Senior Care & Elder Healthcare Guide
People are living longer than ever before, staying active and healthy into their 80s and 90s, which has changed how seniors are viewed, supported and treated in our society. As a result, there are more resources, health and treatment options, and residential and care settings than were available to past generations. There has also been a shift in focus from housing seniors to assuring a meaningful quality of life. This outlook acknowledges that seniors remain vital members of our communities, and their needs and interests matter.
Typical Health Challenges
Older adults face different health risks than their younger counterparts, and will require a different types of care. Depending on the severity of these health issues, a person may have to change their lifestyle, including where they live and the level of support they need to manage their health.
Impacting Short-Term Illnesses and Injuries
- Flu – an infection that includes fever, headache, fatigue and more. It often leads to dehydration, pneumonia and can worsen conditions including asthma and heart disease.
- Pneumonia – a lung infection that has a variety of unpleasant symptoms including coughing, fever, chest pains, nausea, and more.
- Shingles – a rash with shooting pains that is related to the chickenpox. It is extremely painful and continuous.
- Falls – can occur from tripping over carpet or furniture and slippery floors. Millions of seniors are treated in emergency room each year due to falls.
These seemingly small problems can have a life-changing impact on a senior. As we age, we lose our ability to fight infections, making these illnesses dangerous, and even deadly. Brittle bones can fracture during falls, which can also lead to serious problems. When seniors are bedridden due to a short term illness or fall, they lose muscle mass, become weaker, and may not fully recover even with physical therapy or other treatments.
Impacting Long-Term Disease and Conditions
- Heart Disease – encompasses a variety of issues including high blood pressure, strokes, angina and more. It is the leading cause of death among seniors, heart disease can worsen as we age due to inactivity and unhealthy diet.
- Arthritis – a painful disease of the joints that can limit a person’s activity level, which may cause additional health problems.
- Cancer – is the broad term for more than 100 different disease that are caused when cells grow out of control, creating tumors and other problems. Cancer is the second leading cause of death among seniors and preventative care and early detection should be a priority. Seniors are especially prone to developing colon cancer and should be proactive in testing for this disease.
- COPD and other Respiratory Illnesses – is one that affects the proper function of the lungs and related breathing processes. It is the third leading cause of death among seniors and must be actively managed to preserve health and quality of life, as well as reduce the risk of developing pneumonia.
- Alzheimer’s Disease and Dementia – is the deterioration of brain matter resulting in memory loss and cognition problems. Often an exact diagnosis is difficult, but in most cases there are limited treatment options and the focus is on delaying symptom progression rather than a cure.
- Sundowning Syndrome – related to dementia and Alzheimer’s disease, sundowning refers to the connection between the setting sun and an increase in confusion, anxiety, aggression or other behaviors by a senior. It is sometimes an early warning sign that the person is experiencing some level of dementia that has not yet been diagnosed.
- Osteoporosis – low bone mass that places a person at higher risk of a fracture or break when experiencing a fall or other impact. This disease category also includes spinal stenosis, which is a weakening and curving of the spine. The loss of activity due to this disease can worsen its affects and create additional health problems.
- Parkinson’s Disease – this progressive neurological disorder occurs when specific cells in the brain begin to die, limiting a person’s coordination and ability to control their movements. It commonly occurs among the elderly and has no cure, with treatment focused on managing symptoms and slowing the progression of the disease.
- Multiple Sclerosis – Although most people are diagnoses with MS before they reach age 50, many live with this disease well into their 80s, with symptoms changing over time. Seniors with MS experience many of the issues associated with general aging, but more intensely, including muscle weakness, balance issues, cognitive impairment, vision problems and fatigue. Decreased mobility from this disease increases risk of heart disease and urinary tract infections.
- Diabetes – results when the body experiences sustained high blood sugar levels due to decreased insulin levels. It can be fatal if left untreated but the symptoms can be managed through diet and exercise.
- Obesity – this issue can have many causes, the most common of which are diet and lifestyle. However many common medications, such as steroids and beta-blockers, can cause a person to gain wait. Obesity creates additional health problems including Type 2 diabetes, hypertension, heart disease, certain cancers, stroke, kidney disease and more.
- Depression – can have many causes and impacts seniors differently than other populations. When left undiagnosed and untreated, depression can worsen preexisting conditions, cause heart attacks and even result in suicide.
- Anxiety – affects more older adults than depression, and is more likely to go undiagnosed. Generalized anxiety disorder (GAD) is most common, although phobias, panic disorders, and obsessive compulsive disorders can also develop. All of these disorders hinder a person’s ability to function in their life.
Every one of these conditions can significantly impact independence, quality of life, and the level of care necessary for management or improvement of symptoms, treatment and overall physical and mental wellbeing. Each person’s needs are different and the challenge is finding the best solution for their circumstances.
Senior Living Options
There are many senior living options across the country and finding the right one for a specific person will depend on many factors.
Impacting Factors Influence Lifestyle and Residential Options
- Disease Progression – Medical care and emotional support needs are likely to change as conditions progress.
- Family/Community Support – Those with involved families and communities will have more options than those who do not have these resources.
- Financial Resources – People with greater financial resources, including cash in hand, investments, real property, etc., or those with children or other family members with these resources will have more choices than those without them.
- Treatment Compliance – Seniors who follow their treatment or health plans are more likely to maintain or improve their quality of life than those who do not, which impacts the choices available to them.
- Personal Strength and Resilience – People who are determined to live in their own homes, live life to the fullest, or work beat the odds are more likely to stay engaged in the world and experience greater physical and mental health, as well as overall contentment, than those who do not.
Based on these impacting issues, seniors have many choices regarding where they live. These can be categorized as:
There are a wide range of options for in-home care, and what you select will depend on your needs. Choices include:
- Companion Care – This is the most basic level of in-home care and is perfect for otherwise healthy individuals who are at risk of isolation.
- Personal Care Attendant & Home Health Aide – This level is appropriate when a person begins having difficulty with personal care tasks, such as bathing, dressing, and grooming needs.
- Homemaking Services – For those who need help keeping their home environment clean, these services can include mopping, vacuuming, laundry, dusting, ironing, and other tasks.
- Home Health Care – This level includes medical support that is either provided or supervised by an RN or LVN. Care can include tube feeding, IV therapy, wound care, medication management, and other services detailed under the medical plan.
- Adult Day Care – It is usually offered as a free-standing program or a day program within a residential facility, the senior lives at home or in another care environment and attends the program as scheduled. The program is often used by families who can be home in the evenings and on the weekends, but need daytime supervision of their loved one.
- Respite Care – For people receiving care in the home, this is a temporary residential care option that provides caregivers a chance to take a vacation, or just take care of themselves for a few days, without the burden and worry of caring for their loved one. Respite care can also be provided in-home, allowing the caregiver a few hours to themselves to run errands or participate in other activities.
- Hospice Care – End of life care provided in the home can bring comfort to the patient and their loved ones.
For seniors who are able to remain independent but want to be part of a larger community, an independent living environment is the right mix of personal living space and access to resources. Independent living may be a component of a larger senior campus or as stand-alone alternatives that may include:
- Congregational Care – Residents have their own living space, such as apartments, cottages, or villas, and have access to a variety of amenities that may include community centers, laundry, dining rooms, physical fitness areas, pools and more.
- Active Senior Communities – These are age-restricted communities that may include houses, condos, townhouses, apartments, and more. They often have a club-house, offer yard services, and social activities. Some are connected with golf and tennis clubs or other specific activity.
- Cooperative Housing – This unique option brings seniors together as members of a corporation who together own their building and land, manage their group budget and jointly make certain decisions. It allows the senior to take an active decision-making role in their living environment while enjoying the social benefits of the community.
Supported living is used when a person can no longer live independently and requires assistance for health and safety purposes. There are various levels of supported living and the best choice will depend on the amount of assistance the person needs. Options include:
- Assisted Living Facilities – This living environment is designed for people who want to live as independently as possible but need help with specific daily needs. Most facilities provide three meals a day, and assistance with bathing, dressing, medication reminders, and mobility.
- Nursing Homes – This residential living environment provides extensive care support for those unable to do so themselves. Residents receive food, support for all activities of daily living as needed, medical oversight and on-site nursing care.
- Continuing Care Retirement Communities – These campuses are often referred to as CCRCs and they provide a full continuum of living options including independent, assisted, skilled and nursing home levels. This is a great option for someone who, due to medical conditions, is likely to need higher levels of care over time. It is also a good option for couples when one needs more care than the other.
- Veterans Housing – The US Department of Veterans Affairs helps veterans access a wide range of residential programs ranging from independent living to skilled care. Each has its own eligibility requirements and availability.
Specialty Supported Care
Specialty supportive care are programs that offer services that address the needs of specific patient populations. Depending on the program, they will provide long term residential services as part of the program and others are utilized on a short-term basis. Specialty supported care programs include:
- Skilled Nursing Centers – These facilities provide temporary medical care for people whose conditions are expected to improve. They can specializing in rehabilitation or medical services and the patient will be discharged to their home or another facility.
- Convalescent Homes – For patients recovering from an illness, stroke, injury or other condition and requires continued treatment, they are often sent to a “step down” program after discharge from a hospital. These facilities are generally referred to as convalescent homes, which includes a broad range of programs such as skilled nursing facilities, inpatient rehabilitation facilities or rehabilitation hospitals.
