Ask a Care Manager: What you know, what you don’t

Bert made the phone call after copying down the 800 number shown during the commercial. He was worried about his mother since his father’s death and this might be the answer. She was elderly and lived in the family home several miles out of town. Plus, they said, “No cost, no obligation.” They could help with placement and give him the help he needed. Mom has refused to discuss having any help.

You know the ad. It’s on radio and TV all the time about the costs associated with long-term care. The sound bite quotes alarming statistics about nursing home costs. They offer to help you for free, the first red flag. Those misleading ads are correct in one aspect: Placement long term in a nursing home costs is expensive, from $60,000 to 75,000 each year. What they don’t bring up are two things: (1) People want to remain at home. No one wants to move into a nursing home; (2) There are other less intrusive and less expensive options to placement (nursing home or assisted living) that give the person the needed help and support. The family however is not convinced and continues to look for placement because, “She’ll be safe and we won’t have to worry anymore.”

The family with all good intentions continues the search. “Well, maybe I don’t really need a nursing home,” the patient and family say. “I hear an assisted living facility is cheaper and they can be really nice.” They hear about a placement agency that will help them for free. They call and a representative begins taking them to assisted living facilities that they feel are appropriate for your loved one. (What they don’t tell you is that they contract with the assisted living facilities and get a “kickback” commission of 50 to  75 percent of the first month’s fees if you place Mom in their facility.

So the family begins looking for an ALF as they’re called and finds one that will take “Mom” for a base fee of $2,500 per month. Mom is assessed as a Level 1. So Mom moves in and takes a fall a week after she’s there. She’s a Level 1 so should need no assistance but now she does. The ALF now sends an aide to be with her three to four times a day and adds $300 a month to the bill. Her level of need goes up based on the ALF assessment. If Mom needs help with her showers now due to being a falls risk, the ALF adds another monthly fee for assisting with showers. Do you see where this is going? Before you know it, the monthly costs have escalated to $5,000 a month and continue rising. Mom still wants to go home and it’s become very expensive. What is the answer?

Making decisions about moving and placement should not be taken lightly. Looking into what’s available and appropriate is good so as the discussion about “more help” moves forward, everyone (including the older person) understands the options. When faced with some help in her home or moving into an assisted living home, Mom may grudgingly agree to have someone in to help her. She’ll find (as will her family) that having someone to help out and support makes a huge difference in ongoing independence.

Let’s talk about this alternative that is available in the marketplace but not touted by actresses on national TV. Very effective, around for a number of years and in the great majority of cases less expensive, it’s called care in the home, your home. Home care, if set up correctly, is tailored to the needs and wishes of the individual and he or she remains in their home setting, where they want to be.

If you need someone to help prepare meals, that person will cook meals “your way” using your ingredients and with your help. You sleep in your own bed, are able to keep your treasured cat or dog with you and go to church or the grocery store on your timetable. You can invite your family and friends over or have someone take you to their house if you no longer drive. It’s your life, your home, your schedule — not a nursing home or an assisted living’s schedule. In-home care providers are there to help you with all the everyday chores that need doing plus remind you about medications and help you remember appointments. Once an older person is willing to accept the help, the relationship that develops is valued.

If it is less expensive to receive care in your own home, why would you or your family want you to move into a facility? You do not receive one-on-one care in any facility. Depending on licensure requirements, placement staff will have responsibility for multiple clients not just you.

Dorothy’s husband died recently and her children are worried about her being alone. They are pressuring her to move but she’s not ready to make that kind of decision. She does need some help as she cannot drive any longer, needs someone to remind her about her medications and be sure she’s eating a cooked meal once a day. If Dorothy would be willing to accept this part-time help, the solution would ease the children’s minds and give Dorothy someone to talk to and help out on a regular basis. This kind of part-time help in a person’s home is just exactly what can help an older person remain independent in their own home and for a fraction of the cost.

Family might worry how they would find a good, honest, reliable person to help. It may be that they think if you move into a nursing home or assisted living facility you will be safe, not fall and be happier than staying in your own home. That’s likely not to be the case. Older adults want to remain in their own homes for the duration. If you as the older adult are willing to make some slight changes, look for a reputable agency that specializes in home care services. You’ll find it’s a good solution.

Carol S. Heape, MSW, CMC is CEO of Elder Options, Inc. serving the serving the Sacramento Region since 1988.

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Posted by on Mar 13 2014.
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