Interesting you should bring this up. An acquaintance’s husband had a bad fall, went to the hospital then to rehab hospital, then to a skilled nursing facility. She was furious that he did not get the same level of care at the nursing facility as at the rehab hospital. I pointed out that the first was a hospital and the second was nursing care, not the same thing.

I have plunked my money down for a non-profit life care community. Id start off in independent living ( an apartment, probably two bedrooms) and if needed, move on to assisted living then skilled nursing. They also have memory care. I call this Plan B if I can no longer manage in my home, which isnt set up very well for elder living.

As you point out, there are a number of options and its important to do your research to find whats best for you and your budget. These places are eye-wateringly expensive.

My advice is to find a place long before you need it and get on their list. The place I signed up for has a five year waiting list! You dont have to go if you’re not ready when they call you but you stay at the top of the list for when you are ready to make the move.

One should also be aware, as we discovered, that not all memory care units are the same. We first placed my mother in the memory care unit of a life care/continuing care facility. Despite their promises, the memory care unit's "care" was to check on the residents twice a day, transport residents to a dining room for meals, and keep the doors to the unit locked. Basically, the care was at the assisted living level. We were lucky enough to find a room in a dedicated memory care facility which also had a skilled nursing section if needed.

Also, I would encourage anyone considering any facility to visit in the middle of the night because the nighttime staff is often subpar to the daytime staff.

I hope to not have to experience such places but I guess one can never know with certainty in advance. Both of my wife's parents did, as did her grandmother, and it's no surprise that visiting them didn't cause me to have any enthusiasm about finding myself in one some day.

Neither of my parents nor any of my grandparents had mental or physical declines to the point that they needed any level of daily care prior to their final illnesses leading to death. Not from being in denial but maybe out of hope and optimism, I'll take my chances and keep my fingers crossed. I don't plan to make any such arrangements in advance. I won't be surprised either way, though. Anything can happen.

Good luck to all on this front.

My mother was in memory care, and at a care team meeting, her team leader brought up the number of ADLs she needed assistance with, and that she was a two-person assist. I knew all that meant they were going to recommend her move to skilled nursing, and I knew that would not be a good move for her. I also knew that if she were on hospice, she could stay where she was. So I asked, and they agreed. She spent her last six months in by then familiar surroundings, with staff she knew and liked, and who knew and liked her.

In independent, assisted, memory, and even skilled nursing, you can hire or a la carte assistance for certain needs or activities.

Timely for me. My sister went to pick up my 96yo mom yesterday morning to come out east on LI to visit us for the night. (Sis and I have houses very close, vacation for us, permanent for her.) Timing was good, as she found her on the floor with a very broken femur. Happened jiust an hour or so prior.

What’s next is surgery, then rehab, then God lnows what. She did have a plan in place: die in her sleep. But you know what they say about the best-laid plans! She has acknowledged that she may have to move into a ”retirement home.” 😊

ADL=?

Is this an abbreviation/acronym everyone but me knows?

Activities of Daily Living. Bathing, dressing, etc.

There are 6 standard ADL’s which are used as a measurement for a variety of situations. Thinking about them is the stuff of nightmares but, think about them we must. The places I encountered in Phoenix area when looking for a place for my aunt, charged for assisted living care by hours of care needed. Her community has several care levels. All I can recall clearly is that level 2 was 3.5 hours per week of assistance for any combo of the ADL’s. That cost was $1800 per month. Initially my aunt needed stand by shower person & wheel chair to & from dining. Those 2 items = level 2. An assessment was done to determine that level & a physcian must certify care needed. Fortunately she no longer needs this assistance but still lives in assisted living without receiving care. If she needs in future she’ll be assessed again.

This is the list of Activities of Daily Living:

Tax-qualified long-term care insurance policies and state programs look at these six basic tasks:

• Bathing: Washing self in a tub or shower.
• Dressing: Putting on and taking off clothes.
• Eating: Feeding oneself.
• Transferring: Moving in and out of a bed or chair.
• Toileting: Using the bathroom and cleaning up.
• Continence: Controlling bladder and bowel functions.

