John Skelton- Senior Helpers of Tempe November 1st 2022
A majority of Americans over the age of 50 want to age in place, but very few are prepared to do so according to a recent poll conducted by the University of Michigan Institute for Healthcare Policy and Innovation. The findings from this survey suggest that many older adults haven’t planned for the costs of in-home care or the home modifications necessary to continue living safely and comfortably at home.
When a senior begins exhibiting signs of dementia, their family is often left scrambling to research care options, costs, and payment methods. Understanding your loved one’s current needs and how they’ll evolve as their condition progresses will help you devise a care plan and budget for it over the long term.
Planning ahead for the costs of dementia care
Dementia is a progressive condition. Therefore, it’s important to consider that the cost of caring for a loved one with dementia at home will likely increase over time.
Planning for the future is crucial. Seniors living with dementia and their family members should work together to establish care goals (such as aging in place), research the different types of care available, and create a tentative course of action. Addressing these items early on allows those living with dementia to participate in the planning process as much as possible.
Ken Takeya understands the importance of dementia care planning all too well. For the last 18 years, he’s been caring for his wife, Charlotte, who has dementia, at their home in Kailua, Hawaii. In that time, Charlotte’s needs, care plan, and cost of care have evolved considerably. Takeya’s experiences even inspired him to create a support group that helps other family caregivers as they navigate their loved ones’ changing needs.
In-home dementia care costs
During the early stages of dementia, symptoms may be minimal, and individuals are often able to function normally. Eventually, your loved one may begin to struggle with normal activities of daily living (ADLs) such as eating, bathing, dressing, and using the bathroom.
While family caregivers can address many of these daily care needs, it often becomes increasingly time consuming and physically and emotionally demanding. In-home care provides added assistance and supervision that benefits both seniors with dementia and their primary caregivers.
Home companion care is sometimes referred to as homemaker services or sitter services. A companion or homemaker can provide non-medical assistance such as social interaction, help with errands, light housework, and meal preparation. A few short visits each week may be helpful for a senior in the early stages of dementia who lives alone and is still relatively independent. Sitters can also support a loved one who may have the tendency to wander. While they don’t provide hands-on care, they can offer supervision and verbal reminders.
Rates vary from state to state, but the national median cost of companion care was $26 per hour in 2021 according to Genworth’s Cost of Care Survey. As an example, seven hours of companion care each week would cost around $789 per month. Companion care is paid for out of pocket.
Caring for a loved one living with dementia at home often becomes significantly more challenging in the middle and late stages of the disease. Even with the support of family and friends, primary caregivers may still struggle to provide the supervision and hands-on care their loved ones need.
This is usually when families decide to hire a home health aide (HHA) or personal care aide. Personal care includes the companion services above as well as assistance with activities of daily living such as toileting, incontinence care, bathing, and eating.
The national median cost of personal care in 2021 was $27 per hour according to Genworth’s Cost of Care Survey. As an example, a primary caregiver who works full-time and needs to hire a home health aide for 40 hours per week could expect to pay approximately $4,680 per month. These services are often paid for privately.
Ken Takeya’s two adult sons help care for their mother, but he also relies on aides for regular assistance and respite.
“I bring a caregiver in for five hours, six days a week,” he explains. “It gives me time to do something else.”
At about $43,000 per year, in-home care is Takeya’s highest caregiving cost. But it allows him to take a much-needed break from caregiving and pursue his own interests.
Home health care
Home health care is different from companion care and personal care in that it’s medical in nature. It’s usually prescribed by a doctor for individuals who require skilled nursing care or rehabilitative therapies at home. Home health care services are provided by a medical professional such as a nurse or therapist.
Medically necessary home health care is typically covered by Medicare and Medicaid, but private health insurance coverage of these services varies.
Adult day care
Adult day care centers provide a safe, engaging, and social environment for seniors outside of their homes. Generally, they’re open eight to 10 hours each weekday, although night and weekend programs may be available in some areas. These services can complement the home-based care types above and are a great option for family caregivers who work during the day or who want regular breaks from caring for a loved one.
Some adult day programs are purely social in nature, some specialize in dementia care, and some, called adult day health care centers, provide health care services and therapies overseen by medical staff. Many offer meals and transportation services to and from the center.
Takeya’s wife attended adult day care for four years. He feels that it provided a consistent routine and a sense of meaning in her life that has contributed to her continued good health.
The national median cost of adult day services in 2021 was $78 per day according to Genworth’s Cost of Care Survey. However, some programs may offer services on a sliding scale fee structure based on a senior’s ability to pay.
Costs of home modifications for seniors living with dementia
Adapting your loved one’s home to meet their needs may help them live more independently and safely. These changes can also make it easier and safer for both you and professional caregivers to provide assistance. Occupational therapists and physical therapists who specialize in home safety assessments can provide personalized recommendations for products, placement, and home modifications. This service may be covered by Medicare when a doctor writes an order for home health care.
The cost of home modifications for aging in place can range from $3,000 to $15,000, depending on the project. As a senior’s cognitive and functional abilities decline, necessary modifications may become more complex and expensive. If a loved one is serious about wanting to age in place, it’s best to evaluate their home and make adaptations before they’re urgently needed. For example, installing a ramp over steps or an uneven threshold will run between $1,400 and $3,000. But it could also help prevent a potentially debilitating and costly fall.
Installing an Americans with Disabilities Act (ADA) compliant toilet ($150-$400) is a pricier bathroom modification that Takeya feels is worth the expense. He explains that ADA toilets are a few inches taller than standard models, which can make a big difference for someone like Charlotte who isn’t very stable and requires assistance with transfers.
Modifications don’t always have to be expensive or complicated, though. They can be as simple as eliminating trip hazards and arranging furniture in a way that allows your loved one to navigate around the house more easily. Depending on your comfort with common tools, minor improvements like installing grab bars in bathrooms can be inexpensive, starting at around $25. In the kitchen, stove knob locks can help prevent cooking fires for as little as $20.
If extensive remodeling projects fall outside your loved one’s budget, there are also specialized senior care products that can make their home safer and more accessible without breaking the bank. For example, Takeya purchased a sliding bath chair for around $150 instead of modifying his bathtub. Medicare may help cover durable medical equipment like this if it’s ordered by a doctor.
Wandering is another safety concern for seniors living with dementia and their family caregivers. This dangerous symptom can begin without warning, but there are solutions for closely monitoring a loved one who wanders and providing them with a secure home environment.
High-tech home security systems are one of the most expensive options. GPS-equipped wearable devices can cost between $60 and $800, but some municipalities offer low-cost or free devices through the Project Lifesaver program. Stand-alone wandering alarms ($40-$200) are another affordable alternative. They can sound an alarm in your home when a door is opened, and some can even send a notification to a caregiver’s smart phone if their loved one gets out of bed.