How to Broach the Topic of Senior Care with My Loved One

The topic of senior care can be uncomfortable and even difficult to broach, both for the person initiating the conversation, as well as for the elderly individual who currently needs - or may need in the future - some form of long-term care. For adult children, the realization that the caregiver role has - or will soon be - reversed can be challenging, and initiating a conversation about senior care is often dreaded. As the majority of seniors prefer to grow older in their own home - also called “aging in place” - they may be resistant to both the conversation and the potential of giving up their independence.

Fortunately, there are many types of senior care, ranging from minimal in-home care, such as personal care assistance and homemaker services, to daytime care and supervision in an adult day care center, to skilled nursing care in a nursing home. This wide range of services allows seniors to receive the type of care most suited to their unique needs, while also maintaining as much independence as possible. Regardless, broaching the subject of senior care can be challenging. However, this is an extremely important conversation to initiate, as the AARP estimates that just over 50% of adults age 65 years and older will require senior care at some point in their lives.

Below are some practical tips that can make bringing up this delicate topic, as well as having a productive conversation, easier for everyone involved. That said, it is important to remember that unless the senior is mentally and/or physically unable to care for him or herself, it is he or she who ultimately makes the decision about senior care. 

Broach the Topic Well in Advance of the Need for Care

If at all possible, the topic of senior care should be discussed well in advance of the actual need for care. This gives the senior time to consider the many options  without the decision feeling rushed should the need for care arise. It also gives the senior a sense of control over what the future might hold. In addition, waiting too long to have this conversation might make it impossible, or nearly impossible, to have a reasonable discussion. For instance, a senior with mid-to-late Alzheimer’s disease would, most likely, not be able to have this conversation due to cognitive decline. However, a senior who has just been diagnosed with early stage dementia should still be able to actively participate in discussing senior care options and make decisions about future care needs. 

Choose an Appropriate Time and Place for the Discussion

When and where the conversation about senior care occurs can play a role in how the conversation unfolds and how the senior perceives both the tone and purpose of the conversation. If feasible, the conversation should be initiated in person, which allows body language to be read and the conversation to be adjusted accordingly. As an example, a conversation over the telephone does not allow one to see physical signs that the senior is angry, such as a clenched jaw or fists, or feeling anxious or uncomfortable, such as the jiggling of a leg or an inability to maintain eye contact.

While the conversation should always be conducted in a manner that makes the senior feel heard, understood, and respected, the ability to witness any signs of discomfort allows the door to be open to discuss the senior’s feelings and concerns and recognize any signs of resistance. Perhaps the senior feels frightened and doesn’t want to admit the need for help or is afraid to receive assistance from a caregiver other than a loved one. Regardless, it is important to provide reassurance to the senior and listen with empathy. 

In addition, the conversation should take place in a location where the senior feels comfortable, such as the privacy of home. Distractions and interruptions should also be limited, such as turning off the television or a cell phone.

To recognize the signs and indications that might mean it’s time to begin considering senior care, click here.
Do Your Research

It is important to know the senior care options that are available - as well as understanding the pros and cons - in order to have an educated conversation. From in-home care to adult day care to residential care in an assisted living facility, the options are varied and many. Some of these options delay or prevent the need for nursing home care, therefore allowing seniors to maintain their independence at home and in their community for as long as possible. For example, a senior who requires minimal assistance may be able to continue living at home with the help of a personal care aide a few days each week, home modifications to improve safety and accessibility, and a personal emergency response system.

Read further to learn about the most common types of senior care.

In-Home Care

In-home care allows a senior to continue living at home while receiving necessary assistance. The primary benefit of in-home care is that the senior can continue to age at home, a place with a sense of comfort and stability, instead of having to relocate to an unfamiliar living situation. This type of care can also provide the senior’s family members with peace of mind knowing a qualified and caring professional is attending to the needs of their loved one. It is important to keep in mind that both non-medical in-home care and in-home health care are available, depending on the senior’s individual care requirements. Below are examples of the assistance provided via in-home care. Please note that medical assistance is only provided via in-home health care.

  • Activities of daily living (bathing, toileting, grooming, dressing, eating, mobility and transferring)
  • Homemaker services (light house cleaning, meal preparation, laundry)
  • Medication reminders
  • Companionship
  • Transportation to medical appointments and social outings 
  • Medical assistance (changing of bandages, administering medication)  

One major disadvantage to in-home care is that assistance is not available 24-7, unless the senior has a live-in caregiver.

Adult Day Care

Adult day care is a particularly good option for a senior who is cared for by a working relative or close friend and requires assistance during the workday when that person is unavailable. This type of care can also serve as respite care, allowing informal caregivers - often the senior’s adult children - a break from their caregiving duties. Stated differently, adult day care often complements the care provided by an unpaid caregiver. Adult day care is very affordable, as far as care options are concerned, and is generally the most cost-efficient type of senior care. The following assistance is available most adult day care centers.