Thanks to all who chimed in with their knowledge and experiences. I just get tired of people misusing "nursing home". More awareness is needed for all of us, those aging and those caring for loved ones.

Another option I know of is a Board and Care home. My father-in-law lived his last two years in a home near my mother-in-law's house. Basically a privately owned home with up to six residents all taken care of by three care workers per shift. The home was licensed and are required to have medical oversight. The home my FIL was living in was owned by an RN and ENT. Anything medical went through the RN. My FIL had a combination of strokes and dementia but was still intersted in life, he was comfortable there. He did not need skilled nursing but needed help with walking, showering, dressing and most daily activities. My mother-in-law was too frail to take care of him and bringing in help was not an option. The home where he lived was wonderful, very clean and comfortable. Over the years our family has utilized everyone of these care types.

The second factor that many seem not to be aware of is the cost. That varies widely by type of home & care and geographic location. My experience is with my mom in an independent living apartment in a community in WA state that offerred assisted living & memory care in addition to the independent living wing of the building. She paid $3500 monthly for a 737 sq ft 1 bed 1 bath apartment with full kitchen. Weekly cleaning, bed linen laundry, 1 daily meal was included in rent. Social activities & transportation too.

My aunt moved into the same type of community in Scottsdale AZ but into the assisted living wing as described in my earlier post. She has a 1 bed 1 bath apt. full kitchen of 1,000 sq ft & is paying $4500 monthly. That doesn’t include care assistance which as I described earlier was $1800 for 3.5 hours weekly.

A neighbor’s father was paying $7500+ monthly for his room in a memory care unit - here in WA state.

Another neighbor’s mother was paying ~$12,000 monthly for her room in an Adult care family home - the same thing as @jill302 describes as a Board and Care home. This woman was mostly bedridden when she moved into the Adult Family home - here in WA state.

My point in bringing up this dismal topic is that when people think about elder care when we can’t live independently anymore, well, it’s pretty dismal. Medicaid paying for this is an entirely separate can of worms. Medicare doesn’t cover any of this. LTC insurance a person might have may help pay for some of the care after all elimination periods are satisfied but they generally don’t pay any of the monthly rent.

@Elmer J Fudd I understand where youre coming from on not making plans ahead. The women on my side of the family live well into old age. My husband’s parents had the opposite situation.

The one reason you might want to explore some of these situations is to provide some guidance to your children so that if something were to happen, they would have some insight about your preferences.

But if you choose to wait it out in your home, how much planning is there? You don’t know if you’re going to need assisted living or nursing care or memory care unit or whatever.

My father needed full time in home care the last ten months of his life. It was during covid so we weren’t going to put him in a nursing home with no visitation. My sister often vented her frustration to me, ”What was their plan?!” Granted their house isn’t the most practical for this, but beyond maybe moving what’s the plan supposed to be? A continuous care place has answers, but you better have money.

Food, I am so sorry. I hope she isn't in too much pain.

You may have an opportunity here. An alternative living arrangement can be called a temporary, "rehab" stay. Whether it is truly temporary can be TBD, you know? But it worked in my situation. Getting them over the initial hump of just moving in and trying it seems to be the hardest part. Inertia is a hard thing to overcome.....

Annie - you are absolutely correct about living alone. But, even living with someone isn’t a guarantee that nothing horrible will happen. We all remember the nightmare end for poor Gene Hackman and his younger, presumably healthy wife. And their poor dog who suffered too.

What you suggest Annie is what I noticed during my mom's decline. She was in/out rehab places and it was time for her to leave her home to find somewhere more permanent for her care. There were many folks who seemed perfectly healthy and happy!, had their own cars, access to whatever they needed, etc. In the place she went next. I thought to myself, I'm going to come to a place like this before I need to!

Mom's health suffered so much, being her stubborn self, and refusing any thought other than, I will stay in my home. She died much younger than her friends, but I believe she would've lived just as long as they have (they're all still alive) had she been someplace where someone could observe her every moment of every day and intervened before she ended up in a nursing home.

