Options of Elder Care

Know when it is time to get extra help 

and which type of care is appropriate 

for your loved one’s needs.

There is an awful lot to be said for an elderly person remaining at home as long as possible [1]. Home is familiar, its the place that holds a lot of treasured memories, and staying at home is key to retaining independence and feeling less like a 'burden' on family members (however inaccurate that feeling may be). However, there may well come a point when home is simply no longer a healthy, safe, or practical option. People who need medically intensive  round the clock care, or are unable to afford the assistance required to keep themselves safe and their homes running efficiently may well be better off if they receive care in a facility setting. This can be a hard decision to make, but there are a few pointers which may make choosing easier.

Struggling With ADLs and IADLs

'ADL' stands for Activities of Daily Living [5]. These activities include ambulation, bathing, continence, dressing and grooming, eating and toileting.  The ability to manage these activities is necessary to live independently.  IADL means Instrumental Activities of Daily Living and they include doing housework and laundry, shopping and preparing meals, managing medications, money and caring for pets, as well as other basic functions which supplement independent living. As people age they lose the ability to perform these activities as they used to.  Inability to perform ADLs and IADLs are usually the sign that assistance is necessary. Most elderly will maintain a degree of function with their ADLs and IADLs and can often still live quite happily in their own homes with a greater or lesser amount of outside assistance. However, when functionality of these activities drop significantly, then it's considered a sign that your loved one should make some changes so their care needs can be met on a more permanent and professional level.

Home Health Care Option

Staying at home for as long as possible is usually a very good idea. Many elderly prefer to stay at home and will refuse to move despite their need for increased daily care with their ADLs and IADLs.  Moving elderly people away from the comfort and familiarity of home can be very distressing, which in turn can affect their health. For such people, home health care is probably the best option. Home Health care can help your ageing loved one maintain their treasured independence and stay safe in the comfort of their own home. 

With home health care medically trained Caregivers come to the home and provide the individualized care that the elderly person needs. Home health care can be very flexible and provide as little as an occasional visit every two weeks to tidy up the house to round the clock care daily care.  In some cases with the help of home health care, it is possible to remain at home long term and receive appropriate care which includes hospice and end of life care.  The home health Caregiver forms a unique bond with their home patients and in many cases, become part of the family. The elderly person receiving care has dependable care that is tailored to their preferences.  Not only does this keep them feeling comfortable and safe at home, but it also allows them to maintain their independence which is indescribably valuable to the elderly.

Assisted Living Option

The hardest part of sending a parent or loved one to a facility setting can be persuading them that it's the right thing to do. Often they just don't want to go, and it's not unusual for distressing scenes to develop [3]. On these occasions, it may be a good idea to look at assisted living options. In most assisted living situations the facility is set up to feel like home.  The buildings have individual rooms which Residents can decorate with personal items from home.  There are common living areas which promote socialization among all the elderly who live there.  It may not be home, but assisted living facilities try to maintain a home-like atmosphere while providing the care that an elderly person needs. 

When looking at assisted living facility, also known as a CBRF, Community Based Residential Facility, it is best to remember that there are many types of facilities which offer different degrees of care.  It is wise to ask about the facility’s state classification to get a clear idea of what degree of care they are allowed to provide.  Some facilities provide limited care and assistance while others can provide full health care on site, including up to end of life care.  Choosing a facility according to its location and decor is often short sighted as your loved one’s care needs will increase and that may mean having to change facilities in the future. 

Nursing Home Option

If your loved one has an acute health condition, a nursing home may be the best option. When an elderly person requires care which isn't feasible to manage at home with home health care, or is beyond the scope of care for an assisted living facility, then a stay in a nursing home might be the best option. Typically a nursing home has a more institutional atmosphere as the focus in health care rather than just assisting with ADLs and IADLs. 

