There Are Options Before a Nursing Home

Aging isn’t for the faint of heart. Over time, our bodies get more fragile, our eyesight fades, and it’s harder to do things that once came easily. It can be especially challenging to watch this happen to a parent or beloved relative or friend. If you’re wondering how you can help them balance their need for independence with caring for their growing needs, you’re not alone. There’s a spectrum of options you can consider.

Before Looking for a Nursing Home

Before you start the process of evaluating nursing homes, you and your loved one may want to consider these options:

Aging in Place

Lots of older adults want to remain in their own homes, living as independently as possible. And aging in place can be a perfectly good option for many, as long as you carefully consider and address the right concerns to make it safe.

Start by talking with the person’s health care providers to discuss any health care needs that should be addressed—and if your loved one will need any help. You might also want to discuss a timeline. For example, at what point should everyone revisit the issue and make sure that aging in place is still the right choice?

You can also hire an aging-in-place specialist or consultant to meet with you and assess the living space and make recommendations. Resources include the National Aging in Place Council, Aging In Place Directory and National Association of Home Builders Certified Aging-in-Place Specialist Program (for any remodeling of the home).

Hiring In-home Help

Hiring help to assist can go a long way toward allowing older adults to remain as independent as possible in their own homes without sacrificing safety or other important concerns, although options are out of financial reach for some people. Possibilities include:

• A housecleaner. A housecleaner or housekeeper can keep the home clean, removing that chore from your loved one’s to-do list while also keeping an eye on them. Neighborhood listservs, and even senior centers, can be good resources for recommendations on trusted, reliable cleaners.
• A personal care aide. A personal care aide can come into your family member’s home and assist with normal daily activities, such as bathing and grooming. Depending on the arrangement, they might also be able to help with transportation for errands, doctor’s visits and other appointments. They can notify you if they notice any signs of cognitive or physical decline. However, this can be pricey, and Medicare will not pay for custodial or personal care if that’s all that’s needed.
• A home health care aide. Medicare will pay for home health care as long as your loved one meets the requirements. The services vary depending on their needs. For example, some people may qualify for physical therapy or occupational therapy in the home. It’s also important to understand that in-home care will be part-time care, as Medicare does not pay for 24-hour in-home care.

Accessory Dwelling Units

Picture a self-contained independent residence near a larger stand-alone home (or attached to it), and you’ve got an accessory dwelling unit, or ADU. Sometimes called carriage houses, mother-in-law suites or “granny flats,” these offer a loved one a chance to live independently—but very close so they won’t be completely alone. Before you embark upon this option, however, know your local zoning laws and regulations to find out what’s allowed in your city or county.

Age-restricted Communities

The Housing for Older Persons Act of 1995 allowed an exemption in federal housing laws for the creation of living communities just for older adults. Often known as “active adult communities” or “55+ communities,” age-restricted communities can offer a nice transition from living in your home in your original neighborhood to a community of other people at the same stage of life and with similar needs. These communities often offer amenities, such as fitness centers and classes, and reduce burdens like lawn care and home maintenance.

Assisted Living

Assisted living communities could be considered a step up from an age-restricted community. Residents don’t require round-the-clock care, but it can be helpful to have assistance on-site when it’s needed. Assisted living also provides opportunities for socialization, which can help ward off isolation and loneliness, which can pose major health risks such as an increased risk of depression.

Research suggests you’ll have more success if you carefully consider things such as cost, proximity to family and friends, amenities and activities available to residents before choosing an assisted living community.

According to the National Institute on Aging, Medicare does not pay for assisted living. However, if your loved one is eligible for Medicaid, Medicaid might provide some coverage for the cost.

When It’s Time for a Nursing Home

At some point, a nursing home may truly be the best option for a loved one. For example, the individual may have some physical safety or mobility problems, or they may have progressive dementia or some other type of cognitive impairment that requires them to have closer supervision.

According to the nonprofit Health in Aging, there are four main needs that tend to drive the move to a nursing home:

1. Short-term skilled nursing care
2. Long-term physical needs that can’t be met in the home
3. Around-the-clock supervision, which is often necessary for people with dementia or other cognitive problems
4. Memory care for people with mental health deficits that prevent them from being able to care for themselves or handle other tasks

You can compare facilities in your area using a tool on the Medicare website. However, Medicare does not pay for nursing home care as a general rule (except for short-term stays in a skilled nursing facility).

What Do All these Medicare Terms Mean?

What’s the difference between Medicare and Medicaid?
Medicare is health insurance provided through the federal government for adults age 65 and older. Medicaid is coverage for health care costs for people with limited incomes, through a collaboration between the federal government and state governments. Medicaid varies from state to state. Medicaid expansion is optional for states; states that have expanded Medicaid allow more people to be eligible by raising the income limit (meaning you can earn more money and still be eligible).

What is Medicare Part A? Also known as original Medicare, Medicare Part A is hospital/inpatient care insurance. It may cover some short-term care at a skilled nursing facility, and it also covers some part-time or intermittent home health services if you are homebound and meet certain requirements.

What is Medicare Part B? Medicare Part B is essentially medical insurance that pays for medically necessary services, preventive care and care not covered by original Medicare. It’s optional, and you pay a monthly premium for it.

What is Medicare Advantage? You can opt for Medicare Advantage instead of original Medicare and Medicare Part B. You can choose among various plans offered by Medicare-approved private companies. The National Council on Aging shares an article weighing the pros and cons of Medicare Advantage.

Can you have both Medicare and Medicaid? Yes, it’s called “dual eligibility.” Medicaid does cover some expenses that Medicare doesn’t cover, such as nursing home care and personal care services. Medicaid will help pay for your Medicare Part B and possibly some medications and treatments that aren’t covered by Medicare. However, the eligibility depends largely on your income, and the requirements to qualify for Medicaid vary from state to state.

Is long-term health insurance necessary? According to the National Council on Aging, long-term care insurance can help you pay for long-term care, such as nursing home care, that is not covered by Medicare. If you exhaust your benefits, you may then qualify for Medicaid, which can help. The pricing for this type of insurance can vary, but it’s usually less expensive if you buy it when you’re younger.