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This chapter explores the housing options available for the folks. Each individual and every family are unique. Consequently housing/living arrangements will be varied and dependent on many factors. These options range from living completely independent at home to skilled nursing care for the totally dependent individual.
Housing options for the folks can best be analyzed in three broad categories:
1. Independent living – at home or elsewhere
2. Semi-independent (or assisted) living – at home or elsewhere
3. Dependent care – usually somewhere other than home
The determining factors of where the folks will be living are health/medical, financial and familial or combinations thereof.
Decisions on parental housing/living will be come about as a result of changes that occur in the family. These changes could be health or medical events, family moves or financial circumstances or perhaps a death. At some point there will likely be an event, a change in family dynamics that will focus attention on the living situation for Mom/Dad.
You may be fortunate to have a parent(s) who are capable of maintaining themselves in their own home perhaps well into their 90′s. On the other hand you may have a parent with health/medical conditions that will dictate some form of assisted living or acute care.
Obviously the first rule is respecting parental choices. Mom/Dad may wish to stay in their own home with all the comfort and familiarity it brings and avoid the stress and upheaval of a physical move. This should be your first objective but for a variety of different circumstances may not be practical.
he folk(s) may be doing very well in their own in their own home. You have watched them for years doing what they have always done – be Mom and Dad. One day you might notice little things that one could usually attribute to “getting old”. It happens to all of us. Here are common symptoms one might see in an older person.
These signs are not necessarily cause for alarm. They are just signs that things are changing for the folks – and you. Take heed. Getting old is not a disease. It just means the body is being modified. As a result it may be the physical environment, the folk’s house, that needs to be modified.
When considering all of the housing options for the folks, Home Modification should be considered before any other. Given that health, medical and family barriers are not major obstacles home modification may provide practical, financial and emotional solutions to housing for the folks.
Following are some things to keep in mind so that in the event of an illness and/or disability they won’t be forced to move:
SAFETY has to be an overriding consideration. It is estimated that one third to one half of home accidents can be prevented with home modification and repair. If thoughts or concerns of expense arise in considering home modification consider as well the costs associated with medical and/or subsequent health care costs!
Home modification is the alterations and changes needed to accommodate the folks in their home. These could be minor or major items such as installing grab bars in the bathroom to installing a bathroom on the first floor.
Minor items sometimes called Functional Aids or Assistive Devices are generally those products and services that can be installed to assist in the day to day routines around the house. There are entire catalogs devoted solely to this market genre. Here are just some examples some aids and devices;
Major Home Modification may entail significant and costly changes to the home. This could be any number of things such as wheelchair ramps, door widening, room alterations and accessible plumbing and electrical fixtures. Significant costs may be a consideration.
The financial aspects of major modifications may be daunting but so are the alternatives. Your unique family situation will have to be weighed with facts particular to your family. Devise a plan that weighs all the factors involved:
Check with the local Area Agency on Aging and other senior assist agencies in the folk’s community. There are low-interest loan programs for home modifications. If required or prescribed by a doctor the modifications may be tax deductible. If Mom/Dad have an occupational therapist they can provide valuable guidance in planning.
NOTE: If you or the folks are considering major home modification you will most likely need a contractor. As is the case with any industry the vast majority of business people are honest. As you are no doubt aware there are unscrupulous people in the building trades as well. This consumer information is mentioned here because if home modification is planned then 1). It is probably coming at a very critical time, 2). The folks’ house is likely their most valuable asset and 3) Dealing with bad contractors at this time (or any time) is very frustrating.
There are many ways in which a bad contractor can rip you and/or the folks off. A few of the more common ways are, not completing work on time and to satisfaction, using inferior products and materials, overcharging, change-orders, ridiculously low bids, making false claims and adding extra work.
Check with the local Better Business Bureau or contact the National Association of the Remodeling Industry, 4900 Seminary Road, Suite 320, Alexandria, Virginia 22311 or www.nari.org.
If financing the home modifications is an obstacle one possible source of funding may be the house itself. The FINANCES section of this guide discusses among other options, reverse mortgages, a type of Home Equity Conversion.
