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Planning For Another Stage of Our Lives

by Betty Soldz

Numerous studies show that independence and the ability to remain at home are of prime importance to us as we grow older. Each of us will age differently, but eventually most of us will reach the stage of our life when we will need some assistance with care. Previously we looked to our children, especially our daughters, daughters-in law, or perhaps our spouse, for this assistance.  In the past few decades however, family demographics have changed in ways that limit these resources. 
      Although in the past we could count on our daughters or daughters-in-law when we needed assistance, the majority of them are now in the workforce.  Additionally, many of our children are divorced and often single parents.  Due to a high job mobility rate, children and parents may live thousands of miles apart.  Until recently many women thought they would receive assistance from a spouse. This may be unrealistic for several reasons.  Women outlive men by approximately seven years.  Divorce increased dramatically in our lifetime and a certain percentage of women never married or do not have lesbian partners. 
      The old model of caregiving is no longer a realistic one and if we wish to remain independent it is imperative to know our options and make plans before we need assistance  Because each of us is unique there is no single way to do this.  One way to begin is to identify our needs and our resources to determine what can be provided by our informal support system such as family, friends and neighbors and what is available in formal supports exemplified by the government and purchased services. 
      Families, when we have them, will make up a part of this system.  We may be able to count on them when we have a short-term crisis but our children's lives are very full and we should not plan to count on them over a long period of time or as our main support.  The number of children we have and their availability will determine how much help we can expect from them.  Others who could be part of this system are our brothers and sisters and sometimes our grandchildren or nieces and nephews will help.  Neighbors can be an important part of this system as many are happy to pick up groceries when they are going to the store, bring in our mail, or even take us to the doctor. Lastly, don't forget the network of friends we have built through the years.
      Once we have figured out our informal support system, it is time to appraise our needs.  Perhaps we will we need financial help, transportation, housekeeping assistance, nursing help or just emotional support?  Will we need or want new living arrangements?  Although most of us will need some assistance, we should only seek the help we need at the time.  Perhaps we will only need someone to call and check on us each day or to bring us a bottle of milk.  Perhaps we only need someone to take us to the doctor.  If we request only the help we really need at the time, it will be easier to ask for and obtain more help when we need it. We can avoid over-utilization of this informal support system by matching our needs and the formal support system available to us.
      This task may not be easy.  Many women find they have too many assets to receive government assistance but too few assets to purchase help.  Your local Area Agency on Aging(AAA) is the place to find out what services are available and how to qualify for them. Then use some creativity to accomplish the goal of remaining independent.
      Trading services may give you the independence you desire.  Example: Perhaps you can do someone's bookkeeping or cooking and they can drive you to the doctor or for errands;   each exchange should be negotiated ahead of time.  It is also helpful to create a buddy system with someone we know.  We can check on each other either by visiting, if we live nearby, or with a daily phone call. There is something comforting about knowing someone will check on us.
      At the time one needs services it may be wise to have an assessment by a professional case manager who will help determine what help is needed and what you can afford.  They can also help with locating the services. A case manager can even coordinate delivery of services. For those with low income, a case management service may be provided by the local AAA. 
      This may be the moment when we may want to consider whether alternative housing is a useful option.  (See previous article "Home is Where the Heart Is").   In several alternative housing options a range of services will be provided.   Perhaps sharing our apartment or house will be a way to maintain our independence.  If these are not options that you would be comfortable with, consider hiring some of the following services.  Some are low cost or free according to income, but availability and cost  will differ by community and state and a number of  services may be a bit expensive. 

• Emergency alert system for your home allows one to summon aid by pushing a button on a device usually worn around the neck; alerts a central monitoring station of your need for aid. Call your local hospital or Visiting Nurses Association to learn of availability.
• Home health aides provide personal care services such as cleaning wounds, changing bandages, giving injections, or inserting catheters.  Your local AAA may have a list or there may be locating services available through the Home Health Agencies listed in the phone book.
• Nurses and other health care health care professionals are available through the Visiting Nurses Association.
• Medical equipment can be leased or purchased from a hospital or equipment store. If your doctor orders these for you, they may be covered by Medicare.
• Transportation. Check with your senior center or Dept. of Aging for taxi scrip. These vouchers can help pay for transportation to such places as physicians' offices.  Some cities sell discount tickets for public transportation.  Some medical centers have vans to pick up seniors for medical visits.  These services vary widely by community.
• Homemaker services perform such services as shopping, cooking, and cleaning and are available through Home Health Agencies which should be listed in the yellow pages. Those who are on Medicaid may find that these services may be provided.
• Churches and synagogues. Some have 'friendly visitor' or telephone callers who will visit with you in person or by phone.  This service will be free.
• Live in student or helper assist with chores. In exchange for free or low rent  this person can assist with household chores, give personal assistance and companionship. Many seniors have found this to be a workable solution to their need for assistance.  The unexpected result of this many times is a new found friend.
•  In-home support services.  If you have a limited income and receive Medicaid and Supplemental Security Income (SSI),  there are programs to help you remain at home. The services offered will depend on your needs.  Contact your Medicaid office and request In-Home Support Services.  Entitlement to these services will vary by state. 
• Meals on Wheels are inexpensive nutritional meals which can be delivered to your home.  Check with your local Senior Center or church or Agency on Aging.
• Friendly Visitor Program. A service designed to decrease social isolation of those who are homebound.  Check with your Area Agency on Aging or church to locate such a program in your area.  If this service is available, it will be free.
• Telephone reassurance is offered by volunteers who arrange to talk to you on a daily basis to make sure you are safe. When available, this service is free and can be located through your Area Agency on Aging and sometimes through your local hospital.

     Many of the above services require that a stranger come into our home.  Before hiring anyone be sure to check their references.  It is always prudent to put away valuables we would not want to lose.   If  hiring through an agency, check their references and make sure their employees are bonded. 
     For a more complete understanding of what can be done  to prepare for the time when care may be needed,  please use this article along with the author's previous articles for this web site on Caregiving, Alternative Housing as well as Long-Term Care Insurance and Options to Financing Long Term Care.  These five  articles used together will give a more comprehensive view of available choices.
     The best chance of maintaining independence and the quality of life we want is to anticipate our needs and make plans for our future.

 

Betty Soldz is an author, educator and consultant in the field of aging. She facilitated workshops and discussion groups for the University of California Berkeley Retirement Center. Betty is one of the co-authors of Wise Choices Beyond Midlife: Women Mapping the Journey Ahead.  She is Past-President of OWL/CA (Voices of Mid-life and Older Women) and is Past-Chairperson of 50+ and Strong: An Alliance for Women's Health. For 11 years, Betty volunteered with the California Health Insurance Counseling and Advocacy Program (HICAP) of Legal Assistance for Seniors and is active in the struggle to protect Medicare and Social Security. She is now Newsletter Editor and and Public Policy Liaison, as well as a member of the Coordinating Committee of Greater Boston OWL. Betty can be contacted at:Milbet@aol.com.