# How are retirment homes funded/paid for?



## Chris L (Nov 16, 2011)

For a person in Ontario with a government pension with a paid for house, how would a retirement home/care home be funded? Does the home have you pay a set rate or geared to income? Do they require a downpayment? What if you have no money or run out of money?

I know there are many circumstances, but I'm looking for a general idea of the process that happens when a parent is moved from their own residence to a care home. I also get that there probably are various levels of care and quality of care so generalities are more or less what I'm looking for. Any helpful links are welcome. I'm not sure where to start.


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## Spudd (Oct 11, 2011)

If they move to assisted living (like Amica/Chartwell type places) they pay for it themselves. This kind of place is where you have your own apartment, meals are served in a central dining room, and they provide maid service. So it's when you're too old to take care of yourself fully, but not so old that you need nursing care. My mom is in one of these and she pays around 4k/month for a 1bed+den including lunch/dinner and maid.

Once they get badly off enough that they need nursing care, this is publically funded and costs around 21k-30k/year depending on whether you want a private room etc.
http://oltca.com/long-term-care-homes-are-publicly-funded


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## OnlyMyOpinion (Sep 1, 2013)

Further to Spudd's comments: The retirement apartment my folks just moved into offers a range of assistance on a fee-for-service basis. Right now they do not need any extra care so it is essentially an apartment, with central dining and once a week cleaning. It is not cheap, but there was no waiting list - if they got the space and you got the cash, you're in. It also does have a separate floor that provides a greater level of assistance.
As Spudd points out, past that level of care you are looking at a 'nursing home' or long term care facility. If you want a private room at a LTC facility, you pay for it and there is no financial assistance (but rates are prescribed), whereas you will not be turned away from a shared room even if you can't afford the full cost. Note also that the big thing with LTC is the need to first be assessed by CCAC, list your preferred 5 locations and then go on a waiting list. The info is at the site that Spudd provided under 'Residents and Families > How to Apply for Placement...


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## Davis (Nov 11, 2014)

As I understand it, if you get subsidized accommodation in an LTC, effectively all of your income goes towards your care, you get a small personal needs allowance, and the government pays the rest. It is based on personasl income, so if only one of a couple goes into the LTC facility, the other can continue living in the family home.


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## Chris L (Nov 16, 2011)

Thank you, this is very helpful. Say there was a desire to maintain the family home and pass it along, the government can not take mandate it be sold to fund LTC? However, I suppose this then affects how much money is left over to pay for more upgrades such as "private" care. Am I on the right track here? More or less, it will cost 50% more to get a private room in a good facility by the looks of things. I'll have to find out an exact figure for pension, etc. to see what is affordable. Obviously this is a little bit of a balance here and judging how much care is needed is another matter which changes moving forward as well.

Right now she is okay living on her own, but we are doing a lot of assistance and she is getting some outside home care which is funded by the government which helps with groceries and some cleaning duties around the house. She isn't able to get her mail or move any of her groceries, garbage and snow removal, grass cutting, maintenance and on and on.... and is very scared to move around in the winter months. However, she's still quite mobile otherwise and wants to avoid moving out of her house. But right now it's to the point that she can't get basic things done. It's pretty worrying for her to be out and about in the winter. She's also horribly worried about falling, but more than that..moving to a home. She has visited homes for most of her life (paying visits) and so forth. But I think it's nearing and I want to know how to talk to her and be on the same page at least. She's not exactly talking about these things, but when we're over doing things I try to bring it up at least. We just do what we can to help.


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## Davis (Nov 11, 2014)

I was thinking of a couple situation. I don't know about a single senior. If you're looking to get subsidized care in order to pass the family home onto the family, then I think your restricting your mother to the basic level of care in a shared room. If she wants something nicer, then she has to pay for it. 

With my mother, I found that the CCAC care wasn't sufficient. She wants, more than anything, to stay in her house. As my mother still has money, we got private care for her. Now that the dementia is more advanced, we have some in the house with her at all times so that she doesn't climb a ladder, go for a walk without a coat, etc. If she outlives the remaining money, we'll use a reverse mortgage to fund her care out of the value in her house.

It means a smaller estate, and happier last years for her.


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## Sherlock (Apr 18, 2010)

Spudd said:


> 4k/month for a 1bed+den including lunch/dinner and maid.


Geez. That makes it unaffordable for most people.


