Aging Parents & Finances

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TRC
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Aging Parents & Finances

Post by TRC » Thu Feb 21, 2019 11:50 am

Hi Everyone,

As I type this, I'm sitting in Maui while my family & parents are asleep up stairs. While this trip has been awesome, it's caused me to realize my parents (age 75 and 78) are not in a prime decision making capacity anymore. My mom is showing very significant signs of early dementia and my Dad who's a type 1 diabetic is very reliant on her to monitor his blood sugar. They still live by themselves in a house and are physically in a fine condition.

I have 2 other siblings and spouses that are very concerned for their wellbeing. Though they are becoming more vocal to me about them feeling they need to sell their house and move all their assets to us in the event they end up in a nursing home. I for one don't think that's going to be received very well and want to be respectful that they are still independent and have a right to keep everything they've earned.

Most of their income is in the form of military and teacher pensions. They have a decent amount of equity in their house and a small 401K ($150K I think). My Mom has long term care insurance (not sure of the details). My Dad gets healthcare through the military.

I guess my question is how to best help them keep / protect their assets in the event they end up in a nursing home. I've heard that meeting with an eldercare affairs attorney might be the best first step? My Dad is very stubborn and doesn't like to be told what to do.

Thanks,
TRC

Rupert
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Re: Aging Parents & Finances

Post by Rupert » Thu Feb 21, 2019 11:57 am

People sometimes respond better when news is delivered by a neutral third party (not family). So, yes, seeing an elder care attorney or estate planning attorney with knowledge of Medicaid rules would be a good idea. Under no circumstances should they start transferring assets to you without educating themselves about the Medicaid look back period first.

Dottie57
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Re: Aging Parents & Finances

Post by Dottie57 » Thu Feb 21, 2019 12:13 pm

Tell your siblings that your parents money is not theirs.

For positive suggestions, see an elder law attorney. Find out how to preserve money and assets for the surviving spouse. Remember there is a five year look back for transferred assets if applying for Medicaid nursing home. Also get a copy of mom’s LTCi policy to understand the requirements to invoke the policy. Understanding the total picture is extremely important.

Sorry about mom.

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Re: Aging Parents & Finances

Post by Fallible » Thu Feb 21, 2019 12:57 pm

TRC wrote:
Thu Feb 21, 2019 11:50 am
Hi Everyone,

As I type this, I'm sitting in Maui while my family & parents are asleep up stairs. While this trip has been awesome, it's caused me to realize my parents (age 75 and 78) are not in a prime decision making capacity anymore. My mom is showing very significant signs of early dementia and my Dad who's a type 1 diabetic is very reliant on her to monitor his blood sugar. They still live by themselves in a house and are physically in a fine condition.
...
I guess my question is how to best help them keep / protect their assets in the event they end up in a nursing home. I've heard that meeting with an eldercare affairs attorney might be the best first step? My Dad is very stubborn and doesn't like to be told what to do. ...
Because your mother monitors your diabetic father's blood sugar, I think your mother's possible dementia is your most immediate concern. Somehow you need to let their doctor(s) know of this, either through your parents or by contacting the doctor yourself in hopes he/she can see your mother to determine whether she does have dementia, what kind, how advanced it is, etc.

This is your "first step." After that, a good elder care attorney (who will also benefit from knowing your mother's health condition).
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senex
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Re: Aging Parents & Finances

Post by senex » Thu Feb 21, 2019 1:03 pm

Sorry about your situation.

My perspective is that your parents should keep their assets so they can get into a good nursing home. Medicare nursing homes can be terrible.

Your parents worked hard, raised kids, sent those kids out into the world, and now their savings should be used for their comfort in old age. If I had to choose between sending Mom & Pop to a low-end medicare home or getting a smaller inheritance, I would choose the smaller inheritance every time. It's not my money.

You might want to transfer control of the assets for other reasons, like to prevent elder fraud. I defer to others on how best to do that.

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tyrion
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Re: Aging Parents & Finances

Post by tyrion » Thu Feb 21, 2019 1:10 pm

TRC wrote:
Thu Feb 21, 2019 11:50 am

I have 2 other siblings and spouses that are very concerned for their wellbeing. Though they are becoming more vocal to me about them feeling they need to sell their house and move all their assets to us in the event they end up in a nursing home. I for one don't think that's going to be received very well and want to be respectful that they are still independent and have a right to keep everything they've earned.
I think this needs clarification. Are your parents becoming more vocal about selling the house and distributing assets to the kids? Or is it your siblings who want to sell the house and move the money to themselves?

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Re: Aging Parents & Finances

Post by lthenderson » Thu Feb 21, 2019 1:24 pm

senex wrote:
Thu Feb 21, 2019 1:03 pm
My perspective is that your parents should keep their assets so they can get into a good nursing home. Medicare nursing homes can be terrible.
+1000

I'm dealing with this right now with grandparents aged 90 who are using their assets to secure elderly healthcare for themselves. Without their assets, they would be sharing a room with bunk-mates and the room is about the size of a large walk in closet. My grandparents on the other hand can afford their private room with own bathroom, etc. Currently, they live in a section that is for independent seniors but are transitioning to assisted living. They are very happy to be able to afford the amenities compared to many of the other residents. I am happy to spend these final years with them being happy with possibly little to no inheritance versus seeing them live in a hell hole and get a sizable inheritance.

