by Joan Blumenfeld, MS, LPC
In Connecticut, if a person can pay for nursing home care out-of-pocket for several months, or in some cases show enough assets to pay privately for a year, they can select the facility they want and reduce waiting time. If they have spent down their assets and are subsequently accepted by Medicaid, then Medicaid will select the facility, depending on wherever there is a long-term bed available. Thus, setting aside money to privately pay for nursing-home care allows people to make crucial choices they cannot otherwise make.
My 72-year-old client, Sylvia, was outliving her money. And her worst nightmare was inexorably unfolding.
Sylvia was recovering from a stroke and was about to be discharged from rehab when I was hired by the court-appointed conservator to manage her care. Sylvia desperately wanted to return to her nine-room home in one of Connecticut’s lovely shoreline suburbs, but she was ill-equipped to do so.
As a result of the stroke, her walking was impaired, though she could ambulate unsteadily with a walker. One arm and hand were weakened. Sylvia had already been experiencing some dementia, which was exacerbated by her stroke, leaving her judgment and ability to manage her money, her meals, her medications — her life in general — severely diminished. She also struggled with an unrelated life-long mental illness that resulted in hallucinations and delusions, which impaired her relationships with others and required careful medicating.
From a Geriatric Care Manager’s point of view, Sylvia was a challenge!
My first job was to find her a suitable assisted-living facility and organize a transition that was as tranquil and low-key as possible. I located an elegant facility that had the requisite large chandelier hanging in the front hall and a huge bouquet of gorgeous silk flowers sitting on the glass-topped table beneath it. There was a bright and cheerful dining room with tablecloths and flowers on each table and a common room with comfortable, well-upholstered couches and chairs. The place was secure so residents could not wander off into harm’s way.
More importantly, the caregivers were plentiful and compassionate. They were well trained and well supervised. The food was good. The place was spotlessly clean. All in all, a highly superior facility.
Of course, Sylvia was nonetheless reluctant about the move. In addition to the help provided by the in-house staff, she required a private duty aide for the whole time she lived there. It took a long time but eventually she settled in to the environment and the routine, and she made the best of her new living situation.
But just as she was becoming a fully accepted member of the community, Sylvia’s finances became a pressing problem.
If Sylvia had continued to live at the assisted-living facility, she would have run out of money after one more year. Her conservator carefully calculated the pros and cons, both psychological and financial, and finally made a difficult decision. It was time for Sylvia to move into a nursing home based on her financial realities, even though she did not yet require that level of care.
The conservator acted courageously and in a timely fashion. Sylvia was still relatively young. Tragically and unavoidably, Sylvia was going to outlive her money. The decision to move her to a higher level of care in a more restrictive environment was financially driven — a harsh reality that sometimes occurs in the world of eldercare.
Pearl of wisdom: Whenever possible, save your pennies, nickels, dimes and dollars to preserve the ability to make choices. Plan ahead. Get your ducks in a row before a crisis sets in!
Joan Blumenfeld, MS, LPC is a Geriatric Care Manager in private practice in Fairfield County, CT. For information, visit her web at www.joanblumenfeld.com. © Joan Blumenfeld 2012.