Most of us don’t want to think about the day when we can no longer take care of ourselves, or when our loved ones can no longer live on their own. But the hard truth is that 70% of us will need some form of long term care once we reach our golden years. This means we may need assistance with daily activities, such as walking, bathing, dressing, eating or using the restroom.
Many individuals wait until they or their loved one needs this care only to find the process challenging to navigate. There are steps you can take now to better prepare yourself should the day come you or loved one needs long term care.
1. Get Educated
You may have heard the phrase “not your grandmother’s nursing home.” But beyond that fact that nursing homes have evolved into what we now call “skilled nursing and rehab centers,” there are also many more long term care options, depending on the level of assistance you require. Study the different options like assisted living, home health services, independent living, adult day/foster care, and hospice to understand what services each provides. That way when you think it’s time for assistance, you have a sense of what setting may be best, based on your loved one’s or your specific needs.
For example, if a family member is diagnosed with Alzheimer’s, consider whether an assisted living community would be appropriate as the disease progresses, as many specialize in memory care.
2. Get to Know What’s in Your Area
Now that you understand the continuum of long term care, you should begin to research what is readily available in your area. Some state agencies on health or aging also have websites that offer consumers a list of long term care providers. State associations may be another resource for local providers. For example, browse through the state affiliates of the National Center for Assisted Living to possibly find assisted living communities.
The federal government offers searchable databases for skilled nursing centers and home health agencies as well. You can search by zip code, city, or state, and compare those specific providers based on national data the government collects.
You can also easily use major search engines on the internet (e.g., Google, Bing, Yahoo, etc.). Many of these are programmed to pull up options in your area. Other websites specialize in helping consumers find senior care options.
However, conduct your research carefully—do not just rely on the internet or online reviews to hold all the information about a provider. Once you’ve identified a few providers, set up a tour or meeting to learn more about the care they provide first-hand.
3. Start Planning for the Cost
Long term care has costs associated with the services provided. It’s important to prepare as much as possible. The cost of care and your options for coverage vary depending on your state and the type of services you need. As you meet with various providers, make sure to ask about their costs, billing practices, and if they accept any assistance programs. But first, it’s important to understand your options in financing your long term care.
A common myth is that Medicare, the federal government’s health insurance for Americans aged 65 and older, pays for long term care—but it doesn’t. Medicare will help pay for a short stay in a skilled nursing center, for hospice care, or for home health care if you meet specific conditions. But it does not cover what the government calls “custodial care,” or personal care for assistance with daily activities (e.g., bathing, dressing, eating).
Medicaid, the health insurance program for low income individuals, does cover long term care services. However, Medicaid programs and eligibility for services vary from state to state. Contact your state Medicaid office to learn more, or ask a long term care provider who accepts Medicaid for more information
If you don’t qualify for Medicaid, there are private pay options such as long-term care insurance, which experts recommend should be purchased in your mid-50s. Life insurance and your personal income and savings are other options to pay for your long term care. Talk with insurance agents, perhaps a financial advisor, and loved ones to begin planning.
4. Think About Your Health Care Wishes and Make a Plan
More than one out of four older Americans face questions about medical treatment near the end of life but are not capable of making those decisions, according to the National Institute on Aging. One way to ensure loved ones’ or your own health care wishes are honored is to take part in advance care planning. It allows you to discuss values and goals of care with loved ones and physicians. While advance care planning is not exclusive to older Americans seeking long term care, it is recommended and customary. Ideally, advance directives are part of that process.
The Kaiser Family Foundation explains that advance directives are written instructions that are intended to reflect a patient’s wishes for health care to guide medical decision-making in the event that a patient is unable to speak for her/himself. Advance directives often take the form of a living will, which defines the medical treatment that patients prefer if they are incapacitated, or designation of a certain person as a medical power of attorney.
An advance directive should be a topic of discussion and added to the patient’s file upon admission to a nursing center or assisted living community, or when hiring a home health or hospice agency. It will advise providers what you want if you are unable to speak for yourself.
Advance directives fall under state regulation, and the required forms for formal advance directives vary from state to state. You can find state templates through organizations like AARP and Five Wishes. Medicare also recommends getting one from your health care provider, attorney, local Area Agency on Aging or state health department.
5. Communicate Your Medical Wishes to Your Loved Ones
You have your care wishes in a legal document or a durable medical power of attorney, but now your loved ones need to know. It will help give them peace of mind and prevent questions, confusion or disagreements should you become incapable of making medical decisions.
Make sure to share your advance directive with key individuals and review your decisions from time to time.
But you should also make sure you specifically address your long term care wishes—where would you prefer to receive care? What if that preferred setting can no longer meet your needs or is not financially viable? Recognizing that every long term care setting is different, let your loved ones know your preferences.
If you are hoping to understand the long term care wishes of a loved one, make sure to first ask their permission to have the discussion. Don’t get discouraged if you encounter resistance when bringing up this topic. Stay positive and calmly convey your concern, but don’t pressure them. When they are ready to talk, be a good listener, show respect and acknowledge their right to make choices.
6. Determining When It’s Time
Pills go missing. Clothes aren’t getting washed. Bills aren’t getting paid. Confusion is common. Or weight loss is conspicuous.
Be on the lookout for some early warning signs that it may be time for caregiver assistance, including signs that unpaid caregivers are becoming overwhelmed.
Then find some time to tell your close family or friends about your plans.
Acknowledging we need long term care is hard. It’s never an easy decision. But by preparing now, you can relieve some of the pressure and stress. That way, when the time comes, you can find peace of mind in knowing you’ve made the best decision for you or your loved one… and more confident about taking next steps.