She only stayed in that more than nice place for a handful of months. It was light and airy. Great food. She had fun changing her outfits multiple times a day. Sigh.

Like Annie mentioned, there are negative things about "aging in place"......I have no desire to live here if I have more physical limitations, and do not plan to age in place. I think the best thing is to plan to be in a new environment (with whatever services you want or don't want) before you actually need it, so you can take time in choosing the right place for you. And so you don't have to sell your home (if you currently own it) immediately, regardless of whether the market is good or not.

I'm already thinking about giving up my country house for a more urban environment (big town or city), because I know I will not want to continue to clear the driveway, weed the gardens, mow the lawn, or deal with changing water pump filters and water softener salt....I give myself another 3 years or so. We'll see.

But to sushipup2's original post - there are also regional differences in what places are called.....for instance, "senior apartments" here are called retirement homes, and usually come with the option of full board (i.e. all meals) or only partial board. I've never heard the term "senior apartments", but we do have senior's communities, which are owned homes in a purpose-built community with activities - and often built around a golf course - but no services, and are age restricted to over 55 or 60.

I am in the middle of caregiving for my mother. We have no children who will do this for us. I find myself constantly thinking about how to plan for our care if we need it or when one of us is left alone. Let me say this - not all children show up or want to be there, so in my experience it can become a defining moment for "family". A breaking point. I am very interested in all the info shared here, so thank you, @sushipup, for starting this conversation.

I my area if you have the money and think you will want to go to one of the better memory care or nursing care facilities, when the time comes ... you will be out of luck.

The nicer places don't accept people at the later stages of decline. To get into these places you have to buy in when you are still at the independent level. You can then move through the higher levels of care as needed, but there is no buying into the memory/nursing care at the last minute when you, or your family, realize they left things too late. I'll assume these facilities figured out that that is the way to make a profit over the average person's stay. Make a profit in the early years that need no care/support and probably break even in the last few months/years that need a high level of care/support.

Sometimes taking your chances isn't the best strategy.

I have family in NC which has strict regulations around care communities - so lots of very nice CCRCs - my aunt lives independly in a bungalow but can move to higher levels of care if/when needed. My dad was in an apt in the same community and moved seamlessly to more care when needed - it was such a gift after trying to manage care at home for my mom (which was a total nightmare, we had theft, no-shows, folks that went to their car for a smoke and drove off - this from the most expensive at home care provider in the community)

my aunt teaches an OLLLIE course on the financials re: these communities as they are all structured differently and involve big money - i def recommend something like that

we see lots of friends with $$$ who move into swanky senior communities that are convenient for seniors but offer no care or support and they have to end up moving again when their health deteriotes after spending a ton of money - my goal is to go straight from house to CCRC at 70 (God willing)

Same here Chispa. And I am agreeing with Annie, in that if my spouse goes first I would start making plans for my next move. Slowly decaying in my own home, while it too decays around me, and eventually having a medical crisis while all alone with nothing around me but old memories? No thank you.

My dad prospered in his assisted living community. His mood brightened, he made friends, he had good food, he had things to do, and yet had his own room to retreat too when he wanted peace or a nap. No worries about taking care of an aging home, no worries about a snow storm, no worries about needing help and having no one around. Sign me up!

A lot of good food for thought here. We don't really have a plan other than we both agree we're not stuck on aging in place if we decline to the point that doesn't make sense. Once I get all my house selling and moving done I'll start looking into that kind of a move. DH's grandmother was in a board and care home for many years after having a stroke and becoming bedridden. Nice family in their small town ran it. His mother was in a regular nursing home for eleven years after a series of mini-strokes and a broken hip made it impossible for her to stay at home with her DH. Again nice place in a small town. A couple who lived a couple doors down from us in an "age in place" detached town home absolutely refused to move when she developed serious mobility limitations. He had a variety of health problems and would have moved but she refused. It got very bad and finally their kids insisted they get out and they moved to a very nice assisted living facility. The Mr really liked all the social interaction at the new place. The Mrs hated it. He finally passed. She always thought he'd take care of her forever in their home and that she'd go first. Things definitely do not go as planned.

