By Dr. Diana Nevins, Guest Writer“Help, I’ve fallen and I can’t get up!”
The cheesy commercial from the 1990s that featured that line became a national punchline, as the over-the-top acting made it unintentionally comic. The real deal, however, is NOT funny at all. I found that out the hard way.
I had last visited my elderly father—who lives 500 miles away from my home and who is still mentally sharp but suffers from a myriad of serious medical conditions—over Memorial Day weekend in 2024. At that time, he was still living independently (but with some caring neighbors keeping a close eye on him), walking well with a cane, and still capable of safely driving at the age of 89. There was no hint then of what the summer had in store: a series of short hospitalizations followed by stays in rehab facilities, each of which had left him less and less physically capable. I hired some part-time unskilled help (a pair of lovely older ladies who had helped out my father when he was dealing with my mother’s decline due to Alzheimer’s) to come in three times a week and help him with basic chores; they had both told me that they thought he’d soon need more care. Then came his 90th birthday party in early October 2024.
I had flown in for the big event, and I was surprised and dismayed to see he now needed a walker full-time instead of a cane. But I was more surprised when, on Saturday, he fell in the middle of the night and couldn't get up by himself or call for help. He wore a Life Alert-style pendent, but it “didn’t work” (we found out later that it was because he didn’t hold the button down for a full four seconds). He’d left his cell phone and his Apple Watch downstairs, and to my shock, I discovered the landline in the second upstairs bedroom was no longer functional. If I had not been there to call the paramedics, he might have been lying there on his bedroom floor for 36 hours until his housekeeper came on Monday afternoon to do his laundry.
My father had become the little old lady in that cheesy commercial. And one thing was immediately clear to me: it was no longer safe for him to live by himself. Part-time help three times a week was no longer enough. After a long conversation, my father agreed, and the search for a workable option began.
Fortunately, over the summer I had already begun investigating some options. As a WCI devotee, I thought I was well off—until I discovered what 24/7 in-home care costs in the Chicago area. Unskilled care came in at over $20,000 a MONTH. Skilled nursing care was more than $30,000 a month. My father’s assets don’t come to more than $250,000 total, and while I may have a few million in the bank, I am not Warren Buffett; those options were ruled out right away.
Evaluating Senior Living Facilities
I had also started researching senior living facilities. My father has many close friends in his current community, and he’d be broken-hearted if he had to leave them behind, so I didn’t consider bringing him home to my city. Instead, I looked at several facilities in the northern Chicago suburbs and asked his current caregivers and his neighbors about all of them. One, in particular, got rave reviews from everyone, and it was only two miles from his current home.
One of my cousins (who had come up for the birthday party) and I arranged a tour, and we were both impressed with the condition of the place and the care options they offered in their “independent living” section (which is more like “we keep a close eye on you” living than truly independent living). They also offer an “assisted living” option with a higher level of care, which my dad could transition to later if the need arises. My father already knows one of the residents there, which I thought would ease the transition. And he can afford the cost, at a bit less than $4,000 per month for nice a one-bedroom apartment, once the house is sold. My cousin (who had graciously volunteered to stay with my dad for a week so I could return home and take my scheduled weekend call) agreed to arrange for my dad to tour the facility.
More information here:
Cost of Caring for Aging Parents
The Sandwich Generation: Financial Planning for Doctors Stuck in the Middle
Not All Senior Living Facilities Are the Same
My father had been under the misimpression that all senior living facilities were like nursing homes or the memory care unit my mother was placed in when her Alzheimer’s advanced to the point where he could no longer take care of her. But this senior living facility is bright and cheerful, with each resident having a handicap-friendly one-bedroom or two-bedroom apartment with a small kitchen and a dining room where he could eat chef-prepared meals. There are plenty of common areas and group activities. Residents are free to come and go as they please (the facility just wants them to check in and out, so in case of an emergency, the workers know who’s there and who is not). He even knows someone already who lives there.
My father liked what he saw, and after our visit, we had a long discussion. He was worried about the financial aspects and about losing touch with his friends in the neighborhood, but he also admitted to me that the fall on Saturday night had really shaken him up. He was lonely spending so much time at home alone (especially since the death of his dog at the beginning of 2024), and he felt anxious as soon as he arrived home from his last rehab stay. He really didn’t want to be home by himself anymore.
Some quick math showed that the facility wouldn’t cost much more than staying in his current townhouse, and I told him I would be less worried about his safety if he moved there. He agreed it was time to bid farewell to his townhouse and move to the senior living facility. My cousin agreed to have him stay with her in Indianapolis for a month until the apartment he chose was ready (I owe her a lot!), and he moved there in early December 2024.
