Placing Your Parent in a Skilled Nursing Facility or Board and Care
In Asian culture, there’s a lot of pressure to take care of your parents well - it’s called “filial piety”.
My parents never wanted to go to a nursing home; the ideal scenario was to be cared for at home by a family member.
But the reality is, no one in your family may have the skills or physical capability to take care of the person in need.
Can you lift a 140-pound person to get him on to the toilet? Can you be woken up several times at night to help someone go to the bathroom? Can you watch someone 100% of the time to ensure she doesn’t leave a stove on or wander out of your home?
People don’t talk about it much, but elder care has a huge impact on every caregiver’s mental and physical health.
I hope to help you navigate what I’m going through, in case you ever need it.
Price Shock
When I was growing up, my mom always talked about retiring in Taiwan where elder care was inexpensive; people hire live-in caregivers from Indonesia to provide 24/7 help.
If she stayed in America, my mom fantasized about hiring a low-cost helper into her home.
Then reality slapped us all in the face.
I’ve been looking for skilled nursing facilities (SNFs) and one in Walnut Creek, CA, charges around $12,000 a month for a double, and 21,000 for a single.
A home healthcare worker is roughly $29/hr so for 24/7 care it’s $20,880/month.
Board and Cares, which are much smaller than SNFs, cost $5,000 to $10,000 a month in Contra Costa County. Fees increase if your family member needs more care (i.e. getting insulin shots can cost an extra $1k/mo., feeding is $400/mo.) The larger ones can have “community fees” of $4000 to $6000 to enter, which pay for getting the room ready and the facility administrator visiting the patient in the hospital to assess the patient’s needs. The community fee gets refunded proportionally if the resident stays less than 90 days.
And people think college is expensive!
I can’t fathom how the 40% of Americans who don’t have $400 for an emergency fund can afford any of this.
Medicare and insurance pays for the first 30 days of a SNF but after that, you’re on your own. (Unless your total assets are less than $2000, then Medicare pays.)
The Search for a SNF / Board and Care
The hospital provided us with a list of Senior Living Advisors who can help you find long-term care placements into everything from memory care to hospice.
Senior Living Advisors are basically like insurance brokers - you tell them your needs, they call around to various places to see if there are openings, and they provide you with a list of recommendations. They get paid on commission from the facility’s marketing budget.
Some say you should call multiple advisors because they have access to different facilities. But the hospital case manager told me to just pick one because he didn’t want to deal with multiple advisors and update them on my dad’s condition.
The case manager told me everyone on their recommended list was excellent, so pick the person you connect with best.
SNF, Board and Care, or In-Home Care
We had three discharge options for my dad.
A SNF is a larger facility that has a doctor and nurses. The staffing ratio at one place we checked is 1 nurse to 13 residents, and 1 nurse’s aid to 8 residents. There is more opportunity for physical therapy at a SNF and we hoped it would give my dad more possibility to get stronger and go home.
A Board and Care has 6 residents and two care givers, no doctors or nurses. They provide all of the daily living care like dressing, toileting, feeding and bathing and we hoped Board and Cares would provide more personalized service.*
The third option was to hire in-home care but as I noted, it’s prohibitively expensive. Also, my dad was assigned a male caregiver and my mom didn’t want an unfamiliar male in her home overnight, so she was hoping to do 12 hour shifts herself.
I didn’t think my mom could handle the toileting aspect of Dad’s care so in-home care wasn’t really an option. Plus, I (and a doctor I know) don’t think he’s medically stable enough (despite what the hospital said) to be discharged to home.
Although my dad would probably do best at home since he can be confused in unfamiliar places, we can’t risk sacrificing my mom’s physical and mental health.
Choosing a Residence
We started researching SNFs a few weeks ago and Board and Cares today, but don’t get too caught up on reviews and research ahead of time.
It all depends on whether places have availability and whether they’re willing to accept your family member (if the case is complicated, they won’t).
At the end of the day, you don’t get a lot of notice for discharge from the hospital (we’re talking 24-hour notice) so you basically take what you can get, literally that day.
One Senior Living Advisor told me that the difference between a $5k and a $10k Board and Care is how nice the building is - whether it’s been recently renovated, etc. The advisor said staffing ratios are mandated by law and she wasn’t sure whether more expensive places pay staff more, so she thought the quality of care would be similar at expensive and more affordable facilities.
At the end of the day, we ended up with the SNF across the street from the hospital. It’s close to my mom’s house and has a 5-star quality rating through Medicare / Medicaid.
More importantly, Medicare and insurance pays for the first 30 days of SNF, unlike a Board and Care.
I’ll let you know how it goes.
*In the hospital the ratio was 1 nurse to 4 patients and my dad was already neglected.
He shivered from cold and told his physical therapist “I’m hungry. Please help.”
Nurses didn’t always feed him and he couldn’t feed himself.
At discharge today my mom waited for two hours and was barely helped.
Be sure to check on your loved one in the hospital and advocate for their care.
Have you ever placed a family member in a SNF or Board and Care? Or have you ever hired in-home help? How was your experience? Please share any tips that would help our community!
