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It is reported that over 25% of those over 65 will need significant support and services for over 3 yrs during their life time. As population ages, this is going to get worse.
In-home care is very expensive. As per Genworth, the median cost of round-the clock in-home care is $290000/yr, which is 2X the median cost of nursing home or 4X the median cost of assisted living. Such costs can destroy retirement savings of many, or cause significant financial strain to children caring for their parents. Any planned inheritance for children could be wiped out.
Forum had many discussions on long term care insurance and CCRC (Continuing Care Retirement Communities) options. Each has its own pros and cons. Long term care insurance, unless taken very early, becomes very expensive. After serious heath issues, entering CCRC may not be an option. In addition, people want to age-in-place or live in their home as long as possible.
What has been your experience caring for family or friends? How would you prepare financially for in-home care , if you ever need it?
These two links are helpful in understanding Home care vs Assisted living.
https://aging.com/assisted-living-homes-vs-home-care-how-to-decide/
https://www.aplaceformom.com/caregiver-resources/articles/assisted-living-vs-home-care
Reasonable descriptions. However, neither site covers CCRCs. I don’t know about aging.com, but I believe aplaceformom is funded by the places it recommends.
A Place For Mom has an average rating on Yelp of only 1.6 (237 reviews).
https://www.yelp.com/brands/a-place-for-mom
A thought provoking question, thank you for this!
There are forums on FB & other social media where people caring for their parents or other loved ones exchange tips, vent, etc. I urge anyone who is planning to care for an elder to read through the day-to-day issues caregivers face to get a realistic idea of the challenges as well as the rewards. One technical point: in many rural areas, many of the agencies providing home care are not fully licensed. Individual caregivers rarely are licensed, If you’re planning to rely on long-term-care insurance to pay for home care, it’s useful to determine whether your policy has restrictions on what type of caregiving help it will reimburse.
I’m 75, my brother is 78, and my sister is 65. None of us has any other close relatives. When my sister and I realized 3 years ago that our brother could no longer live alone, it was clear that neither of us would be able to care for him. We found an assisted living place for him that currently costs slightly less than his SS, VA benefits, and small pension. He is doing well there. I suspect that in a couple of years my sister and I will have to supplement his costs but it’s unlikely to be a major burden on us.
I will probably go to some sort of senior living facility when I’m no longer able to drive. 24/7 home care doesn’t really appeal to me since I don’t really have any sentimental feelings for my townhouse. I also doubt that there will be enough quality home healthcare workers available to care for all the people who want 24/7 care. That would require 4-5 workers for each patient.
We took care of my brother in law with special needs (Down Syndrome) in our home for over 2 years. He had early onset Alzheimer’s, swallowing issues that lead to pneumonia, along with significant hospital stays over a two year period. My wife and I with a daytime caregiver provided 24-7 coverage. As things progressed, we added a weekend caregiver. For the last four months before he moved to hospice, we attempted to hire 8a-8p care via agencies. $35/hr was offered but it was a struggle with 3 agencies trying to staff. Nursing homes would not accept him as he was too much for them to handle and he was Medicaid. I calculated our annual run rate before he moved to hospice at $260K. The family (6 siblings) contributed towards this expense. His mother was 95 and was in assisted living. She could not help with the cost.
Money is the a solution but it does not provide caregivers or relieve the burden on family.
Managing end-of-life care for a loved one is a huge burden on families. It is better to discuss with family in advance to look at options.
I’ve written about this elsewhere, but I just had a front-row seat for this very question over the past year. My mother-in-law had been in serious cognitive decline for a number of years and finally got an Alzheimer’s diagnosis in 2022, by which time she was in about stage 5 (there are 7). She had a LTC policy that had been in force since 2000.
Her husband (my husband’s stepfather) was in serious denial about her condition, but once he finally acknowledged it, his plan was to keep her at home with him as primary caregiver and hire in-home care as/when needed. To facilitate this, he purchased a unit in a 55+ community and had it remodeled with an extra bedroom and bath for a caregiver. We never thought this plan made much sense, but he didn’t ask our advice(!).