The Home Itself
Check For Obstacles
Availability of Community Services
PERS – PERSONAL EMERGENCY RESPONSE SYSTEMS
PERS are devices used to summon emergency help to the home. PERS are mentioned here as a device to be considered, if necessary, in assisting your folks stay in their home. There may be costs associated with the PERS. Inquire about PERS from the Local Area Agency on Aging. Check the phone book for agencies or contact ELDERCARE 1 800 677-1116 for the agency nearest the folks.
Technology is changing almost daily. Computers with E-mail are getting cheaper and easier to use. Communications can now be accomplished with televisions and pagers. Make attempts to discern what communication devices are currently available and how they might best suit your needs. Start with some questions about the folks, their communicative needs and what might best suit those needs. Expand and/or modify these questions to your situation.
It is difficult to keep up with the evolvement of communication technology. The tried and true way is to network. After assessing family needs talk with local Area Agencies on Aging, support service groups, the phone company, local alarm service companies, friends, etc.
Medicare will pay for some home health services, provided certain criteria are met:
If these conditions are met Medicare Part A will pay the full costs of approved services such as part time nursing or rehabilitation Mom/Dad could be responsible for a 20% coinsurance charge for medical equipment such as a walker or wheelchair.
NOTE:It is Mom/Dad who should be responsible for this co-payment. If they cannot afford this it is time to check into Medicaid. It is wise not to get financially entangled with parents Medicare and health insurance.
Home care can be provided by many types of medical professionals such as nurses, therapists, nutritionists, aides and medical social workers.
The folks have had a home for as long as you can remember. Very likely you grew up there. Your folks have their house(s) their home for a long time and whether or not they own their home its likely they enjoy being there. Over time it can be increasingly difficult for them to stay in their home for either financial or physical limitations. At some point they will begin to need some help staying in their home.
This assistance can range from the once a week lawn and yard service to daily nursing care. Sooner or later the folks, even with the given that they stay healthy, will increasingly need a hand around the house.
Being in one’s home can lend a sense of independence of which much can be said. But you also want to be sure that if Mom &/or Dad are going to remain in their home, that the home is safe, secure and the community services they may need in time are available. Be sure and review chapters Transportation and Safety.
Most often people prefer to remain in their own homes for as long as possible. It is a familiar place – one with the comforts and memories generally acquired through time with family and friends. It has all the accessories of comfort, solace, peace and reassurance. Home is where the heart is.
At some point there may be a time when alternate housing for Mom/Dad will become a consideration for the folks. This may be a planned move to a retirement home or community. It may be that they have just “outgrown” their home or they want to move to another area – for any number of reasons.
It is possible that the folks have planned for a long time to retire to a quiet, remote place of tranquility – the cabin in the mountains or a cabana on a secluded beach. This is a wonderful goal and one they’ve worked hard for. One consideration of this idyllic notion, given the state of their health/medical needs, is the proximity of services should they be needed.
Trying to decide on where the folks should live for maximum safety, comfort and independence may be one of toughest and most emotionally fraught decisions your family will have to make. Moving from one home to another at any age can be an emotional decision that can be complicated by financial and physical logistics.
There is sometimes a misconception that once an elderly person enters a hospital that the “next stop” is a nursing home. In fact only a small percentage of seniors reside in nursing homes, roughly 20% for those over 85 and only about 6% for those 65-84.
Home health care, at any age, has many advantages. It is more personal and familiar. There is a more privacy and better access for friends and family for visitation. Home health care is less expensive than nursing homes.
Here are other considerations for independent living.
In An Adult Child’s, Friend’s or Relative’s Home:
Having Mom/Dad live with you is something only you can imagine – they’re your parents. Family dynamics of relationship and responsibility (including financial) will dictate the outcome of this decision. Having an adult parent(s) living with you may offer a full and rewarding experience. In times past this was not uncommon and is still the norm in many countries including the U.S. But again the key is the relationships amongst family members and how those dynamics work/fit together.
