Hello All,I am a first time poster, and looking for some advice. My older brother and I are experiencing a double whammy. Our 87 year old Mom, and 80 year old Dad both have Alzheimer’s. My Mom experienced a stroke in April of this year and her symptoms of Alzheimer’s has accelerated. I live out of state with my husband and 2 kids who are in elementary school. My Brother lives 15 minutes away from my parents and co-parents his son who is also in elementary school. We hired a caregiver service who provides care 11-5pm everyday. Our parents don’t have a lot of money saved for their retirement. We estimate they will run out of money within a year provided there are no surprise expenses. Our parents made it very clear to us before they had Alzheimer’s that they would like to stay in their home as long as possible vs going to a care facility. My Brother and I would also like them to stay in the house as long as possible because it is more cost effective. They own the home free and clear, however they need a new AC unit, roof, plumbing updates, etc. We explored doing a reverse mortgage so my Brother and I don’t take on additional debt. I will be in a better financial position end of March 2025, should we explore a home equity and then back ourselves back when we sell the home? I know we need to do something, and that we also need to do some updates on the house to gain a better appraisal value on the home. Does anyone have an idea how easy or hard it is to do a home equity on your parents home? How about a reverse mortgage? For context, my parents live in AZ. My fear is that as they age as well as their condition worsens, we will run out of money sooner than later.Thank you for your help.
It’s sad but you can’t always honor the wishes of parents who don’t ever want to leave their homes. It’s often not realistic.
Rather than looking at it from the ground, try the 30,000 feet view. You can better understand not only what the immediate needs are, but also the needs that are coming at you like a freight train (but haven't reared their heads yet). It is hard when you are "in the weeds" to see anything but just what you have to deal with right now. And in focusing on the immediate needs, you often put yourself in a worse situation later.
What you really have to consider is not just what they need right now. At this time, you are managing with caregivers 6 hours a day, You said "everyday" so I'm going to assume that includes weekends and say they have help 42 hours a week. That's still 126 hours a week where they are on their own, where they have no supervision or assistance.
You have not one, but TWO parents who have ALZ. That's just a recipe for disaster as they progress. You can already see this for your mom I'm sure. But right now, there is no one there to make sure they turn off the oven/stove, lock the doors, that no one wanders or tries to drive or gets lost or any number of more serious issues, never mind just the basics of making sure they eat, adhere to basic hygiene, take their meds. Even if you had one parent that was still fully competent to oversee things that would be a lot. But you have two parents with compromised cognition.
You have to think about things like how would they react if the house caught on fire, would Mom know how to call 911 if Dad had a medical emergency, what would mom (or dad) do if the other had to go to the hospital?
At this point, as much as you want to be able to keep them home, I think you are facing what we all face. What they want can't take precedence over what they need.
I think rather than continuing to try to throw money at keeping them home - when you know that will run out quickly (we did the math once for my FIL - for just ONE caregiver (or 3 in shifts of 8 hours each at $25 an hour which is agency low in our area) we were looking at nearly $220,000 for a YEAR at home. Because he was a very large man - and nearly completely immobile, we would have needed two (to be safe and to be fair to the caregiver)
Now granted, it may seem like a wash if you do the math on memory care or SNF - but you are getting ONE person for that amount at a time/money. What happens if your dad has to go to the hospital - does the caregiver stay with mom or go with dad? How do they get to dr appts - does your brother come take one while the caregiver stays with the other.
A residential care option takes all of that guess work out of it. The safety is there, the numbers are there, the needs are met.
Your fear is accurate - you will run out of money. And that's because you shouldn't be using yours. There are programs in place to cover their care costs if they run out of money. The house can be sold and the proceeds to to their care.
If you are even considering taking on debt for yourself and your own family in order to keep them in their home, you are headed down a very slippery slope that is NOT sustainable.
1) If your parents both have AZ, they may (soon?) need care for longer than 6 hours a day, 11am to 5pm. When this happens, in-home care is not likely to be “more cost effective”. As well as longer hours, deterioration may mean that 1 carer alone cannot cope physically with moving one or both of them.
2) Care in the home is more expensive than care in a facility, because staff there can be shared between more people. Care for your parents is 1 on 2. In-home care around the clock is really really expensive. It also needs a lot of monitoring input to cope with no-shows, turnover etc. It is not an easy option for you.
3) Your parents “would like to stay in their home as long as possible”. So does nearly everyone. The reason care facilities exist is because in-home is rarely possible as people’s need escalate. It costs too much, carer’s time is not used efficiently, and professional nursing oversight becomes important. Even if you ‘promised’, you need to remember that it’s care that matters at some point, not the house. For many elders, the world shrinks down to be much smaller than a house. Start thinking about what you can take from the house to put into the care room you will eventually need, to make it as ‘homely’ as possible. Things on the wall, not the floor, are best.
4) Reverse mortgages do not have a good reputation. Nearly everyone eventually feels that they have been ripped off.
5) Exactly what do you mean by “do a home equity on your parents home”?
It would be good to hear from you on some of these questions. You can benefit from lots and lots of experience by keeping reading on this site. Click on ‘resources’ at the top of the screen, then on anything in the alphabet list. Or click on the magnifying glass at the RHS of the screen, enter your query, and you will find many many old threads that use the term.
Best of luck, and good luck finding your way around this site and ‘the system’. Yours, Margaret
Just because "they made it very clear" that the wanted to age in place doesn't mean they crunched the numbers or counted the personal costs to you. Did their parents age in their home until they passed? Did your parents orbit around their parents and spend their own money on that care? And if they did, did it have 0 impact on their lives?
