"Where thou art, that is home." - Emily Dickinson
There may come a time when parents or older family members need to leave their homes. Some "downsize" willingly, recognizing that yard work, climbing stairs and cleaning are becoming more difficult and less enjoyable. Others live in denial of the hazards, and a crisis will make the decision for them.
However, from in-home care to nursing homes or hospice, there are choices and options all along the way to keep the elderly independent as long as possible. This article will discuss independent living and assisted living, and the next in the series will look at senior living communities, in-home care and hospice.
Sommer and Evelyn Truax, of St. Clairsville, have dinner together at Park Health. They have been married for 65 years and were at the facility recuperating from illness and are considering assisted living as a permanent home.
Janalene Kindelberger, left, has been a resident at Park Health since 2012. Her daughter, Debbie Ritter of Belmont, right, is able to visit her often.
Johnny Taylor, left, has been recovering from an accident at Cumberland Pointe for 14 months. His wife Diana, right, brings granddaughter Mikenzie to visit.
According to Morningstar.com, seniors over 65 years of age have a 68 percent chance of losing cognitive skills or will be unable to perform at least two "activities of daily living" (ADLs) such as bathing, dressing and eating as they age. Forty percent of Americans over 65 will enter a long-term care facility; 10 percent of them will stay more than five years. The median annual rate for nursing home care in the United States was $73,000 in 2013, up 3.63 percent from 2011.
In 2012, 9 million Americans over 65 needed long-term care. As baby-boomers age, that number is expected to top 12 million by 2020. By the year 2050, approximately 81 million Americans will be above age 65.
Independent living options are often located on the same campus as a long-term facility. They are designed for seniors who are still able to get out and about, cook and take care of themselves, but they offer a "cushion" or some measure of security in case something happens. Often these are like small, freestanding one- or two-bedroom apartments with a garage. They could also be side-by-side duplex units; they probably have a small yard.
Rent for these could be costly, and there is probably a waiting list, but utilities, maintenance, yard services and a security connection to the main office are usually included. Tenants can opt for additional amenities (with extra charges) such as house cleaning service, assistance with medications or ordering meals at the main facility.
Probably the most difficult part of moving to an independent living environment is realizing that it is a better option than remaining in one's home. The advantages are many. Tenants can keep their belongings and their privacy, since the units are individual. They may need to give away, sell or store some things because of space restrictions, but keeping familiar possessions is comforting. Tenants can come and go as they please in their own cars.
Most units have access to 24 hour security and staff at the main facility via a "panic button" or phone. This should relieve some of the concerns about living alone and also relieve worries of adult children who may not live nearby.
Independent living tenants may have access to activities and programs at the main facility, also. They can attend worship services, concerts, fitness classes or arts and crafts classes for socialization or health.
Assisted living is the next step. These facilities may offer rooms similar to apartments but with on-site services such as meals, housekeeping, transportation and security. Seniors here may also be allowed to bring personal belongings and some furniture to their spaces. If looking at assisted living, compare services and activities among the locations. Extra items like housekeeping or transportation may incur additional charges to the basic monthly payment.
There is generally no skilled medical care involved, however, so this is a choice for healthy seniors who need help with dressing, bathing and managing medications. If a senior becomes ill or incapacitated, he or she will need to move to a nursing facility.
If someone is released from the hospital for physical therapy and continued care, he or she will probably be admitted to a skilled nursing facility. These entities provide 24 hour care in semi-private rooms. Seniors recuperating from hip injuries, strokes and surgeries receive convalescent care and any therapies necessary, for instance physical therapy in regaining the ability to walk or occupational therapy in holding eating utensils.
Once the patient has recovered sufficiently for release, staying at the nursing home may be the best option for the senior's safety. At this point, the therapy sessions stop, and the patient becomes a resident of the facility. Meals and basic needs are attended to, but medical care becomes minimal, and Medicare ceases to cover the stay. The resident and/or family can apply for Medicaid eligibility at this point.
Patients and residents are encouraged to make their spaces their own, so that they are as comfortable as possible. At, for instance, Park Health in St. Clairsville, a bed, a chest of drawers, a bedside table, a chair and a closet with drawers are provided, but residents can add a television, plants, favorite blankets or comforters and post photos and cards on an individual bulletin board.
"We are focused on patient-centered care by providing a selective menu and choices of when to go to bed, when to wake up and when they want personal care," said Kellie Conaway, LSW, of Park Health. "Park Health provides a variety of daily activities and entertainment even on evenings and weekends and takes into account residents' individualized needs and interests."
Regarding this writer's experience, there were two entrance interviews, one with admissions and one with department heads to go over her parents' habits, likes and dislikes, religious backgrounds, dietary preferences and interests in an effort to make their stays as comfortable as possible. Activities include concerts and sing-a-longs, a sock-hop, bingo, Bible study, exercise classes and resident meetings, as well as holiday dinners and picnics where family members are encouraged to attend.
In the U.S., 42 percent of nursing home patients have been diagnosed with a form of dementia. Some facilities, like Park Health, offer specialized services for Alzheimer's care. They have a secure, dedicated wing for Alzheimer's patients with its own television lounge and dining area. This wing uses visuals like family photographs and pictures of celebrities and places from past eras to trigger and foster fond memories for the patients.
Conaway encourages families to research facilities to find the best match for their loved ones, including scheduling tours.
"A facility tour not only allows families to observe the appearance and care provided at the facility, but it also serves as an opportunity to gather information on what services are available, the admission process, understanding the difference between long term care vs. short term skilled care, and what to expect once admitted," she noted.
Payment after the allotted skilled nursing days (medical treatment and therapies) will need to come out of the resident's assets, unless he or she is eligible for Medicaid. There is long-term health insurance, but it is complicated and can be expensive, at least $2,000 per year for an applicant in his 50s in reasonably good health. There must be full disclosure of health issues and history, and there is no guarantee of a claim being approved. Premiums may also increase with age. Research insurance plans thoroughly to weigh all of the options and expenses.
Helping and supporting elderly loved ones as they make these moves is important, even if they are moving willingly. They need to determine what features are priorities for them and find a place that makes them feel most comfortable. Let the senior make as many decisions as possible regarding handling of household possessions and selling points of the new residence. Their safety and happiness are the most important factors. There will still be feelings of loss or grief over the move, so adult children and friends should stay positive and visit as much as possible to help them settle in.