Wednesday, October 3, 2007

Assisted Living: Financing, Choosing and Monitoring

One of the largest potential expenses an elderly person faces is assisted living. Assisted living is for those that have difficulty living independently, but are still capable to some degree of taking care of themselves. Assisted living facilities provide a resident with individual space—usually an apartment or a large room that is comparable to a studio apartment. They also provide meals and help with daily needs like bathing, dressing, taking medication, and getting around. The facility may be as small as a large house, or as large as an apartment complex.

I. Financing Assisted Living

The cost of assisted living is high and headed higher. It’s not unusual in large urban areas to pay $5,000 or more a month. That translates into $60,000+ a year. Medicare does not cover the cost of assisted living. Neither does Medicaid. There are several ways to pay for it.

Long Term Care Insurance. Long term care insurance is growing in popularity because it can cover a substantial amount of the cost of assisted living, as well as other expenses of caring for the elderly. It’s best to buy coverage when you’re under 50 or, better yet, under 40, if possible. The younger you buy, the more likely the premiums will fit within your budget. If you wait to buy long term care insurance until you are in your late 50s or early 60s, the cost will be very high (several thousand dollars a year per person).

Savings and other assets. The potential need for assisted living and other care is one of the strongest reasons for saving scrupulously when you’re younger. If you can’t afford long term care insurance or don’t want to buy it, having a pool of savings will give you peace of mind. Another alternative is to sell non-cash assets. If you won’t be driving your ’71 ‘Cuda convertible with the 426 hemi engine any longer, consider selling it to raise money for the costs of assisted living.

Sell the house. If you weren’t a good saver, but always paid the mortgage on time, you may have entered retirement with your house free and clear of debt. If so, good for you, because the house can be sold to pay for assisted living. Forget about a reverse mortgage—you can’t get a reverse mortgage if you’re not going to live in your house. If you already have a reverse mortgage on the house, you may not be able to raise much money by selling the house, because the reverse mortgage has to be paid first. That’s a reason to be cautious about taking out a reverse mortgage.

Family. Members of your family may be willing to help cover the cost of assisted living. This, of course, is a question each family must decide for itself. If you don’t want to turn to your children, buy insurance and/or save.

II. Choosing a Facility

By the time an elderly person needs assisted living, choosing a facility will likely be the responsibility of a younger member of the family. Almost by definition, the elderly person won’t be mentally or physically capable of driving around and inspecting a number of places. So, if you’re the person responsible for choosing a facility, here are a few things to keep in mind.

State licensing. Many states require assisted living facilities to be licensed. Check to see if that’s the case in your state, and ask the state government if the facilities you’re considering are properly licensed. Also find out if the facility (or its parent company) is the subject of any enforcement or disciplinary proceedings. Ask the state government if you can obtain the results of any inspections of the facilities (probably not, but it doesn’t hurt to ask).

Visit the Facilities. Personally visit every facility that’s under consideration. Take a tour. Ask every question that comes to mind. Don’t be shy or reticent. Your loved one may be living here soon, so be a tough customer. The facility will have its sales staff give you the tour, so you won't learn about the place's imperfections unless you're nosy.

Try to get a look at some of the current residents. If you’re relatively young, seeing elderly folks in a setting like assisted living can be somewhat of a shock. They are frail and move slowly. Many aren't very alert, and some barely seem coherent. Without doing anything you would consider rude or instrusive, though, try to evaluate how the residents are doing. Do they appear content? Do they seem comfortable? Do they look like they’re doped up? Do they appear unhappy? Do they seem frightened or intimidated by the staff? If possible, consider engaging one or more of them in a brief conversation and ask how they like the place.

Find out about staffing, especially at night. If a facility with a couple hundred residents has only a handful of staff on duty at night, be cautious. Ask how often they check on the residents at night. (Nightly checks are essential, since elderly residents can fall and hurt themselves in the darkness, and be unable to summon help.) Find out what qualifications the night staff have—is any one of them a nurse? The night staffing is especially important if your family member is mentally impaired.

Find out how many nurses they have on staff and what kind of nurses these are—the number of RNs is important, as are the times or shifts they work.

Make sure the facility has an emergency electrical generator, which can step in if the power goes down. (Elderly people should always have air conditioning and heat, especially if they’re paying $5,000 a month or more.)

Make sure that you, as a family member, are entitled to visit your resident family member at any time of night or day, any day of the year, with no exceptions for holidays or any other time. You and your elderly family member should never be cut off from each other.

Sample the food. You know it will taste like cafeteria food. But if they can’t even manage to serve fresh or frozen vegetables instead of canned, move onto the next facility on your list.

Get references. Ask people you know for references about facilities. A reference may be far more informative than the facility's sales brochure or a tour. A person with a family member who's lived at the facility will have months or years of experience with the place. Ask how diligent, caring and considerate the staff are. Ask how promptly the staff returns phone calls and how forthright they are in answering questions. Ask what complaints the reference or the reference's family member had. Ask about slip ups and foul ups.

Make sure you evaluate the person giving you the reference. A colleague who is a nice, easy-going person and who doesn’t make waves may tell you a facility is fantastic. Discount that opinion. If a demanding, pushy, and aggressive acquaintance tells you a facility is fantastic, consider that a valuable reference. Don't place much weight on a facility's reputation. Reputation and reality are sometimes far apart when it comes to assisted living facilities. No facility is perfect; you want to know about the imperfections.

III. After the Move

Once your family member takes up residence at a facility, be vigilant. Now is the time to be a really tough customer. Visit the facility often. Don’t go at the same time on the same days each week. Vary the days of the week you visit, and the times when you arrive and leave. Find out if the place is clean all the time, or only during daytime business hours, when outsiders are likely to be visiting? Are the scheduled activities for residents actually conducted? Are residents able to move around, and are they properly escorted outdoors (especially if mentally impaired)? If your family member mostly stays in his or her apartment, does the staff check up on him or her? Is your family member eating regularly? Is the correct medication dispensed and given at the correct times and in the correct doses? Is laundry done on time and is it clean? Has anything been stolen from your family member's apartment?

Be sure to visit at night and observe what’s going on. Do the night staff members have family or friends visiting them in the lobby? Are they playing with their children or chatting with their siblings? Is the staff distracted from monitoring the residents? Are the staff clustered at the front desk, around the nurses station, or in the smoking area outside, catching up on gossip? Are food trays left uncollected in the hallways for hours on end?

Don’t be reluctant to complain. In many cases, your elderly family member won’t be as capable of complaining and following through on a complaint as you. This isn’t like your workplace, where you may have colleagues to help you and supervisors to field the hard questions. You’re on the front line and you’re probably on your own. Take charge.

Caring for an elderly parent or other family member will be one of the most difficult things you’ll do, because it will demand a lot of you and everything you do will be tinged with sadness. But if you do it well, you’ll have the satisfaction of knowing that you did your best when it really meant something to someone very important to you.

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