What Will Home Care Cost?

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cheese_breath
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What Will Home Care Cost?

Post by cheese_breath » Fri Jun 02, 2017 4:40 pm

This is a companion post to my “Different Flavor Should I Time the Market” post. It isn’t intended as a medical post, but of necessity will contain medical information so responders will have adequate information to formulate their responses…

DW, age 70. Massive stroke to left brain.
….. Paralyzed on right side.
….. Comprehends everything around her and everything spoken to her (I think), but is unable to speak to respond.
….. Unable to swallow. All nutrition comes through a PEG tube in her stomach. Don’t know if this will be permanent, but assuming worst case.
….. Currently on catheter and wearing diapers. Don’t know if this will be permanent, but assuming worst case.

The financial questions…

We live in MI, but I’d like to move her to TX to be near her daughter and grandchildren. I see on the Internet there are companies that will perform the transport for me, but I have no idea of the cost. Can anyone help me here?

Given her medical conditions noted above I’d like to care for her at home, but have no idea of the kinds of help (nurse? aides? whoever?) I would need to hire, how many, or how much it would cost. Can anyone help me here?
The surest way to know the future is when it becomes the past.

Carefreeap
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Re: What Will Home Care Cost?

Post by Carefreeap » Fri Jun 02, 2017 4:59 pm

I can't answer the transport question but have a little experience about the home care.

There are agencies in most larger cities that have home care aid workers. My MIL lives in the Portland OR area and recently had to use one when the woman she's used for the last two years got into an auto accident. The agency charges about $30/hr for a care worker. MIL does have LTC insurance which reimburses her for care.

You will need to figure out how much care your wife will need. Are you in good health and only need help with turning her and bathing and washing? Perhaps a half day 5x is fine? Or do you need 24 hour care which means 3 shifts of people?

MIL is a difficult personality and burned through agency caregivers which wouldn't return to her house. She can be verbally abusive and had no patience with training people how to do things the way she wanted. In addition, she has memory issues so she would forget what she told the person to do and start screaming at them demanding to know why they were doing something she forgot she told them to do. In the end she wound up training an illegal housekeeper on how to run her house. It's not the best situation but the woman puts up with her and MIL pays her about $20/hr and the LTC reimburses her.

Good luck; I know this isn't an easy road for you. And don't forget to put in your budget respite care. I've done some caregiving myself and it can be both mentally and physically exhausting.

delamer
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Re: What Will Home Care Cost?

Post by delamer » Fri Jun 02, 2017 5:26 pm

I am very sorry sbout your wife's condition.

Assuming you are relocating to a good sized metro area within Texas, there should be multiple home health care agencies that can provide care for your wife. When I needed care for my mother, the agency that I selected sent out a RN to assess my mother's needs and made recommendations on the amount of care needed. The RN also stopped by periodically to reassess.

My recollection is that I paid in the low-20's per hour (in a medium cost-of-living area). The hourly rate was somewhat lower if care was needed for more hours per day.

There will be a county-level Office of Aging and Adult Services -- or something similar -- where you are moving that can provide information on service companies, etc. available.

Consider that it might make more sense to have your wife in a nursing home at first and then move her home once she has improved. This would also give you the opportunity to find and make changes to a home that is adapted for her issues. Is there a medical professional where you live now that you trust to give you an honest assessment of whether her current level of disability can be dealt with at home?

letsgobobby
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Re: What Will Home Care Cost?

Post by letsgobobby » Fri Jun 02, 2017 5:31 pm

It is a difficult situation.

We recently hired in home care to help my parents. It was non-medical care - personal assistant care if you would - and cost $22 per hour for 40 hours per week. They cannot provide meds but can help with toileting, transportation, ambulation, feeding, changing, laundry, personal support/companionship. It was actually quite helpful.

For true medical care, expect to pay much more. A CNA was $25. An RN was $45-60 per hour. Very little of the care we needed was medical so we provided that ourselves and hired out the rest.

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Pajamas
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Re: What Will Home Care Cost?

Post by Pajamas » Fri Jun 02, 2017 5:37 pm

You said in the other thread that your wife is alternating between hospital and rehab right now. Speak to the social worker or case manager at either or both of those places about what types of care and how much of it your wife needs and to help with planning. There should be some kind of standardized assessment form that is used that indicates what kind and how much care your wife needs when going from the hospital to the rehab facility. The social worker or case manager can also provide or arrange for an assessment for home care. If your wife has managed Medicare, the company may also may make a case manager available to assist with arrangements.

