Paging Dr. Frischer: Elder Care

It is apparent that Mom or Dad needs help, and should no longer be living at home alone. What are the options?

It’s far easier when money is no object, but it almost always is. It is also an easier conversation if your relationship with your parent (and any siblings) is a positive and loving one. Whatever the circumstances, decisions need to be made. Options for care run the spectrum. At one end, your parent may need only minimal assistance with certain daily tasks in order to live safely and comfortably in their own home. At the other end, a senior with chronic medical conditions may require the constant care provided by a nursing home, now more correctly referred to as a skilled nursing facility (SNF).

CARE AT HOME: It is almost always preferable for a parent to remain in his or her own home; a familiar, comfortable environment. They will likely be closer to their long-time doctor, dentist, friends, activities, etc. On the other hand, a move may put them closer to family, who might be better equipped to help provide care.

If they are staying in their home, how much help do they need, and how much can they afford? The cost of an in-home caregiver varies, but ballpark figures may be $20 per hour, or between $160 to $210 per day for 24/7 live-in care. One less expensive option might be to move a grandchild or other family member into their home; possibly a win-win situation.

Responsibilities can include meal preparation and diet monitoring, light housekeeping, errands and shopping, help with dressing and hygiene, exercise, and companionship. Arrangements may be live-in or live-out, part-time or full-time, and temporary or long term. Be extremely careful about who will be spending time in a loved one’s home.  Check background and references thoroughly, and familiarize yourself with local labor laws and regulations.

 Help can also come from a home health agency. These practitioners visit the home and focus on specific health issues. Home health is ordered by the doctor, and may include sending nurses, physical therapists, occupational therapists, speech therapists, lab technicians for blood drawing, nurses for intravenous infusions of medications, and a host of other services. Home health is covered by most insurance plans.

Palliative care is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms and stress of a serious illness such as cancer, cardiac disease, lung disease, Parkinson’s, etc. It can be provided along with curative treatment. Palliative care is often a step taken before hospice care, but can also be a temporary measure, while recovering. This, too, is ordered by the physician, and is covered by most insurance.

Finally, additional help can be brought into the home through hospice services. Hospice is end-of-life care, meaning for those with approximately six months or less to live. Of course, this involves an educated guess by the doctor, and hospice care can be cancelled or extended. Hospice doctors and nurses visit and evaluate the patient on a regular schedule, depending on the health condition. The benefits of hospice are many. It provides medical equipment (such as beds, walkers, wheelchairs, and commodes). It covers most medications. Services include religious counseling, social service support for family and patients, and nursing care.  Note that it does require that the patient and family come to terms with a terminal illness that is not likely to get better. Everyone involved must agree that the emphasis is on comfort and dignity, and not painful or useless treatments. In my years of experience, I have found hospice to be a beautiful, natural experience, especially when it is started early enough for everyone to prepare physically, financially, and emotionally. Hospice care can also be conducted outside of the home, in the settings described below.

CARE OUTSIDE THE HOME: Continuing care retirement communities (CCRC) offer multiple levels of assistance, and may include independent living, assisted living, and nursing home care. The continuum of housing, services, and nursing care are commonly all on one site. Costs range dramatically, depending on the facility and services required.

Assisted Living serves seniors who may need assistance with some of the activities of daily living, but do not require intensive health care services. Meals in a central dining room, social activities, housekeeping, and assistance with medications can be provided. Rooms may or may not include kitchens, and can be private or semi-private. Staff is available 24/7. Most assisted living communities provide additional private care options. They are almost always private pay, but some accept certain Medi-Cal programs. Costs may range between $2,500 to $4,500 per month, or more.

A skilled nursing facility provides 24-hour nursing coverage. Skilled nursing homes serve those who require a high level of medical care and assistance, including those recovering from an injury, illness, or surgery who need a short-term stay for rehab. Long-term residents generally receive comprehensive medical services for complex medical problems. Residents are served meals in a central dining area for those who are able, and social activities are offered. Skilled nursing is paid for by Medicare, Medi-Cal, and private pay, and prices range from $4,000 to $8,000 per month.

Personal residential care homes are available for small groups of people, typically up to six in a house. Live-in caregivers can provide care for those with greater needs, including those with dementia.

Respite care, often offered by assisted living communities and nursing homes, provides temporary housing. It can be used to offer a break for caregivers who may be suffering from burn out and need a rest. Residents typically stay from a week to a month. It may be covered by Medi-Cal or be private pay, and costs can range from about $75 to $150 per day.

Caring for our aging parents can demand some of the most difficult decisions that we will ever face. Start well ahead of the first crisis. Have conversations with your loved ones and with their doctor(s), do your homework, and don’t hesitate to ask for assistance.

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.