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Re: Aging Parents & Finances

Post by Wellfleet » Thu Feb 21, 2019 1:31 pm

lthenderson wrote:
Thu Feb 21, 2019 1:24 pm

+1000

I'm dealing with this right now with grandparents aged 90 who are using their assets to secure elderly healthcare for themselves. Without their assets, they would be sharing a room with bunk-mates and the room is about the size of a large walk in closet. My grandparents on the other hand can afford their private room with own bathroom, etc. Currently, they live in a section that is for independent seniors but are transitioning to assisted living. They are very happy to be able to afford the amenities compared to many of the other residents. I am happy to spend these final years with them being happy with possibly little to no inheritance versus seeing them live in a hell hole and get a sizable inheritance.
How does this work? Say they have $100,000 saved. Do they get a worse room compared to someone having $1 million saved? What if they have a $1500 a month pension.

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Re: Aging Parents & Finances

Post by Jack FFR1846 » Thu Feb 21, 2019 1:32 pm

I expect on the financial side, you're not going to get your father to go to anyone. You can try if you want.

On the diabetes side, if your father isn't on an insulin pump, it might be a priority to get him to consider one. This helps because it can help in regulation 24/7, unlike remembering to check and inject. There are also monitors that can monitor blood sugar and be read wirelessly. I would expect his insurance would likely cover both. These two things can go a long way towards doing a better job monitoring and correcting. Getting the "bother" out of the equation is huge for anyone. It's the difference between not testing and easily taking a reading by looking at a phone. And instead of taking out a needle, especially in public, simply changing a rate or inputting a number into a pump.

You probably know. Not taking care of this can kill him.
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GCD
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Re: Aging Parents & Finances

Post by GCD » Thu Feb 21, 2019 1:47 pm

There's a couple unfounded assumptions that people are jumping to about OP's siblings. It is entirely plausible that OP's siblings aren't money grubbing inheritance mongers.

They may believe that if the assets are transferred now, then in 5+ years when the parents enter a nursing home that money could be used to raise their quality of care, purchase ammenities, etc. above and beyond what medicare would pay.

Another possibility is that the siblings feel obligated to support their parents in a nice retirement facility. In this case the siblings may just want to minimize the amount of money they spend supporting the parents. We don't know what the expectations of the parents and the children are. If the plan is to insure the parents don't go somewhere horrid and the kids will pick up the tab collectively, then it isn't out of line for the kids to expect the parents to make a few decisions that minimize the cost to the kids.

Yes, it's the parent's money, but if they don't manage it well and then expect the kids to pick up the tab that seems unreasonable.

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Re: Aging Parents & Finances

Post by senex » Thu Feb 21, 2019 1:54 pm

Wellfleet wrote:
Thu Feb 21, 2019 1:31 pm
How does this work? Say they have $100,000 saved. Do they get a worse room compared to someone having $1 million saved? What if they have a $1500 a month pension.
I think it is highly variable based on the facility (and perhaps the ever-changing laws).

For large facilities, I've heard second-hand stories of it being essentially an accounting computation. Say the rate for a good private room is $7k/month, you have $3k/month in cashflow (ss + medicare + pension), and your age & condition is such that your life expectancy is 2 years. They would want to see $96k of assets (the $4k/month above your pensions x 24 months = $96k) before giving you the room.

For a small facility and a very ill person (someone whose life expectancy is less than a month), I've seen a patient accepted with no asset check at all, based simply on the relatives' promise to pay.

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Re: Aging Parents & Finances

Post by lthenderson » Thu Feb 21, 2019 2:29 pm

Wellfleet wrote:
Thu Feb 21, 2019 1:31 pm
How does this work? Say they have $100,000 saved. Do they get a worse room compared to someone having $1 million saved? What if they have a $1500 a month pension.
As long as they have the $5000/month rent, they have their own private room/bathroom down one wing of the facility. They have a doorway that opens into a hallway that is largely deserted except for nurses going here and there. The rooms can be furnished by furnishings, pictures, etc. brought in from the outside. There is a separate dining facility, alcoves for hanging out, etc.

Once one can no longer afford the rent, they go to a different wing where the rooms are smaller and shared with whomever is in there. When you walk down this much more densely populated hallway, there are lots of residents sitting around in wheelchairs staring blankly down the hall, lots of supplies stored here and there, different eating facilities, they share one communal bathroom, etc., none of which are as nice as the other wing. These rooms have a few institutional pieces of furniture and that is it other than a few pictures belonging to the residents.

So there is no difference between the person who has $100,000 and the one that has $1,000,000. The difference between them is how long they can afford to live in the private room in the nicer wing before getting shuttled to the other side.

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Re: Aging Parents & Finances

Post by fposte » Thu Feb 21, 2019 2:43 pm

senex wrote:
Thu Feb 21, 2019 1:03 pm

My perspective is that your parents should keep their assets so they can get into a good nursing home. Medicare nursing homes can be terrible.
Just to clarify, that's Medicaid, which is means-based. Medicare doesn't cover long-term care. That's the tricky part.

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Re: Aging Parents & Finances

Post by fourwheelcycle » Thu Feb 21, 2019 2:59 pm

TRC wrote:
Thu Feb 21, 2019 11:50 am
I guess my question is how to best help them keep / protect their assets in the event they end up in a nursing home.
Many people on this forum suggest their goal, for themselves or for their parents, is to protect their assets from being depleted by a nursing home admission. For most people, admission to an assisted living facility or a memory care unit is more likely than a long term nursing home admission. Assisted living admissions can range from $60 - $90K per year. Memory care admissions can range from $90 - $125K per year. These admissions are costly, but they are typically less expensive than a nursing home admission, which can cost from $90 - $200K per year, depending on the type of care required and the area of the US you live in. I am sure costs for all of these facilities can be even higher in some areas of the US.

