As we age, it’s not uncommon to experience physical and mental changes that make day-to-day life more challenging. Geriatricians and other experts say it’s important to plan ahead for our older years.
That means thinking about the type of care we might want and who will help us make medical decisions.
Not only does contemplating the future now result in fewer surprises later, it lets us communicate our wishes ahead of time with the closest people in our lives.
“We all have blinders on about what happens to us if we get frail,” said UCSF geriatrician Anna Chodos. “For most of us it’s not if, but when.”
Here are things to consider.
Types of Care
Most of us will require some level of care as we age. That might be help cooking or dressing, or more serious medical assistance. Think about what type of care and living situation you want and what your financial situation will allow, and talk about your wishes with the people you may rely on in the future — whether that’s a spouse, a child or a good friend.
Professional care at home — For people who want to remain in their home but need day-to-day general help, bringing caregivers into the home through an agency or privately may be a possibility.
Cost: Often runs about $30 an hour in the Bay Area. You may also choose to hire a live-in caregiver and pay lower fees in exchange for room and board. The In-Home Supportive Services (IHSS) Program helps pay for caregivers for seniors who are eligible for Medi-Cal. Medicare generally does not cover ongoing in-home care.
What to consider: Is your home compatible or could 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 generally offer a range of services, including help with showering and dressing, meals, activities and more.
Cost: Can easily reach $10,000 or more a month, particularly 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 in when you’re independent and add care if and when you need it. Explore early whether you will need to move if your condition changes.
Nursing homes — Skilled nursing facilities serve people who require significant medical care.
Cost: Medicare covers limited nursing home stays. Medi-Cal covers longer-term stays, but not all facilities accept Medi-Cal patients.
What to consider: People often stay for just a short time in a nursing home after a hospital visit before returning home or going to assisted living.
Important Documents
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 the people who will one day need to access it.
The Family Caregiver Alliance offers a downloadable form that provides an overview of documents to consider. The form allows you to indicate where different documents are stored and provides space to name important people like emergency contacts, your doctor and accountant.
You may want to set up an advanced health directive, which lets you give instructions about your own health care or name someone else to make decisions on your behalf. You may also want to grant someone power of attorney to make financial decisions on your behalf, outline the type of funeral arrangements you want, and make sure your trust is in order.
To complement an advanced directive, the Physician Orders for Life-Sustaining Treatment (POLST) form gives seriously ill patients more control over care at the end of their life. It’s a document signed by both the patient or their legally designated decision maker and physician, and includes options like “do not attempt resuscitation,” and “comfort measures only.”
Other ways to prepare
If you develop dementia, what type of medical care will you want? Will what you want change as the dementia progresses?
Consider filling out a dementia directive — like an advanced directive but specific to dementia — and sharing it with those who will help make your care decisions and your doctor.
You can explore other informal agreements with family or close friends, such as an agreement that a person of your choosing will tell you that 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.
Important Documents
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 orders for life-sustaining treatment: https://emsa.ca.gov/dnr_and_polst_forms/
Dementia directive: https://dementia-directive.org/
