When it comes time to prepare for the long term care of your aging loved ones, there are a number of things to consider. Caring for an aging loved one can be very difficult, especially if you not aware of all of the options or if you live far away from your loved ones and aren’t familiar with the services in that community. No matter where you are on the caregiving spectrum, it’s never too early to start planning. You can work confidentially with an Elder Care Specialist through your WorkLife and EAP Support to help make the process easier. Call a specialist 24/7 at 800-888-6332.
Here are some examples of things a specialist can help research for you:
- Care options and living arrangements
- Caregiver issues and concerns
- Elder care management
- Hospice care
- Respite care
- Home Meal Delivery & other in-home services
- Medicare, Medicaid & Social Security
- Senior Health and Safety
- Transportation Services
- Financial Issues
- General retirement guidance
Getting Their Affairs in Order
- Put important papers and copies of legal documents in one place. Set up a file, put everything in a desk or dresser drawer, or list the information and location of papers in a notebook. If papers are in a bank safe deposit box, keep copies in a file at home. Check each year to see if there's anything new to add.
- Tell a trusted family member or friend where all important papers are kept. It's not necessary for your loved one to disclose details about their personal affairs, but someone should know where important information is kept in case of an emergency. If an older loved one is unwilling to share this information, they should consider asking a lawyer to help.
- Encourage your older loved one to discuss end-of-life preferences with their doctor. A doctor can explain what health decisions an individual may have to make in the future and what treatment options are available. Talking with a doctor can help ensure your older loved one's wishes are honored, and the visit may be covered by insurance.
- Encourage your older loved one to give permission in advance for their doctor or lawyer to talk with their caregiver(s) as needed. There may be questions about care, a bill, or a health insurance claim. Without consent, a caregiver may not be able to get needed information. Your older loved one can give his or her okay in advance to Medicare, a credit card company, a bank, or a doctor. They may need to sign and return a form.
How to Approach the Conversation
Prepare to be open, honest and not argumentative when discussing these topics with your aging loved ones. Below are some approaches you can take, depending on the personality and your relationship with them:
Direct: If your loved one has a 'no-nonsense, get-to-the-point' personality, openly express your concerns and ask questions for information you need to address specific situations that might arise.
Educational: For someone who might need a delicate push, you might begin by sharing an experience of another caregiver you know about their own personal situation, and explain how it made you realize the importance of discussing issues now that will help you be of better assistance to them in the future.
Expert: For the older loved one who refuses to talk about personal issues or tends to accuse others of trying to take control of their life, seek to make them the expert by asking for their advice about a particular issue - for example, "what type of long term care plan should I look into," or "can you recommend someone to help me prepare my will." This strategy is non-threatening and could lead to them sharing personal details, or at least letting you know where they stand on the subject.
A large part of the planning process is deciding where your loved one will live as they age. There are a number of factors to consider in making this decision, but some common and helpful questions to ask yourself are “what level of care do they/will they need?”, “how much time, energy and money can I commit to their care?”, “what are the financial impacts of each option”, “what do my loved ones want.”
The following information provides an overview of some of the care options available. For more tailored support in finding the right option for you and your loved one, contact a WorkLife Specialist through the WorkLife and EAP Support program; their confidential line is open 24/7 at 800-888-6332.
In-Home Care
Whether your loved ones plans to stay in their own home or move in with you or a relative, there are several types of in-home caregivers who can help you take care of your aging loved ones:
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Homemakers/Companions provide light housekeeping services and meal preparation but cannot provide hands-on care (e.g., custodial or skilled care).
- Home Health Aides (HHAs), Personal Care Aides (PCAs) and Certified Nurses' Aides (CNAs) are all trained to provide assistance with custodial care such as dressing, eating, bathing, meal preparation and medication supervision (in some states). Most are trained in CPR and first aid. All CNAs are required to be certified, but state certification requirements for HHAs and PCAs vary.
- Registered Nurses (RNs) may perform a range of duties, such as administering medication, drawing blood and providing intravenous therapy, as well as other types of skilled care. A registered nurse typically prepares an initial patient assessment and outlines a home care plan (sometimes this is prepared by a physician), which is usually carried out by a home health aide.
- Physical Therapists (PTs) are licensed and/or certified by the state in which they practice, and are trained to help a patient increase and improve physical functioning.
