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FAREWELL TO THE NURSING HOMEA host of alternatives help the aging live independentlyIt was the second call to 911 within a month. Her 88-year-old father had fallen again, and her 84-year-old mother couldn't lift him up. ''I realized then that they just couldn't live alone anymore, but I didn't want them living in anything like a hospital room,'' says the couple's daughter, Marcia Haun. In the past, when Mom and Dad got too old or frail to live alone, they went to a nursing home. Not anymore. Americans are less likely, in fact, to use nursing homes today than a decade ago--even though they're living longer, and the 85-plus population is expected to swell from 3.6 million today to 9 million by 2030, according to a recent Health & Human Services Dept. survey. HELP AT HOME. The nursing-home population has declined 18% since 1985 despite the rising numbers of the elderly. About 41 of every 1,000 Americans over the age of 65 are now in such homes. And the makeup of the nursing home population is also changing. Since hospitals are now releasing patients after shorter stays, nursing homes are focusing on sicker patients who need post-hospital care. ''Many of the people who used to be in hospitals are now in nursing homes, and those who would have lived in nursing homes have gone elsewhere,'' says David Kyllo, a spokesman for the American Health Care Assn. Fortunately, several alternatives are available that help aging Americans live more independently. Some elderly can live alone longer when home nursing and housekeeping services are provided. Health aides, who can help with bathing and shop for groceries, cost $10 to $18 per hour. Registered nurses, who perform more skilled services, such as inserting catheters, cost $25 to $40 per hour. Home care is available 24 hours a day, seven days a week, but it's not really intended to provide long-term, full-time nursing care. Instead, it lets recovering patients get limited assistance with medication and care in the comfort of home. If your frail mother misses socializing with people her own age, you might want to enroll her in an adult day-care center. More than 3,000 centers are operating nationwide. Most can handle elders suffering from a variety of infirmities--including Alzheimer's disease--as long as the person is mobile and not disruptive to the group. Most adult centers provide breakfast and lunch as well as scheduled activities, such as music, exercise programs, and trips to the park. One drawback: Adult day-care centers generally operate from 9 a.m. to 5 p.m., which can make them inconvenient for working caregivers. Daily rates range from $30 for basic care to $150 for rehabilitation therapy and skilled nursing. Often, you must sign up for at least two days of care per week. For a nominal fee, many offer transportation to and from the facility. Seniors who have medical problems that require some help may find an assisted-living facility a good option. They get meals, transportation, housekeeping, personal, and medical care. Services increase as the resident's needs change. Help bathing may be all that is needed at first, but a year later, daily visits from a registered nurse may be necessary. Unlike nursing homes, chains such as Marriott Senior Living Services and ARV Assisted Living offer the privacy of separate living quarters in a residential setting. Residents share at least one daily meal and meet for movies and exercise classes. Monthly fees average $2,160. A cheaper, less comprehensive option is congregate care. ''It's a very hands-off, don't-touch-the-body type of care,'' says Assisted Living Concepts President Keren Brown Wilson. Meals, laundry, and transportation are provided to residents who live in an apartment-like complex with a communal dining and recreation room. Help with bathing and dressing is provided for an hourly fee, but no medical services are available. Generally, the staff doesn't work round the clock, though a manager may live on the premises. TAKE A TENANT. Adult foster care and home sharing are two other alternatives. With foster care, your parent would board in a licensed provider's home and receive 24-hour supervision, meals, laundry service, transportation, and personal care. Many of the providers have been trained by registered nurses; others are RNs themselves. Typically, the boarder gets a private bedroom and use of the common rooms in the house. The cost ranges from $1,200 to $2,000 per month. In a home-sharing setting, a senior would rent rooms to other people, typically younger folks, who can help around the house. ''We suggest that 12 hours of household chores per week equal free rent,'' says Helen Head, executive director of Project Home, a home-sharing referral agency in Burlington, Vt. To find a suitable tenant, check references and, perhaps, use a referral service. For those who are healthy and wealthy, Continuing Care Retirement Communities (CCRC) offer Mom and Dad a home to spend the rest of their days, regardless of how much care they eventually need. In exchange for a hefty entry charge and a monthly fee, healthy, self-caring elders move into a private apartment in a luxurious, campuslike setting. At Fairhaven in Sykesville, Md., residents enjoy a private golf course, swimming pool, nature trail, yoga, and country-dancing classes. As Mom's health declines, she can move to an assisted-living suite--then to a private room in the CCRC's nursing-care wing. Unfortunately, these communities aren't cheap: Fairhaven's entry fee can cost $388,000 and its monthly fees nearly $4,000 for a two-bedroom, two-bathroom apartment with den. More typically, entry fees at less-plush facilities average $100,000, with monthly fees of $1,500. But before you decide on a CCRC, make sure that those monthly fees can be paid for the remainder of your parents' life. You'll typically pay one of three ways. Some facilities offer an ''extensive,'' or Type A, plan in which you pay one inflation-adjusted monthly price, no matter which level of service you need. Other places provide a ''modified,'' or Type B, plan that guarantees nursing care for a specified number of days each year--such as 60--at no additional charge. After two months, you pay a discounted per-diem charge. There is also a ''fee-for-service,'' or Type C, plan, which is usually less expensive initially, but residents must pay prevailing market rates for nursing care when needed. To get more information about CCRCs, try the Continuing Care Accreditation Commission in Washington (202 783-7286). Once you've sifted through the options, how do you pay? Medicare, which pays for health care for people 65 and over and for those who are disabled, covers hospitalization and doctor's services. But it's limited primarily to short-term, recuperative care. So Medicare does not pay for long-term medical service such as assisted living or adult day care. It will, however, pick up some of the nursing-home costs at a CCRC. And Medicare may pay for home care if a doctor deems it necessary and a Medicare-certified home health-care agency provides the service. LIFE INSURANCE. Medicaid pays for health-care services for the very poor of any age. To qualify, nearly all of a patient's assets must be depleted. State Medicaid programs may also cover adult day care, part of assisted-living fees (you pay room and board), and home care if the state substitutes these services for nursing-home care under ''waiver'' programs. But to qualify, the patient must be eligible for a nursing home. Not all assisted-living facilities take federally insured residents. Also, check your long-term-care insurance policy because assisted living, home care, and adult day care may be covered as an ''alternative care benefit.'' Contact the Area Office on Aging or the Elder Care Locator Service (800 677-1116) to learn more about your options. Also keep in mind that more and more employers are offering free elder-care consultation and referral services. For many seniors, no one situation is perfect. Marcia Haun used home care for a year before she moved her parents into the assisted-living facility where they now reside. But as the elderly population continues to swell, a growing list of options are sure to follow that will increase your parents' chances of a secure, comfortable old age. ADVICE: Remember that Medicare won't pay for services such as assisted living or adult day care
By Barbara Hetzer
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Updated June 15, 1997 by bwwebmaster
Copyright 1997, by The McGraw-Hill Companies Inc. All rights reserved.
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