The bottom line is, if your loved one is seriously struggling to manage their ADLs and IADLs in their own home, and their quality of life is declining as a consequence, then it is time to start considering the various options.  Care solutions can be found in many locations, even at home, but matching the type of care to your loved one’s needs requires some thought and planning. Remember the goal is to ensure that your loved one is safe and can enjoy a rewarding quality of life no matter which option is chosen.  

www.homeaidhealthcare.com

www.prairiehomeassistedliving.com

Mel Higham is a writer and editor with a special interest in mental health and wellness.  As a guest writer for HomeAid Health Care’s Elder Topics, Mel brings her expertise to our audience.

HomeAid is sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their residents since 1999. Together the two companies provide comprehensive care for the elderly in the Fox Valley area of Wisconsin.

[1] National Institute On Aging, "There's No Place Like Home - For Growing Old", 

[2] Council On The Ageing, Victoria, "The Voice of older people on Independence", 2009

[3] Carol Bradley Bursack, "Handling a Parent Who Doesn't Want to Live in A Nursing Home",AgingCare.com

[4] KwikMed, "20 Truly Exceptional Elderly Care Sites"

[5] PBS, "Checklist Of Activities Of Daily Living (ADL)"

[6] Alzheimer's Association, "Choosing a Care Facility"

Long Term Planning

Plan for the future and the costs of care.

It can be scary for today’s aging to consider the future.  The cost of care, whether it be bringing in assistance at home, moving into an assisted living facility or the health care costs of a nursing home, is overwhelmingly expensive.  Most everyone understands the need to plan for retirement but few people really understand they need to plan for the cost of long-term care. 

There are many reasons people avoid thinking about needing care in the future.  It is natural for all of us to sidestep dealing with difficult situations, especially when means having to picture ourselves in a position of needing major health care or daily assistance.  Yet the fact is that the majority of aging citizens in the USA today will need long term care during their care years.  Many Boomers are glossing over this fact and not realistically factoring costs as they plan for the future.  Here are some facts about health and long term care costs:

Boomers believe saving $50,000 is enough 

for health care needs during retirement.

Most Boomers believe Medicare will cover all their health care needs.  Medicare does pay for health care. Most dual income couples turning 65 in 2020 can expect about $499,000 in Medicare benefits.  Yet that is not usually enough. The current estimates show that a couple turning 65 today will pay, on average, an additional $220,000 out of pocket medical expenses before they die.  These costs include premiums, co-pays and deductibles for medical care.  In addition to the health care costs, two-thirds of those over 65 will also pay about $50,000 per spouse for long-term care needs, such as nursing home care, assisted living or professional assistance at home. 

Do the math.  Putting aside $50,000 for health care during the care years is just a drop in the bucket compared to what could be needed.  The Employee Benefit Research Institute estimates that a couple who has put aside $165,000 by the age of 65 will have a 50% chance of affording their lifetime medical costs.  Those who put aside $225,000 have a 75% change of being able to cover their medical costs.

Right now the best scenario for Boomers turning 65 is having $300,000 saved per couple to cover health care needs for the future. According to the Census Bureau the median net worth of the average couple at 65 is nowhere near that. 

Boomers believe that Medicare will pay for 

long-term support and services.

Medicare does not cover long-term support and service costs.  So costs for elderly housing, long term nursing care, assisted living, or Caregiver support at home will be out of pocket expenses.

Most Boomers fail to factor in how the costs of long-term support can drain saved wealth.  A long stay in a nursing home, the need to move to an assisted living facility or the long term use of home health aides can diminish savings very quickly.  For instance, the average household wealth of $120,000 can be reduced by half with just a six month stay in a nursing home. 

Most males over 65 will require about 2 years of long-term supports and services and most females require 3 years during their lifetimes, so these long term support and service costs are important to factor into financial planning.

Boomers don’t believe they need 

Long-Term Care Insurance.

Again thinking they can rely on Medicare and their health insurance, most Boomers try to avoid the additional expense of another insurance policy.  What isn’t clearly understood is that Medicare long term benefits often only cover the first 100 days of care, and in most cases the reason for the health care must be serious enough to warrant a 3 day stay in the hospital before Medicare even kicks in.  Health insurance can also be very limited as far as long term coverage.

