Elder care options for seniors to maintain independence

Several types of senior care are available to help fit every individual's and family's needs.

Several types of senior care are available to help fit every individual's and family's needs.

Shortly before she celebrated her 80th birthday last month, Dorothy Raley renewed her driver's license. The mother of six, grandmother of 14 and great-grandmother of 11 also hikes, bikes and plays bocce.

As an active senior citizen, Raley is a member of one of America's fastest-growing population segments. The Federal Interagency Forum on Aging-Related Statistics estimates that by 2010 there will be 40.2 million people in the United States age 65 and older, and 61 million who're at least 85.

Raley, like 84 percent of Angie's List Quick Poll respondents, wants to remain in her home as long as she possibly can — a concept that's been termed Aging in Place. She resides in a guest house on the property of her son and daughter-in-law, Kenny and Robyn Raley of Tucson, Ariz. Dorothy feels secure, yet independent. "I would like to keep it up just as long as I can," she says of the arrangement.

"It's a blessing and the timing was perfect," Robyn adds. "I have two kids who have left home and are in college, with one remaining, so I cook almost every night and my mother-in-law eats with us."

The guest house was built three years ago for Dorothy and her late husband, Johnnie, who was recovering from cancer surgery and needed to be closer to doctors and family. The guest house includes a bathroom big enough for a wheelchair to turn completely around and safety rails in the shower so Dorothy can maintain her independence.

Contractors build for special needs

There is a need for contractors who can modify homes for the elderly and handicapped. The National Association of Home Builders, in collaboration with AARP, has developed a program to address the needs of those who want to remain at home as long as possible. A Certified Aging in Place Specialist (CAPS) can add unique household safety features that enable an elderly person to live independently longer.

Many Angie's List contractors also help seniors to remain in their homes.

Richard Mellinger, 74, moved to Spring Hill, Fla., on his doctor's orders. He retired as director of operations for an Illinois school district after fracturing his spine and is no longer able to care for his yard and pool. Since his wife, Barbara, 69, holds a full-time job, and his three children reside in the Midwest, he relies on contractors to do the work.

"I'll continue to hire as long as the price is reasonable and the contractor reliable," he says.

Tough choices for adult children

An entire cohort, often referred to as the sandwich generation as they care for their own children and aging parents, too, is now facing a host of questions: How do I know when mom and dad need help? What types of care are available? How will I pay for their care? What are my legal rights?

For some baby boomers, it's hard to admit that the parents who took care of them for years now need tending to themselves. But when an elderly parent begins to struggle with daily activities, it may be time to seek help.

Physical symptoms such as having difficulty walking are significant, as are memory and attention problems, depression and social withdrawal. Changes in eating habits and inability to manage medication and finances are also warning signs.

Elderly parents may become frightened and stubborn, fearing they will be "put away" as their health deteriorates. Times are changing, though, and seniors rarely go straight to a nursing home — if they go at all.

"We now know we made the right move"

Julie Benefiel of Indianapolis recently experienced this scenario with her mother, June, 96. "I want her to keep her independence as long as possible but old age is catching up with her," Benefiel says, "Her short-term memory is not good. One of my biggest fears is that she'll leave the stove on and forget about it."

When Benefiel suggested her mother move to an assisted living facility, she was met with resistance. "I'm perfectly fine," June said. "Why do you want to put me away?"

Once mother and daughter visited assisted living facilities and June saw they were different from nursing homes, Benefiel says she made the transition, moving into a local facility called Greentree at Fort Harrison.

"I cannot tell you what a relief it is to have her in a place that is safe, clean and wonderfully accommodating," Benefiel says. "We now know that we made the right move for her even though we had to be persistent."

Benefiel runs her own interior design business and she and her husband, Doug, have one son.

"I can't be driving over there every time [mom] forgets to hang up the telephone receiver all the way or when something comes in the mail that she thinks needs attention in the next five minutes," she says. "You don't realize how difficult this is until you start through it."

Help for caregivers

AARP — formerly known as the American Association of Retired Persons but now accepting members age 50 and over — claims there are 34 million Americans currently serving as unpaid caregivers for family members, spending about 21 hours a week with the relative. AARP estimates the value of that care to be $350 billion in 2006.

"But the unpaid services they provide are not without costs," says AARP Director of Policy John Rother. As caregivers take time off work, the result is lower wages and loss of benefits such as health insurance, retirement savings and Social Security. "Lost time at work and reduced benefits adds to the emotional and physical strain of actually caring for a loved one."

Members of Congress have proposed legislation to give up to $3,000 a year in tax credits to caregivers, regardless of where the relative resides. (Current law allows for a dependent care credit only if the relative lives with you.)

Another bill would allow a caregiver to qualify for Medicare themselves at the age of 55 if they quit their job to tend to an aging relative. Yet another proposal would prohibit Social Security penalties for those who leave their careers to care for a parent. None of these measures have passed, however, leaving millions wondering how to pay for going gray.

Avialable options for elder care

Depending on need, several types of care are available:

  • Independent living facilities are for seniors who don't need special care, just chances to socialize. Some also offer meals and transportation.
  • In-home services consist of help at home with health care as well as meals and transportation.
  • Assisted living facilities allow the senior to live independently, but provide help managing medications and grooming.
  • • Continuing care is a combination of the above situations; good for a senior whose circumstances may be changing.
  • Nursing homes are for those requiring constant care by licensed health care professionals.
  • Alzheimer's care units are generally located within nursing homes with specially-trained staff to treat the disease.
  • Adult day care programs provide supervision and activities during daytime hours to give the caregiver a break.

