What is Assisted Living?
Assisted Living is a service that provides seniors assistance with their care needs that are related to daily activities of living; such as bathing dressing, grooming, ambulation, transportation, meals, medication management and housekeeping. This is provided in addition to their housing and utilities.

What’s the difference between Board and Care, Assisted Living, and Residential Care?
These three terms are used to describe Assisted-living. All three can provide the same level of care. They are interchangeable terms used for describing Assisted-living. In this industry the term “Board and Care” is usually used to differentiate a small 6 bed care home from the larger facilities that may call themselves:

  • Residential care communities
  • Residential care facilities
  • Senior care living
  • Assisted living facilities
  • Assisted living communities

The larger places usually (50 to 100 beds) consist of more apartment style living. Some give you options of sharing an apartment or room or if you can choose a private room like a small studio apartment.

The smaller 6 bed care homes are just that, a Private single family home in a residential neighborhood. They provide more home-style living with a roommate situation. You can have a shared room or private room in a small 6 bed care home.

Whether you choose a large facility or small-6 Bed care homes, they all offer the same amenities and the same services as far as assistance with bathing, dressing, grooming, meals, transportation and medication management.

The smaller 6 bed care homes are better for people who cannot ambulate or walk very far without assistance; because of the home style setting the furthest your senior will need to manage to walk is from their bedroom to the dining room. Which in a small home style setting, most can manage the small area vs. a large facility that may have long hallways, elevators and double doors to navigate just to get to the dining room.

The biggest benefit I see in a smaller setting type of care, is that they get home feeling and have a much better attention from their caregivers. With a few other roommates, it can give your senior better independence and a home feel.

The advantages of a larger facility is they usually have more activity programs for seniors. They tend to have an Activity Director that can fill the week of lots of entertaining activities to create a community with the other seniors. Socialize with others, and this is a health benefit to be able to feel that you belong to a larger group.

Making big decisions regarding which home care works best for your aging family member, we offer a free evaluation and consultation to which fits your budget and the overall goal that you may have. This cuts down on having to research which facilities are available or have vacancies, finding the right budget for the long term can be daunting.

Do assisted living communities have to be licensed?
No matter whether a place is called a board and care, and assisted living or residential care they are all governed by the Department of Social Services and the same state licensing regulatory provisions under Title 22.

Does Medicare or Medi-Cal pay for Board and Care, Residential Care Facilities for the Elderly (RCFE), Assisted Living Facilities or Communities?
No. Because these are not medical facilities, neither Medicare nor Medi–Cal pays directly for the residential care/assisted living. There is an Assisted Living Waiver Pilot Project — to use Medi–Cal to pay for residents with low incomes but there is usually a waiting list and currently they only take high functioning residents. (L.A., Sacramento, San Joaquin) — the Assisted Living Waiver Pilot Project — (ALWPP).

How does an Assisted-living, RCFE or Board and Care Home differ from a Skilled Nursing home (SNF)?
Skilled nursing facilities require an extensive licensed medical nurse and doctor to care for your senior, which is the main difference and it correlates to the person’s diagnosis as well. To get the best possible care, we can help by determining if your diagnosis prohibits you from choosing assisted living instead of a Skilled nursing home.

If someone is bedridden (meaning they are in bed the majority of their waking time of day) they are usually required to be in a skilled nursing home unless they are on hospice. They may be eligible for an Assisted Living/RCFE that has an opening for hospice residents depending on the person’s diagnosis. We can tell you if they are eligible or not after a customized assessment/consult as this is determined on a case by case basis.

What does an assisted living community typically cost?
The average monthly cost is $3,500 but could be as high as $5,000 to$6,000 depending on accommodations (e.g., private or shared room), geographic area, level of care needed, special care services for dementia and hospice. We are able to Find more affordable assisted-living if someone is higher functioning and only needs assistance with minimal daily activities of living (.i.e. bathing, dressing and grooming) Some places have extra fees for medication, Pre-admission, and community fees. Some of these other fees are negotiable and we can help with that as well.

Who is best suited for an assisted-living community?
Seniors who are looking for activities and companionship in addition to assistance with their care needs of daily living i.e. bathing, dressing, grooming, ambulation. Seniors who are outgoing and enjoy socializing with their peers and others will like assisted living communities.

I don’t think it is safe for my loved one to drive. What should I do?
Are you concerned about your loved one’s capacity to be driving? Are you wondering if they are safe on the road for themselves and others or a danger to themselves and others?