Another common misconception is that if it all gets too expensive the Boomer can just go on Medicaid.  Medicaid is an entitlement program and is only for people who have very limited assets.  To qualify for Medicaid means spending down all assets to get to poverty level.  Most Boomers don’t realize that owning a house or car will completely disqualify them from this program.

The cost of care for today’s aging can be intimidating and overwhelming.  Careful and creative financial planning can make long term care a bit less scary.  Today’s Boomers need to actively start looking into long term insurance as well as reassess their financial plans for their retirement years.

www.homeaidhealthcare.com

www.prairiehomeassistedliving.com

Kate McCarthy is Director of Operations for HomeAid Health Care which provides services for the elderly who wish to remain safe and independent at home.  HomeAid is sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their residents since 1999.  Together the two companies provide comprehensive care for the elderly in the Fox Valley area of Wisconsin.

Sources:

Why Baby Boomers Need to Get Real About Health And Long-Term Care Costs in Retirement.  Howard Gleckman. Forbes. 5/22/13.

InShare. Jan Zhdonova. 3/25/14.

photo credit a href=httpswww.flickr.comphotosoneworldgallery3003388845daystar297a via a href=httpphotopin.comphotopina a href=httpcreativecommons.orglicensesby2.0cca

Home Health Care

Most elderly want to stay at home

but are confused about

how Home Health Care can help.

Peter and Mary have lived in their home for over 40 years.  They have loved and cared for the house, the garden and the 4 children they raised there.  Now as they are aging and the children have grown and gone, they find it increasingly difficult to keep up the place.  Basic yard work and housekeeping isn’t being done and daily household chores like cooking and laundry are becoming a bit overwhelming.  Yet despite Peter’s troubles with walking and managing showers and Mary’s failing eyesight, they want to stay at home rather than move into an assisted living facility. They decided to get a Home Health Caregiver who will come and help them out a couple time a week.    

Most elderly and disabled prefer to stay at home and are choosing to use Home Health Care services to make that possible. Home Health Care is a practical and efficient way for individuals with health care or age related issues to get the services they need right in the convenience of their own home. 

There are two types of Home Health Care options, which can be confusing when someone is just starting to look into Home Health as a possible solution to their care needs.

Skilled (Medical) Home Health Care

Skilled or Medical Home Health Care is generally used to help someone get healthy at home. Skilled Home Health is usually recommended after a doctor’s visit or a hospital stay and the care is provided by medical professionals, such as a visiting RN or LPN.  Because the level of care being provided is skilled, the costs can be high.  Skilled Home Health Care is usually limited to just a few hours a week and assists with very specific needs.

With Skilled Home Health Care you can expect:

•   Skilled nursing
•  At-home physical therapy
•  Pain Management
• Caring for wounds
• Prescription management

Non-Medical Home Health Care

Non-Medical Home Health Care is about sustaining and maintaining a quality of life at home.  It is about preserving safety and independence at home for someone who might not be able to remain safe and independent on their own.  Many times the Caregivers who provide these services are Certified Nursing Assistants (CNA).  These services are a lot less expensive than the Skilled Home Health and can be used on a wider scale.  Often those who use Skilled Home Health Care will also have Non-Medical Home Health Care come to help with various tasks to keep the home running smoothly.

With Non-Medical Home Health Care you can expect:

•  Personal grooming services like bathing or assistance getting dressed
•  Ambulation services like assistance getting in and out of the bed/shower
• Medication reminders
• Alzheimer's or Dementia care
• Errands like grocery shopping, picking up prescriptions or transportation to appointments
• Housekeeping, laundry and cooking
• Companionship

Home Health Care Costs

Because both Medical and Non-Medical Home Health can get expensive, people wonder what payment options are available to help with the costs.  The cost of services will vary depending on where you live and the type of services needed.  It is a good idea to shop around and learn what services are provided.  Some Home Health Care agencies have sliding fee scales, and others charge on a per task basis and others provide a Caregiver who can assist with all cares needed at set hourly rate. Non-Medical Home Health Care services are usually paid for privately, but there are also some public and private funding sources.  Funding sources include the following:

