Will Your Loved One’s Senior Care Community Perform CPR?

When our parents move to an independent, assisted living and dementia care community, we often assume we’re paying for their entire care.  I mean, we’ve done our homework, right?  We’ve checked that they have nurses on staff.  We’ve check that the med room is safe, and we made sure that the community has a good safety record and adequate staff.

But what actually happens when there is an emergency?  What happens in the event the staff needs to intervene to potentially save your loved one’s life?  The answers aren’t always clear. And there is no real way to see it in action.

Below is a sad and eye opening story from Bakersfield, California.  In this story, an elderly resident was denied CPR from the nurse on duty because it was not the policy of the community to engage in such activities.  Despite the pleas of the 911 operator, the nurse would not perform CPR and would not find anyone who would.

So this begs the question: do you know what the policies of your loved one’s community is? Would they step in during an emergency? If you don’t know the answer, you should find out and make sure you are comfortable with it.

3 At-A-Glance Guides for Assisted Living

There are many details involved in choosing an assisted living facility that will work for your loved one. The process involves navigating the terminology and verbiage of health insurance policies and also figuring out what a day-in-the-life would be like at a facility.

Here are three at-a-glance guides to help illustrate what long term care insurance is, clarify key insurance terms and show what a typical day at an assisted living facility should look like.

1. Long Term Care Insurance

You may hear a lot about long term care insurance, but how do you know if it is the right choice for your family? Below we’ll outline the target market indicators for long term care insurance, to help give you a better sense if these types of policies would be a good fit for you.

Who needs long term care insurance?

  • People who have assets they want to protect
  • People who want to maintain their financial independence.
  • People who are concerned about having a choice in the quality of care they will receive in the future.
  • The average age of people who buy long- term care insurance is about 65.
  • Married people with assets of above $100,000 (not including a house).
  • Single people with assets above $ 50,000. Otherwise a client would probably deplete their assets before the insurance kicks in, making them eligible for Medicaid.
  • Since women live longer then men,they have a greater chance of ending up in a nursing home. According to a 1997 study by the Health Insurance Association of America, half of all women who live to age 65 will need a nursing home at least once during their life, compared to about one- third of men.

2. Key Health Insurance Terms

Insurance is a major factor in today’s eldercare system. I advise you to contact an insurance advisor who specializes in working with older adults and their families. Here are some basic terms you’ll need to be familiar with:

  • Medicare: A federally-funded health program administered by the Department of Health and Human Services. It is available to all Americans over the age of 65. It is made up of two parts.
  • Part A: This is available to everyone, and covers inpatient care and some aspects of in-home care.
  • Part B: This is optional and requires a monthly premium. It covers many outpatient services.
    Both Part A and B include deductibles and co- payments, and exclude certain services. You may choose to purchase Medigap insurance to cover the “gaps” in coverage by Medicare.
  • Medicaid: This is also known as Medical Assistance, and covers health care services for low-income Americans. Funded by federal, state and local governments; this program requires that applicants meet stringent income and asset requirements. While it covers some inpatient services in hospitals or certified institutions, it rarely covers in-home care.
  • Secondary Insurance: Purchased privately, these policies do not cover long-term health care costs, and rarely cover long-term in-home care. This insurance is designed to supplement Medicare.
  • Long-Term Care Insurance: Such a policy covers both in-home and residential services (including nursing homes) over an extended period of time. Often prohibitively expensive.

3.  A Typical Assisted Living Schedule

When you begin to tour assisted living communities, pay attention to the daily schedule of activities, as physical and mental stimulation will help keep your loved one happy and well.

Planned correctly, activities will become the cherished part of your loved one’s day. To set our frame of reference, let’s look at a typical assisted living day from the perspective of the resident:

  • 6:45 – 7:30am: Have breakfast and receive assistance for a shower from the aide that I’m already comfortable with
  • 7:30 – 9:00am: Make my way down to breakfast. An aide will assisted me to the dining room if necessary, and the medication technician will provide my medications for the day.
  • 9:30 – 10:30am: Morning exercises in the activity room include some stretches, leg lifts and rubber band exercises.
  • 10:30 – 11:30am: Choice of a scenic drive or reading a book by the fireplace. If I take the scenic drive, the van will be wheelchair-accessible.
  • 11:30 – 1:00pm: Lunch and return to my apartment to rest for a while.
  • 2:30 – 4:30pm: Different things happen on different days. During a week, I’ll usually see education presentation, musical performances or craft demonstrations. Nothing is required if I am tired.
  • 4:30 – 6:00pm: Dinner.
  • 6:00 – Bedtime: Evenings can bring visits from family and friends, outings in the community van, or quiet time at home.

