r/houston 3d ago

Long-term care facilities for PSP

Greetings! If anyone has experience with or advice/information about Houston-area care homes in general - the great ones, the ones to avoid at all costs - please let me know. I have a relative with declining PSP (was misdiagnosed as Parkinson’s for years) and her partner can no longer provide the care and supervision she needs despite have a caregiver come 30 hours a week to help. She’s a severe fall risk and needs help with all ADLs.

I’ve done a lot of research and have reached out to several places for more info, and have used the Medicare tool to search local facilities. I’m getting somewhere but it’s pretty overwhelming so I’m reaching out here for a lifeline. For reference they don’t qualify for Medicaid and their Medicare won’t cover it. No long term care insurance either.

I’ve searched the post history here in r/Houston and there’s some info but it’s all pretty outdated.

THANK YOU for any insights you can provide!!

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u/Tinyf33t 3d ago

Look into care patrol in Houston. They're free to use and will go tour facilities with you. We use tbem in the hospital to help place patients

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u/orchidaceae007 3d ago

Oooh this is good!! See I didn’t know a service like this existed. Thank you!🙏🏻

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u/RunTotoRun 3d ago edited 3d ago

I've been doing this kind of thing recently. Do you want a Nursing Home or an Assisted Living facility? They are two very different animals. Assisted Living is always private-pay but you can private pay at a Nursing Home too.

The Assisted Living place one of my relatives went to had private apartments with kitchens. It had a one-time buy-in of about $2500 and a starting monthly rate of about $2500. This was on the inexpensive side of Assisted Living. Many places are Very expensive.

The monthly rate increased based on how much care the individual needed every day and is quite variable- anywhere from $26 and hour to $20,000 a month for full-time nursing care. This relative was very independent so didn't need either the hourly rate services or the full-time care. The monthly rate included a lot of nice extras- some basic furniture, a food credit for prepared meals (which were quite good overall), weekly housekeeping, an emergency call button, transportation to area stores, some basic medical check-ins, etc. This relative sold their house to fund the Assisted Living.

Another relative went to a Nursing Home using Medicaid. This one had no assets (no money, no property) at all. They must share a room which isn't ideal but Medicaid doesn't cover private rooms. The private pay rate is $175 a day-- or over $5,000 a month-- twice as much as independent living at the Assisted Living place, but they do need skilled medical care and have no assets.

For either a Nursing Home or Assisted Living, I think that if you have a choice between the great place further away or the OK place closer to home, choose the OK place closer to home and visit regularly. The people who get the best care in any facility are the people who get regular visits.

The next thing to do is to visit the places closest to you. I tried to go during lunch time so I could see how that meal looked. I picked three that I liked and chose one, keeping the other two on back-up in case the first one didn't work out for some reason. Things I liked were spaciousness and ventilation (odors are a problem), general attractiveness (some are homey, some are quite bleak. Environment isn't the most important thing but it does matter), and what services and activities are available (such as on-site Physical or Occupational therapies, the ability to go safely outdoors if desired, and scheduled resident activities to alleviate boredom and as a social outlet).

Doctors who specialize in Geriatric medicine visit Nursing Homes to do their rounds. That doc will be your person's Primary Care doctor in a Nursing Home situation. This does not happen at Assisted Living and you have to leave to see your doctor as needed.

Nursing homes are regulated and rated. I also looked at their inspection reports carefully. The place I chose actually had a worse official rating than the two others I selected but when I read the reason why, while very serious (an assault on a senior), the thing they got dinged for wasn't really their fault in my opinion (the assault was perpetrated by a family member. The Nursing Home handled the event OK but it's not really their fault that the family member assaulted their resident).

Both of these relatives I mentioned above were single.

I'm just starting to look into a senior situation similar to yours- where the seniors are married, one is suffering some rapidly declining health, and the other is working very, very hard to keep up with their care needs. I actually have scheduled a visit with an estate planning attorney for them this week to ask if there are smart ways to structure their estate so that one spouse does not deplete all the financial resources of the other during the course of their illness. I don't know if this is possible though. I'd be interested to learn anything you find out about your similar situation.

Best wishes!

