Independent vs Assisted Living; any thoughts on these two options?

I'm sorry to read about your mother and stepfather's situation. It's great you and your siblings want to help. First, I would check with an Elder Law attorney before providing them funds though. Your mother may want to consult with an attorney for asset protection, since placement for your step father may be needed .Qualification may depend on assets, and I would avoid inflating those until things are reviewed and she knows where she stands financially. I'd also make sure that she and your stepfather have signed Healthcare POA, Durable POA and Advance Medical Directives. It's imperative to get those, if they are still competent to sign them.

Does your stepfather have a diagnosis? His aggressiveness, dementia (as listed in your profile) and immobility may mean he needs much more care than an AL. States vary according to what they allow in an AL, but, unless it's a Memory Care facility, I'd wonder if he would need a higher level of care than a regular AL. Having low mobility, dementia and blind..... Also, your mother continuing to care for him, under the circumstances......would concern me. Caregivers sometimes die before the person they are caring for dies. It's very stressful and exhausting. She may downplay this, but, it's far too much for one one person to do around the clock, especially someone in her age range.

Are you able to discuss things with your stepfather's doctor? I'd likely explore getting a professional assessment. This would determine what level of care he needs, such as nursing home or Memory care. A representative at a facility may be able to assist with this as well.

Covid makes this so much more difficult, but, it sounds like your father's care is very challenging about now. I hope you can find some help for them. I bet you'll get some more responses and ideas as well.

Your mother's plan is a good one. Begin to check out the cost of assisted living in your area. She should not be in the care of your stepdad now, and she will be injured and then they will both need care. See a good elder law attorney to arrange for what they have and what costs will be. It varies greatly. One room in facility where my bro was, dependent on level of care needed was about 3,000 for the room and from 400 for independent to several thousand for needing care. This is So. California. So costs vary a lot. You need to go to one of the services that takes you to facilities to visit, and Mom should accompany you.

My opinion, your SF needs more than an Assisted Living if he is showing signs of agression. ALs are for people who need some assistance with daily living. They are not equipped for people who have agressive tendencies. Memory Care maybe more suited.

There are Care communities that you start out in Independent living. working into AL and the LTC. One spouse can live in IL the other in AL or LTC.

Before you make any decisions you may want to protect Moms part of the marital assets. Medicaid allows that. Then SDads half (or whatever) is spent down leaving Mom as a Community Spouse and able to stay in her home and pay her bills. Just my opinion, but Sdad maybe better in a ice LTC facility with all his problems.

Find an elder lawyer near you who is well versed in the Medicaid laws for your State and consult with him.

Stepfather wouldn't qualify for any AL or IL facility. He needs memory care or skilled nursing, and Mom will need to either stay home or go to IL or AL. Her staying home would certainly save money.

Independent living is just that. Independent. It is in an apartment arrangement. Usually some meals are provided and housekeeping comes once a week. There is no care provided. Your mother would need to care for him or hire in care. My in-laws started in independent living because mr FIL thought he was fine and he was about to care for her. But she was ambulatory. It lasted 4 months with more and more support from us. They moved right to memory care. He will need a long term care facility. Possibly memory care would work but he physical needs may mean they won’t accept him. Get the financial ducks lined up and the legality of whether she can place him. They might not like the idea but there plans went out the window when he had a stroke and became disabled. She should enjoy her years of being healthy.

Check into board and care homes. There are literally thousands in Phoenix.

This would allow them to stay together if they choose and if not, it is a cheaper care alternative to big facilities.

Instead of presenting this as a choice to SD your mom should present it as a fact. We are moving and that is that. She can stay with him or go home, her choice.

Have his doctor prescribe something to calm him down. The aggression can be a problem in any facility, so it is best to get that dealt with before any move.

Maricopa county counsel on aging can help you find the resources available for aid and finding a facility that meets the need.

Best of luck getting this dealt with so your mom doesn't become a statistic. 40% of caregivers die before the person they are caring for, maybe he can comprehend that and hopefully he loves her enough to get professional help.

I agree with your mom..she is telling you quietly she has had enough. .Put him in assisted, let her visit. My mom needed a hospital visit for the medical staff to see the level of care she needed. The minute she displayed a medical problem I took her to an ER. and they told me..she “needs assisted care”.....that then over rode moms inability to realize it was time for assisted. She is sooo much better there..stronger and well cared for. It has been a rough decision indeed. A man who has put her hands on her needs to live elsewhere before she gets hurt! There is no “little violent“...he IS violent!!