It is usually preferable all around to keep the patient at home if care can be provided there safely rather than in a nursing home. Medicaid can also cover home care as well as a nursing home. So you should definitely talk to the lawyer about financial arrangements and Medicaid even if you are not considering a nursing home. Medicare will also cover some home care services for a period if the patient has skilled needs, usually meaning care provided by a registered nurse, physical therapist, or occupational therapist. (A PEG tube should qualify as a skilled need.) You can also supplement covered home care services with private-pay home health attendants or aides or other services.

Moving from Michigan to Texas may change what services your wife qualifies for as the programs are administered by the states, and if she has managed care rather than straight fee-for-service Medicare (and Medicaid if it works out that way), which company provides her coverage may also influence what will be provided. Some companies cover more than the minimum that is required.

The social worker or case manager in Michigan may not have detailed information about Texas but may be able to help you make contact with their peers there. You may find that coverage is more generous in Michigan than in Texas and that may affect the decision about moving your wife there.

The best way to price medical transport from Michigan to Texas would be to contact a company that provides it. They can also tell you if there is a possibility for the cost to be covered. (It sounds like you could wait on that until a plan is in place.)

https://www.medicareinteractive.org/get ... ealth-care

I'm sorry your wife and you and your family are going through this. Talk to the social workers and case managers for assistance with all of this, don't try to do it on your own.

123
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Re: What Will Home Care Cost?

Post by 123 » Fri Jun 02, 2017 5:49 pm

We looked into 24 hour home care for a relative a couple of years ago. It can be very difficult to accomplish and very expensive. The problem of providing 24 home care on an extended basis is that it usually requires at least 4 or 5 people to cover the various shifts for 7 days. More complications if someone you expect to come-in is unavailable due to illness or other personal business. It would be a separate full-time job to manage the support stuff.

A placement at a nursing home home handles all of these details for you. The nursing home will have additional facilities and staff to lift and move patients as well as handle personal care such as bathing. They can accommodate special dietary situations. For the most part they have already dealt with problems that you haven't even thought of yet. Many states have established standards for how many RNs have to be on staff at all times based on the size of the nursing home. Nursing homes can have established service schedules with health professionals that come in and provide periodic treatment to residents for things like vision issues, ENT, and dental care, A physician will make a "house call" at a nursing home when there are multiple patients to examine or treat that they wouldn't do for a single patient in a private residence.

A nursing home placement will allow family members to spend more quality time with the patient instead of getting overloaded with the arranging tasks of daily living.
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delamer
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Re: What Will Home Care Cost?

Post by delamer » Fri Jun 02, 2017 5:51 pm

letsgobobby wrote:It is a difficult situation.

We recently hired in home care to help my parents. It was non-medical care - personal assistant care if you would - and cost $22 per hour for 40 hours per week. They cannot provide meds but can help with toileting, transportation, ambulation, feeding, changing, laundry, personal support/companionship. It was actually quite helpful.

For true medical care, expect to pay much more. A CNA was $25. An RN was $45-60 per hour. Very little of the care we needed was medical so we provided that ourselves and hired out the rest.
This personal assistance care is what my mother needed too, although they did make sure she took her oral medications and wore her brace.

With needs like a PEG tube, the level/type of care may be different.

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baw703916
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Re: What Will Home Care Cost?

Post by baw703916 » Fri Jun 02, 2017 5:52 pm

I don't have a lot to add in terms of financial and logistical information, but wanted to wish both of you well in this situation.
Most of my posts assume no behavioral errors.

ChrisC
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Re: What Will Home Care Cost?

Post by ChrisC » Fri Jun 02, 2017 8:22 pm

We went through a similar situation with my 98 year old MIL after she underwent hospitalization and rehabilitation. We thought we'd be able to home care her with some outside assistance. After two months, it didn't work out. We just had too much difficulty with incontinence, bathing and transitioning issues, and personality conflicts with MIL. We didn't want her in an institutional environment (my own mother has been in a skilled nursing facility for over 10 years and it hasn't been the best fit for her) and we found a family care home for her -- it's a residential home that operates as a small assisted living facility limited to six residents with 24 hour coverage, medication management, personal care, lodging and controlled dietary meals with the presence of CNAs or LPNs on duty. My MIL shares a room with another resident (though you can opt for a private room) and essentially lives with the other residents in a 4 bedroom house. This is a private pay facility but a bit cheaper than a skilled nursing facility though all the residents have to be ambulatory, not wheel-chair bound.