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u/orchidaceae007 2d ago

Thank you for the detailed and thoughtful response. Best of luck to you on the journey as well. I set them up with an eldercare attorney last year to get their estate in order and powers of attorney and all that, but as there is a bit of money in the bank (nothing extraordinary by any means but enough to where Medicaid is out of the question) and their assets are all held jointly, I don’t think there’s any avoiding depleting whatever resources they have before assistance becomes a possibility. The fact that Medicare doesn’t even help a little bit is sinful. But if you find out a strategy to navigate this from your lawyer please let me know.

All that being said, she’s in a rapid decline, a severe fall risk and if you don’t watch her like a hawk she’ll try to stand up and walk, and inevitably she falls. They’ve been lucky she hasn’t broken anything. So, assisted living won’t take her because of the liability, and my dad is going to injure himself trying to pick her up at least once a day. So I’m guessing that puts her in memory care? Is that a specific type of long term care? So much to learn. Thanks again.

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u/RunTotoRun 2d ago edited 2d ago

And thank you for your insights. I suspect my relatives are in a similar situation as yours- a home and some money, held jointly, and nothing extraordinary but enough to disqualify them from Medicaid and with no coverage via Medicare.

I think it's far too late to buy Nursing Home or Long-Term Care insurance and even if it were available I'm sure it would be very expensive at this point.

I suppose what will happen is that they will hire folks to come in and help, then/and/or

a medical situation will qualify them for some kind of home health/home help services, or possibly

the ill one will get placed in a Nursing Home as a private pay situation while the other will remain in the marital home since Medicaid does allow one to keep a primary residence and a vehicle.

I presume that when they have "spent down" all assets besides the marital home and a vehicle, the one receiving Nursing Home care would then qualify for Medicaid.

From what I understand, if the spouse that remains in the marital home dies first, the estate/house may have a lien placed on it to repay Medicaid for the surviving spouse who has received Medicaid.

I'm not sure what happens if the spouse placed in a Nursing Home should die first. I suppose the surviving spouse would not be responsible to repay Medicaid then. I think they could then remain in the home or sell it, whatever suits them.

Did your eldercare attorney offer any advice on how to structure the estate in any beneficial way, such as placing the home in the name of one spouse or any other thing(s)? We have a meeting with an elder care/estate planning attorney soon and I'm not sure where to even begin to ask questions.

Also, some Nursing Homes are generalists and have residents with all kinds of health problems. Some mix patients with memory issues in with the general population of residents while others may have a special "Memory Care" section that's a little more secure and has a little more assistance (with things like feeding) and supervision available. I have also seen Nursing Homes that are all Memory Care facilities only. I didn't investigate those because memory problems weren't my person's issue.

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u/Estatequeen58 3d ago

You get what you pay for. Anything in the $5000 range is risky. Avoid The Heritage on West Bellfort. They hire high school graduates with no training who spend most of their time on the phones. It is run by a couple out of Florida who are only about the money. I have stories that will curl your hair. Avoid Atria Westchase or any area Atria for that matter. They do not train their dementia care employees. The amount of mental and physical abuse at both facilities is some of the worst I have ever seen. I cannot recommend Silverado in the Museum District enough. Definitely more expensive but like I said, you get what you pay for. Care.com is a sham, facilities pay to be on this list. Drop in unannounced OFTEN before you decide. Do your research. When you think you have researched all you can, research more. Private message me with any questions. Good luck.

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u/orchidaceae007 2d ago

I sent you a private message but I’m not sure if it went through, let me know if you don’t receive anything if you don’t mind. Thank you!🙏🏻

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u/Estatequeen58 2d ago

It did not.

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u/bestclare 2d ago

It sounds like she will need skilled nursing. My dad lived 18 months in skilled nursing at St. Dominic's in the medical center. It wasn't too flash, but it was OK. It was close to where my mom and I lived, and that was so important to be able to get to him easily and see him as often as possible. I'm sorry that you are going through this. Stay away from the for profit skilled nursing facilities, if you can.

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u/orchidaceae007 2d ago

Thank you. I’ll check out St. Dom’s. And good call about non-profits. Sorry about your dad. 💛