Planning Ahead

It is never to soon to begin talking about the current or future care wishes of your loved ones and yourself.

Planning and preparing offer you and your loved ones peace of mind that your wishes will be met. As you and your loved ones look into options regarding long term care, choose a time when you all can focus on the conversation. Experts recommend allowing everyone to share their reactions and encourage family members not to take one another’s reactions personally.

Advance Directive

Advance directives are important planning tools that provide greater control over future care decisions. These documents outline and protect your care preferences in the event that you are unable to express them yourself. These documents guide your loved ones and health care providers by specifying what treatments you do or do not want to receive. It lets you set your own care terms. You decide how, or even if, you wish to be treated in various scenarios. All adults, not just older adults or those with serious medical conditions, should complete advance directives.

How to Pay for Long Term Care

Long term care costs vary, depending upon where you or your loved one preferred method of care and the level of care provided. Once you know the cost of care, you’ll need to decide how to pay for it. There are many sources of care financing. Private resources include out-of-pocket payments, insurance, and donated care (care provided by family or friends). Public sources include Medicare and Medicaid.

Because everyone’s situation is different, people pay for care in different ways. Some people use a combination of payment sources. Common payment sources include:

Personal Resources

Personal resources include your or your loved one’s savings, investments, and assets. These resources are used to pay expenses out of pocket.

Long Term Care Insurance

As with other forms of insurance, long term care insurance allows a person to pay a known, affordable premium cost to protect against the risk of much larger care expenses. Long term insurance is designed to meet long term care needs that may include a variety of medical, personal, or social care services. The Oregon Insurance Division can help you decide if it’s right for you.

Medicaid and Medicare

Medicare and Medicaid are federal and state assistance programs. Some people qualify for both programs and are called “dual eligible.”

Medicare

Medicare, a health insurance program administered by the federal government, is available to people who are age 65 or older, permanently disabled, or affected by kidney failure or long-term kidney disease. There are four different parts of Medicare.

Medicare does not provide a comprehensive long term care component. In general, it does not pay for assisted living costs, though it may cover short term services, such as on-site therapy. If certain conditions are met, Medicare offers limited coverage for Medicare beneficiaries who require post-acute care. For days 1–20, Medicare will pay 100% of covered services; for days 21–100, you or your loved one will need to pay a daily copayment. The daily copayment can change each year. In 2011, it was $141.50 per day. To receive coverage, you or your loved one must have been admitted to a hospital for at least a three-night stay just prior to receiving care from a Medicare certified post-acute care facility.

Medicaid

Medicaid is a joint federal and state health insurance program available to those with limited income and resources. Eligible individuals include pregnant women; children age 19 or younger; persons age 65 or older; and those who are blind, disabled, or in need of nursing home care. Medicaid will pay for post-acute care, provided the care center is certified.

If your income is limited, apply for Medicaid, even if you aren’t sure whether you qualify or not. A qualified caseworker will review and determine your eligibility. Because Medicaid is based on financial need, applicants are asked for extensive information, such as family composition, income, property, and banking or investment resources.

Oregon Project Independence

Oregon Project Independence is a program designed to help people who do not receive Medicaid Long Term Care services stay in their homes. Services may include:

  • Home Delivered Meals
  • Transportation Assistance
  • Respite
  • Help in the home

Questions and Conversation Starters

Below is a list of common questions and issues facing aging Oregonians and their loved ones.

When should I have a care conversation with my family?

Talking about care issues before they come up makes them less stressful and emotionally challenging. Of course, many times care concerns come up unexpectedly, in which case you may not have the luxury of time. In either case, try your best to initiate a conversation about care as soon as possible.

I can’t continue to care for my aging parents and I feel so guilty and helpless. I feel like I’ve failed them. What can I do?

We all want to provide the best care for our loved ones, but sometimes we simply can’t do so by ourselves. Talking with family, friends, or health care providers may help you feel better about the situation. They may also provide suggestions on personal experiences that offer you comfort.

I get so overwhelmed by the legal and financial sides of care planning. Where can I get some help?

You can discuss these areas with an elder law attorney. Elder law attorneys not only know law, they also understand seniors’ unique needs and those considerations specific to care planning. Elder law attorneys offer education, counseling, advocacy, and planning. They can help you or your loved one prepare advance directives, such as living wills, or assist you with estate planning. For more information on legal and financial assistance, contact your Area Agency of Aging (AAA).

I care for my elderly aunt. How do I communicate effectively with her health care providers?

Caregivers play a vital role in communicating patient needs to medical professionals. First, establish boundaries. Ask your loved one how much she wants you to be involved in her medical care. Accompany your loved one on health-related visits and try to provide health care providers with as much detailed information as possible. Keeping records of symptoms and daily experiences can help your health care provider accurately assess situations and prescribe treatment. When you meet with health care providers, take notes and clarify any items you don’t understand. You can always do outside research or seek a second opinion. The key to effective communication is honest, informed conversations.

I have two sisters, but I feel like I’m alone in caring for our aging parents. How can I talk my siblings into helping?

While every family is different, it’s not unusual for one sibling to assume the role of primary caregiver. Because siblings have different personalities and different relationships with their parents, they often have different views of caregiving responsibilities. Dividing up caregiving equally can be difficult, if not impossible. A senior care counselor or social worker may also be able to help you work with your siblings to share responsibilities.

When I try to talk with my dad about care issues, he tells me not to worry so much. How can I make him understand I need his input?

You might try framing your conversation as a request for help. While parents may shrug off the need to plan for themselves, they often will respond to their children when they ask for help. You might say, “Dad, I worry that if something happens to you, I won’t know what to do. Can you tell me how you see the future so I can help you?”

I tried to talk with my parents about changing care needs, and the conversation went poorly. What do I do now?

First, don’t feel bad or guilty. The conversation may have not gone as well as you would have liked, but at least you took the first step in cooperative planning. Discussing topics such as dependence, money or end-of-life care is difficult and emotional. Like any conversation that doesn’t go as planned, you can always try again. Could you try a gentler approach or let your loved ones lead the conversation more? If you continue to have conversation setbacks, consider talking with other family members or an eldercare professional, such as a geriatric counselor.

I’m trying to discuss care concerns with my dad, but I feel like he is being stubborn and difficult. What can I do?

Talking about care can be frustrating and upsetting for everyone. Your loved one may feel like you are more concerned with your own needs or trying to make decisions for him or her. While this may not be the case, try taking a different approach. Be sensitive and empathetic to your loved one’s fears and feelings. Unless you need an immediate solution, give yourself the time you need to better understand your loved one’s concerns and future plans.