The choice to put a family member into long-term care or start planning for your own can be overwhelming. Oftentimes it is a last resort after a health emergency when a loved one can no longer care for themselves independently. But careful financial planning and honest conversation helps families make the best long-term health care decisions for their family later in life.
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Having the Conversation
The earlier you start having conversations about long-term care, the better. As difficult as they may be, these discussions help ensure that family members know your wishes in case of a healthcare emergency. “It’s never too soon to start talking and planning,” said Dorian Froelich, LCSW, director of social work and admissions at Gurwin Jewish Nursing & Rehabilitation in Commack. The more often the conversation is brought up with family, the less fear is attached to aging. Froelich recommends assigning a power of attorney and a health care proxy.
If there comes a day when you can’t make financial or health care decisions yourself, having people in place to do it for you before an emergency helps your loved ones avoid extra stress in the future.
Jumping in to making long-term care decisions might seem taxing, especially since we plan for retirement so we can enjoy it. “It’s easier not to talk about it, it’s harder to take a good deep breath and start that conversation,” Froelich said. But ultimately, it’s necessary to start early to ensure that your loved ones know and can carry out your wishes.
Long-term care can be expensive, but planning will help ease financial stress. Costs will rise over time depending on your location and the type of care you choose. The U.S. Department of Health & Human Services runs a website that provides information on how to finance long-term care, including a “Cost of Care” estimator that predicts cost on Long Island up to 30 years from now.
Medicaid is one resource that could potentially pay for some or all costs, if you meet the requirements. To make the application process easier, Froelich recommends you create a safe place to store important documents like your birth certificate, marriage license and financial statements. There is a five-year look back period when determining eligibility for Medicaid so it is smart to start saving paperwork sooner than later. County requirements and application processes may vary. Check Nassau or Suffolk County websites or contact an elder care attorney before proceeding.
Long-term care insurance might be a smart investment as Medicaid coverage is income dependent and may not cover all costs. Purchasing a private policy guarantees that you are provided the quality and type of care you desire while keeping your assets protected. Policy costs vary depending on many factors, including your age at time of purchase. The Non-partnership insurance option has been available longer, but the New York State Partnership for Long-Term Care teamed up with Medicaid to offer some more affordable insurance options that keep some of your assets protected.
No matter what the choice, the key is to plan early. Qualifying for and researching these options is time-consuming, but it can go a long way in helping your family should a crisis arise.
Seeing the Signs
Many people turn to nursing care only after a health emergency exposes that they can no longer safely live alone. But there may be signs that action is necessary before a crisis occurs, and sometimes it’s up to friends and family to notice them first. Be sure that loved ones are safely performing activities of daily living like bathing, toileting, preparing food and feeding themselves, and remembering to take medications. Beware of signs of dementia, especially “sun-downing,” confusion or agitation that worsens in the late afternoon and evening after the sun goes down.
Try to monitor mobility. “Most patients, if they can’t transfer independently from a bed to a chair, need either 24-hour homecare or someone with them to help at all times,” said Dr. Suzanne Fields, Oberleder professor in Geriatric Medicine and chief of the Division of General Internal Medicine, Geriatrics and Hospital Medicine at Stony Brook University Hospital.
Choosing the Right Facility
There are many factors to consider when choosing a long-term care facility for yourself or a family member, most importantly serious medical needs. Not many nursing homes have the technology and personnel necessary to sustain a long-term ventilation or kidney dialysis unit. If a patient needs these treatments or other types of specialized care, choices can be limited.
Check facility ratings in the latest New York State Nursing Home Quality Initiative (NHQI) report, made available by the New York State Department of Health. Each nursing home in the state is required by law to make information about their rates of patient and bedsores and patient-to-nurse ratio. A low rate of falls and bedsores is ideal.
It is also best to pick a home that is easy for family members to commute to, not only for convenience but also for the well being of the patient. Frequent visits from loved ones keep elders in good spirits, according to Froelich.
Consider philosophy of care and religious affiliation when making a decision. Many nursing homes are associated with a particular religion and offer different kinds of services and holiday celebrations for residents. If religion is an important part of your life, choose a home that offers more frequent services.
“You have to kind of match what the patient needs with what the facility offers,” Fields said. Some facilities have more volunteers and can offer home-like services like spoon-feeding for more of what she called “tender loving care.” But sometimes patients have injuries and require more rehab-focused care. If a patient is near the end of life, they might benefit from a facility that offers palliative and hospice care.
Froelich recommends visiting facilities to find more than a comfortable setting. “You want to look at, when you’re walking through, how the staff react and respond to other residents.” Make sure you are treated kindly and residents look happy and well groomed.
In-home nursing care may also be an option, but make sure there are people available to step in and provide care if necessary. “Long-term homecare very often is an option, but it’s an option that the family has to be willing to take on the responsibility to be there if for some reason the aide doesn’t show up or something happens,” Fields said.
Adult daycare programs are available for elders who need care and supervision during the day but have a caretaker at night. Transportation is provided along with several hours of care and recreation, including help with activities of daily living. At night, participants are brought home to caretakers. This allows relatives peace of mind, knowing their loved ones are being cared for while they are at work.
If it is too early for you to consider long-term care, there are safety measures you can implement in your home to prevent emergencies. “Falls prevention is really key to preserving independence,” Fields said. She recommends tacking down rugs, taping down or removing lose wires and making sure the house is properly lit. Technology and adaptive equipment like shower chairs, life alert buttons and “smart” pill dispensers also help promote independent living.