Though it is quite clear that the elderly would like to live at home for the rest of their lives, what if an older adult cannot live safely at home? There are numerous reasons including the following:

• Alzheimer’s or another form of dementia which is becoming too difficult on the family to provide care.
• Family dynamics including those living long distances from one another.
• There is no family to take care of the senior.
• High cost of outside caregivers when assistance is needed regularly.

Does this mean nursing home? Absolutely not. There are some great options which are like a home away from home.

With over 40,000 licensed assisted living locations in the United States and only 15,000 skilled nursing facilities, the movement is toward long-term living at various types of assisted living locations. These can range from smaller 5-person residential care homes to larger assisted living communities. Today, skilled nursing facilities are placing greater emphasis on short-term stays versus long-term stays. Short-term rehabilitation has become a necessity for skilled nursing facilities, bringing in additional revenue and higher margins.

Because of this shift in long-term care living, companies of all types and sizes are starting up to capture a segment of this growing population. One type of company is known as a placement or referral agency. This segment of our industry has the ability of providing tremendous value to families whose loved ones need a different place to live and be cared for. It is unfortunate that many of these services are treating families like commodities instead of human beings who are under a tremendous amount of stress. Following are various types of services and details of each:

1. Senior Placement Service – Many have an online presence where information can be learned about the senior, but these services generally have local
representation that are trained and experienced to assist with various aspects of the placement process. Commissions are paid to these services (similar to the real estate model), so families will not have to pay additional costs. These companies usually represent most of the locations (care facilities) in the area. Services may include assessing the needs of the family’s loved one, meeting “face to face” with the family, providing background information on locations including any state reports noting citations or deficiencies, touring with families, having familiarity with each location, helping negotiate the best rates and assisting with any medical information from physicians and other resources to help with a smooth transition. The key benefit of this service is having a non-biased professional who assists the family through a process that can be a daunting task filled with stress.

2. Senior Referral Service – As the name describes, a “referral” is when someone is directed to a source for help or information. These are mainly online companies that ask a few questions online and send information directly to the assisted living facilities for them to make contact directly with the family. The challenge is that the “referral” is sent to several locations that will contact the family representative by phone, adding additional stress to the situation. Some companies have a “telemarketer” contacting the family by phone but have not visited the locations nor are familiar with any citations that may have been issued by the state on the locations.

3. Lead Generators – These are online companies that perform similar functions as “referral” services, but instead of getting paid a commission from the
location, they are paid on a “per lead” basis. These types of companies are very common in other industries including insurance, real estate, etc. They are online lead generators and are not knowledgeable on senior care or assisting living. Finding the right type of care facility is not like finding a hotel room online just by asking a few questions. Below is a list of important points to take into consideration:

• Mix of residents – If the senior does not have dementia and are referred to locations where the residents are not alert can be uncomfortable for the loved one being placed. If the loved one being placed does have dementia, it is imperative that the caregivers are well trained in this area and have other residents at a similar stage.
• Visitation – Photos can be nice online, but being familiar with a location, the neighborhood, background, furnishings, cleanliness and know if the residents are happy.
• Family testimonials – It’s always good to know if there are families that have had a positive experience with their loved one at this location.
• Local contacts – In most cases families need additional assistance and may need advice from professionals like attorneys, move managers, dementia consultants, doctors and other specialists.

Helping to reduce family stress and not add to it during this decision making process is essential as the need continues to rise for advice on assisting living
options.

Q – How do costs compare in regards to in-home care versus assisted living and nursing homes?

A – According to the 2011 Genworth Cost of Care Survey, median annual costs for various types of senior care:

• In-Home Services (Assistance with Activities of Daily Living, including dressing, personal hygiene, bathing, etc.) – $57,086 annually (based on approx. 6 hours/day)
• Assisted Living Location – $49,500 annually (private/one-bedroom & 24 hour care)
• Nursing Homes – $97,455 (semi-private) and $121,363 (private) annually

Q – My father has had some falls at home and it is becoming too difficult for my mother to continue to take care of him. Her health is declining as well. He refuses to go to a “nursing home.” Are there other options?

A – There would be additional information I would need to know about your father, but there could potentially be several options for him. If both your parents wanted to continue to live together, there are “Assisted Living” options with various services and can range in size from five residents to hundreds of residents. These locations are licensed by each State and residents staying at these type of locations may need care with various activities of daily living (grooming, bathing, dressing, cooking, medication management, transfers, etc.). Nursing homes, on the other hand, are designed mainly for those needing a higher level of medical care and rehabilitation.

