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ncreasingly, we are seeing families who feel forced to delay placing an elder in assisted living or skilled nursing facilities for economic reasons. The elder’s resources may have declined due to the recession, or the family’s overall financial situation may be compromised so that others are unable to contribute to the cost. This may result in increasingly difficult care situations at home, sometimes leading to a decline in health or even injury. For example, if Mom is falling in her home and really needs a supervised setting, a delay in placement may place her at risk for fall injuries. If Dad is repeatedly hospitalized for dehydration because he is not eating properly or consuming enough fluids, some difficult decisions may need to be made. But how is the cost to be met?

Medi-Cal pays for skilled nursing only, and then only when the resource limits are met. Many facilities do not take Medi-Cal at all. Even if the preferred one does participate in the Medi-Cal program, it may expect a period of private pay initially. As for assisted living, private resources must pay. Especially in a dementia situation, this can be quite expensive.

Rather than hope nothing drastic happens, we encourage clients to seek the help of a good placement service or care manager to assist in considering the options. Facilities with empty beds or rooms may be quite willing to negotiate about costs. A needs assessment will start identifying places that may be appropriate, given the resources available and the location preferred. Going with family members to visit those places, and asking questions that the family may not think about, the placement consultant or care manager can make the process much less stressful, and may be able to reduce the monthly cost.

In one recent case, the placement consultant identified three places, visited them with the son and daughter-in-law, negotiated some cost reductions, and helped the transition by suggesting that the new room be set up exactly like the mother’s bedroom at home, down to pictures on the wall and the rug on the floor. The transition went very smoothly, and the family was happy to have a professional member on their team at this critical time. The care is still expensive, but the cost of the consultant was more than justified by the negotiated monthly savings and the stress reduction all around.