A Checklist for Aging in Place
Here are 8 things to look into before keeping your senior at home.
In a recent survey of Americans over 50, AARP found that 89 percent wished to stay in their current home for as long as possible. But can they afford it? And are their homes a safe place to age?
Whether you are that older adult or the child of an aging parent, there are a number of issues and concerns you need to consider before aging in place can be made a reality. Following is a list of many of the key things to consider.
1. Look into Long-Term Care Insurance
- What is it? Long-term care (LTC) insurance is a form of insurance specifically developed to cover many of the costs associated with long-term care services, most of which are not covered by Medicare, Medicaid, or conventional health insurance.
- What does it cover? Most LTC insurance policies sold today are comprehensive policies, which typically cover services and care in different settings, including your home. Most of these policies will include various therapies (physical, rehabilitation, occupational, etc.), skilled nursing care, personal care assistance (such as dressing, bathing, and grooming), and, in many cases, some domestic services (such as housekeeping, meal preparation, and transportation).
- What to watch out for? First of all, you want to make sure you purchase the right amount of coverage, not too much or too little. And, as with any insurance policy or contract, you need to read the fine print and be certain what will, and what will not, be covered. Before you purchase a LTC policy, review the "Outline of Coverage" closely and make note of all exclusions. Many policies, for instance, exclude care or services by a family member, exclude treatment of alcoholism or drug addiction, or for any care or services for which no charge is incurred in the absence of insurance. In addition, having certain medical conditions may mean you won't qualify for a particular policy. Before purchasing any policy review it with your lawyer and financial advisor to make sure you are choosing an appropriate plan for your needs.
- What other options are there? Several other types of insurance do cover some long-term care costs, including some private health insurance policies and Medicare supplemental insurance. You can also use your life insurance policy to help pay your costs. Other methods for paying for care include various types of long-term care annuities, certain trusts ("charitable remainder" and "Medicaid disability"), and reverse mortgages.
2. Make Your Home Safe and Accessible
Whether you're planning to stay in your current home or considering downsizing to a residence with less maintenance requirements (e.g., a condo or smaller house), there is one overriding issue for you to stay safe in your home: preventing a fall.
Studies have clearly shown that a fall is one of the major causes for a rapid decline in health and well-being among older adults, and is often the precipitating event for transitioning into a long-term care facility.
The simple fact, however, is that most falls can be prevented. For instance, taking simple steps like removing throw rugs, clearing clutter from the floors, installing grab rails in the bathrooms, wearing non-slip shoes, and updating your lighting in and outside of your home will all help.
3. Create Your "Care Team"
Even if you are healthy, active, and completely independent, you will still want to create a "care team" to work with you to assess how you are managing at home and provide you with assistance when needed. A good care team serves as your ally, helping you in whatever ways necessary to ensure your safety, comfort, and ongoing quality of life.
Start with Your Primary Caregiver. To create your care team you will first want to enlist the primary caregiver or head of the team. This person is often a family member or someone you're very comfortable with and who you trust implicitly (proximity might be important, but need not be a deciding factor). "Trust is huge," says Mary Stehle, LCSW, and Senior Care Advisor at Care.com. "This person may be coordinating various details of your care, including oversight of hired caregivers and communicating your needs with other family members. The two of you, over time, may be involved in a lot of discussions and decision-making, and sometimes these can be difficult and uncomfortable," Stehle says, emphasizing the importance of trust and comfort with this individual.
In addition to being trustworthy, your primary caregiver should ideally have a number of other qualities to be truly effective and act faithfully on your behalf. These qualities include strong communication and organizational skills, compassion, empathy, patience, a tolerance for stress, the ability to delegate, and the humility and good sense to be able to ask for help when needed. This person may also be your power of attorney and Health care proxy.
Build Your Team. To create the rest of your care team, you (and/or your primary caregiver) need to reach out to family, friends, and neighbors who you're comfortable with, who have a strong interest in your well-being, and who you think will be willing to commit to playing a role on your team. Of course, it's often not easy to ask for help. But, as Stehle says, "if you're up front and honest with people in explaining why you're having this conversation, and what your expectations are," people often will respond well. The simple truth is most people want to help if they can - and know how.
