Taking an Estate Inventory
Before charting the course for a loved one’s long-term care, you should first determine where you and the person with Alzheimer’s disease are. An estate inventory is a snapshot of the resources at one’s disposal that may be needed to subsidize caregiving. There are six long-term care resources:
- Health insurance
- Income and assets
- Community resources
- Family and friends (themselves a resource for caregiving)
- The home environment
- The person with Alzheimer’s disease’s capacity for self-care
An estate inventory defines three of these resources — health insurance, income and assets, and community resource eligibility. The other three resources are established by the Care Assessment, the third step in the care planning process (see below).
A person cannot efficiently plan or manage long-term care without knowing how much care they can pay for themselves or how much can be subsidized by the community (local, state, federal programs). A clear snapshot of the person’s income from fixed sources (Social Security, 401(k), pension and other retirement income), of their assets (savings, investments, equity in the home, etc.), and what their health insurance will and won’t cover (including long-term care insurance) must be done before you can decide on caregiving arrangements for someone with Alzheimer’s disease.
Creating a Care Assessment
Both the amount and the type of care needed by a person with Alzheimer’s disease will change over time. In the early stages, periodic supervision and homemaking (shopping, cleaning, and laundry) may be all that’s needed. The level of care may gradually increase to include higher levels of supervision, personal care assistance, behavior management, or even placement in a specialized dementia-care facility or nursing home.
A Care Assessment for a person with Alzheimer’s disease examines what the patient needs, how much care his or her family can provide, how the home is configured, and what the person is capable of. The assessment is best performed by family members or loved ones working in consultation with mental health and health care professionals skilled in Alzheimer’s care. Since many people with Alzheimer’s disease are still living in their homes — either with spouses, with children or alone — the best place to turn for a care assessment is often a home care agency.
A skilled assessment by a home care nurse, preferably with a dementia-care specialty, done in tandem with a home health care social worker, can often be ordered by a physician and paid for by Medicare. But if Medicare won’t cover it, the patient or family may have to pay. Spending a few hundred dollars for the advice of a seasoned home care professional is nearly always money well spent in determining the feasibility of home care, how it will be paid for and in setting limits for patients and caregivers alike. Families may also call upon independent care managers or their local elder service agencies (Area Agencies on Aging or AAA’s) to perform the care and needs assessment.