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Elder Care

Do you have an aging family member or friend? Do you need help in caring for this person? Do you know what alternatives are available?

As many of us approach our 40s and 50s, we find ourselves faced with a role we never expected — caring for an aging parent. Over the next decade, millions of baby boomers will face this role. For families with an aging parent who can no longer live alone, finding appropriate care and housing within their financial means can be a frightening and time-consuming experience. Also, depending on the level of care required, costs for elder care can be astronomical, and Medicare and private insurance may not cover most expenses. If you are faced with providing care for an elderly parent or loved one, it is important to carefully review your options in order to provide the best care for your aging loved one without negatively impacting your financial well being. There are many options to consider. This article briefly describes several alternatives to help you evaluate solutions that may work for your situation.

Adult Care Options

  • In-Home care

  • Adult daycare

  • Resident care facilities

  • Retirement communities

  • Assisted living

  • Nursing home

  • Hospice

In-Home Care – Many seniors are independent enough to take care of themselves, but need assistance with grocery shopping, transportation, housework, and managing their finances. Under these circumstances, remaining in the home with either a paid caregiver or family member providing the necessary assistance is a practical solution.

As an elderly person's health deteriorates, in-home care can still be a viable option, although the amount of assistance required may need to increase to ensure that the senior's needs are being met. Support required can include help cooking and cleaning, administration of medicine, assistance with bathing, dressing, eating, and therapeutic care. In-home care can be provided by a member of the family or by a paid caregiver. While it is far more cost effective to care for an aging family member yourself, the financial and emotional drain on you can be detrimental. Adding additional care, such as adult daycare, discussed in detail below, provides the benefits of socialization and activities for the senior while providing you some freedom to care for your needs. For more information about in-home assisted living, including newsletters and support groups, visit the website of the National Family Caregivers Association (NFCA).

In-home care provided by certified nursing care providers is another option if your elderly family member requires more medical care than you can supply. Professional caregivers work through agencies that are strictly regulated by state and federal laws, and services are administered through physicians, social workers, nurses, and therapists. The level of care provided is similar to what is offered in a nursing home, while allowing the individual to remain at home.

Adult Daycare – Adult daycare is a relatively new service for frail, physically or mentally impaired seniors and their caregivers. Care provided varies from custodial care, with programs designed to stimulate and rehabilitate seniors to daycare, to services providing necessary medical care and procedures for individuals who may need more attention. Adult daycare is offered in stand-alone facilities, as well as through assisted living or nursing homes as an outpatient service.

Senior daycare may be a helpful option for members of the family who are providing in-home care to seniors. By utilizing this kind of care, family members are able to work outside the home and are released from what can be a 24-hour responsibility, while still playing an integral part in the care of their loved one. For seniors, adult daycare offers opportunities for social interaction with peers, and physical and speech therapy in a non-medical environment.

When researching adult daycare facilities, the following list can be used as a guideline to begin assessing facilities:

  • Transportation to and from home

  • License for administration of medicine and medical procedures

  • Bathing facilities

  • Professional, friendly staff

  • Daily activity schedule

  • Meals that are both nutritional and meet the needs of the residents

Additionally, some facilities offer respite care, a service designed to provide caregivers an opportunity to tend to their other obligations without neglecting the needs of their loved one.

Resident Care Facilities – Resident care housing consists of small residences where between two and six seniors live together, with a caregiver providing 24-hour-a-day supervision, meal preparation, laundry and housekeeping services, and assistance with daily living activities. This type of care offers a mix between in-home care and assisted living, affording residents the opportunity to live independently, while taking advantage of the benefits of socializing with their peers. Most facilities are licensed and regulated by the Department of Social Services in the state they are located.

Retirement Communities – Some retired people are independent enough to live on their own, but want to live in an environment with others in the same age group. For these seniors, retirement communities are ideal. Many facilities offer residents a wide range of amenities, including meals served in a dining room, transportation, shopping excursions, social activities, and field trips. Residents enjoy independent living by occupying their own home or apartment, but avoid the chores, isolation, and lack of security that many elders experience by remaining in their own home.

Many retirement communities are similar to other neighborhoods or communities, with an age restriction to only allow people over a certain age, such as 62. Many facilities offer a variety of housing options to meet the needs of their residents for the remainder of their lives. Lawn maintenance and cleaning services are offered to reduce maintenance chores. Seniors can purchase a small home when they first move to the community. Then, as they choose to further reduce their home maintenance chores, residents can move into an apartment within the community. If the senior's health complications prohibit them from living on their own, a nursing facility is available in most retirement communities.

Most retirement communities offer a variety of activities for their residents to encourage an active lifestyle. Amenities may include golf, tennis courts, swimming pools, biking trails, exercise rooms, libraries, and a variety of clubs and discussion groups. Planned daily activities include shopping trips, movies, religious services, and speakers.

The average age of new buyers in the larger, more recreation-oriented retirement communities is in the early 60s, with an annual income above $35,000. To learn more about retirement communities in your area, visit www.SeniorHousing.net.

