Planning Ahead for Future Need

If you or a loved one becomes sick and need home health care, what agency should be called? If you or a loved one can't get around and do for yourself but can still stay at home, what kind of services do you want to help you with daily living? Most families don't know this information until the unexpected happens. Plan for the unexpected now and share your plans with family members, NOW.


Ask permission of your loved one to have the discussion. Having a conversation about the need for long term care is in the best interest of the entire family. Because the need for long term care is a challenging topic to discuss, some people might need more time to think and reflect on it than others. Asking permission assures your loved one that you will respect his or her wishes and honor them. Some ways of asking permission are:


- “There is something very important to me that I would like to speak with you about. I’d like to talk about your wishes and desires for the time when your health requires more care than you or I can provide at home.”


- “I would like to speak with you about the options and benefits of long term care. I don’t want to alarm you, but it will make me feel better if I know your wishes when it comes to your health in the future.”


Unplanned decisions are uninformed decisions, and in the heat of a crisis, they are rarely in anyone's best interest. Take proactive steps now:


• Create a "Rainy Day Folder" that places all of your directives in one place and share a copy with family members.


• Fill out a Living Will so everyone will know what you want regarding any end-of-life decisions

• Make a list of all your physicians and identify the hospital of your choice in the event of an emergency

• Choose a Durable Health Care Power of Attorney so a trusted loved one can make health care decisions when you're too sick to make them

• Choose a home health agency that will provide home health visits once in hospital or inpatient skilled care is no longer necessary. An agency that can provide private duty care if needed in addition to visits by therapists and nurses will help eliminate the need to deal with multiple agencies.


Getting your loved one to focus on and speak about this topic can be a very challenging process. A common response is, “I don’t need any special help.” Your loved one may not want to show signs of weakness or loss of control, which many people associate with long term care. Don’t be discouraged. Let him or her know you are concerned and that by discussing this topic, you are looking out for his or her best interests. Although you don’t want to pressure your loved one, be persistent and return to the topic over time.


Be a Good Listener
By listening, you can learn the wants and needs of your loved one.


It is important for you to understand what is best for your loved one when it comes to long term care, so spend most of the conversation listening. Your goal is to answer questions he or she might have and be able to provide insight on the topic. Here are some helpful tips:


Listen to his or her needs; what he or she is sharing is important.
Show respect.
Acknowledge your loved one’s right to make choices.


Provide Information

There’s a widespread misconception that Medicare pays for long-term care, but in fact, it only pays for very short term stays in skilled nursing. The average monthly cost of a nursing home nearly $7,000, and stays that exceed several years, it’s critical for people to start planning while they still have the ability to choose the long-term care service and finance options that are best for them.

It is important to realistically evaluate the costs associated with long term care and identify what is affordable in each case. On this page you can find a link to the National Clearinghouse for Long term Care, which provides helpful tools to support families in planning for future health care needs.

Medical versus Non-medical Care

There are two different types of home care providers, medical and non-medical. A non-medical home care agency can provide bathing and dressing assistance, medication reminders, and assistance with transferring from the bed to a chair. Caregivers will do household chores such as light cleaning, laundry, errand running, grocery shopping, picking up prescriptions, light meal preparation, and getting the mail. They will also provide services that help with socialization and transportation like accompanying the aging adult to a doctor’s appointment, sitting and watching TV together, playing card games or board games, taking the senior to special events or senior centers, going to the library, and other social activities.Non-medical caregivers cannot assist with medication administration but can remind someone to take medications that have been pre-poured.

Medical or "Skilled" home care providers are Medicare-certified home health agencies. Caregivers are licensed registered nurses and licensed practical nurses who can provide assistance with all aspects of personal care as well as nursing care that non-medical staff are unable to do. For example, nurses can assist with medication adjustments, provide tube feedings, insert catheters, care for patients with specialized equipment management and health monitoring needs such as tracheostomy care and ventilator support.

No one can take care of your parent or spouse exactly the way you would, but a good agency will provide caring and compassionate staff who do the best job they can. The squeaky wheel always gets the grease when it comes to service providers. Do your homework prior to hiring an agency, and be sure to check on your aging loved one regularly.Visit unexpectedly, and monitor what’s happening in the home. Speak up and communicate with the agency!

Minimizing Confusion While Your Loved One is Hospitalized

Some older adults experience confusion when they are hospitalized due to the change in environment. Delirium, a temporary confusion can occur to even the completely oriented older adult when they are ill and in a strange environment. Delerium can lead to safety concerns, such as risk for falling since the individual is confused and unable to follow through with instructions that ordinarily he or she could handle.

Here are some things that can be done to reduce the risk of delirium:

1. Bring a complete list of all medications, with their dosages, that your loved one takes to the hospital. It is important to also include all over-the-counter medicines. It may help to bring the medication bottles as well.

2. Prepare a "medical information sheet" listing all allergies, names and phone numbers of physicians, the name of the patient's usual pharmacy and all known medical conditions. Also, be sure all pertinent medical records have been forwarded to the doctors who will be caring for the patient.

3. Bring glasses, hearing aids (with fresh batteries), and dentures to the hospital. Older persons do better if they can see, hear and eat.

4. Bring in a few familiar objects from home. Things such as family photos, a favorite comforter or blanket for the bed, rosary beads, a beloved book and relaxation tapes can be quite comforting.

5. If your loved one becomes confused while in the hospital, plan to stay as much as possible. During an acute episode of delirium, relatives should try to arrange shifts so someone can be present around the clock. Help orient the patient throughout the day. Speak in a calm, reassuring tone of voice and tell the patient where he is and why he is there. When giving instructions, state one fact or simple task at a time. Do not overwhelm or over stimulate the patient.

6. Massage can be soothing for some patients.

7. If you detect new signs that could indicate delirium -- confusion, memory problems, personality changes -- it is important to discuss these with the nurses or physicians as soon as you can. Family members are often the first to notice subtle changes.