Elder Care Choices

The October issue of Consumer Reports has its cover story entitled “Who Will Care for You?” The article focuses on elder care decisions at the assisted-living level. See https://www.consumerreports.org/cro/index.htm

It is generally an instructive and helpful article. I am going to add my own comments and information to go along with this article.

The first obvious answer to the question posed by the article is missed by Consumer Reports. Many people would answer this question by saying that a family member will take care of them. That is not necessarily the best option but is often the plan for many people. More importantly, it is an important issue to be addressed in this context. It is very difficult to care for a family member 24/7 year after year. This may work out for some period of time if the person’s needs are not that demanding. However, at some point in time it simply becomes too much and a person does need to move to a nursing facility. I never discourage any of my clients to at least not try to care for a family member at home but the practical realities and the difficulty of doing so need to be addressed.

The article very accurately points out that the dividing line between an assisted living facility and a skilled nursing facility is not clear. This is true as a matter of the legal definitions and in practice. The first step in determining what type of care a person needs is to obtain a level of care assessment. This is usually done by a social worker, nurse or other personnel from a nursing facility. Is not usually done by doctor although it certainly could be.

As the article points out, some persons are in an assisted living facility longer than they should be. Conversely, some persons are told to leave and go to a skilled nursing facility when they really are not ready for that level of care yet. In these situations is very important for the resident to have a family member or other person monitoring their care and making sure they are not involuntarily transferred out of the assisted-living facility.

The article refers to use of an aging life care expert. This is the new terminology for what used to be referred to as a geriatric care manager. This person is usually a social worker or nurse by training. They can provide invaluable advice and advocacy for families and residents of nursing facilities. Our office had a geriatric care manager for over eight years. Our experience was that not too many clients saw the need for this service. Many people naively assume that the nursing home will take care of their loved one and that you should not need any additional help. In an ideal world this would be true. However, nursing facilities just do not have sufficient staff to be on top of every possible need or request of every resident. A geriatric care manager can make up for this shortfall and also provide valuable advice and training for the family members in dealing with the nursing facility. Our clients we helped with their loved ones greatly appreciated our assistance and expertise. However, most people just didn’t seem to see the need for this service which is why I no longer offer it. You can find an aging life care expert in your area at https://www.aginglifecare.org/ I also refer my clients to a local aging care life expert. http://www.1specialcare.com/

The article also wisely points out the empty promise made by many marketing representatives that “We will take care of your mother for the rest of her life.” “We will never kick her out.” This is pure sales talk and is probably not supported by any of the legal clauses in the resident’s contract. The resident will be kicked out if they run out of money and don’t pay their bill. The resident will also be kicked out if their medical condition worsens such that the facility is not capable of taking care of them. The marketing person perhaps doesn’t fully understand this or chooses to ignore that reality. Promises are also often made that there is some type of fund that can be used for residents who run out of money. Do not believe this. What this really means is that if the person runs out of money they will be able to apply for Medicaid which will pay the nursing home bill.

The article also gives good advice by saying you should never agree to a mandatory arbitration clause. However, simply crossing off a clause on the standard form may not be sufficient. Most nursing facilities will not allow you to do so but is worth a try.

I think the underlying theme and general point of the article is that you should get professional advice and as much reliable information as possible before making these elder care choices.