All You Need To Know About Eldercare Arrangements

It’s never too early to think about how and where you want to live when you’re older.

How far in advance do you plan vacations? A month at the very least, right? You’ve booked the flights and hotels, taken time off of work, gotten the kids out of school and looked forward to it from the moment you made the final arrangements. Let’s use the positive outlook for Eldercare.

Granted, the circumstances may be tough. You could be having trouble getting around, taking care of regular daily activities (cooking, cleaning, driving…) or become ill. Rather than wait for it to happen, here are the options available to ease your worried mind.

4 Thing To Consider Right Now

  1. Health: Will you need doctors and nurses on staff to help with any medical issues? Even if you’re not ill, perhaps you want easy access to medical professionals just in case.
  2. Finances: Long term care is often very pricey so do you have the means to live where you want to live?
  3. Location of Family Members: Do you want to be near family and friends or do you want a complete change of scenery?
  4. Degree of Independence: Do you like doing things on your own or do you want someone else to pitch in and help out with your daily routine?

Granted, it’s hard to predict all of these things in advance. But knowing what to expect and prepping yourself for different possibilities is an achievement in itself. 


How Do You Want to Live at the End of Life?

The reason eldercare decisions can be difficult to make is because you’re often not making them alone. If you have kids, parents, extended family or close friends, this affects them too.

While it might be a tough topic to bring up, it’s helpful to get different perspectives from all the people who matter to you.

Types of End-of-Life Housing and Care

Assisted Living

Assisted living is a good option if you can manage your own care but need occasional help with activities of daily living, such as cooking, cleaning, and managing medications. Assisted living facilities have doctors and nurses on staff at all times in case of emergency.

Facility Overview

  • Most assisted living facilities offer a large degree of independence, which means a small apartment with a kitchen or a bedroom with a bathroom, though some assisted living facilities offer shared bedrooms.
  • Rooms or apartments may be furnished or unfurnished.
  • All rooms should come equipped with emergency call systems in the room.
  • Most assisted living facilities also have a dining room and at least one common room for socializing, while some also have features like game rooms, libraries, computer rooms, gyms, and other recreational facilities.

Basic Services Offered

  • Meals
  • Housekeeping assistance, including laundry
  • Transportation assistance
  • Help with bathing, going to the bathroom, dressing, and grooming
  • Help managing medications
  • 24-hour staff and emergency medical services
  • Facility security

Additional Services

  • Scheduled entertainment and recreational activities
  • Physical therapy
  • On-staff medical specialists

How Much?

The costs varies based on the location, amenities of the facility, the size and style of the room, and services provided. In general they range from $1000 to $5000 per month. Though Medicare will not cover the cost of assisted living, some facilities will accept Medicaid.

In addition, some facilities will accept long-term care insurance, HMO and Managed Care plans, and other forms of insurance. For the most part, however, you will likely have to pay the bulk of the cost yourself. [Dig Deeper: Assisted Living and Checklist: Questions to Consider When Choosing an Assisted Living Facility]

In-home Care

In-home care (aka home health care), is a good option if you’d like to continue to live at home but need some help with activities of daily living, such as cooking and cleaning, using the toilet, bathing and dressing, eating, and managing medications.

Most in-home care is non-medical care, meaning that those providing care are either professional caregivers, certified nursing assistants and friends and family, rather than registered nurses or physicians.

This Ol’ House Might Needs Some Remodeling

Depending on the patient’s medical situation and needs, certain adjustments or modifications may need to be made to the home. These adjustments can make caregiving easier and reduce accidents, and may include:

General Home Modifications

  • Widening doorways to accommodate a wheelchair
  • Installing railings on stairways
  • Installing a stair lift or wheelchair lift on stairways
  • Installing ramps
  • Replacing knobs with lever handles on doors and faucets

Bedroom Modifications

  • Relocating a bedroom from the second-floor to the ground-floor
  • Replacing a standard bed with a hospital bed

Bathroom Modifications

  • Installing railings in the bathroom and shower
  • Installing a bench or seat in the shower
  • Installing a wheelchair-accessible shower stall
  • Installing slip-resistant bathroom flooring
  • Raising the height of the toilet seat for easier access
  • Installing handrails on a toilet

[Dig Deeper: Guide: In-Home Care Supply Companies and Guide: Products for Seniors Living at Home]

The Two Types of Caregivers

Home Care Aides (HCA) are people who provide help with household duties such as housekeeping, laundry, cooking, shopping, personal care, transportation and general care. There’s no state or federal certification required to be a Home Care Aide.

