It’s no secret that America’s population is aging. The baby boom generation—those born between 1946 and 1964—numbers about 77 million, and every day for the next 15 years, 10,000 of them will turn 65. At that time, seniors will comprise nearly 20 percent of the U.S. population, according to the Administration on Aging, up from 13.7 percent in 2012, the most recent year for which data is available.
At the same time, a 2013 report from the AARP Public Policy Institute estimates that by 2030, the ratio of potential caregivers to seniors is expected to drop dramatically, from about seven potential caregivers for each senior to four. Caregivers—especially family caregivers—are often a significant factor in seniors’ ability to remain at home through the aging process. But with baby boomers living longer and generally having had fewer children than their parents—and with those children more geographically dispersed than in the past—the option to stay home with family may not always be feasible. That’s just one of the factors to consider when making decisions about eldercare.
Considerations: Finances, Age and Health
Frustrated by the challenges of finding suitable care for her own mother, Sandi Kistner became a certified geriatric care manager, determined to use her knowledge and experience to help others in the same situation. Realizing that if the process was frustrating for her—someone with decades of social work and nursing home care experience—she could only imagine how overwhelming it must be for those less familiar with the ins and outs of the healthcare industry.
As a care manager with AgingCare Management, Kistner assesses her clients’ unique circumstances and makes recommendations for care, both short- and long-term. She suggests a number of considerations for aging parents and their children, who are often the ones seeking assistance or guidance.
“When I’m helping a child of an aging parent look at the dynamics of where to go… I look at their finances, the age of the person, and where they currently are with their health,” Kistner says. The desires of the parent must also be considered, as most prefer to stay in their own homes if at all possible.
When evaluating care options, she explains, one should aim to “be in the least restrictive environment, but have access to more restrictive care.” That means not only recognizing seniors’ current health status, but also predicting their long-term health trajectory as it relates to their age and financial situation, as healthcare needs typically increase with time.
Every person and situation is different, and Kistner warns against viewing levels of care as a strict continuum. “In a perfect world, you’d start out at home, then go to independent living, and then maybe go to assisted living,” Kistner says. “I have to start my assessment wherever the person is at.”
Staying at Home
The options for in-home care are broad, ranging from having a live-in caregiver in the home—the most expensive option—to periodic visits from a caregiver to help organize medications for the week. According to Kistner, planning for in-home care, like any other option, requires “identifying the need, planning for that need, implementing the plan, and adjusting the plan when needed.”
A home health agency such as OSF Home Health or UnityPoint at Home – Peoria can provide comprehensive healthcare services in the comfort of one’s own home, while a home services agency like Kyle’s Care at Home can complement those services by assisting with daily activities that do not require medical training, such as meal preparation, personal hygiene, medication reminders, errands, transportation and other routine duties. While in-home care is less restrictive and more affordable than other options, the costs can build rapidly, so one must consider which services are actually needed. In any case, it allows seniors to maintain independence in their own homes.
In-home care may also coexist with adult day care services, with some days spent at an adult day center and others at home. “Adult day centers came out of an act to keep people at home who otherwise may require institutional placement,” says Jackie Bowers, director of IPMR Senior World in Peoria, adding that adult day centers offer a myriad of benefits, both social and health-related.
With a medical professional on staff, participants can have their health monitored and receive assistance with their medications. Meals are often provided, and therapeutic activities aimed at exercising different parts of the brain help them sustain mental and emotional health. At Senior World, a range of local community groups offer company and social interaction through regular programs and activities, from Bible studies to pet therapy to woodworking. As adult day centers get to know their participants better, Bowers says, they can cater to their interests and the activities they most enjoy.
“Day care provides an outlet for socialization, good nutrition and getting medication the way an elder should,” affirms Kistner, who wishes more seniors would take advantage of adult day centers.
Financially speaking, adult day care can also be more affordable for older Americans. Senior World, for example, costs less than $85 a day, depending on the number of hours spent at the center, while the average daily costs of assisted living and nursing homes can be more than $100 and $200 respectively, according to the Genworth 2014 Cost of Care Survey. Over time, it’s apparent that adult day care can lead to substantial savings, besides helping seniors stay relatively independent for a longer period of time.
