Showing posts with label long-term care. Show all posts
Showing posts with label long-term care. Show all posts

Wednesday, March 20, 2019

Retirement Housing for Aging Alone - Are You Prepared for the Future?

Millions of Americans are aging alone, often because they are divorced or widowed.  Others may never have married.  Large numbers of them may not have children, or their children may have their own physical, mental or addiction problems which make them unlikely to be of much help.  Although most of us believe we will be able to take care of ourselves for the rest of our lives, this is not always realistic.  What happens if you are diagnosed with a serious illness or dementia?  Everyone needs to understand their options for aging alone, so they are prepared when the time comes and they need extra help.

Reach Out to Others for Help

The first thing you need to realize is that few people really need to be totally alone, unless they are unwilling to reach out for help.  Organizations such as your church or place of worship, the local senior center, and Meals on Wheels have resources to help you, whether you need permanent or temporary assistance, such as after a surgery. 

If you wish to remain in your own home as long as possible, contact the organizations mentioned above, as well as your nearest state Social Services department, and follow their suggestions.  You may qualify for financial assistance, discounts on your utilities, special telephones for the hearing impaired, free or discounted transportation, Meals on Wheels delivered to your home, and handicapped accessible equipment to make it easier for you to live alone.  For many people, these services make it possible for them to remain in their own home much longer than would otherwise have been possible.

It is likely that there are also businesses in your community which will make it easier to stay in your own home as you age.  Find out if you can get your groceries delivered, your cleaning picked-up, and a maid service to clean for you.  Does your local transportation authority have buses or ride share services which will take you to shopping centers or doctors' appointments?  Are you taking advantage of online banking?  All of these conveniences make it easier to live alone, even when you have trouble getting around on your own.

In addition, set up your own circle of friends and relatives who may be in the same situation.  Create a phone circle so you regularly make phone calls and receive calls from others.  In this way, you can help check on them and they can check on you.  This can bring peace of mind in the event you fall or are injured, knowing someone will check on you and, if you do not respond, they will call a neighbor, relative or the police to do a wellness check.

A friend of mine has a 90 year-old neighbor whom she worries about.  Together they came up with a plan that the 90 year-old would open the blinds in her kitchen window by 10:00 every morning.  When my friend sees the blinds have been opened, she knows her neighbor is OK.  A simple plan such as this one can make it easier to live alone, while knowing that your neighbors are looking out for you.

You can also use technology, such as a Great Call device or similar wearable alarm system, so you can easily reach someone in an emergency.  You simply need to push a call button and the agent who answers can call a neighbor, friend, police or ambulance service for you, depending on the situation. You can even do something as simple as taking the time to make sure you always carry your cell phone around in your pocket.

Finally, pull together a few social circles.  These can be people who get together on a regular basis such as book clubs, quilting clubs, lunch pals, or dinner groups.  Join a bridge group or take a class at a senior center or community college.  Send cards or emails to friends and relatives so you stay in touch.  All these social contacts can enrich your life and help you feel less alone, which is important for both your mental and physical health.

Housing for Those Needing More Care

Once you have exhausted all the programs which have enabled you to live on your own, what should you do when you eventually need more care than is possible for you to get in your own home?  This is when you or a person you trust should plan ahead for the best type of housing for you.  You need to consider the types of care you may need, the activities which interest you, the amount of socialization you think you would enjoy, and how close you want to be to your current community support such as your church, old friends and relatives.

You can start by using a reputable agency to hire a personal caregiver.  This may help you stay in your own home even longer.  However, it is important that a friend or relative checks on the caregiver regularly, to make sure they are giving you appropriate care and not taking advantage of you.

You may also consider moving into an over-55 community where you can live in a separate home of your own and participate in community activities, but have an added layer of security as well as the company of neighbors who are also aging in their own homes. 

Several of my friends have moved into a wide variety of special senior living facilities and wondered why they waited so long.  Modern assisted living communities have parties, cocktail hours, special events, classes, trips, pools, art studios, gyms and more, while providing meals, housekeeping and other types of care.  Once they have gotten settled, most of my friends have loved their new homes!

Personally, I am currently living in an over-55 independent living active adult community.  I have plans to move in the next couple of years into senior apartments which include dinner, lunch and housekeeping, but no nursing care.  In the event this is not enough care, I also have long-term care insurance so I can move into assisted living or a memory care facility when I get really old!  However, I'm not in a hurry for that to happen and, perhaps, it never will. 

