Here is the link to all posts in this series.
What is long-term care?
Long-term care or a long-term facility (LTF) is a thing we all dread. Basically, it is care in a nursing home. For many, it brings with it pictures of neglect, even abuse, the smell of urine, and the warehousing of sick, old people. It has a horrible connotation in the minds of most people, even to the point of many making their children promise never to put them in a “home” when they become old and infirm. And by the way, that is an extremely unfair promise for you to insist they make. There are too many variables that can’t be accounted for. Forcing them to make that promise is putting a burden on them that is unfair. Has God been able to be with you in the past during hard times? If His plan is for you to be in an LTF in the future, He will be with you there too.
But it doesn’t have to be this way. Granted, it takes careful looking and it won’t always be the cheapest home. But an expensive place doesn’t guarantee it will be well run. It just makes it more likely.
How to stack the odds in your favor at a long-term facility.
If you have a loved one in long-term care or a long-term facility, you will be wise to make yourself seen there often. It’s amazing how much better the care is when friends and family members pop in to visit and ask questions often. It’s a slant on the proverb that says, “It’s the squeaky wheel that gets the grease.” Staff members know you are watching out for your loved one, you want their care to be good and they won’t be able to ignore him under your watch. They know you are watching his things, so it is less likely they will be stolen. They know you are asking questions about his care for the doctor and nurses. They know it is less likely you will tolerate his care being less than optimal. It is human nature. Accountability tends to push us to behave better than we might if no one is watching.
When do you know it is time to care for your loved one in a long-term facility?
While there are often a variety of factors that may get you to this point, these are some of the major ones that will cause you to say, “Maybe my ability to care for my loved one is more than I can manage right now.”
- Your loved one has become combative or very unmanageable in his behavior. This point may come even sooner depending on your size compared to his or the fact that you have children in your home. Either way, his behavior has become unmanageable, even with medication, and living in the way you are is not sustainable for a long period.
- Your loved one is now unable to be moved in the bed and/or out of bed. Maybe he was able to assist you and was able to get to a toilet, now he is not able to get out of bed or turn over in bed. If he is a large person, it makes managing his situation impossible or nearly so, for you.
- Your loved one needs 24 hour a day care. Unless you can afford to pay someone to care for your loved one at home, this kind of care is not sustainable for you to manage at home by yourself.
These are two major reasons people have to move their loved ones to an LTF. At times, they can get in for the short term under medicare, but medicare will never be paying for the nursing home. It will either be with Medicaid, nursing home insurance, and/or your pocket.
How does my loved one pay for Long Term Care?
- But I have gotten ahead of myself. We need to back up a bit and figure out how long-term care gets paid for. That is where the problem comes. There is such a thing as long-term health insurance, but it doesn’t pay anything like the way health insurance pays for hospitalizations…usually. There aren’t as many people who have it either. And you need to pay the difference.
- Another way that long-term care is paid for is with Medicaid. Almost every nursing home has to have some Medicaid beds. So check out the individual facility because they can vary in quality from one to another. With Medicaid, you need to qualify financially, but there is a formula that I do not know. There are exceptions here and there so you will need help finding out what they help and how they apply to your situation. I found this article very helpful in answering many of my questions regarding Medicaid as it applies to nursing home care. Medicare does not pay for nursing home care with extremely few exceptions that prove the rule. Consider Medicare something that does not pay for long-term care except on a very short-term basis.
- Of course, I can’t leave out private pay as an option for paying for long-term care, but it takes a lot of money.
- A final option I almost left out is VA. I think they only pay in their own nursing homes, but again, there are probably exceptions there too. As with other types of payment, there may be VA beds in ordinary long-term care nursing homes.
When is the best way to work out all these details? It sounds very complicated. Especially if we are going the Medicaid route.
The easiest way to work out the details of getting into long-term care is following a hospital admission. Why? Because it can all be arranged by the social worker with your discharge planning. She can work with your family to come up with a plan that can work. There are arrangements that you may never have thought of that she knows about that can pay for it. You just need to work with her/him and find the arrangement that will work for all concerned. It may make for a busy few days, but it will be nothing like as crazy as if you had to make all the arrangements yourself and fill out the reams of paper and jump through all the hoops she knows about.
The other advice I give is that if you have any friends who have been in this situation, and often you have friends who have done it for multiple family members, they can give advice regarding preferred long-term facilities and ones to stay away from. They will be valuable resources. The same goes for family doctors/ nurses/ social workers/ etc. who are friends. Reach out to your friend group for helpful contacts they have found, etc. They can often keep you away from a bad situation or help you choose a situation that is preferred over others.
Wait a minute. Do you mean I have more details to manage? I can’t manage another detail!
I think this covers the highlights of long-term care. Now for the emotional side of it. In the middle of sorting through all these details, you will probably be overwhelmed with lots of feelings. The details involved with getting all this done can be daunting. You are tired physically and emotionally. You are at some level of grieving. There is no question, this is a difficult time at best. At least, you are holding onto your sanity by your fingernails!
Of all the things I have written about in this series, this is the one I haven’t lived through yet. However, I have watched many patients, their families and friends as well work through it with varied success. I have no doubt I may face this myself someday. I have no way of knowing.
- If you had a parent who made you promise not to put them in a “home” and now you are doing it, recognize that you are giving them the best care you can give them. For whatever reason, you realize it is not possible for you to care for them in a way that will provide for the needs of the other responsibilities in your life….family, job, your physical or mental stamina, I don’t know. But this is a very hard promise to manage when it is out of your ability to care for them any longer. First, it was an unreasonable promise and expectation of them for you. there was no way for you to know if this would be possible. When I think of all the possible things that could have changed your ability to keep this promise, I am astounded that anyone would require it of you. Single parents now, jobs when they need full-time care, children that also need care, and the list goes on. Turn this over to God. He knows you aren’t God. You aren’t superhuman. He knows you aren’t God and there are some promises you just can’t keep. Do not allow the Evil One to hound you with this one. God will forgive you for not keeping this promise, as ill-thought-out as it was. Jesus paid for your inability to keep all your promises when He died on the cross for you. In Christ, you are a wonderful child of your parents because He fulfilled every promise and kept every rule needed for you to be a wonderful child of theirs. Any attempt by satan to nag at you and tell you what a failure you are is a lie!
- If you are struggling with the sadness and loss of your loved one moving closer to the end of their life by taking this step into an LTF, take it to God in prayer as you cry out to Him. Ask close friends to pray for you as you grieve. It is real and appropriate. Depending on your temperament, ask them over or go out to lunch with them. You need to make time to feel the sadness, but there are also times for fun and distraction. Maybe you want to pick up a plant to cheer up your home or front porch. Maybe you want to do a small project around the house. It is difficult for me to know what suggestions to make. Think about the things that will bring you joy during this time. A pedicure, a bubble bath, a massage? Only you know. Take some time to enjoy those things. But make time for some fun projects with friends who are life-giving along with alone time too.
But now thus says the Lord,
he who created you, O Jacob,
he who formed you, O Israel:
“Fear not, for I have redeemed you;
I have called you by name, you are mine.
When you pass through the waters, I will be with you;
and through the rivers, they shall not overwhelm you;
when you walk through fire you shall not be burned,
and the flame shall not consume you.
For I am the Lord your God,
the Holy One of Israel, your Savior.
Because you are precious in my eyes,
and honored, and I love you…
Fear not, for I am with you;
Isaiah 43:1-5 ESV