Assisted Living - which is better?

[Harpsichord23]

Looking at options for parents who are 90+ and have been living independently, but are getting to the stage where they need some help…. They still would like their own apartment at this stage.
The assisted living options seem to vary between those that cater for active residents only and ones where they have care facilities in some floors, and active residents in other.
At their age, are they better off moving to a retirement home where they can stay if they need additional care, rather than have to move again?
Also, buy or rent? Buying at their age doesn’t seem to make sense but I am not finding many rental options.

My neighbour is 94. He lives independently but with lots of help. He has a lovely lady carer who helps with things like cooking his dinner, sorting his bills, taking him to groups etc. He has a cleaner and a gardener. Would this kind of help be better?

They have been living overseas and are looking at coming back to the UK. They could rent a normal flat and get carers, but I thought that a retirement home would be a better environment.

What do your parents want? Personally I would always want to stay independently in my own home. My MIL repeatedly asked us never to put her in a home. She said she would rather be dead.

My parents aren’t fully in agreement about next steps…. They aren’t fluently bi-lingual so I think coming back to UK to receive care would be be a better option.

My MIL was the same and had saved all her working life so that she could have choices in her old age. Unfortunately her DD, who lives abroad, overruled her and less than a year later she died. She had been active, alert and engaged in life beforehand when at home.

@Willowskyblue what did your MIL want? To stay in her home with carers visiting?

I have a real issue with elderly parents saying this whilst leaning more and more on you for support. In my experience a parent always prefers you doing things, sorting out their life admin etc but introduce someone else into their lives and they will dig their heels in HARD.

My FIL has said we should shoot him if he needed to go into a home. Not much to say after that!

I found carers were very hit and miss. If they are paying privately it doesnt necessarily mean that you get better care. Money went missing when DM had one in. The carer seemed to do the root of fxxk all when she was there and Mum never directed her.

I was 100 miles away which didnt help.

Don't buy, only rent. You dont have to look far on mumset to find multiple stories of elderly parents who bought Macarthy Stone type retirement homes that cant be sold after the parents die - but the family are still responsible for the very large maintenance payments on the flat despite it being empty.

@Harpsichord23 Yes, she had carers visiting 3x daily, a cleaner and gardener, plus friends who visited regularly, and she was adamant she wanted to be at home.
She had been a nurse and said she would rapidly deteriorate in a home. Unfortunately her DD (who managed finances solely) had other ideas and ambushed her into going into a home (said it was for respite after a chest infection) but she never came home and had a very unhappy year in the care home before she died. We couldn’t do anything as SIL held the purse strings very tightly.

Personally I would try to steer them towards facilities that can cope with further decline. Unfortunately I would imagine a move at that age will be tough on them and better to have them move once and done, than have to move again soon.

Most people don't want to end up in a home, but then most of us don't want to spend the last several years of our lives bed-bound and lying in our own faeces and urine for hours waiting for the next carers' visit either. Employing a team of round-the-clock private carers, and other staff, would be an option but extremely expensive.

The reality is that residential care can become the better, and only, option.

And if you'd really rather be dead than in a home (which is not an irrational desire) then you need to make your own arrangements for that.

I think the answer probably needs a fine-grained approach. There are brilliant, disastrous and meh options of every type.

Key questions I would ask (you don’t have to answer here, but you could)

• what area(s) are they focused on?
• how much money do they have? (Heavily linked question)
• do they have any background health problems that either affect them now or which will deteriorate in some kind of semi predictable way?
• what are their personalities and interests?

@PermanentTemporary good questions..

• for a move back to UK, to be near their children it would be London or Surrey
• fairly wealthy, once overseas property sold would have healthy six figure sum plus ok pension (not huge)
• remarkably healthy for 90s but becoming increasingly frail
• they have lived all over the world and have outlived all their friends. I think they would benefit from more socialising.

The other question is how much input are you and other relatives will have. I presume the main rationale for moving is so that you can see more of each other, but it’s too easy in this scenario for any adult DCs - and usually one in particular- to become chief organiser of everything including shopping, haircuts, chiropodist, doctors visits etc. etc. The list becomes quite literally endless and the DC find themselves less of a beloved DC and more of an unpaid and badly treated admin assistant or in some cases physical care provider.

I say this not to be gloomy, but to try to be realistic. Yes their wants are important, but moving country will be a huge endeavour in itself at their age and will require a lot of input and coordination from likely you. If you can make it a once and done situation and get them somewhere with on site hairdressers, resident doctor etc. then that reduces a huge potential burden off you. I would caution against independent living with drop on or live in carers. My DPs are allegedly living independently at home but guess who organises everything and lives in fear of something happening.

I have heard that it’s not a good idea to buy at one of these places due to difficultly selling in the future and ongoing maintenance fees, but if you can’t find somewhere to rent then it’s something to weigh up.

Hmm. I think overall I would say that ‘extra care housing’ would be a category that would suit them. This means you own a place to live and quite a lot of people on site will still be well able to take part in activities, but there is some form of staffed presence (usually actual care) on site 24/7. This is different from sheltered housing or warden assisted housing where there might only be someone around in the mornings and any care needed is completely separate.

