The Surprising Cost of Aging in Place

By , The Sarasota Herald-Tribune

Most older Americans — 89 percent in one study — say they want to age in place in their own homes. But the big surprise for many: Even though the kind of home care most elders need is far less expensive than being in a nursing home, Medicare does not pay for it.

When Medicare patients find themselves in the hospital, they can come to expect that every aspect of their treatment will be paid for. But when it’s time to check out, they and their families are often at a loss — faced with a list of new prescriptions, instructions and doctors’ appointments, and little idea of how to make it all happen.

“I would say 50 percent or more of the clients who contact our office think Medicare will pay for everything,” Annalise Smith, a regional director for the home health agency SeniorBridge, told participants in a workshop for caregivers at North Port Library.

The kind of post-hospital aftercare that requires skilled nursing is often covered by Medicare, she explained. Hospice visits are covered as well. But the personal services that can help most older patients recuperate safely at home — help with meals or housekeeping, transportation or medications — are often a stunning and unexpected expense.

Even if they avoid the hospital, about half of people 85 and over need help with the simple tasks of dressing, bathing or meal preparation — known in medical parlance as “activities of daily living,” Smith said. This basic assistance can make an enormous difference in an elder’s quality of life.

“If you spend 15 minutes buttoning your shirt, you may wear yourself out to the point where you can’t brush your teeth,” Smith said. “The caregiver would button your shirt, so you could do the other things you need to do.”

Some long-term care insurance policies do pay for personal caregiving, but “every policy is different,” Smith said. “It’s amazing how many of our clients bought these plans 20 years ago and don’t know what’s included.”

About one in 10 of SeniorBridge’s clients have some kind of long-term care insurance, Smith said. The rest fall into the “private pay” category, and many cases involve situations where the elders live in Florida and their adult children have careers elsewhere.

“Almost 85 percent of the time, the client and their children have a different set of expectations” about the kinds of care needed, Smith said. And even when a satisfactory care arrangement is worked out, it needs to be revisited often because of all the physical and emotional issues involved, she cautioned: “The plan that is perfect today may become completely obsolete six weeks from now.”

Smith suggested that families discuss the potential need for home care well in advance, and be alert for any warning signs before they emerge. These can include increased accidents, falls, wandering, an accumulation of unpaid bills, depression, agitation, isolation, and changes in weight or hygiene.

“So many people wait until the crisis has occurred before they think of these things,” Smith said.

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