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

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

The topic of senior care can be difficult and uncomfortable, for the person initiating the conversation, as well as for the elderly individual who needs (or may need) some form of long-term care. For adult children, the realization that the caregiver role has (or will be) reversed can be challenging, and broaching the topic of senior care is often dreaded. As the majority of seniors prefer to grow old in their homes, 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 supervision and care in an adult day care center, to skilled nursing care in a nursing home. This range of care allows seniors to receive the care they need, 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 turning 65 years old will require senior care at some point in their lives.

Below are some practical tips that can make broaching this topic, as well as having this conversation, easier for everyone involved. That said, it is important to remember that unless the elderly individual is completely unable to care for himself / herself, it is the senior who ultimately makes the care decision for himself / herself.

Broach the Topic Well in Advance of the Need for Care

If at all possible, the topic of elderly care should be discussed well in advance of the actual need for care. This gives the senior time to think about his / her wishes should the need for senior care arise without the decision feeling rushed. It also gives the elderly individual a sense of control over what the future might bring, as well as time to get used to the idea that senior care may be a real possibility. In addition, waiting too long to have this conversation might make it impossible, or nearly impossible, to reasonably discuss it. For instance, a senior with mid-to-late Alzheimer’s disease most likely would not be able to have this conversation due to his / her cognitive decline. However, a senior who has just been diagnosed with early stage dementia should be able to be an active participant in discussing senior care options and making a decision in regards to his / her care needs for the future.

Choose an Appropriate Time and Place for the Discussion

When and where the conversation takes place can play a role in how the conversation unfolds and how it is perceived. 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 a loved one is angry, such as a clenched jaw or fist, or feeling anxious or uncomfortable, such as the jiggling of a leg or inability to maintain eye contact.

While the conversation should always be done in a manner that makes the senior feel heard, understood, and respected, the ability to see any signs of discomfort allows the door to be opened to discuss these feelings, the concerns of the individual, and why he / she is feeling resistant (if he / she is feeling this way). Perhaps he / she is feeling frightened and doesn’t want to admit the need for help or he / she doesn’t like the idea of receiving help from an unknown person. Regardless, it is important for one to do his / her  best to provide reassurance to any concerns and / or fears and listen with empathy.

In addition, the conversation should take place in a location where the senior feels comfortable, such as the privacy of his / her own home. Distractions should also be limited. For instance, one might want to turn off the ringer of his / her cell phone, as well as the television.

Do Your Research

Prior to having a conversation about senior care, it is important to know what care options are available (as well as the pros and cons) in order to have an educated conversation. From in-home care to adult day care to residential care, the options are many. Some of these options prevent and / or delay the need for nursing home care, therefore, allowing seniors to maintain their independence in their home or community for as long as possible. As one example, a senior who requires minimal assistance may be able to continue living in their home with the assistance of a personal care aide a few days per week, home modifications to improve safety and accessibility, and a personal emergency response system. Below are the most common types of senior care.

In-Home Care

In-home care allows the senior to continue to live in their own home while receiving the assistance they require. The major benefit to in-home care is that a senior can continue to age in his / her own home, a place where they are comfortable, instead of having to relocate to an unfamiliar living situation. This type of care can also provide family members peace of mind knowing there is someone looking after their loved one. While non-medical, in-home care is available, so is in-home health care. Below are examples of the types of assistance that are provided via in-home care. Please note that medical assistance is only provided via in-home health care.

• Personal Care Assistance (bathing, grooming, dressing, mobility, transitioning, eating, toiletry)
• Homemaker Services (light housecleaning, meal preparation, laundry)
• Medication Reminders
• Companionship
• Transportation to Medical Appointments / Social Outings 
• Medical Assistance (changing of bandages, administration of medications, 

One major downside to this type of care is that assistance is not available 24-7 (unless the senior has a live-in caregiver).

Adult Day Care / Adult Day Health Care

Adult day care is a particularly good option for seniors who live in the home of a working relative or close friend and requires assistance during the workday. This type of care can also serve as respite care, allowing informal caregivers (often the adult children) a break from their caregiving duties. Stated differently, adult day care often complements the care that is provided by an unpaid caregiver. Very affordable, as far as care options go, this is generally the most cost efficient type of senior care. The following benefits / assistance can be expected from most adult day care centers.

