Older and Wiser

The last article in this series on aging (in issue 28 of the Pulse) defined the categories of housing geared to older people in Wisconsin that involve some degree of on-site care. Here is a summary:

Nursing home: highest level of medical care plus personal assistance in other areas, such as dressing and bathing

Assisted living: less medical care but personal assistance in other areas. “Residential care apartment complexes” (RCACs), “community-based residential facilities” (CBRFs), and “adult family homes” (AFHs) are the three types of assisted living facilities.

Continuing care retirement community: quasi-independent living but with the option to obtain more care as needs change

This article advocates learning about long-term care facilities before a crisis sets in and addresses steps to do so.

Mindset. Many of us don’t seriously explore where we or loved ones might live when older age sets in until a crisis or near-crisis occurs. We’re vaguely aware of a few places that we assume to be some form of senior housing but have little idea what they’re like inside, the services provided, the costs, or how we would come up with the money.

It’s distant and unpleasant, and we convince ourselves that thinking about it is unnecessary. “Heck, Aunt Shirley lived on her own her whole life; I’ve got her genes, so I can too.” “It doesn’t matter that I don’t have the money; where there’s a will, there’s a way.”

Indeed, there usually is some way, but it will be a lot smoother if first explored before a need for care arises. We should have a good idea of what the specific facilities available in our community are, the services they provide, how much they cost, and realistic possibilities for covering costs.

Starter information. Whether exploring possibilities for down the road or dealing with a current crisis, a logical Step One is assembly of basic information prepared by others.

Not much in-depth information is available on facilities’ websites or in their folders and brochures. They usually provide some bullet point-type descriptions of the services available and a few pretty photographs, but they’re typically marketing-oriented. It’s rare to find detail on key matters such as what a person’s living space will actually look like, how it will be equipped and how private it will be, and what the costs – with or without public financial assistance – will be. Of course, facilities never provide negative information and opinions. And reliable compare-and-contrast private websites (or apps) on the order of, say, the travel sites Kayak, Expedia and Trip Advisor, don’t exist.

A few relatively easy-to-read charts prepared by public agencies provide a good starting point, however.

Aging and Disability Resource Center (ADRC). Conversations with ADRC staff can provide considerable information but, even in a quick visit, a good deal of helpful and free reading material can be taken off the racks. For example, I recently grabbed three charts to take home: one listing and showing some of the basics for Door County’s CBRFs and RCACs; the second on Door County’s independent housing options (split into a section on Sturgeon Bay/Southern Door and another on Northern Door); and the third showing agencies providing various types of home care in Door County. Door County’s ADRC and Senior Resource Center have joined facilities. They are open all day Monday through Friday at 832 N. 14th St. in Sturgeon Bay and on Wednesdays at 2258 Mill Rd. in Sister Bay. The Sturgeon Bay number is 920.746.2372, and the Kewaunee County ADRC’s number is 877.416.7083.

Wisconsin Department of Health Services. Charts showing each Wisconsin county’s CBRFs, RCACs, AFHs, and nursing homes can be obtained at the website dhs.wisconsin.gov/bqaconsumer. Some of the information overlaps that provided by the ADRC, and some is different.

Medicare. The federal government’s Medicare website provides information on nursing homes, including an interactive tool for comparing facilities, at medicare.gov/nursing/overview/asp – and on assisted living and other alternatives at medicare.gov/nursing/alternatives/other.asp.

Keep in mind that the information published by these agencies is always subject to change and may include other reliability issues.

Next steps. The above charts and other information help in the initial identification of facilities but are insufficient to answer most practical questions – even including the type of facility (for example, CBRF, RCAC, or nursing home) appropriate for a given situation. And they won’t provide much help in determining costs and financial assistance possibilities or give any real “feel” for places. Several actions should be taken to move ahead.

Talk in depth with ADRC staff. The ADRC is a public agency, dedicated to providing unbiased information and other help to people seeking assistance with long-term care and similar questions. Their services are free, and their staff friendly and knowledgeable. Of course, ADRC staff, while able to counsel people on many aspects of their particular situations, are not in a position to say “Facility A is wonderful and Facility B is terrible” or make other judgment calls on behalf of those whom they serve.

Schedule visits with facility staff and drop in. For any facility that might be even remotely considered as a possibility – whether years from now or in two weeks – it’s advisable to set up a meeting with staff to fact-find and tour. Additional comfort – or discomfort – can be obtained by making unscheduled visits and asking family members or friends to do the same.

Speak to those with personal experience. Residents of facilities, and their friends and family members, are likely to want to share their stories. Of course, one should filter the anecdotes – someone who’s upset with what happened yesterday may not be providing a balanced, long-term view, but personal experiences can help fill out otherwise incomplete pictures.