Care Options for Your Aging Loved One: How to Make the Right Decisions
Making sure your aging loved one is in the proper environment is a high priority. The option you and your aging loved one decide on will depend mostly on the level of care your loved one needs or will need in the future, what he/she can afford, and his/her lifestyle preferences.
Usually, independent living situations that involve little or no medical intervention or help with daily activities cost less than assisted living or skilled nursing situations. But if your loved one needs special care or attention, an institutional environment may be more appropriate. Community environments encourage active lifestyles and social interaction.
Before deciding on a living situation for your aging loved one, consider the following:
- Does your loved one currently live alone?
- What kind of existing support network does your loved one have (e.g., family and friends that live close to your loved one)?
- Does your loved one need medical care or are they likely to need it in the near future? If so, how much and what type(s) of medical care will they need?
- Does your loved one have any mobility needs, like a wheelchair, transport chair or a walker?
- What resources are available to pay for care and housing?
- Does your loved one prefer autonomy or being part of a community?
- How important is it to your loved one to be able to participate in activities?
- How important is it to your loved one to say in his/her home?
- Does your loved one want to remain near to any family or friends?
- What are the costs involved for the various situations you are considering?
- What services are covered by Medicare, Medicaid (varies from state to state) and your loved one’s insurance?
Regardless of which care option you consider, remember to listen to your loved one and respect their desires and needs. It is equally important to look after the happiness as well as the health and safety of your loved ones – a challenging yet important balance.
And remember, when you talk with a representative from the various care options, you are being “sold” by a sales person who often earns a commission and/or whose salary is tied to how many family’s they place in the respective facility. So ask the tough questions, be open minded yet skeptical, check the facility’s record with state licensing agencies, and do your homework.
Lastly, the ShirleyBOARD.com highly recommends that you speak with a geriatric care manager in your loved one’s local area. Geriatric care managers can assess the needs of your loved, help educate you and equip you with information to better assess various care options, offer independent and unbiased advice, recommend care options and even stay involved in the “case management” of your loved one. If you are unable to pay for the services of a geriatric care manager, please call your local area agency on the aging for assistance.
Housing Options for Your Aging Loved One
Staying at Home
Many seniors prefer to stay in their own home as they age because it is familiar and full of memories. If your elderly loved one is fairly independent and does not need close supervision or a lot of medical care, this may be a good option.
Staying at home can still be a viable option for seniors requiring supervision and assistance with meal preparation if an in-home companion or home health aid visits regularly. The average cost of these types of companion services is about $22 per hour and may be covered by long term care insurance if the loved one meets certain criteria (e.g., cognitive impairment). As you’re loved ones needs increase, and staying in their own home is still the preference, you can hire a full-time live-in companion which can often times be less expensive than institutional care such as assisted living.
Making a home safe and accessible can cost much less than institutional residence situations and most medical/personal services can be delivered. Some elders share their home with another elder or a younger adult who may pay rent or help out with household tasks. Sharing a home can relieve issues of loneliness, make daily living easier, and possibly add to your loved one’s income.
- Your elderly loved one may be happier (assuming they are getting sufficient socialization)
- Fewer costs involved, possibly
- Familiarity with environment
- Encourages independence
- Possible income or help with daily activities if sharing home with another
- Safety can be an issue, depending on loved one’s independence level and features of the home
- Someone must maintain the home
- Will need to be checked up on regularly
- Medical and personal services can be more costly since they have to be delivered to the home
- Long term care insurance usually pays less daily benefits for in-home services
- Loneliness can be a concern
- Home sharing occasionally results in undesirable roommates.
Continuing Care Communities
Continuing care communities provide a variety of residence options so that all levels of care can be provided. Usually, an elder joins the community (this can sometimes mean purchasing a home within the community) when they are relatively independent and self-reliant, but as their need for assistance increases, they are moved to a new residence within the community better suited to their needs. So, even if your loved one doesn’t need it now, they can receive assisted living or skilled nursing care in the future without moving to a new facility (although they may need to move within the community)..
