How Do You Want to Live at the End of Life?

Why It Matters:

  • When it comes to eldercare living arrangements, knowing what to expect is the most important first step.
  • The type of living arrangement available often depends on the level of care required.
  • Cost is often a concern as some of these living situations can be very expensive.

Everplans tkc.profilePicture Written by: Everplans | Transamerica
May 21, 2018

4 Min readClock Icon

How far in advance do you plan vacations? A month at the very least, right? You’ve booked the flights and hotels, taken time off of work, gotten the kids out of school and generally looked forward to the getaway from the moment you made the arrangements.

This is how you should view eldercare.

Granted, the circumstances may be tough. You or a loved one may have trouble getting around, taking care of regular daily activities, or one of you may become ill. And since you can’t predict the circumstances that life will throw your way, take a moment to consider the available options.

4 things to consider right now

  • Health: Will you need professional assistance for any medical issues? Even if you’re not ill, perhaps you want easy access to medical professionals just in case.
  • Finances: Long-term care is often pricey. Do you have the means to live where you want to live?
  • Location: Do you want to be near family and friends or do you want a complete change of scenery?
  • Independence: Do you like doing things on your own or do you want someone else to pitch in and help out with your daily routine?

Granted, it’s hard to predict all of these things in advance. But knowing what to expect and prepping yourself for different possibilities is an achievement in itself.

How do you want to live at the end of life?
Eldercare — and particularly end-of-life — decisions can be difficult to make because you’re often not making them alone. These decisions will often affect your family and close friends as well.

While it might be a tough topic to bring up, it’s helpful to get different perspectives from all the people who matter to you.

Types of end-of-life housing and care
The most common end-of-life housing and care options are assisted living, in-home care, and nursing home facilities. Let’s take a look at what each has to offer and the considerations you may want to think over.

Assisted living
Assisted living is a good option if you can manage your own care but need occasional help with activities of daily living, such as cooking, cleaning, and managing medications. Assisted living facilities also have doctors and nurses on staff at all times for emergencies.

Facility overview

  • Most assisted living facilities offer a large degree of independence, which means a small apartment with a kitchen or a bedroom with a bathroom, although some assisted living facilities offer shared bedrooms.
  • Rooms or apartments may be furnished or unfurnished.
  • All rooms should come equipped with emergency call systems in the room.
  • Most assisted living facilities also have a dining room and at least one common room for socializing, while some also have features like game rooms, cafes, libraries, computer rooms, gyms, and other recreational facilities.

Basic services offered

  • Meals
  • Housekeeping assistance, including laundry
  • Transportation assistance
  • Help with bathing, going to the bathroom, dressing, and grooming
  • Help managing medications
  • 24-hour staff and emergency medical services
  • Facility security

Additional services

  • Scheduled entertainment and recreational activities
  • Physical therapy
  • On-staff medical specialists

How much?
The costs vary based on location, facility amenities, the size and style of the room, and services provided. In general, they range from $1,000 to $5,000 per month. Though Medicare will not cover the cost of assisted living, some facilities will accept Medicaid.

In addition, some facilities will accept long-term care insurance, HMO and Managed Care plans, and other forms of insurance. For the most part, however, you will likely have to pay the bulk of the cost yourself.

Learn more: Checklist: Questions to Consider When Choosing an Assisted Living Facility

In-home care
In-home care (also called home health care), is a good option if you’d like to continue to live at home but need some help with activities of daily living, such as cooking and cleaning, using the toilet, bathing and dressing, eating, and managing medications.

Most in-home care is non-medical care, meaning that those providing care are either professional caregivers, certified nursing assistants, or friends and family, rather than registered nurses or physicians.

The two types of caregivers
It’s important to consider the difference between the two types of in-home caregivers. One is called a home care aide and the other a home health aide. Here’s the difference:

Home care aides (HCA) are people who provide help with household duties such as housekeeping, laundry, cooking, shopping, personal care, transportation, and general care. There’s no state or federal certification required to be a home care aide.

