To make sure your loved one receives the right care at the right time as abilities decline, you, your elder and other family members should consider available care and housing options carefully. Then, plan suitable living arrangements given your loved one’s health, preferences and finances. If your elder already requires significant help with daily activities or has suffered a health crisis, the decision-making process will be more urgent. Because living arrangements are life changing and sometimes irreversible, resist making a hurried choice.

Use the Assessing Capabilities Checklist to assess your elder’s capabilities.

Consider Options

Several living options, offering varying levels of care, are available to today’s seniors.

In-Home Care
Types Of Care	Daily living and personal care — housecleaning, laundry, bathing, dressing and other non-medical services. Companionship — daily phone calls, visitors or 24-hour companionship. Personal medical alarm — 24-hour access to medical assistance. Medical services — nurse or physician appointments at home, from weekly visits to 24-hour care. Activity groups — games, trips, shopping and other outings for small groups of seniors. Transportation — trips to medical appointments, grocery shopping or other errands. Adult day-care — programs for elders needing daytime monitoring or companionship. Support groups — meetings for elders facing common circumstances. Hospice — in-home medical care for the terminally ill.
Choosing A Provider	If a company cannot or will not answer these questions to your satisfaction, do not use its services: How long has this company been in business? Are workers bonded and insured? How are employees screened and selected? How experienced are your employees? Is there a Licensed Vocational Nurse (LVN) or Registered Nurse (RN) on staff? Can you provide a detailed list of services and fees? Will you replace a caregiver if I am dissatisfied after a trial period? Are rates negotiable? Will you provide references? Is a company representative willing to visit my elder’s home before I sign a contract?
Things To Consider	If the answer to any of the following questions is “no,” remaining at home may not be an option for your elder: Are relatives or friends nearby and available to help when needed? Is the home in a safe location? Is the home equipped to protect the elder from extreme weather conditions? Do safety hazards need to be addressed? Is the home’s layout appropriate or can it be altered for your elder’s abilities? Does your elder have access to reliable transportation? Are emergency services readily available if your elder becomes incapacitated?
In-home care requires time-consuming management and can be expensive. If it is the best option, ask other family members for help and find out if your elder’s insurance policy will cover some or all of the expenses. Also consider Medicare and Medicaid.

Living With A Relative
Things To Consider	If your elder is considering living with you, a relative or other caregiver, everyone involved should think through the following questions: Does your elder enjoy open and honest relationships with the caregiver and other family members? Do unresolved conflicts exist? If so, can they be addressed in a constructive manner? How do family members feel about sharing their home? Can your elder adjust to the family’s lifestyle? Is the home large enough for an added resident? Will the home accommodate your elder’s physical limitations? Can family members or the caregiver provide the level of care your elder requires? Where will your elder live if this living arrangement becomes unfeasible?
Sharing your home with an elderly loved one can be rewarding. However, a loving and trusting relationship does not always translate into a happy living arrangement. Your elder’s choice of living arrangements should be based on positive considerations — not on guilt or other negative emotions.

Residential Care Facility
Types Of Facilities	Independent living community — housing, meals, recreation, transportation and other amenities for self-sufficient elders. Most are private pay only. Continuing care retirement community (CCRC) — continuum of care from independent living to skilled nursing care in one residential campus setting. Various payment methods and contracts offered. Assisted living — personalized non-medical services and often meals, housekeeping, recreation, transportation and other amenities. Personal care residence — small facility taking care of a few residents in a home-like setting. Most are private pay. Nursing homes or skilled nursing facility — nursing and rehabilitative services for elders needing 24-hour medical care. Most are private pay with insurance assistance. Hospice care — comprehensive palliative care for the terminally ill. Medicare- and Medicaid-eligible.
Choosing A Facility	When evaluating a facility, you should be able to answer yes to the following questions: Is it easy to schedule a tour within a few days? Does facility management allow you to talk with staff, residents and family members without supervision? Are visiting hours flexible? Are other visitors present? Are unscheduled visits encouraged? Does the staff, when unaware of your presence, demonstrate respect for residents? Is a daily schedule of activities posted? Do residents appear busy and engaged in worthwhile activities? Is the facility licensed? Is the most recent state inspection report posted (if in a nursing home)?
A residential care facility should do more than address your elder’s physical and medical needs. The most effective providers understand that the elders they serve are vibrant, whole individuals, who want and need purpose in their daily activities.

Evaluate Resources

There are various ways to pay for your elder’s in-home care or daily living assistance. Payment options include the following.

Personal Resources

Most elders pay for care using current income, savings and investments, or income from the sale of personal assets, such as a home.
Compare elder care costs to your loved one’s current living expenses. Depending on the level of care required, there may be little difference — especially when compared to the potential social, medical and emotional advantages of formal care.

Medicare/Medicaid

Medicare, a federal health insurance program for those aged 65 and older and certain disabled individuals, offers limited payment for in-home care, inpatient hospital care, non-custodial nursing home care (with certain conditions) and hospice care.
Medicaid, a joint federal and state government health insurance program for qualifying low-income individuals, pays for long-term care in a nursing home and for some other services. Benefits and eligibility vary by state and are subject to federal guidelines.

Other Options

Most health insurance policies exclude coverage for custodial care provided in the home, a residential care facility or nursing home. Some policies may pay for necessary durable medical equipment and medical treatment.
Long-term care insurance policies provide coverage for most custodial care and skilled nursing expenses. Some also include care coordination benefits that pay for expenses related to developing an appropriate plan of care. Notify the provider when care is needed.
If your elder is a veteran, ask the Department of Veterans Affairs about eligibility for assistance.

The USAA Educational Foundation publications, Making Medicare Choices and Long-Term Care, offer more information.

Next: Driving Decisions

Updated Thursday, April 01, 2010

HELPFUL FORMS & LISTS

Important Information

Assessing Capabilities Checklist