Is Aging in Place an Option?

Is Aging in Place an Option?

The answer is – it depends.  With a record number of baby boomers coming into retirement age many will need some level of care assistance to help them live the best quality of life possible in their senior years.  This care can range from a small amount of care from a family member up to requiring full-time assistance in a skilled nursing center or assisted living community.  Much will depend on finances and the type of care required. Let’s look at is aging in place an option.

What Factors Determine My Care Options?

Finances will play a large role in making any decision, however it is not the only thing that should be considered.  Here are some other factors to be weighed when making this decision:

1. Home Costs – If one or both of your parents want to age in their own home, you need to look at their monthly costs.  This includes mortgage or rent payments, utility bills, taxes, and maintenance costs or HOA (homeowners association) fees.  If their home is paid off, the rest of the costs are reasonable and the maintenance overhead is low they might find it more cost-effective to stay at home than relocate to an assisted living community.
2. Debt Obligations – in addition to home costs, you also need to examine the amount of outstanding debt that might be paid every month.  This includes credit card balances, outstanding loans, second mortgages, tax liens, bankruptcy status and other debts requiring substantial monthly payments.  If there is little to no debt this would also be a good sign home care might be a good option.
3. Extended Family Care – do your parents provide care for any underage children, grandchildren or disabled relatives? If your parents need care who will provide care for their dependents? Or could any of those dependents help provide for a family caregiving solution?
4. Safety Concerns – depending on the age of your parents home you may need to do some retrofitting on safety products to help guard against falls and assist in activities of daily living (ADLs).  These include grab bars in the bath or shower and around the toilet, ramps instead of steps, replacing outdated toilets with comfort height ones, bath chairs, chair lifts for internal staircases and possibly remodeling a shower or tub for wheelchair access or even creating a barrier free bathroom.
5. Local Daycare Programs – some places have local day care programs for seniors when their family caregivers need to work.  Check with your local senior center or wellness center for possible locations.  On average day care programs for senior care run $18,200 per year (5 days per week and 52 weeks per year).
6. Family Caregiver Costs – if you or other family members have been providing care for an aging parent, did they have to give up a job or take a part-time job to provide that care? Is stress or mental issues, such as depression or anxiety, becoming an issue providing that sole care? Would hiring a home health aide or using a local daycare program allow your family caregiving to go back to work or resume full-time hours thus providing additional money (and perhaps less stress)?  There are hidden costs to be considered too.

What Are My Care Options?

Choosing a care option largely depends on the level of care required and the finances available to afford it.  Once you have a sense of your financial outlook you can start to look at options.  Sometimes you may want to use a combination of options if they prove safe and financially feasible for your family caregivers. Here are options to consider:

• Home Health Care – home health care as the name implies is care provided to your parent(s) or loved one within their (or your) home.  Their are three kinds of care that can be rendered.
  • Family Caregiving – this level of care is provided solely by one or more family members, usually without pay, and will require personal sacrifice in outside work time, reduced pay, increased stress and less time to devote to other family members, such as a spouse or children.
  • Paid Caregiving – this level of care is provided wholly by a paid care profession, from an accredited agency, state registry listing or personal hire.  Depending on the level of care required you may need to pay more for a professional healthcare worker, such as Certified Nursing Assistant (CNA), a physical therapist, a Licensed Practical Nurse (LPN) or even a Registered Nurse (RN) to administer to their medical needs.
  • Combination Caregiving – this level of care may require the skills of a professional caregiver or to cover a gap in time when the family caregiver is unavailable. The hours worked will depend on the special care required, the hours of need or unavailability of the family caregiver, and the amount of finances available to pay for the outside caregiver.
• Adult Daycare Program – this program provides general care and activities to keep aging seniors engaged when no family or paid professional caregivers are available.  These programs can be run by the local senior center or privately administered.  It is a good way to provide watchful care of a loved one(s) while giving them engaging activities to keep the mind and body fit.
• Assisted Living Facilities or Communities – when aging in place is not an option, either financially or not prefered by a parent, an assisted living facility (ALF) may be a good option to provide a safe and caring environment for your loved one. ALFs are growing in popularity for seniors who want to maintain their physical wellness, continue their social engagements and get the care they need should they have medical conditions that require assistance.  Many ALFs offer levels of residency from independent living, to medical assisted care and memory care accommodations for those suffering from Alzheimer’s or dementia conditions.
• Skilled Nursing Facilities – when a loved one has a long-term chronic and debilitating disease or condition that requires regular supervised attention that a family cannot provide at home then a skilled nursing facility (SNF) may be the best place to ensure your loved one gets the appropriate level of care.

