If you are starting to have difficulty with certain essential tasks, such as managing your finances, or physical activities like bathing or driving, it is time to have an honest talk with your doctor or another health care professional about your situation.
They can put you in touch with a social worker who specializes in helping older people (sometimes called a geriatric case manager). This person will help you come up with a suitable long-range plan and locate the services you need now and/or will need in the future.
The services of a social worker or geriatric case manager can be especially useful if your family doesn't live near you or you can't depend on them to help you during this sometimes confusing time.
Learn about the various services for seniors in your community and the types of care available. Ask around: Your doctor, a social worker, staff at a community health clinic, or any health care workers you see regularly can all have good ideas and suggestions about whom to contact.
Another starting point would be to call a local or state social services office and ask to speak to someone who can provide a list of services you might need, such as meal or companion programs, transportation services, day centers, or facilities for more specialized care.
If possible, your family should be consulted and involved in setting up a long-term plan. If you can no longer travel easily to the grocery store or cannot cook, for example, your family and friends may like to deliver some of your meals while others are delivered by a local aid program such as Meals on Wheels.
Think about what services are acceptable to you: Would you mind having an aide come in to help you bathe and dress? Also consider whether your plans are realistic: If you don't drive, will you always be able to depend on a friend to drive you to appointments or will you need to arrange for bus or taxi service?
Before you start firming up plans, find out what services are covered under Medicare or Medicaid, and what your private insurance will and will not cover. Insurance coverage is often very limited and your finances may not be adequate for all the services you would like. Remember that Medicare and private "Medigap" insurance only pay for short-term home health care and nursing home stays.
Decisions about long-term care shouldn't be made hastily. You do have time to think about your plans.
Be flexible. Ideas that sounded fine six months ago may no longer be right for you. Your plan may need to be amended as your needs change or as different programs become available.
When More Care is Needed
It may happen that your support network of family, friends and local meal or transportation programs are not enough to ensure your care and safety. If you are finding many everyday activities difficult, you may need to find a new home with around-the-clock services. There are three main types of residential care:
Home services are very often the first choice for most seniors. Homecare service companies are available for hire and will send staff directly to the senior's home on a predetermined time interval basis.
Homecare companies vary significantly in the amount of services that they provide. Many provide only health and personal services, some provide everything but health services.
Consider homecare services first since they provide the highest degree of independence. Additionally, 93% of seniors indicate a desire to never leave their own residence for alternative living arrangements. Considering this, most seniors will find themselves happier and living a more productive life if they are able to remain in their own home instead of a group home.
Assisted living permits people to rent a relatively private residence of their own and receive staff care. Such arrangements range from room-and-board in a privately run seniors' home to a fully-equipped apartment in a large building.
You may be able to choose from a menu of services, such as some or all meals in the dining room, recreation programs, and help with housekeeping tasks, and personal and medical needs.
Retirement homes or nursing homes, sometimes called "skilled nursing homes", provide 24-hour service and supervision. Many residents will have one or more health problems that require medical and rehabilitation services on site.
Some organizations offer both types of care in "continuing care communities". For example, there may be an assisted living facility located next to a nursing home so that moving from one level of care to the other is a relatively simple matter. Some also can provide living arrangements for couples, which can be particularly useful if one spouse has become disabled and the other is unable to care for him or her alone.
Don't make a move until you are sure
Moving to an assisted living facility may be the right move for you. There are added comforts and conveniences in a group and managed home setting that are hard to duplicate at home.
Such conveniences are however, not without their costs. Depending on what part of the country you live in and what level of services you expect, costs for a single person can range from $2800 per month and up.
Consider first whether you really must leave your house and what the consequences will be if you do. Some people are not very attached to their own home. Some have raised families and lived many years in their home and will be less comfortable elsewhere.
Consider that you will not be able to take many of your own things to an assisted living center. Most are furnished already and you will be limited to clothing and a few mementos. Others allow you to bring some furniture and a few more personal belongings but there are often space limitations.
Consider that you will certainly have less privacy. One of the great benefits of living in your own home is that you can go to any part of the living quarters dressed in any way you want. Assisted living centers are generally not as amenable. There are certainly private areas but that is generally limited to your bedroom and maybe another small room or two.
Other areas are open to the public including everyone that lives at there, their guests, and the staff.
Consider all these factors before making a move because once moved, it is quite likely that you will not be able to change your mind. Your house will probably have been sold or rented and furniture and personal belongings will have been disposed of.
Given all that, it is very possible that you will still opt for the assisted living center at some time and it is important to know how to find the right place for you.
Finding the Right Place
If you are considering making the move to a retirement residence:
Ask a lot of questions. Ask everyone for information and recommendations about various facilities in the area you want to live in. You can start with your physician, friends and relatives who might have done this research in the past, or representatives at your religious organization. Speak to social workers and other staff at your local hospital (for example, ask to speak to a discharge planner).
Your state government can also be an information resource. For instance, the Office of the Long Term Care Ombudsman in your state will inform you whether there have been problems at any of the residences you are considering.
Be aware that privately run residences do not always have to follow the same regulations or licensing requirements as nursing homes. Ask for advice from people who have used them and from local social service agencies. And ask what financial assistance may be available or whether they participate in Medicare/Medicaid programs.
Consider what services will be essential for you: Will you need to go out regularly and will there be transportation available? Will you want all or just some meals provided? What housekeeping help will you require? Do you want to take part in activity programs? What if you need special services, such as assistance with your medications or additional security for a person with Alzheimer's disease?
Call the residences or organizations that interest you. Find out about vacancies and the length of their waiting list. Ask how many residents they have. Of course, you'll want to know about costs, how payments are made, and whether there is financial assistance available to help defray expenses.
Visit. Once you have decided on a short list of residences, it's time to visit. When you do, don't just make one appointment to talk to the staff. Have at least one meal in the dining room to check on the quality and quantity of food provided. Speak to some of the people who live there and, if possible, their families.
To do this, you may want to arrive unexpected, preferably a few times and at different times of the day. In this way, you'll be able to check on everyday concerns:
Is the building clean? Are the residents and their possessions secure? Are staff members doing their best to meet each resident's needs? Do residents have adequate privacy? Are they treated with respect? Are they restrained in any way? Are there enjoyable social activities?
Protect yourself. Once you have found a new home, you'll be asked to sign a contract with details on the services you have agreed on and payment for them. You should have a knowledgeable family member or even a lawyer read over this type of arrangement to make sure your interests are protected.
Your move from your own home to a seniors' residence, nursing home or other long-term care facility can be saddening, traumatic and confusing. Your social worker can help you and your family prepare for this big change. Sometimes, there is a person on staff at the long-term care facility to help with the transition. Give yourself some time to get accustomed to your new home.
Encourage your friends and family to visit often, and go out when you can, as well. Keeping up your social activities can help you feel better about the change that has taken place. And when your friends and family visit they can also check that the care provided is up to the standards you expect.
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