Don't Plan for a Nursing Home - Plan Independence at Home

There is no question that very few people, if any, want to go to a nursing home. That was a fact before the COVID-19 virus crisis hit. Families are doing whatever they can to keep parents and other loved ones out of a facility if at all possible.

Long-Term Care Insurance claims reflect this desire for in-home care. The research analyzed by the American Association for Long-Term Care Insurance (AALTCI) shows 70% of LTC Insurance claims paid for in-home services. At least for those people with insurance, it gave them the ability to avoid, or at least delay, the need for a facility.

For families without Long-Term Care Insurance, they have fewer choices. They will either pay for in-home care or provide the care themselves. Medicaid will pay for long-term care for the poor. The options for care are limited depending on the state the person lives. Often the care must be provided in a Medicaid nursing home. 

Un-Paid Family Caregivers Unprepared for Role

An AARP study showed that from 2015 to 2020, the number of unpaid family caregivers in the United States increased by nearly 10 million people, jumping from 43.5 million to 53 million. Adult children, or their spouses, find themselves in the role of being a caregiver either full-time or part-time with paid care the rest of the time. The desire for in-home care, no matter how it gets done, has never been greater.

As a result of COVID-19, many families pulled their loved ones from long-term care facilities. Many of these family members have assumed the role of unpaid caregivers. However, this trend of in-home care is not new, and family members often are not ready to assume this role.

"The reality for many family caregivers is they start the role unaware of how incredibly demanding the job would be. Caregiving takes an incredible toll not only physically but emotionally too! For some, the caregiving role happened abruptly, leaving little time to prepare," said Alie Johnson, who operates an Amada Senior Care that serves the Naperville, Aurora, and Geneva area in Illinois. 

Johnson says these family caregivers usually underestimate the amount of work and emotional toll that comes with the role of being a family caregiver. 

"Regardless of whether becoming a caregiver was foreseeable, it is nearly impossible to do alone. This is especially true for loved ones who require 'round the clock care," she said.

Family Caregivers Must Juggle Many Responsibilities 

Lauren Hirsch, MSW, LCSW, Director, Assistive Care at BAYADA Home Health Care in New Jersey, says caregivers minimize the level of stress that comes with caring for a loved one at home, especially if they are juggling a full-time job and have kids of their own. 

"Family dynamics can also create challenges. The bulk of the care may fall on the adult child who lives closest, which could cause resentment among siblings," Hirsch said.

She says the reality is the sole caregiver may be an elderly spouse who also needs support themselves. The adult children must step in to assist, but they are usually untrained and unprepared for this role. Much of the care is physical, helping a person with their daily activities.

"The care includes helping with bed and wheelchair transfers, using a Hoyer lift, or helping with bathing, toileting, grooming, and dressing. Without this proper training, both the caregiver and the person they are caring for are at increased risk for injury," Hirsch noted.

The role of being a caregiver for a loved one is physically and emotionally demanding. There is often a high level of anxiety. It can also be embarrassing for many care recipients to have their son or daughter help them with very personal activities. 

The result can be conflict. There can be a conflict with the care recipient and their family. Families members also find themselves bickering between themselves as one person usually is burdened with the primary role of caregiver for Mom or Dad.

Too Many Caregivers Fail to Ask for Help

Johnson explained that it is impossible to effectively care for another person without taking time to care for yourself properly. However, the family caregivers typically may not ask for help. Family caregivers must understand that it is okay to ask for help.

"Very few family caregivers ask for this help or take time for self-care. Many informal caregivers are reticent to ask for assistance because they view it as a sign of weakness or inadequacy," Johnson explains.

She says asking for help demonstrates the acceptance of one's limitations and the courage to do what's right for a loved one. But Johnson says caregivers need to know when to ask for help. Caregivers should be aware of their own health and safety since it is very stressful being a family caregiver.

Stress and Resentment 

"The best time to reach out is before you feel too stressed. Someone new to being a family caregiver may not realize she or he is approaching this point. Some of the symptoms associated with caregiver stress are depression, withdrawal, insomnia, trouble concentrating, health issues, exhaustion, and anxiety," Johnson explains.

Barbra London, MSW, LCSW, LNHA, BAYADA's Director of Client Experience agrees and adds that asking for help from a professional caregiver can decrease stress and feelings of resentment. Yet, adult children may feel they should provide care for the mother or father who raised them. She also adds that a spouse or partner may be reluctant to let anyone else care for the one they love. They hold in their feelings and adds to unhealthy stress and emotions.

Failing to reach out for help can result in something referred to as caregiver burnout. Caregiver burnout is a state of physical, emotional, and mental exhaustion. Among the common signs are having significantly less energy, getting sick often, and feeling helpless and hopeless. Some family caregivers even suffer from a change in attitude, and they become hostile and resentful. 

Professional Caregivers Have Needed Skills for The Role

Another concern with family caregivers is they often lack the skills to provide the care safely. In addition to the physical and emotional burdens these caregivers face, their role of caregiver could be detrimental to the health and well-being of the care recipient, not to mention the risk to their health and well-being.

