Aging parents will reach a stage in their lives where families begin to question if living at home is best or should their aging senior move into assisted living. It’s a valid question and one that deserves a lot of attention and consideration. But, before families make the decision to move their loved ones into a facility, there are definite questions that need to be sought out and answered.
What is assisted living? Honestly, there’s not a real definition by industry standard. It varies from state to state. The best explanation for assisted living is a facility with limited care. Most are not licensed for medical care like a nursing home. It’s important to understand assisted living facilities are not medical care facilities. For lack of better words, we can dumb down the explanation to this: Assisted living is group home living where residents can perform all the necessary assisted daily living skills (ADLs) with minimal help. The general rule for assisted living is, that in the event of an emergency, a resident must be able to remove themselves from the facility (without assistance) within a small time frame. If they cannot, they do not qualify to stay.
Assisted living facilities perform levels of care for residents from those who simply need daily monitoring to those who require assistance with personal care. Residents rent a room or small apartment where they can either cook for themselves or join others in a dining room area for meals. There is usually an RN or LPN on staff in the event of an emergency and who, if the service is needed, will regulate and distribute medications to residents. Those who live in assisted living facilities are fairly mobile and are charged according to the needs.
For example, if you require house cleaning, you may be charged. If a resident needs a higher level of care, i.e. assistance with a bath or dressing, they may be charged a higher price. Should they need transportation, this is additional as well (however, it’s fair to say this service will vary from facility to facility. Some provide transportation as part of the basic package while others charge per month or even per ride.)
Independent care living – It’s important to understand the difference between independent care living and assisted living. The best explanation for independent care living is: A group retirement facility or community – a place where seniors in good health can retire to be with friends their own age. They generally pay a homeowners association fee so their home maintenance is provided. They are able to maintain their own care in its entirety, able to function and drive without help. Cook, clean, bathe – all the things they would do in their home on Maple Street.
Some “communities” allow seniors to purchase condos, small homes or even build within a gated community (this instance requires in-depth understanding of the rules of habitation). They can sell their dwellings to other seniors should they come to a point where their care moves to the next level. It’s important to read every line on independent care contracts and notice where the line is drawn in the sand as far as qualifications to remain living in the facility/community.
Many pre-built homes, duplexes, condos or apartments revert back to the owners of the facility/community upon the death or the need for the resident to move away. Wording can be misleading and so can the sale of the properties. Potential residents may be told they are “purchasing” an apartment, condo, or duplex when in fact, it’s a glorified way to say leasing or renting. The purchase may even resemble the purchase of a home with a down payment and monthly payments, and a closing). The greatest surprise may come when independent care facilities or communities see residents growing frail and begin to push residents out, informing them there is no refund or resale on the property. Instead it reverts back in its entirety to the facility or community. This happens more in independent living facility complexes with apartments or condos but it’s important to know, it happens all the time. Read the contracts in their entirety. Invest in a visit with an attorney to read and understand the jargon and wording so your aging parent is not surprised when their needs shift and they are asked to leave. If there are HOA fees, verify they are yearly and not an extravagant amount monthly. To live in an independent care facility, residents must be fully able to maintain their own care completely. If that changes, they will be asked to move.
Seniors BEWARE! – Assisted living, independent care living, and nursing home facilities are expensive. Unfortunately, insurance does not cover what families assume it will. There is no coverage for independent care living and often with assisted living, there is little to no coverage. Families cannot depend on receiving financial assistance from resources, i.e. Medicaid. If seniors have Long Term Health insurance purchased early in their lives, they will receive some payment here, but as a rule, most insurance companies will pay limited amounts on assisted living facilities but far more on nursing home facilities when their resident requires full medical assistance and care.
Facilities are beautiful. Their lobbies are adorned with lovely flowers, pretty furniture, and smiling faces but none of that bears any thought to what actually goes on behind closed doors. Pay attention to the staff. Make unscheduled visits. Does the staff know the residents names, are they interactive, kind, and attentive? Talk to residents. Are they happy with their care? Seek outside references. Ask past resident’s families about hidden charges or unexpected financial surprises. If ever there was a time to be due diligent, this is it.
In fairness to facilities, it’s important to know there is a horror story for them all. There are few businesses who are incident free. However, 98% of these facilities are wonderful and provide great care. There are those residents and family members who are demanding and are simply unable to please. You, however, can look at the overall picture and get a good feel. Bottom line. If you walk into a facility and your gut says no. Stick with your gut. Instinct follows us for a reason. Listen to the nudge should you feel it.
In-Home Care – The question that rises within families is this: “Why pay for an assisted living when we can get someone to stay at home with our folks?”
It’s a valid question and one that deserves an answer. It is a proven statistical fact that seniors thrive in their own homes. Their own home is familiar and it gives them a sense of holding on to some control in their lives when their cognitive and physical abilities begin to slip away. Educating yourself is still important.
Private caregivers are a dime a dozen. Many are wonderful. But few, if any, meet state and federal regulations for in-home care. There are a few pros. Family members, friends, or someone’s best friend may be willing to care for your senior for a reasonable hourly rate. They will help manage the household chores, take seniors to appointments and provide companionship.
The cons: Many private duty caregivers take pay without paying income tax. Senior’s families are required to provide a 1099 to the caregiver and to pay Social Security/Medicare taxes to the state. Families can be sued if a caregiver is injured because homeowners insurance does not cover paid employees. This injury falls under workman’s compensation. Caregivers can call out and leave families in a bind with no one to care for their parent when they are required to go to work. Eldercare abuse, elder scam and thievery are at a higher rate because no background checks are done. Medical procedures are performed (i.e. sugar tests, feeding tubes, wound care, or injections) with no supervision and limited training. Important warning: This not acceptable by most states governing authorities and families tread on dangerous ground when they allow these procedures to be performed by non-medical personnel.
In fairness there are many private duty caregivers who provide excellent care for aging parents. Either way, this is a job that is regulated by the State and if your caregiver is not licensed, paying the taxes due the government, and receiving continued training, then families and the caregiver run the risk of being called out by the state.
The truth: Cheaper is not always better.
In-Home Care Companies – There is security in hiring a caregiver through a company. First and foremost, caregivers are screened with background checks, credit checks, and motor vehicle driving records to provide the safest care possible. Companies are regulated and licensed through the state. This forces the highest level of care possible. Should a caregiver be ill and need to call out, companies can provide a replacement so families are not left in a bind.
In-home companies provide workman’s compensation. They provide W-2’s, assure federal and state income taxes, Social Security and Medicare taxes are withdrawn. Companies have liability insurance, provide full background, credit checks and motor vehicle reports on all caregivers, and caregivers are bonded. When all is said and done, in-home companies allow aging parents to remain in their homes as long as possible with exceptional care provided. Cost comparison on a senior who requires 24/7 care runs slightly less to equal to assisted living.
All things said, when it’s time to consider living situations, be pro-active. Do not hesitate to research every aspect of the facility or company you are considering. Understand the cheapest route may end up costing you the most due to hidden fees and agendas. Do the homework and find the facility or company that best suits the needs and care level of your aging parent.