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Monday, March 29, 2010

The Importance of Life Planning

The Mr's Grandma went into a nursing home this weekend. She's nearing the end, and the nursing home is the best place for her now.

Grandma never made any arrangements for her "golden" years. She's 94 now. From the time she was about 70 until about 6 years ago, she lived with her younger daughter. Her health began to decline and my in-law's decided to have her come live with them. She was there for about 4 years, health and sanity declining the whole time. This was tough on all of their relationships.

Finally they couldn't take care of her any longer and they had to find a board and care for her. A place where they could deal with a few health issues (incontinence, limited mobility etc.) and allow my in-laws to be just family again, instead of care-givers.

This came at a hefty price. Because grandma never planned and has no assets, my in-laws had to pay for the board and care. My father in-law went back to work part time. Not a lot of time, but it has tied him down at a time when he should be relaxing and enjoying his life.

Last week Grandma was admitted to the hospital and the doctor prescribed skilled nursing for her. This may not mean anything to you - it really didn't to me until Grandma.

Skilled nursing is what you get when you go to a nursing home. On-staff nurses, doctors and therapists. People who know what to do when a medical crisis occurs.

"Skilled nursing" also means Medicare and Medical will cover the charges. For my father in-law it means he can stop working.

We also discussed hospice care. Hopefully this doesn't mean much to most of you either.

Hospice is a service, not a place. Hospice brings care into your own home, be it a private residence, an assisted living facility or a nursing home. Most people want to and can stay at home but if your care becomes too complex to manage at home, hospices also provide inpatient care to control symptoms in a hospice unit, a hospital or a skilled nursing facility. It is an option for people whose life expectancy is six months or less, and involves palliative care (pain and symptom relief) rather than ongoing curative measures, enabling you to live your end days to the fullest, with purpose, dignity, grace and support.

And it is covered by Medicare. Or Medical - when both hospice and nursing homes are required, one pays for the hospice care and one pays for the nursing home.

And they are quite competitive. The nursing home people say that hospice care people are greedy and push the patients into "dying early" and the hospice care people say that nursing homes just want the money from Medicare/Medical and don't have the expertise to give patients in their final days the care that they need. Not sure how to determine who is correct.

So, in the midst of having to come to terms with her mother having to go into a nursing home and nearing the end of her life, my mother-in-law is trying to deal with pushy sales folks, choosing a facility, determining what kind of care Grandma needs... it's a lot of stress for her.

We wouldn't need to worry about these kinds of things at this stressful time, but Grandma didn't plan for her future.

What I've learned - in addition to how I don't want to go - is that I need to plan ahead for my long term care. We need to know where we want to go if we end up needing to go somewhere like that, and how we plan to pay for it. We don't want to leave it up to The Children. That kind of stress no one needs.

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