2008/04/21 00:00:00
By Nanette Lavoie-Vaughan, MSN, ARNP
A recent survey asked people over age 65 where they would like to spend their remaining years. Not surprisingly, the majority chose their own home. Unfortunately, health concerns and the frailty of aging change the options for senior housing.
Those of us in the business of eldercare refer to housing options as “levels of care.” Each option is defined by the level of assistance your loved one needs with his or her activities of daily living. The choices can be confusing for the uninitiated, but a basic understanding of the type of care and the method of payment for each level is essential when discussing choices with your family.
Let’s begin by identifying the levels:
- private home with home care: Your loved one continues to live in his or her own home with the support of home care services, such as a nurse, a personal care attendant, a housekeeper, and/or skilled professionals, providing therapy and medical supervision.
- independent living facilities: These apartment or townhome complexes provide amenities to renters such as in-house restaurant-style dining, on-site medical care, planned activities, transportation, and medication reminder services.
- assisted living facilities: Individual rooms or apartments within a licensed facility can provide the same amenities as independent living, in addition to assistance with daily living activities like bathing, dressing, and taking medication. Staff includes nursing assistants and licensed nurses.
- nursing home or skilled nursing facility: These facilities are licensed to provide medical management and skilled nursing care for those who cannot perform their own activities of daily living or need short-term treatment to return to another level of care or home. In addition to nursing assistants, therapists, and a house physician, licensed nurses staff these facilities around the clock.
- Continuing care community: These multi-level complexes offer all levels of care, including independent and assisted living and a skilled nursing facility. Typically, a person purchases a villa or apartment and then has access to all levels of care as needed throughout their ownership.
Just as the options for care vary, so do the type and amount of resources needed to pay for each level of care. Medicare will pay for some services in the home and for nursing home care in certain circumstances. (Contrary to popular belief, Medicare does not pay for extended nursing home care.)
Most other options are not covered by Medicare and must be paid out of pocket, unless your family member qualifies for Medicaid.
How much should you plan to spend at each level? Amounts vary by location and type of facility, but national averages range as follows:
- Private home care varies widely, depending on whether you are hiring services from a home care agency or obtaining a private caregiver. Home care agencies usually require a minimum four-hour block of time a day and have a set rate. You have more control over the hourly rate you pay for a private caregiver, but they may be harder to find. Expect to pay a certified nursing assistant at least $10 an hour.
- Most independent living communities require a one-year lease and charge monthly rent based on the size of the accommodations. Meals, transportation, activities, and housekeeping often are included. Personal services and some amenities are extra. The average rent is $2,000-4,000 a month.
- Assisted living requires monthly payment that is all-inclusive except for medications, doctor’s visits, and personal services. The average monthly charge is $3,000-5,000.
- Medicare will pay for care in a skilled-nursing facility after a hospitalization of at least three days. However, it pays 100 percent for the first 20 days, and then 80 percent for the next 80 days. Private funds, secondary insurance, or Medicaid must pay for the remaining 20 percent and any subsequent days required. An average nursing home costs $6,000-8,000 a month, which does not include medications or doctor visits.
Now that we have established the basics, next month we’ll discuss who is eligible for Medicaid and how to apply, specific requirements for Medicare, and the use of geriatric care managers if you are a long-distance caregiver.
Nanette Lavoie-Vaughan is an adult nurse practitioner and professional consultant. She is a featured speaker at national professional conferences and writes about geriatrics for multiple publications. If you’d like to send Nanette a comment, question, or suggestion for a future column, please e-mail rolereversal@moaa.org.