I'm Looking to Start a New Chapter in my Life. What Should I be Doing?
To begin, you must determine what your needs are. This would include such things as:
How Can I Prepare My Safety Net From a Position of Security?
The truth is none of us can predict our personal future or that of a loved one. Early planning provides us ways to protect our property and maintain our well-being. It's better to prepare for your future from a position of health and security than to wait for a crisis and make decisions in grief or haste.
What Issues Should I be Most Concerned With?
There are many. A partial list includes:
Be aware of your overall health, your problem areas, and your future risks. Take all necessary precautions, including physical and mental workout as well as diet. Secure a good physician and hospital that you trust with your personal health. Your physician will evaluate your diet and exercise needs as well as other influences on your health. It is never too late to begin an exercise program or to give up bad habits. Working with your trusted specialists can add years of active living.
Do what you can to become educated on all matters concerning your finances. Some things to consider include:
You cannot rely on Medicare to cover all payments, despite the revisions made in the area of health care coverage. The cost of nursing homes, long term care, assisted living or private nursing care must be considered and planned for. Opportunities available through retirement plans, insurance riders, and state programs should be obtained and studied with a trusted financial advisor.
These should be attended to when you are of sound mind and in full control of your possessions. Protecting your personal property and finances is imperative so that they are available for your care when needed. When you are not competent due to ill health, you may not be able to initiate the legal documents necessary to allow a friend or family member to handle your affairs. Now is the time to explore who will have your power of attorney to execute decisions on your behalf when you are incapable of doing so. You should also consider the implications of a living will.
Determine what housing alternatives would be acceptable and available to you should your independence be threatened by illness, disability, or loss of income. Visit locations in your community and make your plans known to your family. Safety, security, cost of upkeep, accessibility, types of residents who share the facility, and even geographic location are important considerations. Assuming that someone else will make a decision to your liking when the time comes is unfair to that "someone", and risky to your future peace of mind. Being informed about deposits, waiting lists, nursing standards and eligibility requirements will lead to a good feeling of control over difficult decisions.
Activities and Lifestyle
As studies have shown, one of the secrets to longevity and health is a peace of mind found through renewed or continued interest in the world and its activities. Whatever your passions or hobbies, seek out furthering your education, get involved in artistic endeavors, correspond with a pen pal, or start a new business.
This is a general term for surrounding yourself with friends, relatives, and resource persons that will serve to inspire you, keep you vital, entertain you, and who will be available when help is needed. This is an area often neglected by seniors, especially after the passing of a spouse. Making plans for your future in later years deserves the same attention, excitement and positive outlook you gave to choosing a college, planning for children, and your career. A safety net of information about health, finances and legalities while continuing to develop personal interests and friendships will support and sustain you through times of difficult decision making.
What are the Different Types of Living Facilities Available for Seniors?
Facilities are organized into the following categories:
Often referred to as Retirement Communities, Congregate Living or Senior Apartments, this is a residential living setting for elderly and senior adults that may or may not provide hospitality or supportive services. Under this living arrangement, the senior adult leads an independent lifestyle that requires minimal or no extra assistance but offers the security and conveniences of community living. Independent living also includes rental assisted or market rate apartments or cottages where residents usually have complete choice in whether to participate in a facility's services or programs.
Some independent communities offer organized social and recreational programs as a part of everyday activities (Congregate Living or Retirement Communities), while others provide housing with only a minimal amount of amenities or services (Senior Apartments).
Prices for units in these communities generally depend upon local market conditions. Most communities that provide services are market rate, but some subsidized senior apartments cater to seniors with limited incomes. Private Funds are most often used, although some senior apartments are subsidized and accept Section 8 vouchers. Medicare and Medicaid do not cover payment since no health care is provided.
Since independent living communities are independent, health care is not provided as part of the fees. However, many communities will allow you to pay for a home health aide or nurse to come into your apartment to assist you with medicines and personal care.
These facilities are licensed and regulated by the State Departments of Public Health and are individually certified by the State for Medicare and Medicaid. They are available to seniors who do not require acute hospitalization but do need 24-hour skilled care. Some of what is provided includes:
The Nursing Home's medical staff sets them apart from other types of senior housing as care is provided by registered nurses, licensed practical nurses, and nurses aides at all hours of the day. Facilities include:
Depending on the facility, some of these services may have extra charges associated with them.
Questions to Consider
When selecting a nursing home, ask the following questions of the administrator or admissions coordinator:
Nursing Home facilities generally charge a basic daily or monthly fee. In most cases, however, residents and or their families will have purchased long-term care insurance in anticipation of the cost or seek alternative forms of financing. These facilities do accept a variety of Medicare, Medicaid, private insurance carriers, and private funds.
