Making Medical Decisions For People With Dementia
With dementia, a persons body may continue to be physically healthy. However, dementia causes the gradual loss of thinking, remembering, and reasoning abilities, which means that people with dementia at the end of life may no longer be able to make or communicate choices about their health care. If there are no advance care planning documents in place and the family does not know the persons wishes, caregivers may need to make difficult decisions on behalf of their loved one about care and treatment approaches.
When making health care decisions for someone with dementia, its important to consider the persons quality of life. For example, medications are available that may delay or keep symptoms from getting worse for a limited time. Medications also may help control some behavioral symptoms in people with mild-to-moderate Alzheimers or a related dementia. However, some caregivers might not want drugs prescribed for people in the later stages of these diseases if the side effects outweigh the benefits.
It is important to consider the goals of care and weigh the benefits, risks, and side effects of any treatment. You may need to make a treatment decision based on the persons comfort rather than trying to extend their life or maintain their abilities for longer.
Medicares Benefits For Alzheimers & Dementia
There is not a simple answer to the question does Medicare pay for Alzheimers care?. Medicare, like most health insurance, does not differentiate Alzheimers and dementia care from other conditions such as heart disease. Instead, Medicare has certain policies with regards to when and how much it will pay for care. For example, Medicare will pay for 100% of the cost of nursing home care if it is medically necessary for 20 days and 80% of the cost for an extra 80 days. If an individual with Alzheimers requires care in a psychiatric hospital, Medicare increases the number of days they will provide assistance up to 190 days.
Medicare does not pay for custodial or personal care that is provided in an assisted living residence. But it will pay for medical care provided in that location. The same applies for home care and adult day care. Personal care services, assistance with the activities of daily living and supervision that are typically necessary for Alzheimers patients are not covered. But medical care is covered. There is an exception to this for individuals receiving hospice care at home. Medicare will pay for homemaker services, which includes personal assistance for individuals determined to be in the final 6 months of their life.
New in 2019, Medicare Advantage plans are able to offer some long-term care services and supports as a supplemental health benefit, given they:
- Home modifications
- Personal emergency response systems
- Homemaker services
Turning Away From Nursing Facilities In Favor Of Home
But the authors say the findings which appear in the Journal of the American Geriatrics Society on Aug. 7, 2019 should not be interpreted as a call to accelerate moving people with moderately severe dementia from their homes.
Rates of nursing home use are declining because they are expensive and people generally prefer the familiarity of home, said first author Krista Harrison, PhD, of the UCSF Division of Geriatrics. People with dementia benefit from consistent and predictable environments and caregivers. Nursing homes may offer more people to help with medical and social needs, but that might mean sharing a room with someone with different daily habits or distressing behavior symptoms.
In keeping with the trend away from nursing homes, Medicaid spending on community and home-based services has surpassed spending on institutional care, the authors noted.
The participants were drawn from a sample of Medicare enrollees, representative of seniors nationwide. Some 499 of the total participants lived at home , 126 lived in residential facilities and 103 lived in nursing homes. In a 2015 study cited by the authors and drawn from a separate nationally representative sample of U.S. seniors, 58.7 percent with dementia were reported to have died in their homes.
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Trends In Potentially Inappropriate Antipsychotic Use Among Seniors With Dementia Improve Over 5 Years
Potentially inappropriate antipsychotic use among seniors in long-term care, percentage, 20112012 to 20152016
Potentially inappropriate antipsychotic drug use among seniors with dementia decreased between 20112012 and 20152016: from 38% to 26% in Ontario from 34% to 21% in Alberta and from 40% to 31% in B.C. This decrease was more pronounced among seniors with dementia than those without.
Mom Keeps Getting Kicked Out Of Assisted Living: What To Do
Esther C. Kane, C.D.S. Housing
Do you remember the episode on Everyone Loves Raymond where his parents moved to a 55 plus community and they ended up getting kicked out because of their behavior?
Well, sadly that happens in real life too. My friends mom is one of those people who keeps getting kicked out of assisted living facilities. Ever since she moved from her independent living apartment she has been to at least 5 assisted living facilities in the last 18 months.
My friend just wants a good quality long-term care facility for her mother, but every place they go, she seems to eventually get kicked out or asked to leave.
She keeps having to move her mom around from place to place because of her inappropriate behavior and refusal to cooperate with the staff. Its so exasperating trying to find the right fit for her. Most places shes been at wont take her back because shes caused so many problems.
It really breaks my heart to see this happen, especially since in this case its all due to mental health issues that have never been properly dealt with. Its a difficult situation and one that often gets overlooked in the elderly care system.
