It is often said that home is where the heart is, but how do you decide where home should be as you or your loved ones age and health decline? Whether you are facing the decision personally or helping an aging parent decide where to live out the golden years, there are many factors to consider. This article will review the key issues that must be addressed when making this decision and also look at how to find resources to support your decision.
First let’s take a look at your main options: independent living/remaining in one’s own home, living with family, or moving into a nursing care facility or assisted living facility.
Independent Living/Remaining in One’s Own Home
This simply means continuing to live in your own residence or perhaps downsizing to a smaller, easier to care for dwelling, but enlisting minimal help, if any at all.
Living with Family
As they age, some people choose to move in with family members who can help care for them, or to have family move in with them.
Nursing Care/Long-term Care Facility
The care provided in a nursing home/long-term care facility care can vary and is usually most appropriate for someone whose needs exceed those that can be met by family and/or community supports.
“Often this is someone who has significant medical issues that need to be monitored and managed frequently by skilled nursing,” said Erin Frankenfield, a social worker with the Central Ohio Area Agency on Aging (COAAA). “Or, this might be someone who has significant memory impairment and requires special programming and supervision to ensure their safety is met, as well as activities tailored to their cognitive capacity. Nursing homes have some private rooms available, but those are more costly. Usually, you have a semi-private room that you share with someone else. Medicaid will only pay for a semi-private room.”
Assisted Living Facility
“An assisted living facility can be an appropriate choice for someone who can live in their own private room,” Ms. Frankenfield explained. “However, there are some facilities that are specific to memory care and severe dementia patients. Also, assisted living has regular nursing care but not as intensive as that provided in a nursing facility. Assisted living facilities often provide meals, homemaking and a living space that is more ‘homey’ rather than ‘medical’ (like you would find in a nursing facility). Often, assisted living facilities will be more selective about accepting patients with extensive medical issues, partly due to the capacity of the facility to safely and adequately care for the multiple health complications of someone who has several and severe health issues.”
Making a Decision
Determining where you or a loved one should live in the autumn of life is a big decision and should not be made lightly.
“When figuring out how to choose the appropriate care setting for someone, it's important to first determine how much assistance someone requires to complete their activities of daily living (ADLs),” Ms. Frankenfield said.
These include:
- Managing medication
- Handling environmental tasks such as shopping, laundry, cooking and cleaning
- Heavy chores
- Yard work
- Home maintenance
- Bathing, dressing, grooming
- Toileting
- Mobility – getting in and out of the shower/bath, up/down the stairs, in/out of bed, ambulation – getting from point A to point B
- Making phone calls
- Driving or arranging transportation
- Managing finances/legal matters
“It is also important to consider whether there are any memory deficits or ongoing issues with confusion,” Ms. Frankenfield said. “For example, are they forgetful about whether or not they have eaten or taken their medication? When they leave the home alone, do they get lost? Do they get out of bed in the middle of the night and wander?”
After taking an honest and thorough look at how much help someone requires, next, it's important to determine if there are enough family and/or community supports to sustain that person either in their environment or in a family member's home.
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“There are options for living in the community with assistance,” Ms. Frankenfield said. “There are private pay home health companies that supply trained personal care aides to assist with ADL tasks, cleaning and running errands. Paying privately for care in the home can be costly, and choosing a company is difficult as there are a lot of companies out there. The cost of private paying for a personal care aide can range, and most companies would like someone to commit to a block of time versus an hour.”
For those who opt to remain in their own home or live with a relative, many communities provide a plethora of senior services, which could include home-delivered meals, a homemaker and/or personal care aide, emergency response pendant, assistance with obtaining durable medical equipment such as hospital beds, wheelchairs, grab bars, shower chairs, etc.
“In Columbus, Ohio, for example,” Ms. Frankenfield said, “there is a program called Senior Options, or for someone who requires a lot of assistance with personal care and is Medicaid eligible, there's a program called PASSPORT managed through the Central Ohio Area Agency on Aging. These two programs are designed to assist people who meet certain income guidelines and who require a certain level of assistance, so they can live in the community setting with supports. COAAA also offers a lot of other resources and assistance with information about long term care, and they are always available to take calls for such information.”
To find resources in your own community, try Google searching for “resources for seniors” in your city or state, or visit the Administration for Community Living website.
“Living in the community can also be enhanced by using an adult day program,” Ms. Frankenfield said. “Usually, they provide transportation. These type of programs are convenient for a working family that needs to have their older adult family member in a safe environment during the day while the working members of the family are not able to be home with them.”
To find information on adult day programs, residents in Central Ohio can contact the COAAA. In other areas, you can conduct a Google search for your city and state plus “adult day programs.”
National Church Residences also has several programs in Columbus and throughout the United States.
Funding the Care Scenario of Your Choice
Whether you and your family choose care at home or in a facility, there will be a significant cost involved.
“Older adults and their families need to look honestly at what they can afford as far as time and money to safely and reliably support the care needs of the family member concerned,” Ms. Frankenfield said. “The cost of private pay for a nursing facility or assisted living is very expensive, and both the cost and quality of the facilities range widely. There is a useful link on the Medicare.gov website: ‘Find Nursing Homes.’ It links to different nursing facilities, including their ratings and is a good place to do research.”
There are four different sources for funding a stay in a nursing facility or assisted living facility. These are:
1) Private pay
2) Long-term care insurance
3) Medicaid
“Medicaid is state-funded insurance, and eligibility is based on income and assets,” Ms. Frankenfield explained. “If someone has several assets and would like to explore qualifying for Medicaid, they could consult an elder law attorney for assistance in determining how or if these assets could be protected.”
Regardless of the decision you make, it should not be arrived at lightly. Take your time to really consider all of the key issues and research your options so you can make the best decisions for you and your loved ones.
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