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Planning for long-term aging care

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Whether you have thought about long term care for an aging or disabled loved one, the fact remains, in that human life expectancy has increased steadily over the past few decades. The number of people living past 70 has dramatically increased, and because of higher standards of living, by the year 2040 the percentage of nursing home residents will jump from 50 to 130 percent. In the United States, more than 70 percent of nursing home residents are 75 years of age or older. Ninety-two percent of those are Caucasian, 6 percent are African-American, 1 percent are Spanish, and the remainder are Asian, Hispanic mix or of other Native American descent. Another important contributing factor to the ever-increasing need for long term care is the decline of the extended family in our culture. American households consist mainly of what sociologists refer to as the "nuclear family." This is where the home is downsized to a single unit family replacing the former agricultural and extended family group.

Because we live in a very mobile society, extended families are moving miles apart as the children become adults. Siblings are becoming far removed from one another, while parents are very likely to have to care for themselves as they grow older. The most common observation I have made is that many adult family care-givers are "sandwiched" in between the ongoing caring for aging parents or relatives, as well as caring for a busy growing family. In many cases, the adult family care-giver is either a single parent or lives on a modest income, making choices for long term care options nearly impossible and narrowed. This is especially a harsh reality for these "sandwich" type care-givers whose aging loved ones do not have a long-term insurance policy, or life savings and assets from which long-term care may be funded. Truth is, many older Americans do not have a long-term care- plan at all.

What's a family to do? Many families I meet express feelings of anxiety or despair when the need for long term care planning comes up in the initial conversations, or when the question arrives as to how the family is choosing to care for their aging loved one... there is only one of two answers, by the way- either care at home, referred to "aging in place," or in facility based care. In either direction, it will cost both time and money, and then some.

How can a family on a modest income plan a long-term care for themselves as well as their aging loved ones? It's never too late, is what I always say. But first, let's take a look at what a long-term care plan actually is. What does a long-term care plan consist of? Can anyone write a care plan?

Yes, anyone can write a plan of care. A plan of care, is just that. A plan to care for someone else, or a "care-plan." Since my nursing school days, I have always used a care-plan for caring for patients in the hospital; and the same format of identifying problems and setting out to resolve each one by a systematic process of resolution or simply, problem solving is the basic concept that is well utilized in this case.

While it is obvious that either care at home or care in a facility is at a staggering prohibitive cost economically, it is also costly of a care-giver's physical and mental wellbeing. That's why I have been involved in care-giver support groups for many years. Care-givers need all kinds of supports. How does a care-plan help though? As stated, the care-plan is based on the scientific method of problem solving. Once each issue is addressed, it is then given a priority. In cost, options must be weighed out on the longevity of a loved one's life expectancy and the options or resources at hand. In other words, means versus extremes. For example, if an aging loved one has a chronic medical condition that the doctors agree is unresolvable; it becomes a matter of planning ahead reasonably for an acute care crisis and the cost estimate by comparison analysis, simultaneous to the chronic day to day care.

In many cases, families realize the beauty of digging deep into creative community resources finding that overall care at home may be less costly and as research has indicated, if possible elder care may be a better quality at home if the circumstances are right. Meaning, there are more than one able-bodied care-givers and creative community supports. If the family has less than adequate able-bodied care-givers, impaired ability to tap into community resource, or monetary means, then the care plan typically swings towards a Medicaid funded custodial type of long term care, if there are no other relatives and significant others to care for a loved one. This is becoming more widespread, which explains much of the complexed application process.

Whether the decision is made to continue care at home or go to a facility based care, there is more to the answer than many families have considered. It's not just about what is thought about either type of care (in home or facility based) as much as it becomes an issue of which type of long term care will best meet the everyday needs of a loved one. Once the decision is made, the care plan develops into a problem list that covers every aspect of human needs, based on Maslow's Hierarchy of needs; that being the bio-psycho-social based needs as well as the economic and geographic and spiritual needs also.

I have had the honor to have met so many families who initiate some sort of plan for long term care, but the problem list may begin to pile up too high, or life just gets so busy these days, and that's when a family needs a professional care-planner such as a geriatric care manager. In addition to having a care-giving coach, the care manager assists families in choosing the best care team possible which includes but is certainly not limited to a geriatric (preferably geriatric board certified) primary care physician, a pharmacist who knows your physician and is familiar with not only the medications you take but the insurance drug plan that you are on, a Medicare certified home health, community resources and the list goes on and on, and needs to be specified to individual needs and desires.

The bottom line is that long-term care issues are here to stay. My advice is for every family--- no matter what age and where you are on the income scale, to begin a long-term plan of care for yourselves and especially for your aging relatives--- while it is still today. It's never too late!!

Also, very important is the awareness that long-term care insurance premiums are usually less if you buy them when you are younger; this is not a preparation that should be postponed until one is nearing the possibility of needing long-term care facility placement. Geriatric care managers assist families to plan ahead as well as assist them in the ferocity of acute aging life care journeys.

Find out more at https://www.aginglifecare.org/.

Dawn Elledge is the owner of Elledge Geriatric Care Management.

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