My friend is doing her best to care for her mom, but there isnt much she can do when the facility wont accept her. Shes often on the search for a place that will meet her mothers needs and accommodate her.
Are you in this situation too?
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What To Do About Medical Conditions
My sweet mom-in-law lives in an assisted living facility and she is declining physically and cognitively. She is now unable to care for herself or even feed herself.
The facility is not equipped to care for her needs so the family decided to hire a private aide that cares for her 24/7. Its an expensive decision but it allows us to keep her in her apartment vs. moving to another facility or nursing home.
Evictions top the list of grievances about assisted living received by long-term care ombudsmen across the U.S. In 2016, the most recent year for which data are available, 2,867 complaints of this kind were recorded a number that experts believe is almost surely an undercount.
Without that private care, the facility would have no choice but to evict her. Hopefully, she will not require medical equipment at any point because it may not be financially feasible for the family.
When it comes to needing medical care, its important to choose a living situation that can provide this type of care, if and when its needed. This usually means a skilled nursing facility. Also, skilled nursing facilities provide full care for dressing, bathing, feeding, etc.
Assisted living facilities can be an excellent choice for those needing a bit of help with their daily activities but who dont yet need medical intervention.
What To Do If Your Mothers Dementia Or Alzheimers Has Progressed
If your mother is suffering from dementia or Alzheimers disease she may require constant supervision to help keep her safe, especially if she wanders.
Not all assisted living facilities have the staff or the environment to protect your mother and the other residents.
The best action to take in this instance is to find a housing solution that can help her in her current condition. This is usually a memory unit.
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Dementia: How To Find The Right Fit For Long
Tap these resources to locate a memory-care facility for a loved one with Alzheimer’s or another type of dementia.
For Larry Barrett, the agonizing decision to find a memory care community for his wife, Martha, began 10 years ago. Thats when Larry first noticed that something was going on with Martha, then 60, a lawyer. Shed forget the name of a person she met the night before. On a trip to Louisville, Ky., where she grew up, she forgot the way to her childhood home.
Larry persuaded Martha in 2010 to see a neurologist, who diagnosed her with mild cognitive impairment. In the years that followed, Marthas condition progressed to Alzheimers. Larry tried to care for her himself, but things got complicated. He sold their house in Friendship Heights, Md., and moved them into a nearby apartment. Martha began to wander. Once, when Larry was attending a support group for spouses of people with dementia, the apartment buildings front desk staff called to say they had found Martha disoriented.
I was reaching the point where she couldnt be appropriately cared for at home, says Larry, now age 83. After a yearlong search, he found a nearby memory care community for Martha in 2017. The process took an emotional toll. Its one of the hardest decisions you can make in your life, he says.
Payment Options / Financial Assistance For Alzheimers Care
For most families, the expenses of caring for a loved one with Alzheimers or dementia are covered not by a single source, but instead by contributions from a variety of sources. Some of these resources are specifically designed for Alzheimers patients and others are of a more general nature.
Dementia Care Central is a free website that offers tips, suggestions, and videos on how to provide hands on care and gain the cooperation of persons with Alzheimers. Visit their site.
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What Should I Look For In A Dementia Care Facility
There are many things to look for when searching for dementia care facilities for your loved one. The first thing to look for is a credentialed staff of doctors, nurses, and caretakers. You should always look into the education and training of the staff that work at the dementia care home. They should have specific experience in working with dementia patients. You should also look at what the requirements are to work there – the more stringent they are during their hiring process, the more likely they are to provide great service for their patients.
Other things to consider are the cost of the dementia care facility and how close it is to the rest of your family. Senior care can be quite expensive, so its important to find a good memory care facility that fits within your budget. If youre struggling to pay for it, talk to the staff about payment plan options, and be sure to look into Medicare as well. There are ways to lessen the financial burden involved in dementia care. Many families will also want to keep their loved ones close, and would prefer a memory care facility thats within driving distance. This is an important consideration for many reasons – not only does it allow family members to spend more time with patients, but it also means that theres someone nearby who can come by in case of an emergency.
Most Seniors With Dementia Live At Home Despite Pain Anxiety Poor Health
Shortfall in Home-Based Medical Care for Memory-Impaired Patients Must Be Addressed, UCSF Researchers Say
Contrary to popular belief, most older Americans with advancing dementia remain in their own homes many until they die. But a new study by researchers at UC San Francisco has revealed that this population may endure more pain and have more complex or unaddressed medical needs than their counterparts in nursing homes.
