Alternatives to Nursing Home Care

In this episode, Lisa Shoalmire and John Ross discuss alternatives to nursing home care: home health, hospice, non-medical in-home care assistance to name but a few.

Episode Transcript
Lisa
Welcome back to another episode of Aging Insight. I'm Lisa Shoalmire and this is my colleague and partner, John Ross. And we're elder law attorneys based right here in the Ark-La-Tex area. Aging Insight is a television program that we want to bring into your living rooms, the information that you need as you look forward to those retirement years and those years of enjoying that time of life where you can enjoy your friends and family, and get to do some of those things you would like to do. But we want you to be informed and have the information you need to make choices about this time in your life.
John
Yeah. Really, the key in living on your own terms is not just randomly saying, "Well, here's what's never gonna happen to me." And you'd be surprised how many times I have somebody in my office and they'll say, "Well, John, you know what? I'm just never going to a nursing home. Not gonna happen. I'm never gonna do it." Well, we don't always get to say never. In fact, I learned from a small child that when I would say I was never gonna do something, that was almost a guarantee that whatever I said was gonna be the one thing that happened. But, one thing we do know is that while not everybody under every circumstances can avoid nursing home care, there are lots of other options where you can get the same or similar type care outside of the nursing home. And that's really what we wanted to talk about today, was alternatives to nursing home care.
Lisa
Well, that's right, because a lot of times as we grow older or we have a health crisis, sometimes we need a little bit more intense care during those times as we recover and regain strength. And then sometimes, our health condition just... It leaves us at a point where we just can't live as independently as we used to. And the one thing we hear over and over again is, "I want to avoid nursing home care." And that's a wonderful goal, and we're here to give you some information on how to meet that goal, but you have to have some information about what services and alternatives are out there to help you get the care that you need inside your home or at another alternative, to an institutional type nursing home. So John, I guess I'd like to start with one thing that seems to come up is if a parent needs additional care and they have an adult child who is maybe available to look in on them, at some point, just popping in once or twice a day becomes not enough.
John
Right. Yeah, the main thing here is that at some point in time, you end up needing some extra care in that home environment. And so the first thing is to figure out what options do you have as far as in-home care providers. And this can get really confusing really fast, because you hear about agencies that call themselves home health companies, you have hospice agencies, then you have in-home assistance, which is not necessarily medical care, and so, it can get really confusing really fast. So the first thing is to learn what different options are out there for that in-home care. The second part of that is then figure out how to pay for 'em, but we'll figure that out a little bit later.
Lisa
Okay. Yeah, so when you're looking at those different types of agencies and things that talk about providing some support in your home, John, you mentioned home health, home health is typically service that is prescribed by a physician, and it's also typically a short-term type service. It addresses an immediate issue through a recovery, perhaps wound care, perhaps central line management, perhaps certain heavy duty medications through IV therapies. Those type things can be done at home through a home health service, but that type of service is not a long-term solution, and that type of service is not something that's going to generally spend hours per day in the home providing care.
John
Yeah, I would say that in a typical situation, you're probably looking at a couple of times a week where a nurse or a nurse's assistant, a CNA-type person comes out and provides some basic services, medical-type services and likely talk about, wound care and different things like that. But it's not the day-to-day, hour by hour care that somebody might need. For example, if you just need a help getting off of the couch and getting down the hall to the bathroom or to the bedroom, home health is not the right provider for that. So home health provides medical type care, and very similarly, you have hospice. Hospice also has some home assistance benefit, but again, it's gonna be typically medical-type care. It's gonna be there to assist the person with some of their medical needs as they go through the aging or in a hospice case, through the dying process. But again, it's not an hour by hour, day-to-day care, that is provided by non-medical in-home care providers.
John
And notice I say, 'non-medical'. So we're talking about people who may have some caregiver training, but these are not nurses. These are people who are there to do light housekeeping, cooking, transferring, so maybe helping you get from that couch to the bathroom, attending to personal needs and things like that. And again, that's a service that's generally gonna be paid for out of pocket by the individual on an as needed basis.
Lisa
Right, and so that is a difference between the three services we just mentioned is often times, home health service and hospice service can be services that Medicare may cover a benefit for those services for a certain period of time, but that in-home care assistance service, that non-medical service is typically always a private pay where you're really writing the checks to cover that person coming into the home to provide that non-medical assistance.
John
Right, and of course, it doesn't have to be an agency, so to speak. Most in-home caregiving is provided for by immediate family members. Whether it's a spousal caregiver, whether it's children, whether it's just other family or friends that have gathered around to provide for that in-home care. I guess our point is, if you intend on staying at home, you got to figure out how.
Lisa
That's right. So, we're gonna take a break and when we come back from the break, we're gonna talk about ways to pay for care in the home, and also some other alternatives that are a little bit newer in our community. So, stick with us.
