There are many options for keeping a loved one at home, including private, insurance-covered and state-subsidized home care, as well as –out-of-home day programs.  As Aging Life Care Managers® (ALCM’s), we begin our partnership with you by conducting a thorough assessment of your loved ones and family’s goals, their medical conditions, social and family supports, home safety, and financial and personal resources in order to determine their care needs and best strategies.  Based on that assessment, we work with you and your family to construct an individualized plan. 

There are many home options and alternate care facilities in Central Massachusetts – ranging from adult family care to assisted living, from rest homes to nursing homes.  When considering the best choice for your loved one and your family, we make recommendations based on excellence of care, specialized programs as needed, geographical location, religious preferences, financial requirements and more.

Developing a financial plan for providing care is often the most demanding part of the care planning process.  Paying for care out-of-pocket is expensive, ranging from more than $25 an hour for home care to over $12,000 per month for nursing home care.  A wide variety of subsidy programs support services from home care to nursing homes, but the qualification requirements differ for each program.  To make matters more complex, if you plan to meet the qualifications for one type of care subsidy, you may run into problems if your loved one needs a different level of care subsidy later on!

We have extensive expertise in understanding how to finance care in Massachusetts and how best to access appropriate subsidy programs.  To explore the options, you need to gather information on your loved one’s income (and spouse’s income, if married), their assets (and spouse’s), and any transfers of assets that your loved one (or their spouse) may have made in the past five years.  Based on this and additional financial records, as needed, we will work with you to create a cost-effective financial plan for your loved one.  As appropriate, we may refer you to other legal or financial planning professionals. 

It’s often challenging to convince your loved one to listen to and understand your concerns.  Underlying their refusal to accept help is the worry about losing control.  We need to approach our loved ones with respect for their independence and dignity.  A few helpful strategies:

• Pick your battles and focus on those issues of true concern.
• Find a good time for everyone involved and a comfortable place where your loved one feels secure to have “the talk.”
• Emphasize your understanding of your loved one’s need for control as well as your concerns for their health and safety.
• Perhaps identify another trusted person such as a physician, clergyperson, etc. that your loved one might listen to.

That said, even if you do your best and still meet with resistance – and if your loved one is cognitively capable – we may have to respect their right to make a bad decision, and plan and wait for the crisis that will enable you to take appropriate action.  We can help you to strategize how best to approach your resistant elder and how to plan, even without cooperation.

As independent, unbiased professionals, ALCM’s can often help families to stop battling over what Mom or Dad needs by conducting a care assessment.  We like to meet and/or speak with all members of a family so that we can hear everyone’s concerns and thoughts.  Our comprehensive written assessment enables you and your family to have a clear point of reference while you consider next steps.  When families get mired in intense disagreements and even the assessment and meeting are not helpful, we can refer you to professional elder care mediators who will help you to find workable solutions. 

Family care agreements have become more popular in recent years, possibly due to the level of care that family members are providing to loved ones, often at the cost of their own employment and health.  A family care agreement is just what it sounds like – a formal agreement between your loved one in need of care (or surrogate) and you as care provider to deliver certain services in exchange for compensation.  A written agreement protects all parties as well as clarifies the relationship for other family members and, perhaps, state agencies, if and when state subsidies are sought in the future for care.  The Commonwealth of Massachusetts has programs that pay for certain family members (generally not spouses, parents of minors, or legal guardians) to be caregivers.  We can help you to understand and access these programs. 

While Aging Life Care Managers should not be writing these agreements; the ALCM can provide a written assessment regarding the type of care needed, how it is provided and the financial value of the services provided.  We have done a number of these assessments in concert with elder law attorneys.  The assessment then becomes part of the family care agreement.   

Aging Life Care Managers often serve as liaisons for out-of-town family members.  We like to think of ourselves as “pseudo nieces” who are your eyes, ears, and caring hands here in Central Massachusetts.  We identify your loved one’s needs, put services into place, monitor the care and report regularly to you.  In consultation with you and your loved one, we adjust the care plan as needed.  Through our professional network, we can also recommend qualified ALCM’s outside of Central Massachusetts if you need support in other parts of the U.S. and even overseas, in limited circumstances. 

There are many factors that go into the choice of an alternate care facility.  We often recommend that your loved one move to a facility near family or friends.  The presence of visitors and others to monitor care is critically important.  If there are no available family or friends nearby, your ALCM can be the liaison and surrogate family.

We also suggest that you consider your loved one’s religious or ethnic preferences.  Word-of-mouth reports from others are useful as well – but take these with a word of caution:  Two families or individuals can have vastly different experiences with the same facility, even at the same time.  We have many stories of clients with positive and negative experiences at the same facility.  An ALCM can also offer guidance for facilities to be considered for your loved one.

After identifying possible locations, you can check your state’s Department of Public Health website to locate annual reports on nursing homes.  In Massachusetts, you can find these on the Health and Human Services website, following the link for Nursing Home Survey Performance Tool. The federal Medicare website also offers information and comparisons.  The Massachusetts Executive Office of Elder Affairs [(617)-222-7586] has an assisted living ombudsman program which may offer some guidance regarding facility complaints. 

It is important to realize, however, that these reports are snapshots in time.  The decision makers (including your loved one, as appropriate) should visit those facilities you are considering.  It’s a good idea to take the formal tour with an admissions representative and then go back at a different time of day to get an informal sense of daily operations. 

Consultation with an ALCM can also help you to formulate a longer term care plans that can be implemented as the disease progresses. 

An early diagnosis of Alzheimer’s Disease or other chronic illness presents you with an opportunity to plan for the future and execute important advanced planning documents.  These may include: 

• Durable Power of Attorney –This document names an agent or agents to act on one’s behalf with respect to financial and other matters.
• Health Care Proxy – This document names an agent and an alternate to act on one’s behalf with respect to health care matters when one can no longer make decisions.  This is also a very good time to discuss your or your loved one’s wishes so that the agent will understand what decisions should be made.
• HIPAA Consent Form –This document names an agent to obtain medical information or review medical records.
• Will – A will directs what happens to an estate after the principal’s passing.

There are other legal documents, such as trusts, which might also be part of an estate plan.  We recommend that our clients see elder law attorneys who work exclusively with elders and persons with disability, who consider the entire family situation, and who will craft an estate plan that meets their loved one’s stated goals while leaving open the best option to obtain care in the future.  Elder law attorneys should understand the various subsidy programs and work with you to arrange assets to maximize care options and eligibility to subsidy as needed.  The rules around these programs are very complex and ever-changing; be certain to work with someone who specializes in this area and up-to-date on its many intricacies.  We can suggest local attorneys or you can find an elder law attorney at www.naela.org.

For supportive services and education, we also recommend that you connect with the Alzheimer’s Association or call 508-799-2386 to speak with someone in the Central Massachusetts office.  The Alzheimer’s Association offers a wealth of programs, training, support groups and written materials that can be most helpful.   They offer a Care Consultation program – a free one-to-one-and-a-half-hour consult with an Alzheimer’s Disease expert.  One of their most popular free programs is called “Getting Started: A Primer After Diagnosis.”