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## OnlyMyOpinion (Sep 1, 2013)

Davis - I like your solution to date - private care so that she can stay at home - because that is where she wants to be. Happiness & comfort are the top priorities. In our case, the family home was not viable over the longer term (4-level split) and they decided on their own that they wanted to sell and move into a retirement apartment. They are still adjusting (1 month into it) but so far are happy with their choice.
They also initially wanted to keep the house 'for the kids', but their income did not allow that. It was only the sale of their house that made it possible to approx. double their monthly costs. 
This is something all of us should keep in mind when projecting our retirement (or 'deccumulation' phase) costs. It is often said that costs go down in your 80's because you stay closer to home - but if you need care or move, your costs can spike significantly. There is the LTC 'safety net' (you won't be refused) but it may not be the setting that you would choose if you could afford otherwise. In the meantime, we are beginning the feel the 'squeeze' of the so-called sandwich generation.
Re/ the value of the house - it is my understanding that it is only your income that is used to determine any subsidy. The vaule of you assets, incl house are not included. But I'm not an expert on those details, and I'm referring to Ontario only.


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## Rebecca (Aug 10, 2014)

My mother moved to an assisted living facility in the Yonge and Eglinton area of Toronto and her place is lovely. She has a very large room that is very much like a studio apartment and the residence provides three meals a day in the dining room and afternoon "tea" (with cakes/cookies) in the afternoon. They also have at least three supervised activities a day (bingo, Wii bowling, movies, etc.) and weekly outings by private bus to local malls. The residents must be independent to live there, but there is a full-time nurse on the premises and they have other services come in weekly (a doctor for bloodwork, a chiropodist, hairdresser, etc.). The nurse also administers all medications (dispensed at the table at breakfast/lunch/dinner as required), and keeps an eye out for any obvious health issues with the residence. The nursing staff also follow up with doctor's orders (checking a patient's blood pressure, for example, after a new medication is introduced into the mix). My mother feared "a home", and there is a very big difference between long term care/nursing home and a "retirement residence"/assisted living facility. She pays about $2,500 for everything, other than the bloodwork services, hairdresser and chiropodist, which cost about $25 each when required. While investigating living arrangements for her when she no longer felt comfortable living on her own (my dad passed many years ago), I found a very broad range of prices ranging from about $1,500 (for a really lovely place in the Beach neighbourhood) to about $10,000 per month at some. I would agree that $4,000 - $5,000 is about average.

Your mother sounds like she should probably move into an assisted living residence at this point, and if you are in the Toronto area, I could pass along the research I did into the homes I visited before (with my mother) choosing her current home.

Editing to add, that my mother has to pay for her own TV and telephone services and I imagine that most residences require the same.


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## wendi1 (Oct 2, 2013)

$4k a month is $48k a year, and that includes almost everything - my grandmother only had to pay for hair cuts, toenail clipping, shoes and clothing. They even had a volunteer with a tool box who would fix chairs and things if they broke.

In my experience, the staff at these places is what makes them - sometimes the older and less beautiful buildings have fabulous staff. You have to meet them, and hang out in the lobby a while, and talk to the residents. Also, it helps if there are already friends there - the change can be quite difficult for older people, and it helps to have someone there already who knows the ropes. Sometimes, having regular meals, light exercise and people to talk to makes for a big improvement within a couple of weeks after they move in.


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## Chris L (Nov 16, 2011)

Last time we spoke she was pretty clear about when/if she moved, that would be it - no going back. So she's going to delay it, I figure until something forces her into a home. Illness or a fall, etc. I'm not sure that's the right thing to do or advise, but it's her life and so long as she can keep going it's not my place to say what's best for her. Ideally, she'd move in on her own accord and decide her next move instead of having nature decide for her. I don't know if it's as bad as she thinks, but has a lot of pride in keeping herself. I would hope it would be a relief and liberating rather than have to worry if the driveway will get shoveled, or worry about the furnace and a hundred other day-to-day issues with being a homeowner...but then again, perhaps these are the things that keeps her going.

Regardless, thanks for all the information. This thread has been tremendously helpful.


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## Spudd (Oct 11, 2011)

Yes, I will add that my husband's grandmother went into a nursing home a couple of years ago. Prior to that she had been living at home and having someone come to help her with the cooking/cleaning once a day. She had been really deteriorating at home but emphatically did NOT want to go into a nursing home. However, once they moved her (she fell, so she couldn't stay at home anymore) she really perked up and is now doing much better than she had been at home. They think the mental stimulation of having activities and people to talk to is really beneficial for her. She seems much happier as well. 

So sometimes, even though people may fear it, it's actually for the best.


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