A new Minnesota law, which took effect on Oct. 1, aims to help the thousands of Minnesota families who are pondering what to do with parents who can no longer live independently. If it is executed in the right way, the law could provide valuable information at an important point in the process of deciding where a person will spend the final years of life.
Many people make the decision to move themselves or a loved one into assisted living because they are in crisis and they don’t realize that staying at home is a viable option. Assisted-living facilities (sometimes called “housing with services”) seem to have all the answers in one place, while there is no single voice making the case for the assortment of Medicare-paid services available in the home. The law gives the many in-home service providers a single voice, through Senior LinkAge Line, which is the free, statewide information service provided by the Minnesota Board on Aging.
Sometimes, the person advocating assisted living is an adult child who thinks it will make life easier for everyone if mom or grandpa is in a place where dining, activities and health services are available. That may be true if the person in assisted living can make decisions without assistance, but if circumstances change, it is helpful to understand that guidance on basic daily decisions — where to put away laundry, what to wear, when to go to meals, and other things that become increasingly challenging for some aging brains — is not included in the cost of assisted living. Help with these things is available, for a price. Once you have moved in to assisted living, changes to living situations and care packages may be difficult and expensive.
I speak from very real, current experience. In 2009, my husband and I persuaded his parents to move back to Minnesota to be near family in their final years. After an enormous amount of research, we helped them select what we thought was the best option: an independent-living apartment in a complex that also offers assisted-living apartments, owned by a nonprofit with a religious affiliation, communal dining rooms, on-site nursing and health-aide services, activities, and an adult day program. It was expensive, but not much more than they had been spending to live in their comfortable home. We thought we would visit them on Sundays, they would be well cared for, and we could go on with our lives.
A maze of bureaucracy
Within six months of settling them into their new home, we found ourselves in a maze of health-care and building-management bureaucracy. Things were taken care of, but each new health issue — an inevitable fact of aging — raised the costs in both terms of their money and our time.
In their two and a half years in assisted living, each had a Medicare-paid visit to the hospital and rehabilitative care. My mother-in-law required some time in memory care, at a cost of about $5,000 per month (not covered by Medicare or insurance), before being allowed back into the independent-living apartment. In order to get the building management’s approval to move her back into the apartment, we had to ensure 24-hour supervision, and total annual expenses ballooned from the $80,000 we thought they would be spending to over $180,000 for rent, meals and the minimum level of care required by the building management.
The toll on our professional lives was no less staggering. It was impossible to care for his parents, our child and ourselves with both of us working full-time. When I left my job and started visiting my in-laws during the day, I began to understand that our situation was the rule, not the exception. One woman had to retire early in order to oversee the care of three parents in three separate facilities. Another, like us, had one parent on the independent-living side of the complex and the other on the assisted-living side and had to visit every day just to make sure her parents were able to see each other, since the assisted-living staff could not be counted on to make such arrangements.
In August, we moved into a house with my in-laws. We have cut their expenses by more than half without scrimping on amenities or outside help. It has greatly reduced our stress and increased the productivity of our working hours, and I am beginning to see the possibility of getting back on the career track in the near future.
Costs to the public
The public costs of private assisted living are just as extreme. The state expects to save $3.8 million in the next biennium as a result of the new law, and that number will go up as baby boomers age. The savings will come from the fact that some people who enter assisted living as private payers end up exhausting their savings, and then rely on a Medicaid-supported program to cover their costs. The state expects that after a conversation with Senior LinkAge Line, some people will choose to stay at home with added services, which costs public programs less in the long run.
There are critics of the law, and their concerns should be seriously considered as the law is implemented. For example, it may be helpful to have the person considering assisted living along with one other person on the call with the counselors.
As the caregiver of two aging Minnesotans, I am grateful that the state has taken a step toward correcting a market failure in our health care system. If we had been required to call Senior LinkAge Line, instead of just offered the number as part of a packet of information, we might have made a different decision about assisted living versus home care. I wish I had known about MinnesotaHelp.info, and I encourage others to visit them online or call 800-333-2433 to find out what help is available for their households.
Becca Vargo Daggett is currently a full-time caregiver, with some experience in public policy and financial services. As time allows, she is a Fellow at the Institute for Local Self-Reliance.