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Sorting through the long-term care process

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GINA R. HEINE
July 12, 2008
— When the supervision and time required to care for parents or grandparents goes beyond a family member, it's easy to get lost and stressed in the plethora of long-term care options.

One of the first resources families seek is Julie Seeman, a certified information and assistance specialist with the Rock County Council on Aging.


"My call volume increases every month for people looking for care," she said.


Everything fell into place recently for Shirley Burns, 58, and her family when they looked for long-term care for her mother, Lorraine Vindedahl, 81. When doctors diagnosed Burns' father with cancer early this year, Burns knew her mother, who has Alzheimer's disease, couldn't live alone at home.


The family was pleased with the staff and tour they received at Huntington Place in Janesville—the first place they called after looking in the Yellow Pages.


Burns' father died in February. A month later, her mother moved into an assisted living apartment, and her parents' Stoughton home sold 10 days after it was placed on the market.


"We really lucked out," she said.


But finding long-term care for a loved one isn't always that easy.


If you will be helping a family member or friend or looking for yourself, here are tips and resources to guide you through the process of finding long-term care.


When to move


Deciding when a parent or grandparent needs additional care can be sensitive. Adult children need to have a heart-to-heart talk with the parent, Seeman said.


Family members should watch for signs that more care is needed. When a family member notices the person spilling food or cleaning house less, for example, it could be an indicator of a health issue such as poor vision, Seeman said.


"The adult child needs to hear issues and figure out why they're happening," she said.


Often, a doctor's exam is needed to determine needs, she said.


Seeman provided other signs to watch for:


-- Poor personal care, such as not taking a bath or not changing clothes.


-- Weight loss.


-- Unkempt house.


-- Phone or other utilities turned off.


-- Bills and envelopes lying around.


-- Problems managing medications.


Families should start thinking about a move before a crisis, said Carrie Kirkpatrick. She works with families in south central Wisconsin as an eldercare adviser with A Place for Mom, a national eldercare referral service.


Before a crisis, a family can look at all the options that best fit its needs instead of only the ones that have immediate openings, she said. But she acknowledged that it's not always easy because the person needing care might resist.


"Sometimes, folks just aren't going to be open to that unless there is a crisis," she said.


Burns had never talked about different living options with her mother, but she knew her mom would need assisted living at some point. Things became serious when her father was diagnosed and needed surgery.


"Then, there was no choice," Burns said.


"Just bring the barriers down and talk with your parents about it," she said. "Know what they want. … If at all possible, talk about it in advance while they're still in good health to find out what they want."


Finding the right fit


Adult children often come to Seeman ready to jump into the process and say, "Mom needs a nursing home," she said.


But people don't know all of the options, she said.


"People forget to ask, ‘What does Mom want? What does Dad want?'" she said.


Burns became familiar with the options when her father-in-law, who also had Alzheimer's, needed a nursing home. She knew her mother wasn't ready for a nursing home and wanted to have the fewest restrictions possible, she said.


"I knew that Mom was at a point where assisted living was all she needed," she said.


Cost is a factor because no governmental agencies pay for assisted living, Seeman said. If assisted living isn't feasible, options are available for the elder to stay at home, go to an independent apartment or a nursing home, she said.


"(You have to) look at all the options, look at finances, then decide which options are feasible," she said.


A Place for Mom offers its consulting services free to families, said Kirkpatrick, who works to try to reduce the amount of stress and uncertainty in the process.


She helps families evaluate the many placement factors that include physical needs, geographical parameters, timeline and finances. Eldercare advisers then narrow the options to three to five so the family can tour at least two to three, she said. Private services such as hers assist in scheduling tours, providing questions to ask and other logistical tasks.


"We want to try and make them aware of all the different kinds of resources that may make sense," she said.


One option often overlooked is smaller adult homes, which can be nice fits and are becoming alternatives to skilled nursing, she said.


Seeman recommends doing an unscheduled visit at a potential home, staying for a meal and chatting with residents and families.


Costs


Previous generations often were able to leave sizeable inheritances to their children, Kirkpatrick said.


"It is becoming less and less likely that families will be able to do that," she said. "So that, I think, is a big change in the mindset. Unless (your) family is very wealthy, you are going to need your personal savings to fund longer-term care."


And cost will limit your choices.


The reality is if you don't have private funds and you need to be on Medicaid to get long-term care covered, you'll have fewer choices, Kirkpatrick said.


"That's a tough reality for some families," she said.


Each nursing facility is different and decides how many beds are private pay or Medicaid funded, which sometimes can make it hard to find an opening that meets your payment plan at a desired facility, she said.