Professional caregivers from reputable agencies have the skills and training to provide quality care and reduce the stress and burdens otherwise placed on informal family caregivers.

"At BAYADA, home health aides are required to pass hands-on demonstrations of their skills in a lab, and they are tested annually by a registered nurse. In addition, all care is supervised by a registered nurse clinical manager, who makes monthly visits to each client's home," London said.

Johnson says Amada finds the most responsible and qualified caregivers for their clients. She says they provide their staff with on-going training to build their skill sets in all areas above and beyond what is required by the state.

"We provide client-specific training when necessary to support a client managing health conditions like diabetes, anxiety, or is recovering from a stroke," Johnson added.

Johnson adds that Amada helps with several services to help the families of the care recipient. These include free assessment, care coordination, and Long-Term Care Insurance claims processing, all helping reduce the stress and burden that otherwise gets placed on the family.

Professional Caregivers Better Equipped for COVID-19 Concerns

COVID-19 has considerably changed long-term health care. While most people desire to avoid a facility, in-home care needs to consider the consequences of infection. 

Caregivers receive regular updates on CDC protocols. Plus, they get specific training on COVID-19 and infection control, including the nature and transference of communicable airborne pathogens. 

Home care providers are always pre-screened for COVID-19. The use of PPE (Personal Protective Equipment) is standard. The goal is to provide quality care safely and limit the risk of causing harm to the care recipient and the care provider. 

"Our goal is to take extra precautions to reduce our clients' and caregivers' exposure to all infectious diseases," Johnson added.

Avoid Family Crisis with Planning

The lack of planning usually places the family in a crisis situation they were never prepared for in the first place. When families lack Long-Term Care Insurance or resources for in-home providers, they do what is necessary to provide care.

Quality professional care options at home will usually be better for everyone, be it the care recipient or the family. Most people are concerned about losing their independence and becoming dependent on loved ones. In-home care provided by quality professionals helps promote independence and relieve the burden on stress otherwise placed on family members.

Johnson says the most significant benefit is that trained and compassionate caregivers can help seniors maintain their independence for as long as possible. With age comes various changes that can challenge a senior's physical and physiological state, some making it increasingly difficult for seniors to care for themselves properly. 

She says the three most common threats to an individual's independence are:

1. Failing to meet nutritional requirements.
2. Neglecting to exercise.
3. Forgetting to take medications.

Caregivers can help those who require long-term health care services with the support they need to maintain a healthy diet, get enough exercise, and stay consistent with their medications. 

Goal is to Help People Maintain Independence

"This independence extends beyond the person being cared for. Now the spouse and children can maintain their independence and quality of life knowing that their loved one is properly cared for," Johnson says.

What people really want is peace-of-mind. Trained caregivers help families know that their loved one will remain safe in their home. Family members will have the time to be family.

"Family members can spend quality time with their ailing loved ones, without the added burden and responsibility of providing their care," BAYADA's London said.

London adds that the adult children must tend to their household and work responsibilities. They usually must care for their children and have time for themselves.  

Need for Care Progresses Over Time

However, as age and health issues progress, the home environment may no longer be the best option for a loved one. London says this is especially true for someone in the later stages of Alzheimer's or dementia.

 "If a loved one's physical and medical care needs exceed what a home health aide is trained and licensed to do, the family may want to consider other options, such as in-home nursing care or facility-based care," she said.

Johnson agrees.

"If the care recipient is no longer thriving or safe in a home-care environment, we will work with that senior and family members to find the best assisted living community that meets all his or her needs and preferences," she explained.

While Long-Term Care Insurance, if you have it, will pay for assisted living, memory care, and nursing home care, in addition to in-home care. Otherwise, the cost of facility care is expensive and will come out-of-pocket outside of a limited amount of days for skilled care.

Geriatric care managers or eldercare attorneys may help the family navigate the available care and cost options. Many Long-Term Care Insurance policies offer case management to help policyholders and their families navigate the various care options. 

Paying the cost of long-term health care is always a concern. Often, in-home care is more affordable, but that could change if a person's needs become more intensive and require 24/4 support. 

The LTC NEWS Cost of Care Calculator can show you the current and future cost of extended care services where you live.

LTC Insurance Offers Choice

When families are in crisis, they have limited options. Those who have Long-Term Care Insurance have access to quality care in the setting they prefer. Long-Term Care Insurance has become an essential planning tool so families can safeguard income and assets, reduce the stress and burdens placed on their family, and provide them with control and independence. 

Johnson says they have many clients who are receiving benefits from their Long-Term Care Insurance policies right now. She indicates it is the only way many of them could afford to stay in their homes. People with insurance, she says, get to decide their future.

The problem is you cannot wait until you need the care to get a policy. Long-Term Care Insurance is medically underwritten. You must have reasonably good health to qualify to get coverage. Experts say the best time to purchase LTC Insurance is when you are in your 40s or 50s when premiums are low and your health is still good.