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How To Choose Among Independent, Assisted Living and Nursing Facilities
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The How-To Business Book
11/20/2000
By: Priscilla Searles
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It's no secret that people are living longer than ever. The U.S. is faced with a generation of senior citizens who never expected to live to 80 or 90. Even our definition of “senior” has changed: We wouldn't refer to someone in her 60s as a senior citizen, though it wasn't long ago when that was about as long as most Americans lived.
The longevity explosion has presented families with a new problem: How to care for someone who can no longer go it alone? Surrendering independence is an emotional decision. Deciding that someone needs in-home care, such as a health aide to help with things like bathing, may not be such a terrible decision to make, but facing the cold, hard truth that a person must move on to another stage is something many families find it difficult or impossible to cope with.
The decision to remaining where you are must be based on what services can be made available to you in your home. Emergency-response systems have made it easier to stay in place, and taken some of the worry away from concerned family members. But having someone come in to cook, do housework, and go shopping isn't easy or cheap. The decision to enter an assisted-living facility, for example, is usually made when people are simply out of options.
And the issue of income comes into play. People with adequate funds can afford to pay for in-home services, while low-income seniors who qualify for Medicaid (Title 19) have some in-home services available to them, albeit on a limited basis. The average middle-class person can find it difficult to get the care they need without moving to a facility that provides those services.
Coming to grips with the loss of autonomy is the hardest thing for people to do - not only for the older person but for families who find it difficult to accept what is happening to their parent or loved one. Assisted living attempts to bridge that gap by giving people a sense of independence and control over their life. Well-run assisted living facilities will go out of their way to help people “age in place,” remaining at home even as their needs change.
A handful of people pre-plan for the time when they may not be able to handle the responsibilities of a home and their personal care, making decisions before something happens to them. But people that have support in place in case they need it are rare. For those who can afford them, long-term care insurance policies are becoming increasingly popular.
When an assisted-living facility is needed, it is usually family members who make the inquiries. Questions to be asked include whether the facility is a state-licensed assisted-living facility. All are required to make three meals a day available, but rules vary from facility to facility. Some require that residents attend all meals in the dining room; others require two meals a day. Round-the-clock security, resident emergency monitors, housekeeping, laundry, transportation and on-site medical personnel are just a few of the services one should expect to be available in assisted living.
It takes most people two to four weeks to become accustomed to the new environment, to feel a sense of home. For family members, knowing that medical assistance is available can ease the stress association with change. Many assisted-living facilities are associated with nursing care facilities that are available for those who need it, whether on a short- or long-term basis.
Today nursing homes provide skilled nursing beds, generally for people requiring high maintenance, people who will likely remain there until the end. Nursing homes as intermediate-care facilities are disappearing due to the increase in assisted-living facilities.
Continuing-care departments of local hospitals are an excellent source of information for people leaving the hospital who are going to require in-home care. A web site, www.seniorhousing.net, is also another resource. The Jewish Care Network in New Haven can also assist in finding the right elder care services.
There is hope for the future that state and or federal governments may legislate some relief for beleaguered middle-class seniors. The governor and state lawmakers are beginning to understand the consequences of the gap for people in the middle.
In the most legislative session, a bill was passed allowing for an assisted living demonstration program in some state-funded congregate housing and two facilities administered by the U.S. Department of Housing and Urban Development (HUD). The program will provide some financial support for people requiring assisted-living services across the board, from people on Title 19 through people in the somewhat higher income brackets who need all the help they can get.
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