Home health aides (HHA) have received formal medical training and are usually certified nursing assistants. These professionals can provide basic healthcare services including monitoring your pulse, body temperature, and blood pressure; managing and administering medications; monitoring wounds and changing dressings.

In addition, medical professionals such as registered nurses, nurse practitioners, physical therapists, occupational therapists, and physicians may all play a role in in-home care.

In-home care costs
Your cost for in-home care depends on the type of care you’re receiving, including the number of home care aides or home health aides you’ve employed. Medicare, Medicaid, and private insurance will all cover some portion of in-home care services but you’ll need to provide evidence that the treatments are medically necessary. Since insurance plans vary, there may be additional qualifications or criteria for coverage. For example: Many insurance companies won’t cover home care aides because it doesn’t qualify as a medical necessity.

In the case of home modifications, some insurance plans will cover some of the costs of modifications if they were recommended by a doctor and seen as medically necessary by your insurance company. In some cases, home modification products are ordered by the doctor so insurance can cover the cost.

Possible home renovations for in-home care
If you choose to stay in your home, consider how a medical situation or disability may create the need for renovations. These adjustments may include the following:

  • Widening doorways to accommodate a wheelchair and installing ramps
  • Installing a stair lift or wheelchair lift on stairways
  • Relocating a bedroom from the second-floor to the ground-floor
  • Replacing a standard bed with a hospital bed
  • Installing handrails in the bathroom and shower
  • Installing a bench or seat in the shower or installing a wheelchair-accessible shower

Learn more: Checklist: Questions to Consider When Choosing In-Home Care

Nursing home or skilled nursing
A nursing home is for those who need a high level of medical care — a full staff of doctors and nurses — in addition to help with activities of daily living.

Facility overview

  • Bedrooms and bathrooms may be private or shared.
  • Bedrooms may be furnished or unfurnished.
  • All rooms come equipped with emergency call systems in the room.
  • Most nursing homes have a dining room and at least one common room for socializing, while some also have features like libraries, outdoor spaces, and other recreational facilities.

Basic services offered

  • Meals
  • Housekeeping and laundry
  • Transportation assistance
  • Help with bathing, going to the bathroom, dressing, and walking
  • Help managing medications
  • 24-hour nurses and staff
  • Emergency medical services
  • Facility security
  • On-site physical therapy and occupational therapy
  • Scheduled entertainment and recreational activities
  • On-staff medical specialists

What’s it cost?
Nursing homes are quite expensive, averaging about $6,000 per month. If you don’t have the means, here are a few options to lessen the financial burden:

  • Medicare will cover a short-term stay in a nursing home (usually about 100 days), and often requires that the stay take place within 100 days of a hospitalization.
  • Medicaid will likely cover most of the costs of a nursing home, though not all nursing homes accept it.
  • Long-term Care Insurance may cover some or all of the costs of a nursing home, depending on the rules of your policy.

Learn more: Checklist: Questions to Consider When Choosing a Nursing Home

Have you made a plan for how you want to live out your senior years? Or, have you had to assist in helping an elderly friend or family member make this decision? Tell us about your experience and join the conversation over on The Community.

Things to Consider:
  • Taking the time now to think about the living and care options for your senior years can save you the stress of making a major life and financial decision at a time when you may feel unprepared.
  • Consider where you would like to live when you’re healthy and when you’re sick. The varying degrees of care may require a second housing option or additional available funds.
  • If you’re not sure what geographical location you’ll end up in, have a good idea of what kind of facility you would like to be in. This may help to define how you want to live, no matter what the location.

This article is provided by Everplans — a life and legacy planning company dedicated to transforming the way people get their families organized. For more information, visit: everplans.com

Neither Transamerica nor its agents or representatives may provide tax, investment, or legal advice. Anyone to whom this material is promoted, marketed, or recommended should consult with and rely on their own independent tax and legal advisors and financial professional regarding their particular situation and the concepts presented herein.

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