When I’m asked this question I always start out with, “Well, let me ask you…” The conversation about long-term care is unique to each family because each is has their own preparedness for and comprehension of financial, legal, medical and lifestyle issues. It’s also not a “one and done” kind of conversation, no matter how all the participants might wish it to be. As your parents age, their goals will evolve, just as they have through every other stage of their lives.
Keep in mind the purpose of the discussions will be to find the best way to meet your parents’ goals within the scope of their resources. Your job is to help them identify the options that will maximize their living, not to winnow your parents’ lives down into the easiest level for you to manage.
Start by framing the discussion as seeking to understand the big picture for your parents. Start with these questions for your parents to answer:
- What is most important to me now, i.e., things, abilities, activities, or values? How has this changed since I was in my 50’s? What caused the changes? How do I think it will change 10 years from now? Why?
- I do/do not want to stay in my current home because____________?
- If I can’t live safely alone, I want to live with_____________?
These questions are a good starting point because they address philosophy and lifestyle preferences. Financial and legal considerations can be addressed in another conversation.
Even if your parents don’t require any help at this point, it’s a good idea to explore possibilities. The following are living options for older adults who are completely independent up to needing moderate care.
Independent Living Facility
- Residential living option for people 55 years and older, who are mostly independent and do not require much hands-on care.
- Can be apartments or condos.
- May have a unit purchase price and monthly fee to cover communal meals and transportation services. Sometimes the monthly fees are incorporated into the monthly rent, so a 2-bedroom apartment can be $3,000 to $7,500, depending on community’s location in Lincoln or Omaha.
- If health worsens, facility will request a resident either move or bring in help since the facility is likely not able to provide care. Residents often choose to stay, with the support provided by their families or a professional Omaha home care agency.
Assisted Living Facility
- Residential living option for people who require assistance to live safely.
- Provides meals, housekeeping, assistance with daily living tasks*, occasional nursing visits and staff available 24/7.
- May have an initial purchase of residential unit and additional monthly fees. Monthly rentals range from $3,500 to $9000.
- A decline in health can cause a resident’s care needs to outstrip the facility’s capabilities to provide it. Residents/families are often asked to move resident or bring in supplemental professional caregivers, as happens in Independent Living.
Continuing Care Retirement Communities
- Residential living, which offers all levels of care, from independent to assisted living to skilled nursing care.
- Since care is provided in one location/building/campus setting, as care needs increase, residents usually move to a new room on property in order to receive appropriate levels of care.
- Typically requires an entry fee of $100,000 to 500,000, depending on style and location of community.
- Similar to independent and assisted living, many residents/families hire home care for more personalized help with activities of daily living as their health needs change.
Home Health Care
- Typically requires a doctor’s orders and is often for wound care, intravenous or nutrition therapy, injections, and physical/occupational/speech therapies when a person needs skilled nursing care 2-3 times a week, but not daily. This is medical care. (Few providers will take private patients.)
- Often ordered post-hospital stay, especially after surgery.
- Short-term care that’s provided in a person’s home, whether private residence or facility.
- Long and short-term care, provided wherever a person calls home.
- For people who need limited or extensive assistance with activities of daily living. (When medical care is needed, Home Care Assistance coordinates with providers for our clients, maintaining and updating plans of care, monitoring pain, and providing support with proper nutrition and medication protocols.)
- Allows a person to continue living in their chosen home as their care needs evolve.
- To distinguish this from Home Health for Medicare purposes, our Federal government calls this “non-medical” care.
- Some agencies, such as Home Care Assistance, provide memory support and personal care.
* cooking, light housekeeping, laundry, groceries and errands, transportation, bathing and grooming assistance, medication reminders, assistance with walking and transferring.
Embarking on the long-term care talk requires you to stretch yourself, no matter how empathetic and insightful you are, or how good your listening skills, you’ll need to perform at peak. Long-term care by definition implies your parent will someday be ill enough to require care for a good long while, and your parents may work very hard to avoid the conversation. Sometimes this discussion gets stopped flat by statements like my friend’s mother made: “I will never go to a nursing home. I take good care of myself, I have long-term care insurance, and when I get ready to, I’ll just die.” Clearly, this nearly 80-year-old lady has built a wall against this conversation. This calls for Plan B, which is for next time.