The best way to handle this is to speak to their doctor’s office. Their doctor can assist you in testing them to see if they should be driving or not. You can put in a simple request to their doctor’s office. That way the doctor is a mandated reporter and responsible to submit a notice to DMV if your loved one failed the test and should not be on the road driving.

This keeps you from being put in the middle of the issue and takes it out of your hands and can give you peace of mind.

What kinds of services do in-home service agencies offer?
There are two types of in-home service agencies:

One provides medical care services, while the other provides non medical Homecare services.

Contact us and we can help you to determine whether your loved one needs medical or non-medical services.

My loved one has dementia. Can he receive care in an Assisted Living/ RCFE/Board and Care?
Yes. Some Assisted Living/RCFE & Board and Cares specialize in dementia care. These Assisted Living/ RCFE/ Board and Cares need to meet certain requirements including training for staff and administrators. Ask about their philosophy of dementia care, and the qualifications of staff and their training program.

Of course, having direct contact and close experiences with these types of facilities, we can recommend the best experienced dementia care facilities to you as well.

I promised my mom/dad I wouldn’t put them in a nursing hospital, but can I really take care of them at home?
Not everyone is suited or able to be a caregiver and everyone has their limits as a caregiver. It’s important to respect yours. You are responsible for providing a safe, healthy living environment–wherever that may be: your home, their home, an assisted living home or nursing home. It’s impossible to do it all so look to their community, family, friends, health care professionals and volunteers to fill in the voids.

How much will this cost?
A large misconception exists that the government, through Medicare and/or Medicaid, will pay for care of an aging relative. Medicare, the federal insurance program typically for person’s 65 and over, has very limited benefits to cover long-term care needs, either in a home or in a nursing home. Medicaid, a state-funded program typically for low- income persons, pays for the costs of in-home and nursing home care–as long as an aging relative’s income is low enough to qualify for benefits. (If you have a concern about your parents–one parent is the family caregiver, the other, the caregiver–then contact your local Area Agency on Aging to learn about your state’s Spousal Impoverishment Program. Assets can be protected in order to provide for the caregiving spouse.)

The majority of costs associated with a chronic illness or disability are assumed by the family and/or the caregiver and/or private insurance (including long-term care insurance). According to our latest annual family caregiver survey, about 50% of respondents spent as much as $500 per month on services (home health, medications, supplies). The majority of costs associated with a chronic illness or disability are assumed by the family and/or the caregiver and/or private insurance (including long-term care insurance). According to Valuing the Invaluable: The Economic Value of Family Caregiving, 2008 Update from AARP, the average family caregiver for someone 50 years or older spent $5,531 per year on out-of-pocket caregiving expenses in 2007.

Home health aides can be hired through a home health agency or privately, by the family. According to the U.S. Labor Department, home health aides, on average based on the state you live in.

Many families prefer to hire a home health aide privately as a way to save costs. If you opt for this, check with your (or your caregiver’s) homeowners’s insurance agent to ensure adequate coverage of an in-home employee and with the IRS about tax implications. Also, consider hiring an agency that provides background checks. In addition, be sure you have a back-up plan in case the aide becomes ill, quits or just doesn’t work out. 

Adult day services may cost from $60 per day and higher; sometimes transportation is included in the cost. Meals on Wheels are available on a sliding fee scale, depending on caregiver’s income level. Each community (local or state level) offers myriad services, usually available on sliding fee scales. The average cost of semi-private room in a nursing home is $222 but much depends on geographic location and care needs. Average length of stay in a nursing home is 2 and 1/2 years. However, many older adults use nursing homes for temporary stays, to recover from a hospitalization (Medicare provides coverage for a short-term rehab stay) or for placement so the family can take a break.

Room and board in an assisted living facility (an aging relative lives in an apartment-like setting but can still receive assistance with personal care) may cost from approximately $48,000 annually and upward depending what state you live in. Residents often incur additional costs depending on their level of care.

In addition to the cost of room and board in nursing homes and assisted living facilities, caregivers also assume the costs of medications, supplies and personal care items.

A financial planner can help you explore ways to finance care. You’ll also want to get a durable power of attorney for health care and finances for your caregiver; an elderlaw attorney can help execute this important document. 

How long can I expect to do this?
In our most recent survey, family caregivers told us that they expect to be a caregiver for at least five years, with many believing the experience will last 10 years.

Because this is a long-term commitment, planning for the future is key. Take into account your caregiver’s financial resources, your emotional resources and the community’s resources. All these connect to make caregiving doable.

