Assisted Living: the Rental Vs
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CCaarriinngg TTooddaayy,, PPllaannnniinngg ffoorr TToommoorrrrooww NATIONAL ALLIANCE FOR CAREGIVING National Alliance for Caregiving in collaboration with the General Federation of Women's Clubs, Business and Professional Women/USA, and the Employee Assistance Professionals Association National Alliance for Caregiving 4720 Montgomery Lane, Suite 642 Bethesda, MD 20814-3425 www.caregiving.org (c) 1999 Consultants John Migliaccio, Ph.D. Maturity Mark Services Neal E. Cutler, Ph.D. The Joseph E. Boettner/Davis W. Gregg Chair of Financial Gerontology Widener University Table of Contents PART ONE — CAREGIVING FOR YOUR OLDER RELATIVE Introduction ................................................................................................................................... 3 Caregiving's Challenge .................................................................................................................4 Health Issues ................................................................................................................... 4 Medicaid vs. Medicare ................................................................................................. 5 Disease-Specific Information ........................................................................................ 6 Basic Care ........................................................................................................................ 8 Medication Management ............................................................................................... 9 Legal Documents .......................................................................................................... 1 0 Caregiver Stress ............................................................................................................ 1 0 Balancing Work and Caregiving ................................................................................ 1 3 Options for Senior Living ......................................................................................................... 1 3 Aging in Your Own Home .......................................................................................... 1 3 Bringing Aging Services into the Home ................................................................... 1 6 Adult Day Services ....................................................................................................... 1 8 Assisted Living: The Rental vs. Condo Models ....................................................... 1 9 Nursing Homes vs. Assisted Living and Other Housing/Care Options.................... 2 0 Options for Long-Term Care Financing ................................................................................ 2 1 Other Ways of Paying for Long-Term Care ............................................................. 2 2 PART TWO — PLANNING FOR YOUR OWN LONG-TERM CARE General Health and Financial Topics .................................................................................... 2 3 Medicare vs. Social Security Eligibility..................................................................... 2 3 Disability Insurance vs. Life Insurance .................................................................... 2 4 Life Insurance: Term vs. Investment-based Insurance .......................................... 2 4 Basic Financial Planning for Later Life ................................................................................ 2 5 Financial Planning Stages to Know and Understand ............................................ 2 5 Defined Benefit vs. Defined Contribution Pensions ............................................... 2 6 Pension Rights of Spouses and Surviving Spouses ............................................. 2 7 Retirement, Early Retirement, and Health Insurance ............................................. 2 7 Saving and Investing for Retirement ....................................................................... 2 8 Long-Term Care Insurance: The Basics .................................................................... 2 9 Harvesting Your Retirement Investments ................................................................. 3 1 Choosing and Using Professional Financial Advisors.......................................................... 3 2 Part One — Caregiving for Your Older Relative Introduction The United States is undergoing what generation." Whether or not you are many experts refer to as a longevity truly sandwiched between taking care revolution. Not only are people living of both young children and aging longer now than in the year 1900, we parents, or are only providing care for are living longer in old age. For an older person, you still have the joint example, in 1940 there was about a 7% responsibility for the elders — and for chance that a 65-year-old would live to yourself. Over the past few years, the age 90. By the year 2000, the estimate National Alliance for Caregiving (the could more than triple to 26%1. “Alliance”) has conducted several national studies of caregivers and But living longer does not always mean caregiving. One of the major findings living healthier. One of the is that caregivers desire information, increasingly important — but less education, and resources on the recognized — consequences of the financial and health aspects of longevity revolution is the change in caregiving. Equally important, the need for long-term care. Many caregivers need and want information people reading and using this guide are to help them plan for their own future family caregivers. Others anticipate needs in the areas of finance and long- becoming caregivers of an older relative term care. in the near future. Almost 80% of all the care provided to older people is The aim of this resource guide for care- “informal," that is, provided by family givers is to introduce you to a broad members or other unpaid volunteer array of subjects that can be helpful to caregivers in the home rather than by you as a caregiver. In caregiving professionals or institutions2. preparation for this guide, the Alliance Benefit programs for those over 65, conducted a Baby Boomer women such as Medicare, provide very little caregivers' survey and then held a financial assistance for long-term care, series of focus groups with members of especially in the home. This is part of the General Federation of Women's the reason why family caregivers step Clubs, the Business and Professional in when needed, often providing Women/USA, and the Employee multiple care services for a much longer Assistance Professionals Association — period than they anticipated. its partner organizations for this project. In response to the There's another important aspect of survey and the focus group requests, we caregiving: While you are providing developed the guide in two parts. The care for others, you should also be first part of the guide covers areas preparing for your own future health, which can help you as caregiver of financial, and long-term care needs. others, while Part Two concentrates on We've all heard of the “sandwich helping you in planning for your own -3- future needs. In this guide, we provide concerns their medical history, you with a basic introduction to each immediate medical problems, subject, show its connection to other prescriptions and over-the-counter topics and to caregiving tasks, and medications, and probable course of identify key resources where you can chronic illnesses. turn for further study and information. Caregiving and planning for your own The best place to start gathering needs are difficult tasks. This guide can information is with the care recipient's be a valuable tool to assist you in both health care professionals — doctors, areas. specialists, nurses, and pharmacists — who are currently providing health care Caregiving's Challenge services. Very often, they have gathered a full medical history as part of their Health Issues treatment of your loved one and can fill Caregiving for an older relative, spouse, in any information gaps you may have, or other loved one usually starts for a and vice versa. Once you obtain the health-related reason, whether from a basic information (e.g., name, address, crisis or the worsening of a chronic phone number), it's advisable to condition. Some of the most common organize this information in one place health problems for people over 65 that is easily accessible to you and include arthritis, high blood pressure, other caregivers. If you're not familiar heart disease, hearing impairments, with these health providers, they are cataracts, and mobility problems. Any often identified on insurance invoices, one of these health conditions can Medicare bills, and other documents. create difficulty for an older person performing everyday activities such as Once you have identified the health walking, bathing, eating, dressing and providers treating your relative, other normal daily tasks which define contact them and let them know you their ability to live independently. are involved with their patient. When they require assistance with these Important questions to ask include: “Activities of Daily Living" (ADLs), a spouse, relative, or friend usually steps - What are the specific conditions or in to assist by providing care diseases for which they are providing themselves, arranging for care, or both. treatment, including the current status of treatment, and prognosis for Every caregiver wants to be able to recovery or improvement? How long provide as much care as possible, and has the treatment been provided,