In fall of 2023, he finally admitted that he needed some help and hired part-time caregivers for about 15 hours a week. We helped him get the LTC claim activated; there was a 90-day elimination period that would end in late January of this year. The caregiver agency he used charged $35/hour, so at part-time rates, they were still under the monthly limits for LTC reimbursement (about $4600/month for in-home care).
Then right about when the 90-day period was up, he had a medical emergency and had to spend three days in the hospital. This was a crisis. He called us at 8 a.m. saying that he was at the ER along with my MIL and the part-time caregiver, who bless her heart, drove to their home early in the morning, drove him to the hospital, and stayed with my MIL in the waiting room for hours. But her shift would end at 2 p.m., and we, 400 miles away, were frantically trying to get the agency to provide extended coverage and/or to get a family friend to meet them at the ER so the caregiver could go off duty and my husband could either get on the next flight to LA or drive there. Thankfully, the agency came through and provided 24-hour coverage while he was in the hospital.
This was the wake-up call he needed that his Plan A (himself as primary caregiver) was full of holes. He’s 82 and has his own health issues, and the stress of caring for her wasn’t good for his health, either. He hired in-home care for about 80% of the week including overnight, but it was crazy expensive. If he’d gone 24/7, it would have cost $25K/month, of which the LTC would cover less than $5K. He never wanted to consider assisted living, but the sheer numbers involved finally convinced him.
She moved into a residential memory care facility in May and passed away three months later. The LTC policy paid enough ($8300/month) to cover 100% of her expenses for a private room in that facility. Until all of this, I had no idea that the payout was different depending on what kind of care and that in-home care costs SO much more than residential care. I would have thought the opposite.
As it turned out, her stay in assisted living was short. But her sudden passing in August was a bit of a fluke. She died of cardiac arrest, which is not typically how Alzheimer’s ends. She was 84 and could have lived for many years longer without that incident. Most people can’t afford $25K/month for possibly years on end. If you can, God bless you.
Thanks for sharing your experience. This is an eye opener. Most may not need in-home care that lasts months, but you can never predict.
As you said, LTC payouts for in-home care is very different compared to a memory care facility. I checked our policy documents and that is correct. Alzheimer’s care is the most expensive and can last a long time.
I was discussing this with a friend who manages several Assisted Living/Memory Care facilities. He told me the average life expectancy of folks who move into these facilities is less than 2 years. Families use in-home care for as long as possible, until it is too late.
“Significant support” is not the same thing as “round the clock care”. If you still have all your marbles and have trouble getting out, but can still limp around your place, then a daily carer is quite affordable. If you really need 24-hour care, then you should be in a nursing home.
Your point is correct. However, I have seen several families opting for in-home care costing more than $250K/yr. For them, going to nursing home was emotionally not acceptable.
That requires a family member to act as caretaker, at least to organize and oversee the in-home care and usually to do some of it. That is a huge burden in addition to the expense.
I prepared by moving to a CCRC, which will provide for my care even if I run out of money. I was living alone, and if I had needed in-home care I would have had to arrange for it myself. That’s not an alluring prospect if you consider that you would be in ill-health at the time.
My wife and I have very little experience. We would spend our savings on in-home care as long as we can afford it. This would reduce the amount our two children would inherit. It would take both of us to need multi-year in-home care to eliminate it. This is possible though unlikely (statistically). We have also both agreed that we would rather opt for assisted physician-assisted suicide rather be kept alive if we have a painful terminal illness. This would reduce the amount spent in some circumstances, further reducing the odds that our savings are wiped out.
The assisted suicide option only works if you live in the right state or are willing and able to travel to Vermont or Switzerland. It also doesn’t work if you have one of the dementia or Parkinson’s type diagnoses, then your only option would be Switzerland.
I understand. I also hope options expand over time. Thanks.
We have had some experience, but not a lot yet. A close family member had a stroke several years ago and I did the research. They did not have LTC insurance. I found in home care was much more expensive than an assisted living place, so the home was sold and the family member moved. The proceeds from the home are paying now. We haven’t gotten to the point yet where they have exhausted the savings that I know of. Other family members are managing that. Chris