Medicare pays for short-term skilled nursing rehabilitation admissions following hospital admissions for strokes, falls, car accidents, major joint surgery, etc. What many people think of as a nursing home admission is really a long term custodial care admission to a facility that accepts Medicaid reimbursement. As others have noted, many "nicer" nursing homes will accept a patient as a private pay patient, realizing they have limited resources and they will become a Medicaid patient in one or a few years. Depending on state regulations, some "nicer" nursing homes will not accept patients who need to go on Medicaid immediately.

I am sure many people who talk about protecting their own our their parents' resources from nursing home expenses are not familiar with the realities of Medicaid nursing home care in the area where they live. Based on my experience, Medicaid nursing home care in some areas of the US can be understaffed and very inattentive. I strongly encourage anyone who plans to rely on Medicaid for their own or their parents' care to visit nurrsing homes in their area that accept patients who will need to go on Medicaid in a few years, and also nursing homes that will accept patients who need to go on Medicaid immediately. If you are fortunate, these nursing homes will provide very attentive, high quality care. In some area of the US, however, this may not be the case.

Depending on state regulations, Medicaid often does not reimburse admissions to assisted living and memory care facilities. People planning for their own or their parents' future care should also visit these facilities, recognizing they may cost less than nursing home care but they may not be eligible for Medicaid reimbursement.

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Re: Aging Parents & Finances

Post by Wellfleet » Thu Feb 21, 2019 3:09 pm

Thank you everyone.

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Re: Aging Parents & Finances

Post by RickBoglehead » Thu Feb 21, 2019 3:24 pm

TRC wrote:
Thu Feb 21, 2019 11:50 am
Hi Everyone,

As I type this, I'm sitting in Maui while my family & parents are asleep up stairs. While this trip has been awesome, it's caused me to realize my parents (age 75 and 78) are not in a prime decision making capacity anymore. My mom is showing very significant signs of early dementia and my Dad who's a type 1 diabetic is very reliant on her to monitor his blood sugar. They still live by themselves in a house and are physically in a fine condition.

I have 2 other siblings and spouses that are very concerned for their wellbeing. Though they are becoming more vocal to me about them feeling they need to sell their house and move all their assets to us in the event they end up in a nursing home. I for one don't think that's going to be received very well and want to be respectful that they are still independent and have a right to keep everything they've earned.

Most of their income is in the form of military and teacher pensions. They have a decent amount of equity in their house and a small 401K ($150K I think). My Mom has long term care insurance (not sure of the details). My Dad gets healthcare through the military.

I guess my question is how to best help them keep / protect their assets in the event they end up in a nursing home. I've heard that meeting with an eldercare affairs attorney might be the best first step? My Dad is very stubborn and doesn't like to be told what to do.

Thanks,
TRC
I'd echo that you want to preserve assets for the best care your parents can obtain - not to ensure the assets survive for heirs.

A good first step would be to setup a family meeting with your parents' primary care physicians to understand their medical needs. During those visits, fill out each office's HIPAA paperwork to give you and whoever else needs it full access to medical information, so you can have conversations with these physicians, including whether your mother should be tested for dementia / Alzheimer's.

It's also a good time to ensure that medical and financial POAs exist, and if they don't to get them. You may want to see if your parents are amenable to you, or one of your siblings, getting current POA for their finances, and be able to monitor what is going on if your mother truly has dementia.
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Re: Aging Parents & Finances

Post by Ybsybs » Thu Feb 21, 2019 3:53 pm

Personal and current experience with my inlaws' assisted living facility (and with the search for a good fit facility with availability) is that what you can get varies widely and isn't as directly correlated with price as I thought it would be. A good fit had to do mostly with comfort for the future resident: other residents who had a similar backgrounds instead of a lot more or less schooling, religious services that aligned with the future residents' preferences, the twice a week ice social existing (even though they may never actually go).

Being able to pay for the first 13 to 24 months (this was the range I saw) of care made many more facilities be possible compared to only places that immediately had a 'medicaid' bed available. Not all places separate out private pay and medicaid pay residents, so we chose one that didn't.

Quality of care seems to relate more strongly to how frequently a resident is visited than to how much the resident is paying.

The day to day staff helping the residents the most seem fairly uniform across high end to lower end facilities as low paid, minimally trained, but trying to be loving people. The tasks they do are nasty and, if my inlaws are representative, usually thankless. Being able to visit regularly and speak to the facility management about the real issues helps some and chatting with the day to day staff to express appreciation for their work seems to help a lot.

Hope this is useful for some of you.

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Re: Aging Parents & Finances

Post by Watty » Thu Feb 21, 2019 4:30 pm

TRC wrote:
Thu Feb 21, 2019 11:50 am
I guess my question is how to best help them keep / protect their assets in the event they end up in a nursing home. I've heard that meeting with an eldercare affairs attorney might be the best first step?
In addition to the finances you should talk with the attorney about getting all the needed powers of attorney documents, healthcare directives, and living wills set up while they can still agree to those.
TRC wrote:
Thu Feb 21, 2019 11:50 am
They still live by themselves in a house and are physically in a fine condition.
A big concern is how their driving is and if they will give up driving when they should.

A typical suburban single family home is hard to manage without a car so that could be an incentive to move to senior community

2015
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Re: Aging Parents & Finances

Post by 2015 » Thu Feb 21, 2019 10:22 pm

Jack FFR1846 wrote:
Thu Feb 21, 2019 1:32 pm
I expect on the financial side, you're not going to get your father to go to anyone. You can try if you want.
...
Yea, and the problem is even if this week they agree to go, next week they'll forget what they agreed. Elder care is a rough ride no matter how you slice it. The best thing that was ever said to me was that no matter what or how much you do, you'll always feel like it wasn't enough or somehow you could have done more. You have to give yourself permission to let that go (besides, if you did the best you could it's not true anyway).

