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Lifespan Planning – Your Options: Health Related Services

Preparing for a Doctor Visit

With the increase in the number of older adults living longer, comes the added pressure on our current medical system to manage these growing numbers. To help the patient prepare for a physician visit, it is recommended that time be taken ahead of the appointment to ensure that all of your questions are responded to by the primary care doctor. 1) bring your medications, or a list, of all medications and supplements; 2) write down any problems you are experiencing from the medications, such as dizziness, headaches, insomnia, etc; 3) write down questions you have regarding treatment or specific therapies; and 4) write down the responses to your questions.

Physical Activity

We know that physical activity that provides a minimum of 30 minutes a day is just as important as eating a healthy diet. Physical activity is not only healthy for the muscular and skeletal system but has been found to help decrease the onset of depression, as well as helps to reduce stress. In addition, exercise can help to minimize weight gain and can help with some sleeping difficulties. Naturally, before engaging in any type of physical activity we strongly recommend talking with your primary care physician first, as well as during subsequent follow-up visits regarding your regimen.  

Psychological Related Issues

 Depression and Anxiety – Both depression and anxiety are treatable. It is not unusual for individuals to experience changes in their mood as their life changes. There are many unexpected events that take place that we are not always prepared to handle such as a loss of spouse, siblings, or friends. There is no need to fear seeking professional advice from a trained and licensed professional social worker who is prepared to assist you in managing these new life changes.

 Caregiver Stress – One major reason a family member ends up residing in skilled nursing is because of caregiver stress by the primary caregiver. It is important to recognize the signs and signals, seek professional help, or join a specific caregiver support group. Many times caregivers will experience some of the following:  an increase in frustration, headaches, sleeplessness, loss of appetite, feelings of anxiety, social isolation and separation from friends, and increase in chronically related health problems.

 Maintaining a Healthy Brain – As we age, there is the fear that we will become increasingly forgetful and eventually develop some form of a dementia. To help prevent the early onset of a dementia, or Alzheimer's disease, "exercising" our brain on a daily basis is recommended. Simple activities such as having a discussion with friends on world and national events, crossword puzzles, word games, board games, card games are some suggestions. Physical activity, attending social events, the theater, movies, and concerts can also be helpful. Avoid spending long hours watching television passively by incorporating an exercise routine at the same time. Also keep in mind that a healthy diet can also lead to a healthy brain.

Social Related Services

 Family Support – Reconnecting and maintaining family connections is of particular value as we grow older. This may be the time to address the issues that separated the family through the use of a trained licensed social worker who specializes in working with families. Perhaps it would be better for family members to begin this healing process in order to garner support for each other at this time when things seem to be going well instead of when there is a crisis or death in the family.

 Adult Day Programs – Social interaction with age appropriate peers can be enjoyable for those who may not even like to socialize. Many state supported programs exist which offer a variety of services for the elderly. Senior centers offer organized activities for the independent adult, adult day programs can provide the necessary relief or respite care of someone who is experiencing signs of early onset dementia, and adult day health services provide a comprehensive list of medical and social  oriented services for persons living on Medicaid.

 Senior Services – There are a wide range of human and health services for persons within all economic ranges. There are programs that can help people who might otherwise be placed in a skilled nursing facility to stay at home and there are services for families experiencing living with someone who has a dementia-related disease. Some families  benefit from working with a trained geriatric professional care manager who can help with identifying resources and navigate through the issues of helping an aging parent or family member.

 Financial Related Services – Paying for care, especially if you want to continue living in your current environment can be just as expensive as living in an assisted living facility. Many families may choose to utilize their existing home to pay for care through a reverse mortgage or equity loan. It is recommended that before considering such an action that the family engage the services of a professional care manager to assess the benefits and your capability to remain in your home first, followed by the discussion as to the best way to fund the plan of action. It is best to discuss long-term financial planning with a certified financial planner, as well as your accountant.

 Medicaid  Long-Term Care – The funding of Medicaid is currently in flux with potential changes in financial qualifications under discussion. Eligibility is determined by meeting specific financial requirements. The program is intended to provide care and treatment for those who are in financial need and in some cases may not have enough income to cover the cost associated with a long-term care facility. Professional social workers can answer questions regarding eligibility qualifications and benefits through this government-funded program.

 Legal Related Services – It is highly recommended that individuals, regardless of their income/financial status, consider composing a Living Trust or will. With these documents individuals can discuss with an attorney an estate plan that will help protect the family's assets, as well as designate whom will have responsibility for making legal decisions if the person becomes unable to make decisions for themselves based on health issues. Typically included in these documents is a Medical Directive that provides specific instructions as to your desires and wishes if you become incapacitated to make such decisions.  

Care Management Services

Services to help you implement a plan of care will be based on your decision about where you want to live. In many situations, families may want to consider hiring professional geriatric care manager/social worker and paying for the services provided on a fee-for-service basis. Before selecting a care manager you may want to first consider your preferred long-term care goals. He or she can help you select a home care agency and identify an assisted living facility.

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Long Term Care Tip Sheet – How to Make Your Own Decisions

Introduction
Staff and Family Concerns
Tell Your Family and the Staff What Matters to You
Take Part in Your Resident Service Plan
Know Your Rights
Find and Use and Advocate

Introduction

Even if you are no longer living in your own home and have moved into a long-term care facility, you still want to be able to make decisions about the parts of your life that matter most to you. Now and then, you might like to smoke a cigarette, drink an alcoholic beverage, or go off a special diet. Even if it risks harming your health, you may want to do it. Staff and family concerns may limit you from living your life the way you'd like.

Staff and Family Concerns

The staff of your residence?and your family?may try to balance your right to live how you want with the way they see their responsibility for your safety and well-being.

