As we get older, it is not uncommon to experience physical and mental changes that make day-to-day life more challenging. Geriatrics and other experts say it’s important to plan ahead for our older years.
This means thinking about the type of care we seek and who will help us make medical decisions.
Thinking about the future not only makes for fewer surprises later, but it also lets us communicate our wishes ahead of time with the people closest to us in our lives.
“We are all blind to what happens to us if we become weak,” said Anna Chodos, a geriatrician at UCSF. “For most of us it is not, but when.”
Here are things to consider.
type of care
Most of us will need some level of care as we age. This may be help with cooking or dressing, or more serious medical aid. Think about the type of care and living conditions you want and what your financial situation will allow, and talk about your wishes with people you can trust in the future – whether it’s a spouse. Be it a child or a good friend.
Professional care at home – For those who want to stay in their home but need general day-to-day help, bringing caregivers into the home through an agency or privately may be a possibility.
Cost: Often runs around $30 an hour in the Bay Area. You can also choose to hire a live-in caregiver and pay a reduced fee for room and board. The In-Home Supportive Services (IHSS) program helps pay for caregivers for senior citizens who are eligible for Medi-Cal. Medicare generally does not cover ongoing care in the home.
What to consider: Is your home adaptable or can it be modified if you experience a loss of mobility?
residential care – Options range from small board and care homes to large assisted living facilities. These communities typically offer a variety of services, including showering and dressing, meals, activities, and more.
Cost: Can easily reach $10,000 or more a month, especially if memory care is involved. Assisted-living facilities are not considered medical facilities, so they are not covered by Medicare.
What to consider: Some facilities allow you to move while independent and take care of yourself when you need it. Find out early if you will need to move if your situation changes.
private hospital – Skilled nursing facilities serve people who need critical medical care.
Cost: Medicare limited nursing home stays. Medi-Cal covers long-term stays, but not all facilities accept Medi-Cal patients.
What to consider: People often stay in a nursing home for a short time after a hospital visit before returning home or leaving for an assisted living.
You’ll want to make sure you have important documents like your will updated and that you share information about where it’s located with people who will need to access it one day.
The Family Caregiver Alliance provides a downloadable form that provides an overview of documents to consider. The form allows you to indicate where various documents are stored and provides space for the names of important people such as emergency contacts, your doctor, and accountants.
You may want to set up an Advanced Health Directive, which lets you give instructions about your health care or name someone else to make decisions on your behalf. You may also want to give someone a power of attorney to make financial decisions on your behalf, outline the type of funeral arrangement and make sure your trust is in order.
To complement an advanced directive, the Physician Orders for Life-Sustaining Treatment (POLST) form gives critically ill patients greater control over care at the end of their lives. It is a document signed by both the patient or their legally designated decision maker and physician, and includes options such as “do not attempt rehab” and “comfort measures only”.
Other ways to prepare
If you develop dementia, what kind of medical care will you seek? Do you want change as dementia progresses?
Consider filling out a dementia instruction — such as an advanced directive but specific to dementia — and sharing it with the people who will help you make care decisions and your doctor.
You can explore other informal agreements with family or close friends, such as an agreement that the person you like will tell you it is time to stop driving for your safety.
Emily Deruy reported this story while participating in the USC Annenberg Center for Health Journalism’s 2021 California Fellowship.
Where to find my papers: https://www.caregiver.org/resource/where-find-my-important-papers/
Advanced Health Care Directive: https://oag.ca.gov/sites/all/files/agweb/pdfs/consumers/ProbateCodeAdvancedHealthCareDirectiveForm-fillable.pdf
Physician’s orders for subsistence treatment: https://emsa.ca.gov/dnr_and_polst_forms/
Dementia Directive: https://dementia-directive.org/