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Value of Care

Research the amount of care your loved one will receive with regard to the expense involved. You should reach a balance between your loved one’s current cost of living and the cost involved in his or her enhanced level of care received. Put these costs in perspective. Consider the types of services or items that may be included with the cost of an assisted living. Services such as laundry, housekeeping, and provided meals may end up providing a cost savings.

Indicators for Assisted Care

With the availability of community based services, seniors and their families will often strive to stay in their own home as long as possible. Staying in a familiar environment, finances, and retaining independence are some reasons that seniors and their families choose to remain in their home. But what about when staying at home is no longer safe? How do you know when mom or dad need more monitoring? There are indicators that additional assisted care may be required to keep your loved one safe.

Is there a lack of adequate food in cupboards or refrigerator? Have there been any falls? Are medications being taken as scheduled? Is there a lack of social interaction outside the home? Are there incidents of bed or clothing being soiled? Have mom or dad wandered and gotten lost outside the home? Is the family having difficulty meeting the needs of the aging parent? It may be time to consider assisted care options

When Home Care Is Not Enough

Non-medical home care may provide monitoring, medication reminders, light housekeeping, cooking, and hands on personal care. Putting these services in place can be a life saver by allowing relief for family caregivers. However, these services may average from $15-25 an hour and are not typically covered by medical insurance.

What if family members are not available to fill in the gaps of time not covered by the home care provider? What if dad has some dementia, and is at risk of leaving home and getting lost?

Depending upon the level of need and the hours of monitoring/care needed, it may become cost prohibitive to maintain care at home. There comes a point in which an assisted living home or community may be a better value in terms of amount of care and cost.

A Variety of Assisted Living Options

You have decided that care outside the home setting may be in order. What is next? Depending upon where you live, there may be anywhere from a handful to a plethora of options! Assisted living options come in many sizes, styles, and offer a variety of care choices.

Available options may include small homes, large resort-like communities, assisted neighborhoods with groupings of small homes, and apartments attached to skilled nursing centers. The options available, and the policies that regulate them, differ from state to state. Additionally, each residence may offer a different level of care.

For example, some assisted living communities may offer only minimal hands on care while others may allow for a resident who is bed bound and at the end of life. Some assisted living homes offer security to protect those with wandering dementia, while others may not. Know what is important to you and your loved one. Do your homework. Ask a medical provider for suggestions.

The Value of Assisted Living

Assisted Living is never an inexpensive choice, but it may be a valuable choice. Family members oftentimes do not have the physical ability, emotional stamina, or time to spend the day with a loved one. As the needed hours for outside help increase, it may be worth a peek at the overall cost.

When families begin the process of investigating assisted living options, they are sometimes surprised by the fees involved. What do these fees cover?

Let's look at the math. Assisted living homes and communities usually include 2-3 meals a day, medication management, monitoring and security during the day and at night, certified caregiving and administrative staff, and housekeeping, just for starters.

What types of things won’t a parent need to pay for any more if they move out of their own home? Groceries, transportation, utilities, home repair, and in-home care are possible examples. Don’t be a victim of sticker shock. It may be that the value received by an assisted living option outweighs the cost of staying in the home.

The Benefits of Community

If a smaller care home is not your cup of tea, consider an assisted living community. A community may range from eleven residents to over one hundred. The elderly person may benefit greatly from opportunities for socialization.

Feeling engaged in a planned event, pursuing an interest, or simply having one-on-one conversations with others can boost the spirit and foster an interest in life.

Assisted living communities typically offer a range of activities from simple board games and puzzles to art programs, religious or spiritual studies, and live music programs.

Often, assisted living communities provide assessment and guidance so that activities are targeted to the desires and interests of each resident.

An Opportunity to Observe

What if mom or dad tends to stick to themselves? What if dad has always preferred to just watch television and isn’t interested in activities? A common misconception is that an elderly person may not benefit from a community that offers activities.

Interestingly, what we sometimes find is that a resident may start out choosing to observe from a distance, but later decides to participate.

Stimulation can be provided not only by doing, but by seeing and hearing an activity as well. Providing an opportunity for residents to choose what and when to join in an activity is important. It provides the right to independence.

Not One Size Fits All

Communities come in a variety of sizes and designs. Some communities are large groups of buildings in a resort style setting with lush and landscaped grounds, some appear more institutional in design, some are attached to skilled nursing facilities, while others are resemble a neighborhood.

When you open the door, what is inside? Fancy lobbies do not equate to better care. Layout and design can have significant impact on the flow of care and the comfort of the residents. Larger communities may offer room to roam and things to do. This might be a perfect fit for mom. But what if it feels too overwhelming?

Perhaps a smaller community would offer the best of both worlds. A community that offers activities, access to outdoor areas, quiet or private spaces but in smaller more intimate setting may fit the bill. What feels good? Listen to your gut. Does a place have a “good feel”? Often your gut knows better than you think!

Making the Move

Moving into an assisted living community is a significant life transition. Ideally the move is planned over a period of time. Unfortunately sometimes this transition occurs suddenly due to a change in condition of a parent or significant other. Prompted by a recent inpatient stay at a hospital or skilled nursing facility, families often scramble to choose a new home with little time to prepare.

There may be a sense of losing independence. An elderly person may feel that they are now at the mercy of others to care for them. However, it is important to understand that accepting care when needed can actually prolong and improve independence and health outcomes.

The Value of Recollection

Every person has a history full of colors and experiences. Every person has experienced both negative and positive situations. The average person has some painful memories and regrets. Each person also has positive memories and emotions. Some elderly dwell on the difficulties of the past. Family and loved ones can assist in reflecting upon the positive aspects of the past by encouraging recollection.