•  Medicare
• Medicaid
• The Older Americans Act
• The Veterans’ Administration
• Private insurance

Home Health Care (Skilled or Non-Medical) is a great way to get the assistance needed without having to give up the family home and move into a facility.  As more and more people understand the options available with Home Health Care, it is bound to become a favorite option for families everywhere.

www.homeaidhealthcare.com

www.prairiehomeassistedliving.com

Kate McCarthy is Director of Operations for HomeAid Health Care which provides services for the elderly who wish to remain safe and independent at home.  HomeAid is sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their residents since 1999. Together the two companies provide comprehensive care for the elderly in the Fox Valley area of Wisconsin.

Choose well – Avoid common mistakes with Assisted Living

Choosing an assisted living facility

should not be done in panic mode.

It happens all the time.  A crisis takes place, an accident, a fall or an illness forces the issue to the forefront.  No one in the family had a real plan on what to do when Mom or Dad needed help on a daily basis and suddenly decisions have to be made and have to be made now.  In a panic to find an immediate solution, siblings debate care options and charge out to tour facilities.  In the rush to find a place, often very basic questions are not asked and future possibilities are not considered.  Knowing how to prepare, what questions to ask and what to look for can save your aging loved ones and the entire family a lot of heartache down the road.  Here are some common mistakes to avoid.

Not having the conversation

It is unfortunate that most families get caught off guard about their aging loved one’s future care needs.  The practical decisions of providing care, in most families, have not been clearly mapped out ahead of time so everyone knows what to expect.  This often leaves the adult children in the family in conflict with each other and scrambling to find a care solution when their aging parent suddenly needs daily help.  Wise seniors and their families will realize that it is better to have a plan in place than go through the rush and stress of making a major life decision in panic mode.

Have the conversation ahead of time and get a clear plan set down that the entire family can work with.   Do the research now and make general decisions about how care will be provided once needed.  Create a short list of facilities and service providers to turn to in the future.  Organize a list of things to be taken and things to be passed along to family members when the time comes to move.  Discuss parent preferences of who in the family will take on managing the finances and who will make care decisions in case they can’t.  Get the legal paperwork set up so it is just a matter of activating the decision once the time is right.  These are serious and often uncomfortable issues that all families with aging parents must deal with and putting off having the conversation and making decisions is being short sighted.

Not being realistic about the future

When shopping for a care facility it is important to be realistic about current and future care needs.  Most families look at an assisted living facility with an eye on location, cleanliness, decor and activities but fail to consider if the facility can provide the level of care needed for possible future health and cognitive issues.  Assisted living facilities are strictly regulated by state governments and fall into different categories which determine what level of health care they are allowed to provide.  For example in the State of Wisconsin, there are three different levels of assisted living facilities: community-based residential facilities (CBRF), adult family homes (AFH) and residential care apartment complexes (RCAC).  Out of these three categories only CBRF facilities can provide significant health care on site. In addition, within the CBRF category there are various classifications which determine who they can and cannot serve.  Pay attention to the facility’s classification and ask specific questions on if they provide up to end of life care as well as if and when they would ever require a Resident to move.

As the elder ages and health needs change, some facilities will be forced to evict Residents when they no longer can provide the level of care required. So it is important to consider future decline in health and cognitive abilities when choosing an assisted living facility.  Moving a loved one from facility to facility is costly as well as emotionally and physically difficult for the elder so it is better to be realistic about the future care needs now.