Who can I contact for help?
The ElderCare Locator can refer you to the Area Agency on Aging in your area (or your caregiver’s area): 800-677-1116. In addition, you can contact your house of worship, the local United Way (an organization that funds programs that may help you), your state’s department on aging, Easter Seals, National Family Caregivers Association (1-800-896- 3650) and Children of Aging Parents (1-800-227-7294). Sometimes, your township (or your caregiver’s) will offer services that can help, including telephone check-in, emergency response or transportation. You also can visit BenefitsCheckup to learn about programs and services that can help.

How do I know when my family member can no longer live safely at home?
I’m asked this question regularly: How do I know when it’s time to make a change? I urge family caregivers to put systems into place which help to avoid a crisis. Personal emergency response systems, adult day services, home health aides, telephone check-in services, Meals on Wheels, volunteer programs all help keep your caregiver safe.

In addition, AARP has checklists available to help you make changes in your caregiver’s living environment (eliminating throw rugs, improving lighting, modifying the bathroom with grab bars and bathchairs) :http://www.aarp.org/universalhome/home.html

Often, a caregiver will resist changes. Usually what’s behind the resistance is fear. Respect and recognize that these changes will be difficult for your caregiver. Start slowly, involve your caregiver, when appropriate, in any discussions and decisions, ask for your caregiver’s commitment to try any services for a month. Allow your caregiver to vent, without judgments or recriminations. Reassure your caregiver that these services will keep him or her at home, safely–that you want to work together to achieve this goal.

If your caregiver is not cognitively impaired and still refuses, then back off, at least for the time being. However, don’t give up. Contact local organizations (such as home health agencies, Meals on Wheels, assisted living facilities, rehab centers) for information about their services, costs and availability. In case a crisis occurs, you’ll have the information you need about community services in order to make good decisions about your caregiver’s future.

If your caregiver is cognitively impaired and you worry about his or her safety, then contact ElderCare Locator at 800- 677-1116 for a referral to your local Area Agency on Aging for help.

I don’t like the aide (or volunteer or nurse or companion) that the agency sends. Am I stuck?
Nope! Call the agency and speak with the social worker or supervisor. Explain your concerns and ask for suggestions. If you believe the situation cannot be resolved with the current aide, ask for a different aide. Personality conflicts are not uncommon and the supervisor will work with you to find an aide that best meets your needs–and your caregiver’s.

What is respite care?
Respite care refers to services used by a family caregiver in order to take a break. Respite care may be offered through a local organization (Lutheran Social Services, based in suburban Chicago, has a volunteer program structured to give the family caregiver a break) or through a state-funded program (New Jersey and Pennsylvania have respite care programs). Or, respite care could refer to a short-term placement in a nursing home for the caregiver while the family caregiver takes a much-needed vacation.

Use respite care regularly, so that when you really need respite care (to take a much needed two-week vacation) you’ll be confident in the providers and staff who will care for your caregiver. You’ll relax and enjoy your time away when you can trust those caring for your caregiver.

This is so depressing! I didn’t realize I would feel this way. What can I do?
Often, family caregivers overlook an important part of their experience: the grief they feel at the losses suffered by the caregiver, by the family and by themselves. It is depressing, which is why taking regular breaks is important. It’s also critical to maintain some hobbies and interests you enjoy. Rejuvenating yourself on a regular basis will help you manage the experience. Finding support will help you unburden yourself, which will lighten your load. You can join an online support group and/or a group in your community. A problem shared is a problem halved!

You can also contact your Area Agency on Aging or your house of worship for lists of groups in your area. Or, call Children of Aging Parents, which sponsors a network of groups, at 800-227-7294.

How can I get help from other family members?
Often, family caregivers feel abandoned by family members, usually siblings, the very people they expected to help. So, how do you get your five brothers and sisters to help out? Recognize that people are caregivers in different ways. Your brother the CPA breaks out into a rash at the idea of visiting your mother in the nursing home. Suggest that he call her every Sunday afternoon, or write letters. Or, ask him to manage her financial affairs. Your sister is conveniently busy every time you ask her to spell you so you can take a break. Suggest that your sister help offset the costs of the companion sitter or home health aide you hire. Should you force them to help? No. Be specific in your requests, but never demand that help be given. If your siblings refuse your requests for help, accept it. But, don’t accept the idea that you are alone. Look to the community for help and for support.

You may find that the caregiving experience changes you and your relationships–another good reason to find support and camaraderie among those who will understand.