The fanciest sites in the extra care category in Surrey I would say are Audley Villages. In my area a different company is the big player but I bet they are similar. Frankly I am not sure they have enough money to really enjoy an Audley Villages site - the prices are really hard to track down but it might be around £600k to buy an apartment plus really substantial monthly charges. I don’t love the local high end provider that much - a bit apt to build places with a lovely view of the car park and not enough light. There are less fancy versions that could work better financially.

What I WOULD say is, the hard sell from the fancier providers is absolutely relentless and you should protect your frail relatives from being railroaded if you can. If your parents will let you, go and be the front face of the search yourself, don’t give them your parents’ contact details and channel your inner hard bitch. Demand financial details and walk away if they won’t provide them. Go and see a lot of places; you need to be realistic about how cheerful the vibe can really be in this setup, but as a person who works in these places a lot, I know a few I would move into tomorrow and a couple I would run from.

I’ve actually talked myself out of extra care while typing that! The holy grail is probably a decent, spacious two-bed flat, either ground floor or in a block with a lift, in a university city centre (Guildford?) Easier by far to get carers etc in a city, you can put together a bespoke package of support that fits them as individuals, without paying a fortune for services they don’t use.

There is a glut of flats on the market atm as there are too many and they’re losing money, but an awful lot of them aren’t selling for a reason - not spacious, leasehold grief, poor soundproofing, no lift etc. if you’re willing to search a lot there might be one out there though.

Block with a lift! I don’t know Guildford at all but this is certainly

central

What nationality are they and how long have they been overseas? If they want to live in the UK, what will their visa status be? They will likely have to pay for their healthcare too, you can't just come from overseas and access NHS services free of charge.

You will need PoAs for Health & Welfare and for Finances, it makes things easier should the worst happen. Be aware that regardless of what they want, if something catastrophic happens, they may need a nursing or care home. If they are self funding, you're looking at a weekly cost of £1400 to £2000 per week.

Without dementia and frail but not disabled - probably not a care/residential/nursing home unless you have one locally with a big population of residents without dementia. Most residential care is oriented towards dementia which can be very limiting if you don’t have it.

For everyone’s sanity they need to be as close as possible to whichever of you is most able/willing to be on hand. “Nip over for 20 mins” close if you can do it. There is no escaping the fact they will need that kind of support over the coming 5-10 years.

And then all the advice above - 2 bed ground floor or no-steps flat, rent not buy if it’s a retirement property, viable taxi to and from a decent hospital, big enough town to make it easy to get carers, cleaners, gardeners etc.

Good luck!

One thing to consider, are there any signs that one will need more care before the other?

If that’s the case then care home in close proximity to where the other lives may be a beneficial feature.

Selling retirement flats is tough going. So well worth looking at rental.

My grandad (97) left an assisted living place last October and now lives independently in a bungalow by family. He’s much happier. He’s supported by a lovely carer twice a week who helps with housework and takes him shopping. Myself, siblings and mum all pop in a few times a week to check on him. He also has a personal alarm incase of falls etc. He rented the assisted living apartment (Churchill homes) and it was a bit of a bitchy place full of curtain twitchers. There were lots of the for sale as they are very difficult to resell. Personally I wouldn’t recommend

My brother is in the same situation, but a lot younger,80.. My SiL has dementia. They roo struggle with the language.they have been living in France for 25 years. They have chose assisted living as he is still very active. He has the option of people caring for his wife to give him a break. There are lots of options but they are to buy rather than rent.

@Harpsichord23
At 94 the move is likely to have a significant impact. I suspect your parents are co-dependent in that they may each have specific but different difficulties so they compensate for each other.

This works whilst they are both here but the impact on the surviving parent when one dies is significant because it’s not just an emotional loss but also a lost of practical assistance that is difficult to replicate.

At 94 I would be looking to rent not buy as it gives more flexibility. I would also want them near to me e.g. 10-15 minute car journey.

The right care home could be the solution. What you need is one that has different areas/floors for residents with their faculties, dementia, nursing care etc. It future proofs so if necessary they can stay in the CH but move to the areas that meet their changing needs.

Residential care homes allow residents to live their lives but cooking, cleaning etc. are taken care of. They have activities that they can choose to join in. I would recommend you go and look at a few to get a feel for what is available.

As pp have said there are retirement villages that also have care homes on site. They are ££ but provide a whole range of support and activities.

Thanks so much for all the advice.
1 is UK citizen, 1 is European, but previously had settled status in UK
No dementia, but old age short term memory loss in 1 who is also reluctant to move.

I think the best fit for them would be renting in a retirement village that also has care home facilities. I have found two of these in London, but they’re are buy only. And v expensive.

Renting a flat and organising private carers is an option, but then they would miss out on the social benefits of being in a retirement village. They are co-dependent, and my thinking is having more friends their age would help when 1 goes before the other.