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Re: Aging Parents & Finances

Post by clip651 » Thu Feb 21, 2019 10:42 pm

TRC wrote:
Thu Feb 21, 2019 11:50 am
Hi Everyone,

As I type this, I'm sitting in Maui while my family & parents are asleep up stairs. While this trip has been awesome, it's caused me to realize my parents (age 75 and 78) are not in a prime decision making capacity anymore. My mom is showing very significant signs of early dementia and my Dad who's a type 1 diabetic is very reliant on her to monitor his blood sugar. They still live by themselves in a house and are physically in a fine condition.

I have 2 other siblings and spouses that are very concerned for their wellbeing.
This isn't what you asked, but given what you have described, I'd be worried in the short run (ASAP) about figuring out how to help them manage things now. A type 1 diabetic relying on someone with signs of dementia for diabetic care really is a recipe for potential disaster. Insulin pumps and continuous glucose monitors can simplify management, but your dad still may need help managing his diabetes as time goes on. Plus your mom with dementia is relying on a type 1 diabetic to help her as needed, if they are going to continue to live alone together. If your dad has any problems due to his diabetes (e.g. low blood sugar event), he may not be able to help her, and she may not be able to help him either.

So think about their current living situation. Are you and/or siblings nearby and able to check in on them regularly? Can one of you help them arrange for in home help if needed? You could try to get them started on hourly help to get them used to the idea. In the long run, live in help may be an option to consider, either a family member if available, or a paid individual. If a lot of hours of care per week are needed, it can be less expensive to have live in help than hourly shift of helpers. This is assuming they would rather stay in their own home if possible.

Depending on how things progress, they might need more care in the home or in an appropriate facility in the future. Figuring out available options and how to pay for that is definitely something that will need looking into. As others have posted, I don't think sheltering their funds is the main concern here. Securing the appropriate help for them now, and into the future is the bigger concern IMO. Making their funds last long enough may be a concern, depending on their income and other factors.

Also, depending on the medicaid qualification requirements in their state, they may not even qualify due to their income alone. I'm no expert, but I believe medicaid requirements do vary by state. Last time I looked it up, for instance my state doesn't offer medicaid above a certain income level, even if asset levels are low. So if they are thinking of relying on medicaid, requirements for that should be looked into. (As others have mentioned, purposely hoping for a medicaid nursing home as a care option may be far from ideal.)

Best wishes. I hope you and your siblings and your parents are able to get some discussions going to help your parents make plans for the future.

cj

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Re: Aging Parents & Finances

Post by BarbBrooklyn » Sat Feb 23, 2019 4:58 am

In some states, one can use a Miller Trust or a pooled income Trust to bring income down to Medicaid-eligible levels.

Seeing an Eldercare attorney is key here. One might approach dad by saying" look, you paid a lot of money for mom's long term care insurance, but the details are tricky to understand. Let's go see someone who specializes in this to make sure we get the maximum benefit from it."
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Re: Aging Parents & Finances

Post by pennywise » Sat Feb 23, 2019 8:29 am

Ybsybs wrote:
Thu Feb 21, 2019 3:53 pm
Personal and current experience with my inlaws' assisted living facility (and with the search for a good fit facility with availability) is that what you can get varies widely and isn't as directly correlated with price as I thought it would be. A good fit had to do mostly with comfort for the future resident: other residents who had a similar backgrounds instead of a lot more or less schooling, religious services that aligned with the future residents' preferences, the twice a week ice social existing (even though they may never actually go).


Quality of care seems to relate more strongly to how frequently a resident is visited than to how much the resident is paying.

The day to day staff helping the residents the most seem fairly uniform across high end to lower end facilities as low paid, minimally trained, but trying to be loving people. The tasks they do are nasty and, if my inlaws are representative, usually thankless. Being able to visit regularly and speak to the facility management about the real issues helps some and chatting with the day to day staff to express appreciation for their work seems to help a lot.

Hope this is useful for some of you.
This is a very wise perspective, thanks for sharing. We have found it to be very true for our loved one in assisted living. My MIL is in a facility that suits her needs well. She is and always has been a very reclusive, solitary person so when we were visiting facilities we knew the places that resembled cruise ships with constant social opportunities, outings, organized activities etc were not going to be suitable for her. She's in a small ALF with people who are very similar to her in terms of social and cultural background which also helps.

I am constantly amazed and so grateful for the people there who do the hard, nasty and as noted above usually thankless task of providing physical care to the elderly and infirm. It's a tough, tough job and the staff taking care of my MIL and the other residents are so gentle, caring and warm. We see her at least 2-3 times weekly so have had a lot of opportunity to view daily life there and have never seen anything other than good care being provided.

Last but not least it is also good to remember that elder care is a continuum. Most people view it as a binary situation: one is living happily and independently at home or one is institutionalized However, especially for folks with sufficient financial resources, there is a huge range of care giving levels. For the medical issues nursing assistance might be warranted. Housekeeping and meal prep help can be hired. Practical nurses may eventually come on the scene for either partial or daily/nightly shifts. And so on. It is a tough and sensitive transition and one that many, maybe most, elderly people find intrusive or insulting. But loving family members need to gently keep pushing to help aging parents make decisions that are going to need to be made.

I'd say that is the simplest and hardest part of the situation: it will get worse. Your parents will not get better. And they are not children who will obey directions with docility. Inside all of us is probably the secret core that believes we are always going to be ok. Even if others clearly see that isn't the case it's almost impossible for most to acknowledge that the end is getting closer, independence is fading away and our lives are going to have to be adjusted to deal with that.

