Navigating Health and Aging: Considering long-term care for you or your loved one

A study conducted by AARP reports that 90 percent of Americans wish to remain in their homes as they age. Most, if given the choice, would remain in their homes while maintaining their independence. But what happens if or when that is no longer possible?

In previous articles, I have been reviewing options for care and the choices available from aging in place through assisted living. What influences the decision to no longer remain in the home? Most often it comes down to the loss of ability to care for one's self due to physical and or mental health issues.

The level of care or the amount of care typically dictates which choice may be the best option. While some may choose to stay in their home with care brought to them if necessary, others may require more care than can be provided in the home. For many the decision for care options becomes a financial decision.

The loss of independence due to chronic or acute health concerns or related to dementia is the toughest challenge facing the aging population. Letting go of the "I used to be able to…" and accepting the limitations imposed upon us when we age is never easy. Holding on to what used to be is a normal reaction. Unfortunately, when ailments interfere with the ability to perform activities of daily living (ADLs) such as bathing, dressing and toileting (to name a few) independently and safely, it is time to reassess the situation.

I have stated in previous articles the importance of making choices when you are able and having control of those choices through dialogue with family and friends and ultimately through legal documents such as a living will and advance directives. Additionally, financial planning for the costs of assistance — regardless of whether it is provided in the home or in a long-term care facility — is critical to optimizing your choices.

While almost no one ever says to me, "I want to check into a nursing home," it's inevitable that some will need the level of care provided in the long-term care setting. What are the choices available? How much does care cost? How do I ensure the best care for myself or loved one? These are all important questions.

Long-term care, nursing home and skilled nursing facility are all synonymous. The necessity to reside at a nursing facility is dependent on the resident's need for assistance with ADLs that can no longer be provided at home due to safety, logistics or cost. A team of professionals including nurses, nursing assistants, social workers, activities specialists and physical, occupational or speech therapists with physician oversight provides care in a setting considered now to be the resident's home.

If the situation arises calling for long-term care, the options can be overwhelming. How do you know what's best for yourself or a loved one? First it's important to obtain a list of options in the area you would like to explore. The Bureau of Aging and Disabilities can provide a list for the county. Another resource to refer to is the Guide to Retirement Living Sourcebook at http://www.retirement-living.com. Medicare has a compare website, http://www.medicare.gov/nursinghomecompare/search.html, that lists nursing facilities within a certain radius and gives a comparison rating.

After receiving the lists of options, it is critical to go tour the facilities. What is right for one may not be a good fit for another. Speak to the admissions director of the facility. Is there availability? Ask questions; see what the daily routine looks like. AARP has a very comprehensive checklist of questions to ask: http://www.aarp.org/home-family/caregiving/info-05-2012/caregiving-resource-center-asking-right-questions.2.html.

The question of cost is always one of the first questions I receive. The news is: Be prepared for sticker shock. Skilled nursing facilities are not cheap. Costs may range from $7,000 to $12,000-plus per month. How does one pay for care?

Long-term care insurance will pay based on the terms of the policy if one is in place. Medicare does not pay for long-term care, which is considered custodial care. The resident pays for long-term nursing home care privately. In the case where the resident may not have financial means, they may be eligible for medical assistance. There is a lengthy application and process that must be completed to apply for Medical Assistance, also known as Medicaid. Forms can be obtained through the Department of Social Services.

Once you have decided on the best option for your situation, talk to the admissions director to discuss options. If your first choice does not have availability, ask to be placed on a waiting list. Shop around and look for the option that feels right to you, or for your loved one. Nursing facilities are becoming much more resident focused. With careful, knowledgeable planning, the difficult decision and choice for where you or a loved one resides can be eased.

Jill Rosner is a registered nurse, certified geriatric care manager and owner of Rosner Healthcare Navigation. She provides patient advocacy and care management services to clients with health and aging issues. Contact her at JillRosnerRN@aol.com.