(From The Long Term Care Solution by Jeffrey G. Marsocci.)

It’s times like this that I really understood why it’s important to have a support staff for Care Assistance Planning. While Jack (not his real name) was well organized, he knew he was in over his head and sought help. While Alyssa helped him organize some papers, Kathy brought him a glass of water and he was starting to look a little more at ease. Then he started in, talking faster than one of those disclaimers for a prescription drug you hear on the radio.

“Look, Jeff,” Jack said. “I know that my Mom’s going to need help, and it’s going to cost money. I just don’t know how much, and I need to make sure that her assets are going to last. I know there’s some shifting around we can do with her accounts, but there seems to be so much conflicting stuff out there. What should we do?”

“Slow down for a moment,” I said, holding my hand up and talking deliberately slower. “Before we go into any of that, how is your mom doing?”

Jack looked a little taken aback. “I… didn’t really expect you to ask that,” he said. “Other people I have spoken to didn’t seem to know what they were talking about, but all they wanted to talk about was her assets.”

I smiled. “It’s a good thing you came here then,” I replied. “Before we can do anything about your mom’s assets, we need to make sure we know what kind of care she needs. While I want to know what the medical professionals think, I first want to know how you think your mom is doing. Is she in good spirits?”

Care Assistance Planning has to be about more than assets, income, and medical reports. Unfortunately, many professionals push those aside and focus only on the money. That is one reason we have a geriatric care manager provide an evaluation and care plan for all of our Care Assistance Planning clients, and, to the extent our clients allow, we involve the family as well. After all, the decision on a parent’s long term personal care plan often involves the family as much as the parent.

The different options available relate often to what is referred to as the Activities of Daily Living as well as the Instrumental Activities of Daily Living. These are medical/health care evaluations more officially done by a medical professional when needed, but a quick evaluation by a geriatric care manager can help guide the big discussion of where is best for long term care needs. While each situation is different and there are many customized personal care plans, there are four main living options:

Option 1—Companion Care: Companion care is when someone comes in to the home to help you continue to live more or less independently but providing assistance only with those activities where help is needed. Companion care can run the gamut from preparing meals, house cleaning, shopping and errands, all the way to assistance with washing and dressing. Companion care can also range from full time to providing a supplement to help from the family. In a lot of cases, this is a first stage of care that may be replaced by a more structured living environment if illness progresses. In many other cases, it is only a temporary measure to assist someone who is convalescing until they regain strength and mobility.

Option 2—Move in with Family: While this is often a first reaction on the part of a family wanting to help as well as provide some cost savings, there are a lot of unanticipated difficulties. On the part of the person needing help, there are often strong emotional difficulties with having a lot of reliance on family members that they themselves used to take care of. Suddenly, the children that were dressed, fed, and bathed by a parent are now the ones doing the dressing, feeding and bathing, and that can be a tough thing for people to emotionally deal with. On the part of the children, there is often a huge disruption in their own lives and routines for work, school and activities for their kids, and other socializations that had been set for some time.
There is no doubt that this arrangement also has a lot of benefits, not the least of which is that the family is together during a time of difficulty and they can gain much emotional support from each other. And the cost savings compared to some of the other options is also a great benefit to the family. In some cases, moving in with the family has also been combined with the companion care option so that while family members are providing a lot of the needed care, there is someone else coming in to help with some of the activities that the parent would prefer to delegate to a non-family member, or, in some cases, cannot be done by a family member. In my own grandmother’s case, she had moved in with my aunt when it was better that she not live alone anymore, but it reached a point when neither my aunt nor either of her two young sons could lift her from bed to a chair or from a chair to a walker without great difficulty.

Option 3—Assisted Living: Assisted living arrangements can range from simply living independently in a more communal environment where prepared meals and dining facilities are available along with organized activities all the way to needing some help with everything short of skilled nursing care. In many cases, assisted living facilities provide the whole range of assistance as needed so there is no need for someone needing more help to move out of the assisted living facility until it is time for more skilled medical care and assistance than the facility can provide.
Assisted living is often less expensive than nursing care, but it is still more expensive than independent living and certainly more expensive than moving in with family. However, there is definitely more that can be done for veterans, spouses of veterans, and widows/widowers of veterans when it comes to assisted living care, but that will be an educational section all on its own.

Option 4—Nursing and Skilled Care: This is often called nursing home care, but the fact is that it really is more accurate to call it “skilled care” because it can be administered in a facility or at home. Many people needing this level of care would prefer to stay at home, and it can be more cost-effective to do so. (When it comes to Care Assistance Planning and having Medicaid or other programs help pay for some of the care, the government is equally willing to have the lower costs of in-home but skilled care since it is cheaper for the government.) In other cases, a facility that provides skilled care may be exactly what it needed, and so staying at home may not medically be the best option for you or the family.

In any event, this is the level of care that often frustrates families the most because, unless they are medical professionals, the care of their loved one is taken largely out of their hands. Again, dealing with the loss of control is difficult for the individual needing care as well as the family, and this is one of the reasons we enlist a geriatric care manager for all of our Care Assistance Planning cases.
While most people come to us to help with the financial aspects of Care Assistance Planning, we have to start with what kind of care is required and preferred by our clients in order to achieve the best possible outcome. After all, saving money is and should be secondary to getting comfortable, competent and appropriate care.