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The least expensive AL I've found is $3,500/mo. & they told me Medicaid only pays $1,200/mo. in my state. My parent only gets $1,500/mo. from SS & pension.
I thought I was doing a good thing when I found out my ma was getting her social security checks redirected and lost 12 ,000$ I contacted S.S. took months on the phone got it all back and saved more money because she cashed out 401 K and now to much money. I didn't know that!!!.
My parents sold their home and cashed out their 2 stocks in order to afford Assisted Living. Then the VA kicked in with Aid & Attendance benefits for dad's wartime service as a soldier on the front line on Normandy Beach. That A&A benefit extended to mom after dad died, so together with their Social Security, the A&A benefits, and their savings, they spent ALL their hard earned lifetime savings of $450K (thanks mostly to the value of TWO stocks) to live in AL and then Memory Care for a total of 7 years.
That's how.
And if mom lived a few months longer than she did, I would have applied for Medicaid to fund her future care in a SNF since she had gone through all of her savings, sparing the taxpayers the need to fund her care while I squirreled away/hid those assets for my inheritance, as we hear about ALL THE TIME.
AL is for people who have finances to pay as self pay. If your parent only has $1500 coming in each month, you're going to be applying for a fed funded/state managed Medicaid NH bed. If bank account is over 2 grand, you'll use that money to self pay the NH to "spend down" that asset. You should be able to apply for the Medicaid online in your state. You cannot give away or "gift" the parent's money or property. One car won't count and a house won't count if you fill out the form saying he intends to return. You should probably call legal aid services in your area. It's very possible you could get free legal advice on eligibility and navigating the Medicaid process
Home does not have to be sold. See Elder law Atty. There’s ways to protect assets. You can write check to NH instead of NH taking all income. There’s the financial side & then caregiving part. Then you have to watch NH care (or lack of it) like hawk! I’m finding it just may be easier to leave LO at home. Skip the complicated paperwork! Hugs 🤗 Good luck & hugs 🤗
You will need to check with a cert. Eldercare Attorney who specializes in Medicaid with with your state's Medicaid Office. Each state operates differently. You are fortunate to live in a state where Medicaid will pay anything for Medicaid. In NJ it is very hard to find an AL that accepts Medicaid initially. You may find some that will accept Medicaid after you are a private pay for so many months (but you need to get that guarantee in writing and even then it may be null should the ownership of the AL change!) but they are very limited in number.
People who have houses/condos generally sell them and use the funds to support themselves in ALs (or better yet in well established non profit CCRCs) very much as if they were moving to a new downsized home. Those who have long term insurance (again, one has to look at what the insurance contract states) may get payment from that source (provided the company has not declared bankruptcy).
The sad truth is that most of us who don't fall into the previously stated groups will go into long term care facilities in shared accommodations because that is what Medicaid pays for in most states.
Unfortunately, the costs only go up from there. In the Midwest US, my Mom's private MC unit room is just <10k per month now.
All assets will need to be sold to cover the costs of their care until that runs out. Medicaid has a 5 year look-back on assets and will levy against any assets given away during that period prior to their qualifying for placement under that program.
This is the hard stuff. I hope that you and yours are able to get everything figured out and managed for the best possible outcome for your folks.
You hope your parents are rich, or you sell everything they have or they have long term care plans. If on Medicaid they move you to the not as nice area. Happened to a family member after living there for many years and paying top dollar. When her assets were gone and she went on medicaid they moved her to a room that faced the woods and was not as nice. She was so scared when they moved her. Sad.
As long as people are willing to sell their parents' homes to pay for care, the states and feds will avoid paying for elder care. What happens to people who don't have a home to sell? What happens to people who don't "plan" on their company going out of business, or their employer (large or small) laying workers off? What about people whose technologies disappear before they can retire? What about people who have disabilities that prevent them from working, but they are not on the list of qualified disabilities? Many people fall through the cracks of any safety nets that may exist. What about all the people who are forced to sign NDA's, and as a result lose their legal rights? This sight is only helpful if it removes the delusions and illusions of good people.