Reverse mortgage: I've been on this forum daily since 2019 and have never once read a positive outcome for RMs. I think part of the problem is that people sign this contract without having done exhaustive research on what it means in worse-case scenarios. Don't do one unless you also talk to a financial expert who can read that RM contract and tell you exactly what to expect. I personally would never consider one, no matter how desperate.
It is true that 100% round-the-clock care for 2 people will eventually excede the cost of a facility. Especially if they need any type of higher-level aid, like for fall risks, giving medication, dealing with catheters or feeding tubes, etc. You will need to check in your home state's Dept of Revenue to find out if home healthcare aids are ever considered contractors. In my state of MN they are never. This means they are always an employee and whoever hires any is thus an employer and must follow the state rules and regulations as an employer: doing payroll withholding, quarterly reporting, filing w2s, having employment contracts, etc. You will probably also need to pay a bookkeeper if you don't want to do this yourselves. And you will need to have the liability insurance to cover in-home accidents. (FYI my own MIL was working as a companion aid and broke her back on the job in a client's home).
In good, reputable facilities, elders will get more social exposure and chances for activities. In a home they will only see you and whoever you hire. In psychology, this is called a "sterile" environment. Your parents probably want to stay in the home because of past rememberences of old style (and horrible) nursing homes. The modern ones are so much better. I'll bet they've never even been to visit one.
If I were you I'd invest in a consultation with a certified elder law attorney or estate planner, and maybe also a Medicaid Planner for AZ (since Medicaid rules vary by state). If you are not your parents' PoAs, then this is another eventual problem: you will not legally be able to manage their medical and financial. Try to get their doctors or banks or investment firms to talk to you with the activated PoA. They won't. They are bound by laws and liabilities that dictate this.
I would consider selling their house to pay to get them into a nice facility local to you, and make sure it accepts Medicaid. Once they start on private pay the are residents and will have first dibs on Medicaid beds when they eventually need it. You and your brother should *never* take on any debt to pay for their care because it is absolutely unsustainable AND it robs you of your retirement and care funds for your own futures.
I wish you all the best as you work towards getting them the appropriate and sustainable care.
"Try to get their doctors or banks or investment firms to talk to you WITHOUT an activated PoA. They won't. They are bound by laws and liabilities that dictate this."
When our dependents are young children, we have the responsibility of making them do certain things for their own good.
They'd rather stay home, but we make them go to school to learn how to read. It's part of our responsibility.
They'd rather not stop playing, but we make them take a bath. It's part of our responsibility.
They'd rather eat potato chips, but we make them eat some protein and fruit, and even vegetables. It's part of our responsibility.
They'd rather run into the street, but we hold them back from traffic. It's part of our responsibility.
Now, at this time in our lives, our parents become our dependents.
They'd rather stay home, but it's not safe. We need to find care that has eyes on them 24 hours/day. It's part of our responsibility.
They'd rather stay home, but they need to pay for their care. We must sell their home to have the money to do that. It's part of our responsibility.
They'd rather stay home, but we know that that's not reality. Both parents are quite far along in their dementia. We now need to make hard choices. It's part of our responsibility.
Let us know how you make out.
Cheering you on! ◡̈
With strokes comes the likelihood of vascular dementia added to the preexisting Alzheimer's. Not a good situation or a safe situation for your parents to be living in a run down home anymore.
Your best bet, imo, is to sell their home as is, and use that money to get them into a Skilled Nursing facility that accepts Medicaid. They'll private pay until the money runs out at which time you'll apply for Medicaid on their behalf.
You've honored their wish to age in place for as long as possible. It's no longer possible, safe or feasible to do so, unfortunately.
Best of luck to you.
If you are POA and if they agree that they need to go into ALF, then I would assist them in sale of the home AS IS and I would put them into ALF together as long as they can afford it. When the funds are gone they would move to a Medicaid facility and be on the government funding.
That is what I would do. As to what you do, that can only be your choice. In a home in bad condition you would be spending the reverse mortgage money on repairs so they can remain, which is not going to work and which is costly. And when they left the home, which is clearly near no matter their wishes, then the home loan (which is what a RM is) would come due and there would be little to no profit in the home.
I would sell and give them the best they can get for the remaining time, myself. Sorry. Awful choices and decisions to have to make really, but we live too long, and these things come to decision time. Sure do wish you good luck. Perhaps go with your brother for a visit and to attend an Elder Law Attorney with their assets and estimates from a realtor (don't buy their "you have to do this and that; they just want a higher price for their own percentage".). The attorney may have some suggestions and options I cannot think of. Whatever you do don't invest your own money for you are going to need a LIFETIME of savings and good luck to afford your own aging.
In your shoes, consider that getting a consult with a well-qualified Elder Law attorney may give you the best guidance.
You need to make sure that the caregiver is being paid in a way that makes it clear that she's being paid wages and not being gifted the money.
With 2 parents with dementia and not much money, Medicaid and a facility are almost certainly in their future. A good attorney can tell you the best path to take.
You would be better placing them in Memory care and selling the house to fund it. When the money runs out you apply for Medicaid. I agree, you should talk to an Elder Lawyer.
If the time comes where you have to put them in memry care and they're on Medicaid, your choices of a decent place will be limited. However, many places allow a person to stay on with Medicaid if when they move in they can cash-pay for a certain amount of time. It's usually a year or two.
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