Not understanding the fine print

Even though moving into an assisted living facility is usually a health care decision rather than a real estate decision, there will still be contracts involved.  Most facilities have straightforward contracts which need to be read in detail.  When choosing between facilities, one of the main sources of confusion is the various pricing structures which should be explained in detail in the contract.  In addition to admission fees, facilities will have diverse systems set up to determine monthly costs.  Some facilities have base rates for room rental and meals and then charge extra fees for cares.  Others may charge for each service provided a la carte or they may rank the level of care needed on a sliding scale and increase the monthly charges according to how many cares the person needs.  With a scale system, Residents start at a lower cost but should expect monthly rates to increase as care needs increase.  Other facilities lock a rate at admission and will honor that rate regardless of increase of care needs due to aging, only to address the fees again if there is a major change in health. Since each assisted living community sets up rates differently, it is important to understand and compare upfront costs and how they may change over time.

Knowing about these common pitfalls can save the entire family stress and regret and allows everyone to focus on making the transition to an assisted living facility easier for your loved one when the time comes.

www.homeaidhealthcare.com

www.prairiehomeassistedliving.com

Kate McCarthy is Director of Operations for HomeAid Health Care which provides services for the elderly and disabled who wish to remain safe and independent at home.  HomeAid is sister company to Prairie Home Assisted Living (Class C, CBRF) which has served the physical, spiritual, mental and health needs of their Residents since 1999.  Together the two family owned companies provide comprehensive care for the elderly and disabled in the Fox Valley of Wisconsin.

Elder Care Options - Assisted Living

Knowing the Elder Care options makes the decision easier for the entire family.

It usually happens unexpectedly.  A fall or an illness leads to hospitalization and rehabilitation. In the midst of all the worry, concern and fear over your loved one’s health and well being, you are told that going home is not a safe option.  Pressed into finding a solution before your loved one is discharged and not even knowing where to start is a very stressful situation for the entire family. Knowing your care options can be a help.  Here is some basic information about one such option – Assisted Living facilities.

What is an Assisted Living facility?

Assisted Living Facilities are designed for individuals that need assistance with basic activities of daily living (ADL's). These activities are self-care tasks that we all learned in childhood, but become more and more difficult to perform as people go through the aging process. ADL’s include feeding, bathing, toileting, dressing and grooming, walking and transferring plus self administration of medications. 

Assisted Living, also known as Assisted Living Facilities (ALF) or Community Based Residential Facilities (CBRF's) are usually used by people who need assistance with their daily living. These people find it difficult to live on their own without relying heavily on family, friends or a home care agency.  People who use Assisted Living Facilities may require medical care in addition to receiving assistance with ADL’s, but they can still maintain some level of independence and do not yet need the level of continuous skilled nursing care as found in institutions like nursing homes. 

Assisted Living Facilities are licensed and regulated by state guidelines. They are grouped into three classes depending upon the level of care provided. Typically “A” class signifies very little external help with ADL’s whereas “B” and “C” class progress in the amount of care that can be provided. A “C” class assisted living facility is licensed to provide all levels of care including most skilled medical care tasks, which traditionally used to be only managed through nursing homes.

It is important to understand the classification of the facility you are considering, as some facilities will accept a Resident at one level of care only to require them to move later as their care needs increase beyond their ability to provide care.

People generally choose between home care, assisted living or nursing home care depending upon the amount of independence the individual can maintain, the amount of care needed, and the cost of that care.

Who can benefit from Assisted Living and how?

There are many types of people who can benefit from residing at an Assisted Living Facility.  Assisted Living is ideal for elderly individuals, or couples, who are capable of some level of independence but require assistance with the basic activities of daily living.  They may also have some medical concerns that require supervision or continuous attention.  An ALF is also a safe place for those suffering from Alzheimer’s or Dementia related problems.  Assisted Living is an ideal living arrangement for disabled individuals as well as those recovering from hospitalization or illness and in need of medical supervision.

There are many benefits for those who choose to live in an Assisted Living facility. The most important benefit is derived from the basic concept of “assisted” living.  The philosophy of assisted living is that it promotes independence, autonomy, privacy and dignity for the residents who live there.  The concept of Assisted Living is more concerned with the approach towards care rather than the actual care received.  This concept is important to families struggling with the less appealing option of placing their loved one in a traditional nursing home or juggling their own lives with the many care needs of their loved ones.  Assisted Living facilities strive to support and maintain the current level of independence enjoyed by residents, but with additional supervision and assistance when necessary.