I’ll also add that my dad enjoyed the retirement community but kept all his friends and activities on the ”outside” as well - so it was a win-win - I think there is a misperception that when you move into one of these communities you have to give your life up, which i don’t think is true (unless someone chooses to do that)

Choosing a place that serves your needs can be tricky, and even harder for couples who may have very different needs. My dad had mobility issues, but was cognitively sound, even after his stroke. Mom was mobilie for a long time, but increasing dementia. After home with caregivers, a twisty route into memory care from rehab was a good move. But Dad’s physical needs could only be met in a facility where most of his fellow ”inmates” as he said, were not communicating well, if at all. There was one place we were all familiar with, that would happily have accommodated him, but he just didn’t want to go, and it was a long convoluted drive for me. I think he’d have been much happier there, except that people he was friends or associates with would have access to his personal history, including medical, and he was a private person in that respect.

Then there’s how much freedom do you have? My aunt in Independent Living gave up her car, but the shopping bus drops you off at one store, and picks you up in an hour, and you have to have maneuvered your way through the store, selected your items, maybe tried things on, complete your purchase, maybe use the restroom, and be back at the pick-up point, while using a cane or walker, in AN HOUR. And if you need to go to another store, you have to wait until the next shopping bus day. I take her out, we include lunch somewhere cute or Panera, and have a good time, and it takes the better part of the day. Getting old is a pain. Her son is finally stepping in to help out, thank goodness, but it is not his forte.

Before my parents’ medical emergencies, we were looking at options. But because of their different needs, no place could accommodate them in the same apartment, or even wing. That sucked.

" an OLLLIE course on the financials "

What's OLLLIE? I can't find mention of that as an acronym.

Oops sorry typo - it’s OLLI - osher lifelong learning institute, lots of universities have these programs

Actually, speaking of lifelong learning, I want to retire to a college campus, where I can audit classes, hear speakers, attend cultural performances, and can I get that cheap student health insurance, too? A well-endowed school that provides at least basic housekeeping and laundry, please? And one with a nursing program, I can be their work-study, internship, etc. (actually, our nearby college fulfils all that, I’ll check into it!)

Love that bpath! there is a lot of interest in putting seniors on campus - they are called URC’s - theres one at FL and AZ i think

My aunt who has no children lives in a wonderful CCRC community in PA. Her "villa" is larger than the 3 bedroom condo that she owned here in CA. She loves her new home. She moved into the CCRC at the age of 80, she had been on the wait list for 4 years before a villa that she liked became available. At 84 she is still independent, driving and involved in a number of community groups. She lived in CA for over 50 years but was originally from PA and has sisters in both locations. There are many more CCRC options in PA (Lancaster area) than in So Cal (Orange County). She chose a CCRC in PA because the pricing was so much less than in here. For a similar residence the CRCC near us charged an entrance fee of about 700k, with $5,000 per month payment. Her entrance fee in PA was $200k and her monthly cost was $1500. She seems very happy with her choice. She has not needed care yet so the jury is still out on that but we hope that she will be comfortable there until the end.

My husband and I have not really made any plans other than buying a house where we can do all our living on ground level. I know we will stay in the area as our kids are here. Our goal is to stay in our current home until one if us dies but we know that circumstances may change. We are healthy and in our mid-60's, caring for our last living parent. Both of our families typically live to late 80's/90's, so we likely have more time to decide

We do have an Olli near us, I have taken taken a class there, I enjoyed it. My neighbor teaches a class. Plan to get more involved at some point.

Good topic for discussion but a bit hard to discuss (I think I still have a bit of trauma from overseeing my parents and in-laws care). Hard also to have a great solution even when you have money. Aging-in-place seems most desirable but not always practical until end of life. Having a Plan B (like moving into a CCRC) and implementing it before an emergency seems like a good option imo. Maintaining one’s health as best as possible through diet and exercise is also helpful.

