The Conversation – Discussing Long Term Care with Parents
Discussing long term care options with your parents can be daunting, but the earlier you can have the talk the better. If you can have the talk while your parents are healthy, they are less likely to make a hasty decision and more likely to think through all their options. The following tips might help ease the talk:
Take Opportunities to Talk.
Rather than jumping right into the conversation, it might be best to wait for your parent to open the door. For example, your parent one might mention a problem around the house that you can relate to his or her need for long term care. For instance, if your mom mentions a problem turning on the faucet, you could ask whether she could use help with managing bathing and other personal care.
Listen to your Parent’s Concerns.
Remain sensitive to your parent’s feelings and let them know you understand their concerns. Point out the benefits of long term care services. Remind your parents that their safety is your primary concern.
Listen to your Parent’s Preferences.
Find out what kind of facility they would prefer, but also recognize their ability to make decisions on their own. You might encounter some resistance from your parents, but stay positive. Keep in mind that if your loved one or parents are mentally competent, they have the right to decide whether they need long term care services or a long term care facility.
If your parent doesn’t respond well to your efforts to talk, involve someone else that can be trusted, such as clergy, a doctor or an attorney.
Understand the Types of Long Term Care.
If you understand the options that are available for your parents, it will be easier to explain them to your parents and for everyone to choose the most appropriate option. Maybe even visit area facilities so your parent can gain a better understanding of which facilities they like prefer.
Types of Long Term Care
Long term care is intended to help an individual maintain as much independence as possible without compromising safety and can range from some scheduled help around the house to 24-hour care in a nursing home. A long term care facility or home health care aide can help with activities of daily living, such as bathing and dressing or chores such as shopping. The following are types of long term care:
Home care includes medical care, but can also include help around the home. Home health aides or personal care service workers can visit daily or as needed to help with activities of daily living, such as bathing and dressing. They can also assist with housekeeping, meals and shopping.
Adult care is a planned program of activities designed to promote well-being through social and health-related services in a safe, supportive and cheerful environment. Adult day care centers can be public or private, non-profit or for-profit and usually operate during daytime hours, Monday through Friday.[3,4] The following are good candidates for adult day care:
- Can benefit from the friendship and functional assistance a day care center offers
- May be physically or cognitively challenged, but don’t require 24-hour supervision
- Are in the early stages of Alzheimer’s disease
- Are mobile, with the assistance of a cane, walker, or wheelchair
- Are continent (usually required)
Services provided by adult day care centers might include the following:
- Arts and crafts
- Musical entertainment and sing-a-longs
- Mental stimulation games, such as bingo
- Stretching or other gentle exercise
- Discussion groups (e.g., books, films, current events)
- Holiday and birthday celebrations
- Local outings
- Activities involving children
Nutritious meals that accommodate special diets, along with an afternoon snack are also typically included.
Senior Housing or Retirement Housing
Senior housing or retirement housing allows for individuals who don’t need continuous long term care. This type of housing is often rental apartments that have been adapted for seniors, including railings installed in the bathrooms and power outlets placed higher on the walls. Other services offered by senior housing communities include meals, transportation, housekeeping and activities.
Assisted Living Facilities
Assisted Living Facilities offer more help than senior housing offers, including administering medications, helping with bathing and dressing and providing some medical care. Some assisted living facilities also have on-site beauty shops and health services, such as a medical clinic.
Nursing Homes are a place for people who don’t need to be in a hospital, but can’t be cared for at home. Some are set up similar to a hospital, while others try to be more like a home. Most nursing homes have nursing aides and skilled nurses around-the-clock, and the staff provides medical care, as well as physical therapy, speech therapy and occupational therapy. Some nursing homes have special care units for people with serious memory problems, such as Alzheimer’s disease.