From a practical standpoint the “new” home should be assessed for the accommodations it can offer the folks. As noted above in the “At Home” section thought and planning should include safety, accessibility and the community services available to them. These are important considerations because they can be as critical to you as they are to your parent.
An unsafe obstacle or hazard may result in a fragile hip break. Your nice big home in the country can deprive a senior of community contacts and services necessitating more immediate family involvement.
In the discussion and planning some thought must be given to what can best be described as the “rules and regulations” of the household. Although not in the strictest sense are these rules so much as they are “understandings” – or acknowledgements of who is responsible for what? Who pays for what? Who’s responsible for what? Having a discussion about these understandings or guidelines before Mom/Dad move in can preempt future turmoil and “mis-understandings”.
A final word. This section discusses the parent(s) moving into a relative’s house as an independent living situation, which it may well be. Consider though that over time this senior will likely become more dependent. What started as an “independent” older adult living in can become a person requiring consistently more and more care. This might progressively continue on through Hospice care.
Accessory Apartments (“Mother-In-Law”Apartment, “Granny Flat”):
Also termed by officials as an Accessory Unit this description typically refers to a separate living unit attached or adjacent to the main house. It can be an upstairs apartment, converted garage or a cottage behind the main house. The distinguishing characteristics are that this living area has its own kitchen and bathroom accommodations and often a separate entrance.
This type of living arrangement will offer a greater degree of privacy than if Mom/Dad were living in your home while the close proximity provides many personal and social advantages.
ECHO Housing – Elder Cottage Housing Opportunity:
Another type of Accessory Unit the ECHO is specially designed modular housing for that meets the needs of elders. These units are moved onto a property usually on the side or back yards of existing homes.
The units are designed to meet the needs of seniors. They are energy efficient and barrier free. They can be design/built to match existing architectural structures and they can be easily moved when no longer needed. Like the accessory apartment they provide independence and privacy while having the folks close to the family.
Accessory Unit Considerations:
Plan on some time spent to get the appropriate permits and selecting contractor. Refer to recommendations noted above in home modification. For assistance contact the local Area on Aging or Better Business Bureau.
Additional helpful information on Accessory Units can be found at the Administration on Aging (AoA) – ELDERCARE LOCATOR 1 800 677-1116 – www.aoa.gov/housing/modification.html. AARP has some booklets on the subject of ECHO Housing (D12212) and Accessory Apartments (D1187), at 1800 424-3410 www.aarp.org
Senior Communities – Apartments, Condos, Mobile Home Parks
There are many types of Senior Communities and they offer a wide range of services and amenities. Generally speaking the Senior Community or Congregate Housing as it is sometimes called, is suited to the active individual or couple who are able to live on their own.
A Senior Community may be a very good housing option for the folks for any number of reasons. Usually these communities offer a variety of appealing social, recreational and cultural activities. Services such as meals, transportation, housekeeping, security and medication dispensation may be offered.
A Senior Community can be Retirement Hotel, Apartment, Condo or Mobile Home Park. They will require that Mom/Dad be mobile and pretty much able to take care of themselves.
The financial obligations will vary as to the types of services offered. Sometimes a monthly fee will cover everything or there may be extra charges for meals, housekeeping, etc. The quality of the facility and services will vary widely as well. It is most likely the folks have done a thorough amount of research and referencing.
A consideration to keep in mind is that a prolonged illness or inability to care for one self may require moving from some Senior Communities as they are not hospitals and generally do not offer acute onsite medical treatment.
Homesharing
Sometimes referred to as Shared Housing, Matched Housing or Group Shared Housing this living arrangement is often appealing to older persons particularly women. Matched Housing is the pairing-up of two individuals. Group Shared being three or more unrelated individuals. Common areas such as the living room and kitchen are shared. The bedrooms are typically individual private areas with bath accommodations determined by specifics of the home.
Although not for every one, home sharing can be a good arrangement with the right circumstances and individuals (think back to college roommate days with the benefit of maturity and wisdom).