More information here:
Helping Your Parents Financially
Lessons Learned to Date About the Eldercare Journey
Plan Early
Physical and/or mental decline can be sneaky, and it can happen faster than you realize. It pays to start doing your research EARLY!
Simple measures—such as putting all bills on autopay, getting yourself added to your parents’ bank accounts, enrolling them in online banking if they will agree to this (my father would not), hiring a housekeeper, and teaching them to use Uber/Lyft—can go a long way to keeping an elderly person independent longer.
Do Estate Planning
If you can, get your parents to do estate planning. You are going to need durable healthcare POAs and durable financial POAs eventually, and a properly structured estate plan can make it much easier to settle your parents’ affairs after they pass. If they are reluctant, try to emphasize that they are helping YOU as well as themselves by doing estate planning. Most older people don’t want to inconvenience their grown children, so stressing this point might get a reluctant parent to agree to get that estate planning done. I was lucky since my parents had already done this several years earlier.
You cannot force a mentally competent senior into a care facility unless it is glaringly obvious to a judge that they CANNOT properly take care of themselves. That is a high bar to clear. You will need the elder’s buy-in if the elder is mentally competent. Look for carrots! In my father’s case, being so close to his old neighborhood was one carrot. The bigger one is that he potentially could have a dog at the facility. His old dog died recently, and the loss really upset him; the prospect of potentially having a dog again (because the facility can help him care for it if need be) went a long way toward convincing him to agree to the move.
Understand the Options and Costs for Care
Research the different types of care available in both your community and your parents’ community now: part-time aides and full-time aides (both skilled and unskilled), independent living, assisted living, skilled nursing facilities, memory care, and continuing care retirement communities. Not every option is available in every area. And brace yourself, the costs will shock you.
Which brings us to Medicaid. Not all types of care are covered by Medicaid, and not all facilities accept Medicaid patients. The total assets your parent can have and still qualify for Medicaid are very low. And Medicaid has a five-year lookback on asset transfers. An attorney who specializes in eldercare law is invaluable here. I have not yet engaged one, but I will.
Tax deductions are also a consideration—some of the money you spend to support an elderly parent may qualify as a tax deduction. This is where a good CPA comes in handy. I will be questioning my own CPA closely about this when tax season rolls around.
There are many considerations besides cost and taking/not taking Medicaid when considering a facility. Can you keep your elder in a place where they won’t lose touch with their current community? Or do you need to move them to where you live? What level of care do they actually need now, and is it available in that facility? If they need to transition to a higher level of care later, does that facility offer the care they need? Does the facility offer activities your parent would enjoy? Is the “feel” right? Interview as many people who have actually used the facility as possible, and pay attention to any negatives they bring up.
Expect Life Disruption
This will disrupt your life in a major way—even if you live in the same community as your elder and especially if you do not. FMLA does NOT cover leave taken to move a parent into a facility, only leave taken to directly aid in their medical care. I had to take an unpaid personal leave of absence in December to move my father into his new apartment, and I may need to make some weekend trips to Chicago in early 2025 to get him completely settled. And after that comes clearing out the house and listing it for sale. But that can wait a few months!
Figuring out eldercare, like aging itself, isn’t for sissies. But the sooner you start to plan for it, the smoother things are likely to go, and the happier both you and your elderly parent are likely to be with the results.
“Help, I’ve fallen. But I CAN get up, thanks to the staff at the senior living facility!”
Have you helped relatives with eldercare? What was the process like? Were the expenses a surprise? What else can be done to prepare yourself and your parents for this phase of life?
Thanks for the thoughtful and informative post. The next transition with your father, to long-term care, may cause him to move closer to your location.
Unfortunately, my father has continued to decline since I first penned this article, but he is still determined to stay close to his friends. Fortunately, some of them have been willing to be my eyes and ears on the ground, so if he does need to move into a long-term care facility, and he wants to stay in his current town, I will have at least a little help. But it is definitely easier to deal with this situation if the senior is willing to move closer to a younger family member!
“Senior living facilities” can mean many things from a continuing care retirement community (CCRC) to a nursing home. Even within those terms there are wide variations: is the CCRC for profit, or non-profit, do they have an endowment to take care of residents who run short on funds. Is the continuing care, if they provide it, on or off campus? I know folks in different CCRC’s with different levels of satisfaction. Research takes time, there are many resources out there. From the level of care, to the satisfaction of the residents to financial stability. Regarding resident satisfaction, a few CCRC’s have an annual resident satisfaction survey done by an independent company – ask if they do that and ask if it can be seen. Check their bond rating. Many are rated on Fitch; I know of one where their rating is B- and anther A; ask to see their detailed financials.