There are a number of senior housing choices available:

Independent Living Apartments:  These are ideal for people who want the security and simplicity of living in a senior community, but do not need any assistance with daily living needs.  In some of these communities, you prepare your own meals and do your own grocery shopping.  In others, your meals are provided.  Some locations have a hybrid system in which dinner and, perhaps, lunch are provided, but you are on your own for breakfast.  You should check out a variety of communities until you find one which seems right for you.  If you are financially limited, many cities provide senior apartments which can be rented on a sliding scale, depending on your income.  You may need to go on a waiting list, so sign up as soon as you begin to think this is something you would like to do. 

Assisted Living Residences:  These are ideal for people who do not need medical care but who might need assistance with the normal activities of daily living, such as bathing, eating, dressing, using the bathroom, walking or transitioning back and forth from a bed to wheelchair.  They usually provide meals, housekeeping, transportation, medication management, and fun, interesting activities.  The cost can range from about $4,000 to $10,000 a month, depending on the amount of help you need, the size of your room or apartment, and the area where you live.  Long-term care insurance may help with the expense.

Continuing Care Retirement Communities or a CCRC:  These are sometimes called life care communities and it is something you may want to investigate years before you expect to need one.  In this way, you will have a say in where you may end up living.  A CCRC is composed of senior apartments and cottages which have a tiered approach.  You start out living in an independent living unit.  Then, as the need arises, you may be moved to a skilled nursing or memory care facility in the same community, so you can get the assistance you need while still maintaining your connections.  Most of these communities require that you are able to function on your own in an independent living unit when you first move in, so it is important you plan ahead.

A few CCRCs are rentals and some allow you to use your long-term care policy to cover the cost, which can vary depending on the amount of care you will need.

However, most CCRCs require you to buy into the community and they will not accept a long-term care policy.  The "buy-in" can range from $100,000 to $1 million, with the money often coming from the sale of your home.  In addition, the monthly fees can range from $3,000 to $5,000 per person.  There are different types of contracts available including unlimited life care, modified life care with limits, and fee for service, with the responsibility for expensive long-term care lying with the resident, not the facility.  Before you choose a CCRC, you will want to visit all the ones in the area where you plan to live and compare whether they are rentals or the type where you pay an entrance fee, the monthly cost, potential extra fees, as well as what type of contract you will have.  It can be complicated to compare them, so you want to investigate your choices thoroughly while you are still in good health and of sound mind.  The benefit of a CCRC is that you can settle comfortably into one and, if you have planned well, you will never have to move again.  They will take care of you for the remainder of your life.  This brings a great deal of peace-of-mind to many people.

Board and Care Homes:  If you are looking for a comfortable, homey setting which is less expensive than most assisted living residences and CCRCs, then you may want to investigate your choices in board and care homes.  They are private homes which have been converted to small senior living facilities with professional staff.  They do not feel as institutional as other facilities and they can feel safer and more supportive than trying to remain alone in your own home.  You will be living with a small group of other people and have a staff to make your life more comfortable. 

Nursing Homes:  Also known as skilled nursing facilities, they will care for you and provide around-the-clock medical care.  Some of them are also rehabilitation facilities and you may stay in one temporarily while you recuperate from surgery, such as a hip replacement.  They have a higher level of care than an assisted living facility or a Board and Care home.  If you pay for a nursing home out-of-pocket, it can average $82,000 a year or more to stay in a semi-private room, according to a 2016 National Nursing Home Survey.  However, your costs may be covered by a long-term care policy or, in some cases, Medicaid.  You should investigate your financial options as soon as you move into one, before any Medicare or health insurance benefits expire.

Plan Ahead for Late In Life Care

If you expect to age alone, it is smart to start early to investigate your various options for receiving appropriate medical care should you have surgery or become seriously ill.  If you are fortunate, you may discover you never need to use the most expensive, comprehensive care, such as a nursing home.  However, if you do have a need for this advanced care, even temporarily, it is smart to know your options and consider how you will pay for it.  Put your choices in writing and give the information to one or two trusted family members or friends, so you are sure your wishes will be honored, should you not be able to speak for yourself.

Whether you age in your own home or move into some type of senior housing, you should make sure you have a will and trust, your finances are in order, and everything is as organized as possible.  Make certain you have a trustee who can handle everything for you, should you become unable to handle things yourself.