It doesn't matter how much your parent gets a month if you place them. The nursing home will take ALL of their monthly income then whatever it doesn't cover Medicaid does. If your parent owns property it will have to be sold and the money spent down on their facility care. Medicaid doesn't cover AL the same way they cover a nursing home. So if you have to work with how much Medicaid pays for AL with their income, find a cheaper facility or go with a nursing home.
Here in CA Medi-Cal will qualify you with these asset limits. Changed mid 2022 from a mere $7,000. meaning you had to have income of less than that per year to qualify. My Aunt fell JUST above the threshhold and was not eligible....until the allowed amt increased. Then she qualified to go nursing faciltity without having to "spend down". She was paying $6,100 mo out of her own savings for 4 yrs at Assisted Living due to dementia Check your state's Medicaid requirements.
Household Asset Limits for Non-MAGI Programs as of July 1, 2022 Household size Asset limits 1 person $130,000 2 people $195,000 3 people $260,000 4 people $325,000 5 people $390,000 6 people $455,000 7 people $520,000 8 people $585,000 9 people $650,000 10 people $715,000
We in California, however are unique in this. In all other states the assets allowed amount only to about 2-3 thousand plus one home one car. We are also, I think, unique in having only a 2 1/2 year lookback where others are still at 5.
Try other assisted living or Adult family homes? Adult family homes sometimes will take on lower paying residents in their mix. Or care for her at home? I believe you can get paid by the state for caretaking and then bring in caretakers, volunteers and family nembers to help, so you don't get burned out.
We did that with MIL...she wanted to die at home. Family began taking care of her,but it was too much. Brought in At Home Healthcare to the tune of $24 hr....$600 per 24hrs...$4200 per week...$16,800 month. She was in hospice during this time with glioblastoma brain cancer, so only lived for 6 weeks. But it took a toll in every aspect for my FIL. No reimbursements from anywhere.
Apply for Medicaid for your parents. However if your parents have any assets more than $2k, they will not be eligible for Medicaid. Also, Medicaid has a 5 yr “look back”. In other words you can’t just give assets away…Medicaid will check and they look back as long as 5 yrs.
Please consult an elder care attorney in your state…many rules go by state, so some info that may be posted here, could be different in your state.
its sad. i only have a high school dipolma and i didnt make enough money to put away for this. i own a house but will now give up so i have a medicade funded nursing home. staffing is a issue in these places. you wait for changing of clothes and a shower from the employees. if you develop bed sores you get to go into a hospital until it heals. if it doesnt heal, you get a infection and you die.
You should not be the one to pay. You will need to save for your own retirement throughout your entire life in order for your own child not to send this question to a Forum. You only can afford this with a comfortable cushion of savings on top of Social Security. If that doesn't exist then there must be the spend down to whatever number the state requires to give medicaid help and your choices will be terribly limited, with very little likelihood of any ALF or MC. Just the typical nursing home, which is none too good a choice. This is the sad fact, and why so many struggle to attempt to caregive their elders which is a nearly impossible thing for their own lives.
You don’t want to extend your life …. because of $? … or… Because your kids won’t have as much, or they’ll be invonvenienced? Or is it because people will write on some forum about the pain of putting you in a nursing home?
My parents sold their townhouse to afford IL and then AL. My mom passed while in IL and my dad lives in AL now. He pays about $5k a month, but both his Social Security and pension plan offset the cost and he has plenty left from the sale of their townhouse. I think selling their townhouse is a better option over Medicaid. If they don’t have a home to sell, then I guess Medicaid is an option or hiring part-time home care which is super expensive. Meals on wheels and help from church members. It’s daunting if you can’t figure out a way to afford it and then once they move to IL or AL, you will quickly discover all the additional costs and shenanigans these owners try to impose. The owners make millions but no one else does. The caring staff get screwed as do the residents monetarily. In the end, if you can afford a good AL that you have researched, your parents will receive better care and safety more than you could ever supply. They will have food, shelter and 24/7 safety plus additional services such as exercise programs or a visiting doctor, onsite therapy-all of which Medicare covers. And skilled staff which is more than the average person can provide. But you pay for it-yearly for rent increases and at any time for increased care as they have levels of care. If your parents are outgoing, they will do better. If your parents are more introverted, they will struggle a bit. Plus, just like anywhere, there will be peer pressure. I apologize, I veered from the topic. I hope you can find a sustainable way to help your parents.
