Customized and Individually Tailored: The New Senior Care
“As baby boomers age and the millenials are coming along, they are going to demand a different level of care,” notes Gifted Healthcare CEO P.K. Scheerle. “The genesis of the assisted living is, ‘I want it my way when I’m old.’”
Right now, “my way” for baby boomers means they want to stay at home as long as possible. To accommodate, the industry offers a highly customized medley of services tailored to one’s needs, in a tiered system, with a possibility of adding or cutting back on various services as the need increases or diminishes.
So, what are the options?
“In 2012 the AARP ranked Louisiana as 50th in the country for this category [assisted living communities],” says Richard Totorico, executive director at Trace Senior Community, noting that nursing homes still dominate in Louisiana.
“However, the proportions are quickly changing,” he adds. “In the last five years, Louisiana has gone from 86 assisted living communities to 138. We see a tremendous need in Louisiana.”
Jason Hemel, principal at Peristyle Residences, says that although Louisiana’s assisted living offerings have been lacking, “that has been quickly changing across the state.” The offerings, he says, are also becoming more diversified.
Who is a good fit for assisted living?
“Assisted living care is often tiered,” explains Jennifer Brammel, marketing coordinator of Poydras Home. “Basic assisted living services provide the resident with housekeeping support, meals in a dining room environment and access to a full activities calendar. Once ADL (activities of daily living) support is needed with such things as dressing, bathing and transferring into and out of bed, a midprice range is reached in the tier. When help is required for more than two ADLs, the top-tier pricing is reached.”
Brammel advises families to consider some questions, such as, “Does your mother or father need help mostly with errands and general home upkeep? Or are they reaching a point that they need help with ADLs? Is your loved one experiencing loneliness, isolation or a lack of stimulation?”
Totorico also advises families to consult with their family physician to see if their loved one could possibly stay at home. “Physicians can give an honest and objective opinion if a senior is at risk,” he says.
Sean Arrillaga, also a principal at Peristyle Residences, defines an ideal candidate as someone who requires assistance with two or more ADLs on a daily basis.
The transition to assisted living may not be as difficult as you’d think.
“Often the adjustment period… can be longer for the resident’s family members than for the actual resident,” shares Poydras Home Vice President of Resident Services Erin Kolb, MSW, LCSW, NFA. “It can be a relief for a resident to let go of the daily responsibilities of meal preparation and housekeeping, and comforting to know that help is readily available for personal care. A new resident can also experience a personality bloom when surrounded by their peers.”
Overcoming the Misconceptions: Yes, You Can Afford ALF
When it comes to assisted living facilities (ALFs), Totorico says the main misconception is that they lie beyond the reach of the typical family. “When the cost of food, insurance, utilities, attendants and transportation is taken into account, we find that most can easily afford to live with us,” he says.
So, how does one fund living in an ALF, and what’s included? The cost varies greatly within the industry, depending on the type of room, level of care and location.
Totorico advises families to not only ask in detail what’s included in the monthly cost now, but what it “would look like in the future should a loved one’s needs change.”
According to Arrillaga, in New Orleans, comprehensive ALF costs can range from $3,000 to over $7,500 per month, with most facilities offering a base pay that covers room, board and two ADLs.
“Memory care settings are typically the most expensive,” he says.
According to Arrillaga, Medicare pays for skilled nursing facilities for up to 100 days per year, while Medicaid will pay for custodial care in a nursing home if the resident qualifies financially. “This process is much more stringent than Medicaid’s regular health insurance program,” he adds.
There are also VA-specific nursing homes, and the VA offers the Aid & Attendance benefit, which can be applied to ALF cost and may pay for a few hours of sitter services.
Bridge loans and reverse mortgage funds may be applied to any setting, but these programs follow the individual and do not directly reimburse senior living or healthcare costs.
The Home Care Option
If your loved one needs one-on-one attention, regardless of whether he or she is in hospital, at home, in a nursing home or an ALF, you can supplement by hiring a caregiver through an agency like Right at Home. According to Owner Loren Berot, the industry average is two caregivers per client.