My single sister lived in independent living in AZ actually before moving to my area last year. Sis was having more and more trouble managing her meds, caring for her cat, laundry etc. She liked her larger apartment in AL area of the complex. There are companies that can come in separately or as add on services to most of the retirement communities. We were able to keep assisted apartment for a short time with to care for cat, manage meds provided through home care company-who provided services to many clients in the community complex. Sis had a housekeeper friend who came in to keep her apt. clean and manage laundry. Eventually we moved sis to assisted/memory care until that was not working for sis when she was having even more troubles.

I have heard of couples having 2 small apartments in same complex-one assisted one memory care-that would involve big bucks unless you got a studio size for each-might be less than a full size apartment in memory care.....Now my parents have 24 hour home care is also big big bucks but mom can not physically care for dad-bathing, med management etc. Mom has some problems too but not as complicated as dad. Having people in their house all day every day is also making my mom a little-lot crazy as most of the time care givers are messing on the phone in between pill time, meal time, bath time......care provided by agency has been spotty at best-not consistent care, leaving dad unattended in the bath tub, on the toilet and he fell.

Nothing, i mean nothing is going to be perfect care all day every day-while knowing 24 hour care provided by one family member is nearly impossible. Some posters have done 24 hour care at a huge emotional and financial cost to their own lives, family, sanity.

I looked into adult day camp for my sister along with bringing her here to my house-transportation was provided to and from-might be something available in your area as a temporary measure until a more permanent solution can be found. At the last minute we got a call from a community that seems to be doing a good job at working with sis -she finally is in a good place and we all have some peace of mind

My mother-in-law had round the clock home health care aides until we could find a caregiver. Then, she went to an adult day program and had a caregiver for when she was at home. With COVID, she has 2 live-in caregivers - 1 for day and 1 for night. Having caregivers in the home is less expensive than full time residential care.

You need to consult a doctor about your father's night pains. Seems he needs a better medication plan that addresses his evening pain. I know your mom wants to be there for your father, but she may need to sleep in another room to get enough rest for herself. If she had a caregiver, home health aide, or sitter - they would be up to take care of your father's needs while your mother rests.

If your father is not expected to survive this cancer journey, please consider hospice care. It is usually covered by insurance.

I think you're mom deserves some time for her after 20 good years of caring for him. I would NOT put her in an assisted living or independent living since she is able to enjoy her own home. I've seen that many times in facilities, and it's rarely a happy situation for the healthy spouse.

Based on the care needs you stated, an assisted living is probably the better option than independent, unless you want to provide private caregivers for him several hours a day and perhaps overnight in independent. If there are no acceptable AL's, then maybe for the first 6 months, spend the money for 24 hour care in the independent living to give him the best care and let him ease into it. We did 24/7 private care for my parents in independent living, as the apartments were better in IL vs AL.

Depending on where you live, for experienced private caregivers (not part of an agency) you'll spent $17-22/hour. An agency will run you about $23-28/hr. I've had much better experiences with independent private caregivers, than agencies, but I don't want to generalize.

Good luck, and bottom line, don't have your mom leave her home.

Did your step-father actually become violent or..did he grab her shirt because he was...
trying to communicate?
Wanted her to stay with him?
Just wanted contact?
My Husband was also non verbal and he would sometimes grab a sleeve of my shirt, or a towel I was holding and I would stop and hold his hand for a bit and he was fine.
Or was your step-father angry at the time he grabbed her shirt?
I guess there is "grabbing" a shirt or "grasping" I guess in my mind it is different.

It is possible that he would qualify for Hospice. If that were the case she could get equipment that would help.
When things improve Volunteers will be able again to visit patients and then mom could get out of the house.
I would also request a Hospital bed, it would make caring for him easier and it would not wake mom in the middle of the night if they were in different beds. My Husband would not have liked the idea of 2 beds so I pushed the hospital bed up to our bed and made it up to look like 1 bed, he never had a problem and I did not have to worry about waking in a puddle and dealing with washing waterproof mattress covers!
Getting caregivers in to help mom out and let her get out of the house is important. If he is resistant she should just tell him that the workers are there for HER not him. They can ease into doing more as he gets used to having "strangers" around.
If he is a Veteran check with a county Veterans Assistance Commission or the VA and find out if he qualifies for help from the VA. Even a little help is help.

