CityView Magazine

I can’t count the times I’ve heard my mother say “I refuse to end up in a nursing home. Don’t even think about putting me in one.” But the reality is, when the time comes that she can no longer care for herself, Assisted Living, Nursing Home Care or something similar may be what’s best for her. The most clearly defined options are those I’ve just mentioned, but there are other options available to us as we age. Assisted Living can be viewed as the bridge between Independent Living and around the clock nursing care. But what does that mean exactly?

Independent Living
It’s important to note the difference between Independent Living and independent living. The latter literally means a person maintains a private residence. Independent Living is for people who want to (and are able to) live independently but wish to live within a community of people around their age and with similar interests. Also known as a retirement community, they allow for social activities, and even travel. Many also offer prepared meals and provide amenities such as swimming pools, arts and crafts, boating, trails and golf courses.

Assisted Living and Continuing Care Retirement Communities
An assisted living facility is for those needing help with the activities of daily living, but wish to remain as independent as possible. Help can cover everything from housekeeping, to bathing, dressing, eating or assistance with medications. Many facilities also have centers for medical care; however the care is usually not as intensive as that of a nursing home. Many are directly associated with Independent Living residences and nursing homes. This combination is known as a Continuing Care Retirement Community. Here, a resident can ease from one type of facility to another as his or her condition changes, without the need to relocate or adapt to a new setting. For example, the resident may begin in the Independent Living residences, move to assisted living as he or she needs help with the activities of daily living, and eventually retire to the nursing home as ongoing medical intervention becomes necessary.

Nursing Homes
Nursing homes care for very frail people who are no longer able to care for themselves and have numerous healthcare requirements. It is crucial to do your homework, for yourself in advance of the time you become incapacitated, or for a loved one who will need an advocate. We’ve all heard the phrases “nursing home abuse” or “neglect” but these situations can be avoided if the proper precautions are taken when making this important decision. Here are some tips for choosing a facility that will ensure the best care for you or your loved one.

1. Buy yourself more time. About half of all nursing home admissions follow a hospital stay. Many times, a patient is unable to return home and is given as little as 24 hours’ notice to find a facility. Since none of us can be sure when we may be hospitalized with a serious condition, it is good to have the appeal option (for patients on Medicare). If appealed the patient will have two extra days to find care. There are resources available to help make an informed decision, such as social workers, nurses, doctors or administrators—ask questions and seek out as much information as possible!

2. Get the list. Begin your nursing home search by calling the Eldercare Locator (800.677.1116). This agency can help you connect with the Area Agency on Aging, which provides a list of all of the nursing homes and Ombudsmen in your area. An Ombudsmen isn’t allowed to promote one facility over another, but can answer specific questions about staffing, problems, or administrative turnover.

3. Look close to home. It’s more convenient for family members, and almost always guarantees better care for you or your charge. Nursing home staffs are keenly aware of the residents who receive regular visits and tend to bestow just a bit more care on those patients.

4. Stop by unannounced. It’s the best way to get a good idea of how the facility is run. Ask to see the administrator and request a tour. Also ask about the caregiver to resident ratio and be cognizant of foul odors or filth.

5. Check out the restroom. Any restroom in a public area will be a good gauge of not only cleanliness but also water temperature. A common complaint in nursing homes is the lack of hot water, especially in larger facilities.

6. Notice where residents are. If they are in activity areas or dining rooms, that’s good but if you can see someone being changed, dressed or toileted it means the facility doesn’t value their privacy or dignity. Restraints are also a red flag. Devices that restrict movement may be temporarily necessary in a medical emergency, but better homes meet patients’ needs using restraint-free methods.

7. Check out the kitchen. Is it clean? Does it smell good? Ask to see inside the refrigerator. Is the food covered? Find out if there is a registered dietician on staff, a list of resident food allergies and plenty of accessible drinking water—dehydration is a special risk for nursing home residents.

8. Read reports. Long-term care facilities must provide their most recent state inspection  survey which will list any recent violations. All nursing homes can have the occasional problem but read this report carefully and weigh the severity of the issues. Now, question the administrator about how problems were resolved.

9. Attend meetings. Nursing homes should support family and resident councils—groups working to ensure proper treatment and care by communicating concerns with ombudsmen and managers. Look for a posted schedule and ask if you can sit in on a meeting to get a sense of what’s going on within the facility. Ask lot’s of questions!

10. Visit often. If you’ve admitted a loved one make sure a patient care plan is on file. This document is required for all patients and will include an outline of care requirements including dietary needs, medications, and rehabilitation directives. The most important thing you can do is visit as much as possible, make sure the care plan is being followed and to consistently monitor care.

