When I asked for topics you'd like me to spend a bit more time writing about, home health care versus living in a nursing home was near the top of the list. Most of the folks I talk with would like to stay in their home as long as possible before the move to a full time care facility. There is comfort and peace of mind in being in a familiar place, with your belongings around you.
Of course, there are obvious complications and problems that can arise. As health deteriorates the risk of falls or accidents increases. Becoming forgetful about taking pills and eating properly can have serious consequences. Your spouse, partner, or grown children must take on a more active role in your care. If you wait too long, nursing care facilities may not welcome you. In an odd irony, you may find you are too ill to be admitted to the nursing home of your choice.
If you are able (and willing) to move into a continuing care community at some point, this situation is already taken care of; a nursing home environment is part of what you contracted for. In the meantime, you can remain independent or have some assistance on a daily basis. But, for many the costs are too great to make this a viable choice. For others, the thought of living among people who are all the same age and social status is not attractive.
Luckily, new technology and options are making it much more viable to remain in your home for a longer period of time. If you would prefer to stay in your present home as long as possible, there are choices you can consider. Something as basic as an emergency button that summons help can provide a much needed level of security and safety. Other new products provide monitors and computer links to family members or care professionals. Pills not taken or daily activities not performed as required trigger an alert to allow for quick follow up.
New options for in-person caregiving are also more readily available. Professional help or volunteer visitations are just two of the possibilities.
Because this is an area I have no direct experience in handling, I really can't offer specific suggestions. My dad (and mom before her death) lives in a three level community with constant supervision and care so I am not faced with the toughest choices. At the moment he is in the assisted living section, but is guaranteed a place in the nursing facility when the time comes.
What I can offer is the following list of links to sites that discuss this topic in greater detail or offer options that may make your decision easier.
Of course, the decision to stay in one's home affects both the individual or couple in the home, as well as other family members who find themselves in a position to take on extra visits, care, or responsibilities. Any decision with this level of seriousness should be discussed with all those who are involved, and that includes doctors and other caregivers.
That being said, here are some sites for you to check out if this subject is one that is important to you:
Nursing Care Alternatives
Visiting Angels
Skilled Nursing Options
Alternatives for Care for Aging or Ailing Parents
Community Care In Your own Home
How Seniors Manage to Adapt to Disability
Options for aging in place
Technological tools that may help:
Alert 1
As the saying goes, "Getting old is not for sissies." At some point Betty and I will face these decisions. Frankly, at this point I have no idea what we will decide. But, just researching the information for this post has helped.
You bring up valid concerns and the struggle people go through deciding what to do. Unfortunately we are dealing with the serious consequences of my Mom forgetting to take pills and not eating correctly after refusing to move to assisted living. Despite some in home support and my brother's frequent visits she ended up in the hospital and now a skilled nursing facility. Her health has improved with the constant care but she still wants to move home. The cycle would repeat however so that is doubtful. We all have to think about this for ourselves and remain open to change throughout the aging process.
ReplyDeleteMy mom wanted to return home from the nursing facility during the last year of her life. We would take her home, but within 24 hours she would be back in the hospital because her condition was too much for my dad to handle alone. This cycle was repeated probably half a dozen times until we convinced her going home was no longer viable.
DeleteIt was tough.
In my grandparents generation everyone in my family has always lived in their own home right to the end and both my parents still live in their own homes (my father is 89 and remarried, my mother is 84 and in her own condo) so I can’t speak from a point of any experience. That said, in the course of my volunteering at a local performing arts facility we often get people on an evening outing from the nearby “retirement residences” which have varying care levels as you talk about for your father. Often before the evening’s show begins I speak with them about various things and to a person they are of the opinion that people stay alone, and lonely, in their own homes far too long. To them retirement residences are place of social interaction and provide a sense of community that they had lost living independently but completely on their own. Certainly in your 60’s and 70’s one still can get about independently but as one ages things change, mobility decreases, you may no longer be able to drive, and a myriad of other issues conspire where being “independent” can also mean isolated. As we age it’s something to consider and not rule out because of some preconceived notion of “independence”.
ReplyDeleteYou make a very good point: independence can mean isolation. Past a certain point, I wonder if wanting to stay in one's own home is more stubbornness and fear of the unknown rather than a choice based on what is best.
