The Costs of Aging in Place

Home Health Care allows

the elderly to age in place.

Image abandoning the place you’ve called home for the past 40 years, surrendering all your income and moving into a long-term care facility, a nursing home.  There you must share a room with a stranger, follow the facility’s schedule and spend the majority of your time alone or with nursing staff.  Of course this is a stereotype, many long term care facilities are lovely places, but this lonely scenario is what many older Americans fear to be waiting for them when they are too ill, injured or grow to frail to live independently. The majority of elderly are adamant that they do not want to end up in an institutional setting.  Today, with the rising costs of care, there is an increasing interest in home health care as an alternative to long term facilities.

Age in Place

Home Health Care provides health care and support services that can be received at home and is available for ill or disabled people of all ages.  The main goal of Home Health Care for the elderly and frail is to allow the individual to age in place.    Home Health services allow aging individuals to maintain their independence and remain comfortable in a familiar setting.  With Home Health Care, the aging can avoid moving to institutionalized long term care facilities.  Studies have shown that Home Health Care can actually improve the quality of care received and many times will reduce the need for hospitalization. 

Benefits of Home Health Care

With outcomes often as effective as care received in assisted living, rehabilitation and skilled nursing homes, Home Health Care brings a lot of benefits to those who use it.  Home Health Care providers get to really know their patients and families and can tailor their services to best meet the Client’s health care needs, finances and family preferences.  They can help families navigate the confusing web of health care resources and can effectively advocate the needs of their patients.  Another advantage is family is invited to become more involved and can participate in providing support and hands on care for their loved one.  In addition patient morale is often better at home and people tend to recover faster with less incidents and safety issues in a home setting.  Finally, there can be significant cost savings when using Home Health Care as there are no room and board costs compared to nursing home, rehabilitation centers and other institutional care settings.

Types of Home Health Care

There are two types of Home Health Care options available; Skilled Home Health Care and Non-Medical Home Health Care. 

Skilled Home Health Care is medical in nature and is used to provide skilled care or treatment or rehabilitation services to homebound patients.  This type of care is usually initiated by a physician and provided by a licensed medical professional such as an RN, LPN or Physical, Speech or Occupational Therapists.  Providers must follow specific federal guidelines and criteria regarding patient care.  Skilled Home Health Care providers are usually Medicare certified and can accept 3^rd party billing of health insurance which is great because out of pocket expenses range from $85 - $150/hour.

Non-Medical Home Health Care provided home services which are not considered to be skilled care but help the individual be safe and comfortable at home.  Services are usually initiated by social workers, family members or by the aging person in need.  Care is provided by trained Caregivers and CNAs (Certified Nursing Assistants).  Providers can be licensed by the state but requirements vary state to state.  Non-Medical Home Health is usually an out of pocket expense and ranges from $20 - $30/hour in cost.  Non-Medical Home Health Care can be covered by Medicare if coupled with Skilled Home Health Care.  Long term care insurance policies as well Veterans Aid and Assistance benefits can be used to pay these Non-Medical services.

How they work together

Let’s work through a scenario to see how Skilled and Non-Medical Home Health Care work together.  Margaret is an 83 year old female who was hospitalized due to a fall.  She was released after 3 days in the hospital.  Upon her discharge, the physicians and social workers agreed that Margaret could not be home alone during her recovery even though she was expected to make a full recovery in time.  Margaret elected to use Home Health Care rather than move into an assisted living or stay at a skilled rehabilitation center. 

Skilled Home Health Care was set up to monitor Margaret’s recovery and ensure she would not have to be readmitted to the hospital.  Weekly, 30 minute RN visits were scheduled to check her vitals, medications and general health.  Physical Therapists visited her at home biweekly to work with Margaret on her walking and balance skills to prevent future falls.  Non-Medical Home Health Care was set up to visit Margaret twice a day.  A 4 hour AM and a 2 hour PM shift came daily to help with companionship, medication reminders, assistance with exercise routines, transfers, showering, toileting and dressing as well as household chores and meals.  Within a month Margaret no longer needed the Skilled Home Health Care which was discontinued.  She retained the Non-Medical Home Health Care long term but reduced the hours to only 3 per day.  Margaret’s combined use of the services cost her very little compared to moving into a facility to recover.  The fact that she retained the Non-Medical Home Health Care means that she will be able to remain at home in the future even as her care needs increase. 