I believe these adult family home care facilities, which are regulated by local governments as assisted living facilities, appear common in some states, like California. In NC, where we live, they seem to be growing alternatives to institutional facilities, though all the family care homes we saw in NC are private pay, and don't take Medicaid. Nonetheless, the cost of the family care home for MIL is substantially cheaper than a skilled nursing facility or for 24 /7 home care in our house. And for now, this is a much better fit for MIL.

InMyDreams
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Re: What Will Home Care Cost?

Post by InMyDreams » Sat Jun 03, 2017 12:07 am

Pajamas wrote:Speak to the social worker or case manager at either or both of those places about what types of care and how much of it your wife needs and to help with planning. There should be some kind of standardized assessment form that is used that indicates what kind and how much care your wife needs when going from the hospital to the rehab facility. The social worker or case manager can also provide or arrange for an assessment for home care. If your wife has managed Medicare, the company may also may make a case manager available to assist with arrangements.

It is usually preferable all around to keep the patient at home if care can be provided there safely rather than in a nursing home. Medicaid can also cover home care as well as a nursing home. So you should definitely talk to the lawyer about financial arrangements and Medicaid even if you are not considering a nursing home. Medicare will also cover some home care services for a period if the patient has skilled needs, usually meaning care provided by a registered nurse, physical therapist, or occupational therapist. (A PEG tube should qualify as a skilled need.) You can also supplement covered home care services with private-pay home health attendants or aides or other services.
I'm not looking at your post, so I'm not sure what you had to say about her existing finances.

Yes, the discharge planner/social worker should be starting to work out discharge details.

How long has it been since the stroke? Is she still in rehab? Are there improvements? Is she able to perform or assist in performing her Activities of Daily Living - toileting, bathing, transferring bed to chair, chair to tub, and so on. Would her new residence be disability friendly - e.g., wide door ways to get wheelchairs thru, bars to assist with toilet transfer, etc. If she's bed bound, do you/will you have a Hoyer lift?

Caregiving like this is very, very draining on caregivers.

Yes, you can probably find a "skill" to bring Medicare home visits into the home for a while, usually no longer than the first year. Still, medicare does not provide 24-hr care. I doubt Medicaid will either.

And typically you must have almost no assets to qualify for medicaid. And any disbursements of funds in the last five years will be scrutinized.

Did she or her spouse serve in the military? If she is almost devoid of assets (even recently), she may be eligible for Aid & Attendance benefit.

basspond
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Re: What Will Home Care Cost?

Post by basspond » Sat Jun 03, 2017 2:00 am

I hope the best for y'all. My mom was taking care of dad who had slight dementia for several years until the last year when she had part time assistance for several days a week and then bumped it up to every weekday. She should have started it earlier because it was wearing on her but also it could have been the fact she was realizing it was getting near the end. The cost was about half the cost of a nursing home but it sounds like your spouse has more care requirements then my dad so it will be a big burden and could last a long time.

Try the everyday part time first and then if if is too burdensome opt for more care. We feel guilty if we have to put our loved ones in a nursing home, but I am sure your loving spouse would feel guilty also if you spent your waking hours providing constant care.

littlebird
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Re: What Will Home Care Cost?

Post by littlebird » Sat Jun 03, 2017 3:33 pm

My spouse became totally disabled about a year ago, with a progressive disease. I could not manage his needs by myself any longer. My research suggested that if home care is needed more than 6 hours a day, 7 days a week, care in a facility becomes economically and logistically preferable.

The social worker in the rehab hooked me up with a man who acts as a liaison between the family of the patient and numerous facilities and group homes (I called him "the fixer"). After discussion with the rehab facility, my spouse and me, he found an assisted living group home, 6 minutes away from our marital home, which felt competent to care for him. Although completely bed bound, he has no meaningful medical needs. The cost is $48,000/year; about the same as 6 hours a day/7days care and everything is taken care of. We, of course, pay the Rx and doctor visit co-pays, but the actual appointment making, Rx refills, meds management and administering is taken care of by the staff. Pureeing foods, hand feeding, laundry are all included in that amount. His care has been excellent.

I think the info you need to gather concerns how permanent your spouse's disabilities are expected to be, how easy/difficult a home care patient she will be in light of your and her relative heights and weights as well as temperaments of both, and how likely it is that her children/grandchildren will actually be able to provide care and support. Good luck to both of you.

littlebird
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Re: What Will Home Care Cost?

