Everyone gets old and dies, yet very few of us ever talk about it. We may recognize it’s inevitability, but we often don’t think about it until it’s far too late, pushing it to the back of our minds when all the while we slowly move toward a time when the need will be immediate.
We put these decisions and conversations off because most of us can never imagine moving into a nursing home or even an assisted living facility unless it was as a last resort. Why do we so fear these places, sometimes even to our own detriment?
In his book, Being Mortal: Medicine and What Matters in the End, surgeon and author Atul Gawande suggests that as we age it becomes more important to have a purpose, something worth living for, and that one of the reasons we fear traditional care facilities is the sheer lack of purpose and quality of life that those places often create in their residents. He suggests that while safety should be a concern, quality of life and a purpose for living should be tantamount to all.
This remarkable book detailing the ways that corporate medicine is failing arguably our most vulnerable population, but what alternatives do seniors in Oregon have? Where can aging people turn to find resources that allow them to choose the way they age in Oregon?
Let’s set off on a journey to discover the tools available to help seniors find the best place to spend their final years.
Let’s ask the internet
A Google® search for “Alternative Senior Care in Oregon” produces limited results; mostly a spattering of facilities that offered “New Programs,” but upon investigation turned out to provide mostly the same services we’ve heard about before. There were a few organizations in Oregon that are available to help aging people make the decisions that they need to, while keeping their wants and needs center stage.
According to Director Rick Davison, Adult Living Alternatives in Portland has been helping to connect individuals to care resources for over 35 years. By calling ALA, seniors and family members can receive support throughout the decision-making process, and can be put in contact with facilities to tour and interview.
Davison said that the decision of where to live as we age used to be much more limited. Up until the last few decades, one of the only options for seniors was nursing homes. “Assisted living facilities were started up in the late 80’s [and] early 90’s to serve as an alternative to nursing facilities. Now, assisted living facilities have become part of the establishment… so now [the] question is ‘What are the alternatives to nursing homes and assisted living?’ and for people with moderate care needs, the most logical alternative would be an adult care home.”
Adult care homes are a truly unique option for people looking for long term care. They offer a much smaller caregiver to resident ratio, typically 1:2.5 whereas in assisted living there can be as large of a ratio as 1:20 on day and swing shifts, and 1:40 on graveyard shifts. Unfortunately, there is no state requirement for staffing ratios, meaning that facilities are left to decide their own ratios. This information can be found by asking the facility to provide a Uniform Disclosure Statement,which lists the staffing on every shift.
The goal of adult care homes is to feel like your house. No front desks or office staff. No long hallways and cafeterias. The residents eat together, talk with one another and the caregivers, and are free to live as independently as possible within the safety rules of the home. Adult care homes are monitored and licensed by the state through Senior and Disability Services. Families can have peace of mind knowing their loved one is being checked on regularly by state authorities.
The downside to adult care homes is definitely the cost. Almost all of them are private pay only, meaning residents who have exhausted their personal resources and who rely on Medicaid payments for care are barred from these facilities. According to Davison, adult care homes cost around $4,500 a month while the average Medicaid payment is around $2,500. Since most assisted living facilities are also private pay only, this leaves many people with a nursing home as their only long-term care option.
It’s important to note that caregiver abuse and neglect can be a factor in all types of care settings, but in adult care homes the caregivers have a direct motivation to excel and go above and beyond the expectations of the residents, since they are typically the owners of the facility. In assisted living, caregivers are often paid minimum wage and have little investment in the success of the facility as a whole.
Often if they are terminated from one facility, they will be hired on at another without question. Information about abuse complaints and tracking of caregivers can be found on Oregon.gov, and families seeking care should definitely look into this and pay attention to the red flags before selecting a facility for their loved ones.
Let’s ask the state
The search led to Randi Moore, Senior and Disability Services Director for the Aging and Disability Resource Connection Branch of OCWCOG (Oregon Cascades West Council of Governments) and Oregon Project Independence.
OPI provides a small number of hours of care or other types of benefits to help keep people safe, stable, and independent in their homes, and hopefully to prevent people from needing to go through the entire Medicaid process if they only need a small amount of care.
These small benefits range from a few hours of care a week as a respite for a caregiver, to Meal on Wheels,and providing an emergency response system such as LifeAlert. They can also provide equipment and transportation. OPI can help with questions about getting the needs of seniors met through their Options Counseling service, which provides information about all the resources available to help families and seniors make informed care decisions.
The goal of OPI is to ask “Where are you struggling?” and then help with those areas.
Let’s ask ourselves
So, what can we do to make sure that we and our families are prepared for aging? Rick Davison recommend several things.
First, families need to make a decision that includes their loved one. Second, an estate planning advisor should be contacted to help families protect their assets. And finally, he recommends that families and patients both do more research than just talking to their friends.
There are many resources available to help people make these types of choices, and they should evaluate all of their options before making a decision. The main goal should be “To make sure that the people entrusted with the care of their loved one have demonstrated an ability to provide that care.” Davison recommends that families treat it like hiring a caregiver that will be in their own home.
There is also a care option that applies in all care settings, and can have enormous benefits to its recipients, yet it’s the option that often gets overlooked at a time when it is needed most – hospice care for those who are in the final days and months of their lives. Hospice and Palliative Care is not available until end of life, but it’s definitely worth including in this article, since it’s benefits for those that qualify are astounding.
According to Angela Hibbard from Lumina Hospice, “Hospice is patient centered care, focused on quality of life for patients whose prognosis is less than 6 months.” Lumina Hospice began as Benton Hospice Service and has been in the area for 40 years. It is a non-profit, community based, independent hospice, that started as completely volunteer based. It evolved over time, and today they have around 60 staff, as well as 120 volunteers.
Hospice focuses on quality of life versus curative care. A Hospice Patient Team is made up of a doctor, nurse, hospice aid, social worker, chaplain, volunteer, and other therapists so that the patient is provided with emotional, social and spiritual support in addition to clinical care.
The problem is that most people have a misconception about what hospice care actually is – thinking hospice hastens death rather than enhancing the quality of the patient’s life. Due to this misunderstanding, many people don’t go on hospice until their final days, which is unfortunate, because they miss out on possibly months of quality of life benefits.
Hospice comes into any environment that a patient calls home, whether it is a nursing home, assisted living facility, an adult care home, or the patient’s own private residence. Team members provide care not just to the patient, but to the caregivers and family as well, offering emotional and grief support, as well as respite and supportive care.
Not only does Lumina do all of these things for local patients in Benton County, they also play a crucial role in the community at large. Last year, Lumina served over 1,500 community members with caregiver and grief support for families. Two-thirds of those people did not even have patients in Lumina’s service; they were simply community members who received support and counseling free of charge. It also provides end of life planning and education seminars free of charge, offering not only unparalleled care to their patients, but beyond within their community to give people the resources and tools to help their loved ones live the best life possible.
There are a multitude of resources in Oregon as we age. From Assisted Living to Adult Care Homes, there is something out there to help each and every one of us. As a parting word, start planning early, look for the resources that are available to you, and help educate the people you love. We can all find the care and comfort we need throughout our final years.