What Kind of Costs Are We Talking for Care?

Home Health Care – Family Caregiving

Many people believe that taking care of a loved one either at home in their house or in your house will save the family a lot of money. The truth is those who provide direct care usually spend a significant amount of money behind the scenes to provide that care.  According to the Genworth Cost of Care Survey conducted in 2017 Exposing the True Costs of a Long Term  Event showed:

• Caregivers miss seven (7) hours of work per week to attend to caregiver services (up 23% from 2010)
• Loss almost 33% of paid income per year
• Caregivers are spending down their retirement accounts to provide care
• Caregivers are spending on average $10,000 out of their pockets annually (up 46% from 2010)
• 43% of Caregivers report providing care negatively impacts their personal health and well being
• 51% of Caregivers report spending significantly less time with children, a spouse and on themselves
• Caregivers report $8,000 in costs could have been saved if better long term care had been planned
• Over half of Caregivers would have planned better and made arrangements sooner if they had to go through this experience again.

Review our previous article on Family Caregiving to see the hidden costs of providing in home care for a loved one(s).

Home Health Care – Paid Caregiving

Paying a caregiver for care for a loved one at home can be a good option for family members who need to work outside the home and cannot provide the care directly. The costs paid for a professional caregiver will vary depending on the type of care required.  It will also vary depending on whether the caregiver came from an accredited agency, a state healthcare registry list or via private pay.  If your loved needs basic ADL (activities of daily living) support, such as getting dressed, bathing, toileting or cooking and perhaps some light housekeeping, like washing dishes, laundry, dusting and vacuuming, then a regular home health aide will meet your needs.  However, if you loved one has a medical condition that requires special care and handling then you may need a CNA, a Nurse, a Therapist or other skilled health professional, which will increase your caregiving costs.

According to Genworth’s Cost of Care 2017 guide a home health aide will cost on average $4,099/month or $40,192 per year for 44 hours per week for 52 weeks.  There are estimates in the guide for each state if you want a closer estimate of cost.

Home Health Care – Combination Caregiver

If your loved one requires 7 x 24 care and there are not enough family members to cover all the shifts you might want to consider splitting the care between family members and paid caregivers. Again this will depend on the family’s financial capacity to pay and absorb the hidden costs of providing family care.

Given the previous cost of of a full-time professional caregiver ($4,099/month or $40,192 per year for 44 hours per week for 52 weeks) you could half that number for a savings of $2,050/month or $20,096 per year for 22 hours per week (part-time) for 52 weeks.  Some find this combination of care more financially feasible and allowing family members to run errands or work outside the home part-time.

Adult Daycare Programs

Placing your loved one in an adult daycare program may be a good option for family members who need to work outside the home and cannot leave their loved one home alone.  Choosing the type of daycare program is important if you have specific concerns about how your loved one’s time is being spent.  Most programs have focus time on physical fitness, to memory activities to day time local trips.  This program can be a great well rounded option to bring quality and improvement to a loved one’s life rather than leaving them in a “babysitting” type program.

According to Genworth’s Cost of Care 2017 guide an adult daycare program will cost on average $1,517/month or $18,200 per year for 5 days a week for 52 weeks.  There are estimates in the guide for each state if you want a closer estimate of cost.  Contact your local senior center, elder care program or AARP Caregiver Center to see what kind of adult daycare programs are available in your area.  Check for waiting lists and get enrolled as soon as decided to avoid delays in getting critical care.

Assisted Living Facilities

Assisted Living Facilities (ALF) can be a great alternative to home care either when your loved decides to no longer live at home or a medical/mental situation prohibits adequate home care by family members.  ALFs no longer have a stigma associated with them as a bad place to put senior family members no one wants to deal with.  In fact many seniors find ALFs a great way to avoid the daily grind of cleaning, cooking and home maintenance responsibilities and engage in a wide array of social activities that are great for both the mental and physical well being of your loved one(s).

