The unexpected costs of caring for your elderly parents.

Debbie Walker had just spent the evening working the red carpets at the Gemini Awards in Richmond, B.C. After a late night of escorting stars and mingling at parties, the publicist returned the following day to the Sechelt ranch home she shared with her elderly mother.

‘They are better prepared for death than for life in the years following the end of work,’ says one financial planner of Alberta couple. Her mother usually sat on the porch in the afternoons and it was a warm, sunny day. But she wasn’t there. Inside, Ms. Walker found that her mother had fallen in the bathroom and called an ambulance.

“That was one of the first inklings that it was going sideways,” Ms. Walker, 58, said. “I had to look at life differently and had to make decisions that I didn’t necessarily like to make: where do we go from here? How are we going to cover things?” Over the next eight years, Ms. Walker would spend more than $50,000 on her mother’s care and raid her own retirement fund to help cover the expenses. To fill in the gaps left by a strained public system, Canadians today are finding themselves spending their own savings to care for their elderly loved ones.

Seven in 10 caregivers were providing some sort of financial assistance to their parents or aging relatives, a 2012 BMO survey suggested, and half of these individuals said they had to adjust their own retirement plans as a result. “People think the government will pay for home care and nursing homes which they will, but that help is really limited,” says Peter Silin, geriatric care manager at Diamond Geriatrics in Vancouver. “Families are not prepared for just how much things will cost — a good wheelchair really does cost $4,000 to $5,000. A new walker can cost $400 to $500.”

In 2007, most eldercare (75%) was provided by those between 45 and 64 years of age, according to Statistics Canada; dubbed the “sandwich generation,” they are caught between having to supplement care for their parents and giving money to their kids to attend university — while trying to save for themselves.

But when your parents, who gave you everything, need extra care, who could deny them? The local health authority may assess your mother and send a personal care worker to help her bathe once a week; but what if your mother wants to bathe every day? What if the workers at the assisted-living facility are unavailable to change your father’s incontinence products as quickly as he’d like?

“You think, ‘Well, I’m going to give her everything I can no matter what the cost and make her as happy at the end of her life for whatever it costs,” Ms. Walker says. “Foolishly, I thought, ‘Of course I can cover this. I am a professional, I can take my clients when I want.’ Then you realize how much time you’re not working with your clients and not bringing the income in. But your head’s up your butt because you’re all stressed out, dealing with whatever emergency that is happening at the time…There’s no management of your money.”

Ms. Walker moved from Vancouver to Sechelt to live with her mom in the mid-2000s to help take her to hospital appointments, cook, shop, clean. Her mother was formerly a receptionist and a ceramics artist; she had money from the Canada Pension Plan and Old Age Security but meager savings. Ms. Walker eventually hired a personal care worker for $20 an hour to come in a few times a week and then reached out to the province to replace private care.

People generally want to stay in their homes and provincial governments will help to make that happen. You can contact your local health agency directly or get a referral from your physician. The agency will likely send a case manager to assess your loved one’s needs and in some jurisdictions, their ability to afford care.

“In B.C., depending on how seriously ill you are and how much help you need, you can theoretically get up to 28 hours a week [from the province] but that’s very difficult to get,” Mr. Silin says.

Hiring a personal care worker through an agency or privately can cost $20 to $30 per hour. Some agencies will offer cheaper rates with more hours. Registered nurses cost $40 to $69 an hour. A full-time, live-in caregiver can cost $1,900 to $3,500 a month, plus room and board. However, note that round-the-clock care may require two or three full-time caregivers. Labour laws which vary by province, have rules about maximum daily hours of work, overtime pay and time off.

There’s no way that you can say, ‘Can’t we wait until next month to purchase a walker?’ You cannot deny your parents that.

When Geraldine Boyko’s father was diagnosed with cancer in 2011 at the age of 87, he required 24-care at his private assisted-living facility. The family hired additional personal care workers — “He called them the ‘hovering women,’” the 53-year-old nurse remembers — and the costs totalled $10,000 a month for the last three months of his life.

If you’re going to hire your own worker, check in with the province first, says Jeanie Burke, owner of Home Instead Senior Care Halifax. “For us here in Nova Scotia, if they’re getting some care from the province, they don’t pay tax on our services.” For Ms. Walker, the cost of equipment — the safety bar for the shower, a commode, walkers and wheelchairs, etc. — began to add up. “There’s no way that you can say, ‘Can’t we wait until next month to purchase a walker?’ You cannot deny your parents that.”

