Can You Manage Their Care in Your Home?
If your home will meet the needs of the person who is ill, and you have someone you can call on to help your spouse shower, eat, and use the bathroom, then you may be able to keep them at home. Are you able to lift your spouse or transfer them to a wheelchair, while not letting them fall? Whether or not you can manage their care at home may depend on how sick the person is, and how much they are capable of doing for themselves. It may also depend on how much assistance you can round up to help you. Are there adult children who can help? Have you considered making some home modifications so it is easier for them to shower, or could you purchase equipment that will help you lift or move your spouse? Is there an adult day-care center in your community where your ill spouse can go a few times a week, allowing you to run errands without worrying about leaving them alone? Can you afford to hire a part-time caregiver? With enough assistance, both of you may be able to manage just fine in your current home. However, do not feel guilty if you cannot do everything by yourself. It is okay to admit you need help.
Should You Move Your Spouse to Assisted Living?
If you are not able to get the help you need in order to keep your ill spouse at home, another option is to move them to an Assisted Living or Memory Care facility. This is especially common when they have severe dementia. They may be at risk of wandering off; or they could try to cook and start a fire. They may try to drive or do something else that could endanger themselves or others. Eventually, it could become nearly impossible to leave the person alone. In these situations, it may be necessary for them to be moved to a facility to keep them safe and where they can get the full-time care and attention they need.
Nearly every community in the United States has a variety of nursing homes and assisted living facilities available. Before you need one in an emergency, check out the ones in your area and find out if they could meet the needs of your family member. Do they have skilled nursing available? Do they offer memory care? Do they offer activities which will interest your family member, such as entertainment, a swimming pool, art classes, or a putting green? Do they encourage patients to be as active as possible? Do they offer physical therapy? Will it be convenient for you and other relatives to visit them in this facility? Has the facility arranged a safe meeting area for residents, so they do not become exposed to Covid-19 by outsiders?
Perhaps, most important, you will want to consider whether or not you will be able to afford this facility. Do you have long-term care insurance to cover the expense, or will you qualify for Medicaid? Do you have enough savings to pay for it? What is your plan?
It may be helpful to read something like: "Choosing an Assisted Living Facility."(Ad)
Consider Moving to an Assisted Living Facility with Your Spouse
Several couples we know have moved into a care facility together, even if only one of them needs extra care. When they made the decision to live together in one of these facilities, it often brought relief to them both. The responsibility of being the total caregiver for a sick spouse is removed from the shoulders of the healthier spouse. Neither person has to buy groceries, prepare meals, do dishes or clean their residence. The healthy spouse is free to come and go as they please, while the sick spouse is cared for. The sick spouse no longer feels guilty for being a burden on their partner. At the same time, they continue to live together and spend time with each other.
Live Together in a Continuing Care Community
The most common way for a couple to live together in a care facility is to either purchase or rent an apartment or cottage in a Continuing Care Retirement Community, also referred to as CCRCs. These residential communities are designed specifically for this kind of situation. Here's a brief description of them:
Buy into a Continuing Care Retirement Community - Some types of continuing care facilities require you to purchase a condo or cottage in their community. You bring your own furniture and decorate your home as you please. You move in while one or both of you are still in somewhat good health ... at least ambulatory or able to walk under your own power. In addition to the purchase price, you also pay a monthly fee. These communities usually have their own skilled nursing facilities and memory care facilities where you will continue to be cared for when you can no longer manage in your own condo. They are called Continuing Care Retirement Communities because they guarantee that they will care for you for the rest of your life, regardless of your needs, as long as you or your family continue to make the monthly payments.
You start by living independently in your own apartment. If necessary, you will eventually be cared for in their skilled nursing or memory care facility. If your total lifetime medical expenses cost more than Medicare and your insurance will cover, plus the amount agreed to in your purchase contract, the excess amount is deducted from the resale price of your condo when you die. A percentage of the remaining value of the sales price is passed on to your heirs. This type of Continuing Care Retirement Community, which requires you to buy your residence, typically does not accept long-term care insurance or Medicaid to pay the monthly fee, but there may be some exceptions.
