprising how many people (some of them posting in these threads about their LTC plans) do not understand the point you are making.

I guess we all believe it won't come to that.

The "lucky aging" ones I've seen -- ones who can easily stay at home -- are those who retain their mental facilities, and enough mobility to manage around the house. Sure they need help with the hard chores, lawncare, maybe can't drive as much, but generally with modest help are okay.

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CULater
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by CULater » Fri Sep 06, 2019 9:27 am

Per those comments about the (in)adequacy of care in ALFs, yes I agree. My mother would always be saying that she was paying for "assisted" living but getting no assistance, and that's not far from what we've experienced. You do have meals, housekeeping, med administration, and general supervision. But you are largely on your own to get to the meals, toilet, shower, dress, and generally take care of yourself. You are able to obtain more assistance with daily activities such as dressing, bathing, toileting, but usually at an added ala carte cost which makes an ALF as costly as a LTC facility. When you do need unscheduled assistance, it's usually up to you to press a call button and then wait around for awhile before anyone arrives. That can be a problem with toileting for example. For the other services you're usually on their schedule and not yours. My mother has always been an independent person who takes care of herself and was never able to shift into a dependent person's mindset. The folks who are like that seemed to fare better in the facilities we've been in.
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dawoof
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by dawoof » Fri Sep 06, 2019 10:56 am

duplicate question
Last edited by dawoof on Fri Sep 06, 2019 10:58 am, edited 1 time in total.

TN_Boy
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by TN_Boy » Fri Sep 06, 2019 10:57 am

CULater wrote:
Fri Sep 06, 2019 9:27 am
Per those comments about the (in)adequacy of care in ALFs, yes I agree. My mother would always be saying that she was paying for "assisted" living but getting no assistance, and that's not far from what we've experienced. You do have meals, housekeeping, med administration, and general supervision. But you are largely on your own to get to the meals, toilet, shower, dress, and generally take care of yourself. You are able to obtain more assistance with daily activities such as dressing, bathing, toileting, but usually at an added ala carte cost which makes an ALF as costly as a LTC facility. When you do need unscheduled assistance, it's usually up to you to press a call button and then wait around for awhile before anyone arrives. That can be a problem with toileting for example. For the other services you're usually on their schedule and not yours. My mother has always been an independent person who takes care of herself and was never able to shift into a dependent person's mindset. The folks who are like that seemed to fare better in the facilities we've been in.
From a terminology standpoint, I believe assisted living IS LTC (and I think that is the common understanding). What do you classify as a "LTC facility?"

And yes, you may have to pay more for extra services (when evaluating a care facility be very sure you understand the pricing for additional services). Which is good for the people that don't need much extra help (they SAVE money) bad for the people who do need extra help. Note also a common scenario -- somebody is pretty independent, then they fall and need extra help for a few weeks. A good facility can generally turn on/off the extra help. Or you move in, don't need help for a year or two, then have to start paying for extra help.

But what is the solution? For someone who does need more help with toileting, etc are you wanting to have someone in the room 24x7? What sort of staffing would you suggest and be willing to pay for? The problem is the number of people (possibly 24x7) needed as the amount of help increases.

I would find the "wait for non-urgent help to arrive" in assisted living very frustrating, but I'm not clear on how to fix that at a non-spectacular price point.

I generally think of the hierarchy as (from least to most expensive):

1) Independent living with some help (housekeeping, meals in a nice dining room, etc). Often very nice apartments. Social activities.
2) Assisted living. Apartments not as nice or as big (won't have full kitchens). Residents not as active. More help available. Social activities.
3) Memory care. Often assisted living on steroids; more monitoring, there is a locked door to prevent wandering, etc. Still have activities, residents may not be very functional.
4) Skilled nursing. Person needs IVs, is completely immobile, etc

I've seen group homes that can handle almost everything in both 2) and 3. More like memory care in cost. Better staff/patient ratio.

