Financial planner Clark Kendall of Kendall Capital in Rockville often helps people determine the feasibility of aging in place. “If a senior stays in their home, you should factor in the cost of eventual full-time care,” he says. “For 40 hours a week, that’s about $40,000 a year. Round-the-clock care at $120,000 exceeds the cost of most assisted living and skilled nursing facilities.”
For a while, my brother talked about having Dad live with him and his family in Falls Church. But because he and his wife travel often for work, it didn’t make sense. I got an estimate for how much it would cost to make my lower-level bathroom handicapped-accessible, but I knew I didn’t have the emotional makeup to care for my father. Guilt and shame piled onto my resentment.
After weighing our options, Phil and I concluded that assisted living would be best for Dad and for us. Since our father had no assets left and only Social Security income, we thought he should qualify easily for Medicaid. Knowing nothing about the process, we made an appointment to tour the Methodist Home (now called Forest Hills) on Connecticut Avenue in Washington, D.C., which offers assisted living, long-term nursing care and memory care, which is the industry term for facilities for people with dementia and Alzheimer’s.
The administrator was kind in the face of our ignorance. Medicaid is complex, but one thing is clear: It pays for skilled nursing facilities, but not for assisted living or help in the home.
Clearly, we needed some help navigating this process.
Cochran says she takes solace in knowing that her dad is in a good place, where the staff is cheerful and kind and he receives plenty of attention. Photo by April Witt.
The world of eldercare can feel like an Alice in Wonderland experience, and not in a fun way. I started attending a support group at my church, as well as lectures at Sibley Memorial Hospital in Northwest Washington and at local assisted living facilities. Each presented an opportunity to learn more and to ask questions as my dad’s condition worsened.
One valuable lesson I learned is that I am, in fact, a caregiver. I’d thought that title (and halo) should be reserved for people caring for a family member in their home, not at a distance. I was wrong.
During a panel discussion about caregiving at my church, I heard about Debra Levy Eldercare Associates, a Silver Spring firm that helps family members navigate the complicated world of caring for older people. Owner Susy Murphy’s hourly fee of $145 was well worth it. She educated me on the basics of Medicaid and Department of Veterans Affairs (VA) benefits. Then she explained the typical cost of care in our area. Assisted living averages about $3,400 per month. Usually, Medicaid comes into play when a person is already in a skilled nursing facility and is running low on money and assets. Although programs exist to offset the cost of home care or facilities for low-income seniors, the wheels of bureaucracies turn slowly, and nothing is clear-cut.
Murphy directed me to a regional VA office in Camp Springs in Prince George’s County, where the director is known to be savvy and helpful. My dad, a World War II veteran, was eligible for a benefit called the Aid & Attendance Pension that was created to help wartime veterans and their surviving spouses pay for help with the activities of daily living. The VA estimates that it takes about a year to process an application, but the award is paid retroactively to the application date.
Almost a year after I applied, the VA granted my dad a small amount of money, significantly less than he was qualified to receive. I made another long drive from Cabin John to Camp Springs for help in trying to correct the oversight.
A while back, a therapist friend recommended an attorney who charged $2,000 for VA cases. That seemed exorbitant. Now, considering the time I’ve spent on the matter, I could kick myself for not scheduling that appointment.
Elder law attorneys, especially those accredited by the VA, have done hundreds of applications; I was doing one. “Having a file full of approvals means you’ve learned what is successful,” says Fralin, the elder law attorney. “As the veteran’s advocate, my goal is to get the application exactly right—on the first try.”
Cochran visits her dad often. It’s hard for him to have conversations with her, she says, but he enjoys looking at photos. Photo by April Witt.
WE DIDN’T HAVE time to wait for the VA to revise its decision, so we continued our search for a place for Dad. My brother and I and our spouses were splitting Dad’s current expenses, bracing ourselves for what was coming.
In 2014, Rodgers, the founder of Capital City Nurses, opened The Cottage at Curry Manor in Bethesda. She calls it “refined residential living.” Monthly fees range from $8,500 to $12,000; the daytime ratio is three staffers for every eight residents. I couldn’t resist visiting, in case I won the lottery. I wish I could give Dad luxury like that: a gorgeous home, gourmet meals, art classes and monthly massages.
Given our budget, Murphy suggested that we look into group homes. In addition to offering the most affordable type of care, group homes provide stability and close attention in a homey setting; there are currently 160 in Montgomery County.
I knew most group homes wouldn’t offer the activities of a luxury property or large facility, but Dad’s interest in such things had become almost nonexistent. Murphy gave me the name of a referral agency called Loving Decisions in Bethesda. Based on Dad’s condition, our budget and current availability, Loving Decisions recommended J’ Rose Assisted Living in Aspen Hill, which I visited right before Christmas 2013.
I felt so good about it that I stopped there. The house was clean and cheerful, large enough, and the owner and staff exuded kindness. When we brought Dad, he told us he was ready to move in. I lamented that I hadn’t taken this step sooner. When I left him there the first night, all I could feel was relief. It helped that Dad exhibited no anxiety. He was probably thinking that it was about time this happened. Although he never admitted he was struggling, he agreed he needed help from the minute I mentioned it.
Dad’s $2,500-a-month fee for a shared room is as low as it gets for assisted living in this area. The owner, Rose Jayaraman, hires kind and respectful people. Two caregivers are present at all times, and the house is licensed for a maximum of five residents. Dad’s roommate, Victor, is one of the home’s devoted caregivers, so we lucked out. The comings-and-goings of five families creates more stimulation and activity than Dad would have had in my home or my brother’s. When we visit, we can be his daughter and son, not harried helpers trying to get things done.
More than a year ago, a neurologist diagnosed Dad with mild dementia and aphasia, a language disorder. He seems to know what he wants to say, but can’t find the words. Conversations are difficult, but he loves looking at photos and videos and doing FaceTime sessions with his grandchildren and their children. He can’t cook anymore, but he loves to eat, so our visits always involve food: We take him out when he is up to it, or we bring favorite foods in. My brother whips up breakfast some Sunday mornings, just like Dad used to do for us.
Although Dad’s home does not provide dedicated memory care, geriatric professionals say group homes are a good place for seniors with dementia. “Small group homes provide constant, attentive, personalized care,” says Carol Kaplun, nurse care manager at Iona Senior Services in the District. “You can’t beat this level of assistance for moderate and advanced memory care.”
J’ Rose will likely be Dad’s home until the end, unless he develops a medical problem or condition that requires nursing care, such as a feeding tube. If we have to move him to a skilled nursing facility, we will be facing expenses of $7,000 or more per month.
The guilt I feel over not caring for my father in my own home, as my mother did for her parents, may never relax its grip entirely. But I take solace in knowing that he’s in a good place. Whether my father is conscious of it now or not, I hope that on some level he feels good about putting his trust in us. I expect my husband and I will have strong opinions about where and how we grow older, and I hope our children and their spouses will be sympathetic.
Fralin calls people who have been through this heart-wrenching process “True Believers.” He says most people who experience this firsthand with parents or in-laws make it a priority to get their own affairs in order.