Once you have your care team in place and your primary caregiver is coordinating the various tasks and assignments of the team, bear in mind that what works today may not work so well tomorrow. "Caregiving is not a static activity, the needs are always going to be changing," says Stehle, so "a spirit of transparency and open, honest communication among everyone on the team is essential."
4. Home Maintenance
Part of the trick of growing older gracefully (and staying healthy!) is to recognize when it's time to stop doing certain things, and this is certainly true for many of the regular tasks associated with maintaining a home. Here are just a couple steps to consider:
- Hire a reputable cleaning company. Perhaps they only come in once a month to do a 'top to bottom' cleaning.
- Contract with a local landscape company or individual to provide regular lawn care, including mowing, trimming, raking, and snow shoveling, as needed.
- Maintain an up-to-date list of qualified contractors and service people (e.g., electrician, plumber, etc.) who can address all of your major home repair and maintenance needs.
- In case of an emergency - say, a leaky roof or power outage - establish a key contact you can easily reach to help you resolve the problem quickly. This person is usually a member of your care team and often the primary caregiver.
5. Area Services
In most locations, you can get help for just about any service or need you have, usually for a cost. To start, check with your local community and government services, including your local Area Agency on Aging and your town or state offices of aging or social services. Also, if you're inclined, many local religious organizations offer appropriate services for older adults.
Whether it's help with meals (look into the "Meals on Wheels" program), hiring a caregiver to cook at your home, driving and errands (consider public transportation, taxis, and volunteer or paid escort services), or wishing to expand your social life (check with your local senior center or adult day health program) - a solution can usually be found.
For older adults living at home there are certain activities that can be dangerous, or at least problematic, such as:
- Bathing. Make sure the tub/shower area is 'senior friendly' (e.g., handrails, non-slip mats), always test the water temperature before entering; avoid any sudden movements, never rush.
- Bill paying. Have a qualified member of your care team work with you to set up the most efficient system (e.g., automated bill paying online), so that everything is in one place and all bills are paid at the same time each month. It might make sense for this team member (or the primary caregiver) to review your bills with you periodically.
- Medications. Maintain a list of all current medications with all pertinent information; ration out pills in a daily dose organizer and keep in an obvious place (e.g., beside the coffee maker); throw out all expired prescriptions; keep all prescriptions in their original containers.
7. Technology Is Your Friend
With today's technology you can now turn your house into a "smart home" with an array of tools and systems that will go a long way to ensure your safety, comfort, and independence. Depending on your particular needs and budget, the kinds of safety and monitoring systems that can now be installed in your home include emergency assistance, automated timers/reminders, GPS locators, video cameras, motion and lighting sensors, and environmental controls. Now, when there's an emergency, help can be literally minutes away.
Today's communication tools also make it very easy to stay in touch with family and friends through email, cell phones, social networking sites, and other free Internet services like Sykpe and FreeConferenceCall. Make use of these tools.
8. Budgeting for Care
Because there are so many variables in terms of the types of services and care available, it is impossible to create a one-size-fits-all budget for personal home care costs. To develop a realistic idea of what it will cost you, you will need to create your own budget, listing all the items (services, alterations, technology, etc.) you think you will need. Break them up into two categories - "must have" and "like to have" - and then get price ranges from the appropriate individuals and companies. Under the price column remember to specify if it is a one-time or ongoing cost.
Once you have a working budget, you should meet with your financial advisor (and perhaps your lawyer) to have a candid discussion about what you can realistically afford. Obviously, this discussion should occur within the larger context of items related to your situation: your projected income over time, whether you've purchased long-term care insurance, your desired lifestyle, future needs and potential costs, Medicaid spend-down, and whether divesting assets to family members makes sense.
Keep in mind that this kind of discussion is not a one-time thing. Going forward, plan on scheduling this meeting on a periodic basis or whenever significant life changes occur. Use our Senior Care Calculator to price out different costs of care near you.