Back to Assisted VS Independent.
It does not sound like he would qualify for Independent Living so at this point Assisted would be the option.
Many have requirements that they can not use "equipment" to lift or transfer someone so if 1 or 2 people can not do it he would not qualify for Assisted it would go to Skilled Nursing. The exception to this might be some Memory Care facilities, if a person enters being able to stand or transfer, or if staff can handle transfer and the person declines they can use equipment due to the decline.

And price the differences between in home care and facility care. Many facilities will increase fees as a person declines and they have to do more work.
Using equipment in the home can make keeping someone at home easier, more affordable BUT you have to take into consideration the toll it takes on the primary caregiver even with help it is difficult.

In home care costed us about $500 per week. And that was for 5 hours & thru an agency so I could go to doctor appts. If you had both in the same Home - typically, one would stay in AL and the other in Memory. They can still eat together, etc, but she could come and go as she pleases. Depending on his level of care needed, they could stay together with him having additional care. This is not only a difficult conversation, but also hard on the day of the actual move. Unless of course they're in agreement.

Frankly, it sounds like you father's health has deteriorated to the point where even "assisted living" might be unrealistic - especially if he has experienced behavioral issues and mental status changes. A person who has violent outbursts is not a candidate for assisted living.

"Assisted living" means that a person only requires some assistance with their ADLs (activities of daily living) such as bathing, dressing, and medications. But other than that, the person is supposed to be independent in their small apartment. It does not sound like your father is a candidate for that type of arrangement.

I only see two options: hire several hours daily of care for him at home so your mother can get away periodically, or place him in a nursing home.

HI... Independent Living.... you have larger living quarters BUT... you also have a stove. You have NO ONE to help you with your medications or really check on you from day to day. Independent living also offers you your meals but YOU have to get to those meals yourself. NO help is provided. You have a place to drive your car so you can have a car. Also. you have a washing machine and dryer. You pretty much do your own laundry. You may have someone come in from the facility and do some cleaning... they come once per week but you have to do most of your OWN cleaning. NO one helps you with day to day activities of daily living --showering, shaving, brushing teeth, going to the bathroom, etc. Assisted Living---no stove to turn or leave on as some of my patients have done. They had turned the stove on and left it on. FIRE HAZARD. There is no washing machine/dryer. The staff assists with getting you there for meals, they assist with showering but most of the time THAT is limited help. Staff does your medications for you. They do your laundry. In Assisted Living, they usually require their patients to show up for meals every day unless there is a good excuse like "not feeling good"... illness. Patients in AL have no cars so they are no longer driving. AL patients need help so this is the best option when your loved one can no longer "do their meds".. need assistance with activities of daily living. I hope this helps. GOD bless.

The key phrase you're looking for when you research facilities is "continuing care." Facilities that offer this mean that the level of care is flexible and increases in line with a given resident's needs; they are also adaptable to the needs of married couples who want to stay together, and should be open to including your mother in as much hands-on care as she is willing and able to engage in.

Does your stepfather not have any concerned family members on his own side? Is he alone in the world apart from his wife's connections?

Just pasting part of Sunnygirls reply (the whole lot was awesome);
"Are you able to discuss things with your stepfather's doctor? I'd likely explore getting a professional assessment. This would determine what level of care he needs, such as nursing home or Memory care."

I agree. If his care needs are past IL & AL already (or borderline) - best to find this out early. If so, an 'aging-in-place' type may work? Where he has MC/SNH room & Mom has an IL unit. They can spend the day together, meals together & if they like, sleepovers too but she can be relieved of the heavy work & socialise too.

I would love this set-up for my folks. Still together-ish but much less burden.

It might depend on where you live as to what the terms "assisted living" and "independent" mean. My mom is in an assisted living apartment in a facility that has aides on staff, a dining hall for those who don't want to cook and many features that allow for independent living. However, her apartment has a small kitchenette with stove. She has chosen not to use it though. My in laws were also there for a time in a one bedroom style.
Mom is 96 and has had a couple falls so now the "assisted" part kicks in. The aides come twice a day to give her her meds (she's nearly blind) and her meals are brought to her. She also gets an assist with her bathing.
If I were in your shoes (and I was once) the best bet would be to call local (to your parents) senior services, tell them what you told us and see what information they can give you. Good luck, it's not an easy journey.