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.

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.

Sibling Troubles Revived

Caring for aging parents can revive

relationship troubles between siblings.

You grew up together.  You learned, played and fought together as children and were the best of friends and the worst of enemies all at the same time. You know your brothers and sisters well but now that your aging parents need their children to actively help them, you may find working with your siblings to be far more difficult than you ever imagined.

Martha‘s mother recently passed away.  When looking back at the whole experience, Martha could say she was now at peace with it but deeply regretted the relationship damage that took place with her brother and sisters during the months leading up to her mother’s death.  Conflicts over large and small issues drove a deep wedge between the siblings.  There was bickering over medications and doctor appointments.  There was squabbling over spending time with mom.  There was quarreling over who was to help with specific tasks.  There were out and out fights over expenses. It was like all the adults in the family reverted back to childhood battle lines and no one was fighting fair.

United in crisis

Ideally, siblings will unite and work together to care for their parents when they are ill or become too frail to care for themselves.  Yet in real life it is often a crisis that suddenly forces siblings to unite to provide care for an aging loved one.   These crisis situations trigger a lot of family friction.   Conflicts are made worse by brother and sister’s fine-tuned ability to push each other buttons and relive childhood rivalries.  Arguments over care sap the strength out of the family at the time when their parents need them to work together.  It is also very upsetting to the aging parents who depend on their children for help. 

To avoid conflicts siblings need to face the fact early on that they will someday be called on to care for their aging parents.  Preventing disputes over how best to provide that care is ideally done long before any care is needed.  Sitting down with parents before any care issues arise and discussing the realities of aging is the first step to keeping the family intact and working together through the care years later on.

Talk it out ahead of time

Long before the need exists, when the adult children are in their 40’s and the aging parents are roughly in their early 70’s, have a serious talk about the future.  Gather the family and openly discuss the possible scenarios of the parent’s future care needs.  It may feel premature and a bit morbid to discuss your loved one’s mortality, but it is foolish to pretend they will not age or face health issues someday.  Most people avoid this uncomfortable discussion and wait until a crisis forces the issue and then they must make quick decisions which often lead to mistakes, conflicts and frustration.  It is wise to talk about the parent’s wishes and how they could be honored so the entire family has a framework for the future.  Having a general care plan in place will go a long way if a crisis hits and also will serve to lay the ground work for future long term care. 

Figure out who will do what

Recognizing off the bat that the division of labor will never be perfectly fair, discuss among the siblings who could do which tasks and how much money each would be willing to pitch in to pay for care if necessary.  Try to roughly divide up the responsibilities according to ability.  Sketch out a game plan that all members of the family can theoretically agree to. Don’t assume that since you were all raised in the same family that you naturally agree on what is best for mom and dad.  There will be some emotionally intense moments when you will not agree at all and these will test your bond as siblings, so try to define roles and rules ahead of time to ward off extra conflict.

Gather all the important documents

The sibling(s) with strong organizational and finance skills should be appointed the Power of Attorney for finances by the parents.  Everyone in the family should have a clear understanding of under what situations that power would be activated and what tasks the Power of Attorney will take care of.  This sibling should know where all the money and accounts are kept as well as all the insurance and investment paperwork. Once activated, the POA of finance should gather the titles to the house and cars, safety deposit boxes, keys and passwords for all accounts. They should review any long term care insurance and all other insurance policies your parents have set up and understand the fine print about what is covered and how it will be covered.  The sibling in charge of finances will take care of organizing all the important paperwork, arrange the payments for all bills and should keep the rest of the family informed.  The POA of finances will become knowledgeable about their parent’s financial details and be able to manage the available money to cover care and end of life costs.  They will be responsible for exploring public assistance options if the funds run short. 

