Navigating the maze of long-term care housing choices.

Posted on September 28, 2011 Updated on January 5, 2015

The most comfortable decisions you can make in life are well-informed ones.  Whether you are choosing a vehicle, the vacation of a lifetime, or a potential residence, doing so is made easier when you’re armed with essential information.  Oftentimes when inundated with too many choices, we exclaim that we would rather have fewer options from which to choose.  “Give me two choices and I’ll be able to decide – six or more? Forgetaboutit!”  There is one time, however, when you will welcome a diversity of options: selecting appropriate care in your Senior years.

Identifying the person in need of care.

This quest upon which you are embarking may be your own personal quest.  You know staying in your current home might prove dangerous to you – and therefore inadvisable – in the years to come.  Or perhaps you just want to retire from doing house repairs and weekend yard work –and who doesn’t?  Whatever the reason, you’re considering your options for when you might be less able to take care of your daily needs.

Another scenario is that your spouse, parent or sibling is in need of some sort of long-term care resultant from a debilitating condition such as cognitive decline, mobility restrictions and/or advancing age, so you’re trying to discern how best to address the care needs associated with their condition.

There are two primary care options from which to choose:

• Aging in Place – This blog posting addresses the option of staying put and making adjustments that modify a residence to suit your needs or that of your loved one.  Also included in this option is the potential for hiring in-home care.  Both of these options allow a person to remain in their home for as long as possible.
• Long-term care (LTC) housing options.  In a future posting I will address the available categories of long-term care (LTC) housing and will provide resources that should be helpful towards choosing a replacement for your current residential situation.

Both options have Pros and Cons involved with them.  But only you know what best fits your personal situation.

Aging in Place: I don’t even want to think about moving!

Aging in Place refers to living where you have lived for many years using products, services and conveniences to enable you to remain where you are.  To successfully age in place without moving you will most likely need to accommodate the physical and cognitive changes that may accompany aging.

Structural changes.  Both the inside and outside of the home could eventually require some structural adjustments to accommodate a person’s current – and future – needs.

• If you live in a two-story house and your primary bedroom and bathroom are upstairs, does your bottom floor afford a bedroom/bathroom alternative?
• Are you financially prepared for the costs of making the inside of your home more accessible, e.g. wider doors for wheelchairs or walkers; lowered counters to accommodate same; showers that can accommodate someone confined to a mobility aid?
• Does the outside of your home allow for the addition of ramps and railings for easier access to the residence?
• If one of you has cognitive decline and is prone to wandering outside of the house – what measures, if any, will assure this resident’s safety?
• If you need care assistance during the day, are you comfortable having a health care provider in the home?  The costs and logistics of hiring and scheduling staff to come into your home can prove to be overwhelming and oftentimes more expensive than if a person moved into a residential community that readily offers the needed care.

How expensive is in-home care these days?  Caveat: I will not be addressing financing sources such as long-term care insurance, Medicare, Medicaid and the like.  My intent in these articles is simply to provide an overview of care options and potential costs.

The U.S. Department of Health and Human Services gives a 2009 run-down on costs for care options both in the home and in a long-term care residential setting.  I know that in Washington State, where I reside, the average Home Health Aide hourly rate is $22; the average monthly cost of an Assisted Living (AL) facility is $2870; and the average daily cost of a semi-private room in a nursing home is $225 which is approximately $6700/month.

Focusing on Home Health Aide/In-home care: based on the average hourly rate of $22, one could expect to pay close to $528 per day if based on an hourly rate.  Keep in mind, however, that most staffing agencies offer a monthly rate which will be less than the hourly rate.  But even with that “discounted” rate, in-home care can be very cost prohibitive.  A great many of us may not have access to that amount of cash and if the need extends out to several years – now it’s really adding up.

So why even think of remaining in one’s own home if it’s so %#^%($ expensive?

All of the above is not to suggest that Aging in Place is not doable.  Many people around the nation are successfully aging in place so why shouldn’t you have a crack at it?  Consider this alternative: some people start out Aging in Place and then transition into a long-term care housing situation when finances, or circumstances, warrant such a move.

The articles, Avoiding the pitfalls of selecting senior housing, and Selecting a senior housing community – easy for some, not for the rest of us, provide some tips for your selection process.

Some links of interest: Alzheimer’s Association Carefinder service; Leading Age; Federal Govt Senior Topics.