Caring for Aging Parents: Home Care Panel Discussion By Don Vinh January 22, 2016
Continuing Care Retirement Community (CCRC)
Continuing Care Retirement Community (CCRC) (1/3) In the last few years, a variety of supportive housing options for elders have evolved. One option is the Continuing Care Retirement Community or the CCRC. CCRCs are different from other types of senior housing because they provide various levels of housing, personal care services, and health care services - all usually in one location. CCRCs offer a supportive environment in which elders can live amongst their peers and receive services that will allow them to "age in place." As their personal and health care needs change, elders can receive increasingly comprehensive care while remaining in the familiar setting of the community. CCRCs typically combine a variety of housing options on one campus, from townhouses or cottages for totally independent living, to apartments for elders who need some personal care assistance, to nursing home accommodations for elders who require more comprehensive care. CCRCs provide or make available, usually for a set monthly fee ranging from $1,000 to $7,000 per month Most CCRCs also require a sizable declining-refundable entrance fee, ranging from $100,000 to more than $500,000.
Continuing Care Retirement Community (CCRC) (2/3) Some combination of the services, activities, and amenities listed below. Nursing and other healthcare services • Meals usually in a community dining facility • Housekeeping and laundry • Scheduled transportation • Emergency assistance • 24 hour security • Personal care assistance, for example bathing, grooming, dressing, and toileting • Recreational and social activities • Building and grounds maintenance • The composition of service packages varies greatly by CCRC. It is important to be clear about which services are included in the monthly fee and which are available at an additional cost. At many CCRCs, the types and amount of services, both available and included in the fee, will depend on the type of accommodations in which the resident lives.
Continuing Care Retirement Community (CCRC) (2/3) In addition, the variety and intensity of health care provided varies greatly by CCRC. Some offer pre-paid insurance as a part of their regular fees; others require residents to purchase insurance on their own. At some CCRCs residents pay the same monthly fee whether they are in an independent living unit or the nursing facility while at others, different rates apply to independent living, assisted living and skilled nursing care. If different rates apply to different types of housing then, monthly fees would increase over time. Other communities offer a partial pre-payment arrangement in which nursing facility care is guaranteed for a specific number of days and beyond that, the resident is responsible for all costs. Still others guarantee only the availability of care and residents pay for care on a fee-for-service basis. Some Local CCRCs: Lexington: Brookhaven Bedford: Carleton-Willard Lasell Village: Newton Concord: Newbury Court Lincoln: The Commons
Home Care Key Principles
Key Principles (1/4) Before you address the “where to live” question, ask questions about *how* the parents want to live, what’s important for them, what’s they are afraid of After you have a good idea of how they want to live, then explore and discuss a wide range of options, pros and cons. Best if you do this when you don’t have to make a decision right away. Some options to consider (ranging from high level of independence High level of care) 55+ retirement communities (e.g., Del Webb, Sun City): You are responsible for everything Private apartment/condo CCRC: villa to apartment to assisted living to skilled nursing home/memory care Live in same home, but with part-time or live-in assistance services (e.g., Visiting Angels) Moving in with children Assisted Living Skilled nursing home/memory care Hospice
Key Principles (2/4) The best living situation is highly personalized, depending on preferences, personality, relationship, cultural, geography, etc. There is no one size fits all. So the best thing to do is to explore these things while your parents still have the clarity of mind. Ask: What kind and level of care parents need? And that means physically and mentally, and what kind of chronic illness that needs to be managed? Usually, when parents move in to live with their children, there are existing health issues. Make sure that you and your spouse and your parents are clear on what the expectations are. Are you supposed to go with your parents every time they visit the doctor? Are they OK with you making health decisions for them? Are you responsible for making sure they take their medication every day? Often parents want to maintain control over their health, and children (especially those they live with) have good intention of making sure they take care of themselves, but this could cause tension.
Key Principles (3/4) Lifestyle issues. Ask: What a good day looks like? What a bad day looks like? Understand routines, habits and lifestyle preferences. Understand what bother them. If your parents like to go to bed early and are light sleepers, having your teenager practicing with her garage band four nights a week is going to be a big problem. Prior to elderly parents moving in with their children, discuss next phases after move in. What criteria would trigger parents moving out, and where to? This could be a difficult conversation to have, especially due to cultural factors, e.g., Asian culture expects daughter or daughter-in-law taking care of elderly paretns. Again, the situation is different for each family, so it is hard to generalize what’s the best thing to do. But it’s important to have this type of conversation before the parents moving in and write it down because it’s easy to forget. Set clear expectations beforehand.
Key Principles (4/4) Make sure that you discuss relationship issues, especially with your children and your spouse, before you, as a family, decide to accept your parents moving in. One rule of thumb is: whatever issue you have with your parents throughout your life, it won’t go away and can even be magnified when you are going to live together. As people age, their personality can change, e.g., if your parents have a problem trusting others, then aging and dementia is going to make it a lot worse. You may feel that it’s your obligation to take care of them, but if anyone in your family is not going to get along, or if relationships within your own family is going to be impacted, then it may be wise to explore other options. Financial expectations/sacrifices: while it’s cheaper than nursing home, it can cost anywhere from $5,000-$15,000 a year out of pocket to take care of your elderly parents. This does not include costs related to you having to quit your job or cutting back on your work hours to take care of them. You may feel that you shouldn’t ask your parents to contribute financially, but if they have the means and you don’t, then I think it’s perfectly legitimate to discuss financial arrangement, whether it’s rent, or contribute to utilities, food/gas, etc. Also discuss what home improvement that need to be made to accommodate them living with you, and who is paying for it and how much. Make sure you discuss and get agreement with your siblings if your parents are going to use money that could eventually become shared inheritance.
Other issues to discuss How much assistance and supervision can you provide? Set realistic expectations • Know your limit • Consider your schedule • How do your spouse and children feel about the move-in? Will your parents be able to live by the rules of your house? Do you need outside assistance? What assistance is needed? Who is paying for it? Is the expectation that the family members have to help out to avoid paying for outside assistance? What adjustment would you and your family need to make? What do you do about family vacation? Do you have the time to take it on? Logistics, supervision, balancing with work, time for yourself, your family Will your parents be able to develop a social network, make new friends? Are there adult daycare facilities nearby? How will they get around?
Summary There are many other issues that need to be considered, so I recommend to you a web site https://www.caring.com/articles/moving-in-aging- relative-or-parent has a good list of things to discuss and consider prior to decision. These are also good questions to discuss even after the parents have moved in May wan to consider a “trial run” before permanent move in Finally, it seems like that we are focusing on the challenges and issues, but there are rewards, too. Relationships can be strengthened, grandchildren can grow closer to their grandparents, and it could make your elderly parents’ last years some of the best of their lives.
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