JACKSONVILLE, Fla. - When aging parents can no longer care for themselves, having a conversation with them about their future is never easy.
Fortunately, there are people who have made it their life's mission to help you figure out what your loved ones can afford when it comes to their long-term care, and where they should spend their golden years.
When my dad turned 92 years old in August 2016, his suddenly failing health was a rude punch of reality.
Up until then, I had seen him as the strong, quick-witted police officer everyone in Trenton, New Jersey, knew.
But suddenly it was up to my sister and me to be his caregivers. We did our best until he passed away in January, but the crash course we received in elder care was eye-opening.
Senior living arrangements
Once adult children get a handle on their parents’ finances, it’s time to figure out what type of care they can afford.
My father soon needed more help than a home health aide could provide, and rushing to find the right fit, I learned there are differences between senior communities, assisted living facilities and skilled nursing facilities (nursing homes).
Simply put, senior communities are a place for older adults to live independently in individual homes or apartment-style living.
Assisted living facilities are mainly for those seniors who require extra care with daily activities, like help remembering to perform tasks, bathing and dressing.
When a loved one needs more specialized health care -- my father suffered from a stage-4 bed sore -- skilled nursing centers, also known as nursing homes, can fill that need.
To get an idea of what's available locally, I visited several assisted living facilities in the Jacksonville area.
Each provide independent living for seniors, as well as assisted living, and memory care services for those suffering from conditions like severe dementia.
Private-pay assisted living facilities
Watercrest Senior Living on San Jose Boulevard in Mandarin was a little intimidating when I walked in, with what seemed like a luxurious atmosphere -- from restaurant-style dining to salon and spa services on site.
Licensed nurses are also available to every resident 24 hours a day, seven days a week.
Renting a studio apartment there, which includes a kitchenette and full bathroom, starts at $3,500 a month.
If the price alone is a deterrent, Sarah Dymond, community relations director at Watercrest, said aging parents might already be paying that amount for the same services.
"You're going to have wifi. You're going to have cable. You're going to have a landline telephone, and all of your normal utilities are automatically included," Dymond said.
Many private-pay assisted living communities, like Watercrest, point to the total of all the monthly expenses parents might currently have -- like property taxes, utilities, home repairs, and transportation -- as comparable to the monthly rent they charge.
On top of rent, assisted living communities add varied pricing for levels of care and attention a loved one might need, starting at an additional $300 per month.
If that cost comparison still puts a facility like Watercrest out of budget, there are similar communities that might be more affordable.
Executive Director Harry Mangini gave me a tour of family-owned Astoria Assisted Living, a new community on U.S. 17 in Orange Park, just south of I-295 in Clay County, in the old Astoria Hotel.
It too provides extra amenities like a hair salon and fine dining, but the rooms at Astoria are less expensive.
Compared to the $3,500 starting price for a studio apartment at Watercrest, Astoria's pricing for a private room starts at a little more than $2,000 a month.
Another pricing difference between the two involves Medicaid, which Astoria accepts.
"Medicaid will only pay so much toward a room," Mangini said, "and it's easier for a Medicaid person to share a room to cover the expense."
A semi-private room in which a loved one shares an apartment with another resident decreases the cost even more, starting at $1,700 a month.
Once rent is covered at Astoria, a resident's short-term health needs can be covered by Medicare.
Home health aide
If the plan was to have a parent live with you when they can no longer live alone, the American Association of Retired Persons suggests that could still get expensive.
In an online article from October 2016, AARP calculated that to have a home health aide for 44 hours a week, or about six hours a day, would cost around $130 a day in Northeast Florida.
That’s nearly $4,000 a month, roughly the same amount to rent a room at Watercrest.
Finding the perfect place
My sister and I didn't have time to tour facilities before we had to place our ailing father. I wish we had.
Assisted living communities are popping up like wildfire all across Northeast Florida.
Seagrass Village of Fleming Island's Sales and Marketing Director Taylor Campbell said tours should never be scheduled ahead at any facility during the decision process -- just show up.
"You want to see the community in its daily action," she said with earnest. "And if you're a good community, you're always going to be in action, and you're always going to be on point."
Campbell said she is going to get a lot of flack from others in the senior living industry for sharing such important tips, but she said they are guidelines she has shared with her own elderly family members in their search for comfortable living quarters.
Seagrass Village is opening at the end of this year and will soon host independent living, assisted living, and memory care services. From the work trailer of the under-construction senior community, Campbell also said it's important to take note on how staff interact with residents as you walk around any facility.
"If you're taking a tour, and the sales person just walks right past somebody without engaging them -- it takes two seconds," Campbell said. "Not even to say hello -- that turns me off."
Campbell also said there might be times when certain smells inside assisted living facilities might not be pleasant.
"However, it shouldn't be ongoing later," she said. "It should be cleaned up ASAP and taken care of."
Campbell strongly suggested trusting initial instincts when on a tour.
