In late 2014, Lisa Hawes’ mom, Elizabeth Hartford, went into a rehabilitative center in Eugene, Oregon, after suffering two strokes. Medicare covered part of her bill for two months of treatment at the facility, Hawes says. When doctors determined Hartford, then 91, was finished with her treatment, they told the family that Hartford would be responsible for the full bill of $8,000 a month if she remained in the long-term care wing of the rehab center. Hawes and her brother started looking for a “more reasonably priced option,” she says.
Fortunately, a county official who worked as a patient advocate provided the pair with a link to a directory of home facilities providing an array of care, depending on the condition of the resident. Hawes and her brother checked out a couple of assisted living facilities. Based on the evaluation of clinicians at the rehab center, Hartford needed a high level of care, with around-the-clock attention.
“We found a wonderful, licensed, family-run ‘adult foster home’ with a maximum of four female residents,” Hawes says. “It is a family home in a residential neighborhood that is outfitted to accommodate the elderly, run by a live-in husband-and-wife team, with their daughter as one of the additional caregivers. The residents eat their meals together at the dining table in the kitchen and sit together in the living room to watch TV, arguing over ‘Law & Order’ reruns vs. Hallmark Channel romances. The caregivers are qualified to give medications and will take residents to medical appointments or run other errands as needed.”
Finding the right kind of nursing care option for yourself or a family member can be an emotionally fraught challenge, since such transitions typically deal with the realities of losing a measure of independence. For many people, the situation is complicated by a limited budget, and the reality is that the annual median cost for a semiprivate room in a nursing home is about $85,000, says Rani E. Snyder, program director at The John. A. Hartford Foundation. The foundation disburses grants to groups that work in the areas of family caregiving, age-friendly health systems and those that provide help for people facing serious illness and end-of-life issues.
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It’s important to keep in mind that “people overwhelmingly prefer to age in place [at home],” Snyder says. Ideally, people should avoid moving to a nursing home, which provides care based on a medical model, for as long as possible. “Nobody should go to a nursing home prematurely or unnecessarily,” adds Robin Marks, Long Island regional director of Amber Court Assisted Living, which operates five assisted living facilities in New York and New Jersey.
Nonetheless, it’s crucial to consider that the older you are, the more likely you are to need long-term care. Many older people cope with chronic health conditions, such as diabetes, Alzheimer’s, arthritis, kidney disease, cancer, depression and high blood pressure, that make it increasingly difficult to live independently. Overall, 70 percent of people turning 65 can expect to use some type of long-term care, according to the U.S. Department of Health and Human Services.
To find the most affordable and suitable nursing care that suits your budget, experts recommend exploring these options:
1. Informal caregivers. Some older people may need assistance with their daily lives but don’t require around-the-clock, professional care, Snyder says. These folks can consider building a network of trusted relatives and friends to act as caregivers by providing assistance with grocery shopping, preparing meals and arranging for transportation to medical appointments, she says. Such caregivers can include spouses, adult children, nieces, nephews, grandchildren and close friends. “Some people may need assistance managing medications,” Snyder says. “There are devices a family member can use to help — special pill boxes that organize medications and remind people when to take their pills, for example.” Such boxes are available for a few dollars at retailers like CVS and online through Amazon.
Informal caregivers can seek help from the National Family Caregiver Support Program, which provides grants to states and territories to help family and informal caregivers. States use these grants to provide an array of services, including individual counseling, caregiver training and assistance in gaining access to services. In the U.S., about 44 million informal caregivers help someone who is aged, disabled or ill, according to the Family Caregiver Alliance.
2. Paid caregivers. For people who require more help than an informal caregiver can provide but who still want to live in their own home, personal care aides can be an affordable option, Snyder says. Caregivers come to the client’s home on a schedule, such as two or three days a week, and help with such tasks as bathing, dressing and using the bathroom. A certified nursing assistant — also known as a home health aide — is also trained to provide such care as changing dressings, providing medication and helping a client with walking aides, Snyder says. On average, it costs $18 an hour to hire a personal care aide and $19 an hour for a certified nursing assistant, according to care.com. Hourly rates for both a personal care aide and a certified nursing assistant vary depending on location.
3. Adult day care. Adult day care centers operate much like child day care facilities do. They look after the needs of the adult during the day in a secure environment. These facilities are for people who require enough assistance that it’s not to their benefit to be home alone day after day, Snyder says. “It’s essentially for people who need a caregiver, but the caregiver has to go to work or needs a break from caregiving responsibilities,” she says. These centers provide family caregivers the opportunity to go to work or attend to other tasks. There are more than 4,000 adult day care centers in the U.S., according to the National Caregivers Library.
These facilities can provide an array of services, such as health monitoring and occupational and speech therapy. Activities such as games, arts and crafts and exercise classes are also offered by some adult day care centers. In 2016, the average care of adult day care in the U.S. was $70 a day, according to payingforseniorcare.com. The daily costs vary from state to state, from a high of $100 in Alaska to $20 in Alabama. Medicare does not pay for adult day care, but Medicaid, the national health insurance program for low-income people, does, particularly if the individual would otherwise need full-time nursing home care.