Post by littlebird » Sat Jun 03, 2017 3:44 pm

123 wrote: A physician will make a "house call" at a nursing home when there are multiple patients to examine or treat that they wouldn't do for a single patient in a private residence..
In our area there are several "house call" companies and even individual docs who came to the house when my spouse was unable to travel, but not yet ready for a facility. Also podiatrists. Dentists I don't know.
123 wrote:A nursing home placement will allow family members to spend more quality time with the patient instead of getting overloaded with the arranging tasks of daily living.
This has been true for us.

NancyABQ
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Re: What Will Home Care Cost?

Post by NancyABQ » Sat Jun 03, 2017 8:08 pm

My parents used a medical transport service to transfer my Dad from Western NY to Albuquerque NM. I don't recall the cost, but it was acceptable to us (I guess probably mid-4 figures?). It was a van (basically the size of an ambulance) with 2 paramedics. They drove straight through and there was room for my Mom and their cat and some of their belongings, in addition to my father on a stretcher.

This is a totally viable thing to do, but of course the expenses and details will vary.

Best of luck with your decisions. If you can figure a way to keep her at home I am sure it will be the most pleasant situation for her. I have dealt with nursing homes and assisted living situations and though they may try hard, the staff is always over-worked and situations go untended for longer than you like (this is being charitable :( ). If you can find the right assisted living facility, it might also work for you and could be more home-like and also less expensive.

If it is a hospice situation, additional care is available for that. You should investigate these options. I was very impressed by what is available totally for free (covered by Medicare) for hospice.

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cheese_breath
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Re: What Will Home Care Cost?

Post by cheese_breath » Sat Jun 03, 2017 9:10 pm

NancyABQ wrote:... I have dealt with nursing homes and assisted living situations and though they may try hard, the staff is always over-worked and situations go untended for longer than you like (this is being charitable :( ). If you can find the right assisted living facility, it might also work for you and could be more home-like and also less expensive.

If it is a hospice situation, additional care is available for that. You should investigate these options. I was very impressed by what is available totally for free (covered by Medicare) for hospice.
Since she can't speak I'm currently staying in her room every night to make sure things such as dirty diapers aren't overlooked until the morning. That's why I was hoping to be able to care for her at home, but it looks like the costs which are more than I imagined might forbid it.

Not a hospice situation. She's seriously damaged, but not life threatening so long as she gets the proper care.
The surest way to know the future is when it becomes the past.

InMyDreams
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Re: What Will Home Care Cost?

Post by InMyDreams » Sun Jun 04, 2017 12:04 am

I'm sorry this is such a difficult time. It's a steep learning curve - you're getting the crash course that usually takes nursing students a term or more to comprehend.

I hope you have good social work resources at her current facility. They should be able to give you good ideas about her care needs at the moment. Perhaps there's a support group for family members of stroke patients?

Perhaps she could remain at her current facility (that she knows, and they know her) while you check out what facilities she might go to in TX? Perhaps you or her daughters can network in the new locale for recommendations - both for doctors and care facilities.

I suspect she'll get the most comprehensive care when she's an inpatient at a Rehab facility. Medicare only pays for that for a specific period of time - your Medicare supplement might extend that period. Social work at your current facility should know, if they haven't already addressed it.

Hopes and prayers to you both - and hope you can find time to care for the caregiver, too

Katietsu
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Re: What Will Home Care Cost?

Post by Katietsu » Sun Jun 04, 2017 12:56 am

While you are spending time with your wife, watch the assistance being provided to your wife. Think about how each function would be provided in your home. Realize that the situation may change as your wife's health changes, your health changes, you identify different options, etc.

We had a family member in a similar situation who was in a nursing home for 3 months for rehab. She stayed another 3 months while arrangements were made for home care. Round the clock care was provided for $12 per hour in a very LCOL area. These were an informal group caregivers who all had at least a CNA and some even had LPN or RN. Going through an agency would have cost $48 an hour because the hourly rate would be double and regulations dictated two caregivers if a patient needed a lift.

On the other hand, we were able to take care of
another family member at home with just an aide for a few hours a day. Then he needed more help than was possible to provide at home. A nursing home was needed because it did take two people to provide aid several times a day.

Please take care of yourself. Your wife is fortunate to have you watching over her. It is very easy to ignore your own physical needs for sleep, food, stress relief,etc. This is not good for your wife, you or your children.

LeeMKE
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Re: What Will Home Care Cost?

