Long-Term Care: A Guide to Making Informed Choices
Mom hardly cooks anymore, and often skips her medication. She’s definitely not taking care of herself or the house as she used to. You’re afraid that she might forget to turn off the gas, or stop cooking for herself altogether. The next fall could land her in the hospital. Is it time to sit down as a family and decide what is best to safeguard the years you have left with her?
Dad has piles of newspapers in the living room and dirty dishes all over the kitchen. He’s often forgetful and confused when you ask him about important matters concerning his finances and upkeep of the house. Worse, you know he’s not taking his blood pressure medicine on a regular basis. What if he has a stroke, even a minor one, and no one finds him for hours afterward?
The scenes described above are played out in thousands of homes each and every day. If you can relate to one of them, it is comforting to know that there have never been more or better options when it comes to long-term senior care. This article is designed to educate family members about those choices and help them select the one that offers the most appropriate services, in the most comfortable setting, and that will allow their loved ones to live the fullest possible lives.
How Do You Know When the Time is Right?
The reality is that at some point, even the healthiest and most robust senior will likely require some level of assistance outside the home. If your loved one is experiencing ongoing health difficulties or needs assistance with activities of daily living, take a few moments to answer the questions below. If you can answer yes to any of them, the time has probably come to make a decision concerning long-term care.
- Has your loved one’s advancing age or a chronic health condition resulted in seriously diminished strength and inability to function independently?
- Has it become increasingly difficult for family members and friends to provide adequate care without regular professional support?
- Have escalating clinical needs or changes in behavior rendered the current setting for care inadequate or unsafe?
All too often, a sense of guilt keeps people from seeking the help they need to care for aging parents or a family member who can no longer function independently. Despite ever-increasing physical and emotional demands, they nevertheless attempt to care for their loved ones themselves and frequently jeopardize their own physical and mental health in the process. Family caregivers frequently push themselves to the limit and put a greater burden on themselves and their families than anyone can be expected to handle. In these situations it is important to make a prompt but well-considered decision that is in the best interest of everyone involved.
Long-Term Care Options: Responding to Changing Times and Changing Needs
Over the years, long-term care has developed and evolved, adjusting to meet changing times and responding to many different needs – the health of the older adult, his or her mental capabilities, the desire for social interaction, and the family’s ability to participate in the care.
In choosing long-term care you will be addressing the health, personal care, lifestyle and social needs
of your loved one. There are several options to consider. Some of these are transitional, some
are permanent, and most offer social and recreational services along with professional healthcare support. The following brief descriptions will give you a basic understanding of the most readily available alternatives.
Assisted living provides relatively independent seniors with health care support and personal assistance in a home-like environment. Typical services may include:
- Private or semi-private rooms
- Three meals a day served in a common dining area
- Assistance with activities of daily living such as eating, bathing, dressing, toileting and mobility
- 24-hour security
- Laundry services
- Social and recreational activities
Limited health care services are provided by the facility. When required, clinical care is generally provided by outside professionals and home healthcare agencies at an additional cost.
Sub-Acute Care and Rehabilitation
Sub-acute care is the answer for those recovering from a serious injury or illness who no longer need the acute care provided in a hospital but still require some help with their recovery. Skilled nursing homes frequently provide sub-acute care both to residents and short-term non-residential patients. In many communities sub-acute care is also provided by freestanding facilities. Sub-acute patients receive skilled nursing care, rehabilitation therapies, wound care and other specialized services until they are able to return home or move to an alternate level of care.
Skilled Nursing Facilities
For most people, long-term care is synonymous with “nursing home care.” When patients are no longer able to care for themselves, a skilled nursing facility provides round-the-clock care and assistance with activities of daily living. Most facilities today offer far more than just quality nursing care. Additional services may include sub-acute rehabilitation, dementia care, respiratory therapy and psychiatric support. They also offer a full range of social and recreational activities to enrich and enhance the lives of the residents.
Programs designed specifically for people with Alzheimer’s disease and other forms of dementia are available through certain residential skilled nursing facilities. Dedicated units, wings or free-standing facilities offer a safe and secure setting for care. A specially trained staff provide health care support and supervision. Structured activities are designed to stimulate and encourage residents to function at their highest possible level.
Paying for Long-Term Care
There are four basic ways to pay for long-term care:
Medicare is a federal health insurance program divided into two parts. Part A pays for inpatient hospital services, care in a sub-acute rehabilitation facility, skilled nursing services in a nursing home for a limited period of time, home health services*, and hospice care. Medicare Part B pays for physician services, outpatient hospital care, medical equipment and other health services. Eligibility for Medicare is not based on financial need and is open to nearly all seniors. (*There are various levels of Home Health Care, some are covered by Medicare and some by Medicaid.)
Medicaid is a combined state and federal program that pays most nursing home costs for people with limited incomes. The program has limitations as to the amount of assets the patient may own and the income he or she may receive each month and still be eligible.
3. Private Pay
Insurance experts estimate that about one-third of all long-term care is paid for by individuals from their own funds. These “private pay” sources include savings, investments, pension plans, employee stock ownership plans, single premium annuities and cash value of life insurance polices.
4. Long-Term Care Insurance
Given the increasingly high cost of health care, long-term care insurance is becoming more popular as a way to help defray future costs and alleviate anxiety. Policies must be purchased prior to needing long-term care, as eligibility is based on current health. If you are already a candidate for long-term care, you may not qualify for coverage. Premiums are based on age, health and the type of plan purchased. Most financial planners recommend that long-term care insurance be purchased when people are in their late 50s to early 60s, when premiums are more affordable.