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Caring for the Elderly

Discuss the types of long-term care before it becomes a necessity is essential to finding the proper care.

Choosing the right type of long-term care is an important decision regarding caring for the elderly that shouldn't be put off. Doing so risks the loss of ability to have the discussion if the elderly person becomes physically or mentally disabled. Because caring for the elderly is such an important issue, having an open discussion should be a priority, though it may be a difficult topic to broach.

From the perspective of an elderly person, such a discussion may be unwanted because it engenders feelings of helplessness, of being a burden on others, or fear of losing their independence. And from a family member's perspective, the topic may be difficult to bring up because of feelings of guilt, anxiety, or respect for the elderly person who has always been the caregiver and breadwinner of the family.

But waiting too long to have the discussion can lead to results that take the decision out of the elderly person's hands and lead to even more anxiety and guilt for family members. Planning ahead gives everyone involved time to contemplate decisions, digest what will happen, and plan ahead financially (long-term care is expensive). Because the discussion can be such a difficult one to initiate (and continue), at the end of the article will be a discussion of suggestions for talking to loved ones about long-term care.

Assessing Your Loved One's Desires

The first thing you should do is assess the needs and desires of the elderly person. There is no "one size fits all" model for long-term care. Rather, it should be customized to the needs of the individual. Long-term care may take place in a home, in an assisted living facility, retirement community, senior center, or nursing home. The choice is dependent on the needs and desires of the individual and the family.

Consider whether the elder will need assistance with only custodial and daily activities of life, in which case a home nurse may be appropriate, or if their needs touch more intimate and essential functions for which they'll need constant monitoring. These needs may change over time, so this type of assessment should be revisited periodically.

In assessing the needs of the elder, their personality and personal preference obviously play a large role. Some people treasure their independence and are willing to go to great lengths to preserve it, whereas others may be more amenable to accepting an assisted living situation. If someone is fiercely independent, they will likely want a situation customized to fit their lifestyle. They can have someone assist them with cleaning, organizing, cooking meals, etc., rather than have a live-in nurse or be placed in a retirement community.

It is precisely because personality is such a large factor that the decision-making process should be collaborative. Family members and the elder may not initially agree on plans for long-term care. That's why it is important that discussions about caring for the elderly be made before services are needed.

Assessing Medical Needs

Aside from self-assessments, elders and family members should also consult with the primary care physician, particularly if the reason for considering long-term care is due to illness, disease, or other disability. A physician will have a better sense of your future needs based upon the nature or progression of the medical issue.

Geriatric specialists are an excellent source of medical and long-term care information. While primary care physicians can describe general physical or mental symptoms which are likely to occur, geriatric specialists have the training and experience to deal exclusively with the elderly. Health services in the U.S. are increasingly skewed toward the elderly as our population grows older, yet there are fewer geriatric specialists. If you are able to get the advice of such a specialist, you would do well to listen carefully to their professional opinion in weighing your decisions.

Planning Ahead Financially

It's also critical to plan ahead so that you're better prepared financially. The difficult aspect of long-term care (from a financial perspective) is that the cost is completely dependent on the type of care necessary, the location of the care, and the length of time required. A hard reality is that you may plan for a few years of long-term care but in the end need several more, and with greater services. Planning in advance can help alleviate at least some of these burdens.

Some health insurance plans include long-term care or offer options that do so. Other people may set aside a specific portion of their savings to long-term care. Medicare can help with partial payments for 100 days of nursing facility care for those who qualify. Medicaid, a government program for those who cannot pay for health care, is another option. Be sure to organize your financial records to prepare for the event of long-term care.

Talking to Loved Ones About Long Term Care

The optimum scenario is to have a discussion (most likely a series of discussions) where all of the parties discuss the long-term care options openly and realistically. Such an evaluation is more likely to result in a decision that respects the wishes of the elder and assuages the anxiety and fears of their loved ones.

For family members, the topic is difficult to initiate for obvious reasons. So to do so, you will want to frame the discussion in terms of the elder's desires and wishes for the future, a time when you may not be able to provide the care they need and they may not be able to care for themselves. If the elder knows that you're talking about future care (not tomorrow) and wish to discuss it in order to respect their wishes, the discussion may be more fruitful.

It's likely that the first discussion will not be the last one. In fact, you may encounter great resistance from the elder, which is natural. Try to have the discussion(s) in a setting that's comfortable to them and emphasize that you want to respect their wishes in the event you cannot care for them.

It may also be helpful to enlist the aid of third parties who are not in the family. These parties may also have useful information on the type of care the elder desires and how best to bring up the subject. If appropriate, they may also assist or initiate the discussion.

Examples of people who may offer such assistance include:

  • Physicians (primary care or geriatric specialists)
  • Close friends of the elder
  • Ministers, rabbis, priests, or other spiritual advisors
  • Social workers or other social services networks
  • Organizations that specialize in the treatment of certain diseases or disabilities
  • Local family service agencies--if they cannot assist in the discussion, they can certainly provide information on long-term care and issues associated with it.

Whatever method you employ to initiate and continue the conversation regarding caring for the elderly, don't be discouraged if your attempts are rebuffed several times. It may take some time for the elder to accept that they will need assistance beyond what their family can provide. Once they do, your gentle persistence will pay dividends in the future by lessening anxiety through respecting the wishes of the elder.

If you have legal concerns with any elder law issues, your first step can be to speak with an elder law attorney. Many offer free consultations to review your concerns.

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Next Steps

Contact a qualified elder law attorney to help you and loved ones plan care and address problems.

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