When your parent can no longer live at home without additional help, here are some steps to take. You are probably feeling overwhelmed but there is hope to navigate through the often confusing options for senior care. The first step is, to assess your situation as discussed below. Then take action.
What type of care will be needed?
This will determine where the care will be provided. For example, if your parent is in the hospital and will be discharged to skilled nursing for rehabilitation, rather than coming home, you’ll need to find immediately a nursing home in a very short time. On the other hand, if your parent can stay at home safely with help, perhaps family members are available for that, or home care can be arranged. The care at home might be for a few hours a day, or it could be around-the-clock. The home care could be ongoing, or you could use it just long enough to find the right care community. Cost is definitely a consideration, since paying for home care is often $20 per hour or more, which means around-the-clock care can be $10,000 to $15,000 per month or more.
If you’re in the hospital, or if you’re considering whether nursing home or assisted living care will be needed, a good place to start is to ask the hospital or your family doctor to prepare an “FL-2 Form.” The FL-2 Form is a summary of the patient’s medical condition, and states what type of care will be needed: home care, domiciliary care (i.e., assisted living), or nursing home care. You can use this as you consider the various care facilities, since it will help the facilities to know what
Where will your parent get care?
Once you understand the type of care needed, you will know where to look. If your parent is in the hospital, talk early with the hospital’s discharge planner to determine whether your parent will be coming home or going to rehab. For home care, there are a number of private agencies to assist. If the only home care needed is therapy, that might be arranged with the hospital’s help as a Medicare benefit. Care beyond therapy is not going to be a Medicare expense however, so you will need to interview agencies and decide whether the cost will fit your budget.
There are PACE organizations throughout the state that provide managed home care. PACE stands for “Program of All-Inclusive Care for the Elderly.” This is relatively new and could be a good option particularly when family is available to also help with care at home. There are both a private pay and Medicaid options for PACE. The North Carolina PACE website has additional information.
Often the move to rehab is done with little time to consider nursing homes. The hospital discharge planner will suggest skilled nursing facilities that have available rehabilitation beds. You should give input about which facility you prefer and also plan to visit the facility before committing. Unless you’re certain that your parent will be coming home soon after a short stay for rehab, confirm with the nursing home whether a long-term care bed would be available after the rehabilitation ends. Nursing homes that have available rehab beds may not be willing to keep your parent for further long-term care, and that is helpful to know up-front especially if your parent may want to qualify for medical assistance through Medicaid.
The other major type of care community is assisted living. This includes both regular assisted living and memory care. In North Carolina, these are considered “adult care homes” rather than “nursing homes” and they are regulated differently, too. Again, be sure to visit, and to explain your parent’s needs for care. Does your parent only need help with medication and meal preparation? Or will help with dressing, bathing or toileting be needed? The assisted living facility’s charges will be based on the amount of care provided. If wandering or other dementia behaviors require, then you may need to consider a memory care area. Not all assisted living facilities offer memory care.
Finding these facilities can be a challenge. You can use our care locator on this site. You can also visit the Medicare.gov site for the Nursing Home Compare page and search engine. You may also find senior living or senior resources guides available as free advertising publications at grocery stores, which often include helpful maps and photos as a place to get oriented. You may also want to check with your local Area Agency on Aging, which has a variety of handouts for facilities for the nearby counties served. Finally, you can download our own booklet listing various assisted living, nursing home and hospice communities in our North Carolina Nursing Home and Assisted Living Guide.
How will you pay for that care, without going broke?
There are only limited ways of paying for long-term care. These include:
- Medicare (for rehabilitation only, and for a brief period of time)
- Long-term care insurance
- VA Benefits, particularly the Aid and Attendance program available for war-time veterans or the spouse of a wartime veteran
- Private pay, including utilizing life insurance policies to finance care
- Medicaid which has strict income and asset guidelines
You should consult with an experienced Elder Law attorney early in this process to consider options for paying for care. This may include accessing medical assistance benefits through Medicaid. The good news is that for a married couple, often nearly all of the couple’s assets can be protected if one spouse needs nursing home care. If your parent owns a home or has investments you should consult with an Elder Law attorney who regularly handles Medicaid application. Otherwise, you may find yourself facing long periods of ineligibility based on potential land-mines in the Medicaid process. Or you might find your application unnecessarily delayed due to misunderstandings of necessary information. While nursing homes sometimes will offer to help file Medicaid applications, the attorneys fee paid to help with the Medicaid application is part of the Medicaid spend-down, and the process often will be easier on you with your own attorney handling the application so you don’t need to even visit the Medicaid office.
Even if your parent has sufficient assets to pay privately for an extended period of time, or can access long-term care benefits it is important to start planning early. Don’t wait a year or two because that delay can be very costly. Get good advice, early, from the right people and you will be glad you did.