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CONSUMER INFORMATION

There are many long-term care alternatives available

By Jim DeBrosse
© 1999 Dayton Daily News|

Finding an alternative to nursing home care may require more planning, more work and more of your own money, but the payoffs often are greater freedom and a homier setting for your loved one.

At age 90, Mattie F. Branham insisted on living on her own after suffering a stroke five years ago. That's when her daughter, Lucille Meadows of Germantown, sold her mother's home and set her up in an apartment with the help of Meals on Wheels and caregivers hired by word of mouth. The family pays $2,500 to $3,200 per month for home health aides, "but it's money well-spent," Meadows said. Her 95-year-old mother "is still walking (with the help of a walker), handling her own coffee cup and she has no bed sores."

Home health care wasn't the solution for Marjorie O'Neil of Huber Heights. She tried three different home health agencies over an 18-month period to assist her in the care of her 74-year-old mother, but found none of them reliable. Her mother's chronic lung condition and osteoporosis eventually forced her to enter a nursing home "where she became very depressed," O'Neil said.

Then, O'Neil hit upon another solution: adult day care.

Instead of paying $572 per week for home health aides, O'Neil pays only $600 per month to place her mother in Senior Resource Connection's day care program in downtown Dayton. Four days a week, nine hours a day, her mother receives care that includes a hot lunch, snacks, a long list of structured activities -- shuffleboard, card and bingo games, access to a fitness center and arts and crafts instruction -- and a van from the center picks her up in the morning and, on the way home from work, O'Neil picks her up and takes her home.

Key questions to ask: Does each resident have a written care plan? Does the facility regularly re-assess the resident's needs? Are additional services available if those needs change? Do costs vary at different levels of care? What services are included in the basic rate? What are the add-on costs? Under what conditions can patients be discharged from the facility? What are the refund policies? About services: Does the staff include a registered nurse? Can the residence arrange personal care services through a home health agency? Does the staff provide 24-hour assistance with dressing, eating, bathing, toileting and shopping? Does the residence provide housekeeping services in residents' units? Does the residence provide transportation to appointments and other activities desired by residents? Weekends, too? Are pharmacy, hair styling and physical therapy services offered on site? About housing features: Can residents lock their own doors? Can the unit access a 24-hour emergency response system? Are bathrooms private and handicapped-accessible? Can residents bring their own furnishings? Do all units have a telephone and cable TV? How is billing handled? Is a kitchen area provided -- refrigerator, sink, cooking element? About social activities: Is there evidence of an organized activities program, such as a posted daily schedule? Do residents participate in activities outside of the residence in the neighboring community? Are residents' pets allowed in the residence? Who is responsible for their care? Does the facility have its own pets?

"I think adult day care is the best," O'Neil said. "I've seen a lot more improvement (in my mother) than having someone come into the home to take care of her."

Adult day-care centers are not just social settings. They're equipped to handle seniors with moderate physical or mental disabilities, incontinence, Alzheimer's disease or who require tube feeding. Many centers give showers for an extra fee and keep a full-time nurse on hand to provide treatments and medications. Typically, programs are open weekdays during business hours and many provide transportation. Cost ranges from $40 to $60 per day.

Some families need a break from caring for older adults in their homes. Trained respite care professionals or volunteers can step in for several hours or days so caregivers can go out. Many assisted living facilities have apartments where loved ones can remain under care while caregivers get away for several days or weeks.

Other services include Meals on Wheels (228-3663) for hot, nutritious meals delivered to the home-bound on weekdays; home repairs, yard work, heavy housecleaning and other chores; volunteers who visit home-bound or institutionalized elders, run errands or call by phone on a regular basis; congregate lunches served in churches, synagogues, senior centers and schools; and transportation to services and appointments.

For information on the cost and availability of community support services, contact the Area Agency on Aging at 341-3000 or (800) 258 7277, the American Red Cross at 222-6711 or the Senior Resource Connection at 223-2112.

Families who decide they need in-home care can either contact a home health care agency or hire a home care worker on their own. Hiring privately may be less expensive than using an agency, but families are responsible for hiring, training, supervising and discharging the home care worker. And while the family chooses the aide themselves and has more flexibility in scheduling, they must find a back-up worker if the person they hire is sick or on vacation.