John
Welcome back to Aging Insight, I'm John Ross and this is Lisa Shoalmire, and today we're talking about alternatives to nursing home care. Something we hear all the time is our clients saying that, "I just don't wanna go to a nursing home if I can avoid it." And that's great, but what you need to know is, "Okay, if you wanna stay in that home, how?" And we talked about in the first segment, your options as far as home health, hospice, but then also non-medical in-home care assistance, and that can be quite helpful. There are some other things, maybe you only need a break every so often, so maybe you do have that family member. Maybe it's a spouse or maybe a child who is that primary caregiver, and they're in the home, they're with you maybe on a 24-hour a day basis. But, it doesn't matter how much your heart's in it and how much you're willing to devote every hour of the day to being a caregiver, sometimes you just need a break. And whether it's to go to the grocery store or get a little shopping done, or maybe you need to go to your own medical appointments. Sometimes, there's just no alternative to that, and so, there are some day options.
Lisa
One is through Opportunities Inc., who's a non-profit, that a lot of folks here are very familiar with. They don't just have programs for children and developmentally-disabled adults, they also have a senior day center, where five days a week a senior can come and get meals, can get medical supervision. For instance, if you have something like a diabetes or something that needs to be managed throughout the day, you can also... There's socialization and opportunities, to just visit and have a home away from home, and that's a daytime program. So, if you have an adult child who's caring for you, you could spend some time at that daytime program, while that adult child works or takes care of their own personal business. So that's one program, and John, tell us about another one.
John
Yeah, and then of course the other alternative you have here in town is with the Alzheimer's Alliance. In the last year or so, the Texarkana Alzheimer's Alliance opened a day respite center and all respite means is rest. And a day respite center over at the Alzheimer's Alliance, is called Our Place. And Our Place is some place that you can take that loved one where they're gonna be entertained throughout the day, they're gonna have lots of events and stuff going on, and they're gonna play games, they're gonna have fun, there's dancing, there's food, there's games, there's all kinds of stuff. And so, it gives the person with Alzheimer's or some other related dementia, a place to go, but more importantly, it gives that caregiver an opportunity to get out and do those things that they've been needing to do, that grocery shopping, that doctor's visit, or maybe just that time to get a break, because the life expectancy of a caregiver is actually pretty short. It's very hard to be a caregiver. But one day of rest from being a caregiver will add 36 days to that caregiver's life expectancy. So, take advantage of programs like Opportunities and Our Place over at the Alzheimer's Alliance and use those as alternatives. And that way, the better the caregiver is, the longer the person stays in that home environment. So use these services that are out there.
Lisa
Well, that's right, John. Very frequently, we've met with caregivers who are just really at the end of their rope, and they're worn out, and they don't feel like they can do it anymore, and they're just beat down. And in their heart they want to, but physically they're just to a point they can't and they're for the first time considering nursing home or institutional care, which they know that's not what their loved one wants, but they just feel overwhelmed. So, one way to avoid institutional care is to make sure your care plan with your caregivers accounts for some down time for those caregivers.
John
Yeah, and using some of these day programs can be a great way to do it. The impact on a caregiver, it's doesn't just affect that caregiver, but it affects all of us as a community. These caregivers are unable to work, they're unable to go to their own doctor's appointments, they end up having their own problems. Which again, this just reverberates through the community. People miss work, they miss opportunities that are out there. And so, utilizing these day centers along with your other in-home care providers and things like that can be a great tool. Now, you may be watching and say, "Well, John, I just don't need that," or "I don't have anybody in my family that needs that." Well, I got a solution for you, too. Volunteer. Both of these organizations are non-profit organizations and they would love to have somebody come up and help be a volunteer at one of these day centers. And you may not be able to help somebody in your own family, but you could help somebody else by putting in a few volunteer hours. So, consider that as well.
Lisa
That's true. So, we're gonna take our last break. When we come back, we're gonna talk about how to pay for some of these alternatives including the day centers and also the programs that might be out there where you can get some assistance to stay at home. So, come back and see us.
John
Hi, I'm John Ross, elder law attorney and board member for the Alzheimer's Alliance, and welcome to Our Place. Our Place is a day program designed to provide rest and relief for the caregivers of people with Alzheimer's and related dementias. Our Place is a safe environment where our friends benefit from socialization in a home-like environment. Alzheimer's is devastating, and affects over 17,000 families in our area. To find out how Our Place can benefit you, please visit our website.
Lisa
Welcome back to Aging Insight, I'm Lisa Shoalmire and I'm here with John Ross. And today's topic, we're talking about avoiding institutional care, and thinking about a plan in advance of some alternatives to nursing home or institutional care if you get to a point, or a family member of yours, gets to a point where they just need some more intent supervision and care. We've talked about some day center programs that are out there. We've also talked about home health, and hospice, and in-home non-medical care. But you know what? One of the biggest concerns for every family is, "How do you acquire the resources to either get this type of care paid for, or be able to pay for it out of pocket?" That's a big concern.
