The conversation could come up while visiting with an aging parent over the holidays. Your 85-year-old mother or father might acknowledge slowing down, but then ask you to promise never to consider a nursing home. Many elderly individuals are adamant they would rather die first.
Occupancy rates in many skilled nursing homes across the country has decreased. Assisted living has gained popularity and more programs exist to help seniors stay in their homes longer. While skilled nursing care serves an important purpose, advance planning for long-term care can reduce time in a nursing home.
Assisted living continuum of care
When one-level independent living is no longer feasible because of deteriorating cognitive abilities, you need to make tough choices and often quickly. If you have extra space, providing family care might be an option. It may not be feasible, however, if you are working a full-time job while raising children.
Most residential care or assisted living communities offer a continuum of care, from apartments with housekeeping to memory loss units. In many cases, the range of care can keep a couple together at the same place even if the spouses have different needs. Mom can remain more independent in an apartment while Dad lives in the memory care unit. Yet they can still have dinner together in the dining room.
Less regulatory oversight and for-profit model
But as the New York Times recently reported, it’s important to recognize that this for-profit model of care is not subject to the same regulatory oversight. Many facilities struggle to deliver on promises of attentive care and security.
Units in memory loss or dementia units are much more expensive and generally not covered by Medicaid. The National Investment Center for Seniors Housing & Care estimates $6,472 per month compared with $4,835 for an assisted living apartment. What does the added cost provide? In Colorado, there are state requirements regarding pre-admission screening, consumer disclosures and building features, but not staffing type or level.
Hallmarks of dementia can include wandering and physical aggression. This is where proper staffing levels and training are important. Without overnight supervision, wandering off at midnight can be fatal. And with nearly 8 percent of those with dementia exhibiting aggression, they can pose a risk to fellow residents. In a California case, a male resident threw an 88-year-old woman to the ground. She broke her hip and died several months later. The man was evicted, but probably should never have been admitted.
Is a nursing home a better option?
Staffing issues are not unique to assisted living; skilled nursing facilities also suffer from gaps and shortages. However, nursing homes are subject to more regulatory oversight and are better at providing health care. A nursing home can also prevent a loved one from frequent trips to the hospital to treat certain conditions.
Because there is no way to predict the future, seeking professional advice can be a first step to putting a road map in place for future long-term care decisions. An elder law attorney can also help with emergency decision-making if a loved one deteriorates quickly.