The move to assisted living: Navigating the fine line between money and emotions

An elderly resident using a walker passes a golden retriever in the New Mark Care Center in Kansas City, Mo.

Chris Gutierrez, director of senior housing at Southern California Senior Resources.

If moving is stressful, moving a parent into an assisted living or nursing facility is off the charts. For many families, feelings of guilt and separation can make the decision hard enough. Factor in the cost of these living arrangements and a tough financial situation, and the decision becomes intimidating for most people.

In this week's episode of Marketplace Money, host Adriene Hill talks to assisted-living resident Ann Sohmer and personal finance expert Louis Barajas about making the transition into an assisted living home.

Chris Gutierrez is the director of senior housing at Southern California Senior Resources, a free service that acts as a match-making service for elderly people and assisted living homes. As a go-between, Gutierrez talks to more than 10 families a day, helping them find a best-fit residence. And it doesn't take long for money to creep into the discussion.

"Many people out there have the idea that Medicaid or Medicare or even their health care covers senior housing," says Gutierrez."And unfortunately we're the bearer of bad news. Usually it's private pay only, month to month."

For many, that news is a shock. Often Medicare is the primary source of payment for their health services. Without Medicare or insurance footing the bill, that means families often have to find completely new financial resources for housing.

"With the economy right now, it's the biggest concern," Gutierrez says. "This whole market with senior housing has changed dramatically with the recession and the economic times we're going through."

Prior to the recession, he admits his job was relatively simple - talk to clients and create a list for them of the best housing options. In the last three or four years, however, Gutierrez says he's had to work a lot harder.

"Now were really giving families a list still, but prior to giving them the list, I'm calling the facilities and trying to negotiate for them a lower rate."

Talking to facility managers in an effort to convince them to waive move-in fees and other flat charges is now a regular part of his job. He's witnessed a spike in the number of families applying for Medicaid as well. "They're calling for elder law attorneys or specialists that help them to get onto Medi-Cal or Medicaid. We're seeing a big surge of people calling and trying to get government help."

Before the recession Gutierrez says, families wouldn't discuss financial issues in detail with him. Some would outright insist it wasn't any of his business. Gutierrez says discussions are still tricky, but he notices a shift.

"With the economy the way it is, people are a little more open. I think it's okay to say your parent doesn't have much money."

He approaches the subject carefully, making sure to walk the fine line between being sensitive while extracting the information he needs to do his job effectively.

"We do ask them how much their parents make in Social Security, maybe a pension, any investments, and really try to get it down to give or take a hundred dollars," he explains. And at the risk of encroaching on too personal of information, he takes it a step further, "and with that we'll still ask them how much of that, let's say for example $2,000, do their parents need for any kind of debt or to pay for their insurance and then we'll take that as a true number towards their monthly budget."

The role that family dynamics plays in the decision making process has changed post-recession as well. Children of the elderly person often disagree as to which home their parent should choose, or if they should even choose a home at all. Gutierrez says these types of disputes have always been a problem, but in the last year they have become much more prevalent. And petty issues are giving way to more serious concerns, such as choosing between housing for their parent, or saving that money for other purposes.

"In the last year," he explains, "we've seen a very big rise of people keeping their parents home even though they have a moderate to high level of care that is needed because maybe they're unemployed and they need that extra money to supplement their income."

Gutierrez says the intersection of heart-wrenching emotional decisions and financial problems caused by the recession makes his job doubly difficult.

"It's an emotional decision but I think in this economy right now people are doing what they have to do in order to keep their home or keep their kids in school or to pay their bills. So if that means mom or dad at $700 or $800 a month being in the home then that's what they're doing."

In Gutierrez's office where he meets his families, a large painting of a lighthouse hangs above his desk. The lighthouse is small, but is surrounded on all sides by towering waves. He explains that he picked it up because in a way it reminds him of what he does for a living - help families navigate during a difficult journey.

He interrupts his own explanation. "Oh, it's kind of dramatic," he says somewhat embarrassed. But it seems like an apt description: families coping with this kind of transition need all the guidance they can get.

Chris Gutierrez, director of senior housing at Southern California Senior Resources.

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