With so many elderly care services, what’s best for you? By Leslie Mantrone
When an older adult is no longer able to manage independently, it is time to consider outside help. There are many choices, and each has advantages and drawbacks. Each involves giving up a measure of autonomy for a measure of care. At COHME, we offer the following information as a guide to older people and their families as they make this difficult decision.
Home care with home health aides allow individuals to age in place, meaning it provides people the opportunity to remain in their home. Research has found that remaining at home is the preferred option of most older adults because it allows people to maintain their routines in a familiar setting and provides the individual with a maximum of choices. Home care allows the individual to determine the hours that home care will occur and gives older adults the power to follow a daily schedule of activity that works for them.
Works best for: Individuals who are highly functioning but need specific types of assistance to keep them independent and active, such as assistance with bathing or monitoring while walking. These individuals are fully capable of overseeing all aspects of their care. For people with more needs and who are less able to direct their care, remaining at home can be a viable option as long as they have relatives or friends who can assist with managing care for the older adult.
Not a good choice for: People with advanced dementia, especially those who live alone without the assistance friends or family.
How it is paid: Out-of-pocket; some private long-term care insurance policies, Medicaid for those who qualify for financial assistance.
A special consideration: For older adults who have experienced trauma, including survivors of the Holocaust or others who experienced displacement as a result of war, remaining at home can be extremely important to maintaining wellbeing. These individuals tend not to function well in institutional settings that limit their individual freedom and choices.
Think of Assisted Living like moving into a hotel and having access to room service. There are many variations of assisted living arrangements, but when one moves to an assisted living facility, it becomes their primary residence. Typically, rooms include a kitchenette, living space and a bedroom. Most facilities require that residents eat one or two meals in a dining room with the other residents and permit individuals to have a limited number of food options.
These facilities often provide a broad array of group-based recreational activities, both on and off site, with the goal of keeping residents active and engaged. Assisted living facilities have 24/7 staff onsite who perform such tasks as housekeeping, laundry and recreational planning. For individuals who require additional assistance, they can pay extra for assistance from a personal aide.
Works best for: Highly independent older adults who are looking to downsize and simplify their living arrangements as well as individuals who thrive on interaction with different people.
Not a good choice for: Individuals who cannot function independently unless they have a private aide. Not a good choice for people with moderate to advanced dementia who cannot make their own decisions or who have cognitive impairments that affect decision-making
How it is paid: Out-of-pocket; some private long-term care insurance policies
A special consideration: Assisted living is not always a good choice for introverts who value their privacy. Some facilities include floors for people with cognitive disabilities (often called” memory care units “) to allow individuals to remain at the facility as their health declines.
Nursing Homes are viewed by many as a “place of last resort.” That’s because most nursing homes offer little in terms of personalizing the experience for residents. Nursing homes historically experience staff shortages, as well, which means there are often very limited opportunities for assistance on an as-needed basis. (Some Not-for-Profit facilities offer a higher level of residential care to older adults who are able to self-pay for a number of years.)
Works best for: Individuals with advanced dementia who have behavioral or physical needs that are difficult to manage in a home setting; Individuals who cannot direct their own care and who have no friends or family who can help; Older adults with significant medical conditions that require regular skilled nursing.
Not a good choice for: Older adults who have medical conditions that are easily controlled and who have other options.
How it is paid: Medicare can pay for some nursing home care, but only a time-limited amount. Most people pay for care using a combination of financial resources, including savings and selling assets, such as a private home. Medicaid pays for nursing home care for people with limited or no resources (and for people who have run through their financial resources paying for nursing home care).
A special consideration: Nursing home residents benefit from strong self-advocacy skills or from having friends and relatives who can advocate on their behalf.
Circumstances change and plans often have to be rethought. If this is the case, reach out for the advice and support you need – from a social worker or case manager at your service agency or an outside counsellor.