Elder Care - 6 Key Considerations
Many people we speak with find themselves in the sandwich generation, taking care of young people finding their way in the world along with aging parents, family members and even friends where the process can be complicated and requires some discretion. Unfortunately, there is no owner’s manual, universally acclaimed book authored by Dr. Spock, or return policy. This can be a bit overwhelming especially without the fun of milestones to celebrate, like graduations or weddings. As we age, wellness does not begin and end with getting an A+ on your annual physical (or taking your medication on time), it encompasses much more, which is why we put together 6 key considerations so that you and your family can age with ease, autonomy, and dignity.
- Physical care: While we may gravitate towards the financial aspects of planning as we get on in years, physical wellbeing is paramount. We often hear about how a little fall can be the start of a decline in health. Continued exercise and diet will go a long way in maintaining your fitness. A short walk twice a day can do wonders; it’s been proven to have a similar positive cardiovascular impact as a much longer run but without the impact on your joints. A walk in nature has a calming effect and has been shown to reduce cortisol levels in the body. As independence becomes more challenging, some people want to age in place, especially given what we witnessed during the pandemic, while others may benefit from the structure and social setting from a live-in facility. To facilitate that decision, means of support come in a variety of forms including home care, assisted living facilities, nursing homes, and memory care units. It may be formal or informal as is often the case with home care. It’s important to understand people’s wishes but also important to be practical about the circumstances. Depending on the specific needs and health condition of your loved one, it can be prudent to have medical practitioners help determine the best option. AARP has done an excellent job of putting together resources for home safety and how to choose an in home care agency.
- Psychological Care: It’s important to acknowledge and discuss one’s emotional and mental state. We know the tangible toll aging takes on our body, but the less obvious psychological impact can result in real challenges for the elderly and their caretakers. Providing emotional support, companionship, and engaging in activities that promote mental well-being are essential for a fulfilling healthy life for older adults. Vive Health put together a list of 10 activities for engaging aging adults. Try to avoid the feeling of isolation as much as possible by scheduling visits, engaging in community programs, or joining senior centers. Caregivers play a vital role in elder care whether they are family members or professionals. Resources can be found for caregivers here to prevent burnout.
- Understanding medical coverage options: First, you may want to educate yourselves on the basics of Medicare (or Medicaid), typically the primary insurance coverage for those 65 or older. Approximately 10,000 baby boomers are turning 65 every day. Eligibility for coverage may not be as exciting as attaining the right to drive, vote or drink alcohol, but an important milestone nonetheless.
- Medicare: This could be an article of its own but we will try to keep it brief. The most popular parts of Medicare are part A, which most people get for free. That covers your hospital insurance and there is a $1600 dollar deductible per benefit period before Medicare starts to pay and there are no limits to the number of benefit periods you can have. Part B is most familiar to people, as it covers doctor’s visits and comes directly out of Social Security benefits. In addition to routine doctor’s visits, it will cover outpatient care, home health care (very limited amount), medical equipment, and preventative services. The monthly amount goes up every year, but depending on your income it starts at $164.90 for 2023. Part B has a deductible of $226 annually before Medicare will start to pay for any services rendered and a 20% coinsurance. Part D covers drug costs. Monthly premiums vary based on which plan you join and your annual income. Make sure you have a plan that covers your drugs and pharmacy. You may end up having a formulary from one insurer who offers more attractive pricing for your medicine than another. For anything that Medicare Parts A, B & D don’t cover, participants usually opt for more coverage through a Medicare Advantage Plan (Part C), or a Medigap plan. We’ll have some more on this topic in a webinar in the Fall before annual enrollment.
- Medicaid – Medicaid provides health care to millions of low-income adults and children. The program is fully funded by the states and the federal government. Because coverage varies from state to state, we encourage everyone to look at their specific coverage and eligibility by clicking here. Medicaid is the primary payer of long-term care services in the United States, in fact in 2015 long-term care made up 20 percent of the Medicaid budget.
If your loved one has a Long-Term Care policy, it’s helpful to know exactly what their policy covers and what it doesn’t. Long-term care helps with medical and basic personal tasks of everyday life and covers a range of needs. Most coverage options help with “activities of daily living” like dressing, bathing and using the bathroom but may also include home-delivered meals, adult day care and other services for longer periods of time. It can be provided at home or in a facility. Medicare part A provides care for a long-term hospital stay for 60 days in a row in a skilled nursing facility for the same benefit period. There are daily copayment costs depending on your length of stay and after 90 days within the same benefit period you are responsible for all inpatient costs. Medicare gives each beneficiary 60 “lifetime reserve” days that can be used to extend coverage in any benefit period. Once you use these days, you pay 100% off all costs. The National Institute on Aging has compiled a comprehensive guide to paying for long term care that includes a cost of care calculator.
4.Formal Planning/Documentation: There are plenty of legal and financial considerations along with advanced care planning techniques to make sure they are implemented. Elder care may involve managing legal and financial matters, such as estate planning, healthcare directives, power of attorney, and understanding what their long-term insurance policy covers. At the very least make sure you can work with an attorney to establish a will that sets forth your wishes regarding the distribution of assets and an executor to carry out these wishes, a living will that details preferences for medical care and who should carry out those decisions if you cannot make them for yourself, a power of attorney for someone to make legal decision for you when you are unable to do so, and updated beneficiary designations for recipient of benefits from your insurance, pension, 401k, IRA’s and other assets not covered by your will. Some advanced techniques include setting up a life estate for a residence in which the aging adult shifts assets out of their name while still maintaining the right to use for the property for the duration of their lifetime. This person is called the “tenant,” and shares ownership of the property with another person. That person is referred to as the remainderman and automatically receives the title to the property upon the “tenant’s” death. This avoids probate and removes it as an asset for Medicaid recovery purposes.
5.Elder abuse awareness: 1 in 10 Americans over the age of 60 experience some form of mistreatment or exploitation. It may be a stranger calling to scam them out of funds or a loved one taking advantage of their generosity. Understanding the signs of abuse, neglect, or financial exploitation is important to protect older adults from harm. If abuse is suspected, appropriate steps should be taken to report and address the situation. The National Adult Protective Services (NAPSA) has created a resource to share information, solve problems, and improve the quality of services for victims of elder and vulnerable adult mistreatment depending on your residency.
6.The whole is greater than the sum of the parts: Above all else, we suggest you approach the challenges and opportunities of aging holistically. When physical, emotional, social, and spiritual support coalesces around the individual themselves, they are bound to feel valued and this provides improved quality of life. It’s important to respect the dignity and autonomy of older adults and involve them in decision-making processes to the extent possible.
Remember that elder care is a complex and individualized process. It is recommended to consult with healthcare professionals, elder law attorneys, and other experts in the field to ensure the best care for older adults. If you would like to schedule an appointment with us to discuss in more detail, please do not hesitate to reach out!