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Care Needs
Caring for our parents or grandparents is something we might not think much about in our 20?s and 30?s and maybe not even think too much about in our 40?s but eventually, most of us will face the challenge of assisting our parents and grandparents to find either help in their own home or a new home with staff and amenities to meet their needs. Also facing most of us is that obtaining the ideal situation for our loved ones may mean trying more than one option and re-addressing care needs as they change.

Becoming familiar and understanding terms such as retirement apartments, assisted living, group homes, skilled nursing care, custodial care and home health care is a start into navigating what is a journey that you will return to more than once.

Talking about options for financing care is another area we can sit down with our parents and grandparents and talk about, keeping in mind talking about money isn?t always something comfortable, but necessary to do before there is a crisis and care needs to be implemented right away.

Retirement apartments are an option for many seniors once they sell their home and want to downsize. I have heard many who have moved to a retirement community exclaim, why didn?t? we do this sooner. Typically lawn maintenance is done for the recipient living in a retirement community and other services are readily available for a fee, such as laundry, housekeeping and shuttle van service for appointments. The social activities can be an added draw for staying active and can be appealing to those living alone. Many places have onsite beauty salons and other services so that one doesn?t even need to leave the grounds unless going out on the bus for an excursion or outing. Some retirement homes have the option to transition to assisted living or a nursing home when and if needed.

Assisted Living facilities (ALF) applies to a living arrangement where there is staff available that may assist with some meals, and help with medication management as well as with housekeeping. In some cases ALF are staffed with nurses who are available on a fee for service basis.

Many patients and families ask what is the difference between skilled nursing care and custodial care as viewed by Medicare guidelines. Ultimately a patient?s physician along with possibly a physical and occupational therapists determine what skilled needs are involved. Assessments by nursing care managers are also important to help determine what needs an individual has and what will be paid for by insurance. In most cases skilled care follows and acute event that requires hospitalization, such as a hip replacement surgery, heart surgery, or stroke. Skilled care involves, nursing care, physical, occupational and possibly speech therapy and implies that the patient?s level of care at the beginning of treatment can be improved by the nursing and therapy given. Custodial care or non-skilled care might also involve care from nurses and therapists, however the key difference is that improvement in the level of function is not expected. To further elucidate this point, someone who has undergone surgery and needs assistance to learn to walk again and build up endurance in order to return home may qualify for skilled care, while another patient who needs help getting dressed, walking and having meals prepared on a long term basis may need care for everyday needs which would be considered custodial or non-skilled. Differentiating between these two types of care also involves a financial component. Care at a Nursing home or Subacute or Acute Rehabilitation center may cost in the range of 3,500 to 7,000 per month inclusive and may not be covered by Medicare or other Insurance, based on the expected outcome of the treatment. Also something to keep in mind is that if Medicare does cover treatment for skilled care, the implication is that once optimal improvement has been reached, care may need to continue but Government assistance discontinues. Care needs are usually determined on a week to week basis and sometimes determined every few days, depending on the expected duration of the plan of care.

After completing a course of skilled care at a Rehabilitation facility many patients and families choose to transition into a long term room where therapy can still be available and nursing is provided around the clock. This care, again is custodial and is either paid for through the individuals estate or application for state assistance can be made for qualifying patients.

Other patients choose to have caregivers in the home. Typically caregivers are paid by in the range of $18.00 per hour. You may be able to negotiate a lower rate for 24 hours of care at a time, e.g a daily rate, although many charge hourly for their time. Finding the right caregiver can be done through an agency, which has checked references for their staff or you may have success checking with people you know through the community. Some people run an add in the local paper to seek a caregiver and many caregivers advertise to find work under the Domestic Services section in the Classified advertisements. Finding the right person has a lot to do with personalities and how your loved one would feel about having someone in their home each day. Many patients become very close with their caregivers and enjoy the companionship and having the benefit of having some light housekeeping and meals made, as well. Caregivers also can be available to help you with picking up prescriptions, errands and even a trip with you to your favorite restaurant for lunch now and then.

Sitting down and talking about options before you need them is so important and vital to do early. It is not uncommon that an unexpected fall or illness takes place and the patient and family are not prepared for the financial burden of caring for a loved one, or a spouse wants to provide the care but physically cannot. Another scenario is that the children of the person needing care is still working or caring for their children and cannot be away to care for their parent. So many families are caught off guard and overwhelmed at what is needed for their loved one when the time comes, that if you stop and sit down now when your loved one can make decisions while things are going well, you will better be better guided to respect his or her wishes when the time comes to make extra care arrangements. Sitting down initially can be anxiety provoking and your loved one might not be ready to talk about the future on the first try. You may want to do a little research on your own and if it is the case and get some brochures and information by phone or over the internet for your next discussion and leave that for your parent or grandparent to look over. Also mentioning experience a friend or someone you know has had can also break the ice. If at first you don?t get through on the topic, don?t give up. The important thing is to keep trying and if you find that you aren?t getting anywhere, share your concerns with another family member that may be able to break the ice. If it appears that care needs are approaching faster than you are ready for, an intervention with several family members could be beneficial. Care managers in your community can be hired to help with exploring options and mediating as well. Talking about getting older and needing care isn?t an easy topic so give yourself and your loved one some time to absorb the information and remember you are doing this for someone who needs your help and in the long run, planning ahead makes the transition as smooth as it can be in a difficult time.

Deception Pass, Whidbey Island, WA Picnic Shelter built by the Army CORPs of Engineers in the 1930's -The Golden Age of Rustic Design