Family Living Focus: Planning For Long Term Care
Gail Gilman, Family Life Consultant, M.Ed., C.F.C.S. and Professor
Emeritus, University of Minnesota
Most older people are independent but later in life, especially in the 80s
and 90s you or someone you know may begin to need help with everyday
activities like shopping, cooking, walking, or bathing. For many people,
long-term care may mean a little help from family and friends or regular
visits by a home health aide. For others who are frail or suffering from
dementia, long-term care may involve moving to a place where professional
care is available 24 hours a day.
The good news is that families have more choices in long-term care than ever
before. Today, services can provide the needed help while letting you stay
active and connected with family, friends, and neighbors. These services
include home health care, adult day care, and transportation services for
frail seniors as well as foster care, assisted living and retirement
communities, and skilled nursing facilities (nursing homes).
Planning Ahead
The key to successful long-term care is planning. You or your family may
need to make a decision in a hurry, often after an unexpected emergency like
a broken hip. Be prepared by getting information ahead of time. That way,
you will know what is available and affordable before there is a crisis. To
start:
* If you are having trouble with things like bathing, managing
finances, or driving, talk with your doctor and other health care
professionals about your need for help. A special type of social worker,
called a geriatric case manager, can help you and your family through this
complex time by developing a long-term care plan and locating appropriate
services. Geriatric case managers can be particularly helpful when family
members live a long distance apart.
* If you are helping a family member or friend, talk about the best
way to meet his or her needs. If you need help for yourself, talk with your
family. For instance, if you are having trouble making your meals, do you
want meals delivered by a local program or would you like family and friends
to help? Would you let a paid aide in your home? If you do not drive,
would you like a friend or bus service to take you to the doctor or other
appointments?
* Learn about the types of services and care in your community.
Doctors, social workers, and others who see you for regular care may have
suggestions.
* Find out how you may or may not be covered by insurance. Insurance
may offer short-term home health and nursing home benefits.
Be aware that figuring out care for the long term is not easy. Needs may
change over time. What worked 6 months ago may no longer apply. Insurance
coverage is often limited, and families may have problems paying for
services. In addition, rules about programs and benefits change, and it is
hard to know from one year to the next what may be available.
A Need for More Care
At some point, support from family, friends, or local meal or transportation
programs may not be enough. If you need a lot of help with everyday
activities, you may need to move to a place where care is available around
the clock. There are two types of residential care:
* Assisted living arrangements are available in large apartments or
hotel-like buildings or can be set up as “board and care” homes for a small
number of people. They offer various levels of care, but often include
meals, recreation, security, and help with bathing, dressing, medication,
and housekeeping. *
* Skilled nursing facilities – “nursing homes” – provide 24-hour
services and supervision. They provide medical care and rehabilitation for
residents, who are mostly very frail or suffer from the later stages of
dementia. Sometimes, health care providers offer various levels of care at
one site. These “continuing care communities” often locate an assisted
living facility next to a nursing home so that people can move from one type
of care to another if necessary. Several offer programs for couples, trying
to meet needs when one spouse is doing well but the other has become
disabled.
Finding the Right Place
To find the residential program that is best for you:
* Ask questions. Find out about specific facilities in your area.
Doctors, friends and relatives, local hospital discharge planners and social
workers, and religious organizations can help. Other types of residential
arrangements, like “board and care” homes, do not follow the same federal,
state, or local licensing requirements or regulations as nursing homes.
Talk to people in your community or local social service agencies to find
out which facilities seem to be well run.
* Call. Contact the places that interest you. Ask basic questions
about vacancies, number of residents, costs and method of payment, and
participation in Medicare and Medicaid. Also think about what is important
to you, such as transportation, meals, housekeeping, activities, special
units for Alzheimer’s disease, or medication policies.
* Visit. When you find a place that seems right, talk to the staff,
residents, and, if possible, family members of residents. Set up an
appointment but also go unannounced and at various times of the day. See if
the staff treats residents with respect and tries to meet the needs of each
person. Check if the building is clean and safe. Are residents restrained
in any way? Are social activities and exercise programs offered and
enjoyed? Do residents have personal privacy? Is the facility secure for
people and their belongings? Eat a meal there to see if you like the food.
* Understand. Once you have made a choice, be sure you understand the
facility’s contract and financial agreement. It is a good idea to have a
lawyer review them before you sign.
A Smooth Transition
Moving from home to a long-term care facility or nursing home is a big
change. It affects the whole family. Some facilities or community groups
have a social worker who can help you prepare for the change. Allow some
time to adjust after the move has taken place. Regular visits by family and
friends are important. They can be reassuring and comforting. Visits are
necessary, too, for keeping an eye on the care that is being given.
Look for more Family Living Focus information from Gail Gilman, Family Life
Consultant, M.Ed., C.F.C.S., and Professor Emeritus – University of
Minnesota, in next week’s paper.
