Finding care that is right for you and your family.

1. Finding care that is right for you and your family.

2. Living options for the elderly. • Independent Apartments • Congregate Properties • Assisted Living • CCRC’s • Nursing Homes • Personal Care Homes • In Home Care

3. Options to Pay for care? • Private Pay • From resident or families cash reserves. • Medicare (short term only) • Will pay for care in some facilities for rehabilitation. • Medicaid • For elderly who meet the income requirements for need. Will cover all of nursing home expense minus a monthly stipend. • Long Term Care Insurance • If resident has purchased insurance it may cover their expenses in different facilities depending on the need of the resident and the facility.

4. Independent Apartments • For those with an active lifestyle who need little outside support. • Can do most Activities of Daily Living (ADL’s) without assistance. • May get outside help in apartment if needed. • Most all apartments are private pay. • May or may not be rent subsidized ie: HUD

5. Congregate Properties • Can do most Activities of Daily Living (ADL’s) without assistance. • Offer some supportive services for the elderly. • May have meeting rooms and planned group activities. • Mostly known as Aging Communities or naturally occurring communities. • Most properties are private pay.

6. Assisted Living • Range in care based on size and level of care provided but are licensed by the state. • Offers services including, medication management, prepared meals, laundry, housekeeping, transportation, etc. • Offer planned activities as well as group meetings. • May offer Hospice Services. • Most are private pay, a few have a minimum number of beds available for Medicaid, but most have a waiting list, may be possible to get funding from the state (Community Based Alternatives).

7. Continuum Care Retirement Communities (CCRC’s) • Offer services ranging from independent apartments, assisted living, and nursing care. • May be a “buy in” or “Life Care” program, where you pay an upfront fee to live in the facility and some may offer a return on your investment. • Allows resident to “age in place” • May allow residents to adjust easier to changing levels of need. • May offer Hospice Services, • Most CCRC’s are private pay but there are some who have assistance programs.

8. Nursing Homes • For residents who require 24 hr nursing supervision. • Residents receive meals, assistance with personal care, supervision of medication, social services available, as well as a chance for socialization and activities. • Licensed by the state. • May be used for short term rehabilitation, but many residents become permanent. • Can be private pay, Medicaid, or may be Medicare, but for limited time.

9. Personal Care Homes • A home in the community with 3 or less unrelated people. • They are not licensed by the state. • Similar to room and board or board and care homes. • Offers services including medication management, help with ADL’s, prepared meals, laundry services, etc. • May be paid privately or through some state funding (Community Based Alternatives Program).

10. Other Things to Consider • How to pay for care? • Where to look? • What type of facility? • Does my loved one or myself have Advanced Directives?

11. Where to look for a facility? • Area Agency on Aging • www.tdoa.state.tx.us/aaadirectory.htm • TAHSA / EIA • www.tahsa.org • Friends and Peers • Church • Location

12. What type of facility? • For Profit • Revenues are divided among shareholders and investors of the long term care facility. • Non Profit • Revenues and dividends are reinvested in the care and the residents of the long term care facility.

13. Non Profit Benefits • Provide more hours of care per patient per day. • Invest more resources in resident care. • Non Profit providers had 34% fewer deficiencies than for profit nursing homes. (Deficiencies are citations from the licensing organizations for less than perfect care) * Information Taken From AAHSA Document.

14. Advanced Directives • Living Will • Directive to Physicians • Do Not Resuscitate (DNR) • Out of Hospital DNR • Legal Guardian • Power of Attorney (healthcare/financial) • Have a “caring conversation” with your loved ones about their wishes for a “good death” and share your wishes too.

15. Making a Decision • Make a decision together. • Plan ahead if possible. • Consider alternatives. • When your loved one is confined to the hospital, request a social service consultation for planning purposes. • Ask Questions!!!!!

16. Questions to ask a Retirement Community. • What type of lease is required? Is it a monthly or lifetime lease or purchase? • What is included in the rate? Are maintenance, transportation, meals, laundry, parking, utilities, and housekeeping included? • What services are included at an extra charge? • Is there an emergency response system available? • What type of meals are offered? Can you be a guest at a meal? • What type of wellness and/or health care services are available? • Does the community offer recreational programs?

17. Questions about Nursing Homes. • Does the facility offer the level of care and services you need? • What type of medical and therapeutic services are available? • Is the family involvement encouraged? How? • Is there an active volunteer program, and are there interesting activities for residents? • Is the facility clean, well maintained, and free of odors? • Do the residents appear clean and well-groomed? • Are residents encouraged to create a homelike environment in the resident’s rooms?

18. Continued • Does the food look/smell good? Are there provisions for special diets? • Does the staff appear attentive and caring? • Do they encourage residents to eat their meals in the dining room? • Does the person you talk with give you honest, straightforward descriptions of the services offered? • What are the visiting provisions? Is their a private area for visits? • What is the ratio of staff to residents? • Does the facility have a current state license? • Is the facility Medicare or Medicaid Certified? • What kind of special care does the facility provide for people with Alzheimer’s?

19. Questions about Resident Activities. • Is the Bill of Rights posted and a copy available? • Is there an active residents’ council? • Are special events held at the facility? • Are special excursions planned for those able to participate? • Do all residents have access to the outdoors? • Do volunteers assist with residents’ recreational activities? • Are daily activities available to meet individual needs? • Are religious services conducted?

20. Questions about Community Services? • What services does the agency provide? • Is the agency licensed by the state? • Are services provided by the agency sufficient to meet your needs? • Who will manage the care and who will supervise the caregiver(s)? • How much will the total cost be for all services provided? • Are services covered under Medicare or other third party payor?

21. Before Placement Considering Utilizing Existing Alternatives. • Home Health Services • Transportation Services • Adult Day Care • Respite Care

22. Caring for the Caregiver • Ask for help! • Try to reduce stress, some suggestions: • Get adequate rest and good nutrition. • Exercise regularly. • Get away. • Allow others to help. • Talk about your frustrations. • Go easy on yourself. • Set personal milestones you can achieve. • Reorganize your work.

23. Internet Resources • Senior Housing • www.seniorhousing.net • Department of Health Suggestions • www.dhs.state.tx.us/nhconsumer.html • Texas Medicaid Eligibility • www.dhs.state.tx.us/programs/elderly/medicaidnursing/index.html • TAHSA • www.tahsa.org