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Time marches on and so do we. Before we know it, we are older and so are our parents or loved ones. Caring for them and being sure their needs are met become a prime concern especially when they begin to not be able to care for themselves as they used to. This dilemma touches most every family. The thing to avoid is to remain under a veil of ignorance by not understanding your options and waiting until the last minute to make an abrupt and often uniformed decision. Care for the elderly is of utmost importance. This will be addressed in a comparison between adult day care, assisted living, and nursing home care.
Adult day care has the shortest care periods and usually lasts up to 8 hours a day and 5 days a week. People with Alzheimer’s, the feeble, the physically handicapped, those infected with HIV/AIDS, people with declining brain function and the hearing and visually impaired are included in this type of care. It serves as respite for busy caregivers and offers social and recreational activities, meals, therapy, health and social services. Usually there is an assessment made of the needs of each person before they enter the program. It is also important to find out how physically able they are because adult day care does provide rehabilitative services and personal care. One of its greatest advantages is that it helps people remain independent and be able to live with loved ones as long as they can plus it gives caregivers the break they often need.
Funding can come through Medicaid if the person qualifies, need-based scholarships, some medical insurance, long-term care insurance or tax credits for dependent care. Medicare doesn’t cover adult day care. Usually centers are non-profit (80% of them) and charge anywhere from $25-$75 a day. This will vary according to location. Transportation is also provided. There are full-time nursing services and these places are licensed by the state.
The next step up in care, if the elderly are not living with friends or family, is assisted living. It is for seniors who are somewhat independent and who need more care than a retirement community has available. The focus is on allowing for individual residents’ independence, need for privacy, choice, and safety. The services offered are personal (bathing, dressing, transferring, toileting, and eating), health care (which also involves management of medications), social and physical activities, 24-hour supervision, education, laundry, linen, housekeeping, unit maintenance, shopping, meal preparation, money management and transportation. A person can occupy a furnished or unfurnished studio or 1-bedroom unit with a bathroom. Some places have a shared bathroom. Also some units may have kitchenettes or even a full kitchen.
A potential resident is assessed according to physical and cognitive abilities, mental awareness, medical history (including medications being taken) and some personal history to find out if assisted living is a good option. Family members are encouraged to continue being a part of the resident’s life and are welcome to attend social activities throughout the year and on holidays. Usually assisted living places have a full-time nurse and trained staff. Meals are eaten in a dining room and assistance is given when needed. Activities are planned throughout the day and residents have the choice to attend or not. Church services are held, some being a specific denomination and there is usually a non-denominational gathering. Assisted care is regulated by the state.
Sources of funding can include personal funds, assistance for families, Social Security, Medicaid, and long-term care insurance. The cost varies, depending on the size of the unit, the services needed and location. It’s between $1,000 and $2,000 per month, the average being $1,873.
The nursing home is the most intensive in care (along with adult family care homes). The residents have definite physical needs. They usually have physical or mental disorders or happen to be too feeble and/or unable to move around, bathe or prepare their own meals. Their ADL’s (Activities of Daily living) are minimal and low functioning. As a general rule, there will be no recovery or ability to take care of themselves, so assistance is a necessity for most or all ADL’s. There are definite medical needs too.
Nurses and nursing aids are available round the clock. Because of the residents’ needs, nursing homes are staffed with that in mind. There is full management of medication and it is administered according to a physician’s orders. A person can obtain a private room if he/she is paying with private funds. Normally, there are 2 people to a room. Meals are brought to them or residents are taken to the dining area. Besides full assistance, nursing homes offer rehabilitative services, exercise, social activities, laundry, housekeeping, and prepared meals. Families and friends are encouraged to visit.
The cost depends on where the home is and what the surcharge is that is attached for private payers versus Medicare and Medicaid. Approximately 70% of nursing home costs are paid by the state and federal governments. The government pays part or all of the fees for about 85% of the residents. Another funding option is long-term care insurance. The actual cost is somewhere around $114 a day or more and can go well above $2,000 a month. This varies depending on the location and the services required.
In summary, adult day care involves hours of care, while assisted living and nursing homes offer more care progressively. It helps to research all the residential and financial options. AARP is a valuable source, as well as Medicare. There are a wealth of other websites that will help relatives and friends find the right place for their loved ones and the phone book lists companies and people that have a network to draw from. Quality care of our elderly is essential. Knowing what can be done is being done, brings a sense of peace of mind.
The condition of the person seeking nursing care is the key factor in your choice of a long-term care facility. All skilled/intermediate care nursing facilities provide personal care and residential services including rooms, meals, planned activities and programming to meet social and spiritual needs. The levels of nursing and therapy services offered vary quite widely, and these should be carefully matched to the individual’s needs. The resident’s physician is involved regularly in the direction of a resident’s care. The nursing staff works with and keeps the resident’s physician updated on any changes in the resident.
People who are functionally independent but need some assistance in daily living, require the care of a sheltered care facility (SC).
Sheltered care facilities emphasize the social needs of the individual rather than the medical needs. Dietary and housekeeping services, medication monitoring, and leisure activities are primary functions of these facilities.
People who are mobile but may need assistance with one or two activities of daily living, may require the services of an assisted living facility.
An assisted living facility is a congregate residential setting that provides or coordinates personal services, 24-hour supervision and (scheduled and unscheduled) assistance, activities, and health-related services; is designed to minimize the need to move; is designed to accommodate individual residents' changing needs and preferences; is designed to maximize residents' dignity, autonomy, privacy, independence, choice, and safety; and is designed to encourage family and community involvement.
