Thursday, August 27, 2015

Eldercare Q-A: Is it possible to save money on Mom's care?

Can your elderly mother save money on health care, even when her care needs are rising?  Money is often a huge challenge for families looking for in-home care, assisted living or adult family homes.

Ask Rose and her son and daughter. .I met them several weeks ago. Her daughter said, "Mom has been in her home for fifty years, and she wants to stay there.  But the cost of in-home care is so high."

In this case, "high" meant $365 a day for around the clock caregivers, or nearly $11,000 a month.  There were other expenses, too, like the caregiver's groceries and household utilities.  Could we come up with care that was more affordable, but still high quality?

"Give me your wish list,"  I asked them. 

"A home filled with light."

"A large bedroom, with a private bathroom or least a bathroom nearby."

"Qualified, competent caregivers that speak excellent English."

"At least a couple of residents who enjoy conversations."

As we toured, we looked at the wish list.  And the cost. In an upscale neighborhood of Seattle, we found two homes with lots of light and gorgeous views of mountains and water. They had everything on the family's checklist. Price tag:  $8000 and $8500 a month.

Moving farther north to a nearby suburb, we toured a home that worked except for the size of the bedrooms.  Price tag:  $7000 a month.

About two miles north of the county line, but still within easy driving of Seattle, we found a home that met all the family's desires, and the bedroom was huge!  "We really enjoyed the caregivers," Rose's daughter said.  Price tag:  $5500 a month.  SOLD!

A savings of $5,500 a month, not counting incidentals.  Such a deal!  Moving to an adult family home, with two caregivers and four other residents, might not work for everyone.  Or it might not save as much money as in this case. But for Rose and her family, an adult family home worked well, saving in time as well as money.

"No more shopping for groceries, no more ordering medications, and fewer bills to write," said her daughter.  "Now we can spend time with her rather than doing things for her."

Saturday, August 22, 2015

Forgiving Our Parents: My Story

"I think I can.  I think I can."  Those words of the Little Blue Engine from the children's story book have resonated with me throughout life.  Especially as I  thought about forgiving my aging parents.

In my late-forties I examined my life. I didn't like what I saw.  Like everyone on the planet, I was raised by imperfect parents.  Yet in my case, my childhood losses spilled into adulthood,
rooting themselves inside me  They bore a crop of anger, resentment and people pleasing.

Surprisingly, my work in a retirement community with seniors and their families set me on a journey toward healing.  Daily I witnessed seniors as they literally, sometimes figuratively, climbed the steep mountains at the end of life.  Their burdens often seemed insurmountable.  Loss of health, friends, life itself. 

I also saw their adult children.  Many had taken the path of forgiveness.  Stripped of resentment, they valued their parents and spoke openly about the their parents' struggles.  They showed love through kind words, hugs and laughter.  And they served as cheerleaders as their parents endured life's trials. Could I do the same?

I couldn't forgive in a vacuum.  I needed people.  I joined a support group. As we sat in a circle, we shared our stories.  Those stories were sacred; so were our laughter and our tears. I remember one night thinking as I drove home, "I didn't have to look over my shoulder.  I'm beginning to feel free."  The group brought to mind Fred Rogers' words, "I like you just the way you are."

One night I left the group and a friend stopped me.  "Alice, I will be praying for you, that God will show you who and what you need to forgive," she said.  "And one more thing. That God will show you how much He loves you."

I began writing out my losses:   A big discovery: Prayer not only enabled me to list and forgive those hurts, but it  showed me my faults.  I needed to forgive myself.  I needed to ask forgiveness of others. As I grieved and let go of the hurts, I started recalling the good things my parents had given me.  Faith in God and reassurance of Christ's unconditional love.  The importance of community and reaching out to others.

As I weighed my life in the balance,  the blessings loomed large.  The forgiveness I had received from God and others allowed me to forgive, as well.

I'd like to say that I suddenly felt warm and fuzzy inside afterwards.  But I didn't, at least not immediately.  I felt sapped.  Like I was standing still.

Not long afterward my sister Carol wrote me with a request.  Daddy and Mother's 50th wedding anniversary was coming soon.  Carol had planned a surprise anniversary party.  She asked everyone attending to write a letter thanking Daddy and Mother for their positive influence on the lives of so many people.

I stalled.  I'd done the forgiveness but my feelings hadn't caught up with my thoughts.   I found a devotional by Melody Beattie, in the "Recovery Devotional Bible,"  that spoke to me.

 "Sometimes, to get from where we are to where we are going, we have to be willing to be in-between. ...Being in-between isn't fun, but it's necessary.  It will not last forever."

The writer's block resolved.  I might have been influenced by the words of  Melody Beattie.  Or maybe the words of The Little Blue Engine, "I think I can, I think I can."  

In the years to come, my siblings and I would help Mother and Daddy make difficult decisions regarding their health and end of life.  Forgiveness made all the difference.

Saturday, August 15, 2015

Medicaid 101: Mom's on Medicaid. How Can I Help?

Fifty dollars a day.  Could that buy you a place to sleep and three meals?  A budget hotel would eat up the fifty dollar bill and then some.  Add breakfast, lunch and dinner at a bargain restaurant, and the total could easily jump to $100.00. 

And suppose you need care--the kind your elderly parent might need.  Help with bathing, dressing and medication reminders?  It's not hard to see that $50.00 a day doesn't go very far.

Welcome to the world of Medicaid.  For a light care resident in a Seattle adult family home, the State of Washington pays the provider $47.59 a day.   Less than $50.00! The rate goes up as the care needs increase, but the highest rate is $163.59.  Translated into monthly rent and care, we're looking at between $1428 and $4920.  Very few residents are assessed at the higher rates.  Those that are assessed higher are usually bed bound, can't feed themselves and need heavy attention by caregivers.

Assisted living providers are paid a bit more for Medicaid residents.  And this year, they got a long-deserved 2.5 per cent raise.  They are now paid between $67.22 and $163.89 a day.

If your parent is on Medicaid, or about to convert to Medicaid funding, you'll need to face some grim realities.  Then you'll see what you can do to help..

1.  Choices for Medicaid residents are shrinking.  Your parent's doctor may say, "Your mother needs memory care," and you think that translates into an assisted living community with a specialized memory care unit.  One problem:  Medicaid. funding.  In the Seattle area, there are only three communities that offer Medicaid in their memory care area, and that is only after two or three years of private pay.  In Washington State, Medicaid residents, whatever their cognitive state, generally go to adult family homes.  Many of these work out well.

2.  You may need to adjust your expectations.   If you know your parent will run out of money in a year or so, it's a good idea to search out places that take Medicaid and move your parent sooner rather than later.  Why?  Because providers often require a certain number of months of private pay before a resident switches to Medicaid.   Offering a provider some private pay months up front will give you more choices of homes.

3.  You can help provide extras for your parent.  Once your parent is on Medicaid, he will be contributing his income toward the cost of the care.  He will get a small monthly allowance, but that won't pay for everything,  You can buy clothes, pay for haircuts, purchase supplies, and even favorite foods that aren't on the menu.  Medicaid providers are often operating on a shoestring, and will appreciation your lending a hand.

Is your parent on Medicaid or transitioning to Medicaid?  Do you have any observations you'd like to share?

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