Skilled nursing can cost $7,000 to $8,000 a month, and the majority of residents eventually end up on Medicaid, Seeman said.


Medicare only covers short-term care and does not cover long-term care, but Medicaid does, she said. If a person meets the financial criteria, Medicaid would kick in right away for nursing homes, she said.


Whatever income a person makes would go to the nursing home, and Medicaid would pick up the difference, she said, though some assets are taken into account and put toward payments.


Assisted living can cost $3,000 to $4,500 a month, Seeman said.


That's the base price because assisted living usually is like a buffet, she said, where the price increases with additional services.


Assisted living facilities are open to private payers, and Burns said her family is lucky to have parents who planned well with investments. Her parents paid off their home years ago, so the money from the home sale is paying for her mom's long-term care, she said.


In-home care generally is provided to private payers, but the care can be bought in increments of as little as an hour a day, Seeman said.


Other payment options that people sometimes forget are veterans benefits and long-term care policies purchased years before the need, she said.


Seeman said the only other funding available through her Council on Aging office is the Community Options Program, a statewide initiative to provide funds for people who need long-term care.


"That's really the only funding," she said.


That program has a six- to 18-month waiting list, she said.


"Now in our county, (there's) very few resources to pay for in-home care or assisted living," she said. "So it's all about, unfortunately, what they can afford."


NURSING HOME VS. ASSISTED LIVING

Skilled nursing homes


A person fit for a nursing home would require around-the-clock care, said Julie Seeman, a certified information and assistance specialist with the Rock County Council on Aging. Such a person would require a high level of care—“someone who just can't care for themselves,” she said.


A doctor has to certify that the person meets the requirements for a nursing home, she said.


There used to be waiting lists for many nursing homes, Seeman said, but that seems to have subsided recently except at some of the more popular facilities. For example, St. Elizabeth's in Janesville has an “extensive” list that can leave people waiting a short amount of time up to more than a year, said Laura Williams, a social worker there.


Eleven nursing homes serve people in the Rock County area, including ones in Fort Atkinson and Stoughton, according to the Council on Aging's database.


Assisted living


Assisted living facilities comprise three types licensed, certified or registered by the Department of Health and Family Services. The main difference is how many people each facility serves. They are:


-- Community based residential facility: A place housing five or more adults who do not require care above intermediate level nursing care. Treatment or services are above the level of room and board but include no more than three hours of nursing care per week per resident.


More than 20 community based residences exist in Rock County, including several with Alzheimer's/dementia specialty, according to the Council on Aging's database.


-- Adult family home: A place housing three or four adults whose treatment or services above the level of room and board include no more than seven hours of nursing care per week per resident.


Janesville has one adult family home, according to the Council on Aging's database.


-- Residential care apartment complex: A place housing five or more adults in independent apartments, each of which has an individual lockable entrance and exit, a kitchen, bathroom, sleeping and living areas. The tenants require no more than 28 hours per week of services that are supportive, personal and nursing services.


Registered care apartments serve only private-pay tenants while certified care apartments may serve tenants who are eligible for public funding.


Rock County has six residential care apartment complexes, according to the Council on Aging's database.


Who do assisted living facilities serve?


People served by assisted living facilities include, but are not limited to:


-- The frail elderly and elderly people with dementia.


-- Developmentally disabled.


-- People with a controlled mental or emotional disorder.


-- People recovering from chemical dependency.


-- People with physical disabilities.


-- People with traumatic brain injury.


-- People with AIDS.


-- Pregnant women needing counseling.


Source: Wisconsin Department of Health and Family Services
WHO CAN HELP?

-- The Rock County Council on Aging, Information and Assistance can be a first step to finding resources for older adults in Rock County. Call (608) 758-8455 or visit www.co.rock.wi.us/Dept/Aging/Aging.htm.


The council provides listings and phone numbers for home and community-based services, and information specialists are available to help you.


-- United Way's First Call: In Janesville: (608) 752-3100; in Beloit: (608) 363-8800; in Evansville: (608) 882-9966.


-- Hedberg Public Library, 316 S. Main St., Janesville, (608) 758-6588, www.hedbergpubliclibrary.org.


-- Mercy Health System's Senior Connection: Call (608) 741-3810 or 1-800-279-6886.


-- Private businesses such as A Place for Mom, which offers free consulting for families looking for care. People can fill out an assessment form at www.aplaceformom.com or contact eldercare adviser Carrie Kirkpatrick, who helps families in south central Wisconsin, at 1-866-333-6252.


-- The U.S. Administration on Aging provides a national eldercare locator at www.eldercare.gov/eldercare/Public/Home.asp.



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