As our parents or grandparents age, we might find that a change in their living situation is necessary. The most likely scenario is if mom falls and breaks her hip. This unfortunately is very common. After surgery and a hospital stay, they will likely be discharged to a rehab or skilled nursing center for around 21 days. The discharge is usually handled by a case manager. A case manager is a nurse or social worker working in the hospital. The case managers are not allowed to make specific recommendations but will provide a list of facilities, and there are various options in our area of Northern Virginia. Some will have available beds and some will not. Some are better than others.
This can be overwhelming and confusing and obviously stressful. The simple questions for the family to consider regarding Moms’ health are: Can mom walk, communicate, use the bathroom? There are medication issues and issues of cognition. The decision about which rehab center to use is based on available beds, proximity to the family, quality etc. After this decision is made, mom will be transported to the rehab center and therapy (physical and occupational) begins. This is very difficult for most elderly people because they likely won’t really understand what just happened. There is the issue of cost – who is paying for this?
There is the obvious question of when can I go home?
Assuming all goes well with the three week stay, mom will be discharged. Medicare will cover most of the cost of the hospital and rehab stays. Medicare will also cover the cost of the equipment that mom will need in the home – wheelchair, hospital bed, walker and medications. Medicare will also cover the costs of in-home health care – the skilled care that mom needs – PT and OT and other skilled needs that she might need.
The family now has to decide how to handle the situation when skilled care is not there. Is mom able to take care of herself under these circumstances? Is she safe alone in her home? Medicare provides certain skilled care for a short period of time but that’s it. Each family’s situation is unique and there is no one solution for everyone. It is likely that mom needs someone close by to make sure that she is safe, healthy, eating and not isolated. If there is no one close by then the family can look at moving mom out of the home. It is not an easy discussion because most everyone wants to remain in their own home.
The family can look at moving mom into an assisted living community whereby the community provides a level of assistance to the patient. There are meals provided and activities. There are staff to help with the activities of daily living.
The other option is moving mom into an independent living community. This is similar to living in an apartment but with meals and activities. There are many facilities that have both independent and assisted living on the same campus. This enables patients to stay on the same campus as their situation changes.
The family can also look at keeping mom at home using home care. Home Care involves a trained caregiver coming into the home for a certain period of time every day, every week or a few times every month and help mom take care of herself and assist with bathing, dressing, feeding, cooking, medication reminders and providing companionship etc. The family can have mom move in with them again with the help of an outside caregiver to help.
All three options require the family and/or mom to pay out of pocket.
This is a very important decision because after the house is sold it is almost impossible to go back in the event that mom doesn’t like the new living arrangement. There are many advantages of moving into a community. The activities, the opportunities for socialization, the safety factor, meals, 24 hour care if necessary.
The downside is that mom just might really want to remain in her own home. There might be issues with the community that you aren’t aware of. The community might be great now, but be sold in a few years to a less scrupulous buyer. The community may not be able to provide mom with the level of care that you are expecting. Assisted living has a certain caregiver to client ratio which varies from community to community but it is certainly not close to one-on-one. The caregivers in the facilities are required to take care of many patients on their shifts. They usually have only a short time with each person. If mom needs more care, the community will likely require you to pay for a caregiver to help out. If you refuse to get more help they can ask her to leave.
The situation in a community can completely change, for example, the tragedy of Covid-19.
Home care is an option whereby an company such as Nurturecare can refer a qualified and carefully screened certified nursing assistant to come to the home and help with the necessary activities. The agency will attempt to match up the personality of the client with an appropriate caregiver. If the match is not successful, the agency will refer another caregiver and continue to do so until the right match is found.
The objective is to have continuity of care whereby your mom with have the same caregiver each time and there won’t be a parade of different caregiver’s which can be different on every shift. Having a caregiver come to the home can be a less expensive option then moving to a community.
Cost of Home Care
Depending on the level of care that is required, Home Care costs can be around approximately $5000 per month for 8 hours of one-on-one in home care in the Northern Virginia area. This does vary based on where you are located in the United States. This is around the same cost as an assisted living community. If mom needs more than, for example, 8 hours of care per day another option to look at is Live-In Care. A caregiver will live in the clients’ home. The caregiver will be provided a room and will sleep and eat in the home. The cost of a Live-In Caregiver is around $7500 per month. The caregiver and client will live together and a strong and healthy bond is formed with the client and the family. We have found this to be a good long term solution for many of our clients.