Mom is no longer able to cook her meals and she needs help getting dressed every day. My friend told me she may have to go to a nursing home! I can't bear the thought of that! Do I have options?
This is a very common scenario. When elders begin requiring assistance, many well meaning friends or family members may recommend a nursing home. The truth is there are several levels of care to be considered based on your loved one's needs. Let's explore those options.
A skilled nursing facility is a medical facility designed to meet the needs of people who have suffered a short or long term illness, or require 24 hour assistance/monitoring by a licensed nurse. These facilities are licensed by CMS. (Centers for Medicare and Medicaid)
When an individual has been in the hospital due to illness, injury or surgery and is unable to return home when the hospital is ready to discharge, many patients are discharged to this environment for continued nursing care or rehabilitation with physical, occupational and speech therapies. The nursing facility is considered a "lower level of care" meaning the patient no longer requires acute care but does need medical intervention.
Skilled nursing facilities also provide hospice (end of life) and custodial care for those who are unable to live on their own and require 24 hour supervision or care by licensed professionals. For instance, a person who has had a stroke and is unable to meet any of their own personal needs may need this level of care.
A common misnomer regarding nursing homes is that Medicare will pay for Mom or Dad "when the time comes." Unless the person has had an acute care stay that meets or exceeds 3 midnights, or their HMO deems skilled nursing is appropriate, Medicare or the HMO will not cover the cost of the stay. If insurance does pay, it is for the short term only. Medicare/HMO benefits are NEVER authorized for long term or custodial care. This type of care may be covered by Long Term Care Insurance policies, Medi-Cal or Medicaid. Otherwise, private funds are used.
Assisted living facilities range in size from 6 bed private homes in residential neighborhoods to multi-unit resort type complexes. At this level of care, depending on need, such things as dressing, bathing, personal care, meals, housekeeping and medication management are provided.
They are all-inclusive and many have exceptional social programs, some even employ professional Chefs! The amenities offered at this level of care vary greatly depending on budget. Many facilities charge for levels of care. In other words, the more care required the higher on the tier level the resident scores and the more they are charged.
This level of care is considered non-medical. Even though there are staff members who can administer medications (with the exception of injectables such as insulin) assisted living/board and care facilities do not provide hands on nursing services even though there may be a nurse or care manager on staff.
As with the nursing facilities, a long term care insurance policy may cover some of the expense as may some Veteran's benefits but this is considered a private pay option. Some states may have a Medicaid waiver program for assisted living. Check with your state's department of health services.
This type of care is provided in the home setting and is sometimes referred to as "Companion Care." Home care agencies offer a wide range of services that include but are not limited to bathing, dressing, meal preparation, light housekeeping and medication reminders. Many home care agencies will assist the client to medical appointments and personal errands. Safety assessments can be done by the provider to insure potential fall hazards are removed or reduced.
This level of care offers the client the ability to "age in place" and often is a great starting point for many families. Care shifts usually range from 4-24 hours per day, can occur 7 days per week or less, and schedules can be developed to meet the needs of the client and family.
It is very important when choosing a home care agency to be sure they are licensed and bonded. Additionally, care providers should be drug tested and pass extensive background checks.
As with the aforementioned levels of care, long term care insurance policies and veteran's benefits may cover a portion of care. Many life insurance policies have a provision for home care. Keep in mind, this is a non-medical option.
When selecting a care option for yourself or a loved one, do not despair! There are several options available, and the Nursing Home is rarely the first stop! Take the time to research the options and discuss them with your loved one in advance to avoid having to make decisions once a crisis has developed.