The benefits to be considered are chiefly economic and social although in some cases it may be to get some help around the house. If a parent is considering this idea it would be good to weigh the pros and cons. In what ways would this arrangement benefit Mom/Dad and what are the downsides?
Home sharing can have its personal considerations as well. A person has to evaluate the consequences of a non-family member living with them. Certain inner feelings and thoughts will be examined. “How well do I really know this person?”. “How well do I want to know him/her?”, “Do I trust this person?”, will be thought about but perhaps not openly discussed with anyone.
Everyone and their situation – financial, home, interests – are unique so there are no set “rules” when assessing this housing option. It is best to look for a compatible person and for starters agree to set up a trial period to see how things work out. There are other considerations that should be taken into account.
The American Association of Retired Persons (AARP) also has good consumer information on Shared Housing. 1800 424-3410 www.aarp.org/getans/consumer/homeshare.html
Be certain to check with the local church or synagogue, libraries and senior centers as they have information on senior/elder housing.
Government Assisted Housing
Government housing assistance is comprised of different programs made available to low-income families, disabled and elderly persons. As these programs are difficult to get into due to long waiting lists and strict financial guidelines they should be considered only if necessary.
Of the government assisted housing programs including Section 8 and Public Housing, the program most suitable for seniors is Section 202 Housing. This program is specifically set up for seniors and offers the best array of services and possibilities.
There are strict income guidelines and many areas have waiting lists. However Section 202 Housing programs do offer some advantages such as transportation and meal service. This can offer the opportunity to live in a better environment with other seniors and have lower housing costs.
If you are interested in low to moderate housing for seniors contact the American Association of Homes and Services for the Aging (AAHSA), a national non-profit organization that can provide information on assisted living, nursing homes, continuing care, retirement communities and senior living at 1 800 508-9442 or at www.aahsa.org.
Also be sure to check with the local housing authority (Blue Pages of phone directory) or Area Agency on Aging – ELDERCARE LOCATOR 1 800 677-1116 or refer to www.aoa.gov/housing/gahousing.html.
Group Homes
This is a category of housing that includes Board and Care Homes, Group Homes and Foster Care. It usually consists of five to twenty residents who share a home like environment. The residents should be mobile and fairly self-sufficient.
Depending on the specific nature of a particular facility the Group Home resident may or may not be responsible for certain household chores such as cooking and cleaning. Some will have full or part-time housekeepers and managers. Some Group Homes will have a set all-inclusive monthly fee while others can charge a fee and charge for extra expenses.
A Group Home may be a good housing option for Mom/Dad given that it meets criteria suitable to them. The idea of moving into such a place may not seem all that appealing to your parent given that they may be leaving their home and living with strangers. This can be difficult and challenging for some people.
The quality of facilities will vary greatly due to its staff, residents, location and other intangible elements recognized by Mom/Dad. A good facility will offer a home-like environment and residents can often form good friendships.
If a Group Home housing arrangement is to be considered it is best to visit some and be prepared to let the folks spend some time visiting with the staff and residents. What are the important things to consider in a Group Home?
A Group Home housing arrangement may not be suitable for Mom/Dad for any number of reasons. But it may be the best of the alternatives considered. Many people find this to be a good home usually because of the amenities and friends with whom they may share some common interests.
Remember if a time comes when Mom/Dad become unable to care for themselves they will be required to move to an assisted living program. An assessment of the folks overall well being should be considered in light of this
Continuing-Care Retirement Communities (CCRC’s) – a.k.a. Life Care Communities
Moving into a Continuing Care Retirement Community is a choice the folks will likely make themselves. This is because the choice is made at a time of Independent living when it is their choice. This form of retirement living is described in this section on Independent Living because this is generally considered to be a long term housing arrangement that commences when one really is independent. In fact one has to be in good health before entering.
This relatively new form of retirement living has some distinct advantages that the folks may find appealing. Probably the unique quality that sets CCRC apart from nursing homes and assisted care facilities is that they are long-term homes that provide all or most all services that a senior may need. Besides the housing other services are included. Nursing is provided on the premises and in most cases a clinic or hospital is as well.
