Understanding Your Long-Term Care Options

"Mom had a fall." I'd come to dread the four words uttered on the other end of the phone, but there they were. Again. Mom had just recovered from her most recent fall last summer when she'd fractured a vertebrae, and I thought things were getting better.

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I found myself lurched back into the reality of the moment. My mother needed to explore options for assistance. It's a conversation that I'd tried to start a hundred times before but just couldn't figure out how to do it. I was suddenly faced with the need to make a life-changing decision. But first, I had to know: what were my Mom's options for assistance?

This concern is shared by millions of seniors, adult children, friends and neighbors, around the world. It isn't a simple problem. The answers involve complex financial, emotional, physical and spiritual considerations, but there are many ways to get an older adult the help they need. When you boil down the choices though, there are really three routes to take:

• Provide assistance within the senior's home, allowing them to remain in their own house.
• Create a place for them to stay in your home (or a relative's).
• Find an alternative residence or care facility, for example, a Residential Care Facility (RCF), or a Skilled Nursing Facility (SNF).

How Do I Make a Choice About Care?

I certainly wasn't the only person whose parent had experienced a bad fall. Every year, the need to make long-term care decisions is precipitated by a fall, an illness, Alzheimer's or Dementia, or the sudden death of an older adult's spouse. Suddenly, you're trying to make a complex decision in the midst of a very stressful event. It's really important to have the tools and questions in mind to think through this difficult and personal decision. Below is a list of questions that can help clarify your own values and beliefs:

1. Consider Staying at Home

Most seniors will tell you that their first choice is to stay at home. They're comfortable in their spaces. They have many memories and it feels safe, even if in reality it isn't what it used to be. To give up their home feels like they are giving up a large part of who they are. It can be a difficult conversation, but I've found that you need to act as a sounding board to help your parents think through their realistic needs and assess what's feasible.

• What level of care is required?
• Is non-medical assistance needed (such as shopping, cooking, paying bills and the like)?
• Do they need help ensuring that medications are not forgotten?
• Is help required with activities of daily living?
• How many hours a day is the care required?
• How much will it cost? Will paying these costs reduce or eliminate other choices later on?
• Is reliable help available?
• Are you able to check that the hired help is not abusing your parent?
• Is the home safe for an older adult? If not, can it be modified to be safe?
• Are railings available for the full length of all staircases?
• Are supports available in the shower or tub?
• Are there gas appliances that must be lit?
• Is there a way to summon help if the parent falls and is unable to move?
• How often will you personally be able to visit?
• What are the demands on your time due to work and other family obligations? (For example, would you be taking time away from other family members or your job to spend hours traveling each weekend to visit?)

2. Consider Moving Senior into Your Home

• Can your parent be left alone and for how long?
• What changes will need to be made to your home to make it safe for a senior?
• Who else lives in your home and how will they be impacted? (e.g. Are there children living at home? How old are they?)
• What will you do if the person becomes ill or simply needs to go to the doctor?
• Are you and your spouse in COMPLETE agreement?
• Are you also in agreement on sharing the responsibilities?
• Have you researched what the role of caregiver can mean in your life? There are lots of resources online that can help connect you with other caregivers and deal with the inevitable stress (and also share its benefits).
• How do you feel about having part-time help come into your home?
• Have you investigated the options for senior daycare?
• What are the options if you want to go away for a weekend?

3. Consider Moving Senior into a Care Facility

• Are the financial resources available for this option?
• How far away is the facility from you? Should you relocate the senior, geographically, so that you can more easily visit?
• Are you prepared for enormous initial resistance? This is a big change for a senior.
• Have you thoroughly researched what's available?
• Have you thought about the possible need to move among facilities with differing levels of care? (For example, eventually a parent might need to move from assisted living to a nursing home).
• If funds are available, but limited, have you learned how the facilities address Medicaid?
• Will the facility accept a client coming in on Medicaid or will they demand an initial paid period? Facilities are becoming increasingly inventive about ways to finance the cost of care. Care costs money. Include this fact in your planning. Ask, don't assume.
• Don't assume that government funded facilities will be horrible (or that private facilities will be wonderful). Visit them and decide for yourself.

There can be advantages and disadvantages to all three of the options, depending on the situations of both you and and your parent. Taking the time to prepare and educate yourself now can make it a lot easier to deal with that dreaded phone call, should it ever come. You'll be glad you did.


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