* The following blog is reposted with the permission of Dr. David Lundin, and first appeared on BreezyMama.com on Jan 17, 2013.Continue reading on Livestrong Voices »Read Blog
You may have concerns about being able to live at home after cancer treatment. Perhaps you have a temporary or permanent physical change or a broader need for assistance with health and personal care. If home health care is not an option, it may be time to consider assisted living or nursing home facilities that provides care in a residential atmosphere.
Many people are opposed to the idea of moving into an assisted living or nursing home facility. You may feel too young or fear the thought of giving up more control. Remember that the move may be temporary. Also, in a good care facility with a supportive environment, you may actually feel more empowered by letting other people assist you with tasks.
Talk to family, trusted friends and your health care team about whether you may have health and safety needs that can no longer be managed at your home. Together you can identify areas where support and problem solving may be needed.
When to consider assisted living or nursing homes:
- Physical health: Limitations caused by chronic diseases or physical disability may cause difficulty performing activities of daily living (ADLs) such as walking, dressing, bathing and preparing meals.
- Mental health: Diagnosis of psychiatric disorders, such as depression, anxiety, psychosis or dementia may result in confusion, disorientation or isolation.
- Concerns about medications: Inability to take medication as directed or a possible need for intravenous (IV) drugs or dialysis.
- Support systems: Lack of a support system, such as key friends and family who can be called in an emergency and are able to assist when you need them.
- Finances: Difficulty managing your own financial affairs or inability to meet present and future care and home maintenance needs with current income sources.
Assisted Living vs. Nursing Homes
Some long-term care facilities provide both assisted living and nursing home care. This allows a resident to start out in an assisted living environment and move into the nursing home level of care later if medical needs change. Ask for more information from your health care team or contact care facilities directly.
Here's an overview of assisted living and nursing home services:
Assisted Living Facilities
|Assisted living homes are not for people who need constant professional nursing care. They provide a combination of housing, personalized supportive services and health care designed to meet the needs of people who require assistance with the activities of daily living.||Nursing home residents rely on assistance with most or all activities of daily living, such as meals, bathing, dressing and toileting. Regular medical supervision and rehabilitation therapy are available. These facilities are licensed by the state and may be certified.|
|Services include meals, housekeeping services, transportation, health promotion and exercise programs, personal laundry services, social and recreational activities. Provides access to health and medical services such as emergency call systems, bathing, dressing, medication management and needed assistance with eating, walking and toileting.||Services include medical care, assistance with personal care, meals, housekeeping and social activities. Provides 24-hour skilled nursing care and medical supervision for the more acute (critically ill) patients that are one step below hospital acute care.|
|Not usually paid for by health insurance or the Medicare or Medicaid programs. Can be paid for by a long-term care insurance policy, but most individuals pay the cost themselves. Costs will vary depending on the level of care and services provided.||Sometimes paid for by private pay, private health insurance policies or long-term care insurance policies. Medicare or Medicaid may pay for nursing home care under certain circumstances. Costs will vary depending on the level of care and services provided.|
Paying for Assisted Living or Nursing Home Care
Payment may come from your insurance coverage, Medicare or Medicaid, from personal funds or from a combination of both sources. You may also Check with Medicare, Medicaid and your insurance providers for detailed information about their policies.
For more information about Medicare, Medicaid, insurance and other types of payments, talk with your health care team members, an area agency on aging, a hospital discharge planner, an attorney who specializes in elder law or an admissions department of an assisted living or nursing home facility. Be prepared with:
- Your Social Security number.
- Information about your health condition.
- The reason an assisted living or nursing home facility is necessary.
- Information about your current insurance coverage.
Each state has an Ombudsman Program to provide information about how to find an assisted living or nursing home facility and what to do to receive quality care. The program also responds to complaints and will provide an ombudsman (government official) to advocate for residents and work for improvements in the long-term care system. If you choose a facility you are not happy with, ombudsmen are trained to resolve problems, identify, investigate and resolve complaints made by or on behalf of residents.
Other good sources:
- Elder care advocates, such as through an Area Agency on Aging.
- Hospital discharge planners.
- Hospital or care facility social workers.
- Doctors or other members of your medical team.
- Local and national cancer organizations, such as Livestrong Cancer Navigation Services.
- The Joint Commission (for reports on facilities).
You can also check with your local Department of Consumer Affairs or Better Business Bureau to see if any complaints have been filed against a facility.
Factors to consider:
- Licensure and certification: Is the facility licensed, certified and does it have a good record of providing quality care?
- Cost: How will the costs be covered for this living arrangement?
- Assistance: Does the facility provide the medical and personal assistance you need to manage your daily needs?
- Facility philosophy: What goals does the facility have for residents? For example, does the facility encourage residents to be active and independent?
- Medical care: Does the facility have reasonable access to medical care, treatment centers and a hospital if necessary?
- Life in the facility: Are social or learning opportunities offered along with medical and practical care?
- Residents: Would you be comfortable living in the same environment with the residents of the facility?
Visiting a Facility
Think About These Aspects of a Facility
- Accommodations (cleanliness, furniture, room, group space, safety, visiting hours, rules).
- Personal and medical care (staff, limits to medications, current residents' opinions).
- Activities and services (leaving the facility, transportation, wheelchair access, exercise facilities, salons, religious services).
- Food and meals (meals included, special diets, bringing in food).
- Residents (happiness factor, residents council or union).
- The assisted living or nursing home admission contract (payments, length of time, temporary or permanent, contract terms).
The best way to find out whether the facility appeals to you is to visit the facility on multiple occasions and at different times of the day. Be sure to talk with both residents and staff. First, call the facilities that are of initial interest to find out if they accept your type of payment plan and if they have space available. Next, arrange for at least one visit to the facility and if possible, make two or three visits.
Tips for your visit:
- Try to visit at least one time unannounced, during a meal time and on a weekend. This will allow you to see the food they serve and how many staff members are available on the weekend.
- Speak with residents and staff members to find out what life is really like in the facility.
Make a list of what factors are most important to you, such as:
- Level of independence given to you.
- Comfort of the environment.
- Cost and insurance coverage.
- Convenience to family and friends.
- Bring a friend or family member with you so you can get their impressions.
Preparing for the Change
Many placements made directly from the hospital to a skilled nursing facility are temporary--an average of four to six weeks. However, even in temporary situations, such a major change in your life can bring up feelings of loss or fears about the future. You may experience grief about having less independence and feel anxiety about leaving familiar surroundings. Such feelings and concerns are understandable and many people have them.
Consider sharing your feelings with trusted family, friends and other people who are in your situation, such as a support group. If your feelings about this decision become overwhelming, talk to a professional such as a hospital social worker, psychologist or counselor.
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Landay, David S. Be Prepared: The Complete Financial, Legal and Practical Guide to Living with Cancer, HIV and Other Life-Challenging Conditions. New York :St. Martin's Press, 1998.
"The Long-Term Care Ombudsman Program." About.com. 10 July 2006. http://seniorhealth.about.com
Morris, Virginia. How to Care For Aging Parents. New York: Workman Publishing, 1996.
"Senior Housing Types and Glossary of Senior Housing Terms." Senior Outlook.com. Senior Outlook: A Guide to Senior Housing. 9 August 2006. www.senioroutlook.com
U.S. Department of Health and Human Services, Centers for Medicare amp; Medicaid Services. Medicare amp; You: 2006. Baltimore, MD, 2006.