Who Pays for Nursing Home Care?
The patient pays for most nursing home costs. Medicaid, the payment source for people without sufficient income and assets, accounts for about 45 percent of all long-term care spending. Medicare, medical insurance for people age 65 and older and those on Social Security disability, accounts for only 11 percent of nursing home costs  as it only pays for short-term skilled nursing care and requires the beneficiary meet conditions before being approved. Ask a Case Manager for an assessment and consultation; nursing homes often help with these arrangements with no charge or obligation. Regardless of how the patient is cared for, whether in home or at a facility, none of his or her assets are immediately taken away from a spouse living at-home, although estate recovery rules may apply. This is the repayment to the state for patient services however, this repayment is not required until the spouse vacates the house. Also, the spousal impoverishment prevention program may apply, which allows the transfer of most, if not all assets into the name of the spouse at home for his or her benefit, and doesn’t count toward eligibility for the patient’s care.

Individuals who receive long-term care in a nursing home not covered by Medicare must pay the entire cost themselves whether it is from their Social Security check, pension, or savings. If individuals don’t have sufficient funds to pay for long-term nursing home costs, they “spend down” their income, savings, and other assets until they are eligible for Medicaid, a Public Aid payment source.

While none of this is all that appealing to consider, we will all grow old if we are so fortunate. These facilities could provide us with shelter and care—we can only hope we’ll also feel at home. Though not everyone will utilize any of these options, it’s good to know what they are in the event that you or a loved one should be faced with such a decision. Weigh the options carefully and make informed decisions.



LET'S GET TO WORK ON THIS...

For the newly retired, Autumn is the perfect season to get your life’s business in order.

Update your legal documents. Families face more complex end of life medical decisions these days. Written guidance helps family members committed to following their loved one’s wishes. Does your healthcare advance directive reflect available end of life choices and your specific wishes? Do your documents designate a back up agent? Is your financial agent accountable for how he/she is handling your money? Does your Will accurately reflect your wishes? Do you have a disabled spouse or child who requires special needs planning? Should you consider a more complex Will because your estate has grown?

Review beneficiary designations on retirement and savings accounts and life insurance. If divorced and your “ex” is still the primary beneficiary on any account, then she/he receives that asset at your death! If designated beneficiaries are dead, the asset will be distributed to your intestate heirs, whom you may not even know! The point is, a beneficiary designation is binding. Be sure it is accurate and keep a copy on file.

Foster Financial Independence in your adult children. The Greatest Generation is renowned for their avoidance of debt. Not so for its baby boomers! Financially dependent adult children may continue to take advantage until the parent becomes impoverished. Insist that children stand on their own
feet financially.

And don’t give away the farm to your children! Folks are often afraid of losing the homeplace “to the nursing home.” However, putting children on  deeds or savings accounts places seniors at greater risk. How? There are tax consequences as well as a substantial penalty if the (former) homeowner needs government benefits, such as Medicaid, to pay for long-term care. And for those financially challenged kids, that home becomes exposed to the child’s judgment creditors. 

Monica Franklin is board certified as an elder law specialist and practices in Knoxville. For more information on elder law issues go to www.MonicaFranklin.com.




ALZHEIMER'S DISEASE OVERVIEW

Alzheimer’s disease (AD) is an irreversible brain disorder related to the breakdown and eventual death of the connections between certain nerve cells in the brain. Initially, people experience memory loss and confusion and gradually other cognitive abilities decline. Researchers estimate that by 2050 13.2 million Americans will have AD.This makes AD an urgent research priority. 

We have made significant progress in the critical area of early diagnosis. The Alzheimer’s Association is the largest private funder of Alzheimer’s research in the world. It is our vision to create a world without Alzheimer’s disease. In the meantime, living with the changes caused by AD and other memory loss disorders can bring about many conflicting emotions. Persons with AD and their loved ones want to be prepared for the changes that lie ahead and to understand their options. AD doesn’t mean a person can’t make decisions about the future. The preferred decision making process is one that considers the best interest of the person with AD as well as their caregiver. 

Statistics report 10 million Americans provide unpaid care for loved ones with Alzheimer’s. However, many utilize services outside their home. Community and home based services exist to support the Alzheimer’s community.The Alzheimer’s Association provides support groups for caregivers and persons with memory loss, educational opportunities, care consultation for families, financial scholarships, in-home assessments, adult day care and many other services. To learn more about care options contact the Alzheimer’s Association at 865 544-6288.

Janice Wade-Whitehead is the Executive Director for the Eastern Tennessee Chapter of the Alzheimer’s Association.