Over the next 10 years, an average of 10,000 baby boomers will turn 65 every day. By 2030, when all the members of this generation reach 65, fully 18% of the nation, some 75 million people, will be over 65.
In time, each and every one will need some form of long-term care when chronic illness or injury prevents them from carrying out basic Activities of Daily Living (ADLs) such as bathing, dressing or eating. Ultimately, they will most probably require the care of Palliative Care or Hospice to ease their transition from this world.
The question for those seniors and their family members will be where and how? Depending on one’s health, prevailing medical conditions and financial resources, there are a number of caring options available.
- Home Care & Home Health Care
Easily reckoned as “the foundation of long term care” is care provided in one’s own home by their own family—effectively allowing them to “age in place.” The preferred choice of most Americans, it is estimated that more than 65 million people, some 29% of the population, provide an average of 20 hours per week of care for a chronically ill, disabled or aged family member in any given year.
While long–term care insurance may pay for some of this care, 78% of adults in need of long-term care rely on the generosity of family and friends as their only means of assistance. This assistance accounts for an estimated $375 billion a year in “free” care—twice the amount actually spent on paid professional home care and nursing home services combined!
Should a senior’s financial station in life allow, professional caregivers can also be hired to come into the home. This can take the form of home care or home health. While the terms sound similar, they are distinctly different.
Non-Medical Home Care (also referred to as personal care, companion care or homemaker services, among other names) is much the same as a family member or other loved one coming into the home. It generally would be paid for out-of-pocket (although long-term care insurance, the VA or Medicaid may help pay for it) at an average cost of $131 a day—though the caregiver could be arranged on an hourly basis with certain daily minimums, as well). A home care aide can assist with companionship or with the activities of daily living that may include:
- Meal preparation
- House cleaning
- Help dressing, bathing or grooming
- Medication reminders
Home care can be wonderful as it allows the person receiving care to remain in their own home amid familiar surroundings. Depending upon the rates and the number of hours you’re looking at, however, you may find it’s actually less expensive to look into adult day care or make a move to an assisted living community.
According to the Genworth annual cost of care survey, home care averages $131 a month. However, adult day care, where available, averages $70 a day. And placement in an assisted living facility averages $123 a day for 24/7 care.
Home Health Care, on the other hand, is clinical medical care provided in one’s own home by a registered nurse, physical therapist, occupational therapist or other skilled medical professionals. Often prescribed as part of a care plan following hospitalization, Home Health may be paid for by Medicare, Medicaid or other private insurance. Here, the services provided by Home Health Care may include:
- Therapy and skilled nursing services
- Medication administration, including injections
- Medical tests
- Wound care
- Independent Living Communities
Perhaps the first step in the move from home is an Independent Living Community. This type of community offers support to seniors who are still very independent or, in some instances, a spouse who is still independent that is providing care for their husband or wife.
Generally chosen when the care of a home becomes unwanted or unmanageable, these communities generally offer studios, one-bedroom, and two-bedroom apartments or cottage homes with a wide range of services and amenities—from fine dining and golf to theaters and outings.
While most Independent Living Communities are paid for out-of-pocket at rates ranging from $1,500 to $3,500 a month, you may see them also referred to as:
- Retirement Communities
- Congregate Care
- Retirement Villages
- 55+ Communities
- Senior Apartments
- Continuing Care Retirement Communities
- Assisted Living Communities
Generally considered to be the next step in the progression of long-term care, Assisted Living Communities are state and federally licensed facilities. They would be best seniors who are no longer able to live on their own independently in their own home or apartment, require assistance with their Activities of Daily Living and do not yet require the higher level of care found in Memory Care or a Skilled Nursing Facility.
Within an Assisted Living community, a senior would benefit from such things as assistance with medication, three meals a day, planned activities and licensed staff available 24 hours a day. Depending upon the structure of the facility, it may also offer Memory Care (see below) for individuals with Alzheimer’s or other forms of dementia.
Here, unless they have long-term care insurance, a senior could expect to pay $2,500-$4,000 out-of-pocket per month, depending upon the size of apartment and level of care required. They can be referred to as:
- Assisted Living Communities
- Personal Care Homes
- Memory Care Communities
Much the same as Assisted Living Communities, Memory Care Communities are licensed facilities that offer medication management, meals and a licensed staff 24 hours a day. The important difference here, however, is that the senior has been diagnosed with Alzheimer’s or another form of dementia, possibly hindering their ability to even understand their own Activities of Daily Living, let alone be able to perform them on their own.