DeleteA very important topic, Bob. I have only one experience with these situations. We moved my mother into a community in 1993 after my father passed away. She was able to stay in her own apartment and partake in the meal plan at the facility virtually up until the day she passed in 2012. They had graduated levels of assistance but my mother needed nothing beyond her apartment and meals until a few months before her passing. It worked out extremely well for us, in no small measure due to my mother, her ability to function largely on her own with help in some areas from her children (e.g. I took care of her investments and taxes among other things), and her willingness to get involved in the community.
ReplyDeleteThere is a cost involved with such a setup, but for those that can afford it, it offers a wonderful option for the family.
Except for getting involved in the community, your mom's situation sounds much like my dad's. At 90 he is living in an assisted living apartment. But, he still takes care of his daily pills, goes downstairs to the dining room for two meals a day, and spends a part of each week in the library getting a stack of new books to read.
DeleteHe participates in no activities and avoids meeting people, probably because his hearing is so bad, even with hearing aids, he can't properly interact with them. In fact, he does his own laundry every week at 3am. He claims it is so he doesn't have to wait for machines. I think it is so he doesn't have to engage in conversations with other folks he can't hear.
I worked in and have studied aging for the past 25 years. The desire to stayin one's own home independently is something I've seen it almost all cases. The reality is that if illness or general decline requires in home care the cost will far exceed that of a residentail community and may have the additional drawback of lower levels of care, lack of continuity and increased complication for those coordinating care. Just as an example, I know of a couple who were in their own home until this past year. Neither person is mobile, neither can drive. The had no bathroom on the main floor of their home .
ReplyDeleteThey installed chair lifts on the stairs, a bath on the lower level and hired home health aides to come in, initially 8 hours a day. They received meals on wheels and paid the serice additionally for transportation to medical visits. As their health decline they increased the care to 24 hours at the cost of $24,000 per month. Even a reverse mortgage on their home was exhausted within 2 years. If instead they had planned and moved to an assited living facility with nursing care for the future, they would now be living comfortably; instead they are in a nursing home and will have to sell their home and "spin down" to qualify for Medicaid. Their children's health has deteriorated as well, as they were on constant call to provide help and assistance. Don't be naive. Get long term care insurance if you can. Plan NOW to downsize and transition to assisted living. Living in your own home is betting on a clear mind, healthy body and resources few may realize.
All very important points, Bonnie, from someone who has direct experience. I think most people believe staying in their own home is cheaper than moving to a full service retirement community. But, as you note in your example, costs can begin to spiral out of control rather quickly.
DeleteMy parents used the profits from a house sale to pay the rather substantial entrance fee to their choice. Dad continues to pay over $3,000 a month to stay. But, using your example, that $39,000 a year he pays is nothing versus the $24,000 a month disaster you reference.
Bob, as you know we live 6 mos. in AZ in a 55+ resort and 6 mos. in OR in a 55+ subdivision. We are both in our mid-70's and see people both older and some younger than us in our home areas. It is a difficult thing for people to make the transition from active lives to "having" to move to assisted care or nursing homes but most of us at some point will have to do just that. To put off the enevitable we believe that seniors must keep as active both physically and mentally as possible. It seems to delay having to make that move any sooner than necessary. Ex.: The man who lives across the street from us, by himself, is 93; plays horseshoes regularly, golfs a couple times a week, is as neat and clean as anyone can be. He lives in AZ for 5 mos and in IL for 7 or until the bad weather closes the resort where he lives. He drives and takes good care of himself.
ReplyDeleteAnother 92 yr. old lives here in the resort in AZ year round by himself. Loves to dance and finally had to give up golf because he got dizzy when he put the tee in the ground. Still is a very sharp man and great conversationalist.
There are many residents here who are in their late 80's and 90's but still active physically and mentally and I think they challenge each other to stay "young" and healthy. We love being with them as it keeps us going too.
We all hate it when someone has to "make the move" but know each of us will probably have to do that too some time. When someone dies suddenly most will say, "they were lucky they got out of here the way they did", without having to make that move that almost all older people hate to think about.
Good luck in your search for answers to all of our problems in aging, "It Ain't Easy Getting Old."
You and Barb are excellent examples of folks who continue to live a very full life on your on terms. In fact, it wouldn't surprise me if one of these days I will learn you guys decided to get back into the RV lifestyle and hit the road again!