We had to sell moms house. It was not paid off, but she had $50,000 in equity in the home. I pulled from that and added it to her pension. She has not run out of money and we have moved from private pay into a Medicaid accepting facility. It's awful, but it's the best I can do at the moment. We are Medicaid pending....hoping it will kick in soon. I have no idea how much that will cover.
Is either a veteran? My dad was retired military and we worked with the VA counselor to get full disability. This pays for a lot in addition to his SS and pension. He was also a saver so has money set aside to supplement.
Being a Veteran is a great answer, but you still have to qualify with the amount of income and assets. My father was a veteran but bc my gfather left money to my mother, she had too many assets and did not qualify for Veteran Benefits for MC.
If either of your parents are veterans, start first with the VA to check on Aid and Attendance.
I'm sorry this won't help your parents now, so my suggestion to you and everyone else is start now planning for yourself. Contact an eldercare attorney and see if a trust is appropriate to hold assets and your savings to be better prepared and have more choices if the time comes. In our state Medicaid has a five year look back and VA has a three year look back. Our trust has only been in effect for almost 3 years so I hope we have no immediate needs. Our intent is not for our family to have it after we are gone. We are trying to make the most of what we do have and not have to immediately get rid of everything to qualify... especially if one of us never needs a nursing home. Many facilities, if you can come in as private pay, will keep you if you later qualify for Medicaid. As others said, once on Medicaid you are allowed to have very little yet there are still expenses not covered... we will still need clothes, personal care items, etc. from time to time. In our case, my husband is at a higher risk so I also want to protect our assets, if I should die first, that no one comes in and takes advantage of him.
The VA process for this meager aid amount is outrageously tedious and over complicated. Your loved one Will likely die before it’s done and approved. We started last week. They’re asking for every legal or money doc ever received and your first born child to give my COMBAT veteran, already qualified on 100% war related disability, the additional $1300 he’s entitled to by law AND AND!!! Once they get every scrap of paper perfectly filed in triplicate it will take 9-12 months to approve. Start that paperwork now. They may not outlive the VA BS
I echo the advice about getting with a licensed eldercare attorney familiar with Medicaid applications in your state. Your area agency on aging may have recommendations as to who to contact. And there are many steps to navigate through all of which can be complex and confusing.
You mentioned "parents" -- if your parents both need nursing home care that is different than if just one needs this. Medicaid has various rules -- so-called spousal impoverishment protections -- that may be put into play to protect some assets for the one spouse NOT in need of nursing home care. If both need NH care, then that is an entirely matter and yes all assets (home, IRAs, 401Ks, stock/bonds, car -- any tangible asset) needs to be spent down so that the asset and income level is below the level your state requires (may be something such as a total of $2K to TOTAL assets). One can pre pay funeral expenses, pay the elder care attorney from any revenue from selling assets; but ONE cannot give away, gift, hide any such funds or assets. One may also pay the nursing home privately as part of the spend down process.
Meeting the income and asset tests to qualify for your State's long term nursing home coverage through Medicaid is one part. The other part, is that your loved one (or perhaps both parents) must demonstrated they meet your State's Medicaid "level of care" necessary for long term nursing home care. If they are relatively healthy, independent, can handle safely and independently all their activities or daily living (toileting, showering, dressing, feeding themselves, walk or "transfer" if using assistive devices such as a wheelchair) and handle safely and independently other independent activities (manage finances, go shopping, prepare meals, manage their own meds) they may NOT qualify.
Assistive living (ALs) is generally for "more independent" individuals who may need some general help (cleaning, dressing, showering, food prep) but are still rather independent and likely do not yet have severe cognitive issues. Some ALs that are "higher level" may provide help with Medication Management and some other things but they are NOT "skilled nursing facilities/SNFs" that can handle other actual medical-type services. SNFs generally are for those further along in their decline physically and cognitively/mentally and need a lot of hands on help with most if not many activities of daily living and can no longer really handle the other actives such as financial decision-making, health-care decision making, cooking/meal prep, driving, dressing, on and on and have a range of medical conditions including perhaps dementia.