The CCRC option can be expensive but costs should be weighed with the services provided and balanced with anticipated long-term needs. Over a period of time if one parent needs medical care the other can remain in the home.
The folks will likely remain in the CCRC for the remainder of their lives. Depending on the facility they may own or rent their apartment or condo. Their housekeeping, social, cultural and recreational activities are available a set monthly fee or as used basis depending on the facility and their contract.
If the folks are considering a CCRC it is suggested to visit a number of them. They will want to evaluate the services and features offered at each and inquire about the contracts available. These are legal contracts that should be examined carefully and with consideration towards their specific needs and desires. CCRC contracts will vary is costs and scope of services. It would not be a bad idea to have the family attorney review a contract before signing.
Semi-Independent Living also called Assisted Living will be at a time when the folk(s) have difficulty performing their daily routines and tasks (sometimes called Activities of Daily Living or ADLs) and will need to be in a housing environment that provides some basic levels of support.
Here are some typical signs that Mom/Dad may start exhibiting that are indicators that they are going to need some assistance:
The Semi-Independent condition/state for a person can be problematic for all of those involved for a couple of different reasons. First of all here is a human being, your parent, who has for all his/her adult life been responsible and caring for others and of themselves. And now there are signs that their independence is diminishing. Secondly, somehow someone is going to have to look after Mom/Dad. Who? How? Where?
Assisted living is the 24/7 (24 hours, 7 days) care of an individual for Activities of Daily Living (ADL’s) of meals, personal hygiene, medication, transportation and other support services. This can be in the home or these services can be provided in another assisted living environment.
Providing a parent at home assistance with their ADL activities can be an burdensome and sometimes thankless task for the caregiver. Traditionally eldercare given in the home has been overwhelmingly done so by women This is not to say that there are not opportunities for rich and wonderful family rewards in store. It is well to evaluate the needs of the parent and the realistic abilities of the family to properly provide for those needs in the home.
Providing care in the home for a parent can sometimes be accomplished with additional help. This may involve the hiring of a person(s) to assist Mom/Dad with their ADLs. This person may be a part time or full time employee and they may or may not live on the premises. These factors are determined on an individual basis.
If and when the time arrives to consider moving the folks from the home, the objective is to assess their living, care and housing needs at present and also discover what options are available as their needs change and how to discern when those needs have changed. This is something that may need to be re-evaluated from time to time depending upon circumstances at any given time. The objective should be to find a means by which Mom/Dad can, with assistance, continue living as independently as possible.
Having discussions with the folks about what they would want should they need assistance before they need it will save everyone a great deal of stress and “second-guessing” in the future. This may not always be possible. Discussion, thought and planning are always best when done before a “crises” or emergency dictates a course of action.
Depending on the inter-personal relationships in particular family it may be a good idea if the folks put their wishes in writing stating specifically what type of care and/or facility they wish to live in. This can prevent second-guessing and acrimony with other family members about the care Mom/Dad should receive.
Assisted-Living or Assisted-Care Facilities
These are typically Licensed Facilities that can range from a large private home (Board and Care) to a substantially larger complex. They can offer private or semi-private rooms. They will have shared areas such as dining and recreational rooms and offer meals, housekeeping and social activities. Some will offer other services such as assistance with bathing, dressing and other routine functions and they may offer medication administration.
If it has been determined that the option for Mom/Dad is an assisted living facility it is recommended that some facilities be visited. This checklist can be used to evaluate these facilities. Whenever possible the folks should be involved as much as possible. They are the ones who will be living in this facility and they should have the opportunity to talk with residents and staff.
TIP:Arrange to visit a facility at lunchtime. Most facilities appreciate the opportunity to serve lunch to potential residents. This is a good way to see the residents and sample the food.
Looking for an Assisted Living Facility for the folks might seem a daunting task. But you are not the first to do this and good references can direct you in the right direction. Discuss this housing situation with your parents and their friends and acquaintances. Doctors, health care and social workers can be good sources for referrals. Talk with your friends and co-workers. You can also get good advice from churches and senior centers. The Local Area Agency on Aging can help with housing referral services – (ELDERCARE LOCATOR 1 800 677-1116).