4. Adult foster care. Hawes found a good adult foster care home for her elderly mother. Adult foster care — sometimes also referred to as adult family care, elderly foster care and small group assisted living — typically involves a home-like facility with a small number of residents and paid staff members who help residents with daily personal care, dispensation of medications, transportation and meal preparation. These facilities are different from other live-in care options, such as nursing homes and assisted living communities, in that they are much smaller, housing typically just a few residents. The maximum number varies, but most states limit the number of residents for these facilities to five, according to payingforseniorcare.com.
In contrast, many nursing homes and assisted living facilities are much larger, providing care for dozens or hundreds of people at a time. Adult foster care is also much less expensive than nursing homes or assisted living. Typically, adult foster care prices range between $1,500 and $3,500 a month, according to payingforseniorcare.com. Medicare does not cover adult foster care, but Medicaid does provide assistance for the care portion of the monthly fee, according to the website. The quality of adult foster care varies widely, says Howard Gleckman, a senior fellow at the Urban Institute who researches aging policy issues and is the author of the book “Caring for Our Parents.” To gauge how well an adult foster care facility is run, he advises visiting it to see how residents and staff members interact, talking to current residents and their families and asking for references from relatives of people who have previously lived there. Find out how long the owner has been running the facility and observe how he or she interacts with residents, he says.
5. Faith-based and community resources. Some churches, temples, mosques and other places of worship have volunteer groups that help older people, Gleckman says. Some faith-based volunteer groups will help older people with transportation to medical appointments or to the grocery store, for example, he says. Throughout the country, community villages — typically groups of neighbors that band together to help each other — can also provide assistance, Gleckman advises. For example, in the District of Columbia, Capitol Hill Village provides volunteers to members to run errands, prepare meals, do light home maintenance and simple repairs, provide pet care and wait for a home repairman or a delivery. The group also offers a “Rise and Shine” program for members who live alone and wish to receive a daily phone call to see how they’re doing. Calls are scheduled, and if a call isn’t answered, volunteers will make follow-up phone calls. Eventually, a volunteer could visit the person’s home to see if any additional help is needed.
“CHV also puts on about 75 educational programs annually, covering topics including health and wellness, proactive aging, technology and current affairs,” says Molly Singer, executive director of the organization. Many of these programs are free and open to the public. “We really are about keeping everyone healthy and smart,” she says. The yearly fees for a membership at CHV are $925 for households, $625 for individuals and $125 for people with lower incomes. Urgent memberships, for people with serious medical needs, are $900 for individuals and $1,350 for households. CHV has two social workers on staff who help older adults determine what services they need and help them live independently and safely in their homes. CHV also has a wide array of social groups for members, such as book and movie clubs and wellness groups that engage in yoga and meditation.
6. Veteran’s benefits. Veterans and their survivors who are eligible for a Veteran’s Administration pension and are housebound or need the aid and attendance of another person may be eligible for additional monetary benefits under the Aid & Attendance and Housebound programs. For veterans who are eligible, the program boosts the monthly VA pension. Under Aid & Attendance, veterans may obtain increased pension benefits if they require the aid of someone to perform personal daily functions, like bathing, feeding, dressing, going to the bathroom and adjusting prosthetic devices; if they are bedridden or have a disability that requires them to stay in bed, aside from any prescribed convalescence or medical treatment; if they are in a nursing home because of mental or physical incapacitation; or if their eyesight is bad.
Monthly benefits for this program can reach $2,127 for a month for a veteran and spouse or $1,794 for a veteran and $1,158 for a surviving spouse, according to VeteranAid.org. The Housebound program can boost the monthly pension for veterans who are substantially confined to their immediate premises because of permanent disability. Many veterans are unaware of the benefits available to them, says Craig Maurer, owner of SYNERGY HomeCare of Broadview Heights, Ohio, in the greater Cleveland area. SYNERGY HomeCare provides an array of services, such as caregiving and transportation, to seniors. “It always amazes me how many veterans and their families do not know about the benefits available to them,” he says. “I speak to multiple people each week who could benefit from some sort of assistance from the VA. They are shocked when I tell them they could possibly qualify for a variety of benefits.” Veterans can learn what benefits are available to them by calling a VA hospital and talking to a veterans service officer, Maurer says. Checking with a veterans service organization, such as www.americanveteransaid.com, can also be useful, he says.
7. Consult with an elder law attorney. Attorneys who specialize in elder law can help you plan to find senior care options, protect your assets and navigate complex Medicaid and Veteran’s Administration rules. For example, Heidi Friedman, an elder law attorney in Fort Lauderdale, Florida, recently helped a woman suffering from Alzheimer’s and her husband. The husband was paying about $9,000 a month for his wife to live in a shared room in a nursing home, Friedman says.
The husband hired Friedman, who, with proper planning, helped the wife qualify for Medicaid, which paid for the cost of the same shared room in the nursing home minus the wife’s monthly income, leaving her a $105 personal monthly allowance to keep. This reduced the couple’s nursing home cost to less than $1,000 a month, she says. Some elder law attorneys, such as Friedman, don’t charge for an initial consultation. Hiring an attorney for the kind of work she did for the couple typically costs between $8,000 and $15,000, which can look like a substantial amount of money but could pay off with significant savings in the long run, she says.
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What Care Options Are Available for Aging People on a Budget? originally appeared on usnews.com