Unless they qualify for a special state program, the family also must pay the worker, deal with required tax forms and may also have to purchase liability insurance if the worker injures herself or himself on the job.

Going through an agency helps families avoid those hassles. But costs are higher, with less flexibility and control over the worker's hours and dutie.

HOUSING OPTIONS

As Bill and Sue Jacox of Kettering entered their retirement years, they realized they had no children to look after them if their health began to fail. But they did have each other, so long as they could stay together.

In 1993, while both were still healthy, they sold their home and moved into a cottage at Bethany Lutheran Village, a continuing care retirement community in Centerville.

CCRCs are large complexes that offer all three levels of care -- independent living, personal care (or assisted living) and skilled nursing care -- so that residents can "age in place."

Independent living is for seniors who can mostly take care of themselves but no longer want to care for a home.

Personal care means assistance with bathing, dressing, using the toilet, transferring in or out of a bed or chair, eating and walking as well as taking medications and preparing special diets.

Skilled care is the highest level of care, such as injections, catheterizations and dressing changes, provided by nurses, doctors and physical therapists.

CCRCs usually require a lump-sum entrance payment of anywhere from $20,000 to $200,000, depending on the type of housing and the level of care provided. Although they are private pay, most CCRCs, including Bethany, will accept Medicaid payment if residents eventually need nursing home care.

The big advantage of CCRCs for couples like the Jacox's is that they can stay near each other even as their health status changes. "That was a great thing -- to know that we would be cared for here through all levels of care," Sue Jacox said.

In 1996, Bill Jacox was diagnosed with Parkinson's Disease, a progressively debilitating muscle disorder. By bringing in home health aides, the couple could stay together in their own cottage. When Bill's condition deteriorated this year, requiring full-time supervision, he was transferred to Bethany's nursing home unit. Sue can either walk or drive to visit him every day.

Smaller, home-like settings for long-term care also are available in adult group homes, sometimes called board-and-care homes or adult care facilities. These state-licensed residences, often single family homes, offer housing and personal care services for three to 16 residents. Meals, laundry and transportation usually are provided by the owner or manager.

Joe Majka, 86, says he's happy he moved into Roy Wells' adult care facility -- a totally remodeled, five-bedroom Centerville ranch house with private rooms and baths, three lounge areas and an enclosed patio and garden. It's all handicapped-accessible and equipped with call buttons for safety. Majka, who uses a wheelchair, says he has far more freedom and privacy in a group home than he would at a nursing home.

"I like it here very much," he said. "They let you sleep as long as you want, and when you get up, they fix you breakfast."

Depending on the resident's level of care, Wells charges from $2,000 to $2,500 per month.

He personally trains his caregivers and visits his home two or three times a day. But he says Ohio lags behind in offering the elderly this option which he calls "about as close to home as you can get."

For some of the elderly, easing the transition from their own home to a more dependent situation can be a matter of finding the right living space.

That's why Gordon and Carla Ersted of Kettering, in their mid-80s and in wheelchairs, chose a spacious assisted living apartment at 10 Wilmington Place in Dayton -- complete with meals, dressing, bathing, laundry and housekeeping services. Much of their own furniture from home has helped recreate what they left behind.

"It gives them the feeling of home, of being in their own house," Rahimi said. "Coming from a full-sized house, it was an easier adjustment going to a full-sized apartment."

An assisted living facility can be anything from a high-rise apartment building to a cozy group home, with a wide variation in services and living space. Generally, they are apartments that can also offer meals, housecleaning, medication and personal care. Although residences that advertise assisted living may be licensed as adult care or residential care facilities, there are no mandatory state standards or staffing requirements for assisted living.

Because assisted living facilities and CCRCs are not regulated by the state, they may require closer scrutiny by consumers.

Main story:

One family's painful choice
His wife Beverly has Alzheimer's, and Earnest Prather may put her in a long-term care facility

Sidebars:

Long-term health care coverage isn't for everyone
Numerous factors need assessment

CONSUMER INFORMATION:
There are many long-term care alternatives to choose from

A Consumer Guide to Ohio Elder Care