In the midst of this now with aging relative......... assisted living geared toward dementia, $8,500 per month, I understand nursing homes are in the area of $10,000+ per month.
I've been lurking recently so decided to register so I could add my 2 cents on this aspect of end-of-life investments/scenarios. I went through it three years ago with my mom so am rich with recent experience. My 84 year old mom had a series of strokes related to dementia - the same dementia that prompted her to invest all her savings (over half a million) in Las Vegas REITs.
Although her financial advice came from her equally addled neighbors in the retirement community where she lived, she did do some things right. She had a trust and a will. She had an Advance Directive. She had LTC and supplementary medical insurance. We weren't close but although she had named several executors in attempts to buy "friends," the one with my name on it was the only one that was notarized. When the very unexpected call came I got to learn a whole lot about subjects I had no previous knowledge of.
Someone on the thread mentioned how their mom spent her last years or months in a vegetative state in a nursing home. They call those places "vent farms" here in California - I suppose everywhere. When my mom started having strokes and I got called in I had the opportunity to see these places - acute care, sub-acute care, hospice care, hospital care . . . you name it. They are all nightmares. The nicest thing you can do for anyone is to keep them out of these places. At best they are spacious motel-like facilities with fancy facades and smooth talking administrators and at worst they are smelly, noisy warrens with halls lines with people hanging out of their wheelchairs. The latter is the norm.
They are all expensive. Anywhere from 6K to 10K per month and up.
Before I get carried away and write a book I'll cut to the chase with my "two cents."
Number one is to get the person back home - either their own home or yours. Build another bedroom onto your place if you have to - it'll be cheaper than keeping them in some godawful facility.
Hire an RN or LVN on a live-in basis. Using my mom's LTC I paid $100/day. There are plenty of nurses out there who are looking, for a variety of reasons, for just this sort of situation. Don't use a nursing agency - although you'll be tempted. The agencies, medical supply houses, etc. are all just part of the machine. The nurse will need one day off a week plus other breaks so you'll figure that out along with them. Online (eBay, Craigslist, etc.) you can buy constant-pressure air beds, oxygen, feed pumps, medical food, monitors, wheelchairs - all medical equipment you can imagine and some you can't - for a small fraction of what the medical supply companies will charge you. LTC and Medicare will pay for some or all of these things but why contribute to the incredible gouging that goes on? The entire medical "system" is unbelievably inflated. When someone dies at home or private care all the items I mention above get put out for sale for next to nothing since the people selling them didn't pay anything for them in the first place.
Anyway, get the person home. They may have lost their ability to talk but what consciousness still in there has to prefer being among familiar things and people and their pets. I brought my mom home not to live like a vegetable but because after 84 years of being self-sufficient I didn't want her to die in a noisy, smelly "facility" surrounded by people speaking Tagalog.
Long term care insurance and the supplementary-to-Medicare insurance along with Medicare itself will pay for doctor visits, rehab nurses that come in several times a week, ambulance transportation, and medications. Post the Advance Directive on the bedroom door so everyone, especially the nurse(s) you've hired, knows there will be an end to it all when the time comes . . . when Morphous comes to call. Nobody wants to live like a vegetable - it's worse than just being a passive carrot or potato and fading away gently. Oh no. You need to be "turned" every four to six hours so you don't develop bed sores - interrupting whatever dream or peaceful state one might have temporarily attained. You get a catheter stuck into you and a feeding tube stuck into the receptacle implanted into your stomach. Another implant into your arm receives medications & fluids of various kinds. Even if you can breathe on your own you still get an O2 cannula stuck up your nose. You have to have your diapers changed frequently. Also bedding. There's an endless list of 24-hours per day indignities to be suffered by anyone in this predicament. I don't think anyone is so attached to life that living like this can bring any joy. Once one has reached the "vegetative" state it is time to make them comfortable and give them time to process their memories and to say goodbye to whoever and whatever was important to them.
I kept my mom in this situation, in her own bedroom in her own house with her cats and familiar surroundings, for six months. Looking back I realized that was about three months too long but there were improvements during that time which made it easier to just keep going than to call it all off. In my own example I had the great good fortune to hire a new nurse who had just the right experience and skills. She knew that many people will not let themselves die naturally no matter how uncomfortable life might have gotten. They need "permission" to let go. It's common. I never knew anything about it and in my case it wouldn't have worked for me to try and give my mom "permission" for anything. The nurse however was believable and trustworthy apparently since during the night following "the talk" my mom passed away very gently and gradually and had a heart beat of 2 BPM in the morning.
I didn't know anything about end of life scenarios and what's involved but fortunately my life allows me plenty of time to learn whatever I need to know. I think most people abandon their loved ones (or even their not-so-loved ones, as in my case) to the feeding-frenzy medical system because they don't have time to learn what is necessary to bypass or avoid most of it. It's really awful - take a tour of your local care facility and just imagine being there 24 hours a day with the smells, the constant beeping of patients trying to summon nurses who are out back taking a smoke break or just ignoring the calls since they never end . . . yet the care facilities in all their many names are bursting at the seams they're so full. I would think, speaking of financial investments, that an investment in "care facilities" would be one of the most secure and profitable investments available. We baby boomers are dropping like flies and surviving relatives often foolishly just "go with the system" whether it's because of lack of time to figure out how it works (so we can consider alternatives) or because we are just too brainwashed by people in white coats to look into it. The "system" has a powerful momentum to it.
One pitfall it's extremely important to know about. If anyone steps into the cow paddy called Medicaid (called Medi-Cal here in CA) it's all over financially for whatever estate was left. The insane bloated billing that goes on together with the fact they (the government) will come back after it's all over and take every asset that's retrievable will utterly ruin any carefully laid-out investment plans made prior to involvement with Medicaid or Medi-Cal. The SNF's and other agencies LOVE that government money and will encourage you at every step to use Medicaid even if you don't need it. That was always kind of a mystery to me but surely has a lot to do with the money they make. They're very profitable so they clearly know what they're doing
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Mike
KSEE