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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by littlebird » Fri Sep 06, 2019 11:28 am

lthenderson wrote:
Thu Sep 05, 2019 8:27 am
Four out of 10 people will opt for paid care at home, and the median annual cost of a home-health aide hovers at $50,000, according to the U.S. Department of Health and Human Services’ Administration on Aging. Most people over 65 will need help with daily living tasks. Men will need such assistance for an average of 2.2 years, while women will need it for 3.7 years, the government data found.
Both my grandparents opted for renting an apartment in independent living facilities for seniors with attached assisted living and nursing homes. Their rent was $25k per year so half that price. For that they had access to nursing staff, cleaning staff, dedicated drivers, fitness centers, activities, meals cooked for them by a chef, etc. Based on the three years they lived there, they were extremely happy and contented. I don't think I would a home-health aide that would provide less services that costs twice as much money.
Your grandparents sound as if they needed no personal assistance at all, or that one helped the other, if needed. An independent living apartment was exactly what they needed. But it’s not a substitute for a home health aide, who might have to assist with dressing, toileting, feeding, dental hygiene. If they began to need that, the cost would be in addition to the apartment, if even permitted. You are comparing the proverbial apples and oranges.

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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by increment » Fri Sep 06, 2019 11:39 am

TN_Boy wrote:
Fri Sep 06, 2019 10:57 am
Note also a common scenario -- somebody is pretty independent, then they fall and need extra help for a few weeks. A good facility can generally turn on/off the extra help. Or you move in, don't need help for a year or two, then have to start paying for extra help.
It is understandable (from their care perspective) but quite annoying (from a consumer perspective) that the facility may insist that you will receive (and pay for) particular services. The alternative would be to move out.

In my father's case, almost immediately after he moved to assisted living it became clear that he would never be able to remember any needs that might arise. The main source of information (because no family members are there 24/7 to monitor) about things that happened and what should be done was the facility, which of course is the main supplier of extra services.

littlebird
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Re: Are you thinking about having a home healthcare aide instead of moving to a retirement home?

Post by littlebird » Fri Sep 06, 2019 11:45 am

rjbraun wrote:
Thu Sep 05, 2019 1:00 pm
dodecahedron wrote:
Thu Sep 05, 2019 7:44 am
NYT had article with in-depth coverage of homehealth live-in aide who is on duty 24/7 for 27 days a month caring for an elderly man with dementia and Parkinsons. A colleague provides relief four days per month. Her life seems exhausting and unsustainable. Theoretically she is supposed to have at least six hours of uninterrupted sleep but since his condition now requires that he be turned/moved in his bed every two hours, she doesn´t even get that.

Family says they are paying $75K per year for his care.

https://www.nytimes.com/2019/09/02/nyre ... -aide.html

A more humane schedule (i.e., multiple shifts of caregivers each day) with more reasonable compensation would cost more.

I would personally feel awful about imposing such an exhausting toll on another human being as described in this article.
I also read that article. Sobering, to say the least.

I found a couple of the photos odd, though, and hope that they were simply "staged" for the benefit of the NYT's photographer. In one photo the caregiver is seated at a table with a cup of tea in front of her. She is looking aside, perhaps out a window. Meanwhile, the 77-year old man she cares for, who has dementia and Parkinson's, is behind her walking by himself across the living room. In another picture, she has her back to him as she makes the bed and he is, again, on his own, pedaling an exercise bike.

Not at all suggesting that the profiled caregiver is anything but fully capable and caring, but as it is the pictures sure seem misleading to me as to the attention and commitment required by a caregiver. It would be unacceptable to me if the ones we hire were anywhere but side-by-side to the "cared for" as they walked or exercised.
As someone who recently spent about eight years as caregiver to a beloved spouse with Parkinson’s, in my opinion the pictures you saw were an accurate representation of the care required for such a patient who is still mobile without need for a walker. Nobody can supply, and nobody can endure, 16 hours a day of body to body contact during every minute of mobility. The result would be to simply limit mobility severely. For the sanity of both patient and caregiver, the patient is allowed to ambulate on a well-maintained indoor surface as much as s/he can reasonably manage. If you were in that situation, you would quickly realize that it’s what common sense requires.

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