Yes, some State Medicaid program have waivers to pay for AL but there typically is a long wait list. Ditto for Medicaid-paid aides to come to one's home to help. But these aides (Medicaid paid or private paid out of your pocket) are NOT FULL time. Most come only a couple of times per week for a few hours. Of course one can pay private agencies to send aides for daily help or even 24/7 help but that ends up costing more than AL generally.
The eldercare attorney can help you w/this as well as get all the paperwork in place, such as a durable POA, medical POA, advanced directive, etc. So you can help take over on these things as needed. PS also set up everything (all accounts) on line so you can process paperwork moving forward, as there are lots of docs Medicaid will require for the application as well as the annual "redetermination." YES this is all very expensive and most people have no idea or no way to pay for this on their own.
We have an Aunt in NY city who has 3 aides 24/7; one for the entire weekend and the other 2 split 12 hour sifts M-F. It costs $6K a week, or $24K for the month; more than AL. But Auntie has millions, no adult kids to leave it to; the family decision was blow it all on 24/7 care so she can live her last days in her huge/familiar 3 bed condo, she is 96. Any left $ charity gets.
"I am caring for my mother PJ, who is 83 years old, living in my home with anxiety, depression, diabetes, hearing loss, heart disease, and urinary tract infection."
Does she live with you? Does she have any assets?
How did you come to be her caregiver? Sounds like it might be getting to be too much for you?
There are elder care legal advisors free of charge. It’s not as convenient but nothing is when no plans were made for possible financial burdens. This is why we need insurance for cars, houses, health etc… Long term care insurance is a joke and it’s better to self insure by saving early on. Parents who don’t do this will place the burden on their children to take them in or fall into the Medicaid category which doesn’t give them many options. Those options are usually not the most appealing. You will have to sell all their assets if they have any to help pay for the exorbitant cost of elderly care. I have friends that did have to take in their parents because they had no money or didn’t want them to go into a Medicaid nursing home. Medicaid nursing homes are awful here in FL. You are stuck between a rock and a hard place when parents don’t have the financial resources for their care later in life. I have one grown son and I know damn well I need to plan and save for my care if needed. I will not depend on him to take on the financial cost of my care. I have peace of mind knowing I will be in a decent facility with my savings and investments.
the nursing home industry has changed not for the better since covid no matter how much or how little money you have. if you dont have enough aides you suffer. most places have 1 aide per 10 12 patients. no one wants to do this kind of work since covid. you dont get showered or changed on time and you the patient, suffers,
I can tell you this in our state if they are in a nursing home the average cost per day is about $260 but this is for a single. My BIL is in a nursing home and we are getting him back on Medicaid we had to spend down his financials until he is under $2000 the Medicaid allows you to keep that for them.
But on the social security and pension Medicaid takes all of that but $50 that is what you have left to pay for any bills. I just learned this when we were working to get him on Mediciaid. So after 2 months and 4 days I had to pay $15,637 to the nursing home for him. We have spent down his financials now he will have to pay his social security and pension to them and they will leave him $50.
That is where family comes into help with items they need. I know this because his family came in and got him a mini fridge because he likes his diet pepsi and his snacks. I can't do it all because of limit funds he has I am his representative payee for social security and I am on all his accounts no POA because he likes control of his money.
In a nursing home they still can go out and enjoy what they like to do but if they need help its there for them. My BIL still goes out with family members.
I would look into a nursing home that has memory care because if they would need it later in life its a blessing to have it in the same place. My BIL is in memory care in a nursing home.
Isn't there a limbo situation from independent status to an AL to get Medicaid? Too limited to stay independent but still unable to move to AL due to lack of sufficient income. Once on NH condition, Medicaid pays after the asset spendown period.
You have to play the Medicaid game. This won't work for most assisted living facilities as most don't take Medicaid, but nursing homes do take LTC Medicaid. Your parent will easily qualify based on the income. Whatever savings he/she has needs to be spent down (on his care) until the amount left in the bank account is under the state's limit for Medicaid qualification. The catch is your parent also needs to qualify Medically for NH care. You need a SW and a physician to recommend NH care for your parent.
For my mother’s NH care, she used a long term policy that she and my dad had bought, combined with her Social Security check. The policy proved to be a mistake as it was completely exhausted in about a year. All it accomplished was shortening the time until something else had to be done. She was private pay from their savings briefly until the Medicaid process was completed, and from then on the NH was paid through her SS and Medicaid.