While you are at it, you may also want to consider discussing your healthcare wishes with your doctor and putting them in writing, too.  A Living Will or Healthcare Directive is another way to make sure your wishes will be honored during the last few years of your life.

In you are interested in learning more about aging, common medical problems, where to retire, financial planning, Social Security, Medicare and more, use the tabs or pull-down menu at the top of the page to find links to hundreds of additional articles.

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Wednesday, November 19, 2014

Long-Term Care Insurance -- Should You Buy It?

It may be hard to imagine today, but the time may come when you will have difficulty bathing yourself, getting dressed, preparing meals, eating, moving from the bed to a wheelchair or walker, using the bathroom, remembering to take your medication, or with incontinence.  This situation may come on slowly as we age, or it could happen suddenly as the result of a stroke or accident.  No matter the cause, it is important that you have a plan for dealing with these issues when the time comes.

Cost of Getting Long-Term Care

If you have not properly prepared, obtaining the care you need can be extremely expensive.  Although the exact amount varies across the nation, the Orange County Council on Aging estimates that it can range from $50,000 to $80,000. 

The least expensive type of care is when a family member provides the care you need.  However, this is not always a possibility.  Personally, I know of several widowed, childless men and women.  They have no near relatives who can care for them if they should become incapacitated.

Another option is to apply for MediCal.  This is a government program that covers long-term care expenses for many people.  A company called Nursing Home Solutions provides professional financial planners who can help you see if you qualify for MediCal.  In their ads they say that you do not have to spend down all your assets in order to qualify for MediCal assistance in paying for a nursing home. I am sure there are also other companies that can help you apply for this program.  You can contact Nursing Home Solutions at

The next least expensive type of care is the use of a part-time caregiver in your own home.  The cost becomes more expensive if you need full time care in a nursing home or assisted living facility.

The most expensive care is for those people who choose to have 24-hour caregivers in their own home, since this requires three shifts of caregivers, seven days a week.

What Does Long-Term Care Insurance Cover?

Fortunately, there is a type of insurance that will pay for your care when you are no longer able to take care of yourself.   In California, where I live, these insurance policies must include coverage for in-home caregivers, as well as the cost of residing in an assisted living facility or a nursing home.  This gives you the option to receive your care in the setting that is most appropriate for you and your family.  For example, if your spouse needs long-term care, having this insurance may make it possible for them to stay in your home with you, without forcing you to put them in a nursing home.

Purchasing Long-Term Care Insurance

This type of insurance gives you a variety of options, so different people can choose the amount of insurance they can afford.  You can select a policy that covers your care for a few years, or you can choose one that would cover you for as long as necessary, even if that is the rest of your life.   The shorter the term of care, the lower the premiums will be.

Why Would You Buy a Short Term Policy?

You may be wondering why everyone wouldn't just buy a policy that would cover them indefinitely, rather than have a time limit on it.  Of course, that would be ideal, but it could be too expensive for many people.  When my husband and I purchased our policies, we bought a long-term policy for me, and one that would last a maximum of 4 years for my husband.

Our insurance agent said that you have to look at things practically.  I am more likely to outlive my husband.  If he were to become debilitated, I would probably care for him by myself as long as possible before bringing in a caregiver.  Once we reached that point, four years of long-term care would probably be adequate.

On the other other hand, when I am elderly and losing my ability to care for myself, I probably would not have a spouse to take care of me.  I would need to hire a caregiver sooner and would most likely need the care for the rest of my life.

Based on our conversations with our insurance broker, we purchased the policies that seemed to be affordable and would meet our projected needs the best.  The right policy for you will vary depending on your personal circumstances, such as whether you are single or married, whether or not you have adult children who are capable of providing the care you might need, the health and life expectancy of you and your spouse, and how much insurance you can afford.  Even a short-term policy is better than no long-term care insurance at all.

Whatever you decide, you want to make sure you select a policy that you can afford now, as well as in the future.

What If You Do Not Qualify for Long-Term Care Insurance?

The younger you are when you buy the policy, the better off you will be.  It will be less expensive in your 50's or early 60's and you are more likely to qualify for it.  However, if you do wait until you have a chronic condition and you have trouble qualifying, there are alternatives.  If you or your spouse is a Veteran, you may qualify for $2000 a month in long-term care aid from the Veteran's Administration.  There are also special life insurance policies that include long-term care riders.  You can talk to your insurance agent about those choices.  You may also be able to qualify for MediCal.