In my MIL's case the very good ALF is also a place she bitterly resents being forced to occupy, and a source of constant complaints. She maintains she is perfectly fine to go back to living independently back at home. Of course, she is also deep enough in dementia that for her 'home' is usually is the duplex she grew up in almost 90 years ago which was torn down long ago. She can barely walk and has severe cataracts that can't be repaired because of the dementia, yet she tells me constantly she could still drive and play tennis if she wants to and that she was riding her bike just a week ago (she's been in the ALF for almost 4 years). It's a sad, heartbreaking thing to see and yet we had to make decisions for her to keep her safe if not happy.

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TRC
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Re: Aging Parents & Finances

Post by TRC » Sat Feb 23, 2019 8:58 am

tyrion wrote:
Thu Feb 21, 2019 1:10 pm
TRC wrote:
Thu Feb 21, 2019 11:50 am

I have 2 other siblings and spouses that are very concerned for their wellbeing. Though they are becoming more vocal to me about them feeling they need to sell their house and move all their assets to us in the event they end up in a nursing home. I for one don't think that's going to be received very well and want to be respectful that they are still independent and have a right to keep everything they've earned.
I think this needs clarification. Are your parents becoming more vocal about selling the house and distributing assets to the kids? Or is it your siblings who want to sell the house and move the money to themselves?
They have not mentioned 1 iota about selling their home. My siblings feel they are soon going to be unable to take care of their home, which I do agree with. However, they aren't there yet.

They are worried that if my Mom goes into a nursing home, it's going to eat up all of their assets.

It's a shady situation and I'm trying to be the voice of reason for everyone.

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TRC
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Re: Aging Parents & Finances

Post by TRC » Sat Feb 23, 2019 9:02 am

Jack FFR1846 wrote:
Thu Feb 21, 2019 1:32 pm
I expect on the financial side, you're not going to get your father to go to anyone. You can try if you want.

On the diabetes side, if your father isn't on an insulin pump, it might be a priority to get him to consider one. This helps because it can help in regulation 24/7, unlike remembering to check and inject. There are also monitors that can monitor blood sugar and be read wirelessly. I would expect his insurance would likely cover both. These two things can go a long way towards doing a better job monitoring and correcting. Getting the "bother" out of the equation is huge for anyone. It's the difference between not testing and easily taking a reading by looking at a phone. And instead of taking out a needle, especially in public, simply changing a rate or inputting a number into a pump.

You probably know. Not taking care of this can kill him.
He is on an insulin pump, but his blood sugar still swings wildly. It was up as high as 417 this week during one day. He has an appointment to get on a continuous glucose monitor in the coming weeks, which has been a long time coming.

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Re: Aging Parents & Finances

Post by Mr.BB » Sat Feb 23, 2019 9:10 am

Has your mom been officially diagnosed with dementia or early stage by her doctor? If not, then you first need to do that because if the news comes from them it will probably be better received; as well as any suggestions from the doctor which you can talk to at a time, as well as other courses of actions that you and your family should take.
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Re: Aging Parents & Finances

Post by Mr.BB » Sat Feb 23, 2019 9:26 am

TRC wrote:
Sat Feb 23, 2019 9:02 am
Jack FFR1846 wrote:
Thu Feb 21, 2019 1:32 pm
I expect on the financial side, you're not going to get your father to go to anyone. You can try if you want.

On the diabetes side, if your father isn't on an insulin pump, it might be a priority to get him to consider one. This helps because it can help in regulation 24/7, unlike remembering to check and inject. There are also monitors that can monitor blood sugar and be read wirelessly. I would expect his insurance would likely cover both. These two things can go a long way towards doing a better job monitoring and correcting. Getting the "bother" out of the equation is huge for anyone. It's the difference between not testing and easily taking a reading by looking at a phone. And instead of taking out a needle, especially in public, simply changing a rate or inputting a number into a pump.

You probably know. Not taking care of this can kill him.
He is on an insulin pump, but his blood sugar still swings wildly. It was up as high as 417 this week during one day. He has an appointment to get on a continuous glucose monitor in the coming weeks, which has been a long time coming.
Have you tracked or watch his eating for a day or two? Insulin reaction is directly affected by nutritio. Is he is eating sweets for breakfast, lunch, dinner? Does he have a balanced diet? is there any exercise involved? all those things can affect how is insulin reacts.
"We are what we repeatedly do. Excellence, then, is not an act, but a habit."

Topic Author
TRC
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Re: Aging Parents & Finances

Post by TRC » Sat Feb 23, 2019 10:55 am

I'd like to thank all of you for your very helpful suggestions. Seems like reading the fine print on the LTC policy, meeting with an eldercare attorney and figuring out short term Diabetic management plans are the most pressing items to focus on.

On a side note, I spoke with my sister this morning and she said "we need to have the visit with a financial advisor". Ugggh.

Topic Author
TRC
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Re: Aging Parents & Finances

Post by TRC » Sat Feb 23, 2019 10:58 am

Mr.BB wrote:
Sat Feb 23, 2019 9:26 am
TRC wrote:
Sat Feb 23, 2019 9:02 am
Jack FFR1846 wrote:
Thu Feb 21, 2019 1:32 pm
I expect on the financial side, you're not going to get your father to go to anyone. You can try if you want.

On the diabetes side, if your father isn't on an insulin pump, it might be a priority to get him to consider one. This helps because it can help in regulation 24/7, unlike remembering to check and inject. There are also monitors that can monitor blood sugar and be read wirelessly. I would expect his insurance would likely cover both. These two things can go a long way towards doing a better job monitoring and correcting. Getting the "bother" out of the equation is huge for anyone. It's the difference between not testing and easily taking a reading by looking at a phone. And instead of taking out a needle, especially in public, simply changing a rate or inputting a number into a pump.

