Our parents, the people we have always looked to for guidance and direction, will reach a point in their lives when they need our advice and assistance. As the years pass, the aging cycle will bring a family full circle, and adult children learn to face the reality that their parents need assistance with day-to-day living. Aging parents need their adult children to help them with decisions at this time. Whether Mom now needs help cooking or Dad needs assistance with yard work, or their needs involve more personal care, the time will come when it is best for everyone to consider a change in lifestyle with less of life’s daily chores to bear. The question now is “How do we begin?”
We have all heard the multitude of terms related to senior living tossed about in casual conversations, in advertisements and in the medical community. They include words like Nursing Home, Assisted Living, Retirement Home, Retirement Community, Independent Living, and Independent Living with Assisted Services to name just a few. Unfortunately, the definitions of those terms can be ambiguous or misapplied and many people may feel at a loss when they begin making the first inquiries to research options for their loved one. The following list is by no means comprehensive, but may offer an introduction into the realm of senior care.
Independent Living (sometimes referred to as Retirement Living):
Designed for seniors who require little or no assistance with the activities of daily living, independent living communities provide services for residents such as housekeeping, maintenance and, in some cases, meals, activities and transportation to professional appointments. In this setting, the senior adult requires minimal or no personal care assistance. However, residents in independent living may choose to have some home health care or personal care services provided by an outside agency. This would include senior living residences that identify themselves as Independent Living with Assisted Services.
The Assisted Living Federation of America (www.alfa.org) defines assisted living as a long-term care option that combines housing, support services and health care, as needed. Assisted living is designed for individuals who require assistance with everyday activities such as meals, medication management and/or assistance with bathing, dressing and transportation. Some residents may have memory disorders including Alzheimer’s, or they may need help with mobility, incontinence or other challenges. Residents are assessed upon move in, or any time there is a change in condition. The assessment is used to develop an Individualized Service Plan. Medicare does not cover assisted living, but low-income residents may qualify for special assistance from Medicaid in certain assisted living communities. Some residents may have Long Term Care Insurance policies that will help with some of the costs.
When looking into assisted living options, asking a lot of questions is always a great idea, but, often, it is difficult to know the “right” questions to ask. Calling a list of communities and only “checking prices” will not give you the best comparison because telephone price quotes are often misleading. Payment options, level of care charges, quality of care, environment, staffing levels and tenure all factor into the choices you have and will vary greatly among different assisted living communities. In the state of North Carolina, licensed Assisted Living Facilities are regulated by the NC Department of Health and Human Services Division of Health Service Regulation. Their website (www.ncdhhs.gov/dhsr) provides valuable information including a comparison of communities based upon DHSR’s on-site visits to those communities. Keep in mind, however, that state ratings only provide a small piece of the puzzle and that information cannot replace a personal visit to the community whenever possible.
Skilled Nursing Facility or Nursing Home:
AARP explains nursing homes in this way. “There are generally two types of care available in a nursing home — short-term, rehabilitative care and long-term care for chronic conditions. In addition to rehabilitative capabilities, nursing homes are staffed to provide for daily medical needs and can accommodate patients who spend most or all of their time in a bed. Nursing homes can accommodate patients with a wide variety of conditions”. (http://www.aarp.org/relationships/caregiving/) Short-term rehab stays in skilled nursing usually follow a hospital stay resulting from an injury or serious illness. In skilled nursing rehab, patients may receive skilled medical treatment and/or physical, occupational, or speech therapy. There are Medicare guidelines that govern the coverage for these services. For more information on what part of skilled nursing rehabilitation is paid for by Medicare, www.Medicare.gov is a good resource. Long term care in a skilled nursing facility is not covered by Medicare. Some residents may have Long Term Care Insurance policies that will help with some of the costs of care. Residents who have depleted their assets may qualify for Medicaid in
Most importantly, it is wise to educate yourself before an emergency strikes. Often seniors are doing fine living alone, but experience a fall or sudden illness which would require immediate placement. You will appreciate that you did your research early before a crisis situation. Discuss your findings with your parents and fully understand their desires for their care. Early discussions help develop a positive mindset and allow a period of comfortable adjustment for your parents. However, keep in mind that many seniors will want to stay in their homes even beyond a reasonable point. Many homes are not handicap accessible and are not safe for bathing or the use of walkers or other medical equipment. Often, seniors living alone have trouble eating healthy, regular meals, taking scheduled medicines, and keeping clean. It is best to be vigilant in recognizing signs of change sooner than later and seek guidance from qualified professionals as soon as those changes occur.