I have had family members tell me there mother is a little lonely since the loss of her spouse. They are going to visit assisted living. WHAT? This person can care for herself and take her own medicine, but walks with a cane sometimes. Assisted Living is too much care for that person. She will become depressed and not stimulated enough in that environment.
When an older adult, or her family, realizes that living home alone independently isn’t working anymore, what are the options? What are the differences between independent and assisted living? How do I know which living facility is the best match? Does every building do everything? There are so many options now, the choices are dizzying.
Options
Home Care/Companion Care
By choosing home care/companion care, you stay at your own home with one-on-one service. Most home care agencies will do bathing/dressing/toileting/homecare. Companion care services will not do any personal care (like The Extra Daughter). Many agencies require four hours per day with a minimum of twelve hours a week. The Extra Daughter only charges two hours but we don’t do personal care. You can stay in your own home until you die, if you wish to do so.
Independent Living
When you are in independent living you live in a full apartment with minimal support. You will likely get one meal a day (dinner) with some options to purchase other meals and the apartment will come with a full kitchen. There will be activities, transportation to doctors and grocery shopping, and an emergency call system. Depending on the facility, you may be able to purchase additional services such as medication passes, housekeeping, and bathing assistance. You cannot pay for independent living with Medicare or Medicaid. Ask what happens if you need more assistance as time goes by. Prices range for a few to several thousand a month, depending on how many services they offer and how elaborate the facility is.
Assisted Living
You will get an apartment or room with a small refrigerator and microwave and all meals will be included. There will be a nurse to pass medications and nursing assistants to help with personal care. This may or may not be included in the cost. A nurse is on duty 24 hours a day. Activities are included and more geared toward people with limited mobility and sometimes limited mental capacity. Residents are much more carefully monitored than independent living. Medicaid will cover this if you qualify and the facility takes Medicaid. Medicare will not cover living expenses, but will cover in-house therapy if prescribed by a doctor.
Memory Care
These locked units are designed specifically for those with memory loss. While there is usually a nurse on duty, the primary focus is on reducing agitation and increasing awareness, right down to the best color for plates to increase appetite of those with dementia. Staff is usually specially trained to work with people with dementia and all activities are geared toward that. If someone develops severe health concerns they will likely be transferred to nursing care.
Nursing/Long Term care
This is the most intensive of care for someone who cannot care for any or most of their personal needs. Nursing staff is there around the clock and there is significant nursing assistance. All meals are provided and rooms can look like hospital rooms. Good long term care facilities can prevent someone from going to the emergency department too often.
Hospice care
Hospice is end of life care, but someone can be in hospice for two years. Hospice is dying at home so any setting is considered home, including all of those described above. The nursing and care staff work in conjunction with other care staff. Hospice is not necessarily a place, but some hospice providers have a respite care facility for short stays.
All in one
Some places have all living options on one campus and allow you to move between the when the need arises. Make sure you know the terms of moving from one building to another.
Cost
There are luxury buildings that surpass most people’s home in terms of luxury and amenities. Those are pricy and often assume you will use the value from your home to pay for their facility. Others are more reasonably priced but are more modest and are still private pay. Medicare does not pay for any of these long-term living arrangements but will pay after a hospital stay for rehab for a few weeks. Medicaid will pay for assisted or long-term care once you run out of money. There are also programs that take Medicaid and help people stay at home. These programs are wonderful but often underfunded and they use up their allocation quickly.
How do you know what type of facility is right for you?
The answer comes down to what a person can and cannot do for themselves. A primary care provider can help you decide what type of facility will best suit your needs. Your financial advisor can help you decide what you can afford. There are people whose living it is to help people find placement. They will assess you and know the market and can find a place that meets your physical and financial need. These people are paid by the facility and not by you. Many facilities participate, but some do not.
Summary
It can be a daunting task to place an older relative where they will thrive and have their needs met adequately. Reach out to professionals who work with older adults for recommendations of who can help and have a better idea of which setting is best.
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