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Living Arrangements and End-of-Life Care

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Choosing the Best Place for Care
"Home is where the heart is." "There is no place like home." It is obvious that home holds a special place in each of our lives. It is often a source of comfort and safety for us. It holds many of life’s memories. However, as the person for whom you are caring becomes more impaired, you may need to consider changing things about your home or where you live. This site is meant to provide information about some of the choices available. We hope it will help you to make a decision about the best place for both of you to live. Remember that these choices are individual and need to be flexible. A list of possible locations and services is listed below with links to provide more information. Information about charges is included but it is recommended that you check with your individual insurance plan for what services they will cover.

Living at Home

Senior Centers
These are community-based centers that focus on providing socialization and leisure activities to independent elders who do not require assistance or supervision. Services vary by site but may include meals, transportation, health screening, and recreational activities. These centers are usually funded by cities and counties but a small fee may be charged which is not reimbursed by insurance plans.

Adult Day Health Care Center
These centers provide social, medical and emotional support in a structured and supervised environment by trained professionals for patients who are functionally or cognitively impaired. Services vary by site, but may include counseling, meals, transportation, personal care, physical therapy and exercise. These centers often have a minimum number of days/week that individuals are required to attend and charges are on a daily basis. Some insurance carriers will reimburse for part of the fees when medical care is provided.

For more detailed information:

Care at Home

Often people prefer to remain in their home and have help come in as needed. The level of help you require can vary depending on the needs of the individual. Early on, supervision and socialization may be all that is required. Later, the needs of your family member may include more physical care such as bathing, toileting, and feeding. Individuals can be hired through personal contacts or local agencies can provide trained staff to meet these needs. It is always a good idea to interview someone and speak with references before you hire them. If there are medical needs (ex. wound care or blood monitoring), sometimes a Visiting Nurse Association (VNA) will provide services for a short time. These services may be reimbursed by insurance providers, especially if the individual is determined to be “homebound” or unable to get out for required medical treatments. Arrangements for these services can be made by you, your provider, or staff in a facility if the individual has been hospitalized.

For more detailed information:

Respite

Respite care refers to periods of time where care is provided by an alternate person or facility to allow a break for the caregiver. This can be for specified times each day by in-home or community-based caregivers or for longer periods of time such as a week-end or vacation period. Some long-term care facilities and community organizations offer these services which may be reimbursed by insurance providers.

For more detailed information:

Hospice

Hospice is a philosophy of care for patients who are expected to have less than 6 months left to live. Care is given by a well-trained team of professionals and can be delivered in a variety of settings (at home, nursing home, etc). Services are focused on providing comfort to patients and families and include things such as pain management, nursing care, and counseling. These services are covered by Medicare for patients with end stage dementia and may also be reimbursed by other insurance plans.

For more detailed information:

Residential Care

Retirement Communities

These communities can be primarily for healthy, independent individuals where the focus is on social networks and leisure activities or they can provide multiple levels of care and service from independent homes to nursing home settings. The latter can often accommodate diverse needs for a couple by allowing for one to live independently on the same grounds as someone in a health care facility. Movement between facilities is also permitted according to changing conditions. These communities generally require a significant entry fee as well as monthly fees or additional fees according to services provided. Generally, residential costs are not covered by insurance but costs associated with health care may be reimbursed.

For more detailed information:

Assisted Living

Assisted living facilities are facilities that provide some assistance to residents who remain largely independent but may be somewhat functionally impaired. Assistance varies according to facility but can include help with bathing, toileting, laundry and meal preparation. Skilled nursing or medical care is not provided and the level of independence required by the resident varies by institution. This category also includes Residential Care Facilities and Board and Care Homes. These residential facilities do not qualify for reimbursement by insurance providers.

For more detailed information:

Nursing Home

Nursing homes are residential facilities for those individuals who can no longer live independently due to disease or the need for round-the-clock supervision or skilled nursing care. These facilities provide for all the physical needs of the residents. Cost and types of payment accepted, special programs, and availability of additional services such as physical therapy vary by facility. Some facilities have specific dementia services such as activities or a secured (wander-free) environment.

For more detailed information:

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