In the past, the question was often whether an elderly relative could remain
in their home or had to go to a Nursing Home. Today, there are multiple options, offering a full range of services. Many of
the facilities in this area have supplied us with copies of their material and you are welcome to take them.
at Home The first desire of most elderly people would be to remain in their own home. Properly supported,
this option frequently yields the best long term results. Aside from financial aspects, the key consideration is whether the
person will be safe at home. Specifically, if they are a fall risk, suffer from dementia, or are otherwise unable to perform
some of the activities of daily life (known as ADLs) it may not be possible to provide a safe home environment.
HISC has extensive experience in helping people remain in their homes. Many times a relatively low amount of incremental
assistance can substantially lengthen the amount of time an elderly person can remain home. A detailed list of the services
we can perform can be found in our brochure which you can request by calling 781-314-0153 or by filling out the form
on the page "Homecare From Us"
At some point, it is likely an elderly person will need additional assistance
to remain in the home. When they are unable to bathe themselves, become incontinent or require the administration of medication
it will be necessary to supplement the services provided by HISC with an agency able to provide these medical services. Many
times these agencies will come in for short periods 2-3 times a week to assist in these areas.
Home Care agencies,
such as HISC, normally charge between $18 and $25 per hour. For this you can expect a bonded and insured employee that has
undergone an extensive background check. Alternatively, you can hire a Caregiver privately for $10-$12 per hour, however,
you assume a significant insurance risk, especially workers compensation and unemployment coverage. If you hire a Caregiver
privately, you will not have access to the State's Criminal database (known as a CORI check), nor will you be able to check
your potential employee against the Elder Abuse Registrar. Finally, you will have no protection in the event the Caregiver
does not show up for a shift.
Homecare agencies are required to be licensed by the Massachusetts Department of
Occupational Safety. All licensed agencies are subject to a twice a year inspection and are required to maintain a Performance
Moving to an Eldercare Facility If the prospect of maintaining a private residence
is too much, or if is not possible for an elderly person to be left alone, it may be appropriate to consider one of the more
than 600 eldercare facilities in Massachusetts.
Many people are under the misconception that the choice is either
a nursing home or remaining at home. That is no longer the case. Today, there are 5 distinct and separate options to consider.
These include Continuing Care Communities, Retirement Communities, Assisted Living Facilities, Alzheimer Facilities and Nursing
and Rehabilitation facilities. Each of these options is discussed in more detail below. We should note that, except for nursing
or rehabilitation facilities, most of these options are not covered by medicare or medicaid and must be paid for privately
or with a long term care insurance policy.
It is absolutely critical to evaluate, at an early stage, the eldercare
facility option. Many of the more desirable facilities have two or three year waiting lists. Additionally, each facility has
their own criteria for admission. These criteria are both medical and financial and policies vary amongst facilities as to
how they operate under them. For example, two facilities may both require a medical exam before acceptance but one may require
an additional exam on the move in day. It is also important that the appropriate type of facility is selected. Some
facilities will require a resident to move out when their condition deteriorates while others, known as Continuing Care Retirement
Communities or CCRCs will keep a resident for their lifetime.
While you can undertake the process of identifying
and selecting a facility yourself the sheer number of different options strongly argues for the hiring of a professional to
assist you with this process. Elderly housing specialists generally charge an upfront assessment fee of around $300 and then
an hourly fee for additional services provided. Since facilities will range in cost from $2500 to $11,000 a month it makes
sense to use a professional. We have the names of some of the good local ones in our office on Route 9 or you can call your
local Senior Center or 1-800-AGE-INFO.
Types of Housing and Care The following describes
the various types of senior housing. We start with the most inclusive, a CCRC or Continuing Care Community, and then discuss
the various other senior housing options. We have marketing materials from many of the Eastern Massachusetts facilities in
our office on Route 9 in Newton. Please feel free to stop by and take some without the pressure you may feel in an actual
When the time comes for a site visit we STRONGLY recommend you take one of the checklists offered
by Senior Communities to assist you in your evaluation. You can find the checklists online at http://www.myguideforseniors.com/ResCommunityChecklist.asp
CCRC Continuing Care Retirement Communities. Combine independent living, assisted living
and nursing in a single setting. Typically these facilities have a hefty entrance fee but promise a lifetime of care. Generally
they will only accept new residents that are initially capable of living independently for a number of years. It is not unusual
for these facilities to have lengthy waiting lists. In this area, there are 8 CCRCs, including North Hill in Needham and Brooksbury
Village in Peabody. CCRC's generally require a large up front payment in return for a lifetime of care.
Retirement Independent living with amenities such as meals, transportation and activities. These facilities offer an excellent
transition from the burdens of home ownership but will normally require residents to move out when they require additional
care. Two highly respected ones in the area include Cabot Park Village in Newton and Norumbega Point in Weston. Retirement
communities are unusually rented on a month to month basis.
Assisted Living A combination
of housing, personalized supportive services and healthcare. Assisted Living facilities offer more than retirement communities
but significantly less than that offered by Nursing homes or rehabilitation facilities. There are a number of excellent local
facilities including Goddard House in Brookline, Boylston Place in Chestnut Hill (New England's only 5 star rated facility
and also its most expensive), Evans Park at Newton Corner and the Falls at Cordingly Dam.
Alzheimers Facilities offering specialized programs for residents suffering from memory loss. Some Assisted Living facilities
also have Alzheimers units (frequently called harbor units) including Goddard House and the Falls at Cordingly Dam. There
are also specialized facilities such as Epoch of Weston that just focus on the unique needs of these clients.
Nursing and Rehab Nursing and Rehab facilities offer the most intensive level of care for those people
with complex or potentially serious medical problems. Youville in Cambridge is good and the Newton Center is improving under
new management. Briarwood in Needham has just been bought by a family and will likely rapidly improve.
Care If a Seniors primary doctor determines the Senior is unlikely to live more than 6 months Hospice care
can be arranged. Hospice care can occur either in the home environment in in an elder care facility. Generally hospice care
is funded through government programs.
Hospice Care is especially traumatic for all involved although we have
found that the elderly person is probably the most comfortable with what's happening. The one thing to really watch out for
is that ALL parties that may be in the home or facility understand what a DNR order is and how they should respond (we intentionally
don't discuss it here to force you to ask about it).