Finding a New Home
If staying at home is not possible or desired, independent living facilities are often the next best option. Retirement communities and senior apartments provide safe environments with freedom, privacy, and little to no maintenance or other responsibilities, in addition to offering a social community that seniors may not be able to find at home. If physical or mental impairments increase with time, however, a more restrictive level of care should be sought.
Assisted living is for seniors who are unable to live safely on their own, either at home or in independent living, but do not have extensive mental or physical impairments that require the services of a nursing home. Staffed 24 hours a day, assisted living facilities provide medication assistance, help with daily routines, housekeeping, meals and transportation, as well as social engagement through community activities, outings and events. This level of care still allows seniors to live a fairly independent lifestyle, but with greater support. In some facilities, both assisted and independent living options are offered, so when additional care is needed, the resident can stay in the same location and simply adjust the level of support.
Kistner notes that both independent living and assisted living are primarily private-pay environments, meaning the expense must be met out of pocket. In the mid-1990s, the Illinois Supportive Living Program was created to help those who qualify for Medicaid and can’t afford such facilities, as well as a way to control increasing healthcare costs.
Supportive living mirrors assisted living, offering assistance with daily routines, medication, housekeeping and meal preparation, and providing low-income seniors with more cost-effective care than nursing homes, the most restrictive—and expensive—level of care. The Tri-County Area is home to numerous supportive living facilities, including St. Francis Woods and Courtyard Estates of Peoria, Supportive Living of Washington and John M. Evans Supportive Living in Pekin.
More Extensive Care
For those with a substantial injury, illness or surgical rehabilitative needs, or if long-term, extensive oversight is required, nursing homes provide the necessary care. “When a person breaks a hip or has a stroke, can’t stay in the hospital any longer, and can’t go home because there is no one to take care of them… a skilled nursing home has trained personnel to manage them,” Kistner explains.
Whereas assisted living facilities are just that—assisted living—nursing homes provide 24/7 care and supervision. Because residents typically require extensive medical and personal care and may have significant cognitive impairment or behavioral issues, staff members have additional training and credentials to help manage them. As the most restrictive level of care, nursing homes are usually viewed as a last resort.
If specialized Alzheimer’s, dementia or memory care is needed, facilities like Grandview Alzheimer’s Special Care Center in Peoria offer services similar to assisted living, with enhanced safety features and additional support and structure. Staff members are trained to care for those with memory impairment, while the facilities are easily navigable and carefully designed to minimize wandering—common among those suffering from Alzheimer’s disease. Due to greater staff-to-resident ratios and the additional training required, this type of care is typically more expensive than other options.
Toward the end of life, the primary focus may shift from curing an illness or prolonging life to allowing the dying process to occur naturally in the most comfortable and painless way possible. An alternative to traditional hospital and nursing home facilities, hospice care offers counseling, respite and social services for these individuals and their families, in addition to medical, nursing and daily routine assistance. Hospice care traditionally occurs in one’s home, but can be offered at medical, nursing or special hospice care facilities, such as the OSF Richard L. Owen Hospice Home in Peoria.
Accepting the Aging Process
While selecting the right level of care can be taxing on its own, the process is often complicated by the conflicting emotions of an elder’s children, who may work, have children or are otherwise busy in their own lives, leaving them feeling guilty or uncomfortable about the welfare of their parents. Aside from helping them understand the appropriate levels of care, Kistner helps them accept the changes that accompany the aging process. “I work with a couple of very professional businesswomen, and they are always trying to ‘fix’ their parents,” Kistner says. “They don’t have to fix everything—nor can they, nor do they need to. Just let your parents be.”
Bowers sees the same thing in the adult day care setting. “When families are getting their loved ones started, it’s usually their guilt and grief we’re dealing with,” she explains. At first, people are often wary of whether their loved ones will like the program, she notes, but after acclimating to the environment, they often look forward to coming back. “It’s their social setting. They say ‘hi,’ they have a place to go, and they look forward to seeing each other.”
With the ranks of seniors on the rise for the foreseeable future—and with the corresponding loss of boomer-age healthcare providers—an already-stressed healthcare system faces challenges unlike any it has seen in the past. Whatever level of care is needed for you or your family members, preparation and a thorough understanding of the available options are essential to making a wise decision. iBi