A Primer On Living Choices For A Loved One With Dementia

Dorian Martin Health Guide

         When Mom was starting to have memory loss and severe breathing problems in 2002, she began to encourage Dad to consider moving to a retirement community. That didn’t happen. But in September 2005, Mom’s mental and physical health was so diminished that a decision needed to be made. Unfortunately, by that point my parents were at loggerheads so Mom wouldn’t listen to Dad’s opinion and feedback. I was forced to step in, putting a down payment on an apartment in a senior independent living community.  However, a series of hospital stays and a geriatric psychiatric evaluation found that Mom couldn’t live in that community. Our family started talking about assisted living, but we were told that Mom really needed a nursing home.

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        All of these living options have different requirements, none of which I really understood until recently when I attended a recent seminar about care options presented by Dr. David Hackethorn, who works in the Department of Internal Medicine at Scott & White Healthcare.  By that time, Mom had already died, but I thought the information would be beneficial to HealthCentral community members so they can avoid the quandary in which my family found ourselves.
          So here are the living options that were presented at the seminar:

    • Independent Living – This type of living arrangement is designed to assist older adults in maintaining their independence while understanding that they are aging. Those who living in these communities (which are designed to emphasize lifestyle, security, and peace of mind) need little or no medical assistance. (I remember my mom describing this type of situation as reminding her of living in a dormitory in college.)  People who living these communities must pay for them out of their own funds, although there are some exceptions for people with low incomes.
    • Assisted Living – This type of living situation is designed for individuals who require some assistance with basic activities of daily living. Assisted living facilitates, which are regulated by each state, provide personal care and other types of services, such as assistance with medications. People typically pay for these types of facilities from their own funds; however, at times, long-term care insurance can provide assistance with payment.
    • Nursing Home – This type of living arrangement is designed for individuals who need 24-hour nursing care.  These facilities, which must meet stringent state and federal regulations, provide complex medical therapies as well as personal care services.  In addition, skilled nursing and rehabilitative services are provided to people who recently have undergone surgery or had a serious acute illness for which they have been hospitalized. Payment to stay at a nursing home either comes from the person’s personal finances, Medicare, or Medicaid. Quality of care information on nursing homes can be found at www.medicare.gov.
    • Continuing Care Retirement Community – This type of living situation offers all three forms of elder housing – independent living, assisted living and nursing home care in one location. Therefore, elders can easily transition between the different facilities as needed. The CCRC provides numerous medical services based on the person’s needs and capabilities. Payment structures vary for these types of housing, which can be confusing.

         When considering a move to one of these types of facilities, Dr. Hackethorn suggests that you plan several visits to the facility and eat a meal there. In addition, thoroughly inquire about fees that will be assessed. Also, be sure to assess opportunities for socialization for the elder.

  •      In the second part of his presentation, Dr. Hackethorn addressed aging at home. He described the following options:

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    • Home Health Care – This option, which provides both skilled nursing care and custodial care, is designed to assist elders remain at home in order to avoid being placed in an assisted living or nursing home.  In order to have home health care, a patient needs to be homebound, under a physician’s care, and have a need for skilled nursing services. Medicare will pay for this type of care. “The problem I’ve seen with this type of care is that patients are placed on it, but the skilled care need goes away. However, the family is enjoying the custodial care,” Dr. Hackethorn explained. He also pointed out that this type of care is being watched closely by the federal government due to fraudulent billing.
    • Custodial Care – This type of care is designed to address a person’s limited ability to perform daily living activities. Custodial care is paid either through the person’s own funds or through long-term care insurance.
    • Respite Care – Often known as adult day care, this type of care is designed to provide a break for the caregiver as well as socialization for individuals who have debilitating chronic illnesses (such as dementia). The program is paid for by the user.
    • Hospice – Dr. Hackethorn mentioned this program, but didn’t go into detail. However, HealthCentral has a great video about Hospice care.

        I hope this information helps readers be more proactive in identifying what is right for their loved one. In making a decision, be sure to explore all of your options and ask lots of questions.

Published On: September 21, 2010