You probably know. Not taking care of this can kill him.
He is on an insulin pump, but his blood sugar still swings wildly. It was up as high as 417 this week during one day. He has an appointment to get on a continuous glucose monitor in the coming weeks, which has been a long time coming.
Have you tracked or watch his eating for a day or two? Insulin reaction is directly affected by nutritio. Is he is eating sweets for breakfast, lunch, dinner? Does he have a balanced diet? is there any exercise involved? all those things can affect how is insulin reacts.
You don't even want to know. It's carbs, carbs, carbs all day long. And not the healthy ones. And the sad thing is this nutritional advise is coming from his diabetic nutritionist which must be based on the old food pyramid. I've tried encouraging more vegetables & healthy fats, but like I said originally, he's stubborn. To his credit he's 75 and has had no severe diabetic complications (ie. still has all fingers & toes and eye sight is good).

Ybsybs
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Re: Aging Parents & Finances

Post by Ybsybs » Sat Feb 23, 2019 11:32 am

TRC wrote:
Sat Feb 23, 2019 10:58 am
You don't even want to know. It's carbs, carbs, carbs all day long. And not the healthy ones. And the sad thing is this nutritional advise is coming from his diabetic nutritionist which must be based on the old food pyramid. I've tried encouraging more vegetables & healthy fats, but like I said originally, he's stubborn. To his credit he's 75 and has had no severe diabetic complications (ie. still has all fingers & toes and eye sight is good).
Have you heard the nutrition advice directly from the nutritionist? With my inlaws it took a little while to realize it, but sometimes what they say an authority has said is an inaccurate wishful memory. It can help with encouraging healthier choices to attend some of those appointments and ask directly about the seemingly contrary to medical science claims. Though sometimes a person doesn't *want* to make the healthier choice and if they are of sound mind, those remain their choices to make.

fposte
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Re: Aging Parents & Finances

Post by fposte » Sat Feb 23, 2019 12:26 pm

TRC wrote:
Sat Feb 23, 2019 10:58 am


You don't even want to know. It's carbs, carbs, carbs all day long. And not the healthy ones. And the sad thing is this nutritional advise is coming from his diabetic nutritionist which must be based on the old food pyramid. I've tried encouraging more vegetables & healthy fats, but like I said originally, he's stubborn. To his credit he's 75 and has had no severe diabetic complications (ie. still has all fingers & toes and eye sight is good).
Is this person a dietician? There's no licensing of the term nutritionist--everybody here could call themselves one if they wanted. If the person isn't a dietician, maybe it's time for him to see one.

Gnirk
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Re: Aging Parents & Finances

Post by Gnirk » Sat Feb 23, 2019 1:23 pm

OP, I am sorry about your mom. As others have said, first get the diagnosis for your mom, so that she can receive proper treatment. Then learn the terms of her LTC policy. My widowed mom had Alzheimer’s, and she was in a care home for 8 of the 12 years. Her retirement income paid for some of the care costs, the difference was covered as follows: Her LTC policy covered 4 years, and 4 years was private pay out of her assets.

By all means, see an elder care attorney about protecting assets for a surviving spouse, but I wouldn’t transfer assets just to protect them for a possible inheritance. To me, it’s far more important to use their assets to find the best quality of care for them when that time comes.

And be sure your parents have current Durable Powers of Attorney for both financial an healthcare that name at least one successor or alternate, a will or trust, and health care directives.

As DPOA, I managed both my mom’s finances and her healthcare. It can be a lot of work, and when you have siblings, it’s important to be as transparent as possible. I kept monthly excel spreadsheets detailing all expenses and income for ten years, so that when my sibling had questions, I had ready answers.

Mr.BB
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Re: Aging Parents & Finances

Post by Mr.BB » Sat Feb 23, 2019 5:23 pm

Ybsybs wrote:
Sat Feb 23, 2019 11:32 am
TRC wrote:
Sat Feb 23, 2019 10:58 am
You don't even want to know. It's carbs, carbs, carbs all day long. And not the healthy ones. And the sad thing is this nutritional advise is coming from his diabetic nutritionist which must be based on the old food pyramid. I've tried encouraging more vegetables & healthy fats, but like I said originally, he's stubborn. To his credit he's 75 and has had no severe diabetic complications (ie. still has all fingers & toes and eye sight is good).
Have you heard the nutrition advice directly from the nutritionist? With my inlaws it took a little while to realize it, but sometimes what they say an authority has said is an inaccurate wishful memory. It can help with encouraging healthier choices to attend some of those appointments and ask directly about the seemingly contrary to medical science claims. Though sometimes a person doesn't *want* to make the healthier choice and if they are of sound mind, those remain their choices to make.
+! So true Ybsybs! I have witnessed this with my MIL.
"We are what we repeatedly do. Excellence, then, is not an act, but a habit."

megabad
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Re: Aging Parents & Finances

Post by megabad » Sat Feb 23, 2019 5:57 pm

As long as proper estate planning has already been done with a durable POA, medical POA, health directive and a will; I am not convinced that any further action needs to be taken.

It appears that both parents have heath concerns and are similar ages so shielding assets from Medicaid doesn’t seem like a necessary strategy statistically. The main reason to do so would be to benefit heirs which I am morally opposed to in most cases.

I am with your father, no one will ever tell me what to do with myself, my family, or my finances. Call it stubborn if you want. This is coming from someone who will never go into any assisted,nursing, or memory care facility for any reason. It is actually in writing and distributed to various members of my family and legal representative.

