Long Term Care Planning: Community-Based Care Settings

We were invited to write a series of brief articles for the monthly newsletter of our friends at MDK Insurance Services, describing the continuum of long term care, and how to navigate oneself through it. You can sign up for the newsletter on their website, and each month we provide a copy of the article here as well. Please share the information with someone you know who is thinking ahead about how to plan for (and pay for) their own or a loved one's long term care.

Volume VI: Community-based care settings

Previous installments of this series have described the resources available to those planning for care at home, and the goal of this issue is to describe the basic options for community-based long term care. Those who choose to move out of a private home and into a "senior living" setting do so for a variety of reasons. For some, it is a financial decision, while for others it is a lifestyle choice - freedom from the day-to-day responsibilities of managing a household, or the opportunity to interact socially with more people on a daily basis.

Independent Living communities are also sometimes referred to as "retirement communities." Some amenities such as communal dining, light housekeeping, transportation services, and planned activities may be available, but no personal care is provided. In these communities, residents must usually be able to ambulate independently.

Residential Care refers to a range of different housing providers that are licensed (in California by the Department of Social Services' Community Care Licensing division) to provide assistance with activities of daily living such as bathing, dressing, and medication management. A Board and Care home is a small residence (usually a single family home) with between six and twelve residents and a small staff of attendants. An Assisted Living facility is a larger community that usually offers several different levels of care and more supportive services.

Skilled Nursing Facilities are sometimes referred to as "nursing homes." They are licensed (in California by the Department of Public Health) to provide skilled nursing and supportive services for those who require assistance with most - or all - of the activities of daily living.

Next month we'll explore some additional specialty community-based residential services that are available, and then we will move on to a discussion of fees and funding sources for each level of care.

Looking "Up"

On a recent cross-country flight, I enjoyed the opportunity to watch Disney/Pixar's most recent animated feature, "Up." The main character, Carl, is an elderly and childless man who, upon losing his wife Ellie with whom he'd led a long and happy life, finds himself being forced out of their beloved little house and into a retirement home when he is deemed a "public menace." He and his wife had an unfulfilled, lifelong fantasy of moving to a place called Paradise Falls in South America, and on the day the staff from the retirement home come to take him, Carl ties hundreds of balloons to his house and flies away in pursuit of his and Ellie's dream. Once in the air, he realizes he's accidentally taken along a neighborhood boy, Russell, who had been on his porch attempting to earn a merit badge for "assisting the elderly." The movie is focused on the adventures that Carl and Russell experience while in South America (and I won't spoil the plot, for those who haven't seen it!), but it brought to light some issues and themes about which I often reflect both as a professional geriatric care manager, and as a person who cares deeply about the inner lives of our elders.

Carl is a cantankerous old grump of a character, and Russell is a loud, high-energy schoolboy and "Wilderness Explorer" scout. Through the course of their journey, we learn that Russell is being raised by his single mother, and wishes he spent more time with his re-married father. Russell eventually endears himself to his aged traveling companion, and a deep friendship is born. They learn about the world and about life from one another, and fulfill important roles in each other's lives. It is a sweet demonstration of the value of intergenerational relationships, and I hope that "Up's" younger audiences will internalize this lesson and seek out friendships with the elders in their communities, and value time spent with their own parents, grandparents, aunts, and uncles.

When Carl and Russell's balloon-powered house lands in South America, they realize that they've made it close to Paradise Falls, but have an arduous journey ahead of them, to relocate the house to the precise spot about which he and Ellie had dreamed. When faced with a difficult choice, Carl comes to the realization that "it's just a house." Until then, he had been very focused on it, and the things therein, as essential to his happiness and to the fulfillment of this particular dream. This brings to mind the complex relationship that many elders have with their family homes, as symbols of independence and a source of connection to memories and former roles and relationships. For my own grandmother, leaving her house meant not only accepting a new type of dependence on others, but relinquishing an important role - her home would no longer be the gathering place for celebrations and holidays, and she would no longer be able to provide a warm meal or a bed for visiting friends and family. Warm hospitality was a central feature of my grandmother's character, and looking back with hindsight, I wish we'd found more ways as a family to continue to foster that part of her after she moved into her assisted living apartment. For my grandmother, and for many others, letting go of her house felt like a loss of independence, but was in reality only a shift to a new type of interdependence.

The most important message I received from "Up" was that setting goals and achieving dreams is an ongoing process that should take place throughout our lives. Carl and Ellie had dreamed of children - and did not have them. They had dreamed of Paradise Falls - and did not get there. But they adapted to their circumstances, set new goals, and lived a happy and full life together. When things are looking grim in South America, Carl finds a message that Ellie had left for him before her death, which reads "Thanks for the adventure - now go have a new one!" and is renewed in his efforts. Carl's dreams of a life in South America with his beloved Ellie were not realized, but through the journey and his friendship with Russell, a new purpose for his later life was revealed. We see this in our work with our clients, and know it to be true: we are always growing, it is never too late to set and achieve goals, and there is purpose in every moment lived.

Finding the Right Nursing Home

This morning's Today Show (NBC) featured an interview with Sarah Baldauf, who wrote a comprehensive, step-by-step guide to finding the right nursing home for U.S. News & World Report. Click here to read the article and watch the video.