Friday, September 28, 2018

Levels and Choices in Elder Care

I think many people have a dream of living a long fulfilling life and then going to bed in their own home one night and just never waking up again.  Unfortunately, not many of us go that way.  Most people undergo a period of declining health, mobility, cognition and independence before death.  For some it is a relatively quick process caused by their final illness.  For others it can mean years of being cared for by others.

As we plan our race to retirement we need to consider the types of care available to the elderly as function decreases; how much those options cost; and how we can arrange our lives so that, if desired, we can maintain independence as long as possible.  Let's take a look at some of the options, as well as how to finance them.

Family Care

Traditionally spouses have cared for each other, and yes, this often means that women spent months or years caring for an ailing husband.  Other family care can range from the grandchild cutting your grass to moving in with a child or grandchild (or having them move in with you) and them providing care ranging from periodic company to full custodial care. This care can be the least monetarily expensive but the most costly in terms of time for the able-bodied.  

Family care can actually accomplish quite a bit for a little effort, particularly if family lives nearby.  While you can always hire a lawn service to cut the grass, the grandchild will often come inside afterwards for a cool drink, sweet treat and conversation with the grandparents.  A son or daughter who expects text messages or emails several times a day is a safeguard against having to lie unattended on the ground for too long.  Family can run errands, clean house, or help with activities of daily living, depending on the needs of the person.  Leveraged with technology such as panic buttons, video monitors, and cell phones, family members can discreetly keep an eye on the elderly while allowing them independence and privacy.

In-Home Care

As with family care, in-home care can accomplish a lot toward allowing you to remain in your home and reasonably independent for relatively little money.  You can hire a home health worker/sitter to spend a few hours with you on a regular basis.  This person can do light housekeeping, transport you to the doctor, the store, or to social events.   He or she can spend the night at your house and be tasked with helping you to the toilet in the middle of the night, or being available via a monitor for any other needs.   As your needs increase, the number of hours can be increased, though when they get to certain point, the cost becomes more than a nursing home. 

If you are medically unable to leave the house without a lot of trouble, Medicare will pay for some home health services.  Nurses or  therapists can visit you in your home rather than you going to them. However, Medicare does not pay for all-day custodial care at home, nor does Medicaid. 

Adult Daycare

Just like daycre for kids, adult daycare exists to provide a place for the dependent to spend the day so that adult family members can work outside the home.  It also provides a place to be and some supervision for those who either have family to help a few hours a day or who are able to live independently but who need to be around other people.  

Senior Housing

As they approach retirement age, some seniors question whether it is in their best interest to keep the home in which they raised their family.  A two-story home with the master bedroom on the second floor is less attractive at 70 than at 30 and when only two people are in the house, 2000 square feet can seem like overkill.  Once older people start to consider moving, the question of "where?" comes into play.  One popular answer is independent senior living communities.  

Independent senior living communities can be either rentals or condominiums, and the level of services can range from a few social events to housekeeping, meals and more.  These communities provide the security of being around other people who are paid to keep an eye out for  you, and can prevent the social isolation that often comes when your ability to drive fades or as your friends pass away or move away.  

Assisted Living

When your health gets to the point that you can no longer be completely independent, Assisted Living may be the answer.  People in assisted living often still have independent apartments but the facility provides help with dressing, medications, transportation, meals, and more.  There may be more than one service level, and patients are given the level of help they need at that time.  

It is not uncommon for a facility to provide independent living, assisted living and full nursing home care all under the same roof.  Sometimes patients move from one part of the facility to another; sometimes the only thing that changes is the level of care.

Skilled Nursing Facility or Rehabilitation Hospital

The older you get, the longer it takes you to bounce back from things.  What seems like a relatively minor procedure--something that might have caused you to miss a day or two of work when you were younger--can end up keeping you in bed for a week.  Unfortunately, that's not the end of it because after laying in bed for a week you can barely stand up without help, much less walk across the room. 

Following a hospitalization that is at least three days long, you are eligible for Medicare benefits for up to 100 days of care in a skilled nursing facility or rehabilitation hospital.  Sometimes these facilities are located in the same building as a "nursing home".  The difference between these facilities and nursing homes is that skilled nursing facilities and rehabilitation hospitals are trying to make the patients well--to send them home, whereas nursing homes exist to provide custodial care to those who are unable to care for themselves. 

Nursing Home

As stated above, nursing homes exist to take care of those who are unable to take care of themselves due to age, infirmity and/or illness.  If you have long-term care insurance it will pay a certain amount toward the bill.  Otherwise, you must exhaust your assets before Medicaid will pick up the bill.  Nursing homes do it all for their patients.  They provide food, shelter, medical care as well as personal care and supervision.

Taking a look at local options for all levels of care can help you or your loved ones make good choices when and if the need for such care arises.  

*Part of Financially Savvy Saturdays on brokeGIRLrich.*


  1. Back when my mother could no longer live on her own, she came to live with me for a year or so. Then when that was no longer viable, we moved her into assisted living which worked out quite well until she passed. You don't always know ahead of time what kind of care you may need, but it's good to be familiar with the options.

  2. My children (35 &33) are looking at elder pods. Both of us (61&68) are fine with "living in the backyard". The major obstacle is their ability to move. Knowing that both of our relatives have lived well into their 80's and now 90's- that is a long commitment. I don't expect us to need anything in particular for the next fifteen years. That will get both of their families into their "first" retirements.
    Robots may be the key to the future of being more independent longer. I look forward to the invention of comfort robots. I think they are on the edge- and will be available (like self driving cars) in the next ten years. I hope to make it to heaven before I need turning in my bed....