Many people prefer to age in place at home when help is needed, rather than go to a care facility. The expenses of assisted living, memory care and home care are all quite high. The best of care at home is attainable, but at a price some don’t consider. Here are two case studies of families who will not allow their loved one to be separated from family and home, even as dementia creates a need for constant monitoring.
Loretta is 86 and was diagnosed with Alzheimer’s disease several years ago. She is able to engage with her loved ones and was living with a daughter since her diagnosis. But that daughter became frustrated as the mom got more difficult. Another daughter then took mom into her home. Mom is generally cooperative except when it comes to hygiene. At any attempt to clean her, she becomes very aggressive and combative. She kicks, bites, punches and yells at caregivers. She needs care 24/7 to keep her safe. The family has sold mom’s real estate, used her invested assets and all her cash to meet the $30,000 a month cost of maintaining her in her daughter’s home. Two of her daughters are with her around the clock to ensure that the caregivers from a combination of an agency and a private hire are able to do the job at the difficult moments. The daughters are devoted to their mother and are willing to be deeply involved, even with helpers around the clock onsite.
Bernie is in another category altogether. He is 76, ultra high net worth and has a palatial home as well as a country estate. He was diagnosed with dementia, cancer and Parkinson’s disease and is slowly declining. He can no longer make sense talking and is only sporadically aware of who is caring for him. His wife, June, has taken charge of managing his care with an extensive staff. Bernie is better cared for at the country estate home, as it is a smaller space and it is safer for the caregivers to manage him there than at the family primary residence. Two full-time caregivers together tend to him 24/7 and one relief caregiver fills in when the primary ones are off duty.
I interviewed June, a client at AgingParents.com about the costs of care for Bernie. She has needed advice throughout the process of caring for Bernie’s declining health and we have witnessed what she is responsible for doing, guiding her along the way. The caregivers do everything for him: bathing, feeding, dressing, toileting, walking with him and helping him get around in the house and grounds for short walks. June is spending $50,000 a month for the caregivers. That does not include groceries for the caregivers every day, laundry multiple times a day, increased utilities with all in the house using water, gas and electricity and her transportation back and forth from their primary residence to the country house every week. She is maintaining two households simultaneously.
For Loretta’s family, assets they have now will run out within a year. One daughter is very wealthy and can support the costs of care. She is reluctant, however, because it is her belief that their mother would be better off cared for “in a home”. She has no idea of the truth: a home will not accept a combative elder who is as difficult as Loretta is.
For Bernie’s family, the cost will be well within their means. Nonetheless, June reports that she finds it “shocking” that caring her her husband at home is so expensive. She will maintain him there until the end of his life.
For elders who want to remain at home to the end, care can certainly be delivered there. Some families hire helpers to live in with the elder for convenience and because transportation of caregivers can be an issue. Others have the caregivers on shifts, rotating responsibilities among them as they come to the home each day. Essentially, even if skilled care is needed, they can hire nurses to come to the home, and physicians can order needed equipment, such as oxygen, to be delivered.
Elders usually do better when family is present to oversee the care helpers offer. Being at home is a comfort, and familiar. Management of caregivers is a burden in itself for the spouses or adult children. That is a serious consideration.
- When the family can afford the expense, people who need full time care typically do better at home.
- Just about everything one could get in a nursing home for an aging loved one needing a lot of care can be delivered at home for a price.
- If family wishes to maintain an elder in their own home to the end of life, know the costs, the need for supervision and oversight of the team, and the need for family participation in the management of all.
- Be prepared for the real out of pocket costs and have the cash available for payroll, and the attendant expenses associated with having multiple workers in the home for an extended period.
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