There are some issues that you can explore before having to make a decision. Consider some of the advice already given, but I would recommend at least the following:

1) full medical assessment of his capabilities and needs*
2) consult with EC atty to determine the best financial course
3) check out various facilities and home care options

Knowing what his needs are would be first on the list. There may be medications to help with his aggression and/or pain, but even then given what you have said, IL would most likely NOT be a place to relocate him. This would basically just be a place to replace the home they are in now, and that doesn't seem to be working. Certainly help can be brought in, but that can be done in the home as well. AL *might* be an option, but it sounds like he would be beyond their capability. As others noted, AL is more geared towards those who are still somewhat independent, but need some assistance with ADLs. As with IL, it sounds like he is beyond the AL option (varies by facility - you'll have to check with each place considered.) I have no experience with care homes - those could be an option, or it may need to be MC (some NHs have MC units as well, if he needs more skilled care than regular AL/MC can provide.)

Consult with EC atty is recommended (check naela.org to locate several in your/their area using zip code.) Many offer a first time limited consult. They can make recommendations to help preserve the home and finances for your mother. If they can't afford the EC atty, you and your siblings could contribute to that cost to help them out. Unless there are no other options, you shouldn't be using your own funds - if your circumstances change (job loss) or your own needs escalate, it could jeopardize the situation and/or your own retirement for all of you!

Every facility has different offerings and costs. Even the home care can vary wildly, but it is NOT always less expensive. Guesstimate for 24 hour care at $25/hr (costs vary a lot by region!) would be $18K per month. This is about $10k more per month than our mother's MC cost. If he remained in the home and mom could use less than 24/7 help, it would defray costs, but she would still be tied down, somewhat, and depending on how many hours/time of day, it could still end up costing more than a facility.

Get informed (his medical needs, legal options, financial situation) first, then explore any/all options that would work and proceed from there. Temporary assistance in the home might help mom some now, while you gather information.

*something not mentioned here yet - he should also be checked for a UTI. UTI's can present in bizarre ways in people, more so in elders and definitely in those cognitively challenged. Given he is non-verbal, it is possible the aggression (and maybe some of his pain) could be related to a UTI, especially if this is new behavior. It is a simple, inexpensive test, and can quickly rule out UTI as the cause. Mom's first UTI at MC resulted in some really severe sun-downing, totally out of normal behavior for her! Subsequent UTIs have presented as night-time bed wetting, so it can't hurt to have this tested too. I was a skeptic initially on hearing this recommendation, but have witnessed it myself, so any sudden change in demeanor or behavior should be tested.

What I have found out through experience is that once a resident needs a two person assist in AL they are moved to skilled care. If one person can’t help him get dressed or bath etc then it’s time for more care than AL can provide. But everyplace is different so you really need to research the facilities in your area. Best of luck.

Contact a social worker with your state's Senior Services. There are checklists that help you to determine what a person must be able to do to be in one type of care or another. When my MIL was in rehab after a medical incident she was given a list of 23 things she would need to be able to do for herself in order to qualify for AL. To her surprise (she had been living in her home, unassisted) she was unable to do about half the items on the list. Part of her rehab was to build herself up so she could be discharged to an appropriate facility. You may find that your parents need more care than you think they do, and more assistance than they think they need. None of us like to face the fact that we are not as able as we would like to be.

I probably tend to be a tad too matter of fact on these things, but I think the answer is move him to AL. He doenst like the idea, I get it, we often don't like what happens to us.

In an ideal world your mom could get an IL unit in the same complex, but as others have said then you are into big bucks, although you could then sell home and depending on how much that yields, it may cover a lot.

So I think he needs to go into AL and your mom can stay home and visit.


But yea, HE needs AL, not IL, IL is really not much better than what she has now. Both in AL would be more expensive.

Some 12 years ago, I became disabled and due to an old spinal injury, I was no longer able to walk although I am 99.9999% competent, still drive safely, handle all of my own affairs, still work (51 years same job - I will be 87), finished six years of college courses, and the list goes on. I ended up in assisted living and am the fish out of water. Assisted living is for people who have dementia or are physically unable to function normally. It is an environment NOT suited for people of my level but I am stuck. Independent living has people who live in a community setting with many different activities and opportunities to meet people who are active and mentally and physically normal. If your mother would want independent, that would work for her. However, as to your father, unless she is willing to give up her own life, must go into assisted living where he can be cared for. He is "gone" but she still has life so for heaven's sake, let her live.

