One of the hardest decisions anyone can make is to send a loved one to a nursing home. For many caregivers, it feels like they’re giving up and abandoning that person, and the guilt is tremendous. But in many cases, a nursing home is the best — and sometimes the only — option for a person with a serious condition who needs care 24 hours a day.
Making that decision is actually the easy part. The next steps — finding the best home and figuring out how to pay for it — are harder.
And don’t think these decisions are something to postpone until retirement age, said Alice Hedt, executive director of the National Citizens' Coalition for Nursing Home Reform, a consumer advocacy group in Washington. She urges people to begin planning years in advance.
“Nursing homes don’t just take care of elderly people,” she said. “They are often used for rehabilitation for people of all ages who are incapacitated by accidents, diseases and head injuries. So any adult needs to think about what they want for care in case they become incapacitated and (to) have a discussion with their family. It’s something to think about when you’re creating a living will and power of attorney.”
Prep yourself for the costs
Getting an early start can help you find the best possible home and the money to afford it. You can spend months, even years, researching how to pay for care, filling out applications and getting on the facilities' waiting lists.
Even though it’s a touchy subject, elder care needs to be brought up by children to their parents, said Charles Bell, programs director for Consumers Union, which publishes Consumer Reports.
“Many times, children of aging parents aren't aware that the parents may need assistance in arranging for these long-term care services,” he said. “If you don't ask, chances are they may not tell you. Effective advance planning involves talking about money and assessing how much is available to pay for health care relative to other needs. You need to understand the details of your parents' retirement income and health insurance.”
Even if you’re on the younger side of retirement age, nursing home costs are something to pay attention to for your sake because they can add up. Nursing homes can charge an average of $5,000 per month, with annual costs ranging between $50,000 to $80,000.
“For people with moderate income, a year in a nursing facility could go through all their savings,” said Eric M. Carlson, author of "The Baby Boomers Guide to Nursing Home Care" and an attorney at the National Senior Citizens Law Center. “You need to look at it as part of your overall planning for retirement, and make an estimation of what you’ll need.”
Long-term care insurance is a consideration, but from a financial standpoint it makes little sense to buy it before age 55. “You don’t want to invest in insurance you may not use until 40 years from now,” says Carlson. “It’s a long time to be paying premiums when you have no idea what long-term care costs will look like in the future.”
In its September issue, Consumer Reports listed its Nursing Home Quality Monitor, which identifies the best 10 percent and worst 10 percent of homes in each state as measured by three dimensions of quality — staffing levels, state inspection surveys and various quality indicators. According to Bell, the study showed that while some nursing homes have been improving, poor care is still all too common, especially at nursing homes run by for-profit chains, now the dominant force in the industry.
“Since we started publishing our first nursing home watch list in 2000, we've seen little evidence that the quality of care has improved much since then,” said Bell. “Indeed, 186 of the homes cited for poor care on our 2006 list have also appeared on earlier lists of poor-quality homes.”
Differences in care emerged between various types of nursing homes. One reason not-for-profit homes are more likely to provide good care than for-profit facilities is they put more resources into staffing.
"We found on average that not-for-profits provided almost an hour more of care per resident compared with for-profits," Bell said. "They also provided nearly twice as much care from nurses."
Nursing homes with questionable track records are all across the U.S., and chronic poor performers receive only token state fines or none at all, meaning consumers need to choose a home carefully no matter where they live.
Even when good information is available, you may have little time to digest it, especially if a hospital discharge planner says your relative must be out in 24 hours. He or she will often suggest a particular nursing home in the area, but you may not know whether the home is your best choice or a very bad one. If you find yourself in this situation, you can use your appeal rights under Medicare to extend the hospital stay for two days. That will buy you additional time.
Whenever possible, it’s best to choose a nursing home in close proximity to your own home so you can visit frequently and closely monitor your loved one's care. If you live too far away, you can hire a "geriatric care manager" to monitor care of and report to you on how things are going. It’s best to interview several potential care managers to learn more about their philosophy, training and credentials, and professional experience.
After you find a home you like, the ball is in the home’s court whether to admit you or not. The decision basically depends on how much you’ll be paying for care. Even though Medicaid pays for about half of all stays in nursing homes, some facilities will turn away prospective residents if they are likely to start out needing support from Medicaid or will need it in the near future.
“It shouldn’t be like this, but the reality is that people who pay privately tend to get priority, says Hedt. “That’s why having the resources to pay the first few months up front is a good idea.”
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