Maybe it's important for you to decide whether to go for a walk by yourself, as best you can, knowing you might fall. But the staff may think you'd be safer in a wheelchair. They may feel your danger of falling is bigger than you think.

The staff may feel their job is to protect you and do things for you, instead of helping you to be as independent as possible. This may come from their own beliefs, from your family's instructions, or from what they think a government agency requires. They may also be concerned about getting sued.

But you don't need to accept these limits. Talk with your family and the staff about what you want to do and which decisions you want to make for yourself.

Tell Your Family and the Staff What Matters to You

People who mean well and are concerned about your safety and well-being surround you. Tell them about your values. Explain the benefits of any choice you want to make?even the plus side of any risks you may want to take. Do you want to take a walk by yourself, for example? Tell the staff if you've always loved walking. Explain that it may help keep up your strength.

Take Part in Your Resident Service Plan

If you want your services provided in a certain way, you need to make sure your Resident Service Plan describes how. Your doctor or nurse should be available to discuss your medical needs and how to meet them. Find out if?and when?staff members meet to discuss your plan. Attend these meetings with your family. Help write and update your plan to ensure it reflects your needs and wants. For example:

  • Do you like baths, not showers?
  • Are you trying to be more independent in toileting yourself?
  • Do you need to share your needs and wants in a language other than English?

Your plan should say so.

Know Your Rights

Rights seldom come automatically. You have to assert them. The first step?  Find out:

  • Your residence's obligations to you
  • Your specific rights to choice and decision-making, or general rights that support free action
  • Your admissions agreement or contract or your state or local government regulations

Find and Use an Advocate

Sometimes you may want an outside advocate's help?maybe to get information, or to help resolve a complaint that wasn't handled well.  Know the advocacy resources in your community, and call on them when needed.  Many communities have a Long-Term Care Ombudsman Program.  It can suggest ways to get the best possible assisted living. Your local Agency on Aging may list other advocacy groups in your area.  These organizations may be part of a big consumer community, where you can join with others to achieve the potential of assisted living.

Source:  Resident's Guide for Assisted Living.  Maintain Your Independence Choice, and Control. Coalition of Institutionalized Aged and Disabled (CIAD) and the Nursing Home Community Coalition of New York State (NHCC) 

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About Residential Long-Term Care

Introduction
What Is Long-Term Care?
What Are the Options?
How to Find Long-Term Care Services
How to Finance Long-Term Care

Introduction

Most of us would prefer to live independently in our own homes as we age.  However, Americans over age 65 have more than a 75 percent chance of needing some assistance due to chronic illness, accidents, cognitive impairment, or disability.  Families have traditionally been the primary sources of care and support for older relatives, however, today there are other choices for care available.

What Is Long-Term Care?

Long-term care covers a variety of arrangements such as skilled nursing facilities, shared housing, group homes, continuing care retirement communities, and assisted living. Given the complexity of the systems of care for older adults, it is critical that they and their families become familiar with the various options for long-term care prior to the onset of a disability.

When the older adult's safety becomes a critical issue, or when a family caregiver can no longer provide adequate care, families must explore other options, such as institutional care.  For example, a person with Alzheimer's disease that quickly becomes advanced and requires constant supervision may receive the best care in the dementia unit at a local nursing home.

What Are the Options?

If you or your family are considering various types of long-term care, your decision will be based on the level of care needed. An example of one option is an assisted living community for someone who can no longer live at home, but does not require skilled nursing care. Assisted living residences may provide meals, basic housekeeping, and assistance with bathing, dressing, and other activities of daily living.  Some residences also arrange for transportation and provide limited health care services.  These residences may be known by various names, such as personal care homes, sheltered housing, residential care, catered living, and board and care homes.

Assisted living residences may be a part of a continuing care retirement community (CCRC). These communities provide separate housing for active and independent older adults, those who require some assistance, and those who have serious physical and mental disabilities.  Residents move from one location within the community to another as their needs change with age or illness.

Older adults who need round-the-clock nursing care and help with meals, bathing, medications, personal care, and other tasks may want to consider moving to a nursing home.  Also called skilled nursing facilities, extended care services, or health care centers, nursing homes provide 24-hour services and supervision, medical and nursing care, personal care, and residential services for social and spiritual needs.  In most nursing homes, living spaces consist of a single room for one or two residents.

How to Find Long-Term Care Services?

Selecting a long-term care option can be challenging.  Social workers both in private practice and community-based social service organizations can help identify the type of long-term care services needed.  In addition, social workers can help explore available options for financing long-term care services and help older adults and their family members become acclimated to the new living environment. 

Nursing homes and assisted living residences often have social workers on-site to answer questions about the facility and to help smooth the transition from home life to an institutional setting.  Contact the U.S. Administration on Aging Eldercare Locator at www.eldercare.gov or (800) 677-1116 to find in-home or residential long-term services in the local community.

How to Finance Long-Term Care?

Unfortunately, there are many misconceptions about how to pay for long-term care services.  Many assume that Medicare, supplemental policies, or standard health insurance policies will cover the expenses for long-term care.  Medicare is a federal health insurance program for people age 65 and older and certain disabled people under age 65.  Medicare does not provide comprehensive long-term care and generally does not cover the costs of custodial care, such as assisted living.  Even when Medicare does cover long-term care services, coverage is limited and the services will only be paid for after certain conditions are met. 

Costs of long-term care are typically paid for with private money or through long-term care insurance.  Whatever the case may be, everyone is encouraged to plan ahead for long-term care needs and make knowledgeable decisions before services are needed.  Determining the type of care needed and choosing the highest quality facility takes time and planning.  Social workers can help you choose the right option for you and your family.

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