"I tell people all the time that sit in front of me, if you don't get that warm and fuzzy feeling, please don't move in," Campbell said. "I want you to, but at the end of the day, you're going to see my face, our team's faces all day, every day, and if you don't feel comfortable, this is your home. This isn't the perfect place for you if you don't feel at home and comfortable around our team."
Planning financially for long-term care
My parents never discussed finances with my sister or me, saying it was personal and "none of (our) business."
It made me laugh when they'd say it every time we'd ask all those years ago.
It was not so funny last year when my sister and I suddenly had to review and digest decades of our parents' financial dealings to figure out how my dad could afford his mounting medical bills.
Elder care attorneys
No matter what a budget allows, senior financial experts strongly suggest planning early so you're not scrambling -- like we were -- to find the best fit for your parents in their golden years.
To help with that often awkward discussion, you might need to visit an elder-care attorney, like Vicky Bowers.
In Jacksonville, Bowers specializes in finding cost-effective ways to plan for a parent's future.
She said not discussing personal finances with loved ones can lead to confusion when it's time for adult children to make health care decisions.
"It's not always the way they think it is, and they're quite surprised sometimes that things are not set up the way they thought," Bowers said.
She said she has a secret weapon to help families break the ice.
Bowers rescued a border collie named Sadie after the dog was abandoned by its owner.
Sadie has free rein in Bowers' office, and it often helps older guests relax when the 13-year-old dog lies down at a visitor's feet, waiting to be petted.
One piece of advice Bowers shared was to name specific people who will oversee a parent's finances and health care.
"It's important, particularly for blended families, or if you have children that don't agree, or you're a single individual," she said. "It's really important to have that in place and in writing."
Bowers said the price to see an elder care attorney can vary from a flat fee of a few hundred dollars to an hourly rate, depending on how complicated the financial situation is for whomever is footing a loved one's health care bill.
"What we do for our elderly or disabled clients is very different than what we're going to do for estate planning for a young couple with toddlers," she said.
Financial help for veterans
If one of your parents was in the military, Joe Solsona has made it his life's calling to get veterans and their spouses the monetary benefits promised to them, which they might not know exist.
Solsona broke down the numbers for me.
"Right now, there's 22 million veterans in the United States," he said, shaking his head. "You add another 20 million spouses, that's 42 million. And out of that, there's only about 300,000 that hopefully are taking advantage of the benefits. It's a small percentage."
Solsona founded the National Association of Veterans and Families about 10 years ago, when his aging aunt was told there were no military benefits available for her, despite the fact that her dead husband served in the military.
It costs $9 a month to be a member of NAVF and have access to all of the services it provides.
Solsona's biggest advice: If you use any service organization to help your family find money due from the military, be sure the person you're working with is experienced.
"Are they doing it part-time? Are they full-time?" Solsona asked. "Are they strictly volunteer? Because learning how to navigate the VA, you can't learn from a book. It comes from experience."
Who's footing the bill?
Often adult children find themselves bearing the burden of paying for their elderly parents' care.
I was caring for young children while trying to figure out how to care for aging parents, so it's not an impossible task.
Local financial planner Jud Mallini of the firm Together Planning works with families to help them foot the bill, no matter their financial situation.
He stressed that it’s important for adult children to still put their own retirement needs first when considering financial planning for their family.
He also suggested getting to know a parent's financial situation before decisions for long-term care need to be made.
Mallini also provides several helpful websites he said he uses when helping his clients navigate through the process of caring for an elder:
- Northeast Florida's council on aging: https://www.myeldersource.org
- Northeast Florida Estate Planning Council: http://www.nefepc.org
My own advice
After making it through the emotional experience of having to remove a parent from the home in which they felt safest and most comfortable, you can't help but want to warn others about the challenges you encountered on that journey -- to save others from heartache.
Among the lessons I've learned throughout the process of caring for my dad before his death:
- Find someone you trust. Whether it's a doctor, an attorney, a nurse, or simply a friend or family member, find someone who can help you research the resources available for the elderly. Don't do it alone. I had my sister with me on this road. She handled the financial aspects, involving things like Medicaid and Medicare, our parents' bank accounts, Social Security and benefits. I took care of the emotional trek of talking to health-care workers while keeping daily tabs on dad's care, plus physically and mentally helping him leave his home to live in a nursing home.
- Develop a tough skin. Throughout the moves in and out of the hospital, rehab facilities and a nursing home, while health care workers I dealt with were kind and made sure I understood my options, they were also running businesses, and often called to find out how long they would have to "hold your father's room" because there was always someone waiting in the wings who also needed it.
- Live close by each other. If your elderly parents live far away, make plans to have them (or you) move to within an hour's drive of at least one of the adult children or someone who can care for them or be their advocate in person when decisions concerning their well-being are needed. It was physically, mentally and monetarily exhausting to help my parents as we traveled back and forth from Florida to their home in New Jersey.
This article doesn't contain all the resources available for seniors, but hopefully it gets you thinking and gives you ideas you might not have considered for caring for your aging parents. There's nothing worse than feeling all alone in this process.
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