In an ideal world, we would all receive preventative and integrated healthcare throughout our lives. This care would enable us not only remain alive longer, but to be healthy and independent as we age. It’s what most of us wish for: to age in place in our homes. But the reality is that staying in our home or in the home of a family-member is unrealistic without around the clock care and that care is unattainable for most of us. According to HealthyAging.org, more than 80% of people will need assistance with some Activities of Daily Living (ADL) as they age. These activities include hygiene, such as bathing, oral health, as well as dressing, eating, mobility and maintaining continence – being able to get to a bathroom, get off and on a toilet safely and cleaning one’s self after using the toilet. Even 90% of elders who can walk and are still mobile will need some sort of supervision or assistance for safety at some time.
Some options for helping with these activities include receiving help in the home, and 80% of people report to hospice agencies that they would prefer to continue to live (and die) at home. Yet, many relatives cannot provide around the clock care or even know how to provide the assistance needed to help with ADL. Also, many caregivers in home settings – spouses, siblings, or adult children – are also over the age of 65 (about 14% according to LongTermCare.gov). Instead, people have to use outside agencies, home health, companionship care, Meals on Wheels and other resources to remain in or keep their loved one at home. The costs of some these programs are many and can be prohibitive.
One of the first things that need to happen for elders to remain home is making modifications to their home environments. Replacing a bathtub with a walk-in shower, adding grab-bars, widening doorways and adding ramps for wheelchair or walker access, are just some of the things that can be done to make our personal spaces more accommodating as we age. Anyone who has ever done any type of home improvement knows projects such as these are time-consuming, messy and expensive. Making these modifications is also impossible for people who rent or who survive on social security benefits or other minimal income.
Assistive technology such as medical alert and alarm systems are also helpful for people who live at home. Other assistive devices such as walkers, wheelchairs, stairlifts, and lift chairs can help people with mobility issues and improve safety in the home. But many of these products are not covered by insurance or have minimal coverage or caps that make them cost prohibitive.
If a person can make some of these modifications and stay in their home, they may still require assistance with cooking, cleaning, and getting to appointments. This could mean home health or companionship care. Simple companionship care such as assistance with housekeeping and ADL are not covered by insurance and require 100% out of pocket costs. The average cost for a visiting aide or companion of this type that offers no medical help is between $16 – $27 an hour. According to Aging.com, people and families who want nearly daily, multiple-hour at-home care assistance should expect to pay about $4,000 a month on average. Again, mostly out of pocket.
These at home care costs are for non-medical care. Certain qualifications must be met to receive medical care at home. If a patient is “confined to home,” Medicare and Medicaid may provide benefits for nurses, therapists and others to make home visits to provide care (HealthInAging.org). An assessment will need to be made and more information is available in the Medicaid and Medicare Care Booklet, but many services and reasons for in-home care can and are excluded.
Some interesting community care programs are available around the country which are providing alternatives for temporary, respite care, or day care. We’ll look more closely at some of these alternatives in future posts. Right now, most communities do have some time of adult day care programs available, a physical space for people who are aging at home or in the home of a family caregiver to go to receive assistance with ADL during the day. Adult day care programs also provide a resource for caregivers who are employed outside the home to have their loved ones cared for while they work or when they need a break. Similar to home companionship help and aides, adult day cares rarely offer any sort of medical or medication assistance, which means they are not covered by insurance and require out-of-pocket expense, on average $74 per day and $1,500 per month (SeniorLiving.org).
If someone has a life-limiting or terminal disease or condition, they could qualify for palliative or hospice care, but assessments are needed and specific criteria must be met to be enrolled in these services, which are often done at home and are covered by insurance. Neither palliative care or hospice care include 24/7 care, however, which means some type of at home caregiving, supervision or assistance is still required and is still outside the benefits covered by insurance.
It is never too early to make some plans for yourself. If you want to age well, at home, I can help you find resources, estimate costs for budgeting and saving purposes, and outline alternatives that may help you. As an elder care doula, I provide non-medical, holistic care at a reasonable and competitive rate for you in your home or for your loved one in theirs. Don’t wait until you are old to plan, to advocate for yourself, or to attempt to accomplish your goals to age comfortably in place.