Home Health Aides (HHA) have received formal medical training and are usually certified nursing assistants and can provide basic healthcare services as monitoring pulse, body temperature, and blood pressure; managing and administering medications; monitoring wounds and changing dressings.

In addition, medical professionals such as registered nurses, nurse practitioners, physical therapists, occupational therapists, and physicians may all play a role in in-home care.

In-home Care Costs

This all depends on the type of care you’re receiving, including the number of Home Care Aides and Home Health Aides that are employed. Medicare, Medicaid, and private insurance will all cover some portion of in-home care services but you’ll need to provide evidence that the treatments are medically necessary. Since insurance plans vary, there may be additional qualifications or criteria for coverage. (Example: Most insurance companies won’t cover Home Care Aides because it doesn’t qualify as a medical necessity.)

In the case of home modifications, some insurance plans will cover some of the costs of modifications if they were recommended by a doctor and seen by the insurance company as medically necessary. In some cases, the products used for home modification will need to be ordered by the doctor for insurance to cover the cost.

[Dig Deeper: In-Home Care and Checklist: Questions to Consider When Choosing In-Home Care]

Nursing Home or Skilled Nursing

A nursing home is for those who need a high level of medical care--there are doctors or nurses on the premises at all times--in addition to help with activities of daily living (cooking, cleaning, dressing, grooming, managing medications, etc…).

Facilities Overview

  • Residents often live in either a bedroom with a bathroom or a shared bedroom.
  • Rooms may be furnished or unfurnished.
  • All rooms come equipped with emergency call systems in the room.
  • Most nursing homes have a dining room and at least one common room for socializing, while some also have features like libraries, outdoor spaces, and other recreational facilities.

Basic Services Offered

  • Meals
  • Housekeeping and laundry
  • Transportation assistance
  • Help with bathing, going to the bathroom, dressing, and walking
  • Help managing medications
  • 24-hour nurses and staff and emergency medical services
  • Facility security
  • On-site physical therapy and occupational therapy

Additional Services Offered

  • Scheduled entertainment and recreational activities
  • On-staff medical specialists

What’s it Cost?

Nursing homes are quite expensive, averaging about $6,000 per month. If you don’t have the means, here are a few options to lessen the financial burden:

  • Medicare will cover a short-term stay in a nursing home (usually about 100 days), and often requires that the stay take place within 100 days of a hospitalization.
  • Medicaid will likely cover most of the costs of a nursing home, though not all nursing homes accept it.
  • Long-term Care Insurance may cover some or all of the costs of a nursing home, depending on the rules of your policy.

[Dig Deeper: Nursing Home and Checklist: Questions to Consider When Choosing a Nursing Home]

Hospice Care Overview

Hospice focuses on providing comfort and dignity to patients at the end of life and include pain and symptom management, caring for the patient in the patient's home, and delivering care through a network of caregivers.

Hospice also helps the family of the patient cope, and offers emotional and psychological support both before and after the patient dies.

How Hospice Works

Hospice patients are usually in the last six months of life and most patients arrive after deciding to forgo life-support treatments or other life-saving medical interventions. In some cases patients may require a referral from a doctor in order to be accepted to hospice.

Where?

Hospice care is generally administered to the patient at his or her home, though care can take place in a dedicated hospice facility, an assisted living facility or nursing home, or a hospital. It’s generally preferable for the to beat home, as being at home can provide physical, emotional, and psychological comfort to the patient.

Who?

Hospice care is managed by a team of caregivers that includes medical professionals including nurses, physicians, social workers, psychologists, and trained volunteers, as well as the family of the patient. Close friends of the patient may also participate in caregiving. A primary caregiver (usually a friend or family member) works closely with medical professionals to create and execute a unique care plan for the patent.

Cost?