- Speech-Language Pathologists (SLPs) are certified or licensed by the state to assist individuals suffering from speech loss due to illness. To practice, a speech-language pathologist must have a master's degree in the field as well as a license from the state.
- Occupational Therapists (OTs) are licensed and/or certified by the state in which they practice and are specially trained to help a patient improve physical, mental and social functioning, and to promote independence.
Registered Dietitians (RDs) are specialists who evaluate patients' diets and offer diet and nutrition counseling. Dietitians must be registered by the state in which they practice.
Cost of Home Care
Fees for home care services vary depending on where you live, whom you hire and the type of services you require. A variety of government assistance programs such as Medicare, Medicaid or special state programs may cover some or all of the cost of certain home care services as outlined briefly in this section.
Residential Care
All long-term care facilities must offer 24-hour supervision by a registered nurse, and be overseen by a doctor who serves as the medical director. And now, more and more facilities are offering additional levels of care to meet the needs of more residents. Insurance companies and programs (including Medicare and Medicaid) typically determine coverage based on the level of care provided in a facility. Therefore, it is important to understand the following various levels of coverage that may be offered by a facility.
- Custodial Care offers assistance with activities and functions of daily living such as eating, bathing, dressing and using the restroom. Although Medicare offers no coverage for custodial care, Medicaid typically does in some states. Many private insurance policies offer some coverage as well.
- Intermediate Care is custodial care plus some form of medical care and supervision. Medicare does not provide any coverage for intermediate care, though Medicaid typically does. Medicare Part B, however, covers physician services for patients using intermediate care, but does not cover the cost of regular nursing home care. Private insurance may offer some coverage.
- Skilled Care offers health care services furnished by licensed medical professionals such as nurses and therapists. Skilled care facilities cater to people with chronic illnesses and impairments by offering high levels of care, therapy and monitoring in addition to personal care assistance, typically from licensed vocational or practical nurses. Medicare, Medicaid and private insurance will usually pay for skilled care up to pre-determined coverage limits, as long care is prescribed by a physician.
- Sub-Acute Care Medical care, including 24-hour monitoring and rehabilitative therapies, designed for patients who require high levels of medical care, usually after hospitalization, surgery or illness. (Hospital-based facilities are for temporary care only). Medicare, Medicaid and private insurance typically cover some of the cost.
Remember, all long-term care facilities must provide daily supervision by a registered nurse, but additional levels of care are optional. Many long-term care facilities also offer separate wings or units for residents with Alzheimer's disease or dementia.
When considering long-term care facilities, find out what levels of care are offered -- and what is covered by insurance -- and make sure the facility meets the needs of you or your loved one. Keep in mind that your (or your loved one's) needs may change over time, so try to find a facility that will accommodate both current and future needs.
Cost of Residential Care
The cost of a long-term care facility depends on its location and the duration and level of care a resident requires. Cost varies dramatically according to where you live and it can be significantly higher in some areas of the country. Medicare pays minimal long-term health care costs and only for skilled care (additional restrictions apply). Medicaid covers most of the cost but only for those who are eligible, and many facilities only have a limited number of spaces for Medicaid patients. While long-term care facilities are not required to set aside beds for Medicaid patients, if a current resident becomes eligible for Medicaid, the facility is required to accept Medicaid payment and cannot evict the resident. Private medical insurance or long-term care insurance may cover some of a long-term care facility's cost, depending on the policy
Many concerns and questions arise as those we love grow older and need more care. Some examples of legal questions to keep in mind as your loved ones age will relate to:
- Age discrimination
- Asset protection
- Disability
- Estate planning
- Guardianship
- Long-term care
- Elder abuse
- Medicare and Medicaid
- Mental health issues
- Social security
- Will preparation
Free Legal Consultations
You are eligible for a free 60-minute consultation with a local attorney. If you would like to continue working with an attorney beyond the free consultation, you will receive discounts rates on their fees. To set up an appointment, call the WorkLife and EAP Support program; their confidential line is open 24/7 at 800-888-6332.
Legal Documents
There are many different types of legal documents that can help a person plan how his or her affairs will be handled in the future. Many of these documents have names that sound alike, so make sure your older loved one is getting the documents he or she wants and needs. Also, State laws vary, so find out about the rules, requirements, and forms used in your older loved one's State.
Wills and trusts let an individual name the person he or she wants his or her money and property to go to after he or she dies.