DeleteBetty and I worry about waiting too long and burdening our kids. That will prompt us to move sooner than we may want, but soon enough to not scare the kids.
No easy answers on this one. Long term care insurance unfortunately has some major drawbacks. The insurance company can raise the premium, and if it is raised to a level you can no longer afford, well, you unfortunately are out of luck and lose the money you invested. Also, enough of these companies have gone under, leaving people high and dry, without any coverage.
ReplyDeleteI had a patient who had faithfully paid his LTC premiums for many, many years. When he finally needed to utilize this benefit, the insurance company fought him and his wife every step of the way. He was in renal failure, had dementia, and was no longer able to stay at home. I felt so bad for his wife, who through all of her grieving, had to fight the system to get the benefit that they had paid for all those years.
Another option would be to take the money you would pay for LTC insurance premium and invest it. In my opinion, it beats the uncertainty of this industry.
We plan to choose a CCRC at some point; we hope not to need this for a long time!
LTC insurance has become a real crap shoot, and that shouldn't be. To promise a benefit that has been dutifully paid for over many years and then try to stall long enough that the policy holder dies or gives up is a perfect example of what is happening in our society: greed trumps common decency, business ethics is an oxymoron,, and all sense of right and wrong is all too often gone. In my humble opinion, people who perpetrate such scams should be either imprisoned or forced to live in a substandard nursing home.
DeleteInvesting the money (in a sense being at least partially self insured) is probably a much better idea.
Personally, when the time comes, I'd want to stay in my own home. But a lot of people love the idea of going into the "system" -- independent living, to assisted living, to nursing home. Independent living definitely has some benefits, such as friends, meals, activities. In any case, thanks for posting a great resource here.
ReplyDeleteYou are welcome, Tom. I don't like the idea of a three-level community, but we can afford it and it relieves our kids of a terrible burden. I will adapt when the time comes.
DeleteThe aging process is inevitable. My hope is to make the necessary life changes and moves proactively rather than be dragged kicking and screaming with my heels dug in. I anticipate surrendering the responsibilities of home ownership/maintenance and look at it as freedom not unlike retiring from paid employment. The level of care needed will certainly depend upon health status and the quality of care will depend upon what one can afford. I think we've been left with a poor impression of aging. Bonnie may have more current stats but I learned in a sociology of aging course that only 10% of the elderly end up in care. I see many older seniors who are not on meds engaged in a busy active lifestyle up to the end. Maintaining physical and mental health is a priority as I move toward that stage of life but then, shouldn't that be a priority always?
ReplyDeleteI like the concept of thinking of leaving a high maintenance living environment like leaving work - there is a freedom one can almost taste. I have taken care of yards for almost 40 years: that is more than my radio career! It sounds wonderful to have it no longer be my responsibility.
DeleteThese are the hardest kinds of decisions to make ahead of time! A dear friend of mine, in her mid seventies is still vigorous,still working, but is opting to move to Friendship Village, a 3 tiered place with very nice town homes.. I went to see the campus with her.. she will buy into a nice place with an option to use the other faciilities on an as needed basis without extra fees.. a nursing center, a rehab center, hospice on campus, a hospital.. she is fully independent but is planning ahead..it was surprising to me that a lot of folks in the village still work part time! There's also a gym, shared meals option, a restaurant, just lots of great services and a happy atmosphere.. it did me good to go see the options.. one day Ken and I will also need to make those kinds of decisions, if we are unable to live in our home.. . It's less money to "buy in" when you are still HEALTHY.. hard to figure out the timing.. ??
ReplyDeleteBut we all hope that day is a long ways off,don't we!!??
My dad lives in Friendship Village. Betty and I are pleased with his care and the amenities. It seems to be well maintained and the employees are friendly. Even so, we are in no rush to move there!
DeleteA very relevant topic you have chosen. Often when people retire they think of leaving peacefully without bothering anyone at their own place. But very often this does not happen. Mostly this will be because of the poor health of the retirees. Because of this their children will be skeptical about their parents living alone. And because of this most of them turn to assisted living. Or else they install the personal emergency response system at home so that medical assistance will be there within a short time in case of any emergencies. Or else their kids and close ones will be in forever concern about them
ReplyDeleteThanks for your thoughts, Mabel. I did have to remove the rather obvious link to a commercial site, but otherwise let the comment stand.
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