Dilemmas arise in decisions on elder care

Consider options, situations in exploring choices

Sooner or later, most of us will have to deal with the inevitable issue of aging parents and the questions that go with finding a place for them to live or people to care for them.

“Seniors these days have a ton of options,” said Michelle Herman, coordinator and community liaison for the UCSD Senior Behavioral Health Program, an in-patient psychiatry unit offering comprehensive behavioral and medical care for seniors.

“When people are living in their own homes independently and have things start to go wrong, the biggest triggers that cause people to leave their homes and go into a more supportive setting are things like decreased mobility, maybe not being able to drive anymore or not being able to walk very easily, incontinence, needing help managing bowel and bladder issues, general needing support with things like cooking because that has become an overwhelming chore,” said Herman.

Sometimes though, it’s “a big catastrophic event … something that gets the elderly person admitted to the hospital,” she added.

Cost confusion

One of the main concerns with senior care is cost and how much insurance covers, she said, noting that many are wrongly under the impression that Medicare will cover more than it actually does.

“What everyone needs to be aware of is that nursing homes are in this business to make money,” said Herman.

Nursing homes stay in business by maintaining a balance of residents, she explained, “basically minimizing the number of straight Medi-Cal residents they have and maximizing the number of residents who are there for rehabilitation purposes, because they get paid a lot more money when they’re providing a skilled therapeutic need.”

Ask how much caregivers are paid. “Generally speaking when it comes to elder care, you get what you pay for,” said Herman. “So if somebody’s paying on the lower end of the scale, I would say probably $9 an hour or less…you can expect to see a lot of turnover in caregiving staff and discontented staff.”

Besides financial concerns, depression can also become an issue for residents in senior communities.

Herman said the reasons vary. “Not only have they probably had many friends and family members die, so they’ve had a lot of grief, they’re grieving their own losses, whether that be their functional decline … the loss of leaving their home behind, coming to peace with the phase of life they’re in.”

Spending too much time indoors also can cause depression, she said, noting that when families are looking into facilities, they should ask if the facility works to get people outside, she said.

“Especially in San Diego, there’s really no reason that every resident in a community can’t get outside periodically. It’s not like we have long winters.”

Stressful times

Those who decide to care for elderly loved ones on their own need to be mindful not to neglect their own needs, Herman said.

“They say caregiving for your parents is the most stressful thing anyone will do in their life, more than having children, more than losing a job, more than buying a house,” said Herman. “There’s only probably one thing more stressful than an adult child taking care of their parent, and that’s an elderly spouse taking care of an elderly spouse. It’s too common in that situation that the caregiver ends up dying because of stress, because of neglecting their own health, that the caregiver will die before the person that they’re caring for.”

Fast Facts

Living options

• Resident community: for seniors able to live independently who want to downsize. Includes meals, transportation and activities for a monthly fee.
• Assisted living: for seniors who need help with medications and daily activities such as dressing and bathing.
• Nursing homes: provides skilled nursing under the supervision of licensed nurses.
• Rehabilitation: offers inpatient and outpatient treatment to restore abilities.
• Residential care or board-and-care: a single-family home that a licensed individual has turned into an elder care home. Some facilities will take social security as payment if the senior is easy to care for.

Home care

• Privately paid for in-home care.
• Home health: in-home care usually covered by insurance, designed for a specific service, such as physical therapy.
• Day care: provides meals and a way for the senior to remain active during the day. Facilities are usually either social day cares or health care models. Health care models are usually covered by Medicare and Medi-Cal, while social day cares are not.
• Care management: A care manager, usually a registered nurse or licensed social worker, manages an elderly person’s care for an hourly fee.
• Hospice care: end-of-life care for patients whose families have decided not to pursue any curative measures for a terminal diagnosis. It is always covered by Medicare and can either be in-home or in a facility.

What to look for

• Staff-to-patient ratio during all three shifts of the day, including night.
• Residents should appear well-groomed.
• An extensive and varied activities program.
• Facility should be free of foul odors, such as stale urine.
• Ask how are medications managed, what about medical care transportation and what kind of medical director is on staff.