The equipment costs to make a home comfortable and safe can exceed $10,000, Mr. Silin says. He cites: electric hospital beds ($3,000 to $5,000), scooters ($2,400 to $5,000), walkers ($100 to $450), bath lift ($1,200), ramps ($200 to $8,000) and medication dispensing machines with monitoring ($800). For short-term equipment needs, call the Red Cross in your area to see if they have a loan program or look online for second-hand finds, Mr. Silin suggests.

Ms. Walker didn’t want to put her mother in a nursing home. “I had always told her that I would never do that to her,” she says. “I thought she would be better off with loved ones. But at that time, I did not realize she was affected by dementia.”

Private retirement homes, which often offer a continuum of care from independent living with prepared meals and housekeeping to assisted living for seniors who need more help with bathing and changing, can cost between $1,500 to $5,000 a month.  “My mother is in a place that is more than $4,000 a month. That’s your base rent,” says Lise Andreana, a certified financial planner and author of Financial Care for Your Aging Parent. “On top of that, because she needs help with the activities of daily living — dressing, bathing, toileting, feeding and mobility — it’s $500 a month for every 30 minutes of help that she needs per day. Other places charge by the task.”

In cases where people need more help in retirement facilities, as Ms. Boyko’s father did, families have to hire additional outside personal care workers. Ms. Andreana suggested that families consider using the funds from selling their parents’ home to fund the care. People are often unwilling to leave their homes; couples stay, believing they can care for each other. Arranging for them to talk with an independent third party such as a financial advisor or personal care worker could lay out their options.

“If you sell the house, you now have the resources to pay for care,” Ms. Andreana says. “ [To make it last] you have to budget carefully. You have to figure out how many years you’re going to need it for and then some…The average senior has 15 to 20 years of good health and up to 10 years of bad health.”

Forward planning is important but budgeting for long-term care may not be the best strategy, says Fred Vettese, chief actuary for Morneau Shepell.

Among Canadians 65 and older, he says, only one in 16 will find themselves in an assisted-care facility or needing high-level home care. If you’re among these individuals, you might be in your 80s and older retirees spend less than younger retirees. Also, older Canadians can draw on the equity of their home.

Ideally, you can depend on the public system. Ms. Boyko’s father had sufficient savings to cover the extended care that he needed; he was going blind and deaf and would fall into diabetic comas. The family moved him to a private assisted-living facility that cost about $4,500 a month with an extra $30 a month for laundry and cleaning. He also had personal care workers from Home Instead visit him at the facility for a couple of hours, twice a week at $27 per hour.

But after his cancer diagnosis, Ms. Boyko contacted the province three times to get her father into a hospice with 24-hour care. Since he was deemed not qualified for palliative care, the family shouldered the cost until he died.

“Everybody thinks, ‘When I need a facility, it will be available.’ A lot of times, there’s over a year wait. You get your first bed and maybe the bed is on the other side of the city or in a rural area.” In Ontario, the average applicant waits almost four months (113 days) for placement in a residential care facility and 154 days in Nova Scotia, says a 2012 report from the Canadian Institute for Health Information. Families must cover the cost of care in the interim.

Long-term care homes vary in cost depending on the provider whether public, private, not-for-profit or religious-based organizations. Provinces will share the cost with you at the facilities they support. In Ontario, basic accommodations are $1,708 a month, semi-private rooms are $2,012 and private rooms are $2,362.

If your parent can’t pay for basic accommodations, subsidies are available. The province will assess your ability to pay based on their parent’s tax return. If there is a shortfall, Ontario residents, for example, must pay residence costs equal to their monthly income less $100, with the balance covered by the province. When you apply, your needs may impact how quickly you are placed in a home. “You can’t put your name on a list for five years from now. In Ontario, you need to be ready immediately to make a move,” Ms. Miller adds.

Ms. Walker lived with her mother for several years before deciding to put her mother into a provincially funded nursing home in Vancouver. She only had to wait a few days after applying. Her mom paid $1,300 a month using most of her monthly income. If she needed additional care or medicine, Ms. Walker paid the bill. “They can rebound so well by having interaction, proper care, a nice place to live, a garden to work in and they get this second life.”

Her mother, Betty-Lou, passed away in the beginning of May, just shy of Mother’s Day and her 85th birthday.


Melissa Leong | May 24, 2014 | Last Updated: May 27 8:56 AM ET


Illustration by Chloe Cushman, National Post

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