The promise never to put Mama in a home: Never demand, never consent

By Sandra W. Reed

Attorney Sandra W. Reed answers your life planning questions.

Attorney Sandra W. Reed answers your life planning questions.

Julie’s dad pulled her aside and, whispered, “You have to promise me you will never let your mother and me be put in a nursing home.” The urgency in his voice and the intensity with which he gazed into her eyes sought to secure Julie’s oath of assurance.

Startled, Julie fought for time and composure. She patted her father’s hand and said, “Not now, Dad. It’s your 75th birthday. Let’s talk about that later.” Her father, by nature mild-mannered and gentlemanly, uncharacteristically responded with anger: “Not later, damn it, I want you to promise me now.”

What’s a loving daughter to do? Should Julie make such a promise? And if she promises, should she honor it at all costs? What about her dad? Does the fact that he has devoted his own time and resources to raising his children give him the right to make such a demand?

Forego Promises; Plan Financing of Long-Term Care

These promises never to put Mama or Dad in a home are being extracted, pledged, followed and broken in households across the country. Yet no person should ever seek and no person should ever consent to a promise to never put a loved one in a long-term care facility. Each of us as individuals has the responsibility of planning, to the best of our capabilities, for financing the care needed in the event we can no longer care for ourselves. Whether or not that care is to be given at home or in a nursing home environment will depend upon the sources and amounts of financing each individual has available.

Instead of acceding to her father’s wishes, Julie turned the tables on him and asked what preparation he had made to finance his own and her mother’s care inside or outside the nursing home. As a nurse, she was well aware it would be impossible to keep such a promise if Dad hadn’t made provisions to do so.

The Price of Private Pay Care

Julie explained to her father that 24-hour custodial care at home for a disabled parent would cost from $12 to $20 an hour, resulting in an annual cost of $105,120 to $175,000 a year. “If one of you needs this type care for the average anticipated period of two and a half years, Dad, you will need from $262,800 to $437,500 to handle that expense.”

Despite her father’s look of alarm, Julie pressed on. “If both of you were to need that level of care for two and a half years, it will take from $525,600 to $875,000 to cover the cost. Do you have that much?” It was obvious from Dad’s expression that he had not set aside that sum for long-term care. “I had no idea,” he said.

Julie gently questioned whether he might afford the preferred private pay nursing home in their city. She told him a private room in that facility would cost $5,000 to $8,500 a month, or $60,000 to $102,000 annually. Julie did the math on the two-and-a-half-year period for first one and then the other parent and asked, “Dad, do you have $300,000 to $510,000 that can pay for long-term care?”

When Dad sadly shook his head, Julie suggested a semi-private room would come with a smaller price tag of $2,800 to $5,900, or $33,600 to $70,800 a year. Julie’s Dad initially brightened when asked if his savings could cover the $84,000 to $177,000 a semi-private room would extract. He had that much. “Dad, that’s good for now,” Julie reminded, “but you and Mom may not need a nursing home for 10 years and, with inflation, it will take more. Or, heaven forbid, you need care for longer than the average two-and-a-half years.”

Long-Term Care Insurance as Alternative to Self-Insurance

Clearly, Julie’s father was not prepared to pay for long-term care through self-insurance. Scrambling for a life vest in a sinking ship, Dad protested, “But I bought that long-term care insurance policy 20 years ago.” Julie acknowledged a policy might help but asked to examine it. After reviewing the terms, Julie pointed out to her father that the policy would pay only $50 a day for nursing home care and contained no inflation factor, when current private rooms run from around $164 to $279 a day and semi-privatse run around $92 to near $194 a day.

Too late Julie’s dad realized his premium money would have been better spent on a policy that adjusted the payable amounts for increased costs over time. Julie agreed to check out the company that had issued dad’s policy. She was relieved to find that the insurer was financially strong, rated “A” or better by rating enterprises like A.M. Best, Standard & Poor’s, Moody’s, Fitch or Weiss.

Unfortunately, the policy contained a 60-day waiting period before any benefits were paid. As she expected, Julie found the policy would pay when the insured could no longer perform two major activities of daily living such as continence, dressing, eating, transferring, toileting, bathing or mobility. The policy promised to pay benefits for a two year period. Julie then determined the policy was an “indemnity” policy, meaning it would pay the maximum daily benefit amount of $50 for the contract period rather than a “reimbursement” policy which would have reimbursed expenditures up to a contract amount.

Additional Resources for Funding Long-Term Care

Julie and her father now realized the family would have to seek additional sources for payment of long-term care her parents might need in the future. Next week’s column will explore some of those sources.

Sandra W. Reed is an attorney with Katten & Benson, an elder law firm in Fort Worth. She lives in beautiful Somervell County, near Chalk Mountain. If you have questions about this column or wish to suggest a topic of interest, she may be contacted by phone at 254-797-0211 or by email at

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