There's No Place Like Home: Elderly Qualify for Wide Range of Services
Jane Bennett Clark
Home care and skilled nursing
"What would I do?" says McCarthy, who's held the post for 20 years and, at 87, is running for reelection. "It keeps me busy."
McCarthy has lived in his home for 35 years. Five years ago, he suffered complications from knee-replacement surgery that left him wheelchair-bound and unable to drive. Now he gets around with the help of paid companions, wheelchair-accessible public transportation, and assistive devices and renovations that let him navigate his home and keep him safe. Leave home and job for a retirement community? No way, says McCarthy, rocking gently in his brown-corduroy glider. "I'm settled."
Like McCarthy, the overwhelming majority of people 60 and older prefer to grow old in their homes and communities, according to an
SET UP HOME CARE
However independent they hope to be, most adults who grow old at home eventually need help with housekeeping and transportation -- and sometimes with daily activities, such as dressing and bathing. The most likely helpers will be family and friends (usually spouses and daughters), according to the
For McCarthy, daily care from his family isn't an option: His wife, Helen, died years ago, and the nearest of his five children lives in
That may sound pricey, but it's cheap compared with the cost of an assisted-living facility, for which the median price is
Most long-term-care policies cover home care, including homemaking and personal services, but only a small portion of U.S. adults carry private insurance to pay for nonmedical services.
Hiring a caregiver can be less expensive than going through an agency but it involves vetting candidates and doing a lot of paperwork. As an employer, you must pay
Some states require disability insurance, as well. And you are responsible for having employees fill out an Employment Eligibility Verification form, which affirms that they're legally entitled to work in the U.S.
The most comfortable and equitable arrangement is often to pay a family member to provide care. But even when that's the case, the duties should be spelled out in a formal contract and payments should be in line with rates for the area. Drawing up such a contract can help shrink an elderly person's estate without jeopardizing future
In recent years,
Adult children who are overwhelmed by the choices, or live a considerable distance from their parent, might consider hiring a certified geriatric-care manager. These professionals will assess the needs, develop a care plan and, if necessary, supervise its execution.
"If you're on the
LINK WITH OTHERS
McCarthy lives off a winding, two-lane road several miles outside of town. To run errands and get to doctor appointments, he takes a public bus that accommodates his wheelchair. McCarthy schedules the trip a day ahead, and the bus driver picks him up and drops him off at his doorstep. The price for this chauffeur service:
McCarthy is a beneficiary of the Americans With Disabilities Act, which requires public transit for the disabled, and the Older Americans Act, which promotes (and partly funds) community services to help the elderly age in place, including home-delivered meals, telephone check-ins and case management. Local area agencies on aging identify, coordinate and sometimes administer the programs.
"They make sure that older people's needs are met," says
If your parent lives in a neighborhood with a high percentage of older residents -- otherwise known as a naturally occurring retirement community, or NORC -- he or she may enjoy an even stronger support system. Successful NORCs pull together services for their elderly residents through local social-services agencies, businesses and philanthropies, says
A few NORCs, such as one in
RETROFIT THE HOUSE
McCarthy, who lives and works on the first floor of his 1960s-era rambler, has made modest changes to his home and habits to stay safe and comfortable. He had the doors to the bathrooms and bedrooms removed to make room for his two wheelchairs (one of which is electric), and he had a wooden ramp installed outside his back door.
Each room in the house, including the bathroom, has a phone, but he also wears a medical-alert necklace to get emergency help when he is outside or beyond reach of a phone. McCarthy uses a "grabber" device mounted on a wooden pole to reach objects that are high up and another pole with a metal prong to flip light switches.
Such minor accommodations are often all an elderly person needs to live at home indefinitely, says
Among the easy fixes: better lighting, wheelchair-friendly floors, grab bars, and hinges that hang on the door outside the door frame, creating a wider opening. Bigger projects include installing a no-threshold shower, chair-height kitchen counters and maybe a home elevator, which runs
Loss of mental acuity increases the chances that an older adult will fail to recognize danger or have a mishap. You can keep an eye on your parent and his or her house remotely with an environmental-sensor system, such as the Sensaphone (about
All frail adults would do well to sign up for a personal emergency alert system, such as the Philips Lifeline (about
"The main thing about technology for the elderly is that it has to connect with someone outside the house," says
FREE UP FINANCES
Despite the recent decline in home values, your parent's home may represent the financial resource that allows him or her to age in place. A small but growing number of homeowners are tapping their home equity to cover the expenses of remaining at home, using a home-equity line of credit or a reverse mortgage, according to a 2009 report by
With a home-equity line of credit, you can borrow up to 80 percent of the appraised value of the house (but significantly less in areas where home values have fallen) and repay the amount over a fixed period -- say, ten years. Most lenders require a credit score of at least 680 and documentation of income and assets.
The interest rate, which is variable, depends on the size of the loan and the region. Recently, rates have averaged about 5.65 percent for a
Another option, a reverse mortgage, offers a solution for older homeowners who are house-rich but cash-poor. These loans let seniors who are at least 62 draw on a portion of their home equity while living in the house. When they die or move out, they or their heirs repay the amount, plus the accrued interest, with the money from the sale of the house. If the house sells for less than the amount owed, the lender eats the difference.
To get a reverse mortgage, the house must be your primary residence, and the mortgage must be either paid off or minimal. There's no income or credit test. The older you are and the higher your home value (up to the maximum federal loan limit), the more equity you can pull out.
Fees, closing costs and insurance on reverse mortgages can add up to as much as 10 percent of the loan amount, making them a costly deal. Before you go this route, consider taking out a home-equity line of credit or downsizing to a less expensive residence. (Thanks to a new rule, you can use a reverse mortgage to buy a new home. For more details, see "Reverse Mortgages to the Rescue," at kiplinger.com/links/reversemortgages.)
McCarthy's family, including his seven grandkids, visit when they can, but much of his social contact comes from
"Isolation has a profound negative effect on the quality of life." For McCarthy, the interaction provides a welcome break in what would otherwise be a solitary day. "Ron and I get along great. We share the same sense of humor," says McCarthy. Adds Murphy, "It's like working with a friend."
KIP TIPS: WHERE TO FIND HELP
Eldercare Locator (800-677-1116), for community resources, including the local area agency on aging.
NORC Aging in Place Initiative (www.norcs.org), for information on naturally occurring retirement communities.
Golden Gateway Financial (www.goldengateway.com), for information on reverse mortgages, including a calculator to estimate how much you can borrow.
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