  • Daytime supervision  
  • Physical and mental health monitoring 
  • Activities of daily living (bathing, toileting, grooming, dressing, eating, mobility and transferring)
  • Medication monitoring
  • Meals and snacks
  • Social, educational, and recreational activities
  • Physical, occupational and/or speech therapy 
  • Transportation (not provided by all centers) 

Unfortunately, this type of care is only available during daytime hours. In addition, care is not one-on-one, so depending on the staff-to-resident ratio, adult day care might not be an appropriate option for a senior who requires more extensive care.

Assisted Living

For a senior who requires regular supervision as well as some care assistance, but not yet the level of care assistance provided in nursing home facilities, assisted living can be the ideal option. Residents of assisted living facilities live in a home-like setting and are still able to maintain a fair amount of independence, with the option of choosing a private or shared apartment or room within the facility. Some areas, such as dining rooms and recreational spaces, are shared, which encourages residents to socialize and form friendships.

One of the primary advantages of assisted living is that many of these facilities offer “pay-as-you-go” care, which means the amount one pays is based on the level of required care. Therefore, residents who need minimal care do not pay as much as residents who require a higher level of care. Following are some of the benefits of most assisted living facilities.

  • Room and board
  • Medication monitoring
  • Activities of daily living (bathing, toileting, grooming, dressing, eating, mobility and transferring)
  • Transportation
  • Homemaker services (light house cleaning/laundry)  
  • 24/7 supervision/care
  • Social, educational and recreational activities 
  • Medical care (typically limited)

One disadvantage to an assisted living facility is that extensive medical care is not available, so seniors who have more serious health needs or fairly severe cognitive issues are often not appropriate candidates for this type of care. In addition, the cost of assisted living can be quite expensive.

Alzheimer’s Care

Alzheimer’s care, also often referred to as memory care, is frequently located in designated wings of assisted living or nursing home facilities, though they sometimes operate as stand-alone locations. A major advantage of this type of care for a senior with Alzheimer’s disease or dementia, particularly when the disease has progressed to mid-to-late stage, is that the staff is specifically trained to care for residents with the disease. Other benefits include additional security to prevent residents from wandering and a higher staff-to-resident ratio than generally found in assisted living or nursing home facilities, ensuring each resident has more individualized attention and care to meet unique needs. Below are several examples of the benefits of Alzheimer’s care units.

  • Room and board 
  • Homemaker services (light house cleaning/laundry)
  • 24/7 supervision/care/security
  • Activities of daily living (bathing, toileting, grooming, dressing, eating, mobility and transferring)
  • Social, educational and recreational activities intended to stimulate cognitive functioning

Due to the highly specified level of assistance, this type of care is more expensive than assisted living, typically about 25% more costly.

[attention color="green" id="1"]Senior long term care can be expensive. For assistance finding affordable care in the area in which you or your loved one lives, click here[/attention]
Nursing Home Care

Of all senior care options - with the exception of hospitals -  nursing homes, also called skilled nursing facilities, offer the greatest level of care and the lowest level of privacy and independence. However, when a senior’s level of care becomes unmanageable by loved ones or unsuitable for other living arrangements, this is usually the best option. In addition, some nursing homes are well equipped to care for a senior with Alzheimer’s disease or dementia. Following are several of the benefits of nursing home care.

  • Room and board
  • Medication administration and monitoring
  • 24/7 emergency care/supervision  
  • Activities of daily living (bathing, toileting, grooming, dressing, eating, mobility and transferring)
  • Physical, occupational, and/or speech therapy
  • Social, educational and recreational activities

Unfortunately, while often the type of care that is required, nursing home care can be very expensive. In addition, it is often difficult for some seniors to adjust to this type of group living and the loss of independence that accompanies it, including a somewhat strict schedule.

Discuss the Financial Means to Pay for Care 

As already mentioned, senior care can be very expensive. This is especially true when the need for care is long-term as opposed to temporary care to recover from an acute illness or injury. Fortunately, for persons who do not have the means to pay out-of-pocket - also called self-pay or private-pay - for care, there are several options to help cover the cost. However, it is important to note that the senior’s current income and assets are nearly always taken into consideration first. For seniors and their loved ones who think they may need financial assistance in the future, it’s best to start planning well in advance of the need for care.

Long-Term Care Insurance

Long-term care insurance isn’t generally available to seniors in immediate need of long-term care, as most insurance companies will not enroll a senior in this position. For seniors who do not yet require immediate care, it may still not be a viable option, as the monthly premiums are quite expensive. However, for seniors who do have this type of insurance, it can prove very beneficial in helping to cover the cost of in-home care, adult day care, assisted living, and nursing home care. Learn more about long term care insurance here.

Medicaid

Medicaid is a state and federal health care program for low-income persons of all ages. Available in all 50 states, Medicaid offers assistance with long-term care for seniors who have limited income and assets. The program varies based on the state in which the senior resides, but the following home and community-based services may be available: personal care assistance, home health care, adult day care, respite care, adult foster care, assisted living, and nursing home care. Learn more about Medicaid and long-term care here.

Non-Medicaid Programs

Depending on the state in which a senior lives, there may be non-profit programs, state programs, county programs, and even national programs available to provide financial assistance for necessary long-term care.