Health Care Decisions

As parents age, their health care becomes an increasing concern.  From managing their medications and doctor appointments, to helping with mild cognitive issues to working out end of life care, the amount of decisions can be overwhelming.  The sibling who has been appointed POA of health care will have their hands full once their power has been activated.  If the aging parents were clear about their health care directives and where they wish to be when full time care is needed, then the many decisions will not be such a major source of stress.  Yet even with clear guidelines in place there will be many health care issues where conflicting opinions between siblings cause stain.  One family set a rule that the sibling present at the moment gets to make the decision and, once made, it cannot be second guessed.  Even though all agreed to this rule in the beginning, the siblings found it quite difficult to abide by.  Again, it is having a clear understanding of the roles and rules between siblings that make the care years easier to manage. 

With long term family ties, a little grace will go a long way, especially when stressful situations demand a unified working cooperation.  Know ahead of time that all decisions regarding the aging loved ones will not be unanimously accepted but agree to disagree nicely for the sake of the parents and future family relationships. 

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.

Cost of Caring for Parents

There are obvious as well as hidden costs

when caring for aging parents.

Trish responded as most of us would when she realized her aging parents needed help.  Her mother was diagnosed with cancer and her father just wasn't up to the task of caring for his ailing wife during her recovery.  Being a single woman without children, Trish left her career and closed up her house and returned to her childhood home to care for them.  What was to be a temporary stay turned permanent when her mother passed away quite unexpectedly and Trish was faced with the long term care of her aging father.  Siblings with their own busy families pitched in here and there, but the day to day tasks of caring for Dad fell squarely on Trish’s shoulders.  Trish struggled to make ends meet on her father’s limited pension but medical bills and living expenses made it difficult. She also began to worry about her own future as she had given up a profitable career to be the family Caregiver.

Adult children Step up to the Task

Trish’s experiences are not at all uncommon these days as the Baby Boomer generation enters their elder years.  In fact, over 25% of adult children over 50 are now providing personal care and financial assistance to their parents.  This percentage has tripled over the past 15 years and is expected to continue to grow. 

Family values play a large role when deciding to put personal lives on hold and become the primary Caregiver for an aging parent.  Most families, in response to a sudden need, make the decision without true consideration of the depth of commitment required or the present or future cost.  Of course providing care for a cherished loved one is not about the numbers, yet it is wise to know what to expect when taking on this responsibility.

Pull out the Calculator

Providing care for an aging parent does have a cost.  According to a 2011 study by the MetLife Institute, women who take time off work to care for a loved one, on average, lose close to $350,000 in earned income, pension and Social Security benefits.  Men statistically average less loss, but that is because they are less likely to become the primary Caregiver for their parents.  It is job that is traditionally taken on by daughters and daughter-in-laws.  In addition to lost future income, there is often the present loss of health insurance, benefits as well as opportunities for career advancement.  Moreover rejoining the workforce at a later date is sometimes much harder than expected.  All these issues add up to real financial cost for caring for aging parents.  This financial loss taken on by the adult children can often be multiplied by their parent’s cost of health care and elder care.

Most aging Americans have some financial preparations made for their retirement.  Yet the financial planning industry has traditionally focused on perfecting portfolios and building nest eggs.  Until recently there has been little talk about planning for the cost of the care years. The cost of care can totally derail a sound financial plan and then the burden of paying for later life care often falls on the adult children.  With hourly rate for certified home nursing aides ranging from $17.00 up to $30.00/hour and nursing facility costs averaging over $80,000 a year, the cost of elder care can be staggering.

Have the Conversation

The problem is that most families don’t start thinking about their parent’s care needs until there is need for actual care.  Usually that is due to a parent’s illness or a crisis situation which demands immediate attention. Aging parents and adult children generally are not proactively arranging for these long term care needs and so are caught unaware and unprepared. 

The best time to make caregiving decisions is long before they are needed.  Having open dialog with your parents and siblings about the financial situation and making advanced decisions on how to cover care costs and divide up care tasks with family members will make the entire process much easier.

Trish never regrets the time she spent caring for her parents, but now that they have passed on, she wonders how to get her own life back on track and get prepared for her own elder care 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 family owned companies provide comprehensive care for the elderly in the Fox Valley of Wisconsin.

Sources :

“How to Prepare to Financially Support Aging Parents” by Philip Moeller.  Retrieved from www.money.usnes.com on 3/10/14.

 "The MetLife Study of Caregiving Costs to Working Caregivers” by MetLife.  Retrieved from www.metlife.com on 3/10/14.