I have been around assisted living facilities for quite some time. I notice the ads for A/L and see photos of vibrant seniors. I laugh. A/L seems to be a nursing home for people with money to spend before medicaid. Most (not all) of the A/L facilities’ residents need full-assist care which translates to big bucks.

A/L is a room and food. Everything is alacarte. In a wheel chair? $$$. Need your laundry done? $$$. Need a med pass? $$$.

Prior to admission, the resident will be given a cognitive test and meds will be reviewed. These items will be the determining factor for admission. Oh yes, they will also peak into your finances to see if you can afford the service.

Some A/L’s don’t have continued care. Which means if you need hospice or NH, good luck.

My parents moved to an Assisted Living facility when Dad went on Medicare hospice status. (They of course paid for the AL unit. Medicare DOES NOT pay for AL.) He was in "assisted" status with the hospice staff also coming in. Mom was an "independent" living in the same unit for no extra charge except meals. She did not use any other services. There was an underground parking garage for resident vehicles, if they had them, and their apartment had a full kitchen, where I prepared meals and they made their breakfasts.

However, based on the description of the medical needs, the patient may need more nursing care than just "assisted."

As far as in home care, that seems to be a luxury for people with $100,000 to 200,000 a year to spend for 24/7 care through an agency. At $20 an hour, the annual tab would be $ 175,200 just for the caregiver. My father in law insisted on staying in AL when he needed a nursing home. The only way that the AL facility would allow that was if we hired a full time caregiver for him in his AL unit. So we did, based on referrals from the AL facility. Warning: LOTs of problems with undependable caregivers. You would need to schedule 3 shifts daily and a weekend crew, or your caregivers will burn out quickly and leave you in the lurch.

I am dealing with the same issue for my brother. My recommendation, since your mom wants to stay in her own home, is to put your step-father in an assisted living facility near your mother. That way he gets the care he needs and she can go and see him everyday. I don't think she would be happy in an independent living facility but she might insist if she feels really guilty. You didn't say whether your step-father could qualify for a state-assisted program. In California, we something called an assisted living waiver for those who are low/limited income on Medicaid. They take all but a small allowance from a person's Medicare/Medi-Cal income and the state pays the balance. I would consult an attorney who is familiar with AZ laws. They might be able to transfer any questionable assets to your mother so she can keep the house and the state could supplement his care. Even some assisted living facilities won't do any heavy lifting if someone falls; so you have to call each facility and find out what they will and will not do. Another thing to consider - at least in California - most facilities are NOT prepared to accept people with mental health issues. If he has or develops dementia, he will need to be in a much more secure facility that caters to dementia/Alzheimers'. My brother doesn't have dementia but he is bipolar and experienced some brain damage while on a ventilator in the hospital. Most facilities don't want to take him. This is a big factor and you need to check it out. I would hope that Arizona is much less expensive but an assisted living facility in LA County is a minimum of $2,000/month for basic "room and board"; then they add a certain amount for additional services. A really good assisted living facility can run $4-$5,000/month in this area. Good luck!!

Imho, it is not an ideal situation at all for stepfather to be placed into an AL. Btw, the financials for said care of parent should not be footed by the adult children.

The last first. Do not discuss with the facility. They are selling space.
You are doing a good job in getting a total picture which is great.
Your Mother needs help...plus if she wants the together relationship to continue and they are attached to their home. get a bed he does not have to get out of, but he is at a level he just has to stand up.
You and your Mother come up with a plan and your father will do it. Your parents being together is important for each to maintain life style. There are assisted living places you have a help button and they come. Your Mothers physical well being must be right up there with your Father's.
The family can come up with whatever. This money is a investment toward everyone's peace of mind..not forgetting their physical needs. Everyone later will spend it on something foolish.
If everyone needs the support of a shrink to help with decision making, a good psychologist is the answer. A shrink is a brain Dr. It does not sound like your Dad is ready for "brain" meds.

In home caregiving can be very expensive. Not only that but there 8s the concern regarding caregivers calling out sick, quitting, etc. Assisted living is a broad term. Typically, a bas8c creplan is formulated based on the person's needs. Usually, bathing and dressing are standard care along with providing meals and housekeeping. Some assisted living facilities charge 3xtra for medication and laundry. Memory care is also an additional expense. There are some communities that offer independent as well as assisted living. Independent living communities offer some services such as meals and housekeeping. No personal care involved. I 5hink what you are th8nking is correct. Same community. Independent living for mom; assisted living with memory care for dad. Good luck.