John
Right. 'Cause in-home care, non-medical type in-home care, the cost of that can range anywhere from $10 to $20 an hour, which that can add up real fast. And essentially, when you're paying for long-term care, you have three options. You can pay cash, well, that's one option. And some people are blessed with enough resources, that paying $10 or $15 dollars an hour, even for 24-hour a day care is within their realm, but not very many people can afford to do that. The other option is to have long-term care insurance, but if you're one of those folks that has long-term care insurance and you're concerned about the future and about staying at home, one thing to be sure and check, does your policy cover in-home care? Not every long-term care insurance policy will cover in-home care. Some of them will, some of them won't. If you want to stay at home and you're using long-term care insurance, you've got to make sure that that long-term care insurance will pay for in-home care, not just nursing home care. After that, you get into various forms of government assistance, like veterans benefits, which we've talked about before on the show, and Medicaid. Now this is one...
Lisa
This is different than Medicare. [chuckle]
John
Which is different than Medicare. And this is one that a lot of people, when most people think of long-term Medicaid, they think of nursing homes.
Lisa
That's right, that's all they think of, that Medicaid only pays for that institutional at a nursing home type care. And actually, that's just not the case. Medicaid these days, governments are recognizing that care at home in the community is frankly cheaper on government budgets...
John
It is.
Lisa
Than care at an institutional or a central facility. So, there are a number of programs that are cropping up to help families keep their loved one at home with utilizing some Medicaid financing.
John
Right, on the Texas side, we have a program called "The Community Based Alternative", and most people just refer to it as the CBA Program. And on the Arkansas side, the same type program but for the Arkansas residents, is called "Elder Choices." And these two programs have roughly the same eligibility criteria as nursing home Medicaid. So you do have to have relatively limited assets, but again, looking down the road and trying to figure out, "How are you going to pay for care?" That maybe an option, although, there may be things that you need to do ahead of time so that when the time comes, you will be eligible for those programs.
Lisa
And John, what those programs look like is that those programs can include paying for a certain number of hours a week for that in-home assistance that we were talking about earlier. So, it may pay for 20 hours or 40 hours. I met with a lady recently, and the CBA for her family member ran 100 hours a week of third-parties, nurses aids, CNAs coming into the home to assist her to care for her family member. And so, it was a great program to keep that family member at home. These programs can also cover things such as adaptive medical devices that, whether it's that four-point walker or whatever adaptive devices might be needed for your family member or yourself to stay at home, and so those programs can pay for that as well.
John
Right. And then of course, the other thing that we talked about were these day respite centers like the Opportunities Senior Center, and like the Our Place at the Alzheimer's Alliance, and although these are private, non-profit organizations... For example, the Alzheimer's Alliance has a fund paid for by donors who have provided their own money to the Alzheimer's Alliance to provide scholarships so that people who can't afford that, that they can now because of these generous donors out there in the community.
Lisa
Oh, wow! And I know that the Opportunities Program can accept CBA and Elder Choice monies for the care that's rendered there.
John
Right, so there's lots of different options. So what we want you to do is look down the road. The first question is, are you one of these folks that says, "Hey, I don't wanna have to go to a nursing home"? And if you are, great. But that's not the end of the discussion, that's the start of the discussion. The second thing is, how are you gonna stay at home? What programs might you use? Would you want in-home care providers? Do you have family that can do it? And how are you going to pay for all of these? And, how are you gonna do that without going broke in that process? And of course, we don't have enough time today to cover all of that, but we do want you to think that there are some alternatives to nursing home care. They are available out there, you've just gotta know where they are, who they are, and how to get 'em.
Lisa
That's right. We so often run into folks where they have a family member, a husband that says, "I don't ever wanna go to a nursing facility," and then we have a spouse that is just wearing themselves out to the bone, trying to keep that promise...
John
That's right.
Lisa
To their husband or wife. And all the person who needs the care ever said was, "I'm never going to a nursing home. Don't ever do that to me," but they didn't make any plans. And so, what we're talking about today is make those plans. Think about it and figure out how you're not gonna burden that caregiver who's going to be managing your care or looking after you with a promise that they're killing themselves trying to keep.
John
That's right. And of course, if you have more questions about this, you can always listen to us on the radio every Saturday at noon on 107.1. You can find us on the internet at aginginsight.com, and of course, if you've got specific questions about say, the Medicaid or the VA benefits that we talked about, look for a copy of the Aging Insight Magazine in your local doctor's office, or hospital, or even swing by and pick one up from us. But, of course, if you do have questions, you can always just keep tuning into Aging Insight TV.
Lisa
Alright. Well, we'll see you next time.
John
Bye bye.

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