Post by LeeMKE » Sun Jun 04, 2017 1:08 am

I was laid up when I broke my leg last year. We needed someone to be with me 7 AM to 3 PM each day.

Agency support in my area was over $25/hour. Agencies are ideal when the patient is living alone and any and all absences of the staff MUST be covered.

I didn't need several shifts of help, and I was able to help with the training. So, I opted to hire help on my own. The best resource was http://www.Care.com

They have home care workers who range from $12/hour for basic care (help dressing, fetching, light cooking and cleaning) to much more for accomplished professionals who could do much more than I needed.

If you are going to have her at home and be there yourself, you may be able to get by hiring your own help through Care.com.

Sorry to hear you and your wife are going through this.
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Longtermgrowth
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Re: What Will Home Care Cost?

Post by Longtermgrowth » Sun Jun 04, 2017 3:16 am

Wishing a fast recovery and the best for both of you. Home care can add up fast even at the lower range of 20 an hour here. I would look up and call the various agencies in your area, describe to them the situation needs, and get an hourly quote.

It may be in both of your best interests to schedule an appointment with an elder law attorney. I'm sure laws vary by state, but in mine I know the spouse attempting to act as caregiver can put the house in their name along with a decent amount of assets. It may even be possible to start a special needs trust, but in my state doing so easily would require a surviving parent to do it. Either way, both of you could benefit from a competent elder law attorney consultation; your state laws may vary quite a bit in favor of both of you compared to what my states laws are.

SGM
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Re: What Will Home Care Cost?

Post by SGM » Sun Jun 04, 2017 4:21 am

We have 24 hour care for a centenarian who lives in her own home. Most of the time the geriatric aides sit around watching TV. The cost is at least double NH care.

Assisted living facilities are less expensive than nursing homes. However, many assisted living facilities will not take care of someone who has a feeding tube. We found a very good assisted living facility for another elderly relative for about $5500 a month. NHs would be more like $9500 a month in our location.

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Re: What Will Home Care Cost?

Post by Call_Me_Op » Sun Jun 04, 2017 5:50 am

Cheese_breath,

I have little to offer in terms of answering your question, but I do want to express my sincere hope that her condition improves significantly. She is still fairly young, so it sounds like there is reason to be hopeful.
Best regards, -Op | | "In the middle of difficulty lies opportunity." Einstein

stan1
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Re: What Will Home Care Cost?

Post by stan1 » Sun Jun 04, 2017 11:56 am

My in-laws needed a home health aide on an ad-hoc basis last year. Cost was $25/hour in a low cost of living area through an agency. They cooked meals, cleaned, did laundry, etc. They are not medical professionals. If you need this service long term you could start with an agency and then look for someone you like who would work directly for you on a regular schedule. We've since moved the in-laws into an assisted living facility. It took a bit of time to do so because most assisted living facilities set up for singles not couples (in-laws needed 2 bedrooms).

I can't speak to cost of home medical care because my father in law is eligible for in home hospice through Medicare.

It definitely helps to located in a low cost of living area if you need elder care services. I hope your wife's condition improves quickly and your needs are short term.

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Re: What Will Home Care Cost?

Post by JGoneRiding » Sun Jun 04, 2017 12:19 pm

cheese_breath wrote:
NancyABQ wrote:... I have dealt with nursing homes and assisted living situations and though they may try hard, the staff is always over-worked and situations go untended for longer than you like (this is being charitable :( ). If you can find the right assisted living facility, it might also work for you and could be more home-like and also less expensive.

If it is a hospice situation, additional care is available for that. You should investigate these options. I was very impressed by what is available totally for free (covered by Medicare) for hospice.
Since she can't speak I'm currently staying in her room every night to make sure things such as dirty diapers aren't overlooked until the morning. That's why I was hoping to be able to care for her at home, but it looks like the costs which are more than I imagined might forbid it.

Not a hospice situation. She's seriously damaged, but not life threatening so long as she gets the proper care.
There are very good nursing homes, really there are. You need to find one that not only is good but the right fit. For example you don't want one with tons of ambulatory dementia patients--they tend to cause problems and stress for other residents, but if you can find one with other people that want to interact with your wife quietly bec they are old too it can be a boon. I can't tell you how much we appreciate the friends my grandmother has at her home, it makes it so much more pleasant for her. Cost wise for us it might be cheaper to provide home care, she broke a hip so got bumped up to full time nursing but is able to stand bec of her dementia it was decided to keep her in full time care and cost is about 11k per month. The problem is she doesn't really need it. But at 97 and no spouse we are going the just spend all her money down route and then Medicaid will kick in. You need to consider some of the stuff the lawyer told you because ultimately you have yourself to consider and your wife wouldn't want you to be in a really bad situation bec of her. Even if you go homecare route (which might not be best from both a care level and cost level--only you can decide) separating finances NOW rather than in 5 years when you have to restart the 5 year look back would still make sense financially.

