[Noah930]

Sorry you have to go through this. You never imagine it when you're a kid and your parents are vibrant and healthy.

My mother developed dementia a couple years ago. She also had Parkinson's, further complicating things. My dad was stubborn and wanted to remain in their house. We tried to float the idea of an elder living facility, which as time went on became a recommendation for an assisted living. But they refused. With time, my dad admitted that it was too much for him to care for my mom alone in their big house.

My dad, being cheap and Asian, of course tried to find an under-the-table caregiver. He tried three or four of them, all live-in. Ridiculously cheap. But that's because they had no useful skills. Predictably, that failed.

So my wife found a memory care facility. They're not cheap. They run about $5K to 14K per month (a topic which deserves a whole 'nother thread, but is crucial to this discussion of elder care options). My mom lasted there 2 weeks. But it was my dad (and sister) who couldn't handle it. They couldn't stand to see my mom there, amongst strangers. It was heartbreaking. So my sister volunteered to take in my mom. Which, by default (because of our medical backgrounds) became Casa Noah taking in my mom. I felt like one of those Looney Tunes cartoons where they ask for volunteers to step forward, and everyone (but Mrs. Noah and I) takes a step back.

We hired professional caregivers for M-F, daytime hour coverage. Mrs. Noah and I took night time and weekend duties. We did it for about 8 months. It was hard. Not so much because of the physical aspects; Mrs. Noah and I have medical backgrounds. But it was challenging to run a household with 2 children AND be there for my mom. Fortunately my mom was always a pleasantly demented person. No nastiness. No combativeness.

Of note, your two options for home caregivers are either going through a staffing agency, or hiring those same women, but on the side. The benefit of hiring on the side is that you get caregivers who know what they're doing but for less than what you'd pay an agency (and they like it because they get paid more than what they normally receive while working for an agency). But, if that caregiver cancels last minute, you're sometimes left scrambling for coverage at 9:30 pm for the next weekday morning. And sometimes they go on vacation, too. And it's very typical for them to go back to their home country on vacation...for several weeks at at time. So you kind of need a couple of them on per diem basis. The alternative is going through an agency. You'll pay more, but if the caregiver can't make it, the agency will be able to provide backup coverage.

But last summer we went on vacation, and we moved my mom back in with my dad. Again, it was critical for my dad to be able to stay in his own home. So we used an agency to provide 24-hour, live-in caregivers. One woman would work M-F, and another would cover the weekend. It was about $4K per week. Not cheap, but that's what my dad paid so that my mom could live out her last days at home (which was also important to my mom, before she lost the ability to tell us herself). My mom passed earlier this year, but she was able to do so at home.

Other issues: hospice. It doesn't cost you anything. It'll be paid for by insurance/Medicare. And they do offer some useful services: a nurse or aid will come once or twice per week for bathing assistance; hospital bed/wheelchair/walker rental; and oxygen and narcotic pain medications for comfort in those last moments.

My dad has some unusual elder care insurance plan which reimburses for half of elder care costs. So while he had to pay $4K per week for 24-7 home care, he would get half of that back. Not a small deal, as I counted up his medical care costs for 2024 taxes, and he paid about $100K out of pocket.

Cost of those memory care facilities: In LA, they seem to run between $5-19K per month, depending on fanciness. Mrs. Noah works at such a facility, which charges about $14K/month. How does anyone afford any of these? Well, a lot of elders don't have high incomes (even if they have assets), so they may be able to qualify for Medicaid (MediCal here in California). So you pay full fare for the first month or two, and by then the Medicaid application comes though and you're no longer responsible for anything. My parents--between pension, social security, and rental income--made too much to qualify for MediCal, so they would have borne the full cost.