One important benefit gained for residents and families alike is family roles are often restored when caregiver responsibilities are taken over by trained staff.  The professional care provided by assisted living facilities relieves the stress and burnout experienced by families when dealing with loved ones who need daily care.

Peace of mind is gained from living in an Assisted Living facility.  The residents benefit from continual monitoring of their health by the trained caregivers, Facility Directors and RN.   Safety against accidents or falls is another plus. The availability of nutritious meals and housekeeping, in addition to opportunities for social interaction, all add to the quality of life experienced by residents at assisted living facilities.

Who lives in Assisted Living facilities?

Currently, more than a million Americans live in an estimated 20,000 assisted living residences.  Assisted living residents can be young or old, affluent or low income, frail or disabled. A typical resident is mid-eighty and is either widowed or single. Residents may suffer from Alzheimer's disease or other memory disorders.  Residents may also need help with incontinence or mobility.

How much does Assisted Living cost?

Each resident has unique needs and preferences.  That is why most Assisted Living facilities will schedule an initial assessment meeting with each potential resident and his or her family.  The goal of the assessment is to learn more about the resident and determine what type of care is needed.

After an initial assessment, the facility will work together with your loved one’s health care provider to put together a Care Plan.  The Care plan is an individualized list and schedule of the services your loved one will receive.  The goal is to provide a level of care that addresses health concerns and provides necessary assistance while helping seniors to maintain their lifestyles.

Only after the Care plan is developed should there be a determination of the monthly cost of care.  That way there never should be any hidden costs or surprises.   On average Assisted Living costs are usually half the costs of nursing home care or full-time, 24 hour a day, home care.  While some assisted living facilities charge per item of care or service, there are some that includes a wide range of services within a standard monthly fee.  There are also some assisted living facilities which base their prices on a sliding scale and often raise rates for each additional service required. Those can start out at a rather reasonable price but soon escalate to be quite costly as care needs increase.

How does Assisted Living compare to institutionalized care?

A: The main difference between an assisted living facilities and institutionalized facilities, such as nursing homes, is the level of care a resident receives and the level freedom the residents are allowed to enjoy. 

In nursing homes, a majority of the residents have health issues that require continual medical supervision as well as need of assistance with daily living tasks.  They are no longer capable of living independently.  Residents in such a facility usually live in shared rooms with little to no private space.  Nursing staff provide medical and general assistance, but are limited in their time and attention by a high resident to staff ratio.  Nursing home residents typically are unable to leave the facility on their own, mainly because they are physically or mentally unable to.

Assisted living residents are far more independent.  They typically do not need as much hands-on medical attention.  Beyond requiring assistance with medicine management, bathing and other tasks of daily living, residents remain very independent. In many assisted living facilities they have individual room furnished and decorated to their own tastes.  Assisted living residents might still cook, entertain, participate in activities, and go on outings, while still enjoying the security of medical supervision and social interaction with other residents.

In the past the main distinction between Assisted Living facilities and institutionalized facilities, like nursing homes, was the ability to provide skilled nursing care.  These days Class C Assisted Living facilities are able to provide many medical services.  Under the supervision of a RN, medical care usually includes medication monitoring, pharmaceutical services, Alzheimer's and Dementia Care, physical and occupational therapy, pain management and hospice care.

Getting an overview of Assisted Living faculties does not make choosing the best one for your loved one’s needs any easier.  But knowing some of the basics about Assisted Living can help with asking the right questions so you make the right choice. 

www.prairiehomeassistedliving.com

www.homeaidhealthcare.com

Kate McCarthy is Director of Operations for HomeAid Health Care which provides services for the elderly who wish to remain safe and independent at home.  HomeAid is sister company to Prairie Home Assisted Living which has served the physical, spiritual, mental and health needs of their residents since 1999.  Together the two family owned companies provide comprehensive care for the elderly and disabled in the Fox Valley of Wisconsin.