Photo Credit: Jan Krömer

Long-term Care And Financial Considerations

As you’ve seen, long-term care is expensive. Even a temporary stay in an assisted living facility can derail years of careful financial planning. Although costs may vary significantly depending upon where you live, a family’s assets can be quickly depleted.

According to the U.S. Department of Health and Human Services, one year of care in a nursing home (based on the 2006 national average) will cost over $62,000 for a semi-private room. One year of care at home, assuming someone needs periodic personal care help from a home health aide (the average is about three times a week), could cost almost $16,000 a year. I’ve seen folks spend close to $100,000 per year on 24-hour in-home care.

When my father died in 1989, my mom invested what he left her and did well. She thought she had planned for everything, including adjusting her expenses to be comfortable for many years. The one thing she didn’t plan for was an illness that required long-term care, where all expenses are paid privately. While she was fortunate that my father planned for her, the growing expenses continue to be a growing burden. Each year, the financial-related stress increases.

I’ve spoken to many people in similar situations. Those who don’t have the financial ability to pay for their assisted living solution, through asset allocation or long-term care insurance may find themselves forced to depend on their family to pay their bills – and that can be devastating.

It is imperative that you assess where the money can be found to implement any forthcoming decision regarding a specific assisted living location and I urge you to do so early on in the process.

What are the costs of long-term care?

And costs for long-term residential care services vary greatly depending on the type and amount of care, the provider, and in which state your loved one resides.

It is a surprise to some that ordinary health insurance policies and Medicare usually do not pay for long-term care expenses. I repeat: ordinary health insurance policies and Medicare do not pay for long-term care expenses.

Medicare pays only about 2% of all nursing facility costs, and nothing at all for residential care. Medicaid, a federal/ state health insurance program, will only pay for long-term care if the person has already spent most of their savings or other assets, and Medicaid pays nothing at all for assisted living or residential care facilities.

The average stay in a long-term care facility, according to the government findings, is about three years.

Private Long-Term Care Insurance

According to the U.S. Department of Health and Human Services (2007), at least 60 percent of people over age 65 will require some long-term care services at some point in their lives. The Department estimates that about 12 million Americans over the age of 65 will need long-term care services by the year 2020. This same study found a person may need long-term care services at any age: Forty percent of people currently receiving long-term care are adults 18 to 64 years old.

At costs ranging from $60-100,000 a year, you can easily see why Long Term Care insurance is of interest to many Americans – but as you age, it can become prohibitively expensive. According to Dianne Duva, Certified Financial Planner and Senior Financial Advisor for the JWS Group, Merrill Lynch, there’s a ‘sweet spot’ for purchasing this coverage: that optimal age where you’re not so old that such coverage is prohibitively expensive, and not so young that you’re paying needlessly for insurance you won’t use for many years.

Policy Parameters

Benefit Amounts: Policy benefits may be paid on a daily, weekly, monthly, annual or other basis. For example, a policyholder may receive $100 per day to cover their nursing home costs or $350 per week for home health care. It is important to know the average cost for nursing home care in the area before selecting a benefit amount for your loved one’s policy.

The Elimination Period: Most policies include an elimination period of 20, 30, 60, 90 or 100 days. This means that a policyholder will not receive benefits until after the elimination period has passed. Policies with longer elimination periods cost less than policies with shorter elimination periods.

The Benefit Period: This is the length of time that benefits will be received from the policy. Benefit periods can range from one year to life.

Lifetime Maximum Benefits: Most plans have a total maximum benefit paid over the length of the policy’s duration.

Inflation Protection Rider: Without inflation protection, policy benefits may be much lower than what is actually needed down the road to maintain your loved one’s standard of living.

Naturally, your loved one may not have had the opportunity to purchase such a policy. After all, we’re talking about “at-need” situations, not “pre-need.” If your loved one needs assisted living right now; paying for it has become a major issue in the present.

What’s next?

It’s time to look closely at your loved one’s assets and income. When families get together to talk about money, emotions can run rather high; it may prove useful to bring in the family attorney, accountant, or other objective third party to assist you.

You’ll quickly discover (unless your loved one has been extremely attentive to these details) that the financial and ownership records you’ll need are to be found in different places: safety deposit boxes, checking or savings accounts in different banks, stock portfolios held by different brokers; pension records, mortgage documents, deeds of trust. It’s time to get them all organized and accounted for.