Some ideas for recollection might be to develop a scrapbook together, go through photo albums, tell stories, view home movies, or perhaps listen to music of that elder’s youth.

Anticipating the Future

Uncertainty about the future is common among the elderly, especially during times of transition. The transition into an assisted living community can feel overwhelming. Worry, anxiety, fear, and helplessness are some emotions that the elderly person might feel.

While it is natural to have these feelings, there are some actions that can be taken by caregivers and family to ease their loved one's mind.

Give hope by focusing on the abilities that a loved one still has instead of the loss of certain functions. Set some goals to accomplish. Plan an outing or a special activity together at the community. Anticipating a future event or activity gives the elderly person something to look forward to.

Access to Nature

Contact with nature is known to have significant positive effects on older adult health. When choosing a new assisted living home, it is important to look at the environment of the home. Whether in a smaller or larger assisted living community, identify the residents’ connection to nature.

Does the community have easy access to the outdoors? Are the outdoor areas maintained in such a way that they are inviting and safe? Does the landscaping reflect visually interesting aspects of nature and with varied colors and textures?

Bird feeders, flowers, plants, and different seating options offer residents a way to connect with their outdoor world.

Natural Light in Assisted Living

Natural lighting may be helpful in improving mood of the older adult as well as assisting with the natural sleep/wake cycles. Often, those with dementia have more difficulty regulating sleep/wake cycles and can benefit from access to natural light and views of outdoors.

Assisted living communities that pay attention to natural light access are more likely to reap the benefits of improved mood and better sleep patterns for their residents.

Happy and Hydrated

Hydration is very important in caring for the elderly. Elderly residents are more susceptible to dehydration and may present symptoms that look much like symptoms from other causes.

Caregivers who can identify these symptoms in those residents who have dementia and cannot verbalize their needs, is especially important. Knowing what to look for in these residents is vital to managing their care. Fatigue, restlessness, dizziness, confusion, dry mouth, and palpitations are some of the possible symptoms of dehydration.

Offering water on a regular basis is important. Assisted living communities should offer residents easy access to water in common areas. Better yet, having a hydration schedule is a proactive approach to keeping residents hydrated and happy.

Discussions with Mom and Dad

The birds and the bees were bad enough but what about the discussion concerning aging and end of life? Discussions with mom and dad about aging and how they feel about its associated care can be uncomfortable for both parties.

These discussions may be emotionally charged or slow and scary. If everyone thought of aging and end of life in a positive manner, perhaps these discussions wouldn't be so daunting. But the fact is, they usually ARE daunting.

Often, there is a role reversal taking place. Adult children used to turn to their parents for support and comfort, but now the course may be shifting. Parents may become more debilitated or confused and may not be as socially involved. They therefore may be relying more upon their children to fill their needs.

Discussions in Advance

Aging parents may feel the need to protect their children from the reality of physical or cognitive decline. Sometimes however, the children are confronted with the reality when prompted by an event such as a sudden health decline, fall, or financial change.

What then may then happen is decisions made in crisis mode with no time to plan. There may be little time to honor parents’ needs and desires in a circumstance when a quick solution is needed. There may be more pressure to act and options for care may be limited.

With these possible circumstances in mind, parents and their adult children may reduce the potential for last minute decisions, by having these important discussions well in advance.

A Reversal of Roles

A reversal of roles can be difficult for both the parent and adult child. The parent may be resistant to their children “stepping in” and assisting with day to day affairs.

The parent may feel a sense of powerlessness and loss of control over decision making. There may be fears about their own physical or cognitive decline and worry about becoming a burden on their child.

Involving the parent in each step of change or decision made, may ease these concerns for the parent. Preservation of dignity and respect is key in making this reversal transition go more smoothly.

The Reality of Parent Care

A child may feel overwhelmed by the prospect of taking over the physical, emotional, social and financial concerns of their aging parent. The reality of responsibility on top of their own life may seem unmanageable.

Depending upon the past and current relationship between parent and child, there may be feelings of resentment, apprehension, or inadequacy.

Reaching out for help and advice may lessen the worries of the child. A local agency on aging may be a good place to start. Often these organizations have information about local resources, support, and education.

Covering Care in Assisted Living

You may be surprised to find out that Medicare does not cover assisted living services for your loved one. The premise of assisted care is that a person can receive help with non-medical needs such as medication reminders, assistance with dressing or bathing, eating, mobility, and even housekeeping.

One would assume that since these basic needs are essential for the care and safety of their loved one, that they would be covered. This is not the case. Care and safety related services, sometimes referred to as “custodial” services, are considered non-medical/non-skilled care in the eyes of Medicare.

In the assisted living setting, room, board, and custodial services are paid privately by the resident. This means out-of-pocket expense for the resident or family members. Since the price tag on these services may be cost-prohibitive for some, there are a few different programs a person can use to help fund this care.

Veteran related assistance, long-term care insurance, and state-funded assistance may provide supplemental funds. These types of assistance all come with their own requirements and should be planned for in advance of actually needing them.

Medicare and Assisted Living

The room, board, and personal/custodial care services provided in the assisted living setting are not covered by Medicare. Physician services, medication, lab work, health nursing and therapies continue to be covered by your Medicare or other health insurance policy.

Residents and their family are still in control of their medical care in that they may continue with primary and specialty physician appointments in the office setting. However, some assisted living facilities may offer their own in-house physician services.

This may be a very prudent choice for residents. In-house physician care can alleviate difficulties with outside scheduling and transportation. It is also a great option for those residents with dementia, as it eliminates waiting in a crowded physician office which may prove to be over-stimulating and stressful.