For patients who are expected to live no more than six months, the cost of hospice care is fully covered by Medicare. In addition, most private health insurance plans and accountable care organizations (ACOs) offer a hospice coverage and/or benefits. [Dig Deeper: Hospice]

Palliative Care Overview

Palliative care is an approach to end-of-life care that focuses on relieving pain and other symptoms, and improving the comfort and quality of end-of-life for patients. Palliative care is delivered through a network of caregivers, from doctors, nurses, and social workers to psychiatrists, clergy members, and family members.

What is Palliative Care?

Palliative care is an approach to medical care that focuses on relieving pain, stress, and other symptoms of illness. Palliative care is available to all seriously ill patients, whether the diagnosis is terminal or not. Many patients receive palliative care in conjunction with other types of care, such as dialysis, chemotherapy, or surgery.

Palliative care is usually delivered by a network of caregivers who work together to focus on the patient's overall comfort, including physical, emotional, psychological, and spiritual comfort. This network of caregivers works closely with the patient's family to help everyone understand the nature of the patient's illness, the types of treatments and medications that the patient is receiving, and how to be effective caregivers for the patient while taking care of themselves.

How is Palliative Care Different From Hospice?

Both palliative care and hospice care focus on alleviating pain and other symptoms that a patient may be experiencing. However, hospice is solely dedicated to helping patients who are in the final months of life. Palliative care, on the other hand, is an approach available to all patients with treatable or terminal illnesses, no matter where they are in the life cycle. Palliative care is also often combined with other life-saving treatments, such as chemotherapy, radiation, or surgery.

Reasons to Choose Palliative Care

Palliative care is available to all people suffering from illness. Whether you are continuing to receive treatment for an illness or not, palliative care can help you feel more comfortable physically, psychologically, and emotionally. In addition, palliative care can empower you and your family to understand and manage your care yourself, and deliver that care to you in the comfort of your home.

Where To Receive Palliative Care

Most hospitals with at least 200 beds have some sort of integrated palliative care program, and so many patients can receive palliative care in a hospital setting. Palliative care is also often available at care facilities (assisted living facilities or nursing homes) and may be available to patients receiving in-home care. If you are interested in receiving palliative care, talk to your doctor or the hospital that serves you to learn about their palliative care programs.

Palliative Care Costs

Because palliative care integrates the services of many different health care professionals, it might seem as though the cost would be quite high. However, in general patients receiving palliative care generally save money, as palliative care tends to reduce expensive trips to the emergency room and long hospital stays. Most patients receiving palliative care are suffering from illnesses that are often expensive to treat in a traditional medical setting; by empowering patients to understand their own care in conjunction with their families, many of the costs often associated with these illnesses—specifically costs associated with treating unchecked or misunderstood symptoms—are avoided.

In addition, many palliative care programs are associated with Accountable Care Organizations (ACOs), a health care model that uses integrated care to deliver lower-cost health care.

Talk With Your Family

If you have decided that you would like to receive palliative care, it's a good idea to share your wishes with your family. For many palliative care patients, family members are integral in providing care; it's important for you to know if your family will be willing and able to participate in your care.

In addition, many people disagree with the values of palliative care, arguing that it is a form of "giving up" and believing that aggressive treatments should be pursued at all costs. If you have decided that you would like to receive palliative care and you have family members who do not support your decision, remember that you are making decisions for your life and your care, and while you may like to have the support of all family members, you can still get the care you want without that support. [Dig Deeper: Palliative Care]

What’s An Accountable Care Organization (ACO)

An accountable care organization (ACO) is a network of hospitals and health care providers that treats Medicare patients based on a model of shared responsibility, resulting in more integrated and lower-cost care.

Within an ACO, a patient's care is being coordinated between hospitals, doctors, and specialists (often including in-home care services and hospice). Not only does this coordination promote greater communication and collaboration between a patient's health care providers, but can potentially reduce costs across the board for the patient, the providers, and the hospitals.

ACO Patients

ACO patients are primarily Medicare beneficiaries, meaning that patients are over the age of 65. For older patients, a population that generally requires more care, the coordinated care offered by an ACO can be a critical difference in terms of improved care and cost savings.

ACO Cost and Payment

Unlike the traditional health care payment model of fee-for-service, in which healthcare providers are paid per procedure (a system that often suffers from providers performing an abundance of unnecessary tests and procedures), in an ACO health care providers are offered financial incentives to keep costs down. This approach, combined with coordinated care, offers ACO patients organized, effective, and affordable health care.

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