Q – Is Assisted Living different than Retirement Homes?

A – Though there are many similarities, there is a difference. “Retirement Homes” is a generic term usually referring to independent or senior communities whose residents are at least 55-60 years of age and are in good overall health. Assisted living, on the other hand, may have many of the same activities as a senior community, but these locations have caregivers on staff 24/7 to assist residents with various care needs. As described above, there are many options available in assisted living including a range from small, adult family homes to facilities with multiple levels of care.

Q – How do you decide which locations are best?

A – What is best for one person may not be best for someone else. However, it’s important to meet and talk with those that run the location, as well as caregivers and residents. Also, it’s imperative to review the reports to see if there have been any citations issued against the location, the severity of those citations and how they were remedied. The questions that need to be asked are too numerous for this article, but please call our office, and we would be happy to provide you guidance in all these areas.

Q – As I age and will need some sort of long-term care assistance, I do not want to burden my children with taking care of the two of us. What are the options to help pay for this type of care?

A – Aside from “private pay,” below is an overview of the options that are available for long-term care assistance:

Medicare/Medicaid
Most private health insurance plans follow the same general rules as Medicare. If any long-term care is covered, it is usually for only skilled, short-term and medically necessary care. Home care is limited only to medically necessary skilled care. Custodial or personal care is not covered by health insurance. The coverage in a Skilled Nursing Facility must follow a hospital stay and is limited up to 100 days.

For long-term care, you must meet Medicaid’s (name varies on state) financial eligibility which is jointly funded by the state and federal governments. Since Medicaid is managed by each state, eligibility varies from state to state. Even if eligible, in most long-term care cases, you may only select a Skilled Nursing Facility that accepts Medicaid.

Long Term Care Insurance
Long Term Care Insurance could be the best investment one can make. Unless medically necessary, you can avoid Skilled Nursing Facilities by residing at an Assisted Living location, Residential Care Home or at your own home with the needed In-Home care. This type of insurance makes it much easier to cope with most otherwise uncovered health issues as you get older.

Life Insurance
There are various ways you can use your life insurance to help pay for long term care, including Accelerated Death Benefits (ADB), Viatical Settlements and Life Settlements.

Veterans Aid and Attendance
The Aid and Attendance pension benefit offered by the Department of Veterans Affairs (VA) may be available to wartime veterans and surviving spouses who have in-home care or who live in Assisted Living Facilities or Nursing Homes. The current monthly benefits are as follows:

• Up to $1,704 per month for a single veteran
• Up to $2,020 per month for a married veteran
• Up to $1,094 per month for widowed surviving spouse

Though there are minimum qualifications, below I have outlined the prerequisites for review:
 Served in the military during time of war (or spouse).
 Have less than $80,000 in investments excluding home/car. Note: There are other options still to consider.
 Monthly income less than the monthly cost of care including prescriptions.
 Need help from others in one or more of Activities of Daily Living.
 If surviving spouse, married to the veteran at the time of death.
 Have sufficient resources to pay for care while awaiting a decision for the VA (may take 3-6 months).

The boomers are changing the course of retirement by not only working longer but living longer as well. This generation will also change the future of senior care.

In 2011, the boomers started turning 65 years of age and many are looking more closely at the type of care options offered as they age. They want their independence, not just from a physical standpoint, but also by having influence and control of the environment they reside. This group will demand the current models of Assisted Living and Nursing Homes to change…but how?

Assisted Living is for those who cannot live at home anymore and need help with basic activities of daily living (transfers, bathing, grooming, etc.) to more specialized areas including dementia care. Today, there are many options available in Assisted Living including a range from small, family residential homes to facilities with multiple levels of care.

Like the larger facilities or “communities,” the smaller homes are also licensed by each state. They are spread out geographically and may range from 4-12 residents. Some owners own multiple homes which may not be in the same neighborhood. The communities are usually one building that may have several floors and incorporate independent living, assisted living and dementia care.

With the exception of long-term care insurance and Veteran Administration benefits, assisted living is not covered by any medical insurance in most states. Knowing that, the boomer generation will want choices. This generation wanted choices in cars…they got it. They wanted choices in coffee…they got it. They will want choices in assisted living…they will get it.