Thank God my parents saved and saved and have plenty of money now that they need it for their care. Able to live in a beautiful AL instead of a horrible Medicaid funded place. They didn't rely on any of their 4 kids for this day. I'm very lucky my parents were good with their money.
Call your county office of aged and disabilities. They will give you good guidance.
use your loved ones assets.
in my area , if you self pay for a time period , the AL ( that accepts Medicaid) will keep you when you go on Medicaid. This is crucial knowledge. I would have insisted my mom move sooner to my state if I had known. I was fortunate, our care advisor from care patrol was able to get my mom into a place that waived the year requirement ( she had about 10 months of funds) better places required 2 or more years…
get yourself a care advisor who lives in the area, who can meet with you. These people are invaluable. They are like a real estate agent who gets paid by the placement facility. They know what’s available, cost , your needs, reputation etc. if your not ready , that’s ok , be upfront , the care advisor still will educate you for the future…
By proceeding, I agree that I understand the following disclosures:
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Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
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APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
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That's how.
And if mom lived a few months longer than she did, I would have applied for Medicaid to fund her future care in a SNF since she had gone through all of her savings, sparing the taxpayers the need to fund her care while I squirreled away/hid those assets for my inheritance, as we hear about ALL THE TIME.
Good luck & hugs 🤗
People who have houses/condos generally sell them and use the funds to support themselves in ALs (or better yet in well established non profit CCRCs) very much as if they were moving to a new downsized home. Those who have long term insurance (again, one has to look at what the insurance contract states) may get payment from that source (provided the company has not declared bankruptcy).
The sad truth is that most of us who don't fall into the previously stated groups will go into long term care facilities in shared accommodations because that is what Medicaid pays for in most states.
All assets will need to be sold to cover the costs of their care until that runs out. Medicaid has a 5 year look-back on assets and will levy against any assets given away during that period prior to their qualifying for placement under that program.
This is the hard stuff. I hope that you and yours are able to get everything figured out and managed for the best possible outcome for your folks.
If your parent owns property it will have to be sold and the money spent down on their facility care.
Medicaid doesn't cover AL the same way they cover a nursing home.
So if you have to work with how much Medicaid pays for AL with their income, find a cheaper facility or go with a nursing home.
Check your state's Medicaid requirements.
Household Asset Limits for Non-MAGI Programs as of July 1, 2022
Household size
Asset limits
1 person
$130,000
2 people
$195,000
3 people
$260,000
4 people
$325,000
5 people
$390,000
6 people
$455,000
7 people
$520,000
8 people
$585,000
9 people
$650,000
10 people
$715,000
No reimbursements from anywhere.
Please consult an elder care attorney in your state…many rules go by state, so some info that may be posted here, could be different in your state.
because of $? … or… Because your kids won’t have as much, or they’ll be invonvenienced? Or is it because people will write on some forum about the pain of putting you in a nursing home?
This is disturbing indeed.
I'm sorry this won't help your parents now, so my suggestion to you and everyone else is start now planning for yourself. Contact an eldercare attorney and see if a trust is appropriate to hold assets and your savings to be better prepared and have more choices if the time comes. In our state Medicaid has a five year look back and VA has a three year look back. Our trust has only been in effect for almost 3 years so I hope we have no immediate needs. Our intent is not for our family to have it after we are gone. We are trying to make the most of what we do have and not have to immediately get rid of everything to qualify... especially if one of us never needs a nursing home. Many facilities, if you can come in as private pay, will keep you if you later qualify for Medicaid. As others said, once on Medicaid you are allowed to have very little yet there are still expenses not covered... we will still need clothes, personal care items, etc. from time to time. In our case, my husband is at a higher risk so I also want to protect our assets, if I should die first, that no one comes in and takes advantage of him.
You mentioned "parents" -- if your parents both need nursing home care that is different than if just one needs this. Medicaid has various rules -- so-called spousal impoverishment protections -- that may be put into play to protect some assets for the one spouse NOT in need of nursing home care. If both need NH care, then that is an entirely matter and yes all assets (home, IRAs, 401Ks, stock/bonds, car -- any tangible asset) needs to be spent down so that the asset and income level is below the level your state requires (may be something such as a total of $2K to TOTAL assets). One can pre pay funeral expenses, pay the elder care attorney from any revenue from selling assets; but ONE cannot give away, gift, hide any such funds or assets. One may also pay the nursing home privately as part of the spend down process.