There are three care programs. They are:
Continuing Care Retirement Communities (CCRCs)
Generally, CCRCs are communities which provide several levels of continuum of care for elderly persons. This continuum of care is sometimes referred to as the levels of care and may include the following:
CCRCs are different from other housing and care facilities for seniors because it usually provides a written agreement or long-term contract between the resident (frequently lasting the term of the resident's lifetime) and the community which offers a continuum of housing, services and health care system, commonly all on one campus or site.
Questions to Consider
If you are thinking about a CCRC, the following are some questions you might want answered:
CCRCs offer a variety of residential services, including the following:
The agreements or contracts used by CCRCs differ, but are generally based on the health care provided. The three most common types of health care coverage in the CCRC agreement are listed below.
The three general types of payment or fee arrangements are:
Monthly fees generally cover the following:
Active Adult Communities
The terms "Active Adult", "Senior" or Resort Communities, refer to rental communities where you must be 55 years or older and sometimes 62 years or older to live. These options are designed specifically to attract "age qualified" retired persons and those nearing retirement age who wish to get a start on owning a place where they will eventually retire and who desire the maintenance-free lifestyle. They offer an independent lifestyle in addition to social and recreational activities with older adults.
These communities may offer facilities and amenities such as:
At some point, the needs of the Alzheimer's patient may be too great to continue home care or prior care in an Assisted Living Facility. Transferring to an Alzheimer Care Facility presents the patient with a treatment center whose focus is geared toward supervision. These facilities are part of a new trend to provide specialized care for those with Alzheimer's. Some of what differentiates these facilities from Nursing Homes or Assisted Living Facilities are elements like design features within the facility that assist with the problems associated with this disease such as: color-coded hallways, visual cues, and secure wandering paths for additional security.
Questions to Consider
Similar to Assisted Living communities, most provide assistance with dressing, grooming, bathing, and other daily activities. Assistance with medications differs according to state regulations. Meals, laundry and housekeeping are usually provided within private and semi-private rooms in a residential type setting.
Assisted Living Facility (ALFs)
Assisted Living Facilities are privately owned facilities which provide room, board and limited personal services (such as help with bathing and dressing) as well as access to available community services. ALFs can range in size from a few residents to a facility housing as many as several hundred older adults. ALFs also vary considerably in monthly rent, types of services offered, and physical amenities. Some ALFs accept certain low-income adults who are certified eligible for state-supported assistance as determined by the Department of Children and Families. ALFs usually are appropriate for persons in the early to middle stages of Alzheimer's disease.
ALFs will generally provide a range of services that promote resident quality of life and independence, including:
Questions to consider
If you decide that assisted living is the right solution, consider the following when evaluating the assisted living choices in your area:
While costs vary across the nation, assisted living generally costs less than home health services or nursing home care. The following factors should be considered:
Most assisted living residences charge monthly rates and do not usually have an entrance fee. Many also have daily rates for short-term stays (respite care).
What should I Know Before Choosing a Senior Housing Facility?
Perform a thorough review of the services, operations and finances of the establishment, including a review of their audited financial statements.
Consult an attorney and/or a financial advisor to determine if the establishment is appropriate for your lifestyle and financial situation.
Spend as much time as you can visiting the establishment and try to participate fully in its activities.
Compare Establishments. Do as much research as possible. Make sure that whatever place you choose, your choice is right for you.
Interview residents and staff. Objectively evaluate the services and amenities based on your lifestyle and your condition.
Share the details with someone you know and trust. They might be able to be more objective than you and assist in your evaluation.
What Should I Know About Private Insurance Policies?
Some insurance companies offer private insurance policies specifically for long-term nursing home care. These policies vary widely in coverage and cost, and it is important to understand precisely what kind of policy you are purchasing.
Make sure the policy being considered does not duplicate skilled nursing facility coverage provided by any coordinated care plan such as Medicare or Medicaid or other coverage already received. Check for any prerequisites required before the company will pay benefits. For example, ask if the company requires that a patient have prior hospitalization before any benefits are paid out. Some diseases such as arthritis-related problems and Alzheimer's do not require hospitalization before the need for nursing care arises.
If possible, seek an insurance policy that pays benefits immediately upon entry into a nursing care facility. Many insurance policies, which are purchased prior to the need for nursing care, require a waiting period after entry into a nursing care facility before payments are made. It is highly unlikely that nursing care insurance can be purchased after a person has entered a nursing care facility.
Another private insurance policy, Medigap supplemental insurance, is designed to close the gap between medical costs and amounts paid by Medicare. However, both Medicare and Medigap are primarily designed for short term, acute care and, consequently, are unlikely to meet the long-term needs of nursing care residents