Best approach for aging support? Plan, plan, plan
June 12, 2014
Despite 35 years of experience in the assisted-living industry — both as an operator and a state regulator — Wendy Simons continues to be shocked at the lack of thought that most of us give to the needs of ourselves and our families as we age.
"We plan better for getting a puppy," said Simons, who today works as a Reno-based consultant to organizations who serve the aging.
At the bare minimum, she says families who are preparing for the changing needs of an aging relative — or individuals who are beginning to think about their own future — need to begin educating themselves about the supportive-care options that are available.
And Simons says families need to steel themselves to make difficult decisions that almost always will be opposed by the senior.
Don't put the burden of the decision on the senior, and be prepared to shoulder a heavy dose of guilt and blame from a senior who doesn't want to leave home.
"This is the gift that the family can give: To make a decision," says Simons. "Whatever you decision you make, you will be told that it is wrong. But make a decision."
While the alternatives for supportive services appear to be lined up neatly along a continuum from less-intensive home care to intensive end-of-life care in a hospital or hospice, Simons notes that most people won't move step-by-step through the continuum.
Instead, their needs will shift — sometimes requiring the intense care of a hospital, sometimes requiring the care of a skilled nursing home — and people will find themselves moving backward and forward along the continuum of care.
Keeping that in mind, Simons outlines the levels of supportive care that are available:
These services are the least-intensive services available. They are intended to provide help to the aging person who is able to remain living at home with some assistance.
Sometimes, in-home services are provided by a family member who can stop by regularly.
Other seniors rely on paid caregivers whose menu of services can included light housekeeping, meal preparation or help with personal care.
Some agencies and private companies also provide skilled nursing care at home. These services might include administration of medications, regular visits by nurses or wound-care and dressing changes.
Long-term care policies sometimes include payment for in-home services. The thought: In-home services are more cost-effective than assisted-living facilities.
Assisted living facilities
An assisted living center provides a home — generally, an apartment-like room with common dining areas and other common space — and support for people who aren't able to make basic decisions about their basic care.
Staff in an assisted living center help residents with the tasks of basic living, monitoring of residents' condition and coordination of services by health-care providers.
Assisted living is a fairly new concept — it's been around barely more than two decades in its current form — and was developed for the care of people who no longer are able to live independently but don't need the 24-hour medical care provided in a nursing home.
Some specialized assisted-living facilities meet the needs of people with some form of dementia such as Alzheimer's disease.
A subset of assisted living facilities, Simons said, is composed of homes that are licensed to provide care for one or two residents at a time. Simons notes that amenities and the personality of their operators varies.
Skilled nursing facilities
These are the facilities that are commonly referred to as "nursing homes."
Skilled nursing facilities serve people who need more intense care than the services of an assisted living center — usually, they need custodial and skilled nursing care around the clock.
The big difference between a skilled nursing home and an assisted living center is the intensity of the medical attention that's required.
The most intense support of all is a hospital stay, often short-term for individuals who otherwise live in skilled nursing facilities or assisted living.
While these are the major points on the continuum of supportive care, Simons notes that other specialized options are available to meet specific needs.
But the important thing, she emphasizes again and again, is to put some thought into possible directions before a crisis arises.
The need for supportive services often arrives quickly — literally overnight, in some cases — with a health emergency that places an extra load of emotion into already challenging times.
"The only comparison I can think of is that this is like a surprise pregnancy — and you're giving birth tomorrow," Simons says.