Other Long-Term Care Sources
By David Braze (TMF Pixy)
In Those Dratted Statistics Made Easier, I noted that only 4% (or 1 in 25) of the age 65 or older population resides in a nursing home at any point in time. Nevertheless, data shows that in 1994 some 6.6 million (or about 1 in 5) people age 65 or older received help with at least one Activity of Daily Living (ADL) or Instrumental Activity of Daily Living (IADL). A female family member usually gives this assistance to allow an older person to remain in the home (an overwhelming desire of the elderly in survey after survey), thus avoiding institutionalization. According to the National Center for Health Statistics, in 1995 older persons living outside of a nursing home were more likely to receive help for IADLs as opposed to ADLs. In the ADL area, one-third had help with bathing and one-fourth with walking. However, 58% had another person do shopping, 56% needed assistance in reaching destinations outside of their walking distance, and an overwhelming 80% required someone to do heavy housework. All of the latter are IADLs, none require skilled help, and it's highly unlikely that they would be covered by insurance unless coupled with one or more ADLs or IADLs. Yet all are essential to independent living. And the older a person gets, the more likely that a person will need such assistance.
Let's agree that no one wants to enter a nursing home or see a family member do so unless it's absolutely necessary. Also, in today's society families are frequently geographically separated, thus making substantial help from family members less likely. Given a preference for remaining at home and given the increasing likelihood that family assistance may not be available, other sources of assistance may meet our needs as we age. These include home care, independent living (sometimes called congregate housing), assisted living, and continuing care facilities. Each provides a large measure of independence for as long as possible at varying levels of cost based on the care provided.
Home care is exactly what it sounds like. A person dependent on others for some essential activity receives that service while living at home. The services can range from skilled medical care to ordinary household chores. Depending on the activity involved, the cost can range from nothing to $100 per hour or more for medical professionals. If skilled care is needed, this option can be quite costly and, at worst, can even exceed the cost of a nursing home. Home care is probably best suited for those who are still reasonably independent and mobile, but who need some help with such tasks as house cleaning, maintenance, cooking, laundry, and shopping. The cost of some home care services may be offset by long-term care insurance depending on the type of policy purchased and the assistance rendered.
In general, independent living (or congregate housing) involves either the ownership or rental of a unit in a senior's complex within which one may receive a variety of services. These may include (but are not limited to) shared recreational facilities, common dining, housecleaning, 24-hour security, transportation, organized activities, and health monitoring. The arrangement affords private living coupled with available assistance for those needing help with limited health services, cooking, shopping, transportation, and housecleaning. Costs vary depending on location, but often range between $1,500 and $2,000 per month. Note, though, that those costs can be much higher. Typically, the resident covers the majority of expenses in these facilities. Long-term insurance, though, may pay for some services, depending again on the type of policy purchased and the assistance rendered.
Assisted living is much like independent living in that it still affords a measure of independence and private accommodations; however, it is most appropriate for those who are less independent in caring for their personal needs. It's a living arrangement suitable for someone who is mentally capable but physically impaired, or physically capable but suffering from cognitive difficulties. Like an independent living facility, assisted living offers transportation, meals, common leisure areas, and organized activities. Additionally, assisted living will, along with other services, provide greater assistance with medications, ambulating/transferring, bathing, eating, dressing, and laundry. Daily rates depend on the location, services provided, and facility involved, but typically range between $50 and $75. These charges can be much higher. Assisted living facilities are most beneficial for those who require some daily assistance but not continuous nursing care. Most of the expense will be borne by the resident, but some long-term care insurance now provides coverage for many of these expenses. Because of the expanded skilled medical services available, assisted living facilities are licensed by the states, and Medicaid might cover their cost for residents who qualify.
A continuing care retirement community (CCRC) provides lifetime housing and care over a wide variety of services to include medical and nursing home care when needed. While the resident must be independent on entry, if that person later becomes disabled, then extensive personal, health, and nursing services will be provided by the facility. Although these arrangements run the gamut of lifestyles from totally independent living through 24-hour nursing care, they are quite expensive. An entrance fee of $20,000 to $500,000 is required, and monthly fees ranging from $600 to $3,000 will be assessed for maintenance, household work, and other personal services. Almost all of this expense must be borne by the resident. Because it is a contractual arrangement and because these contracts are complex, legal advice is a must prior to entering such an agreement. A CCRC is perhaps best suited to someone who is wealthy enough to afford the fees and who wants to provide for health needs as he or she ages without having to relocate.
Other long-term care services are available to those who require some assistance while living outside of a nursing home. These include adult day care centers, meals-on-wheels, and local health screening programs. Many communities also offer free or low-cost escort, companionship, shopping, transportation, cleaning, and other personal services through volunteer, social, and professional organizations. Good sources of referrals for these services include the local area Agency on Aging, senior centers, fraternal and religious organizations, friends and neighbors.
Most long-term care is not provided in a nursing home. Much of the care needed outside of a nursing home will also not be covered by long-term care insurance unless the recipient meets some very stringent criteria in the area of ADLs and IADLs or is willing to pay a substantial premium for having that coverage. Regardless, as we age the likelihood of our need for such care (but not nursing home care) increases. Long-term care insurance under certain conditions may help meet this need. So may the options discussed above. We each must decide for ourselves what option, with or without insurance, is most appropriate for us.
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