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Re: What Will Home Care Cost?

Post by bayview » Sun Jun 04, 2017 1:42 pm

^^ re the Medicaid spend-down: OP, you mentioned being reluctant to put your wife in a Medicaid nursing home. Many good nursing homes will take self-pay patients who can cover the first two years (sometimes one year) of expenses and then switch to Medicaid. That might be something that you want to consider. Alternative settings are going to be tough to find as long as she has a PEG tube...

I'm very sorry to hear of your wife's and your situation. It is the elephant in the room that those of us who don't have 7-figure investments or LTHC try to plan for but really don't know how. Best wishes to both of you in this terrible time.
The continuous execution of a sound strategy gives you the benefit of the strategy. That's what it's all about. --Rick Ferri

DetroitRick
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Re: What Will Home Care Cost?

Post by DetroitRick » Sun Jun 04, 2017 2:25 pm

Sorry for the situation. We're in Michigan and use an Illinois-based agency to care for my wife's mom at home. Cost is pretty much a flat $21.50/hour, with a 50% premium for holidays. It's a similar set of services to those on your list, except paralysis (but she is bed bound) and the feeding tube. We average around 22 hours daily, with short gaps between shifts. I'm sure wages and billing rates vary a lot by locale.

Assistance is in the realm of personal care - hygiene, cooking, light cleaning, errands, grocery shopping, social interaction, and communication with us/doctors/nurses. The agency insures, screens, trains and handles payroll/timekeeping and, for us at least, does a good job. We started out with a short schedule, 5/hrs per day and 5 days per week a few years ago. Switched to full-time last year. Most, but not all, of the workers we've come to know have been stellar - good communicators, helpful, caring and generally sweet people. A few, particularly the fill-in folks, have been mediocre (but acceptable). This is a small agency, probably around 50 or so clients in one suburban Chicago local.

There are pluses and minus to home care vs. long-term care facilities. Every case is different, and we've done both, so I can't presume to give advice in that regard. We do coordinate this care with her personal physician so we feel that this is working for now and it is definitely her preference.

Be aware that there are some narrow circumstances where these types of personal care services can be deducted as medical expenses when a chronically disabled person requires this type of care administered under a doctors plan of care. Look at IRS Pub 502 (Medical Expenses) and consult with your tax preparer. It is a narrow set of circumstances that qualifies for this, but they do exist. We obtained the requisite letter from her physician that verifies these circumstances are fulfilled for our case. Lot's of sources, but here's a relatively good one from 2011 in the Journal of Accountancy (no, not my usual magazine:)):
http://www.journalofaccountancy.com/iss ... ction.html

One more thing I can share about our experience. Even when mother-in-law was in a long-term-care facility for 2 months last year, we still retained these home services for a few hours per day several times each week. Because we couldn't be there, they handled minor day-to-day details (mainly at the LTC facility) and kept us informed. Even though that facility had staff. It kind of shows how much we thought of their services.

Best of luck to you both.

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Re: What Will Home Care Cost?

Post by Katietsu » Mon Jun 05, 2017 2:48 pm

It is my understanding that a nursing home that accepts a patient under Medicare can not transfer them out if the patient switches to Medicaid. However, that same facility might not accept a Medicaid patient from the outside. Just one more issue to consider.

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cheese_breath
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Re: What Will Home Care Cost?

Post by cheese_breath » Fri Sep 01, 2017 7:59 am

Well it’s been 3 months since my original post, and since then we’ve been back in the hospital for nearly 3 weeks with a nasty C. diff recurrence. But we’re back in the nursing center now, and I’m still staying in her room overnight. And it seems after considering all the options the nursing home (unfortunately) seems to be the best choice. I never wanted to do this, but in-home care is too costly for my financial means and I don’t believe the other options can provide the level of medical care she needs.
The surest way to know the future is when it becomes the past.

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Shackleton
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Re: What Will Home Care Cost?