Wakefield1
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Re: Aging Parents & Finances

Post by Wakefield1 » Sat Feb 23, 2019 6:50 pm

Is the mother's Doctor doing everything possible to deal with remediable problems that could be promoting dementia?
(such as vitamin B12 deficiency/pernicious anemia,diabetes,other nutritional issues? )
Atrial fibrillation if present,properly treated? Anticoagulant if indicated?

quantAndHold
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Re: Aging Parents & Finances

Post by quantAndHold » Sat Feb 23, 2019 7:48 pm

Wellfleet wrote:
Thu Feb 21, 2019 1:31 pm
How does this work? Say they have $100,000 saved. Do they get a worse room compared to someone having $1 million saved? What if they have a $1500 a month pension.
Probably. Facilities often have private pay beds, and Medicaid beds, usually in separate wings. At the facility dad was at, if he could show that he had the assets to private pay for the length of time he was expected to be there, he could get a private pay bed. If not, he would go into a Medicaid bed. If he only had $100,000, that would have meant Medicaid bed, which he would pay for out of his pocket until the $100k was spent, then he would go on Medicaid.

The Medicaid wing was Dickensian. The private pay wing wasn’t. I was very glad he had the money.

randomguy
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Re: Aging Parents & Finances

Post by randomguy » Sat Feb 23, 2019 8:38 pm

megabad wrote:
Sat Feb 23, 2019 5:57 pm

I am with your father, no one will ever tell me what to do with myself, my family, or my finances. Call it stubborn if you want. This is coming from someone who will never go into any assisted,nursing, or memory care facility for any reason. It is actually in writing and distributed to various members of my family and legal representative.
So what is your plan for taking care of yourself when assisted, nursing, or memory care is required?

megabad
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Re: Aging Parents & Finances

Post by megabad » Sun Feb 24, 2019 12:38 pm

randomguy wrote:
Sat Feb 23, 2019 8:38 pm
megabad wrote:
Sat Feb 23, 2019 5:57 pm

I am with your father, no one will ever tell me what to do with myself, my family, or my finances. Call it stubborn if you want. This is coming from someone who will never go into any assisted,nursing, or memory care facility for any reason. It is actually in writing and distributed to various members of my family and legal representative.
So what is your plan for taking care of yourself when assisted, nursing, or memory care is required?
Home care followed by death. I recommend everyone marry a nurse.

BobTexas
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Re: Aging Parents & Finances

Post by BobTexas » Sun Feb 24, 2019 12:59 pm

Your number 1 concern should be their health and living, not their finances

You or one of your siblings should be going to the doctor and dietician with them. Make sure you understand their conditions, and what the directions are. Make sure they are following the care, your father is headed to trouble with the diabetes

Do you need to monitor their decision making? My mother and in-laws are all similar age and I have to constantly watch their decisions. They been scammed a number of times, and gave out their ssn

Can they maintain the house?

Once these things are taken care of you can look at their assets and financial planning

JGoneRiding
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Re: Aging Parents & Finances

Post by JGoneRiding » Sun Feb 24, 2019 1:06 pm

Your parents have set them selves up to not need Medicaid. Don't handicap them by trying for it. Your mom has insurance and basically so does your dad with thr military. Also it sounds probably depending on their state that their pensions are high enough that even with no assets they would not qualify.

I would start now with looking with then for continue care retirement facilities. These can be very nice and are best entered as a non emergency situation where you have lots of choice. Even if they aren't ready looking now while still competent is a huge help. I think my grandma ended up on a waiting list for like 10 years before she finally moved into one. Then she was in independent care until the second leg fracture then she immediate with no wait moved to nursing and has stayed there.

Ybsybs
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Re: Aging Parents & Finances

Post by Ybsybs » Sun Feb 24, 2019 1:07 pm

megabad wrote:
Sun Feb 24, 2019 12:38 pm
Home care followed by death. I recommend everyone marry a nurse.
What if the nurse needs care? What if the nurse predeceases you?

Death and infirmity have an annoying tendency to not develop in the order that'd be most convenient.

megabad
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Re: Aging Parents & Finances

Post by megabad » Mon Feb 25, 2019 10:03 pm

Ybsybs wrote:
Sun Feb 24, 2019 1:07 pm
megabad wrote:
Sun Feb 24, 2019 12:38 pm
Home care followed by death. I recommend everyone marry a nurse.
What if the nurse needs care? What if the nurse predeceases you?

Death and infirmity have an annoying tendency to not develop in the order that'd be most convenient.
Life involves risk. It is statiscally unlikely that a younger female will predecease me but still possible. Given me medical history, it is extremely unlikely.

InMyDreams
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Re: Aging Parents & Finances

Post by InMyDreams » Tue Feb 26, 2019 1:36 am

OP -
First: if your father qualifies for TriCare, then I think he also qualifies for VA benefits. The VA often contracts with area nursing facilities. You might check them out - I have heard good things about some (but not all).

It doesn't sound like you're really talking about such a facility for your father at this time, however. The VA may have other programs that extend assistance (e.g., homecare) that may enable your parents to remain in home for a longer period. I don't think nursing facility benefits extend to your mother, but might not hurt to inquire.

My parents were of a generation and mind set that it wouldn't/didn't occur to them to divest themselves of their assets to qualify for federal programs. Opinions vary. It sounds like both of your parents would qualify for Veterans Aid and Attendance if they had divested themselves of assets for a sufficient period (much like Medicaid).

It's a complicated journey - wishing you and yours the best.

hvaclorax
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Re: Aging Parents & Finances

Post by hvaclorax » Tue Jun 25, 2019 6:34 am

I am surprised at the level of medical advice allowed in many of these responses. I expected more supervision and deletion.

clip651
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Re: Aging Parents & Finances

Post by clip651 » Tue Jun 25, 2019 6:45 am

hvaclorax wrote:
Tue Jun 25, 2019 6:34 am
I am surprised at the level of medical advice allowed in many of these responses. I expected more supervision and deletion.
If there is a specific post you think crossed the line, you can report it to the moderators and let them decide. Use the "!" icon at the top of any post.