Options can be severely limited by ability to pay, however. According to a MetLife Mature Market Institute report, the average annual cost for a semiprivate room in a nursing home is nearly $67,000.

The average cost for an assisted living facility was $35,616 a year in 2006; and the average cost for a home health aide is $19 an hour. Many baby boomers live in fear of losing their life savings, pensions and investments to care for aging parents.

Finding financial relief

Medicare and Medicaid can provide some relief. Established by the federal government in 1965, Medicare was designed to provide basic health insurance for people 65 and older.

"This program has not only moved most of the aging population into health insurance, it has also removed a huge financial burden from their families," says Judith Stein, executive director of the Center for Medicare Advocacy.

Her organization is working to provide plain and simple information about what Medicare covers and how to get necessary services, Stein explains. Medicare covers hospital, hospice, a short stay in a nursing home (up to 100 days) and some home health services, but does not cover long-term care or even adult day care.

Medicare has undergone many changes lately, however, and the entire program could be in jeopardy, Stein says.

"Unfortunately, the administration and Congress have been moving Medicare back toward private insurance. Recent laws have fragmented the program into hundreds of private Medicare Advantage plans. This makes the program much more complex and far more expensive than the traditional Medicare program."

Medicaid is only for people with very limited assets and income. Some seniors are forced to spend their own assets in order to qualify for assistance. Medicaid covers nursing-home care, but not other types of long-term care. Stein suggests seeking assistance from a qualified elder law attorney.

"The National Academy of Elder Law Attorneys is a good source," she says.

Not only are elder care attorneys familiar with Medicare and Medicaid rules, but he or she can guide the caregiver through other financial options such as long-term care insurance and reverse mortgages.

An elder law specialist can maneuver through a myriad of legal issues, too. A caregiver must establish power of attorney when a loved one loses the ability to make sound medical or financial decisions. A living will or health care declaration expresses desires with regard to medical treatment; a living trust is used to transfer property to avoid probate court. And a last will and testament provides instructions on distribution of property after death.

There are other elder care specialists available as well. Since the older Americans Act of 1972, every state is required to have an ombudsman who serves as an advocate for residents of assisted living facilities and nursing homes, investigating complaints and mediating settlements.

Moving to stay independent

Mary Ann Tokmenko of Broadview Heights, Ohio, has begun to wrangle with such issues as a member of the sandwich generation. A secretary in the history department at Cleveland State University, Tokmenko is caring for her mother, Gertrude Tokmenko, 84, who lives nine miles away in Parma, Ohio.

Mary Ann takes her to the doctor and grocery shopping, handles her finances and assists a brother with her mother's yard work and would like to have her under her roof.

"She refuses to give up her home although it is too much work for her," Mary Ann laments.

Gertrude volunteers in the kitchen and school of her church. She says she would feel isolated if she left Parma and her home of 46 years. However, she knows her health isn't what it used to be. Gertrude has osteoporosis, needs daily breathing treatments for asthma and takes 10 to 12 pills a day.

"I do things slowly," she says.

Gertrude is fixing up her home in order to sell it. Mary Ann is helping her by using Angie's List to locate plumbers and drywall workers. Gertrude won't be moving in with any of her five children, however.

"They have their ways and I have mine," she says. Instead, she hopes to find a small apartment she can manage herself and maintain her independence "a little while longer."

EXTRA: Nursing homes still face scrutiny for abuse, neglect

Nursing home abuse has been a problem for decades, and the latest statistics indicate that the situation hasn't changed much. The U.S. Centers for Disease Control and Prevention reports that neglect or abuse caused nearly 14,000 deaths in nursing homes between 1999 and 2002, while the Government Accountability Office found that 20 percent of the nation's nursing homes in 2006 were cited for harming residents or putting them in jeopardy.

The Nursing Home Reform Law of 1987 requires nursing homes receiving federal funds to report incidents of abuse, but investigators say self-reporting isn't dependable and state inspectors make infrequent visits. The GAO adds that federal health officials are imposing only minimal fines.

Still, there has been progress. Arkansas now requires the coroner to investigate every nursing home death. Many states are establishing nurse-to-patient hourly ratios. "Almost everyone agrees nursing is the best indicator of quality we have," says Janet Wells of the National Citizens' Coalition for Nursing Home Reform. Visit medicare.gov/NHCompare to learn more, including nursing homes' history of violations.

In addition to seniors needing to find help for themselves, about 37 percent of the U.S. workforce will be faced with caring for an older adult next year, and that number will only continue to grow as the elderly segment of the U.S. population escalates.

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Indianapolis in-home elder care services help seniors


Sue Staples (right) of Home Instead Senior Care on East 86th Street helps client Barbara Toby with daily activities, such as gardening. 
Photos by Brandon Smith
Sue Staples (right) of Home Instead Senior Care on East 86th Street helps client Barbara Toby with daily activities, such as gardening. Photos by Brandon Smith

Personal care services fill an important gap for those needing assistance and wanting to remain in their homes.


It is very challenging for a person to worry about elderly parents. This is a very helpful article. I would like to see more of these.

Great article!

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