People who need 24-hour nursing care by licensed nurses as prescribed by a physician, require the care of an intermediate care facility (ICF).
Rehabilitative programs, social services and daily activities for persons not capable of full independent living, (such as persons who are convalescing or persons with chronic conditions which are not critical) are provided. Physical, occupational and other therapies are also provided. This type of facility may be certified to participate in the Medicare and/or Medicaid program. Check with each facility.
Skilled Nursing Care
People who need 24-hour care require the care of a skilled nursing facility (SNF).
Registered Nurses (RN), Licensed Practical Nurses (LPN), and Certified Nurse Assistants (CNA) provide care and services prescribed by physicians with heavy emphasis on medical nursing care. Social services, as well as physical, occupational and other therapies are provided. This type of facility may be certified to participate in the Medicare and/or Medicaid program. Check with each facility.
Over 30 million Baby Boomers provide countless hours of assistance to elderly parents at no charge. It is estimated that, using average hourly wages, the total amount of this uncompensated care is comparable to the entire Medicare budget. For the estimated 7 million Boomers who provide long distance care, actual out of pocket expenses amount to almost $5,000 per month. For caregivers who have, or are considering leaving the workforce to care for an ailing parent, the costs are even greater – over $650,000 in forfeited salaries, benefits and pensions.
This stark economic reality shows only one dimension of the price caregivers pay for this act of love.
Caregivers pay with losses that extend well beyond their bank accounts. They often forego the activities that bring joy and richness to their lives, like meeting friends for dinner, or going out to the movies or taking family vacations. They pay with their time, the loss of professional opportunities and the erosion of personal relationships that result in isolation.
Sometimes, otherwise healthy loved ones need a short dose of care as they recover from an acute medical episode like a broken leg. Usually loved ones are on a path of steady decline with cascading assistance needs. Some caregivers sacrifice large chunks of their own lives as they help their parents and other family members and friends peacefully make their transitions. Caregivers can pay with their own health and well-being. In fact, we have evidence that some caregivers pay for their acts of care with their very lives.
You can decrease the personal and economic costs of caregiving. This means proactive planning rather than reactive responding. Planning saves money. You know this as you reflect upon your experiences of going to the grocery store with and without a shopping list. Planning also minimizes personal wear and tear and decreases stress. You will feel much better when you know your options and develop back-up plans before you jump into a challenging project.
5 Tips to Decrease the Cost of Caregiving:
1. Begin the conversation today. We have tremendous cultural resistance to the recognition of aging, disability and death. Just as the first few steps uphill are the hardest, so, too, you may meet the greatest resistance simply starting the conversation about their possible need for care. Say today, “Mom and Dad, it would be great if you lived forever, but the discovery for the fountain of youth is nowhere on the horizon. What thoughts and plans do you have about enjoying your golden years?”
2. Create a plan. Talk with your parents about their ideal plan if they are no longer able to care for themselves. Then, start to work toward that proactively. Investigate long-term care insurance. Draw up the appropriate legal documents. Find out who would make medical choices if they were not able to make them on their own, along with some guiding principles for the choices. You can anticipate and limit parental resistance by saying, “Mom and Dad, I just got back from the lawyer’s office signing my will and durable medical power of attorney. I’ve asked Mitch to make my medical choices if I cannot make them myself. Just so you know, if I were in vegetative state, I wouldn’t want to be maintained on a machine. You probably already planned ahead too, right?”
3. Use personal and community resources. Make caregiving a family job to which each member contributes. Even children can make grandma’s life special with drawings and phone calls. Identify services that make your job as a caregiver easier. If you and your parents live in the same community, check with friends and neighbors and local organizations to learn about services and resources that will make your job easier. You say, “Mom has just moved in with us, and she wants to ‘find a card game with the girls.’ Do you know of any senior centers that have social events? How about transportation?”
We’re a mobile society and millions of caregivers live more than an hour away from their parents. Executive Daniel Yamane learned from his own personal experience how challenging it is to identify community resources from afar. As he was carving the path that ultimately led his on-line internet marketing management service, he became the caregiver for his mother. Talk about mixed emotions! Professionally, he was introducing a service that let business owners manage their online presence. Personally, he was investing untold hours just to find one bit of information to help his mom.”
As with so many innovators, he used his personal and professional experience to launch All Senior Guide (www.allseniorguide.com), a service that he wished would have made his life as a caregiver-at-a-distance easier.
4. Gather cost-savings tips. This might mean something as simple as ordering generic medication or regularly inquiring about senior discounts. But, most cost savings opportunities aren’t as obvious. Mr. Yamane found, for example, that some states will pay for phones for hearing, visually or mobility limited seniors or fund home safety improvements. He said, “We’ve invested heavily to locate time and money saving resources that most would have difficulty finding. I made it a personal mission to help other caregivers avoid some of the costs and frustration I encountered.” You don’t have to re-invent the wheel. Tap into the resources others have collected.
5. Take care of yourself. You will be able to provide the best care as a caregiver when you’re at your best. Get good nutrition, enough sleep and regular exercise. Manage your stress and do a little something every day to nurture your soul. Understand that you are at increased risk for anxiety, depression, and weakening your immune system. Talk to your doctor if you see worrisome signs such as problems sleeping, changes in appetite or loss of interest in activities you enjoy.
Despite the costs, most caregivers say that they received much more than they gave. Most say they would do it again, and many do.
Sometimes the question is not the personal cost of caregiving; it’s the value that you bring to the lives of others that matter at the end. What personal cost are you willing to pay for the privilege of helping those who welcomed you into the world to enjoy their golden years and travel the road of illness with love and dignity?