FINANCIAL CONSIDERATIONS
Typically the costs for Assisted Living residence will range from $1,000 to $3,000 a month and up. The fee varies do to type of accommodations and services provided and the location. Be certain to find out what is covered by the fee and the cost of “extras” if any.
In most situations the family will bear all or most of the cost of Assisted Living. However some states do have programs that provide assistance through Medicaid. This is best determined by contacting your local social service or housing service agency – check the Blue Pages in the phone directory.
Continued Care Residential Community
As noted in the section – Independent Living – residence in a CCRC is an option that was determined, most likely by the folks, to be a good consideration. This is something that is thought out and planned with the idea that assisted living would someday be a necessity.
A requirement for residence is good health when first moving in. These “Life Care” facilities can be expensive. However over a period of time they may be a good choice due to the assisted forms of care and service that are provided later on.
To learn more about Assisted Living options contact the Assisted Living Federation of America, 10300 Eaton Place, Suite 400, Fairfax, VA 22030, 703/691-8100 or www.alfa.org.
Dependent Care is the form of housing that requires 24 hour/day assistance or long-term care. This will typically be in some form of a nursing home. Long-term care is intended for those with disabilities or chronic, degenerative illnesses who require on-going support over a long period of time.
Just the term “nursing home” can be unsettling to many people bringing to mind some uncomfortable finality. Yet they are often the best housing option if a disabled person requires a variety of services. Most nursing homes are not skilled nursing facilities. A skilled nursing facility provides doctor prescribed services by or under the supervision of licensed nursing personnel. In most situations, they participate in Medicare in varying degrees.
The decision to move Dad/Mom to a nursing home will be made by their health care practitioners, the family and the overall condition of their health. The cumulative factors weighing on this decision will vary on circumstances unique to the individual and family.
Long-term care can be expensive. The folks may spend more on this care in a few short years than what they paid for their house! If you were thinking of taking care of Mom/Dad at home consider the costs associated with that. Just three home health care visits a week could cost $200 to $300 a week or $15,000 a year or more! Then consider if other care and services are needed.
For those who do remain at home there are local and community based organizations that provide services and some assistance in the home. However a good nursing home will offer a variety of services in one place including social and recreational activities often not available in a private home.
Most nursing homes are not skilled nursing facilities. A skilled nursing facility provides doctor prescribed services by or under the supervision of licensed nursing personnel. In most situations, they participate in Medicare in varying degrees.
Nursing homes typically provide care that is termed “custodial”. This is generally considered to be help with personal and daily living needs. Help with walking, eating, dressing, bathing and taking medications are examples of custodial care. Medicare does not pay for this.
Finding the right nursing home
As the senior population grows it is anticipated that there will be an expansion in the number and varieties of nursing homes. Finding the right home for the folks will be a new and perhaps awkward experience. Start with the basics – what do they need regarding medical, personal, social and physical assistance?
TIP:If Mom/Dad have a preferred doctor, ask if he/she can recommend a facility that they might be associated with or that they visit. This will assure some continuity in physician care.
There are profit and non-profit nursing homes with advantages and disadvantages to each or so it may seem. The daily fees (billed monthly) will vary greatly as will the services and programs offered. Here are things that should be considered:
Licensing/Certification
Every state has operator licensing protocol and standards. Ask to review this with the administrator who also must be currently licensed. Is the facility certified for Medicare and Medicaid? This is important.
If possible, two or more visits should be made to a prospective home at different times and days. Visit during a meal and sample the food. Try and get a sense of the facility. Are the residents engaged in activities and social interactions? What is the overall demeanor of the home? Could Mom/Dad be happy and well provided for here?
One can be apprehensive about placing Mom/Dad in a nursing home, which is understandable. Perhaps there is some subliminal concern about placing a parent, who has raised and nurtured you, in the care of others. This is about a link in the family that is being separated.
