Your parents have lived in the same house for decades. They have invested time and money, not to mention the memories in making it their own, and want to live out their lives there. As time goes by, adjustments are made in the home to accommodate their physical challenges but now those accommodations are no longer sufficient to meet their level of care. They can manage for now but they are realizing that now may be the time to think about other living options. There are however many types of long term care options that are available.
What is Long Term Care?
Long term care (LTC) is a range of medical, nursing, supportive and/or community services that are provided over a period of time for people in need of it.
Selecting the right care environment for any particular situation can be difficult. A team of family members and professional advisers such as the family doctor, a financial adviser and an elder law attorney can provide valuable input with the decisions.
This article describes the pros and cons of the six most frequently referenced settings for long-term care.
At-home care is often the preferred option for most families. It is the most affordable and the least traumatic for the patient who continues to live in his or her own home. Generally, a spouse or other family members provide the care needed.
However there are problems with that plan. Since family members are usually not trained to give nursing care, there is considerable impact and stress on the caregivers providing constant care. Further, often families find that the home environment is not always appropriate for advanced degenerative illnesses.
It is possible to include custodial or skilled home care add-ons, provided by the family. Medicare Skilled Home Care can help in some situations. There are also numerous private home care agencies that provide a variety of services and levels of assistance. Unfortunately, limited public assistance is available to help pay for private, at-home care. In Michigan, private home care services usually average between $17 to $30 per hour.
Transitioning to an assisted living facility may be an acceptable option since it is similar to a home environment. The resident remains independent while the facility provides concierge services such as meal preparation, driving them to and from errands, housekeeping, laundry and basic personal care. Assisted living can also be less stressful and traumatic for the patient and costs less than a nursing home.
Concerns about an assisted living arrangement include:
- Facilities are unlicensed
- Medical assistance is limited
- It is a rental relationship thus there is the risk of a one-sided lease
- The renter is vulnerable to eviction
- There is limited public assistance available to cover costs
For more on tips to remember when selecting a caregiver or assisted living facility, click here.
Adult Foster Care Homes and Homes for the Aged
An Adult Foster Care Home is a setting with 20 or fewer residents, sometimes known as family or group homes, and do not exclusively serve the elderly. Homes for the aged have 21 or more residents and are exclusively for persons over 60 years of age. The benefits are that these facilities are licensed and inspected by the Michigan Department of Human Services. They provide room, board and supervised personal care. However they can’t offer medical treatment or continuous nursing care.
Each home is required to have a written agreement with the resident. There are extensive patient bills of rights, a formal complaint process and procedures for eviction. Some public assistance such as Veterans Affairs aid and attendance or Supplemental Social Security are available.
Continuing Care Retirement Communities
Continuing Care Retirement Communities (CCRCs) promise residents the ability to receive care for life in one facility or campus. They offer a wide spectrum of levels of care ranging from independent to assisted living to skilled nursing home care.
CCRCs usually attract people with enough money to pay substantial entry or membership fees. They involve complex admission and service contracts, and public assistance may or may not be available. Services offered by CCRCs are subject to the same licensing and regulation as they would be in other settings. Other concerns with CCRCs are:
- Inadequate internal grievance procedures
- The financial stability of the facility
- Recovery of investment, and
- The availability of a nursing home bed when and if it is needed.
Nursing homes offer skilled nursing care and medical treatment for illness, injury or infirmity. They are highly regulated and scrutinized by both state and federal agencies and there are strict licensing requirements. A patient can only be discharged if the facility can’t meet the patient’s needs, the patient improves and no longer needs the services, the patient’s conduct endangers the other residents and staff or the bill is not being paid.
Nursing homes are the costliest level of care—averaging over $8,000 a month in Michigan. However, Medicare, Medicaid or VA may be available to assist with costs of care if the resident is eligible and the facility accepts those benefits.
While nursing homes present the most difficult transition for many patients and there are concerns about the quality of care, a nursing home is sometimes the only option. Those considering a nursing home should consider:
- The location
- Hiring a geriatric care manager who knows the local facilities, their staffing and any unreported issues, and
- Advocating diligently for the family member in order to obtain good care.
Your elder law attorney can help you review the nursing home documents and provide insight. It is important to understand your rights and responsibilities before signing admission documents.
Obtaining quality long term care is a major undertaking for families. Seniors and their families should plan as early as possible, investigate the options, and consult with trusted advisers (doctor, family members, and elder law attorney). The legal needs for aging individuals are broad and complex. Counsel from experienced elder law attorneys can assist you in making the best decisions for your circumstances.