SOURCE: Administration for Community Living

November 21, 2013 05:00 ET

Starting the Conversation

Many Decisions About Elder Care Begin at the Holidays

MISSION, KS--(Marketwired - Nov 21, 2013) - (Family Features) Holidays are a time for families to gather together for celebrating, reminiscing and sharing the joys of the season. It's also a time when out-of-town family members may suddenly be confronted with the declining health of a loved one. Those taking care of aging family members are often unable to fully convey to those living far away the true needs of an elderly parent. So, these times of gathering together are a good time to start the conversation of how to handle long-term health care needs.

Gather Together
The first step should be gathering all involved family members together, including the person needing care. It's important to take the time, while you have it, to develop a strategy for how things should be handled when a loved one eventually needs care. Create a checklist of topics to discuss by visiting Click on the "LTC Pathfinder" link, answer simple questions and this valuable tool will generate a list of topics to consider when planning for care. It is also a great resource for finding national and local resources.

Where can you receive care?
Most people prefer to stay in their home or apartment for as long as possible. If this is your plan, it is important to step back and consider if modifications would allow you to remain at home longer. The goal of home modifications is to maximize your ability to safely care for yourself. Examples of home modifications include roll-in showers, stair lifts and grab bars. These kinds of modifications can be done well before they are needed and may help to avoid or delay the need for long-term care by helping to avoid a fall. For things you can no longer do for yourself, there are a number of other needed services available in most communities.

Should care outside the home become necessary, several types of housing come with support services for people who cannot fully take care of themselves due to aging and/or disability. Public housing is available for low-to-moderate income elderly and persons with disabilities. Assisted Living or "board and care" homes are group living settings that offer housing in addition to assistance with ADLs and other services, such as meals. Generally, they do not provide medical care. Continuing Care Retirement Communities provide a range of housing options, including independent living units, assisted living and nursing homes, all on the same campus. Nursing facilities, or nursing homes, are the most service-intensive housing option, providing skilled nursing services and therapies as needed.

Who pays for care?
Long-term care is more expensive than most people realize. Many people believe wrongly the Medicare, Medicaid, medical insurance or disability insurance they currently have will pay for all or much of their long-term care. In general, health insurance covers only very limited and specific types of long-term care. Disability policies don't cover any at all. In fact, the cost of care is usually paid for out of personal savings and income.

For those who qualify, long-term care insurance is available to cover long-term services and supports. Medicare only covers medically necessary care and focuses on medical acute care, such as doctor visits, drugs and hospital stays. If very specific conditions are met, Medicare will help pay for all or a portion of a short stay in a skilled nursing facility, hospice care or home health care. Medicaid helps people with low income and assets pay for some or all of their health care bills. It covers medical care, long-term care services in nursing homes, and long-term care services provided at home.

For more information about additional Medicare, Medicaid and paying privately for long-term care, visit

What resources are available?
The most common source of long-term care help is often unpaid family members. However, they may not always be available to provide the care a declining elderly loved one needs. Look for caregiving services in your area, including in-home care providers and elder daycare centers. Find out about home delivered meals and other services offered in your community.

It's also important to consult an attorney to make sure your loved one has appointed one or more individuals to make health care and financial decisions for them. An attorney can also prepare an advance care directive, which is a set of written instructions detailing what medical care your loved one wishes to receive.

About 70 percent of people turning 65 can expect to need some kind of medical or personal care services for months or years as they age. Planning for the care that a loved one may need one day is an important gift family members can give each other during the holiday season. The conversations can be difficult but are an important step to gaining valuable time to research options, prepare for the future and make the best decisions possible.

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