Dementia is the real game changer imo especially if there is no spouse or family to oversee the care plan. Care options become limited if the dementia is severe and the person becomes violent, wanders or is unable to take care of their activities of daily living like personal care or meds.

Hopefully there will be more tools developed to help the aging. Ubers and self-driving cars when perfected help with the transportation issue. Home delivery services for groceries, meals, etc. are good tools. The Robotics technology being developed may offer some real benefit too.

I journeyed with my parents and in-laws through aging-in-place, in-home aides and facilities for assisted living, memory care and skilled nursing. The quality, reliability and honesty of in-home aides was appalling. Most facilities in our area have been purchased by private equity firms who have driven up the costs to unaffordable levels. Care costs here are very expensive. I don’t know how the average person without LTC insurance (also expensive) can afford this.

La_La Girl thanks for the info on OLLI -- I did not know about it and I just found so much cool stuff going on in my area. I will definetly be looking into it more!

I agree with @Design Fan (NE z7a) that this is tough topic. No matter the path chosen it always leads to money - lots of it is needed. And, even when lots of money is available, that doesn’t ensure quality of care and services. Also, it’s easy for me to understand having ”a bit of trauma…” from overseeing care for a family member. Having that experience makes it crystal clear that after moving into any kind of senior living or care arrangement no person can be left on their own without an outside person advocating and overseeing the care and services being delivered. This is a scary situation, or should be, for all of us. One would think that because of the graying of the US, the increasing number of long lived seniors, the challenges of long term care would already have been actively legislated to provide more protections. We only have to look at the approaching crisis for social security benefit payouts to see that we have little hope of our government doing advance planning to avoid a national crisis. Most of us know we need to plan for ourselves but that’s quite the task. Multiple plan B’s are needed to cover all of the what if’s that our lives throw at us!

We have experience with all types of care options for immediate family members and there is no one size fits all— and options vary so much by location. Amenities taken for granted in one part of the country are not even offered as add ons in another, but the more basic choice may have superior caregivers or better food service. My dad was in a very good nursing home in Atlanta but my mother still felt she needed to hire a private CNA to come in three mornings and two afternoons a week for more frequent and extensive personal care and walks in the grounds (he was in a wheekchair). And this was concurrent with her visiting almost daily.

DH and I live in a retirement community that is comprised of single family homes only. The biggest need in our area is for assisted living and rehab/ nursing care facilities nearby so that one spouse could stay in the home here while another is getting more care a short distance away— ideally via golf cart. I have no idea why the people who own assembled parcels of land near our gated community havent started building these!

I have no idea why the people who own assembled parcels of land near our gated community havent started building these!

Because they don't make money.

Been through this with both my dad and my grandmother. I had POA for both. I would think things might vary from state to state?? Both were in Assisted Living facilities and both of the facilities also had a memory care unit. It was not uncommon for a AL resident to move to MC at some point, as my grandmother did as her illness progressed. I also have a relative in a veterans nursing home as they have a spinal cord injury. It us s fabulous facility and they also have PT and some other medical perks that a regular (non VA) home wouldnt. My relative is on medicaid plus VA benefits and did not have to use their own savings, so if you are military or spouse of military you might consider that. We also at one point had in home care for my grandmother as my mother became ill and she had been helping with my grandmother. wonderful caregivers who cooked and did light housework. Of course an expensive route to take, but the best option while my mother was still living.

ETA i agree with KSWL, no one size fits all. Also be sure to thoroughly ck out the facility. The AL my grandmother went to was amazing when she was there. When my dad decided it was tome for him to go, we of course wanted him there. New management made changed and dad hated the place! Moved to another facility.

Sushi, I personally know a family who built an assisted living facility because they did not want an elderly relative living in one of the few available in our area. It was so profitable that they have since built a nursing care facility with a memory care wing and a rehab / step down wing. And a hospice. They all make money. 🤷‍♀️

I have no idea why the people who own assembled parcels of land near our gated community havent started building these!

They may need a CON (Certificate of Need) or the equivalent. CONs are not always easy to come by.