Post by Shackleton » Fri Sep 01, 2017 8:07 am

I'm so sorry to hear that your wife is back/still in the nursing home. My thoughts are with you and just know that you are doing the best for her.
“Superhuman effort isn't worth a damn unless it achieves results.” ~Ernest Shackleton

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Re: What Will Home Care Cost?

Post by cheese_breath » Fri Sep 01, 2017 8:08 am

DetroitRick wrote:
Sun Jun 04, 2017 2:25 pm
.....
Be aware that there are some narrow circumstances where these types of personal care services can be deducted as medical expenses when a chronically disabled person requires this type of care administered under a doctors plan of care. Look at IRS Pub 502 (Medical Expenses) and consult with your tax preparer. It is a narrow set of circumstances that qualifies for this, but they do exist. We obtained the requisite letter from her physician that verifies these circumstances are fulfilled for our case. Lot's of sources, but here's a relatively good one from 2011 in the Journal of Accountancy (no, not my usual magazine:)):
http://www.journalofaccountancy.com/iss ... ction.html
.....
I’m pretty sure DW qualifies. I found some Internet sites that discuss the qualifying circumstances. Here’s a quote from one of them…
”” wrote: To qualify as chronically ill, an individual must be certified by a physician or other licensed health-care practitioner (e.g., nurse, social worker, etc.) as unable to perform, without substantial assistance, at least two activities of daily living (eating, toileting, transferring, bathing, dressing, and continence) for at least 90 days due to a loss of functional capacity, or as requiring substantial supervision for protection due to severe cognitive impairment (memory loss, disorientation, etc.). A person with Alzheimer’s disease qualifies.
Except for eating she can’t do any of the activities in the first set of conditions. With respect to eating they just stopped feeding her through the PEG tube last week, but all she can do is move the food from the plate or glass to her mouth. I still have to get it all arranged so she can reach it with her left hand and help her getting it onto the fork or spoon.

Concerning the physician’s letter is there any preferred form or format for that, or does the doctor just compose it however he pleases?
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Re: What Will Home Care Cost?

Post by cheese_breath » Fri Sep 01, 2017 8:14 am

DetroitRick wrote:
Sun Jun 04, 2017 2:25 pm
......
One more thing I can share about our experience. Even when mother-in-law was in a long-term-care facility for 2 months last year, we still retained these home services for a few hours per day several times each week. Because we couldn't be there, they handled minor day-to-day details (mainly at the LTC facility) and kept us informed. Even though that facility had staff. It kind of shows how much we thought of their services.
.....
Agreed. There are some aides here who I believe would give their lives for my wife, but others are just putting in their time for the paycheck.

Since I'm retired I can spend almost 24/7 here to keep an eye on things except for a few hours in the afternoon when I go home to get cleaned up and handle miscellaneous tasks. I'm at the nursing home right now. She just finished breakfast awhile ago and is sleeping.... which allows me the time to write this now.
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ResearchMed
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Re: What Will Home Care Cost?

Post by ResearchMed » Fri Sep 01, 2017 8:56 am

cheese_breath wrote:
Fri Sep 01, 2017 8:14 am
DetroitRick wrote:
Sun Jun 04, 2017 2:25 pm
......
One more thing I can share about our experience. Even when mother-in-law was in a long-term-care facility for 2 months last year, we still retained these home services for a few hours per day several times each week. Because we couldn't be there, they handled minor day-to-day details (mainly at the LTC facility) and kept us informed. Even though that facility had staff. It kind of shows how much we thought of their services.
.....
Agreed. There are some aides here who I believe would give their lives for my wife, but others are just putting in their time for the paycheck.

Since I'm retired I can spend almost 24/7 here to keep an eye on things except for a few hours in the afternoon when I go home to get cleaned up and handle miscellaneous tasks. I'm at the nursing home right now. She just finished breakfast awhile ago and is sleeping.... which allows me the time to write this now.
So sorry for your situation, and hope your DW is comfortable.

I seem to have missed this first time round, due to being out of country for a few weeks, and thus not regularly on forums, etc.
Did you ever have the transportation thing figured out, or done, or do you not want to do that anymore?

Very elderly MIl was already (and finally) in an ALF (Assisted Living Facility) when she fell, having refused to use a walker or such.
She spend some time in hospital, and then rehab at a different ALF with more services (where we later moved her... a much better place).
But they help us connect with a couple of agencies who supply aides, anything from simple care (or almost just "watching"), to LPN, to full RN care, which we didn't need. Even once she was back in her regular apartment, we had someone stop by each morning and at bedtime, to help her dress and shower.
One nice thing about the agency, as mentioned above, is that if one aide can't make it, someone else *will* be there.
We had arranged for 2 or 3 different aides to alternate, so that MIL wouldn't become too accustomed to a single person and thus find it disruptive if someone else suddenly showed up.