Photo Credit: Images_of_Money

10 Benefits of Culture Change on Skilled Nursing

Culture Change (also known as person-centered care or resident-directed care) transforms the traditional long-term care model from medical facility to a supportive home environment.  This movement is designed to change the overall mindset and environment of nursing homes into personal communities.  Culture change is designed to nurture the human spirit of aging residents as well as take care of their medical needs.  Its focus is on both quality of care and quality of life as guiding forces for improved life experience and life expectancy.

Within the culture change model, seniors have more privacy and choices, much like they would in their own homes.  They are given more control over their daily lives including meal and bed times and the caregivers are given more autonomy to care for residents in this flexible environment.  Residents’ needs and preferences come first, and care community operations procedures are shaped by this perspective.  Even the physical structures are changing from large hospital-like units to smaller communities resembling more of a group-home atmosphere in which they are cared for by a dedicated team of caregivers.

10 Benefits of Culture Change

  1. Respects the right of the resident to make their own decisions and honors their need for control over choices in their daily lives.
  2. Reduces boredom and helplessness in residents.
  3. Improves mental health (reduces loneliness, depression, behavioral issues).
  4. Encourages a personalized home atmosphere by allowing residents to create their own living style in their rooms.
  5. Increases enjoyment and life expectancy of the patients.
  6. Focuses on using person-centered language that respects and honors the patient by putting the person first and then the characteristic second.  For instance, instead of a wheelchair-bound resident, the description is modified to a person who uses a wheelchair for mobility and instead of a feeder the patient is referred to as someone who needs assistance with dining.
  7. Focuses caregivers on person-centered care, rather than completion of tasks.
  8. Individual care focusing on personalized needs and preferences of the staff and the residents creates a supportive environment that puts people first, over the facility.
  9. Promotes a dedicated team approach rather than rotating assignments for staff thereby creating personal connections and familiarity for the residents.
  10. Creates a team-building environment for the staff based on consistency of staff teams.
  11. Reduces employee turnover which in turn keeps a steady team of familiar faces rather than the need for temporary staffing agencies with training needs and learning curves.

The essence of culture change is about transforming philosophies and management style so that aging is no longer synonymous with decline and illness.  The principles of culture change are founded in a new way of caring and being cared for that is based on choice, creativity, and flexibility.  The future of culture change lies in the commitment to improve resident and staff quality of life through empowerment.

For more information on the culture change movement, visit the Pioneer Network.

Photo credit: K?vanç Ni?

Start Saving Now – Assisted Living Crunch Predicted

Americans are getting older – in fact, way older. We are on our way to a profound shift in our population; one which will have costly impacts on our nation. The U.S. Census Bureau projects  that by 2030, when all of the nation’s 76 million surviving baby boomers will be 65 and older, nearly one in five U.S. residents will be 65 and older. This age group is projected to double by 2050, increasing to 88.5 million from the 38.7 million we currently have in 2008. The Census Bureau projects that the 85 and older population growth will be even bigger, tripling from 5.4 million in 2008 to 19 million in 2050.

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Long Term Care Series – Part 4: Preserve Your Choices

Patrick Cloyd has already shared with us the financial importance of long-term care (LTC) and illustrated the gamble one takes by not having it. As I mentioned in a previous post, my family has scars on our backs from not having this important protection.

In the final part of our series on LTC insurance, Patrick asks you to consider some critical questions as you decide whether or not LTC insurance is right for you.

Preserve Your Choices with Long-term Care Insurance

By Patrick Cloyd
State Farm® agent
(410) 766-4488

Choices. Most people value the ability to make choices. Whether choosing the car you drive or where you live, choices mean flexibility. You probably want that same flexibility when making choices about your future – especially when it comes to health care. Having long-term care insurance will help preserve your ability to make these important choices.

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Prudential Cost of Care Report: Assisted Living Rates Continue Climb

The folks over at Professional Caregiver posted a great summary to a recent Prudential Cost of Care Report.

By the year 2030, the number of Americans aged 65 and older is expected to reach over 71 million, or almost 20% of the entire U.S. population.  As the population ages the need for care is expected to grow with it, and recent studies continue to show increases in the cost of long term care throughout the country.

A recent Prudential Insurance report found the average daily cost for an assisted-living facility is now more than $100, or $3,241 per month.  The report examined both assisted living and nursing homes, but found the largest increase in cost of care in AL, increasing about 13% since 2006.

Read their full post.

Download the Prudential Report.