Families are often caught off guard when a parent’s health takes a nosedive.
One day Dad is the picture of health; seemingly the next day he can’t drive himself to the doctor. By the time the kids realize that Dad can no longer live independently, they feel pressured to make a quick decision about his care. In their haste, many families don’t stop to consider exactly what kind of care their parent needs.
“The most expensive way of providing care for a parent is mistaking the level of care they need,” said Erica Karp, president of Northshore Eldercare Management in Evanston.
Karp and other elder-care specialists say that families tend to assume that their ailing parent is more independent than he actually is. A typical misstep is to place a parent who needs help with medication management or other aspects of daily life in a retirement community designed for seniors who are healthy enough to handle such tasks on their own.
The result? You could be looking at extra charges you didn’t count on.
When a parent is at the stage of needing some help, but is not ready for 24-hour care, their best options are probably home care or an assisted-living facility.
To decide which path to take, visit several assisted-living facilities to determine the average cost. Next, add up the cost of home care. This should include the home health caregiver’s fees as well as supplies and modifications that may be needed to the home, such as installing handrails in the shower.
Nationwide, assisted-living facility fees range from $2,000 to $3,000 per month, according to the Washington, D.C.-based Assisted Living Federation of America (ALFA).
The cost of home modifications and supplies that may be needed for seniors who live at home varies depending upon their needs.
As for caregiver costs, a MetLife survey shows that in 2002 the national average hourly rate for a home health aide was $18. For a licensed practical nurse it was $37.
According to Brett McWhorter Sember, an attorney in Clarence, N.Y., and author of “The Complete Legal Guide to Senior Care,” after you gather your estimated expenses, “factor in the normal budget for the home and see where you’re at. Many people are surprised to find that it really is less expensive to pay for home care, even if that means doing so out-of-pocket.”
Your out-of-pocket costs for home care might be eased slightly by health insurance or long-term-care insurance coverage. Don’t expect much help from Medicare. It covers only home care that may be required for rehabilitation after surgery or an accident.
The Illinois Department on Aging’s Community Care Program provides in-home assistance for people over the age of 60 whose non-exempt assets are $10,000 or less.
Beyond financial concerns, consider your parent’s personality and interests when weighing the merits of staying at home versus assisted living. Would he enjoy eating dinner in a large dining hall? Does he like to interact with a lot of people, or does he prefer privacy?
A geriatric care consultant can help you evaluate your needs. Ask health-care professionals for a referral, or log on to www.caremanager.org, the Web site of the National Association of Professional Geriatric Care Managers.
If you decide on home care, a consultant can help you find caregivers. You can also ask friends for referrals, or hire someone through an employment agency or registry that specializes in geriatric caregivers. Make sure that the agency is bonded and that they check the references and criminal background of their caregiver applicants.
Many agencies charge the worker and the family an amount equal to one week’s pay for placing the worker. The family is then responsible for paying the caregiver’s salary. That includes making sure that Social Security and unemployment taxes are paid.
Other agencies pay the worker’s salary and related taxes, and charge the family a weekly fee.
“A lot of these agencies make money for every hour and day that the caregiver works,” said Karp. “Some try to arrange shifts around the clock, even though the person can easily be served by a live-in caregiver. Live-in rates are less than hourly rates. Financially, it’s in the interest of the agency to staff the case hourly.”
If you opt for moving your parent into an assisted-living community, evaluate the service and fee structures carefully.
Assisted-living fees generally consist of a base fee for basic services with extra services provided at an additional cost, or a flat rate for a full slate of services.
When you visit an assisted-living home for evaluation, ask a lot of questions.
“I think people are hesitant to be really pushy and nosey, and you need to be,” said Sember. “Insist on eating a meal there. Insist on seeing social activities. Visit the facility at 11 p.m. to see what’s going on. Sit and watch the residents, staff and activity for an hour at a random time.”
Encourage your parent to meet other residents. “Take your parent there and have him or her get to know a few people. Talk to the social worker about who he or she might enjoy getting to know,” advised Sember.
Talk about the issues
ALFA spokesperson David Goldberg urges families to have a frank discussion about medical problems that might limit their parent’s freedom before deciding on the level of services they need.
“For example,” he said, “incontinence is a common problem among seniors, but many family members don’t know that their parent is incontinent because the parent is too embarrassed to admit it.”
Be careful about signing a contract that requires a large upfront fee and offers no refund options. Look for facilities that let you pay a monthly fee. That way if you are unhappy with the facility, or if your parent’s needs change, you have some flexibility.
Consider communities that include multiple levels of service so that your parent can move into a more advanced-care facility on the same premises if his health declines. If your parent needs more attention than the community provides, some facilities will allow you to bring in an outside health aide. However, it might be more cost effective to move your parent to another facility or take care of him at home.
Sometimes, families find themselves paying to have a caregiver from an in-home care agency move into an assisted living facility, said Mary Kay Buysse, manager of Parent Care Solutions, a not-for-profit agency in Hinsdale that helps families find elder-care resources.
“Talk about expensive. They’re paying for both assisted living and in-home care,” she said.
Often, these seniors would be better off in a nursing home. “Don’t promise relatives that you’ll never put them into nursing home. When they need a lot of medical care, when dementia is involved, a nursing home is the best place for them,” said Buysse.
Once your parent has moved to a retirement community or nursing home, consider selling the family home.
“Many people keep the home intact even after the senior has entered assisted living. It’s an emotional issue. Letting go of the home is admitting he or she is never coming back,” said Sember. “But the expense of running the home in addition to paying assisted living can be large.”