As a result, the caregivers within Memory Care Communities are specially trained to deal with dementia patients. The facilities will be secure to ensure that patients do not wander off. And the activities or programming will be specially designed to accommodate short-term memory loss.
Without long-term care insurance, you would be looking at a cost of $3,000 to $7,000 per month, depending upon the size of the apartment, whether it is private or semi-private, the needs of the senior and their geographical location. You may see a community referred to as:
- Memory Care
- Dementia Care
- Alzheimer’s Care
- Skilled Nursing Care
Designed for seniors who require specific skilled care unavailable at home or in an Assisted Living/Memory Care Community, a Skilled Nursing Facility (or SNF) is also a state and federally licensed facility offering 24-hr care. SNFs are commonly used for short-term rehabilitation stays following discharge from a hospital. The ability to extend a stay into longer-term care must be medically necessary and is largely dependent upon state and federal regulations.
Examples of services provided in a SNF might include:
- Wound care
- Intravenous (IV) therapy
- Physical Therapy (PT)
- Occupational Therapy (OT)
- Monitoring of vital signs
- Medical equipment use and monitoring
While Medicare/Medicaid and Long-Term-Care Insurance may often pay the bulk of the cost of a stay at a SNF, a semi-private room in a SNF can currently average some $7,148 a month, while a private-room average around $8,121.
- Continuing Care Retirement Communities
For those that can afford it and make the decision to move before major health concerns catch up with them, a Continuing Care Retirement Community (CCRC) is pretty much the gold standard when it comes to retirement living.
Encompassing the best of Independent Living, Assisted Living, Skilled Nursing and often Memory Care all on one campus, a CCRC allows seniors to “age in place” as they seamlessly transition from one level of care to the next—lessening the stress and worry for both the resident and their loved ones.
Often indistinguishable from an upscale suburb, you might find landscaped grounds, cottage homes, townhomes, apartments, swimming pools, fine dining and a wealth of social outings and activities. The benefits of a CCRC are not without their cost, however.
Generally financially unavailable to lower or even middle-income seniors, those with serious prevailing medical conditions or already at an advanced age, most of these communities require an entrance fee ranging from $100,000 to $1,000,000 (which may or may not be refundable upon death). Residents must then also pay a Monthly Maintenance Fee that can vary from $3000 to more than $5000 a month.
In some communities, this Monthly Maintenance Fee may be guaranteed to remain constant throughout a stay, possibly saving tens or hundreds of thousands of dollars should a long-term stay in memory care or skilled nursing be required. However, contracts vary widely from community to community and it would be well-advised to have family members, an attorney and/or financial advisor to review any contracts and understand all potential costs thoroughly before signing.
There are three basic types of contracts offered by CCRCs include:
- Life Care of Extended Contract. The most expensive option, this plan offers unlimited assisted living and skilled nursing care without additional charges.
- Modified Contract. This contract offers a selected set of services for a set length of time. After this occurs, additional services can be obtained for a higher monthly fee.
- Fee-For-Service Contract. With this contract, the initial entrance deposit may be lower, but Assisted Living and Skilled Nursing will be paid for at current market rates.
- Palliative Care/Hospice
The final level of care for those facing life-ending illness or injury, Palliative Care or Hospice seeks not to cure or heal a condition. Instead, a dedicated team works together to provide pain relief, while ensuring that the patient is as mobile, self-sufficient and as comfortable as possible during their finals days, weeks or months. This service can occur in one’s own home, at any of the care facilities listed above or at a free-standing hospice facility.
This team can include:
- The patient’s personal physician
- A hospice physician
- Social workers
- Clergy or other counselors
- Specialists in art or music therapy
- Trained volunteers
The services the hospice team may provide include:
- Managing the patient’s pain and symptoms
- Assisted the patient with the emotional, spiritual and psychosocial aspects of dying
- Provide needed palliative drugs, medical supplies, and equipment
- Coach the family members on how to care for the patient
- Make short-term inpatient care available when pain or symptoms become too difficult to manage
- Provide bereavement care and counseling to surviving family and friends
Hospice services are generally covered under Medicare, Medicaid, most private insurance plans, HMOs and other managed care operations. At the center of everything they do, however, is the underlying belief that each of us has the right to die pain-free and with dignity. And that the patient’s family receives the necessary support to allow it to occur.
In time, America’s aging seniors will all require care of some form. The paramount question for them and their families will be where and how? If you know the options in advance of your journey down the gray mile, however, you’ll be much better prepared. And you’ll know where to stop along the way to get the help you need.