Then there are the incidentals which may or may not be included: transportation, meals, laundry, haircuts, computer support, TV and so forth.
Ask to see all of their levels of care; with the exception of the locked memory ward, they should be proud to show them off for care and cleanliness.
In VA, several long standing non-profit , religious based CCRC’s, sold out to for profit companies; their long term plans didn’t include such a large number of folks living into their 90’s and even beyond; on the flip side, another has an endowment of $250,000,000.
Meanwhile, elder care in VA is so bad – with chain so bad, the medical director and over 15 employees were arrested after the death of a resident and abuse of others; the AG has set up a task force.
It’s the Wild West with states regulating it differently.
What do you say is absolutely true, and that is another reason why doing research early is important. You don’t want to be caught in a mad scramble or trying to find a facility you can open bed at the last minute! It takes time to sort the good facilities out from the bad facilities, and to figure out how you and your elderly family member are going to pay for all of this.
Most of those decisions aren’t irreversible though. If you end up in a crappy facility, you can usually move, no?
As long as the parent is still private pay, yes. Once the parent spends down to Medicaid levels, though, they may be stuck at the facility they are currently at. Most of the good facilities want a resident to be private pay for at least a few months before they will allow the switch over to Medicaid as payment.
And while moving from one apartment to a different apartment or from an apartment to a single room is not as big a hassle is moving from a house into an apartment, it is still a hassle. The elderly parrot will not be able to manage the move themselves, and you have to take time off of work in order to travel to make the move happen.
So it is good if you can get your parent into the right facility the first time!
Thank you for writing this interesting post.
You’re welcome!
We went through something very similar. Parents were 800-miles away. My mom spent 7-years in the Memory Care unit until she passed. Once, she passed my dad’s health deteriorated quickly. He also made some decisions that weren’t to the betterment of his health. My dad also wasn’t honest about what was going on.
My mom’s younger sister and husband were in the area and that was the only thing that even made it possible for him to remain so far away. Make sure family and/or friends are nearby and can reach you and provide updates that your loved one may not. My dad had several falls and car accidents that he didn’t tell us about.
He did agree to move into the facility and even though he had the funds, he wouldn’t sign up for the level of care that he needed. And as you noted, we couldn’t force it on him.
My oldest brother was able to get added to his primary bank account, but we ran out of time on his other accounts. He did have a Trust and Will, but it turns out they weren’t complete in some areas and we had copies and not the original. The brokerage company wouldn’t accept the copies so took a little longer to get that solved. Thankfully there was $ in the main checking to pay the bills for few months.
Everything went fine splitting everything up except for the house. We were hoping to buy my brothers out but couldn’t agree on a price. My dad was a hoarder and except for my wife’s and my first effort at cleaning things up, nothing has been done, so house sits. So have those difficult conversations about how to split up all of the assets. Outside of my dad selling to us before he passed, not sure what would have solved this current kerfuffle.
cd : O)
Chris,
I feel for you. My mom is also a hoarder. She and husband live in multi level house and won’t consider other options, despite him now being bedbound. He needs full time caregiver and they have a long term care policy that will fully reimburse for home care, but they say they don’t like having someone in their home. It’s hard dealing with parents who choose to make poor decisions, I think especially as a health care provider who wants our parents to do the smart thing!
What a tough situation to be in! I’m doubly fortunate, as not only was my father, reasonably cooperative, but my brother (who I am not particularly close to) is fine with the way I am handling things and content to receive his 50% of the proceeds when we sell the property.
I am actually taking some time next week to go back to my father’s town and start the work on clearing out the house. I am not looking forward to it! My father was a pack rat, and while he did do some cleaning out over the years, even with people who are not pack rats a lot of stuff accumulates over the course of 28 years of residence in a home.
Diana, thank you very much for sharing such an important information. Of course, in a short article it’s impossible to make the audience understand how much complex everything is when it comes to a long term care. You mentioned several times Medicaid. It seems your father has a good amount of assets in a form of cash and the house. Is there a formula to better understand when one becomes eligible for the Medicaid coverage? I live in North Chicago suburb and would like to know what facility did you choose, if you can share. Thanks again.
