Question

Consider this scenario, a composite of actual circumstances.

Bob and Mary were happy when their military service ended, they married and embarked on their civilian careers. Bob and Mary were healthcare professionals; Bob was a professor at the local medical school and Mary was a hospice nurse. Bob and Mary were always active in their church and volunteered their time in the community. They both retired at age 65 to pursue their dream of domestic and international travel. During the early years of their retired life, the couple continued to work part time, travel extensively, and spend time with their grandkids. When Mary turned 78 years of age Bob noticed that she was having memory problems.

Mary always kept up on the latest topics and was always the first to complete the crossword puzzles and other logic games in the newspaper. However, Mary seemed to become increasingly forgetful; she would run errands to purchase specific items and return home empty-handed. The couple decided to seek help from a gerontologist. An extensive battery of cognitive and neuropsychological tests determined that Mary’s language skills and mental abilities had markedly diminished. Mary was diagnosed with Alzheimer’s disease, an incurable terminal brain disease. After the initial shock of the diagnosis, the couple developed a plan that included Bob serving as Mary’s sole caregiver.

Over time, the disease progressed making it difficult for Bob to meet Mary’s needs. In addition, the progression of the disease was tough for both Bob, the children and grandchildren to witness. At first Mary became confused, then she became progressively irritable and aggressive. Five years after the diagnosis, Mary became almost totally withdrawn. Her appetite was nonexistent, and she became incontinent. Additionally, Mary was diagnosed with “sundowners’ syndrome” – a phenomenon whereby the individual experiences confusion and exasperation during the late afternoon or early evening hours.

Bob struggled to care for her and keep an upbeat attitude; however, he too was experiencing health issues due to aging . Bob was a competitive runner for years which impacted his knees and other joints. At times, this condition prevented him from daily activities, self-care and taking care of Mary.

Bob eventually hired a home health aide to visit daily to assist Mary and also do some light household chores. As Mary’s condition grew more serious, he had to make a decision. He was no longer able to care for her, and his own ailments were starting to severely impact his ability to take care of himself.

Bob and Mary had no assets and their retirement savings was gone. They were forced to ask for financial assistance from their children. Luckily, their children were professionals and able to assist Bob and Mary financially. The family had a meeting and agreed that Bob and Mary need to move into a home where they can both get the care that they need.

Questions

1. What long-term care options should be considered by Bob and his family for both himself and Mary?

2. What are the requirements necessary to access the care you have chosen in Question 1?

3. What funding mechanisms are available to Bob and Mary, and how does this affect the choice of their care options?

4. What could Bob and Mary have done to plan their care during their later years?

5. What is your plan to prepare for the possibility of your need for long-term care?

Your discussion should be in the form of a case study analysis.  

Answer 1

1. Long term care options :-

Nursing home- illness or disability requires daily nursing care with other support services; will provide room, meals, skilled nursing/rehabilitative care, medical services, protective supervision; actually many are rehabilitation centers with short-term stays

Skilled Nursing Facility- provides most intensive nursing care available outside of hospital; responsible for taking vital signs of patients

Intermediate Care Facility- for those who do not require hospital/skilled care but need some kind of institutional care for health-related services

Residential Care Facilities- provides 24-hour care and supervision to those not needing health/nursing related care; provide meals, housekeeping, assistance with personal care (some offer more like managing medications and rec/social activities)

Board and Care Home- a group living arrangement for those who can't live alone and who need nursing services; typically help with activities of daily living; typically found to be understaffed by undertrained workers

Assisted Living Facilities- housing complex where older people live independently in own apartments; pay monthly rent that usually includes meal plan, transportation, social activities, and housekeeping.

2. Eligibility for long term care facility :-

- Who wants to regain self care abilities

-Can't care for themselves

-Are fail and elderly and need continuous nursing care.

3. Bob and Mary has financial help from their children as they don't have any Medicaid insurance . As they have to pay from their pocket and because of that they have to go for a long term care facility which is cheap.

4. Bob and Mary must have taken a Medicaid insurance plan for their care during their later years.