My experience in dealing with many boomers some, feel that the smaller homes are great but not enough activities. On the other hand, they feel the larger facilities are very nice but may be too large or some appear too institutionalized. The future will bring:

1. A cluster of homes, even an entire sub-division, whereby seniors will have the option to attend activities in a community center, centrally located, just for the residents of the sub-division. At the same time, residents will live in the privacy of a smaller home.

2. Instead of larger, single structure buildings, there will be multiple single levels, smaller buildings grouped together. Each one will have varied levels of care including dementia care. Though meals and individualized activities will take place in each building separately, there will also be a centrally located community center for larger, group functions.

3. For these communities to be competitive, they’ll have to provide the most up-to-date technology including:

• A continuous update of medical records for physicians to access and make necessary changes to medications.

• Technology that will be incorporated to help prevent falls such as motion sensors that monitor balance. In addition, there will be walkers that can automatically steer away from obstacles which can also be reached by remote control.

• “Skype like” programs will be installed so residents can see and talk with children, grandchildren and friends. There will be enhancements for those with disabilities, including poor site and hearing, so they can still participate.

4. Geriatric physicians, podiatrists, dentists, optometrists will be readily available to visit with residents where they reside.

5. On-site exercise equipment and aquatic therapy will be commonplace at the larger communities.

6. These locations will have gated, secured communities in order to keep outsiders from coming in without permission.

What about Nursing Homes? Though nursing is dealing with rehabilitation and acute care, a new model called “The Green House Model” has already started. Their goal is described on their website, “The Green House model is a de-institutionalization effort designed to restore individuals to a home in the community by combining small homes with the full range of personal care and clinical services expected in high-quality nursing homes.”

The hope is these various models will be ready when the “Silver Tsunami” hits.

Well, it’s not the case, and your children are no longer the only parenting role you have. It now includes the care and decision making for your own parents. Role reversal for aging parents is difficult on all concerned. If you need a dose of growing up, elder care will make it happen whether you’re ready or not!

This is the day you thought would never happen. Your roles in life are reversing. You are trying to make decisions for yourself and your Aging Parent. What will be best for them without altering your life too drastically? How do you keep up the pace and ultimately please everyone around you? You are not alone in life; you have a family, significant other, and a career to think about. You want to balance everything, to keep everyone happy and for life as normal as possible. Think again! Those once a week visits or daily phone calls may not be enough anymore. Your parent needs care, the real kind.

The care includes making sure they eat, that they take their meds, that their money isn’t being floundered away on TV shopping. You have siblings that think Assisted Living or Nursing Facilities are awful and they don’t want to put Mom or Dad in one even though they also don’t want to help out. How do you cope? How do you deal with this situation without alienating every member of your family?

Please understand, it’s not about you. What I mean by that statement is that it’s not about guilt and what some think is the “right thing to do.” It is not about hanging on to someone that they used to be. They are an elderly person in need of constant care and attention. If you need a dose of growing up, this situation will make it happen whether you’re ready or not!

Start with their doctor. Have an appointment to discuss the health of your beloved parent. Between the doctor and senior care advisors, you may be able to determine the types of help and living style your parents current status requires. Keep asking until you have the best situation for all concerned.

It may not be as simple as a caregiver visiting a few times a week to help with showering, dressing, meals and meds. Their health may need more than that and the visiting nurse or doctor’s office is the place to apply the concern. The best word to learn to help an elder parent is the same as if your infant child were being cared for and that is SAFETY. If safety is not at the level necessary, keep pushing until you get the help you need. Keep on insisting the area of SAFETY.

It may take you time to uncover everything available to your parent to help with this care process but trust me, it will be worth it in the many years elder care can stretch out to be. It is best to discuss with them all their health and medical, financial and personal situations before that day arrives.

When they are older the best thing you can give them is you. Spend quality time instead of stress time. Have them over for a day and dinner instead of needing to pawn them off on someone else. The resentment builds if you do this alone and there are many really good options out there to take that burden off your shoulders.

Safety and honesty is what makes those later years a good memory!

Frank M. Samson is Founder of Senior Care Authority based in Sonoma and also hosts “The Aging Boomers” on KSVY 91.3 or can be listened to live at www.ksvy.com, every Monday at 2pm PT. The company provides free assistance to families in helping them find In-Home Care, Independent and Assisted Living for their loved ones. He can be reached at 707.939.8744 or
e-mailed at frank@seniorcareauthority.com. The company website is www.seniorcareauthority.com.