Factors to Consider When Thinking About Long-Term Care or End-of-Life Care
Factors to Consider When Thinking About Long-Term Care or End-of-Life Care
by guest author Jacob Edward
elderly woman with nasal cannula
Unfortunately, we cannot tell when someone will begin to need long-term care or end-of-life hospice care. Many individuals begin long-term care after a sudden life change that leaves them unable to care for themselves at home, such as a stroke or a fall. Others simply decline with advancing age. In the best-case scenario after a stroke or a fall, patients return home after successful rehabilitation, but often patients are unable to fully recover. When this happens, depending upon the severity of the person’s impairment, they are either taken care of by family members or moved into an institutional setting. About 80% of elders receiving long-term care remain in their own homes or in the home of a family member. Those who remain in their homes are often eligible for home-health services to aid family members in their responsibilities.
Long-term care simply refers to helping people with cognitive or functional limitations to perform daily activities such as eating, using the bathroom, bathing, and getting dressed. If patients are unable to return home, facilities continue rehabilitation to try to strengthen patients and improve their quality of life. The more a resident can do by himself or herself, the happier they generally are. According to the Medicare Current Beneficiary Survey, the elderly population in nursing homes has declined over the past ten years. The number of people living in assisted living or group homes and not needing 24-hour supervision has increased. Inevitably as age and illnesses advance, we begin to naturally decline. It is important to keep this in mind so as not to have unrealistic expectations.
People in long-term care eventually move toward end-of-life or palliative care. When a loved one does make the transition into hospice care, it is not about hastening death. Rather, it is about making passing as comfortable and painless as possible. Many people mistakenly believe that to be admitted to a hospice facility, the patient must be expected to live less than six months, but there is no set rule determined by life expectancy. Palliative services exist to relieve emotional and physical pain and to manage symptoms. Before getting to this stage in life it is important to outline in writing how you would like the end of your life managed, just in case you are unable to make decisions for yourself when the time comes. According to a 2011 study by the Agency for Healthcare Research, only 15-22% of patients have preference information available in their medical records.
Generally, long-term care is not covered indefinitely by insurance companies, if it is covered at all, so cost is definitely a factor when deciding what is best for your loved one. With 80% of elders receiving care through informal caretakers such as family members, the Congressional Budget Office estimated the value of this donated care at approximately $234 billion in 2011. This number is determined based on calculating the time that could be spent employed elsewhere, forgone wages, transportation, and performing duties otherwise performed by paid healthcare aids. Although some private insurance policies do cover the cost of end-of-life or long-term care, many facilities, especially hospices, work on a sliding scale fee. In some states, some facilities charge no fee beyond Medicare coverage. Room and board at skilled nursing facilities is sometimes not covered, but eligibility for financial aid can be determined by faculty evaluation and financial background. Reaching out to a social worker may be important because there are benefits you may not be aware of in your home state.
Jacob Edward is the manager of Senior Planning in Phoenix Arizona. Jacob founded Senior Planning in 2007 and has helped many seniors navigate the different types of care available in Arizona. This includes assistance to seniors and the disabled, finding and arranging care services, and applying for state and federal benefits. In his spare time, Jacob enjoys dining out and supporting his alma mater Arizona State’s Sun Devil sports teams. Jacob lives in Tempe Arizona.
A note from Colin Family Mediation Group: If your family is having difficulty agreeing on a plan to care for an aging family member who can no longer make decisions alone, working with a family mediator may be helpful.
