Julie Jason

As families and friends come together over the holiday season, consider the welfare of elder members of your circle.  Families forget that the older you get, the more difficult it becomes to remain healthy, wealthy, and wise -- and independent.  
Mom may suffer a fall or a paralyzing stroke calling for immediate skilled nursing care.   

Dad may be disoriented from time to time and unable to do things that he normally took on with ease, such as balancing the check book.   Could dementia or Alzheimer’s disease be the cause?     

Before anything like this happens, it’s best to be aware and armed with information that can avoid a crisis.         

“Hospital stays are so brief nowadays,” says Susan Welsh, Director of Admissions, Nathaniel Witherell Rehab and Nursing Center of Greenwich, “that almost all people age 65 and older who are discharged from a hospital can anticipate a short term rehabilitative stay at a skilled nursing center.  We do 350 admissions a year and 90 percent of them are for short-term rehab.  The average age is 74 and the average stay is 24 days.”   

Almost 7 out of 10 people (69 percent) who live to the age of 65 will need long-term care of some sort before they die, according to Connecticut’s Office of Policy and Management (OPM); the majority of long-term care is provided at home. 

According to Welsh, only 4 percent of the general population needs long- term nursing home care, but for the older population (over age 87), the percentage rises to 40 percent.  

The cost of nursing home care ranges from $130,000 to $160,000 a year (from $356 to $438 a day) in lower Fairfield County, according to Welsh.   Statewide, the average cost for a semi-private room is $119,000 a year ($326 a day), according to OPM and the average stay is 2-1/2 years ($297,500).   

Typically, what brings someone into long-term care is some type of cognitive impairment, according to Welsh.    

If you are concerned about that possibility, consider a “geriatric assessment” from an institution, such as the Center for Healthy Aging at Greenwich Hospital, advised Richard Fisher, an estate planning and elder law attorney with the Stamford law firm of Cacace, Tusch & Santagata. 

Ronnie Lang, a social worker with the Center, explained that the assessment involves a health history, memory assessment, a medical exam, and a review of medications.  (Some symptoms of cognitive impairment can be caused by medications.) 

Lang emphasized that the Center works hand in hand with the patient’s primary care doctor, and is available to consultative services with the patient and the patient’s family.   The assessment, which takes about 2 hours, is performed by a board-certified geriatric physician, a geriatric nurse practitioner, a pharmacist, and a gerontologist.  Social workers are also on staff.   

A geriatric assessment provides a comprehensive evaluation and the basis for making decisions about the need for future care, according to Fisher.   The results may reassure the family that there is no need for alarm or identify the need for medical or other care.  

Moreover, it allows for an assessment as to the type of help needed.  Some cognitively impaired persons benefit from supportive services in the home and an adult day enrichment program, said Welsh.   Others may only need a less expensive assisted living facility as opposed to a skilled nursing center, explained attorney Sam Starks, who is an estate planning and elder law attorney in Stamford.   

In contrast, someone with advanced Parkinson’s disease may need skilled care that a nursing center such as Nathaniel Witherell can best provide.  
  
To read Part 2 of this series, click here.