Planning Ahead: A Guide to Aging (and the Decisions That Accompany It)
FOR HER JOB as a registered nurse and co-owner of Care Weavers, Cindy Hostetler helps families decide how best to navigate the often overwhelming world of eldercare. She explains the differences between nursing homes and assisted-living facilities. She discusses the sometimes shocking cost of moving into one of these facilities, and whether alternative steps can be taken before committing to spend thousands of dollars each month.
Still, she can’t always give everyone peace of mind about a decision that is incredibly emotional.
Recently, a client had to move her mother from a hospital to a rehab facility after a stroke, with three days to decide which among a long list of options she would send her to. “I can’t even make a decision about a car I want to buy in three days, let alone where I want to place my mom in a rehab facility,” Hostetler says.
That happens all the time, though, as the labyrinth of eldercare options is often presented only after a crisis. Even the terminology can be hard to understand.
Assisted living, which is further broken down to multiunit assisted housing or residential care homes that have six or fewer beds, is different from nursing homes, which are different from continuing care retirement communities (CCRC). All of which are different from age requirement communities, or independent living communities. “It’s very confusing, and if you don’t work in this field, it’s extremely overwhelming,” says Lindsay Tice, the regional ombudsman at Centralina Area Agency on Aging, whose job is to advocate for people who live in these facilities.
The best thing for anyone who is aging or has aging family members who might need to use these services soon, is to talk about the many options. “People with plans don’t get wrapped up in crisis situations,” Hostetler says.
“And if you have a plan, you have choices,” adds Elizabeth Pruett, a nurse and co-owner who works with Hostetler at Care Weavers. “The more you think about these things and have conversations about it, the easier it is. It’s about understanding what’s going to happen and how to move forward.”
Here are some factors to consider when deciding whether it’s time to move to an assisted-living facility.
What are the alternatives?
Are there friends or family available to help with care? What about home care or home health care agencies? Is shared living an option? Maybe an independent apartment that provides services such as meals?
Talk to your doctor
Oftentimes, a doctor will know the medical situation best and know if special care is needed. For instance, people with dementia from Alzheimer’s disease might be best served at a facility with memory care. Additionally, the doctor will need to provide a medical letter of necessity for moving to an assisted-living facility, nursing home, or rehab center if that is needed.
Consider your financial resources
Aging can be expensive, and financial considerations are among the most important when deciding next steps. Families and individuals need to think carefully about what resources are available to pay for options: a pension, savings, long-term care insurance, Medicare, Medicaid, and Social Security are among the most common means of paying for care. Additionally, research what type of care is covered by your insurance. Typically, Medicare does not cover long-term care, only medical expenses related to specific health ailments.
“I just encourage people to not expect it will be easy,” Pruett says. “Because it’s not always easy. If there is a question about a loved one needing care, the first time you have that thought, look into it. Don’t wait until something bad happens and the person ends up in the hospital, and then you have to make a decision. If you can be proactive, be proactive.”
Making the Decision
When trying to decide where someone should go for eldercare services, Lindsay Tice refrains from offering specific suggestions, to avoid bias. But she does offer advice on how to approach narrowing down the options.
Most important among the advice: visit.
“We do have some beautiful buildings in town, and then we have some buildings that aren’t as beautiful,” Tice said. “Beautiful drapes and crown molding does not equal good care all the time.”
Pay attention to details, and look for services that the person who would live there covets. Is someone interested in a plethora of activities? Would he or she rather have a garden view?
“See how the staff’s interacting with all the residents,” Tice says. “Are they going up to people and saying, ‘Hey, Miss So-and-So, how’s it going today?’ Or are they just walking by? Look at the activities calendar. My favorite thing to do when I go in is to look and see, ‘Oh, hey, Bible study is supposed to be happening at 10. It’s 10:15, and there’s no Bible study.’ So, is what is planned actually happening?”
A full list of options can be found in the “All About Seniors” directory produced by the Centralina Area Agency on Aging. An online version can be found at allaboutseniors.org.
Additionally, medicare.gov allows users to compare nursing homes, while the North Carolina Division of Health Service Regulation website (ncdhhs.gov/dhsr/) allows users to view inspection results and ratings.
Some options in Mecklenburg County—and there are many others—include:
Assisted-Living Facilities (called “Adult Care Home” in North Carolina)
The Laurels in the Village at Carolina Place, 13180 Dorman Rd., Pineville. 104 beds; it accepts private pay. 704-540-8007
Brookdale South Charlotte, 5515 Rea Rd. 51 beds; it accepts private pay. 704-452-7924.
East Towne Manor, 4815 N. Sharon Amity Rd. 120 beds; it accepts private pay and special assistance (Medicaid). 704-531-0948.
Asbury at Aldersgate, 3800 Shamrock Dr. 100 beds; it accepts private pay and Medicare. 704-532-7000.
White Oak Manor – Charlotte, 4009 Craig Ave. 180 beds; it accepts private pay, Medicare, Medicaid, and veterans’ assistance. 704-365-2620.
Sardis Oaks, 5151 Sardis Rd. 124 beds; it accepts private pay, Medicare, and Medicaid. 704-365-4202.
Continuing Care Retirement Communities
Aldersgate, 3800 Shamrock Dr. 704-532-7000.
Sharon Towers, 5100 Sharon Rd. 704-553-1670.
Southminster, 8819 Park Rd. 704-551-6800.
The Pines at Davidson, 400 Avinger Ln., Davidson. 704-896-1100.
A new concept opening in south Charlotte this month is a grassroots effort supported by volunteers. It delivers core services found to be most important for aging adults who want to live at home, but require some assistance. For a modest annual fee ($450-$500), seniors 55 and older can receive transportation, a daily well-being phone call, technology assistance around the home, and minor maintenance such as replacing light bulbs. More information can be found at cvn.clubexpress.com. The Davidson Village Network launched in late 2017: davidsonvillagenetwork.org.
A service that provides transportation for older adults, people with disabilities, and veterans, through a network of certified volunteer drivers. More information can be found at centralinavts.org or 844-887-7433.
The most surprising and overwhelming factor when considering assisted-living facilities often is the cost. “There’s a really bad disconnect between what people think is going to happen and what Medicare will pay for; Medicare doesn’t pay for any long-term care,” Pruett says. “There’s just not a safety net, and people don’t realize that.”
Assisted-living facilities in Mecklenburg County can range from $2,800 to $10,000 per month, according to Centralina Area Agency on Aging. Those $2,800-per month beds often come with a roommate—and are difficult to find, because the low price point is in such demand.
And for many facilities, that is a basic fee that covers a package of room and board and basic services such as housekeeping. There can be additional fees for other services that include higher levels of medical care.
“Those level-of-care charges can really add up,” Tice says. “That’s where people don’t realize sometimes how expensive it can be. You see that base rate and you go, ‘Oh, I can afford that.’ And then Mom has pneumonia one year and comes back and needs more help. Well, her price could go up.
“Family members have to think, ‘OK, so Mom needs some help. Does Mom need to stay at home with some nonmedical home care company coming in, maybe doing some baths or laundry or errands or whatever? Or is it going to be cheaper for Mom to go to a facility?’ There’s no easy answer to that. Everyone has to sit down and crunch their money numbers.”