Kaiser Permanente South San Francisco physician Russ Granich, MD, discusses how to determine when older adults need your help — and finding the care that’s right for them.
It’s one of life’s most poignant transitions: After years of being cared for by our parents, there comes a time when we need to care for them.
We spoke with Russ Granich, MD, chief of Geriatric Medicine at Kaiser Permanente South San Francisco, about deciding when that time has come and finding the best care option. Dr. Granich is the Northern California lead for Skilled Nursing, Home Health, and Elder Care.
What are the signs that an older person can’t live independently?
The basic rule is that when someone can’t care for themselves, they need help. Their challenges may be physical — such as trouble walking or using the toilet — or due to confusion, such as in dementia. In early dementia, people can often live by themselves, but there comes a point where they can be a danger to themselves by doing things like forgetting to turn off the stove. Another consideration is folks who use poor judgment: Someone who needs a walker but refuses to use it is at high risk of falling and fracturing a hip.
Is keeping a senior at home an option?
Yes, and that’s generally best because it’s where they feel most comfortable. Adjusting to a new environment is hard for someone who is losing their vision or memory. Caregivers can be hired to help with care from a few hours a day to 24/7. They can help with everything from giving medication to bathing, dressing, and driving.
Two options for finding at-home care are to use an agency or hire someone privately. Agency care is more expensive, but providers are insured and undergo a criminal background check.
What care options are available for people who can’t stay at home?
Residential care facilities are the next level of care.
At an independent living facility, seniors typically have their own space with a kitchen and bathroom. Many offer housekeeping, meals, transportation, and activities.
Assisted living facilities and board and care homes provide meals, 24-hour supervision, medication management, and help with activities like bathing, dressing, and eating. They range in size from a few residents to hundreds.
Make sure that the facility you select will meet your parent’s changing needs. Ask about the cost of additional services, such as incontinence care, and if they can accommodate hospice patients. Consider the social aspect too: Would your parent like a larger facility with activities or a smaller, homelike environment?
A skilled nursing facility (SNF) is the next level, and there are two types of residents. Some patients are there short term to build up their strength or get services that require skilled care, such as IV fluids, tube feeding, and wound management. Many seniors will transition from the hospital to a SNF for this type of care.
The other type of resident is there long term — the SNF becomes their home. SNFs can supply any type of care needed, including care for someone totally dependent on others.
Will insurance help cover the costs of care?
Unless a senior has long-term care insurance, at-home and residential care are not covered by insurance.
Skilled nursing care at a SNF is usually covered by health insurance for a maximum of 100 days, as long as the person requires skilled care. Long-term custodial care at a SNF is not covered by health insurance, but low-income seniors who need help with activities of daily living may qualify to live in a nursing home as Medi-Cal patients.
Visit these websites to learn more: California Advocates for Nursing Home Reform, California Department of Aging Long-Term Care Ombudsman Program, and Family Caregiver Alliance.