Meeting the income and asset tests to qualify for your State's long term nursing home coverage through Medicaid is one part. The other part, is that your loved one (or perhaps both parents) must demonstrated they meet your State's Medicaid "level of care" necessary for long term nursing home care. If they are relatively healthy, independent, can handle safely and independently all their activities or daily living (toileting, showering, dressing, feeding themselves, walk or "transfer" if using assistive devices such as a wheelchair) and handle safely and independently other independent activities (manage finances, go shopping, prepare meals, manage their own meds) they may NOT qualify.
Assistive living (ALs) is generally for "more independent" individuals who may need some general help (cleaning, dressing, showering, food prep) but are still rather independent and likely do not yet have severe cognitive issues. Some ALs that are "higher level" may provide help with Medication Management and some other things but they are NOT "skilled nursing facilities/SNFs" that can handle other actual medical-type services. SNFs generally are for those further along in their decline physically and cognitively/mentally and need a lot of hands on help with most if not many activities of daily living and can no longer really handle the other actives such as financial decision-making, health-care decision making, cooking/meal prep, driving, dressing, on and on and have a range of medical conditions including perhaps dementia.
Yes, some State Medicaid program have waivers to pay for AL but there typically is a long wait list. Ditto for Medicaid-paid aides to come to one's home to help. But these aides (Medicaid paid or private paid out of your pocket) are NOT FULL time. Most come only a couple of times per week for a few hours. Of course one can pay private agencies to send aides for daily help or even 24/7 help but that ends up costing more than AL generally.
The eldercare attorney can help you w/this as well as get all the paperwork in place, such as a durable POA, medical POA, advanced directive, etc. So you can help take over on these things as needed. PS also set up everything (all accounts) on line so you can process paperwork moving forward, as there are lots of docs Medicaid will require for the application as well as the annual "redetermination." YES this is all very expensive and most people have no idea or no way to pay for this on their own.
We have an Aunt in NY city who has 3 aides 24/7; one for the entire weekend and the other 2 split 12 hour sifts M-F. It costs $6K a week, or $24K for the month; more than AL. But Auntie has millions, no adult kids to leave it to; the family decision was blow it all on 24/7 care so she can live her last days in her huge/familiar 3 bed condo, she is 96. Any left $ charity gets.
Does she live with you? Does she have any assets?
How did you come to be her caregiver? Sounds like it might be getting to be too much for you?
on time and you the patient, suffers,
But on the social security and pension Medicaid takes all of that but $50 that is what you have left to pay for any bills. I just learned this when we were working to get him on Mediciaid. So after 2 months and 4 days I had to pay $15,637 to the nursing home for him. We have spent down his financials now he will have to pay his social security and pension to them and they will leave him $50.
That is where family comes into help with items they need. I know this because his family came in and got him a mini fridge because he likes his diet pepsi and his snacks. I can't do it all because of limit funds he has I am his representative payee for social security and I am on all his accounts no POA because he likes control of his money.
In a nursing home they still can go out and enjoy what they like to do but if they need help its there for them. My BIL still goes out with family members.
I would look into a nursing home that has memory care because if they would need it later in life its a blessing to have it in the same place. My BIL is in memory care in a nursing home.
Prayers
Average 5k a month each West Coast of Florida.
They planned that is the key or as my father said "If you do not have a plan, you plan to fail".
use your loved ones assets.
in my area , if you self pay for a time period , the AL ( that accepts Medicaid) will keep you when you go on Medicaid. This is crucial knowledge. I would have insisted my mom move sooner to my state if I had known. I was fortunate, our care advisor from care patrol was able to get my mom into a place that waived the year requirement ( she had about 10 months of funds) better places required 2 or more years…
get yourself a care advisor who lives in the area, who can meet with you. These people are invaluable. They are like a real estate agent who gets paid by the placement facility. They know what’s available, cost , your needs, reputation etc. if your not ready , that’s ok , be upfront , the care advisor still will educate you for the future…