She doesn't need that at this point, and IS using a walker, but as she approaches 100...

Also, I did use "A Place For Mom". Yup, seeing the Joan Lunden ad a couple of years ago... I gave them a call. I found them borderline helpful, but there is no charge. They helped fill in "facilities nearby" from what I had found on the Internet already.

But their links (paid ads) inclluded information about medical transfers.
I called one of them, because we hadn't yet transferred MIL 'cross country (DH ended up being able to accompany her on a regular flight, with wheelchair assistance at airports) to an ALF, and she finally agreed to go.

Apparently they are quite flexible in terms of what equipment is needed, and how the transport works. They can arrange room for a companion, in addition to the aide already provided. And that aide can be whatever is required/requested, including full RN care.
The patient could be seated or fully reclined on a gurney, etc.
Obviously, with more serious medical care, air ambulance would probably be needed, but this seemed to provide pretty specialized services for a variety of medical needs.

We wish both of you well.

RM
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Re: What Will Home Care Cost?

Post by littlebird » Fri Sep 01, 2017 2:03 pm

Katietsu wrote:
Mon Jun 05, 2017 2:48 pm
It is my understanding that a nursing home that accepts a patient under Medicare can not transfer them out if the patient switches to Medicaid. However, that same facility might not accept a Medicaid patient from the outside. Just one more issue to consider.
Medicare covers only short term (generally post-hospital) stays in a skilled nursing facility. Many of those facilities do not accept Medicaid. Many of them are short-stay (e.g. rebab care) only. I imagine the rule you state, if it exists at all, is only applicable in specific, narrow circumstances.

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Re: What Will Home Care Cost?

Post by cheese_breath » Fri Sep 01, 2017 8:08 pm

ResearchMed wrote:
Fri Sep 01, 2017 8:56 am
.....
I seem to have missed this first time round, due to being out of country for a few weeks, and thus not regularly on forums, etc.
Did you ever have the transportation thing figured out, or done, or do you not want to do that anymore?
......
The transport issue has been on the back burner due to concern more about her health issues, but I do have a couple recommendations from the social worker to eventually investigate.
The surest way to know the future is when it becomes the past.

ResearchMed
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Re: What Will Home Care Cost?

Post by ResearchMed » Fri Sep 01, 2017 8:21 pm

cheese_breath wrote:
Fri Sep 01, 2017 8:08 pm
ResearchMed wrote:
Fri Sep 01, 2017 8:56 am
.....
I seem to have missed this first time round, due to being out of country for a few weeks, and thus not regularly on forums, etc.
Did you ever have the transportation thing figured out, or done, or do you not want to do that anymore?
......
The transport issue has been on the back burner due to concern more about her health issues, but I do have a couple recommendations from the social worker to eventually investigate.
Good. It's best if you have a professional recommendation.
(I obviously would have checked for references for the aides, etc., but I may have had to call around a lot [!], including to different providers, etc.)

We had terrific luck with the local recommendations for health care aides, as needed for MIL at the ALF, but it could have been at home or anywhere.
(They'll even go with a patient on a vacation, with advance notice. We've read about some rather seriously disabled people going on cruises, with full-time attendants, and even hospital beds and hoists delivered to the cabin/suite for the trip. Pretty amazing.)

Hope all continues well.

RM
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Re: What Will Home Care Cost?

Post by DetroitRick » Tue Sep 12, 2017 2:21 pm

RE: your question on the letter

My apologies for missing your specific question on that doctor's letter itself - I'm not sure how it got past me. After reading through the IRS requirements, several elder care sources, and then after talking specifically to her tax preparer myself (he's an Enrolled Agent, but pretty incompetent) - we gave her doctor a detailed sample letter with the exact content we were looking for. This was well-received and the doctor then turned it into her own supporting letter with only very minor tweaks and signature. But they had done this sort of thing before for others for the same reason.

Our letter very specifically stated these details:
my MIL's name (plus address and date of birth), that she was currently under this doctor's care, that she was chronically ill and needed assistance with "normal daily activities such as bathing, dressing, meal preparation"... when the condition began, and that the need for personal home services will continue in (the doctor's) opinion. And of course the doctor's complete contact info. We intend to get this letter anew every year.

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