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What To Ask To Help Determine Level Of Assistance A Facility Offers Growing Older / Liz Taylor Monday, January 12, 2004 - Page updated at 12:00 A.M. Q: I'm a home-care nurse and am often asked about living settings. Do you have any guidelines for deciding between assisted living versus retirement communities? A: Here's a good, simple question that gets muddied by a number of important "it depends" answers. The first "it depends" is how much assistance a person needs, not just now but down the road. Since no one has X-ray eyes to foresee the future, you have to go with your gut — and a reliable diagnosis (some diseases progress more predictably than others). The next "it depends" is the facility's flexibility — how much assistance it provides, not just now but as the person's needs change. Moving is hard on older people (and their families who have to move them), so choosing a place that allows you to "age in place" — live there as long as possible — is ideal. As your needs change, you pay to obtain additional care versus looking for a new place. Here are two examples. Let's say your aunt, age 87, has arthritis, is nearly blind, walks with a walker, and is mentally still sharp and able. In most cases, a retirement community would fit her well. But let's say her cousin at age 77 has been diagnosed with Parkinson's disease, walks with difficulty, needs help remembering his medications and has no spouse. Because his diagnosis indicates continuing decline, an assisted-living facility offering a progression of care would probably work better for him. But don't go by labels. There are no rules requiring these facilities to provide certain services. Some retirement communities require you to be very healthy and offer no extra care beyond the basics, while others will care for you until you die. Similarly, some assisted-living facilities provide only "lite" care, while others specialize in caring for very disabled people, including those with severe memory loss. So kick tires, ask questions, and compare how much "flex" different facilities offer. Here are questions to get you started, framed in the hypothetical of what happens to residents who: • Become incontinent and can no longer go to the bathroom alone? • Are unable to bathe or dress without assistance anymore? • Are confused and need redirection? • Need help with injections or other medicines? • Use a wheelchair? • Need help getting to the bathroom at night? • Are dying? Several other "it depends" include: • Where you live — the more rural the community, the fewer choices you'll have. • What you can afford — there's a much smaller range of choices for people on Medicaid. I know of no assisted-living facility in our area, for example, that takes severely demented residents on Medicaid, but there are excellent choices for people who are private-pay. • If a spouse can provide care, a couple may be able to live a long time in an independent facility. Be careful, though, not to let the apartment become a prison as the healthy caregiver becomes isolated and exhausted. Choosing between an assisted-living facility and a retirement community is a personal decision involving lots of factors. That's the beauty of having alternatives. By asking questions ahead of time, you'll be able to target the right choices, then gauge when you'll have to begin your search again. Q: My husband had his first stroke at age 40, long before long-term care insurance was part of most people's vocabulary. He returned to work and retired 11 years ago. Ten years ago, he had more strokes, diabetes, congestive heart failure and macular degeneration. I took care of him for seven years, 24 hours a day, with very little help. Three years ago, he fell and broke his hip. He's been in a nursing home ever since — one of the 8 percent who stay longer than three years. After using up our meager resources, I frankly don't see an alternative to Medicaid, do you? I don't want to cheat the taxpayers but don't know what else to do. A: I'm sorry you and your husband have such difficult circumstances. I decided long ago that "fairness" has no meaning, and often this is demonstrated as we get older, when some people are hit with a ton of bricks and others pass gently into the night. Unlike my criticisms of those who "sneak the system," as one of my readers calls it, you are the reason Medicaid exists — to pay for care when there are no private resources left. A good number of people in nursing homes today were private- pay when they began needing care, then spent down their assets legitimately on the care they needed — didn't hide them or give them away. Have no hesitation about using Medicaid to pay for your husband's care. That's why you and I and everyone else pay taxes — to provide for those who've done their best and now need help. Under Washington state law, the healthy spouse can keep up to $40,000 in savings, the house, a car, personal possessions and some portion of their monthly income, while the unhealthy spouse obtains care through Medicaid. Don't spend all your assets before getting your husband on Medicaid — you need money to live on as well. Liz Taylor's column runs Mondays in the Northwest Life section. A specialist on aging and long-term care, she consults with individuals and teaches workshops on how to plan for one's aging — and aging parents. E-mail her at [log in to unmask] or write to P. O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at http://www.seattletimes.com/growingolder/ SOURCE: The Seattle Times, WA http://seattletimes.nwsource.com/html/health/2001833442_liztaylor12.html * * * ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn