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The Physical Challenges of Choosing In-Home Long-Term Care

Posted by Daniel J. Eccher, Esq. | Aug 20, 2020

According to a 2018 survey from AARP, aging at home is a goal for 3 out of 4 Americans aged 50 or more. Aging in place presents some physical challenges. These seniors and near seniors are willing to employ alternative solutions to facilitate the process. These alternatives include home-sharing (32%), building an additional or accessory dwelling unit (31%), and moving into villages that provide services that enable aging in place (56%). These communities become a source of support and engagement for residents and give a sense of grounding through memories of a long-time home environment. 

Seniors who want to reside in a community (aka, age in place) rather than seek residential institutions or nursing homes are mostly dependent on unpaid caregivers and family members for assistance with activities of daily living (ADLs). These activities include laundry, self-care actions like bathing and dressing, meal preparation, and transportation. Medicare provides some long-term care services and supports (LTSS); however, the LTSS program falls far short of the need. While the aging population in America is rapidly increasing, lawmakers have been slow to respond to the need to increase the availability of LTSS for seniors choosing to age in place. The goal of LTSS is not to replace but to supplement the contribution of unpaid family and caregivers. The addition of a Medicare benefit to support family caregivers as they help their loved ones would enable more aging adults to successfully remain in their homes.

Technology Provides Some Solutions For In-Home Caregivers

Technology is allowing in-home caregivers to monitor their loved one remotely while they stay engaged at work. Smart environmental controls and personal assistants have lightened the load of constant oversight but cannot replace the helping human touch. Nearly 60 percent of seniors who have seriously compromised mobility report being house or apartment bound, while 25 percent of those seniors say they often remain in bed and do not get dressed daily.

Low tech devices like canes, walkers, ramps, grab bars, shower seats and raised toilets can help increase the level of accessibility and safety for seniors aging in place, but transferring in and out of bed and moving around their homes still provides difficulty for many. The senior who wants to age in place is typically independent-minded and, therefore, has trouble foreseeing a time when help is not a want but a need. Aging adults and their families need to plan to address changing physical capacities before an adverse health event such as an unintended fall or dementia changes everything. While aging in place is a great goal for many seniors, it requires planning just as if they were planning to move into an assisted living facility.

Many Seniors Have Little or No Long-Term Care Assistance

Johns Hopkins researchers report 42 percent of older adults who have problems performing ADLs or are living with probable dementia receive no assistance at all from family, friends, or paid caregivers. That is a staggering number of unaided seniors. Additionally, twenty-one percent of seniors with a minimum of three chronic conditions and high needs received no assistance at all. LTSS through Medicare will have to make changes to meet the ever-increasing demand for human caregiving.

Approximately 60 percent of at-home seniors use at least one low tech device, most commonly for bathing, toileting or in-home movement, throughout their day but their needs multiply as they age. Unfortunately, Medicare does not cover the expenses of most of these nonmedical devices and services. The resulting problem is that low-income seniors go without assistance - human or technological - putting themselves in a very precarious position. Hardships for these seniors on the edge include the inability to pay medical bills or prescription costs, utilities, or rent, and some resort to skipping meals to balance out their unaided lifestyle. These situations are heartbreaking. 

The CHRONIC Care Act would allow Medicare Advantage plans to offer supplemental benefits for seniors to cover devices such as wheelchair ramps, grab bars, personal care, and transportation to chronically ill seniors; however, there are 21 million people who have needs to be met and how this will be paid for is unclear. Meanwhile, the 39 million people enrolled in traditional Medicare are entirely left out of any supplemental benefit. Affordability for at-home care is a significant issue on a personal, family, and government level.

Caregivers and assistive low-tech devices are an absolute necessity for seniors opting to age in place. The extent of the adjustments senior adults make as their needs become more profound are not well documented. As aging in place is a common strategy now, new solutions and programs must be explored to ensure success. 

If your strategy is to age in place, have a discussion early on with trusted counsel and family members to address some of the challenges you will eventually have to overcome. If you would like to discuss how we can assist you, get in contact with us by calling (207) 377-6966. 

About the Author

Daniel J. Eccher, Esq.

Daniel J. Eccher, Esq. is the Managing Shareholder at Levey, Wagley, Putman & Eccher, P.A., in Winthrop, Maine. Dan's favorite problem to solve is helping clients figure out how to afford long-term care while having something left for their family.

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