Your love and caring do not end when a parent resides in a nursing home. You are providing a professional level of assistance for their well being. You will continue to be involved with care. See Chapter – CAREGIVING.
When a parent is moved into the nursing home frequent visits should be made. An adjustment period of two to six months should be allowed to let Mom/Dad settle in. There may be problems. Mom may feel resentment about being placed in the home and demonstrate difficult behavior. Perhaps Dad doesn’t like a particular resident. It is wise to monitor and assess their feelings and attitudes. Discuss their issues with them and bring them up with staff.
Resources to learn more on housing for the folks:
There is a myriad of services available addressing the elderly and housing issues. The Older Americans Act established the Administration on Aging (AoA) In the Department of Health and Human Services (DHHS) to, among other things, assist the elderly with housing issues.
The AoA has 57 State and Territorial Units on Aging, 655 Area Agencies on Aging (AAA), 221 Tribal Organizations, and over 27,000 service providers that deal with housing issues for the elderly. To get assistance with housing questions and concerns about Mom/Dad in their area, contact the AoA’s NATIONAL ELDERCARE LOCATOR – 1 800 677-1116 or go to the AoA website at www.aoa.gov.
For fact sheets (booklets) on housing call the AOA’s National Aging Information Center – 1 202 619-0724 The National Council on Aging – has information on senior housing, long-term care and adult day care. 1 202 479-1200 – www.ncoa.org
Home Health Care
After hospitalization, it is determined that your parent may go home. It is likely that he or she will need some form of care. First, they will need some help from family or friends. This should be accorded some thought and planning. It is recommended that duties and responsibilities be delegated. It may help to prepare a list of what is needed and who can do what and times available.
Growing old does not necessarily mean going to a “nursing home”. In fact, only about 7% of our senior population will need the services of a skilled nursing facility and then it will be on average for less than six months. It is most likely that your folks will receive care in the home by family, friends, or a social service agency.
If skilled health care is needed at home, Medicare will cover those services provided by a participating Home Health Agency. This is an authorized agency, public or private, that provides skilled nursing or therapeutic care in the home.
There are criteria for getting Medicare assistance in the home:
1. The doctor determines that home health care is needed and sets up a plan,
2. The home health care agency is a participating Medicare agency,
3. The patient is homebound, that is, they are confined to the home,
4. The care required includes intermittent skilled nursing care, speech therapy or physical therapy.
NOTE: If Mom/Dad have a terminal illness and it is decided to bring them home from the hospital, this is called HOSPICE and there is an entire section on hospice in the CAREGIVING,Chapter.
What to Look For in a Senior Care Facility
There are a number of things to consider when selecting a nursing or senior care facility. One of the first things to consider is the expected length of stay. A skilled nursing facility can become expensive and in due course may not be the appropriate situation for the care of your parent. For example, Mom may have been placed in a skilled nursing facility for a particular medical problem which has now been remedied, in which case it would be time, under direction of the doctor, to move her. If a skilled nursing facility is required after hospitalization, the discharge planner can provide recommendations. Locating the ideal nursing facility may prove to be difficult. You and/or your parent will have to take a variety of factors into consideration: cost, acceptability and location are issues to be considered.
Depending on the type of facility (skilled nursing or custodial), there may be assistance from Medicare. Still there will be expenses incurred that must be considered.
Finding a facility that is acceptable to both yourself and your parent may prove to be a daunting task. A good approach is to talk with family, friends and neighbors. It is likely that people in your parents’ age group can recommend some appropriate facilities. Perhaps a friend or relative is presently who residing in a facility may assuage some anxieties Other sources for locating an acceptable facility are hospital discharge planners, church and civic organizations and local senior service agencies.
Use a list such as this one to evaluate homes visited.
The_____________ Family Survey
Rating Nursing Homes
Home #1 Home #2 Home #3 Home #4
Name___________________________________________________________
Referred by:______________________________________________________
Excellent/Average/Poor
A-B-C-D-F
1-2-3-4-
NOTE: One should NEVER visit a nursing home with a cold, the flu or any other contagious illness.
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