Home Care, Eldercare Finances, Housing, and Insurance: Gathering Non-Medical Information
When we started our steps for family caregiving, we advised you to create and continually update a problem list of all the issues your family is facing. First, it's a tool for working with your parent's doctors. Your problem list is also a guide for gathering and evaluating the non-medical information you will need to help your parents stay independent, or deal with such issues as home care, insurance, and healthcare finances.
Step 3: Gathering and Evaluating Non-Medical Information
As elderly parents develop serious chronic illness, the specific things you need to coordinate to keep them safe at home can become many and complex. There are the basic activities of daily living (you may hear them referred to as ADLs) that were previously routine and can become difficult - eating, bathing, walking, dressing, using the bathroom. Instrumental activities of daily living (IDLs) - housework, meal preparation, administering medications, shopping, getting to and from appointments, using the phone, and managing finances - can also become harder over time, and relate directly to your parent's ability to remain independent.
Housing Options
Your parents will want to remain independent for as long as possible. As those instrumental activities of daily living become more difficult, your first goal will be to find credible in-home aide service to help parents remain safe in their own home. It is important to find credible people to be in your parent's home. Try not to buy too much or too little time, if possible. Even trusted agencies and individuals need be monitored. This is a time to be vigilant as elder abuse of all sorts occurs daily throughout the country.
As frailty advances, many seniors begin to think about moving to senior housing where various degrees of assistance are provided, depending on your parent's degree of mobility.
• Independent living - for seniors who live alone and can perform all ADLs.
• Assisted living - facilities that provide assistance and monitoring, and care for a parent who can no longer live alone but does not need 24-hour nursing care.
• Nursing home - a skilled nursing facility for a parent who can no longer perform many of the activities of daily living and needs extensive assistance, and also rehabilitative services in the case of accidents and reversible illness.
How to Pay for Care
In addition to the stress and emotional issues you may face as a caregiver, you will probably have to deal with a number of financial issues. Caregivers often miss work and lose income while looking after their parents. Depending on all the family dynamics it is helpful for the immediate family to make a financial plan for ill parents' needs. If you can afford a family care manager, you may be able to reduce the number of long-distance trips that you need to make and thus, get the most out of your healthcare dollar.
First and foremost, you need to gather information on how to pay for care.
Medicare. Medicare is a government-funded social insurance program that supplies the elderly with health insurance. Medicare is offered to all U.S. citizens and longtime legal residents who are 65 or older. In certain situations, younger people may also qualify for Medicare. Medicare pays for 80% of covered medical and hospital services, and people who buy the program's Medicare Supplemental Insurance have the other 20% paid for.
Medicaid. This is the U.S. health program for people and families with low incomes and few resources. It is jointly funded by the federal government and by individual states administering their own programs. Policies will vary from state to state, so if you are considering applying for Medicaid for your parent, be sure to find out what your state does and does not offer. Many elders qualify for both Medicare and Medicaid.
Long-Term Care Insurance. Private long-term care insurance helps pay for certain services to assist people who are too sick to perform ADLs like dressing, taking showers, or walking. The insurance also covers services within assisted-living facilities, adult day care, and nursing homes. These services are generally not covered by regular health insurance, Medicare, or Medicaid.
Managed Care. Managed care provided by Medicare has limits on the services they provide. Some take the form of Medicare HMOs (health maintenance organizations). Managed-care organizations often employ care managers to help control usage and costs.
A good family care manager - that is, one you hire yourself to work directly for you - can help you and your parents decide what their particular needs are, and understand options and how to pay for them - whether through Medicaid, private long-term care insurance, or services that you would pay for yourself. The care manager can help you find good sources of in-home care. Be careful to work with care managers who are not selling other services and/or getting a commission for steering you to other services.
Predictable Needs
There are predictable needs of seniors and their family caregivers, and understanding and gathering non-medical information can help prevent a great deal of uncertainty and stress. For example, your parent's driving may be restricted at some point and you will need to investigate alternate transportation resources.
Some independent experiments in aging are building independent housing that allow each person or couple to own their own home, but share a community plan for leisure activities as well as for medical and in-home care as aging and frailty advance. We can also expect an increasing number of services and monitoring options to allow seniors to "age in place," that is, age in their own homes, remaining safe and independent for a longer period of time.
In our earlier blog on medical information, we gave guidelines for evaluating information from the Web, which also apply to non-medical eldercare information.
Other Information Resources
Other good sources of information are public libraries. Many public libraries have librarians who have received training in a new specialty called "Consumer Health Information Services." Some librarians will review Websites and books and even prepare information packages for patrons. We learned at Care Support of America of librarians who have provided such help as:
• Providing information resources for preventing falls in the bathroom.
• Arranging for the Office for the Aging to provide counseling assistance for seniors trying to understand Medicare Part D benefits.
The National Association of Area Agencies on Aging (n4a) provides free telephone referrals for specific community-based services to help elders at home with transportation, Meals On Wheels, and crisis counseling.
Remember, gathering and understanding information will put you in a better position to cope with issues as they arise.
Five Tips for Information Support
In sum:
1. Keep updating and refining your Problem List with useful and necessary information. Include information on non-medical issues such as home care, insurance, and healthcare finances. This will help you solve the non-medical problems that you can, and better adjust to changes as they unfold.
2. Look for referrals from trusted individuals or organizations when planning to get home care aides in your parent's home. Understand the difference between certified home care, private duty nursing, private duty homecare, personal or companion aides, and hospice homecare.
3. Try not to become overwhelmed or confused by all the information that is available. Learn to be critical about what you read on the Internet, see on television or hear from friends. Review information with a trusted health professional whenever possible.
4. Be sure to monitor your parents' driving abilities and look for information on alternative transportation when necessary.