Whatever you decide, you need to give this issue some thought and let your loved ones know about any policies you own or money that has been set aside for your long-term care.  You do not want to wait until you are injured and cannot speak for yourself.

If you are retired or planning to retire soon, you will find links to more information about long-term care in the Medical Concerns tab at the top of this page.  You may also be interested in the article links you will find under the other tabs, which cover issues such as financial planning, where to retire, and family isues.


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Thursday, April 10, 2014

Are You A Retirement Planner, Procrastinator or Crasher?

When researching Continuing Care Retirement Communiites recently, I came across an interesting quote by an industry expert.  He said that most people fall into one of three groups when it comes to moving into a CCRC ... they are planners, procrastinors or crashers.

For those of you who are regular readers of this blog, I assume that most of you fall into the role of planners.  You are already thinking about your options for the near-term, as well as for the more distant future when you may need more services. 

What is the difference between the three groups?

Continuous Care Planners

These people are in acceptance of the fact that they will probably need help or extended care at some point in the future.  They also do not want to be a burden on their adult children or other members of their family.  They want to have fun and enjoy life as long as they can, while feeling comfortable that they have taken steps early to assure that they will be taken care of when the time comes and they need more help.  These are the people who explore their options early, decide where they would like to live when they are ready, and let other family members know about their decision.

Continuous Care Procrastinators

Procrastinators are similar to planners except they postpone investigating continuing care facilities as long as they possibly can.  Sometimes they later regret their procrastination, later admitting they wish they had made the decision and moved sooner.  They just didn't realize how much more fun they could have been having by moving to a community where they no longer had to worry about meal preparation, cleaning and similar day-to-day chores.

Continuing Care Crashers

These are the people who do not believe that they will ever need help.  Sometimes you may hear them say things like, "I don't expect to live that long," or "With a heart like mine, I'll probably die suddenly," or "I eat right and take care of myself so I don't think I will ever need someone to help care for me."  No matter which opinion they hold, there is a good chance that they will be wrong.  With today's modern healthcare advances, people often do end up living longer than they expect and discover that they do need assistance later in life, whether they ever thought that would happen or not.  What frequently happens with this group is that they go directly from independent living in their own home directly into a skilled nursing facility, skipping the transition period of living independently in a continuing care community.

Which Is the Right Choice for You?

There is nothing wrong with falling into any of these categories.  Of course, the managers of Continuing Care Retirement Communities would prefer that people move into their facilities when they are in their late sixties or early seventies.  However, for people who are still working or active, this may not be the right decision.  Becoming a procrastinator may be the right decision for a large percentage of people.  I know my husband, who still works, enjoys our traditional over-55 community that does not provide continuing care.  I don't think he would be happy living in a CCRC where no one else had a job.

In fact, there is a good chance that many people, like my husband, would be perfectly happy to be labeled as "Crashers."  He plans to continue to work for several more years and has no intention of moving out of our current community until he is ready for a nursing home.  Circumstances may change as we get older, but that is how he feels at the moment.

On the other hand, if I were a widow in my seventies, I would probably be perfectly happy in one of the Continuing Care Retirement Communities in our area (and there are a number of lovely ones.)  I know that I do not always prepare healthy meals for myself when I am home alone and it would be nice not to have to worry about it.  I also enjoy being around other people and would love to be in a social community where my meals are prepared and there are planned trips, outings and parties I could enjoy, as long as I also had my own, private apartment or cottage.

This is a decision that each of us has to make on our own.  The important issue is not which category you fall into.  What is important is that you make the decision consciously.  Personally I've always believed that the best inheritance we can give our children is the knowledge that they will not have to spend their senior years taking care of us when we are sick and fragile.  I am investigating various CCRC's because I want to know that regardless of the type of illness or dementia that may befall me, my children will not have to feed and care for me 24 hours a day in my later years. 

If you are interested in learning more about Continuing Care Retirement Communities, you may be interested in reading this article that I wrote last week:

Choosing a Continuing Care Retirement Community

In addition, be sure to check out the tabs at the top of this page to read more about where to retire, family relationships, medical issues and financial planning, including topics like long-term care insurance and its alternatives.

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