Continuing-Care Retirement Community (CCRC)
CCRCs usually have large campuses that include separate housing for people who live very independently, assisted living facilities that offer more support, and nursing homes for those needing skilled nursing care. Residents can move from one housing type to another depending on their needs, and many CCRCs guarantee lifetime shelter with long-term contracts.
Because of the expense for long term care, many parents may be reluctant to discuss their options. Keep in mind that there are multiple sources that provide funds to pay for long term care, including the following:
Long Term Care Insurance.
You pay an annual premium for long term care insurance. In exchange, when you or a loved one needs care, the insurance provider pays a daily rate to the long term care facility. Daily rates differ, depending on the insurance policy. If long term care is needed immediately, it may not be possible to get long term care insurance. However, if you or your loved one is currently healthy but likely would need long term care in the future, you might want to consider this option.
Before you purchase a policy, make sure it covers pre-existing conditions you disclose when you buy the policy, and covers conditions that could arise later in life, such as dementia. Also check whether you can reduce your coverage later if the premiums become too expensive.
Medicaid is a state and federal program that will pay most nursing home costs for people with limited income and assets. Eligibility varies by State. Check your State’s requirements to learn if you are eligible. Medicaid will pay only for nursing home care provided in a facility certified by the government to provide service to Medicaid recipients.
Under certain limited conditions, Medicare will pay some nursing home costs for Medicare beneficiaries who require skilled nursing or rehabilitation services. To be covered, you must receive the services from a Medicare certified skilled nursing home after a qualifying hospital stay. A qualifying hospital stay is the amount of time spent in a hospital just prior to entering a nursing home. This is at least three days.
Medicare Supplemental Insurance.
This is private insurance. It’s often called Medigap because it helps pay for gaps in Medicare coverage such as deductibles and co-insurances. Most Medigap plans will help pay for skilled nursing care, but only when that care is covered by Medicare. Some people use employer group health plans or long-term care insurance to help cover nursing home costs.
Reverse mortgages, annuities or setting up a trust fund for long term care are options that carry a risk or charge fees. Deciding how to make payments for these options can be difficult. Discuss your options with your lawyer, accountant, a social worker or your local agency on aging. Also talk to your doctor, who may recommend community resources.
When it comes time to discussing long term care with your parents, remaining sensitive to your parent’s needs and having as much information about their options is the most prepared you can be.
- Mayo Clinic. (June 23, 2009) Long Term Health Care: Plan Ahead. Retrieved July 12, 2009 from the Mayo Clinic Web Site: http://www.mayoclinic.com/health/long-term-care/HA00054.
- Jernigan, Kristie Janeway. (October 18, 2006) How to Discuss Nursing Home Placement with Aging Parents. Retrieved July 13, 2009 from the Associated Content Web Site: http://www.associatedcontent.com/article/1785656/how_to_discuss_nursing_home_placement.html?cat=5.
- Retirementcommunity.com. (n.d.) Active Day Services. Retrieved July 10, 2009 from the Retirementcommunity.com Web Site: http://www.retirementcommunity.com/Category/Adult-Day-Care/.
- Helpguide.org (n.d.) Adult Day Care Centers: A Guide to Options and Selecting the Best Center for Your Needs. Retrieved July 11, 2009 from the Helpguide.org Web Site: http://www.helpguide.org/elder/adult_day_care_centers.htm.
- MedlinePlus. (June 23, 2009) Nursing Homes. Retrieved July 6, 2009 from the MedlinePlus Web Site: http://www.nlm.nih.gov/medlineplus/nursinghomes.html.
- AARP. (n.d.) Continuing Care Retirement Communities (CCRCs). Retrieved July 2, 2009 from the AARP Web Site: http://www.aarp.org/families/housing_choices/other_options/a2004-02-26-retirementcommunity.html.
- Medicare. (May 8, 2009) Nursing Homes: Paying for Care. Retrieved July 13, 2009 from the Medicare Web Site: http://www.medicare.gov/nursing/Payment.asp.
By C. J. Newton, MA, Counseling.info Editor