Eldercare: Making the Best Choice

If it's time to talk about getting your parents a little help, here's the lowdown on the different types of service you might choose

When the holidays arrive, far-flung families have a chance to reconnect and celebrate. It's an opportunity to reminisce and catch up on the year gone by. A family gathering can also be a convenient setting to bring up important but uncomfortable subjects.

For many in the so-called Sandwich Generation—those folks coping with bills for their kids' education and for living and medical expenses for their parents—it might be an opportunity to discuss what will happen when their parents can no longer care for themselves. [LINK TO SR TIPSHEET: Making Eldercare Less Stressful]

The first step is to watch and listen. Sandwichers should keep an eye out during the winter to see if such additional care is necessary. What should they look for? Barbara Friesner, a generational coach who started the company AgeWiseLiving, says "a sign is anything that makes you say something's not right."

That can amount to a tangible problem such as bills going unpaid, or in some cases, just a feeling. Many times it's difficulty managing the volume of medications that many seniors ingest daily.


  When it becomes clear that additional help is needed, negotiating the next step can be a grueling process, especially for those unfamiliar with the vast network of eldercare options out there. [LINK TO SR STORY: A Game Plan for Long-Term Care]Here's a rundown on some of the more notable options:

Home care: Industry experts say most people want to live at home for as long as possible—understandable since it is the easiest place to be in control of your life. Ann Howard, director of federal policy at the American Association for Homecare, says that for adults who need limited assistance "probably what they need more than anything else is personal care"—an assistant to help with routine tasks such as getting dressed, bathing, and food preparation. Since much of the work is routine household chores, a personal attendant, at least part time, can be one of the most affordable options.

Howard's organization promotes home care, so it may not be surprising that she says it is not just for seniors who need a little assistance. Home care can also work for more sophisticated services such as telemedicine (access to remote medical expertise) and hospice services for the terminally ill.

Of course, major surgeries remain the purview of hospitals, she says. Since most people prefer living at home, a number of adult day care centers have also sprung up. These are places where adults receiving home care can pass the day, and, in some cases, receive medical treatment. Adult day care also gives family members time to focus on other parts of their life.

Assisted living: This is the next step after home care, one that combines elements of independent living with more vigilant attention. However, the residents are more independent than those in nursing homes.

As with all these options, assisted living situations cater to a range of budgets, but they tend to be less expensive than nursing homes. They add round-the-clock nurse availability to the mix. The higher degree of expertise and attention brings higher prices than home care.

A variation on assisted living is what Pat Long of H.E.L.P., a counseling center for elder adults, calls "six packs." Typically, this kind of setup involves an entrepreneurial family turning its home into an assisted living facility. In the Los Angeles area, where H.E.L.P. is based, six packs usually cost at least $2,000 per month, Long says.

Nursing homes: These are probably the best known living arrangement for the elderly. Nursing homes are for those who because of the loss of physical or mental abilities cannot care for themselves. They offer more access to nurses and medical treatment than assisted living provides, so consumers can expect them to be more expensive. As with the other options, however, they vary widely in price, based on factors including the available amenities.

Other options: The idea of continuing care retirement communities, or CCRC, appeals to those who like to plan ahead. Often on their own campuses, CCRCs accommodate the needs of seniors as they progress into the greater difficulties of old age. They offer services for people who need only minimal supervision while expanding their services as residents' needs grow.

CCRCs can be pricey. Some require monthly fees plus a one-time entry fee that can run well into six figures, though in some cases they are refundable at the time of death. "You can move in when you're 55," says H.E.L.P.'s Long.

One of the most unusual options, and potentially one of the most pleasant, is known as naturally occurring retirement communities or NORCs. These can be found when a building or community houses a number of people who just happen to begin to need special services at the same time.

Elinor Ginzler, director for livable communities at AARP, says that in some cases NORC residents can wheedle bargains from providers of senior services since so many potential customers are all in the same place. Sometimes it even amounts to pooling funds as a way to convert a building into a NORC.

Unfortunately for those folks looking to find an appropriate place for Mom or Dad, "adult children might not even know they're looking at a NORC," Ginzler says. And whether one sprouts up somewhere owes a great deal to luck.

The bottom line for those looking for the best options for their elderly parents: Look hard at their physical and mental health and their finances, and consult health-care and financial professionals if necessary. As always, a little foresight may be a big help.

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