- Alzheimer’s and Memory Care – These residential programs have the trained staff and physical design to provide the best care possible for this population. Safety and security are priorities as is establishing a calm, undemanding environment designed to address the needs of each specific patient.
- Hospice Care – Hospice care can be provided in the home, and as a person ages that home may be an assisted living facility or other residential program. In addition to these locations, some skilled nursing facilities and nursing homes provide specific hospice programs that provides all the end of life services the patient and family requires.
- Palliative Care – Palliative care offers similar services to hospice for patients and families in terms of comfort and care during final stages of life, but it is also used to care for patients with long-term, debilitating conditions. Palliative care can be provided in the home, hospital, skilled nursing facility and other settings, and care is received as long as it is needed.
As a person ages, their health issues and care requirements will change, and the best choice today might not be the right one six months from now. For this reason, it is important to evaluate your loved one’s needs on an ongoing basis to assure they have the support necessary to achieve the highest possible quality of life. Make an effort to anticipate needs and plan ahead so any necessary transition can be managed with as little disruption as possible. As you make these residential care decisions, remember that once you’ve identified the best type of program or living arrangement, you still need to investigate specific options to select the provider that delivers the highest quality of care.
Basic Care Needs and Payment
Whether living at home or in any level of senior living environment, basic health care issues must be monitored and managed. Too many seniors ignore or postpone these needs, which can exacerbate certain conditions. At a minimum, older adults should receive regular examinations that include:
- Dental Care – Seniors are more susceptible to certain dental problems including gum pockets, tooth decay, tooth loss, periodontal or gum disease, and denture stomatitis. Pain in the gums and teeth can cause someone to limit their diets to unhealthy levels, increasing the risks of experiencing other medical problems.
- Vision Care – Many seniors avoid a vision evaluation from fear that they will lose their driver’s license. The cost of these services is also a factor in delaying this care. General aging is the most common cause of impaired vision but vision deterioration can also be the result of diabetic retinopathy, glaucoma and cataracts. Many of these issues can be managed through treatment, protecting the person’s sight.
- Hearing Care – Hearing loss due to aging is common among the elderly population, and most is not curable or treatable. By age 75, approximately 50% of seniors experience detectable hearing loss and this increase to 95% by age 94. Hearing examinations are important to diagnosis the problem and monitor loss levels over time.
- Hearing Aids – The best solution for a person with hearing loss is a hearing aid, and an evaluation and fitting is necessary for the best results. Despite the great need for hearing aids, only 20% of seniors purchase one and even fewer use it. The reasons they don’t’ is cost, not wanting to look old, difficulty getting used to them, not liking how they look and unrealistic expectations of what they will accomplish. Despite these roadblocks, family members should encourage their loved one to purchase and use hearing aids to improve their quality of life.
Medicare and Medicaid do not pay for dental, vision and hearing care unless these is a medical need for these services. These programs also do not pay for hearing aids. Many Medicare supplement plans cover the cost of dental, hearing and vision care, and a few even include hearing aids and fitting exams, but these insurances will cost more. A few states’ Medicaid programs include coverage for hearing aids, and other financial resources may also be available.
Other Important Terms
As you evaluate basic health care services and residential options, there are common terms that are important to know and understand. These are:
- HIPAA – This acronym stand for the Health Insurance Portability and Accountability Act, and it refers to a law designed to protect a patient’s medical records and other health information from being made available to unauthorized people or organizations. Every healthcare provider must have a plan in place to protect your information and will often have you sign a paper stating that you are aware of their policies. This type of form is required by law and each provider must have their own HIPAA program, which is why you will sign many HIPAA forms throughout your adult life.
- Medicare – This is a federal program designed to provide necessary healthcare services to people 65 and older. There are limits to what is covered, both in terms of type of care and treatment locations, and these limits may be expressed as dollar amounts, number of allowed treatments or number of days of care. Some services have designated co-pays that must be paid by the patient, and some services are not covered at all, such as dental care. Purchasing a Medicare gap or supplement plan can lower copays and increase the types of covered services.
- Medicaid – This is a state program that provides necessary medical services to people of all ages who cannot otherwise afford the care. What is and is not covered under Medicaid is determined on a state-by-state basis, and you must contact the program in your state to determine if your needs are paid for through this service. Dental, vision, hearing, and hearing aid care are not covered by most Medicaid programs and there is no supplemental insurance options for this care.
Understanding Medicare and Medicaid coverages can be confusing, but fortunately many healthcare and residential care providers are experts on these issues and can help you make the best choice given your circumstances.