• Daytime Supervision  
• Monitoring of Health 
• Personal Care Assistance (bathing, grooming, dressing, mobility, transitioning from one position to another, eating, toiletry)
• Medication Monitoring 
• Meals / Snacks
• Social / Educational / Recreational Activities 
• Transportation (not provided by all centers) 
• Therapies (physical, occupational, speech) 

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, for seniors who require more extensive care, adult day care might not be an appropriate option.

Assisted Living

For seniors who require regular supervision and some care assistance, but not the level of care that is provided in nursing home facilities, assisted living can be a wonderful way to allow them to continue to live in the community. Residents live in a home-like setting and are still able to maintain a fair amount of independence, with the option of having a private (or shared) apartment or room within the residence. Some areas, such as dining rooms and recreational areas are shared, which allow a wonderful way to meet other residents and to socialize. One of the major benefits of assisted living is that many assisted living residences offer “pay-as-you-go” care, which means the amount one pays is based on their level of care need. Therefore, those who need minimal care do not pay as much as those who require a higher level of care. The following benefits can be expected in most assisted living residences.

• Room and Board
• Monitoring of Medications
• Assistance with Daily Living Activities (bathing, grooming, dressing, mobility, transitioning, eating, using the toilet / cleaning up)
• Transportation
• Housecleaning / Laundry 
• Medical Care (limited) 
• Around the Clock Supervision / Care
• Social Activities 

One downside to assisted living facilities is that extensive medical care is not available and those who have greater 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 called memory care units or special care units, are frequently in wings of assisted living residences or nursing home facilities, though they sometimes are standalone facilities. A major advantage of this type of care for persons with dementia, particularly when the disease has progressed to mid-late stage, is that the staff is trained specifically in dementia care. Other benefits include security to prevent wandering and a higher staff to resident ratio than generally found in assisted living or nursing home care, ensuring each resident has more individual attention and care. Below are some examples of what benefits are found in Alzheimer’s care units.

• Room / Board 
• Housecleaning / Laundry
• 24-hour Supervision / Care / Security
• Assistance with Activities of Daily Living (bathing, personal hygiene, dressing, mobility, transitioning, eating, toiletry)
• Activities (Music, art, etc. intended to stimulate cognitive functioning)

This type of care is even more expensive than is assisted living, approximately 25% more costly in fact.

Nursing Home Care

Out of all the 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 so great, this is often the best option. In addition, some nursing homes are well equipped to handle seniors with dementia. Follows is some of the benefits of nursing home care.

• Room and Board
• Monitoring / Administration of Medication
• Activities (Social / Recreational) 
• Emergency Care / Supervision (24-hours / day) 
• Personal Care Assistance (bathing, grooming, dressing, mobility, transitioning, eating, toilet assistance)
• Physical / Occupational / Speech Therapy

Unfortunately, while often a type of care that is required, it can be very expensive. In addition, it may difficult for some seniors to adjust to this type of group living and the somewhat strict schedule that comes with it.

Discuss the Financial Means to Pay for Care

Senior care can be very expensive. This is especially true when the need for care is long-term and not just temporary to recover from an illness or injury. Fortunately, for person who do not have the means to pay out of pocket (privately pay) for care, there are several options to help cover the cost. However, it’s important to note that several of the options below consider one’s income and assets. For those 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

This option isn’t generally available to those who are in immediate need of long term care, as most insurance companies will not enroll a senior in this position. For persons who do not require care right away, it still may not be an option, as the monthly premiums are quite pricey. However, for those who do have this type of insurance (or can afford it), it can prove very beneficial, 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

A state and federal health care program for low-income persons of all ages, Medicaid, which is available in all 50 states, offers assistance with long-term care for seniors who have limited income and assets. The programs vary based on the state in which one 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 one lives, there may be non-profit programs, state programs, county programs, and even national programs that are available to provide financial assistance for needed long term care.

Veterans Affairs (VA) Programs

The VA offers a Veteran-Directed Home and Community Based Services Program (VD-HCBS) that allows veterans who require a nursing home level of care to receive care in their own homes, the homes of a relative, or in independent living communities.

There is also the Aid & Attendance Pension and the Housebound Pension, both of which provide a monetary benefit above and beyond the basic pension. This extra monthly benefit can help veterans and surviving spouses remain living in their homes by receiving the care they need there, cover the cost of adult day care, or allow them to live in assisted living residences or skilled nursing facilities. Learn more here.