Freetime76
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Re: Aging Parents & Finances

Post by Freetime76 » Wed Jun 26, 2019 10:52 pm

TRC: Our extended family just had a very similar situation. Independence - most especially financial- is a Big Deal with our Mom. The challenges are similar: various locations and financial constraints for the 4 siblings, not to mention spousal perspectives, changing level of care needs for early stage dementia, on top of not the best organized record-keeping and a surprise IRS debt (which triggered the whole discussion, especially after 2 siblings spent a week on a trip with Mom). I am sorry you’re writing this on your trip, however it is incredibly helpful to realize what is going on.

This is going to be a long haul, and the best advice I can think of is to start having the conversation. It’s great that you know they have pensions. A few things we’ve found to be helpful:
1. Triage the various concerns: is anything critical? It sounds like the financial aspect was ok for now? And the concern is the future plus the medical piece?? Anything critical medically? Address critical first.
2. Go on a fact-finding mission... this is an emotional thing... so what are the facts? Address the “ big ones” that are pretty standard [Do they have wills, POAs? Long term care insurance? What are THEIR concerns? Tag-teaming between siblings may be helpful, meaning everyone can help in different ways. And do be sure to share information between yourselves to keep the story straight, especially if dementia might be involved.
3. Depending on what you learn, start the conversations. The big thing I noticed with both of my parents and both in-laws is a very strong desire to not be a burden, financially or otherwise. We’ve been able to discuss in light of this, very carefully. Example: what can we do now to keep them independent (as much as possible, but maybe not saying that part right away). Are they ok with income vs expenses? Insurances? What else can we do

We are right in the thick of it now, ourselves, so I empathize. Empowering your parents is really important- they meet with advisors etc...

jbranx
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Re: Aging Parents & Finances

Post by jbranx » Wed Jun 26, 2019 11:14 pm

{I deleted two contentious off-topic posts} Rule 2 (a) rules#Moderation
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Sandtrap
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Re: Aging Parents & Finances

Post by Sandtrap » Wed Jun 26, 2019 11:26 pm

DW and I have encountered this a few times.
My parents are long gone, both with similar medical and financial progressions that you are concerned about.
DW's/FIL past last year, medical and financial concerns over that period and transition.
MIL at present, age 94 with demential, 24 hour home care. FIL left a substantial portfolio to care for her needs. Costs run 10-12,000 per month.
DW has POA so we have structured her finances into a "Bogle Portfolio" and it is working out well, along with ample SS, Annuities, Pensions, etc.

Actionable steps for you.

Consider posting a portfolio review for an overall financial picture of your parents.
You can gather information that you can and post unanimously. Let's start there.
Here is the format: (please try to follow it for best results)

Portfolio Review Request
https://www.bogleheads.org/forum/viewt ... =1&t=6212

From there, you can talk about issues with your parents and perhaps an elder legal counsel, estate planning, etc.

Concurrently, bring discuss your concerns here on the forum. There's are deep resources here as well as many many that have been in a similar position and concerns as yourself.

From that, rough out a workable strategy that you can work with your parents and family on.

Rather than ask selective questions based on little information, you would benefit greatly from trying something like this as it's more comprehensive. Inputs are not subjective input with little data.

j :happy
Wiki Bogleheads Wiki: Everything You Need to Know

littlebird
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Re: Aging Parents & Finances

Post by littlebird » Thu Jun 27, 2019 12:00 am

TRC wrote:
Sat Feb 23, 2019 8:58 am

They are worried that if my Mom goes into a nursing home, it's going to eat up all of their assets.

It's a shady situation and I'm trying to be the voice of reason for everyone.
In general— at the point where one spouse goes onto Medicaid, hopefully after paying the bill privately for a while to expand the options for good quality care as others have outlined, the spouse still at home can stay in the home until it’s no longer possible and can keep about $130,000 in assets ( varies by state) and her own income. In your case it looks like they’ll both have to go into some care soon, so what are their assets for if not for being “eaten up” by their own care?

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burt
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Re: Aging Parents & Finances

Post by burt » Thu Jun 27, 2019 6:15 am

Ybsybs wrote:
Thu Feb 21, 2019 3:53 pm

Quality of care seems to relate more strongly to how frequently a resident is visited than to how much the resident is paying.
I agree 100%.
I am so thankful for a sister who lived nearby and visited our Mother 3-4 times per week.
This was a "nice" facility. Mom had a private room and was able to pay out-of-pocket.
So many times my sister had to intervene when care or conditions were unacceptable.
Employee wages are low, turnover is high, job duties are unpleasant, and training is essentially non-existent.

Ybsybs
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Re: Aging Parents & Finances

Post by Ybsybs » Thu Jun 27, 2019 7:08 am

littlebird wrote:
Thu Jun 27, 2019 12:00 am
TRC wrote:
Sat Feb 23, 2019 8:58 am

They are worried that if my Mom goes into a nursing home, it's going to eat up all of their assets.

It's a shady situation and I'm trying to be the voice of reason for everyone.
In general— at the point where one spouse goes onto Medicaid, hopefully after paying the bill privately for a while to expand the options for good quality care as others have outlined, the spouse still at home can stay in the home until it’s no longer possible and can keep about $130,000 in assets ( varies by state) and her own income. In your case it looks like they’ll both have to go into some care soon, so what are their assets for if not for being “eaten up” by their own care?
Once your own assets are depleted and you are using Medicaid to pay for your care, it becomes near impossible to move to a new facility. The prospect of losing even the final freedom of being able to go somewhere else if you really wanted to makes choosing a facility very very hard.

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