A short-term perspective on long-term care
Aging isn’t easy to watch, and it isn’t easy to do. It’s even harder to talk about.
But approaching the reality of aging with a positive, plan-ahead attitude will help ease the minds of both the aging and the ones responsible for care and decision-making.
Unfortunately, when the subject comes up, along with it comes a lot of potential for misunderstanding and hurt feelings. Candid conversation about insurance, final wishes, funeral plans, do-not-resuscitate orders, living wills, nursing homes and long-term care before they’re necessary can help reassure those who are aging that their wishes will be honored, and will save those left behind the heartache and conflict of trying to resolve those issues.
Ending up in a nursing home or assisted-living facility is not a popular option for the last days for an active rancher. But planning ahead and asking the right questions can make the experience more positive.
“The topic is important: one in two Americans over age 65 will have an extended nursing home stay,” said Cole Ehmke, agriculture entrepreneurship and personal financial management specialist in the Department of Agricultural and Applied Economics at University of Wyoming Extension. “One in 10 Americans over age 65 will stay in a nursing home more than five years. Depending upon the care level and care facility, long-term care can cost $30,000 to $100,000 per year.”
Ehmke said when he brings up business transition and personal estate planning with ranchers, they are typically indifferent and think it won’t be a problem. Their tune changes, he said, when he asks them which part of the ranch they intend to sell when they go into a nursing home.
Heather Goddard is currently making the transition with her husband and three daughters to the family ranch. She has worked in the assisted living industry as a risk manager.
“It’s not about ‘You’re old, let’s get you off the ranch’. It’s more about ‘Everybody should have a plan for long-term care, because you’re never going to know if you’ll need it,'” Goddard said. “If you get your ducks in a row, maybe you don’t have to go into a nursing home. Maybe if you purchase hospice insurance, or you have long-term care insurance, and you make sure the policy within the parameters allows for home care, it might work. You have to have that planned, otherwise it’s not going to happen.”
The appropriate time to have these conversations is around the ages of 40 to 50, not 65 to 75, Goddard said. Nursing homes often use a five-year look-back period when assessing a potential client’s ability to pay that can result in increased costs that can be burdensome. If estates, ranches, and other property are not properly placed in trusts prior to the five-year look-back, such property can be liquidated to pay for unexpected long-term care facilities.
“It’s the job of the senior generation to make sure that the ranch gets passed on to the next generation,” Ehmke said. “This means thinking in advance about dealing with short-term crises, such as with a power of attorney. But it also means thinking long-term about an orderly transition of the labor, the management authority, and the ownership of the assets to the next generation.”
Ehmke shared that 40 percent of people who need long-term care are under the age of 65.
“Elderly ranchers, ranchers with medical conditions, or ranchers whose families have a history of needing long-term care should be considering options for protecting the family’s wealth position,” he said. “There are quite a few topics to investigate, including current costs of long-term care alternatives; what Medicare does and does not pay for; Medicare supplemental insurance; veterans’ benefits; Medicaid and issues of asset and income eligibility, spend down provisions, gifting and asset transfers, trusts (revocable, irrevocable, supplemental and special needs), irrevocable pre-paid burial plots, and treatment of annuities; family care, self-pay, and self-insure options; and long-term care insurance.”
Ranchers tend to work long past retirement age, Ehmke pointed out, so problems like frailty or dementia can become a bigger issue than for some in other lifestyles and careers. The ranch itself also poses physical hazards, such as moving machinery, slippery surfaces, and unexpected bronc rides, sometimes requiring individuals to think about assisted living earlier than they would expect.
When choosing an assisted living facility or nursing home, several factors need to be considered to create a smoother transition into the new home. Asking questions of the nurses, directors, and food staff can indicate if the facility might be a good fit.
“I think it’s not just the nursing staff you should speak with when you go to a facility; speak with the registrars, secretary, or housekeeping staff, or dietician or administrators, the people who all interact with residents,” Goddard said. “I think that makes a huge difference in quality. If everyone doesn’t buy into the fact that this is their home, they deserve dignity, and they’re people too, then even if the nurses are good nurses, they’re probably not going to buy into it too.”
Those living in nursing homes can sometimes be disregarded in their treatment and dignity. Find a nursing home that is adequately staffed in order to pay proper attention to cleanliness, quality of life, and activities that are tailored to the joy and health of the patient, Goddard said. Gardening and caring for animals are two areas that have been proven to improve the outlook for those in long-term care, and could be especially important to ranchers or farmers who have been outside and around animals their entire lives.
“Having animals and gardening has been shown to help people feel normal and like they have control over something,” Goddard said. “Kids too, the nursing homes or assisted living facilities that have daycares nearby or within the facility show higher quality of life than those that don’t, particularly preschools because they kind of function on the same level. It’s all very instinctual, instant gratification. Great for them to be around little kids, an 85-year-old with limited emotional capacity and limited motor skills doesn’t mind playing with toys for 45 minutes with a little kid that can barely talk.”
Consulting a dietician in regard to food needs, whether diabetic or geriatric restrictions or others, ensures that a loved one doesn’t get offered whatever is most convenient, but rather, fits the required nutrition guidelines in a way that keeps the individual’s dignity intact.
“Most of these people are on diet restrictions, whether diabetic restrictions, geriatric diet, low sodium diet, so a facility’s ability to accommodate them and still fix them really good food is important. A lot of people have to eat mechanically processed food because there’s a choking hazard, but doing it with dignity is a big thing,” Goddard said. “When they have to have mechanically processed food, you could lump it all together and throw it on the plate, or you can mechanically process each thing and still portion it on the plate and make the plate look nice. Better facilities are not under staffed and not so stretched they can’t make those accommodations to improve the quality of life.”
Goddard pointed out that refusing a person a favorite meal like bacon, eggs, and toast, for no reason other than it isn’t the healthiest meal can really minimize the quality of life for a person who has consumed it each morning for 70, 80, even 90 years.
“It’s a common sense factor, I think that bugs a lot of people,” she said. “It’s just all those little things that pile up. It’s their home, it might be where the other people go to work, but it’s their home.”
Once a loved one is in a nursing home, don’t feel tempted to bring them back home if they have marked improvement. That is a sign they’re right where they need to be, Goddard said.
“Almost invariably, when they put someone in a long-term care facility, they get better. Their health improves, their mental clarity improves, because they’re getting all their medications, a really good diet, proper hydration, stimulating activities, exercise or physical therapy; they’re not engaging in any bad habits, skipping meals, smoking or chewing. You see an improvement and you think, ‘Oh, they’re better, I can take them home now. No, they’re better because they’re where they need to be,'” she said.
Taking the first step early can help your loved one end up in a home that is the best possible fit for them, and ensure that their legacy, their ranch, is passed on to continuing generations.
“Engage in planning for early long-term care, but also for transitioning the ranch to the next generation. You don’t want to wait for the problems to occur. Proactively work to avoid potential threats that could really hurt the ranch, like having to pay for expensive long-term or end-of-life care, or not having a transition plan in place,” Ehmke said. “Training up and transitioning to the next generation could easily take five years. So think long-term about an orderly changeover of the labor, the management authority, and the ownership of the assets. The best time to plan is when you don’t need it. The day you need it, it is too late.”