Services are individually tailored and Right at Home charges by the hour, not tiers: $19 to $21 per hour for personal care services (bathing, grooming, etc.) and $18-$20 for companionship/homemaker services for people who can still, for example, shower themselves but may be at risk for fall. The latter services include things like making sure the client has taken their meds or has eaten.
The services are covered out of pocket by long-term care insurance and, in some cases, by workers’ comp.
Cargivers provide one-on-one assistance with both personal care and companionship/homemaker services. Photo courtesy of Right at Home
The most common misconceptions when it comes to home care, Berot says, is often people “want a maid.” “We’re less expensive than a maid service… but we’re not that,” says Berot. “My caregivers are not housekeepers, they are not professional chefs. They make sure our clients get fed a nutritious meal, and they’re going to make sure the kitchen is clean when they’re done, but they are not there to clean windows or do baseboards or clean out closets.”
“Smart” Aging and “Aging in Place”
Like everything else today, aging has now gone high tech. Analiza Schneider of Home Care Solutions explains the concept of smart aging: “The current wave of new services and products to help with aging is in technology services — such as medical monitoring devices, remote emergency response systems, and medication reminder devices.” She adds that as quickly as new technology and practical applications are emerging, millennials should have access to many more ‘aging in place supports’ than we can even imagine today.
Smart aging may gain momentum, as Louisiana “shares the nationwide challenges of both shortage of home caregivers, as well as limitations of Medicaid waiver programs for community-based funding of caregiver services at home,” Schneider notes.
Private Nursing and Travel Nursing
If your loved one needs medical assistance you may consider hiring a private nurse, even for a few hours a month. One local company, Gifted Healthcare, works with hospitals, ALFs and other facilities. It serves the New Orleans and Northshore areas, but its nurses travel both throughout and out of state.
Company CEO P.K. Scheerle says there’s a great benefit to it: “When nurses travel, they bring home experience. They become better nurses from a wider range of experiences in the profession.” The average age for traveling nurses is 44, versus 24 for the average nurse, indicating they tend to be more experienced.
Travel nursing is a quickly growing sector, but the supply is shrinking, says Scheerle, who cites a shortage of qualified nurses and increasing demand for nurses in different settings. “Plus, the job is only just beginning to pay well,” says Scheerle.
Nursing Homes
Living at home, even with assistance, is not for everyone. The state of Louisiana allocates a lion’s share of Medicaid money for institutional care versus community care, points out D. Scott Crabtree, president and CEO of Broadway Services, Inc./Lambeth House. “The nursing home model has been, and still is, the primary focus of the Medicaid funds for long-term care in Louisiana,” he says.
Louisiana currently has a moratorium on building new nursing homes, he explains, which includes private-pay nursing homes that do not rely on any federal or state funding.
“Louisiana cannot be complacent in its public policy related to the aging of our citizens,” Crabtree says. “Opportunities exist for the state to use senior living as an economic force within the state. Specifically related to Louisiana, the number of residents in the state age 85 and greater will grow 84 percent by the year 2030 (when compared to the 2007 population).”
Joe Donchess, executive director of the Louisiana Nursing Home Association, points out that although most prefer to stay at home as long as possible, the nursing-home setting is economically more feasible.
“You cannot provide one-on-one care at an economical rate,” he says. “The efficiency factor is not there.”
Donchess’ parting advice for families is to do your homework and remain realistic in your expectations. “One thing that family members have to understand is that their loved ones are in a nursing facility because their level of dependence is very high. Therefore, although there are certain things nursing facilities can do to care for their loved ones… they may not improve simply because improvement may no longer be a viable alternative for that person.”
Cost of care in the New Orleans area
• Aide/companion: locally, $17-$24 hourly; nationally, $20
• Caregiver: locally, $18-$21 hourly; nationally, $20
• Adult day care: locally, $60 daily rate; nationally, $69/day
• Assisted living: locally, $3,200-$6,500 (based on level of care); nationally, $3,600/monthly
Source: Home Care Solutions
