Fortunately, there are resources available to you and you do not have to make this difficult decision alone.
Having a clear understanding of your loved ones wishes and knowing what is important to them in their later senior years is the first step to determining the right level of care they will require or want.
Many people avoid the difficult conversation of advanced care planning and never speak to their parents or family members about what may happen as they age. Although aging is an inevitable part of life, planning for a time when we are not able to care, or possibly make decisions, for ourselves if often too uncomfortable and frightening for many people to face. But it doesn’t have to be.
The California Care Planning Council has fantastic resources available on their website, including planning tools, such as a Guide to Long Term Care Planning and Descriptions of Care Services.
The Coalition for Compassionate Care of California also has great tools to support advance care planning conversations to help you and your loved one make a plan for the future.
These resources can assist you in preparing before your loved one is in a crisis. Knowing your parents wishes while they are still happy and healthy is important. There may come a time when your parents are unable to communicate their wishes due to a debilitating health event or cognitive decline, and you will be left to make care decisions quickly and without delicate consideration.
Questions to consider when determining the right level of care for your aging parent or loved one may include:
- Do they require assistance throughout the day?
- Is their memory impaired? Do they have (or show early signs of) dementia or Alzheimer's?
- What are their medical needs? (doctor visits, taking medications, etc…)
- Which activities of daily living can they perform themselves (eating, bathing, personal care)?
- What level of care are you comfortable or capable of providing?
- What resources do you have available?
Know Your Care Options
Understanding the different care options that exist for aging seniors, as well as the level of care each provide will help you and your loved on to make an informed decision. Here are some of your options:
According to Senior Living, 90% of seniors want to stay in their homes as long as possible, a goal that can become increasingly difficult with age. Fortunately, home care provides medical and social support to individuals living within their own home, and reduces the risk of serious injury, as well as the number of visits to the doctor by 25-50%.
There are many different types of home care which vary based on the needs of the person. Everything from nurses, to physical therapists, to non-medical practitioners like personal care attendants offer care at home.
Home care attendants can also help seniors with personal care tasks, such as getting dressed, using the shower and making meals. They can also help with housekeeping and other day-to-day chores.
You can help to ensure that your loved one is safe at home by making it more accessible and safe:
- Install handrails, secure carpets and take other steps to reduce the risk of falls
- Invest in an emergency response system
- Regularly discuss medical needs such as taking medications
- Help them maintain an active and social lifestyle
- Take on the role of caregiver (but be sure to attend to the emotional and financial stress that caregiving often causes).
The California Department of Social Services offers an In-Home Supportive Services (IHSS) Program that helps to pay for services to allow seniors to safely remain at home. Those who meet the eligibility requirements are able to access a variety of services free of charge or at subsidized rates. IHSS is considered an alternative to out-of-home care, such as nursing homes or board and care facilities.
Assisted Living is another form of hybrid care that bridges the gap between home care and nursing homes. According to the California Care Planning Council, before assisted living was available a person needing professional care went to a nursing home, even though the level of care they required didn't always merit the intensive supervision and control of a nursing home.
Assisted living is a great in-between option. It generally has a homey, apartment-style atmosphere with private suites, lounges, fireplaces, gardens, atriums, etc.
At assisted living communities, there are often one or more large banquet-style dining areas with music or other forms of entertainment during and after mealtimes. Meaningful activities and social outings keep many residents active and stimulated, and there is a large emphasis on fostering independence. Twenty-four hour medical assistance is usually available onsite and can support residents with activities of daily living and medication administration.
Some assisted living facilities and nursing homes specialize in Memory Care for residents with Alzheimer’s and dementia. The level of care provided is designed to meet the specific needs of individuals with memory impairments and is based on the progression of the persons disease.
Alzheimer's facilities often emphasize 24-hour supervision and have locked entrance doors to prevent residents from wandering. In some residential care facilities, Alzheimer’s Special Care Units are integrated. Such units most often are cluster settings in which persons with dementia are grouped together on a floor or a unit within a larger residential care facility.
Continuing Care Retirement Communities
Continuing Care Retirement Communities, or CCRC’s, are designed to offer long-term continuing care, including housing, residential services and nursing care, for a person’s lifetime. This type of care is intended to meet all the needs of a person 60 years of age and older as they age and become more dependent. CCRC’s often include all levels of care, including acute care and physicians' and surgeons' services. People are often required to sign a contract and enter into an agreement to receive continuing care, and a hefty price tag is often attached.
Nursing homes, also referred to as skilled nursing facilities, long-term care facilities, or custodial care, are often the best option for individuals who require ongoing, or round the clock nursing care and supervision. This care can be acute for people recovering from injuries, illnesses or postoperative care needs, or ongoing for residents who have chronic illnesses and long-term care needs.
Nursing homes are licensed by the state of California and regulated by the federal government, and approximately 98% of nursing home residents use Medicare as their primary insurance provider.
The California Department of Aging offers a Long-Term Care Ombudsman Program that is authorized by the federal Older Americans Act and its state companion, the Older Californians Act. According to the State of California, the “primary responsibility of the program is to investigate and endeavor to resolve complaints made by, or on behalf of, individual residents in long-term care facilities.”
Finding the right level of care can only happen when you talk about it openly and ask the right questions. The above facilities and care options are great resources, intended to ensure your parents receive the appropriate level of care they need when living independently becomes too much.