Ask a Care Manager: I Want to Stay Home – What is the Real Truth?
Marie is 88 years old and lives alone in her home. A new Assisted Living Facility just opened in her community and she’s feeling pressure to move in. How can she and her family decide what’s best for her ? To add to the discussion, Marie fell at home a few weeks ago and broke her hip. She is doing well with rehabilitation at a local skilled nursing facility but when she’s discharged, how will her needs change at home?
What does the elder want? Marie has lived in her home and community for well over 25 years and wants to return home “for the duration”.
What do the adult children/family want? Marie’s 3 grown children don’t all live close. They want her to be safe, happy, comfortable and in a place she can remain so they don’t worry. They are doubtful about her ability to return home.
If families don’t agree, is there a compromise? Yes, there is a compromise when client/families take some time to find out the Real Facts of remaining at home versus going into placement. Overwhelming statistics from AARP and other aging research show that older adults prefer to remain at home, are happier and with support can extend their life there. Often remaining at home with support is less expensive than any move.
How do we know how much help is needed? Talk to the doctor about what he/she recommends. Talk to the elder, visit the house, see what’s not getting done and if anyone is helping out. What chores need doing? What is left undone? What is the biggest worry? Make a list. In many cases, a good home care employee can accomplish a multitude of tasks in a few hours along with fixing a meal, helping with a shower, laundry and other necessary tasks. This may be done at 3 hours day/3 days/week to start.
What is the real truth about costs? Assisted Living Facilities began to emerge about 20 years ago in response to the number of older adults and the complete reluctance to go into a nursing home as a person’s health declined and needs increased. Initially, it also was a more inexpensive alternative to a nursing home . Costs have increased and in many cases, assisted living can now equal or exceed nursing home care ($6-7,000/month) particularly when health declines and needs increase.
Who pays? Health insurance does not cover non-medical help in your home. Medicare and a supplement will pay for wound care, physical therapy, an R.N., speech therapy or social work when ordered by a physician. Preparing meals, providing transportation, assisting with bathing, light housework, laundry, or supervision when memory is an issue is considered non-medical tasks. This is called home care and should be considered as a viable support option.
Long-term care insurance may very well help pay for non-medical help (home care) services if the client elected to purchase LTC insurance and may be an option for Assisted Living.
What is available to help with the costs? There are some public programs that will help defer the costs associated with non medical home care. If an individual is Medi-Cal eligible, In-Home Supportive Services (IHSS) can assign and pay for hours/month to help with care. Additional public funding may be available through the Area Agency on Aging i.e., Family Caregiver Support Program (FCSP) and MSSP programs. This funding is limited but may be a valuable short term support.
How to make an informed decision.
- Don’t hurry the process. If it means staying in the nursing home an extra week or two, it can save money and heartache later.
- Get the true facts about placement (assisted living), the costs, the benefits, the “points” or “tier levels” that increase the costs. Inquire about facility’s reputation for care.
- Get the true facts about what home care services can provide, reputation of agency and expected costs. Use a Care Manager to assess the client’s needs and help develop a care plan to address all of client needs.
- Does the individual have LTC insurance? Understand the benefits and limitations. File a claim.
- Strongly consider the wishes of the older adult and include them in the decision process unless there is an indication of memory impairment/decision making ability.
- Plan for the present – think for the future. What do you want to put in place as the person ages and needs increase?
In some cases you can’t go back. If you and your parent sell the family home , most of the furnishings and move your loved one, it’s final. The decision to move someone close to you (the adult child) can be beneficial if:
- You’re not moving yourself in a few years due to a promotion or retirement.
- Your parent is moving because he/she absolutely wants to and not to make You happy.
- You recognize that you as POA will still have responsibilities that won’t go away with placement.
- The older adult is unconnected with his/her current community i.e., neighbors, church, fraternal organizations, family history, etc.
- You and all those affected have researched for the present situation and planned for the older adult’s future with them.
Carol S. Heape, MSW, CMC is Founder/CEO of Elder Options, Inc. serving the Sacramento Region since 1988. She is firmly entrenched in the family home, is aging in place with no plans to move from home.