When one becomes eligible for Medicaid varies by state, but it’s basically pretty close to broke. Here’s the Illinois info:
https://www.medicaidplanningassistance.org/medicaid-eligibility-illinois/
Basically an income of $1,304 a month and assets of < $17,500 Countable vs. Non-Countable Assets The value of countable assets are added together and counted towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. In Illinois, IRAs also counted. There are also many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, and generally one’s primary home. Additionally, irrevocable prepaid funeral burial contracts up to $7,981 are exempt, and if funded by a life insurance policy, there is no limit.
Thank you for such an important and thoughtful post. A couple of things come to mind at the moment. First, you asked about deductibility of expenditures. Christine Benz has a couple of articles on her experience with her dad you might find informative. While perhaps not as clean as HSA withdrawals, health care deductions in her case largely offset income from traditional IRA withdrawals used to fund the expenses. Secondly, for our own estate planning, this is a topic that lends itself well to a letter of instructions that should cover incapacity as well as passing away. Thanks for sharing some of the cost info too.
Thank you for the tips! I will check out this article by Christine Benz!
We met with a well informed broker who we contacted through partnershipforlongtermcare
They explained how the plans work and the Medicaid asset protection. We only wish we would have started sooner.
I think anyone who has gone through this wishes they had started planning sooner!
Just a tiny note about dogs. If you find yourself leaning toward a facility that doesn’t allow dogs, and this is disappointing to the elder, ask if the facility has (or is willing to start) a therapy dog program. My two dogs are trained, tested, and registered with Alliance of Therapy Dogs, and I take them (one at a time) to a local nursing home, where the residents absolutely light up when they see them. When we first started, some told me it had been two years since they’d been able to pet a dog. It’s not the same as having their own dog, but for the residents who have photos of their past dogs on their walls next to (human) family photos, who tell me all about the dogs they’ve had, and yell out my dog’s name from down the hall (they don’t remember MY name!), it makes a huge difference. It’s 100% free, and minimal effort is required from the facility. They just had to show me around once, take care of the volunteer paperwork, and now my dog and I just go and walk around on our own. It seems to be a nice little boost for the staff, too.
Therapy dog programs are wonderful! I am fortunate that my father is in a senior living community that has one. Since I wrote this post, his mobility has unfortunately declined significantly, and even with assistance a dog may not be in the picture anymore. That makes the therapy dogs even more important!
Great article and very coincident with our concerns and journey to get my mother (84) and her husband of nine years (90) into an independent living apartment. An unexpected twist blind-sided us, though. The danger I didn’t foresee involved the husband’s family. Despite a prenuptial and long independent histories before their marriage, the family did everything in their power to source her estate including very nearly preventing the sale of her house. Its somewhat of a unique circumstance due to the Texas Homestead Law, his signature was required to sell the house even though it was clearly and legally her separate property. I had to get legal counsel and threaten a lawsuit. At the very last hour they relented, so we were able to close the sale. Complicating the situation is significant dementia on both sides of the couple, my mother’s worse. Despite having the POA needed and taking over all her financial accounts, we had our hands full converting her physical possessions to cash and protecting it. So- far-so good seven months after the move from their house. We pay for pop-in care 6 days a week, primarily so my mother can get a weekly bath and take her daily Losartan, and some light housekeeping. We visit monthly from 300 miles away to asses the mental decline on both their parts, staying a couple nights to capture the foibles the neighbors and caregivers don’t see. So far both sides contribute half of the $5K monthly rent at the DFW metroplex facility, which consumes virtually all their income. The quality of life is better than assisted, and certainly much better than memory care, so we are keeping them in their “independent” apt as long as possible, knowing we’re a phone call away from moving them.
Wow! I am glad you were able to defeat the vultures and keep the money from the sale of your mother’s and her husband’s estate from being siphoned off, so it can be used for their care. Sometimes family members foolishly count on an inheritance, without understanding that if someone lives to a great old age, there is often no money left when they pass because every dime had to be spent on caring for the senior.
In the time that has passed since I wrote this article, my own father’s physical condition has declined quite a bit. Right now he is in a rehab facility after a hospitalization, and it is not clear whether he is going to be able to go back to his beautiful, independent living apartment, even with the help of aides, because his mobility has declined so significantly. So even when you think you have things under control, you don’t! Like you, I am hoping I will find a way to keep my father in the independent living apartment longer, but if not, I’m going to have to take another leave from work to move him into the assisted living side of the facility. Such is life!
Brent, I am in the DFW area and was wondering if you can give me the name of the facility you were talking about. My parents went through two bad facilities in north Dallas and I would like to check out a good one.
Thank you,
Steve
This could be slightly hilarious if he names one of those two facilities.