What, Where and Who

These three words represent critical questions on what kind of care a person with
dementia or physical disability will need, where that care will be given, and who is going to pay for it.

What kind of care is determined by the activities of daily living (ADLs) a person can or cannot do. These are dressing, bathing, toileting, eating, or having an overall safety risk. If a person is unable to put on clothes, or dress appropriately due to dementia or physical problems, or if that person needs prompting to do those activities, he or she misses that activity. If he cannot bathe because he would not remember to bathe or needs supervision or help to avoid falling getting into or out of the shower, he misses that ADL. Someone who is incontinent or needs changing “Depends”, or who cannot do proper hygiene when toileting, misses that ADL. A person who cannot feed himself by putting food into his mouth misses that ADL. Note that preparing meals is not the test. If it did, I’d miss that one as I can’t cook worth beans. Being an overall safety risk means that the person would be a danger to himself by being a serious fall risk or leaving on the stove, or not being able to get out of the house in time in case of a fire. 

If someone needs help, that can mean a companion, or a home health aide or a nurse. A companion keeps company, could prepare meals, and is there for safety reasons. A home health aide can assist with bathing, dressing, feeding and can prepare meals, and give reminders to take medications. If injections are required a nurse is needed and that means higher expenses.

If someone cannot get up on their own two feet, a Hoyer lift might be required, or two aides might be needed. It is increasingly difficult to find home health aides due to COVID, because many care workers have children, and some cannot work because of childcare needs. In addition, some workers have traditionally come from the NY area and right now there are fewer of them.

Where to get the care is a critical issue. Most people want that care at home. Let’s face it, no one prefers a nursing home. We are fortunate that Connecticut has better homecare programs than most states. It has some of the strictest eligibility rules in the country, but has good funding if a person can qualify. That can include care in the home, and day care at a nearby facility. Day care gives socialization as well as supervision. We had a lady whose children convinced her to go to day care by saying she would be helping set tables as a part time job. After two weeks she demanded to know where her paycheck was.

The decision of staying in one’s home may depend in part on the physical layout. Are
stairs a problem? Is there a room or space where an aide can sleep? Can the bathroom accommodate a wheelchair? And for round the clock care an aide must get 5 hours of uninterrupted sleep for every 24-hour period. 

The who question is who is going to pay for the care. The cost is quite expensive and beyond the means of most people who need long term care. Unless there is a rare person who has long term care insurance, government programs must help pay or many people would be forced into a nursing home. At some point, most people need to evaluate if they qualify for VA benefits for a wartime veteran or a widow of a wartime veteran, or qualify for the Connecticut Home Care Program for Elders Level II or III. Level II is solely funded by Connecticut, and Level III is Medicaid, which can pay over $71,000 per year for home care. Knowing the eligibility rules is very important because Connecticut pays for the care but does not pay for living expenses. Therefore families who prepare in advance to qualify by getting accurate advice on protecting assets increase the likelihood they will have sufficient funds to pay for living expenses. If there are not enough funds for living expenses, it does no good to have the care paid for by the state, because the needy person won’t be able to afford to stay in their home. Doing proper planning for the cost of living at home is a big issue for staying in your home, whether it’s a house, condo, or an apartment. 

Those who plan and get sound advice on how to plan for the What care is needed, Where it will be given, and Who will pay have a far better chance of getting the care they may need to stay out of the nursing home and in a more desirable living arrangement.