Rent an Apartment in a Continuing Care Retirement Community - Another option is to move into the type of continuing care community which allows you to rent on a monthly basis without the need to actually buy a condo. You do not own your unit, but you are able to bring your own furniture and decorate it as you please. The basic monthly rental will vary, depending upon the size of your apartment, with extra fees assessed based on the level of care you need. These communities may accept Medicare and any other insurance you have as payment for your medical expenses, and Medicaid for your long-term care, if you qualify for those programs. They will also accept long-term care insurance or private payments. Otherwise, they are very similar to the type of CCRC which requires you to buy a condo.
Like the CCRCs which require you to purchase your home, you start by living independently in your own apartment. If necessary, you will eventually be cared for in their skilled nursing or memory care facility. It is very important to find out the base price as well as the assessments charged for the extra help your spouse may need, such as assistance taking a shower. Your cost of living in these facilities will increase when your medical needs become more serious. You need to take that into consideration when you move into one.
Cost for Two People to Live in a Rental Continuing Care Apartment
Since I was curious about what it would cost if my husband and I decided to move together into a continuing care community, I decided to get information about it from one of the facilities in our neighborhood. The one I chose was Las Palmas in Laguna Woods, because it is owned and operated by SRG, a company which operates senior living communities all over the United States. I assume their model and pricing will vary somewhat from place to place, but is generally similar. Below is what I learned. I rounded the numbers up to the nearest $100, since prices are likely to rise each year. These were their 2019 prices.
Typical Rental Fees for Couple in Independent Care / Assisted Living
Rental for a 1 bedroom, 1 bathroom independent living apartment: $3900 to $5400 a month
Second resident (who does not need assisted living care): $900 a month
Community Service Entrance Fee: one time charge of $3000
Extra care fees:
Level 1 Care for one person - additional $900 a month
Level 2 Care for one person - additional $1,500 a month
Level 3 Care for one person - additional $1,800 a month
Total Monthly Expenses for Two
This assisted living facility is in Southern California, near Laguna Beach, so it is probably more expensive than facilities in other parts of the country.
Based on their fees, however, a couple with one sick family member and one healthy one, living together in this continuing care facility, with one person needing Level 2 or intermediate extra care, would spend about $7,000 a month for both of them. Some of my friends have told me that is approximately what they are paying to live together in other, similar facilities in our area, so this seems like a common price in Southern California. Most people would NOT need to pay all of that out of pocket, however. Depending on your situation, a sizeable portion of those costs might be covered by either Medicaid or your long-term care insurance. The remaining living expenses could be covered by your Social Security benefits or other retirement income.
The $7,000 monthly fee would include rent, three meals a day for both of you, utilities (except phones), maid service, most activities, and entertainment for two people, plus necessary medical care for the ill spouse. This is only $900 to $1400 more than the cost for one person to live alone in a studio apartment in the same facility, so the healthy spouse can live with their partner for very little extra.
Deciding Financially How to Care for Your Spouse
Whatever you decide, finances will probably play a large part in your decision. As you can see, in some cases it may be more affordable for a couple to live together at a continuing care facility than to live separately in two different locations. In other cases, it may be less expensive for the healthy spouse to remain in their current home, while using Medicaid or long-term care insurance to pay for the sick spouse to stay in a skilled nursing or memory care facility. In fact, that might be the best choice if there is reason to believe that the ill spouse will recover and be able to move back into your home in the future, for example, if they are recovering from Covid-19.
You need to be realistic when you consider how seriously ill your loved one is. If they have advanced dementia, and you cannot afford memory care for them, it might help to read "The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, other Dementias, and Memory Loss." (Ad) It contains an extensive amount of information about how to make it easier to care for someone with dementia in your own home.
You should also check out different facilities in your area. Find out whether or not you and your spouse are likely to qualify for financial assistance from Medicaid. Many people are surprised to find out they can qualify, even if they own a home or business. If not, see if you can purchase a long-term care insurance policy while you are both still healthy. There are also life insurance policies which can be converted to long-term care insurance, so you can use the benefits while you are alive.
Make a plan now for how you and your spouse will cover the cost of care, should one of you become ill. Whether you decide to keep your spouse at home, move them to an assisted living facility, or both of you move to a continuing care facility, it is wise to investigate local facilities and have a plan before one of you is diagnosed with a serious illness. It will be much more difficult if you have to make a last minute decision.
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Photo credit: Las Palmas SRG Senior Living Community in Laguna Woods, CA