Assisted Living – For many elderly people, staying in their own homes or living with a relative is not an option because their health complications require constant supervision and attention. Assisted living housing offers families' piece of mind by providing a mix of residential living with personalized care services to those who need help with the activities of daily living. Residents live in a comfortable private room that is designed to combine the coziness of the living room and bedroom into one. Meals are served in a dining room with other residents, encouraging individuals to socialize. As most residents in assisted living facilities are unable to completely care for themselves, 24-hour assistance is offered for eating, bathing, dressing, toileting, and walking.

Costs for assisted living vary by region, room size, and the types of services needed by the residents. To learn more about assisted living facilities and options in your area, visit the website of the Assisted Living Federation of America.

Nursing Home – Due to a debilitating illness or from the after-affects of a stroke, many elderly individuals need to reside in a nursing home, where 24-hour medical attention is available. If your loved one is unable to move without the assistance of a wheelchair, walker or another person, a nursing home may offer the necessary environment.

As need requires, most nursing home facilities are very similar to a hospital. The rooms are equipped to accommodate the residents' health needs rather than to provide a comfortable environment. Many residents are required to share a room with another patient. Because of mobility restrictions, meals are served in the patients' room. Activities, such as bingo, and arts and crafts, are offered to stimulate residents and provide rehabilitation.

When researching a nursing home for a loved one, use the following list as a guide:

  • Does the facility appear clean and relatively free of unpleasant odors?

  • How does the staff interact with residents?

  • Are seniors able to wear their own clothes and decorate their rooms with personal affects?

  • Is the facility licensed?

  • Do the residents appear happy and content?

  • Is a physician available at all times in case of emergencies?

  • Does the home provide rehabilitation therapy?

  • Does the home participate in Medicare and Medicaid programs?

As each patient has unique needs, you will want to do a thorough analysis of nursing homes in your area to ensure that all of your loved one's requirements will be met. Use the Medicare.gov Nursing Home Compare search engine to help evaluate nursing homes in your area of the United States.

Hospice Care – Hospice care is an option for patients who are terminally ill and are no longer responding to cure-oriented treatments. This type of care focuses on providing comfort, spiritual counseling, and physical and social support to the patient and his or her family during the final days. Hospice care can be provided in a hospice facility, a nursing home, or at the patient's home, which is where over 90% of hospice care is provided.

The goal of hospice care is to make the patient's final days as pain free and dignified as possible. Trained hospice staff and volunteers have the skills and resources to provide support to the patient on all aspects of the disease, with a special emphasis on controlling the pain and discomfort.

A variety of bereavement and counseling services are offered to family members before and after a patient's death to help those close to the patient cope with the trauma. Hospice staff is also available to help with legal and funeral arrangements. For more information on choosing a hospice, read the Mayo Clinic article Hospice Care: An Option for People with Terminal Illness.

For more information about retirement living options, see the Senior Living article on the PBS.org website.

Payment Alternatives

Now that you have a better understanding of your options regarding care, you'll want to evaluate your payment alternatives. The following list contains options for financing care for the elderly:

  • Private Funding

  • Medicaid

  • Medicare

  • Insurance for Long-Term Care

  • Supplemental Security Income

Private Funding – There is no program on a federal level that provides help for residents in retirement communities or resident care facilities. As a result, approximately 90% of payments to these facilities are through private funding. Medicare and Medicaid are federally funded programs that pay for nursing home care only, although approximately 30% of payments to nursing homes are provided through private funding.

Medicaid – Medicaid is a financial assistance program administered on the state level. Benefits are offered to the economically disadvantaged, disabled, and elderly. Medicaid is the part of the Medicare program that pays for nursing facility care for individuals who cannot afford to pay for these services. Recent surveys show that approximately 50% of the nation's care costs, and nearly 70% of payments for residents in nursing homes, are funded through Medicaid. Visit the U.S. Department of Health and Human Services (HHS) Medicaid website for information about the program and the available coverages.

Medicare – Medicare is a federally funded program to provide medical insurance for individuals over the age of 65, regardless of income. Coverage includes hospital and nursing home care, in-home care, physician services, and required therapies. Hospice care is also paid for through Medicare. To learn more about Medicare, visit the HHS Medicare.gov website.

Long-Term Care Insurance – Long-term care insurance is a privately issued insurance policy that covers the cost of elderly care in certain nursing facilities. Typically, only nursing homes and in-home care are covered under this policy. Premiums are based on specific criteria, such as age and health. The younger you are when you purchase the policy, the lower your premium will be. Check with your insurance company to see if they offer this type of policy.

Supplemental Security Income – Supplemental Security Income (SSI) is a state-regulated, federally funded program to provide assistance to seniors who have little or no income. Most people who receive SSI also receive Medicaid benefits. SSI is the only federally funded program that will pay for assisted living care, because benefits are paid directly to the individual, who then pays the facility. To learn more about this benefit, visit the website of the U.S. Social Security Administration.

To summarize, selecting the appropriate care for an elderly loved one is a difficult choice. It is important to carefully consider the needs of the senior and yourself when making your selection.

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