One of the most common issues I encounter when visiting elders in the community, relates to the hardships couples face, when Long-Term Care is on the table.
Often the perceived, possible, and real losses are draining; emotionally, financially and spiritually:
- The Couple are not ready or willing to relinquish the care to an external provider
- The Couple do not want to be separated by physical distance. Who can blame them after decades of being together?
- There is a possible or perceived loss of control over future care and planning
- The costs of one member entering a home can cause huge financial ramifications to the loved one left behind
What about Costs?
Consider couples sharing a pension, and the pension holder is the prospective LTC client. In Ontario, the entitlement to subsidy in a LTC home is based on the Notice of Assessment of the Client. Hence, the holder of the pension may well be able to afford the full tilt of the payment, but the reduction in left over monies, may create a financial hardship for the spouse left behind.
There is the opportunity for the spouse to apply for involuntary separation: an adjustment to Old Age Security benefits for qualifying individuals. (http://www.elderpilot.com/site/blog/2014/02/28/the-top-questions-ontario-citizens-are-asking-about-long-term-care)
Perhaps it is time to consider creative problem solving for the long-term care sector. This is not an all-encompassing solution, just a bud of a blossoming idea that may impact the way we offer senior care in the future.
What if LTC homes were designed with some couple's living spaces for caregivers who wish to continue in their life journey, and not be separated from a loved one needing care? This would mean admitting the couple as a team to a designated area, when only one person qualifies to meet the admission criteria.
Recognizing that increased square footage building costs would pose a problem, suites could be the size of a basic (2 beds) in the current new LTC home builds. Creative configurations could create privacy. Already in many homes, shared spaces have two separate rooms, and a shared bathroom.
The individual requiring care would pay the cost of the basic room per protocol, and receive care as set out in the MOHLTC (Ministry of Health and Long-Term care) regulations.
The spouse would pay a lesser rate as pro rated by the MOHLTC. In effect, the spouse would become an integral member of the team, assisting with the care of their loved one by choice. The caregiver would be able to manage their own activities of daily living: personal care, and mobility. Think of how this would enhance care for individuals, especially those living with dementia.
Factors for consideration:
- Establishing rates for the caregiver senior and subsidies paid by the MOHLTC to the homes
- Establishing criteria when rates would increase for the caregiver, as their needs for care change
- Establishing criteria to qualify for, and remain in a couple’s suite (not all couples are spouses and that is ok)
The purpose of this idea is not to force elders into providing care for a family member, but rather to allow them the opportunity to continue in this role if desired.
For the naysayers who retort the LTC home wait lists are too long already, and this would not be feasible, I would ask you to consider:
- Why do certain homes consistently have empty beds and what is the action plan to address this issue? Why are some homes not attracting elders?
- If there are long waiting lists, and filled ALC beds, what is the obstruction? What is the corrective action? What are we missing?
- What costs are being incurred for home care, because couples are struggling to stay together, potentially unsafely, as options are limited?
- How are we addressing seniors living in poverty?
What might life look like?
- Caregiver seniors would find friendship and support in a place that was affordable, while staying together with their loved one
- Aging in place in this home would be possible
- Structured care and services to meet the needs of the client, and assist seniors who wish to remain as caregivers
- We may just find that there is a new wave of volunteers, living on site, looking for ways to contribute
Yes, there are many unanswered questions:
- What would happen if the Client requiring care dies, what next for the Carepartner?
- How would Caregiver criteria be established for admission?
- How would the reduced admission rates for Caregivers, be offset by the MOHLTC? : Would reduced home care costs, and less ALC bed issues open funding avenues for LTC?
What I do know is that too many elders are being kept apart, instead of aging together, because we aren't studying or pursuing new ideas. (Including couples where both require care services.)
However, on the flip side, affordable home options need to be considered for elders who may wish, or need to relinquish their role of caregiver. Not all Caregivers want to enter a LTC home before they need personal care, nor have the capacity, energy, desire or interest, to be a caregiver in another setting. This is totally acceptable and understandable.
Every idea starts with a spark that has the potential to ignite to greater things. One thing is for certain, with the aging population, creative problem solving for care provision needs to be the new focus. Maybe its time we harness the abilities of these wonderful caregivers, who willingly want to continue to help, and can’t find the avenue, because they don’t qualify for Long-Term care.
For those who are shaking their heads and asking, "Are you considering making elders part of the Long-Term Care home workforce?"
Maybe the right question is, "Are we acknowledging and facilitating the rights of caregivers to continue to provide for, and assist with the care of a loved one?" Whether we recognize it or not, senior caregivers are part of the team of community supports, a growing "Workforce" providing home care without recognition.
Photograph credit: Lauren Fleishman
Download the free Elderpilot: Long Term care or Elderpilot: Retirement mobile tour apps (iPhones and Androids) for more information. The resource section is full of tips and strategies including things to think about re care needs of individuals living with dementia.. The apps will guide you on your tours, providing prompts, recording your observations and creating a report to share with others. Looking for more help? Visit us at www.elderpilot.com. and read my blogs.