Who can I count on for help?
Family caregivers often find that the health care system, the family system, the social service system AND the caregiver present huge obstacles in finding, keeping, providing and affording quality care. Recognize that caregiving may not be easy and that perfect solutions do not exist. Compromises do, though. Work within the system’s limitations. Continue to ask for help. Keep an open mind about which services and organizations may be helpful. Listen to your caregiver’s suggestions. And, accept help in whatever form it arrives.

What are my obligations?
You are obligated to provide a safe and healthy living environment for your caregiver. And, you are obligated to protect your caregiver from abuse–physical, emotional or financial.

A durable power of attorney for health care, in addition to a living will, is a powerful legal and health care document. If you do not have this document for an aging relative, consult an elder law attorney as soon as possible. A durable power of attorney for health care allows a responsible party to make financial and health care decisions on behalf of a family member or friend if that family member or friend is no longer able to make such decisions.

My caregiver won’t cooperate!
Sometimes, uncooperative caregivers are just asserting themselves in order to gain some control in an uncontrollable situation. Listening to the gripes and complaints may improve your caregiver’s disposition. And, if you listen to their gripes, you may learn some new approaches and solutions. For instance, your caregiver gripes that her noon-time meal, delivered by Meals on Wheels, arrives cold every day. You may not want to hear this complaint; knowing that a Meals on Wheels volunteer delivers a noon-time meal to your caregiver lessens your guilt while you’re at work. Thinking that your caregiver receives a cold meal just increases the guilt you feel! So, rather than acknowledging that your caregiver may have a justified complaint, you choose to downplay it: “Oh, Mom, you expect too much”. Or, “Mom, it only costs $2.50. What do you expect?” Instead, try listening and accepting the gripe, then calling the agency to pass along the complaint. The agency probably can make some simple changes (perhaps a new volunteer forgets to include hot packs in the coolers that store the meals) that will greatly improve the experience your caregiver has with Meals on Wheels. What a benefit for both of you!

And, sometimes an uncooperative caregiver is simply displaying symptoms of his or disease, such as a dementia. In these cases, keep in mind that the disease, not the person, is causing problems. Learn about the disease and how to cope with the behaviors associated with it by contacting the local chapter of the Alzheimer’s Association.

How do I do this (caregiving) and take care of myself?
We often “guilt” family caregivers into self-care with this simple question: If you don’t take care of yourself, who will take care of your caregiver?

The only way you’ll effectively manage this experience is if you take time for yourself, daily, weekly, monthly and yearly. When you take regular breaks, you can cope with the stresses, the decisions and the responsibilities. Otherwise, the situation can become unbearable–for you, for your caregiver, for your family. Our weekly care plans, just for you and available every Thursday, can help you determine what you want and need each week.

I’m upset with the nursing home. What can I do?
Always begin by addressing your concerns with the charge nurse, the Director of Nursing and the Administrator at the facility. Explain your frustrations; ask what they can do to improve the situation. Ask for a timeline: When can you expect to notice changes? Tomorrow? In 36 hours? Next week? Follow up with these three persons regularly.

If you do not feel the staff adequately addresses your concerns, then contact the nursing home ombudsman in your area. (Your state’s department on aging can direct you to the proper department and phone number.) The ombudsman will represent your caregiver
in ensuring the nursing home provides quality care.

In addition, attend the care conference meetings offered quarterly at the nursing home. Family members are encouraged to attend–and this meeting is a great place to communicate concerns with the interdisciplinary team: the charge nurse, the social worker, the activities director. Finally, be an active voice and a familiar face to the staff. Become an informed advocate on behalf of your caregiver. Ask questions, share concerns and, whenever possible, offer accolades. The staff will view you as a pleasant and welcome addition to the facility.

I feel so guilty–about everything.
Your caregiver will make you feel guilty. Which makes it only worse, as you already carry around enough guilt. How do you keep it at bay?

Keep your perspective. Consider, whose problem is this? Does your caregiver
expect you to make him or her happy? That’s not your job. Does your spouse badger you about the time you spend with your caregiver? Try to work out a compromise, so that you have a workable schedule for your spouse, your caregiver and yourself. And, remember, you can only control yourself, your reactions, your words and your feelings. The rest is up to everyone else. Asking for, and receiving, help also can help minimize your guilt. The wider you cast your net, the more help you receive, the better your caregiving experience will be for you and your caregiver. You can listen to podcasts and read tips about managing guilt here.

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