Elder Law Practice of
Douglas R Jones &
Cynthia Orlicek Jones

A few weeks ago a client asked, “But what if I want to STAY OUT of the Nursing Home???” That is a fair question. I mean, if we were to take a straw poll of the readers of this blog asking something like the following question:

If you were to become incapacitated before you die and need assistance with your care, which of the following would you prefer?

  • Spouses take care of each other at home.
  • Receive care at home with outside caregiver assistance.
  • One of the kids move in with me.
  • You move in with one of the kids.
  • Assisted Living Facility.
  • Nursing Home

Which answer do you think would be the winner?

I started to add “None of the above” as an option. But, for purposes of our little quiz, assume that these are the only options. At least, from what we see regularly, these appear to be the most common options. So, let’s discuss them one at a time.

Spouses take care of each other at home.

Between spouses, there is usually an unspoken pact that neither will ever put the other in a Nursing Home. They will do whatever it takes to make it work at home. The problem with this plan is that the “well” spouse may not be so well themselves. It is common to see the “sick” spouse suffering with Alzheimer’s while the “well” spouse suffers from physical health ailments. As a result of the added stress of keeping the sick spouse at home, the well spouse sometimes dies first.

Receive care at home with outside caregiver assistance.

Many declining seniors choose this path. While they may not want “strangers” in their home, this option at least let’s them stay at home for a while longer. Maybe even for the rest of their life. That is, if they have the money to pay caregivers and find caregivers who will meet their needs while being easy to get along with.

One of the kids move in with me.

This is the last option (at least in our quiz) that allows someone to stay at home. For this option to work, many things have to fall into place: (1) You get along well with this child and vice-versa. (You are going to be spending a LOT of time together.) (2) This child be unemployed and/or needs a place to stay;  retired;  independently wealthy; or able to work full or part time AND still be able to meet your needs; (3) It would help if all of the details of this be hammered out at a family meeting to reduce the potential future fall-out from such an arrangement; especially if compensation is involved.

You move in with one of the kids.

This is the first option where you are no longer at home; you would now be living in your adult child’s home with his/her family. How would that work? Are both you and they O.K. with that? Are you sure? Would you have your own room/living area? How will your needs be met when they are at work, out of town, or on vacation? Will your friends or other kids still feel welcome to come to visit you there? Again, as in #3 above, it’s important to work out the details in a family meeting; especially if you are paying the kids for the privilege of living in their home.

Living in an Assisted Living Facility.

These facilities typically provide your own living space (sometimes bedroom, living room and kitchenette), meals, maid service. Some may also have a nurse on call. Usually for an increased fee, they may assist with certain activities of daily living such as feeding, bathing, dressing, toileting, transferring and may help with medication management, etc. The services offered vary a lot from facility to facility; you would need to tour several and ask questions. Some ALF’s accept Medicaid reimbursement, but most are private pay.

Skilled Nursing Facility (aka Nursing Home).

If we were to take a poll asking, “How many of you would like to go to a Nursing Home?” How many hands do you think would go up? Not many! It’s the last option in our question above, and the last choice for many who need assistance. Nursing homes are the most restrictive option of the ones listed and are typically the most expensive. However, they do have the following things in their favor:

  1. When you need a nursing home – you really need a nursing home! They provide a level of skilled care that is difficult, if not impossible, to replicate at home.
  2. Even though they are expensive, government assistance is usually available to help pay for nursing home care. Read our blog post How to Get Medicaid to Pay for Momma’s Nursing Home Care for more on that.

Unfortunately, many individuals who could possibly live at home with assistance or live in an ALF cannot afford to pay for this care out of pocket. Therefore, the only choice financially available to meet their care needs is a nursing home.

As unpleasant as it is to be thinking about these things, it is important to do so and to have this discussion with your family before you need this type of care. For more information on planning in advance, read our blog post entitled, “If you haven’t done your estate planning, here’s your sign”.

If you or a Loved One is in a Nursing Home now or is going there soon AND are paying for nursing home care out of pocket, then download our How to Find & Pay for Nursing Home Care” Tip Sheet by clicking the link.

Best wishes as you make some difficult but important planning choices for your future care needs.