An ALF can have different areas of their facilities dedicated to loved ones in various stages of physical and mental health.  Their are wings with suites, dining halls, recreation centers and activity rooms for those enjoying fairly full physical and mental health.  There are also wings for loved ones who are mentally fit but need some level of physical care thus requiring a health professional, such as a CNA, LPN or RN onsite to oversee that medical care.  And there are wings for loved one(s) who may or may not be physically well but suffer from mental impairments such as Alzeheimer’s or dementia.  The are frequently referred to as Memory Care units.

According to Genworth’s Cost of Care 2017 guide an assisted living facility will cost on average $3,332/month or $45,000 per year based on 12 months of care in a one-bedroom private room.  There are estimates in the guide for each state if you want a closer estimate as costs vary widely from state to state.  Contact your local senior center, elder care program or online sources like A Place for Mom for recommendations on local ALFs.

Skilled Nursing Facilities

If your loved one has a serious medical or mental health condition and the care required is either financially or above the skill level of family members then a skilled nursing facility (SNF) may be a good option for you.  There are doctors, nurses and therapist available on rotating or scheduled basis to assist your love one in improving or maintaining their level of care.  Day to day care and needs are usually provided by licensed CNAs that are trained to monitor, report and provide assistance with ADLs for your loved one.

According to Genworth’s Cost of Care 2017 guide a skilled nursing facility will cost on average $7,148/month or $85,775 per year based on 365 days of care in a semi-bedroom room.  There are estimates in the guide for each state if you want a closer estimate as costs can vary widely from state to state.  Contact your local senior center, elder care program or your healthcare provider to see what SNFs are located in your area.

How Do I Pay For Care?

A large percentage of Americans over 65 will require long term care services at some point caused by disease or accidents.  The bad thing is most Americans believe Medicaid and Medicare will be there to pay for most or all of these costs.  Unless you meet very strict guidelines Medicaid will probably not be an option for you.  The same for Medicare.  This means you and your family will be shouldering much of the costs for long term care coverage.  Here are some options for paying for long term care services:

• Long Term Care Insurance – this is a separate health insurance policy you take, like a life insurance policy, to help cover some of the costs associated with long term care events.  Invest early, somewhere in your 50’s, before long-term illness set in to get the best rates.  Beware that certain policies will not pay for  care on pre-existing conditions such as Alzheimer’s, Parkinson’s disease, kidney failure and post polio syndrome or if you are currently receiving funding for ADLs or mobility care.  You can read more at Senior Advisor.
• Veteran’s Administration (VA) – is your loved one(s) a military veteran that server during a time or war or is a veteran widow/widower? The VA may be able to help with some in-home care.
• Medicaid – your loved may qualify for in-home care assistance through state funding if they meet both financial and medical condition needs.  Each state has its own rules, regulations and funding.  Check with your state’s Medicaid office for more information.
• Medicare – many people are confused on what Medicare covers regarding care assistance.  Medicare does not pay for in-home care for ADLs.  It will pay, if you qualify, for a specialist to come in to treat a specific physical therapy need, but will not pay for ongoing regular personal care.  Medicare will pay for skilled nursing services.  Here i more information on what Medicare will and will not cover related care coverage.
• Personal Pay – families have also been known to pay for care services with family funds, by withdrawing early from pensions, retirements and health reimbursement funds, selling investments and even taking a reverse mortgage on their home to help cover long term health care costs.

Start Talking Today

You and your family should start talking today if you think a loved one(s) in your family will require some level of caregiving soon.  To get started download AARP’s Prepare to Care guide to get that conversation started.  Learn more about your care options, what you need to consider and when you might need to put that plan in place.  Talk to your loved one(s) about their financial situation and their wishes for ongoing care for when they need assistance in their senior years.  While the topic seems awkward and uncomfortable it will save a lot of money, energy, confusion and scrambling by family members to have critical documents and decisions lined for when the care is needed.

Resources:

• 6 Things You Have to Know for Successful Aging in Place
• American Association for Long-Term Care Insurance
• Video on Long Term Care Insurance
• Video on Best Age To Buy Long Term Care Insurance
• Video on Long Term Care Insurance Rates
• Video on Long Term Care Insurance Questions Before You Buy

 

We welcome any suggestions or resources you might have to help people in that planning process.