When Home is No Longer an Option: Part I

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No family wants to permanently move a parent or spouse out their home. However, for families caring for someone with dementia, there often comes a time when it is no longer possible to give the needed care at home. Caregivers become exhausted, unsupervised vulnerable people get injured.  Be aware of increasing needs and signs of caregiver burn out. It is good to know the alternatives before a full-blown crisis develops.

How to Identify Your Options

Understanding the Differences Between Assisted Living and Nursing Homes
Typically, the choice for someone who can no longer live at home is between an assisted living residence or a nursing home. Even though people use these terms interchangeably, they are not the same.  They offer different types of care, have different costs and payment structures, and are not regulated in the same ways.

Assisted living residences are housing options with added support services. They are regulated solely by the state in which they are located, and requirements vary from state to state. Assisted living generally offers 3 meals a day, transportation, social activities and some assistance in a home like environment. Not all assisted living residences have nurses on staff.

In recent years, some states have created a new category of assisted living, called special care units, or SCUs.  These units are designed specifically for people with dementia, offer a fuller array of support services, and usually will be a preferred choice for a family member with memory problems.

Nursing homes, also known as skilled nursing facilities, are health care facilities, licensed by the state and regulated by the federal government.  They have nursing staffs, and they provide skilled nursing care as well as support services.  The environment is generally similar to a hospital, not a home.  Many nursing homes also have dedicated units for those with dementia.

Step 1: What Are Your Needs

The first question is to determine if you are looking for an assisted living residence or a nursing home.  Most families prefer assisted living since its environment is less institutional and it costs less.  Typically, those seeking placement for someone with dementia will need the following services:

  • Assistance with the activities of daily life (ADLs), such as bathing, dressing, eating, walking
  • 24 hour awake staffing, offering supervision and direction
  • Medication management by trained staff
  • Activity program designed for those with dementia
  • Incontinence care
  • Proximity to an involved family member who visits regularly

If you have significant other medical conditions, a nursing home may be the only option. Be honest about what your family’s needs are, and do your homework to make sure the residence you chose will be able to meet them.

Step #2: What Can You Afford?

The costs of both assisted living and nursing home care are privately paid. Traditional health insurance provides no coverage and Medicare provides very limited coverage, and only for nursing home care.  Long-term care insurance generally covers a portion of assisted living costs and nursing home charges, but policies differ widely in terms of extent of coverage and duration of benefits.

Assisted Living Costs.  Assisted living residences require the residents to enter into a lease and pay monthly rent. There is a base rent, and there are additional charges. Understand what is included in the base rent, and how the additional charges are calculated. For example, residences usually provide assistance with ADLs, but the amount of care covered in the base rate usually has a time limit.  Supplies, assistance with medications and laundry are often added charges, and can nearly double the monthly cost. Know what the residence will charge you based on your expected needs.

Ask for the history of fee increases for the past several years. Find out how often the residence can increase its fees.

Nursing Homes. Nursing homes charge a daily rate that covers basic nursing services.  It does not cover the cost of medications, physician visits, medical equipment, and supplies, including incontinence products.  Medicare provides very limited coverage for nursing home stays.  However, if you spend down all your assets, you can usually be qualified for coverage under Medicaid.

Step #3: What Are the Discharge Policies?

You may have heard this story: we found a wonderful assisted living residence for my mother, but as soon as her condition worsened, the residence said it could no longer care for her. This issue is for assisted living residences only; nursing homes rarely discharge anyone unless they need hospitalization.

Residences can limit the type or amount of care that will be provided, limit outside help, and/or require a transfer if the resident develops certain behaviors. Ask for the discharge policy as part of your initial screen.

Once you have identified the type of care you need, what you can afford, and which facilities will continue to care for residents as their conditions decline, you can hone in on the choices that best fit your family’s needs.

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