- Relatively consistent environment until end of life
- All levels of care provided
- All care is paid for in advance through entrance fees and monthly fees—no increasing care costs
- Surrounded by peers, many activities and services available
- Usually covered in part by Medicare; Medicaid and state grants may be available
- Can be costly: entrance fees $200,000 to $400,000 (Source: How to Care for Aging Parents by Virginia Morris, 2004 Workman Publishing) with possible additional monthly fees
- Services provided within the community may change
- May be difficult and/or costly to leave the community if your loved one has a change of mind
- Large upfront investment means you should verify the company’s financial stability before moving in
Congregate Senior Housing & Group Homes
In congregate housing or group home situations, your loved one will have his/her own bedroom or apartment and will share living areas with other residents. Congregate housing usually has more residents and help with daily activities is limited. Group homes are usually smaller, but on-site caretakers are available 24 hours a day to help residents. In both cases, some or all meals may be provided and residents may be expected to help with chores.
- Surrounded by peers, loneliness not an issue
- Some help available
- Less expensive than facilities with more staff
- Less autonomy and privacy
- Residents expected to help out
- Advanced medical care not typically available
Shared Housing & Foster Care
In these situations, your loved one goes to share a private home with someone else. Both can reduce concerns about loneliness, supervision and help with daily activities to an extent. In shared housing, your loved one rents out a room and shared living space from another elder or younger adult. In foster care, another family adopts your loved one and cares for them as you would in exchange for a monthly fee, usually $500 to $3,000 per month (Source: How to Care for Aging Parents by Virginia Morris, 2004 Workman Publishing).
- Can be less costly than institutions
- Other people around frequently
- Encourages independence but help with daily activities is available
- Must check references of roommate or foster family
- Trained staff not available
- Requires financial output not usually covered by insurance, Medicaid or Medicare
Assisted living facilities are designed for elders that need some help with daily activities or personal care, but do not need a lot of supervision. In an assisted living facility, your loved one can have a private room of their own and will share common areas with other residents. Assisted Living often provides skilled nursing care and may or may not be equipped for dealing with frail elders that require intensive medical care. Assisted living facilities usually provide autonomy, independence and a home-like atmosphere and typically encourage a healthy, active lifestyle.
The national average for assisted living fees is $2,500 per month, although there may be additional costs for services like room cleaning, transportation to medical appointments or grocery shopping. And if your loved one needs assistance with daily activities like getting dressed or bathing, you may be required to pay extra for these services and/or hire a local companion service. When these additional services are factored in, the annual cost for Assisted Living can easily increase to beyond $60,000 in many states.
- Skilled nursing care and 24-hour staff available (may cost additional)
- Help with daily activities and personal needs available (may cost additional)
- Meals usually provided
- Recreational and exercise facilities often available
- Social activities
- High level of autonomy and independence
- Tends to be a healthier, younger community although this varies by facility.
- Among the more expensive options
- Some medical services may cost extra
- May be a financially risky move, especially of your loved one is required to sell their home to pay for care.
- May not be covered by Medicare or private insurance
- Your loved one may not be guaranteed a room and/or the same level of service if they go on Medicaid
- Transportation to outside medical appointments can be difficult
Nursing homes are residential facilities that provide skilled nursing care and more extensive medical care, supervision and staff than assisted living facilities. They are designed for elders with significant illness, dementia or other frequent medical needs, with living conditions resembling a dormitory or hospital. Autonomy and independence is fairly limited due to the scope of medical intervention most residents require. Even if your loved one does not require a nursing home environment, it is good to be familiar with what they provide since many elders spend some time in a nursing home as they convalesce from injuries and illness. Nursing homes can easily cost more than $100,000 per year (Source: How to Care for Aging Parents by Virginia Morris, 2004 Workman Publishing).
- Skilled nursing and advanced medical care available
- Help with daily activities and personal needs available
- 24-hour supervision
- Meals provided
- Some social activities
- Significantly more expensive than most other options
- May not be covered by Medicare or private insurance; Medicaid may cover some services
- Some medical services may cost extra
- Not well suited to autonomy and independence
- Residents are often older and require significant medical care. This can be depressing for seniors who are still relatively independent, causing them to age more rapidly.
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