In the study, researchers compared the medical characteristics of 728 adults over 65 with moderately severe dementia, in three settings: the participants own homes residential care, which spans the spectrum of retirement communities from those offering support at extra cost to assisted-living facilities and nursing homes, which care for people unable to attend to their most basic needs.
Although the living-at-home participants had an average age of 82, four years younger than the nursing home residents, the researchers found that they had more chronic conditions 3.2 versus 3.1 were more likely to be bothered by pain 70.8 percent versus 58.6 percent and had fallen in the last month or had concerns about falls 67.1 percent versus 50.4 percent. Additionally, they were more likely to have anxiety and fair or poor health, rather than good or excellent health.
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Policy Options At The Intersection Of Ltss And Dementia
Approach
We first reviewed four publicly available national plans and reports for strengthening LTSS and dementia care. All of these plans and reports have outlined strategies either for dementia or for LTSS , but none have focused exclusively on their interrelationship. In addition, many of the strategies apply a top-down approach in which federal agencies are mainly held responsible for implementing the strategies. In our approach, we identified options through engagement with a range of stakeholders from federal, state, and local levels, including patients, the public, purchasers, formal and family providers, public and private payers, policymakers, and researchers. This approach is necessary to involve stakeholders in a continuous process to more effectively move policy forward. The result was a list of 38 priority policy options grouped into three categories: service delivery, workforce, and financing. This three-domain framework is the same used by the Commission on Long-Term Care.
To qualitatively determine which of the 38 dementia LTSS policy options were the most promising, we evaluated these 38 options against 14 impact, equity, and feasibility criteria and summarized their impact , their feasibility , and the stakeholders responsible for or affected by the policy option.
Priority Policy Options
Alzheimers And Dementia Care
FamilyAssets Staff
With people living increasingly longer lives, the risk of developing Alzheimers disease or some other type of dementia is a very real possibility. In fact, someone is diagnosed with Alzheimers almost every minute in the U.S., while 1 of every 3 seniors will die with some form of dementia.
In this guide, you will learn about the changing care needs of individuals with Alzheimers disease and other dementias, as well as some of the financial and legal needs that may arise. In addition, we will identify some important things to consider and steps to take when selecting a long-term care facility for a person with Alzheimers or dementia. We will also highlight some of the key organizations and supports for caregivers and families of those affected by these disorders.
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How To Get Into Assisted Living With No Money
If you do not have the monthly income to pay for an assisted living residence, you may be surprised to find you can draw money from other sources however, Medicare is not one of them. Long-term care insurance will pay for assisted living, but you may have to jump through some hoops to receive your benefits. Many long-term care insurance companies automatically deny request for payment the first time. To get the insurance company to pay, you may need a doctor’s note describing your physical limitations that require help in at least two areas of activities of daily living. To speed along the process, ask a representative from the assisted living home to act as an advocate on your behalf.
Life insurance is another resource you may already have that can cover the costs of assisted living. There are many ways life insurance can help pay. If you want your life insurance to remain in place but are comfortable having less to leave to your beneficiaries, pull money out from the built-up cash value. If you are ready to cash out completely, expect to pay income tax on the full amount. Some policies do not allow cashing out before death. In this case, you may consider selling the policy to a third-party company in order to receive 50 to 75 percent of the original policy’s value. A final option is life insurance conversion, which converts a life insurance policy to a long-term care payment plan the downside to this option is that your policy value will be significantly reduced.
Advanced Planning Is Key
Although it does cover care planning with a medical expert, long-term care is not covered by Medicare. Individuals newly diagnosed with cognitive impairment, such as Alzheimer’s disease and other dementias, and their carers can learn about medical and non-medical treatments, clinical trials, and community resources with this coverage.
Individuals and their caregivers can use care planning to gain access to information and support to improve their quality of life and help them prepare for the future. Advanced preparation allows you to make decisions based on your financial status and available possibilities.
Read through our resources at Senior Strong to further understand what long-term care insurance for dementia has to offer and other dementia care facilities available to consider.
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What Are My Options For Long Term Care
You may qualify to purchase long term care insurance through commercial insurance programs or through the Federal Long Term Care Insurance Program .
- Eligible beneficiaries include active duty and National Guard members activatedCalled or ordered to active duty service for more than 30 days in a row. for more than 30 days, retired uniformed service members, and members of the Selected Reserve.
- Eligibility and enrollment requirements are complex. Not everyone who applies for this insurance will be approved for it.
- For complete details, please visit the FLTCIP website.