Advance directives let an individual make arrangements for care if he or she becomes sick. Two common types of advance directives are:
- A living will gives the individual a say in his or her health care if he or she becomes too sick to make his or her wishes known. In a living will, a person can state what kind of care he or she does or doesn't want. This can make it easier for others to make tough healthcare decisions for the person.
- A durable power of attorney for health care lets an individual name the person he or she wants to make medical decisions for him or her if he or she can't make them. The person creating the durable power of attorney for health care needs to make sure the person named is willing to make those decisions for him or her.
Legal Insurance
Provides you with access to a network of more than 11,000 attorneys and is available through Hyatt Legal. Enrollment and cancellation can be made during benefits open enrollment or during a qualifying life event. To learn more or to enroll, login to Workday, then go to Benefits>BenefitsPlus.
In addition to legal documents such as a will and a durable power of attorney, you need to help your loved ones compile their other personal and financial documents, such as:
- Financial Accounts including all bank accounts, investment accounts, and credit/debit card account numbers.
- Professional Contacts including names and contact info for your parent’s accountant, attorney, financial advisor, and insurance brokers.
- Recurring Bills such as loans, mortgage payments, telephone and electric, cable service, and insurance premiums.
- Sources of Income including annuities, social security, pensions, and retirement accounts.
- Miscellaneous Documents such as automobile ownership papers or lease agreements, home ownership papers, and mortgage documents.
- Computerized information such as email accounts, passwords, and online billing service.
Free Financial Consultation
You are eligible for two free 30-minute telephone consultations per topic, per year with a financial coach. If you wish to continue working with a financial coach beyond initial consultations, you will receive discounts rates of their fees. To set up an appointment, call a WorkLife Specialist through the WorkLife and EAP Support program; their confidential line is open 24/7: 800-888-6338.
Health Insurance Costs
Health care is a high-cost necessity, so it is crucial to know what is available to meet your loved ones' needs, and what they are eligible to receive. Most adults over age 65 are covered by Medicare, the federal health insurance program that helps pay medical expenses for older Americans and younger people with disabilities. However, Medicare does not cover all needs, such as long term care including nursing homes or extended care, and Supplemental Insurance (also called Medigap insurance) might be necessary to cover additional health costs. Medicaid, on the other hand, is the federal and state insurance program that helps pay the health care costs of low-income individuals of any age. Long-term care insurance is available through the private market to assist individuals to cover the cost of long-term care services such as home health and nursing home care.
Ask your loved ones questions like ...
As your health status changes, are you prepared to meet your long term health care needs?
Do you have proper health insurance coverage (not too much or too little)?
Are you comfortably able to pay for prescription drugs and other out-of pocket health care costs?
Who are your doctors and how can they be contacted?
Where do you keep your insurance card, Medicare information, and other important health care documents?
Dependent Care FSAs
You can contribute up to $5,000 per year of pre-tax dollars to a Dependent Care Flexible Spending Account (DCFSA) to use for elder care expenses incurred at work (elder must be a tax-qualified dependent). Enrollment is available during Benefits Open Enrollment or during the plan year if you experience a qualifying life event.
New Job-Protected Paid Family Leave (PFL)- Effective July 1, 2021
Paid Family Leave covers time taken off to care for a qualifying family member (and for bonding after the birth, adoption, or foster care placement of a child). Qualifying family members include grandparents, spouse or domestic partner, parents of spouse or domestic partner, siblings, children and grandchildren. Employees may take up to 12 weeks of Family Leave in a rolling calendar year. Between Paid Family Leave and Paid Medical Leave (which covers an employee’s own medical condition), employees can take up to a total of 26 weeks in a single benefit year. For more information please contact Aflac at 888-902-4583 or email DisabilityManagement@baystatehealth.org.
Confidential Counseling
Providing care for an aging loved one can be tremendously stressful. It’s common for caregivers to put their own health, feelings and well-being aside. The results can be damaging: anxiety, sadness, guilt, and a whole host of physical ailments. It’s beneficial to find an outlet. Talking to a sympathetic listener can provide the support, comfort and perspective needed to improve your quality of life. Get the help you need in a convenient, confidential, safe and non-judgmental environment. Call 800-888-6332 whenever you need support. Every call is answered by a master's level licensed clinician who listens to your concerns and connects you with the resources to best meet your needs. You and your dependents and household members each have up to 6 counseling sessions per issue/concern per year.