Is This A Need in Central Illinois?

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Finally spring is around the corner; the sun is brighter and the days are getting longer. Children’s spring school projects now underway. This morning you received a phone call from a friend whose mother had a stroke about a month ago asking for your thoughts. Life today is active, especially for women aged 45 – 55 who care for both their parents and children. These are the people caught in the “sandwich generation”.

Her mom, let’s call her Helen, was young for this stroke that left her partially paralyzed on the right side. She is only 58 and has been in a skilled nursing facility (SNF) for therapy following her hospital stay. Now, she is being given notice that she must either pay privately to stay there or find another place to live.

Helen is not able to care for herself yet, and this is the hope. So, she is told she can have outpatient therapy to assist her gain control and strength back. Yet, her insurance has deemed that she has reached full potential and will no longer pay for a SNF. Helen cannot move back home; she will need help. She cannot afford to pay $7,000 a month for the SNF. Helen has a daughter in the Chicago area and family in Peoria. What are her options?

Her age of 58 works against her. Locally, she must be age 65 to get into a supportive living facility (SLF). These are like assisted living facilities (ALF) and much like an apartment with limited assistance for one’s needs. Unlike ALF, SLF will allow a person to stay even after they have spent through their assets. She could probably qualify for SLF, but in Central Illinois they are licensed for people 65 and over. Therefore, she could not get into a SLF.

The Chicago has at least one SLF that is licensed to accept people under age 65. This is her second option. Her daughter in the Chicago area would be more involved to make this work.

The third option is home health care. Helen does not have the funds to pay about $20 an hour for services every day; nor does she have long term care insurance to help with these expenses. This option s is not practical.

A fourth option would be staying with family and going to outpatient physical therapy. Due to the design of her adult children’s homes, this is not an option. The purpose of this month’s column is to discuss a need here in Central Illinois. Helen’s case is not unique and there are more people suffering from dementia and other conditions that could benefit from a SLF for people under age 65. . Supportive living could cut the state’s Medicaid costs by allowing people like Helen in living in supportive living. When a person is under age 65, the most often used alternative in Central Illinois is a nursing home which has a greater cost.

In addition, a SNF provides for a better quality of life in most cases. This author would suggest Illinois issues a certificate of need for a SLF for Central Illinois and let a private company build and run this facility.

Coordinating care for your children and parents simultaneously is not easy. What can you do to manage this? Three words of advice: Plan, Plan and Plan. Legal, financial, residential, mental and physical healthcare elements must be addressed prior to a crisis. A sandwich generationer should guide their parent through these issues and the primary issue of safety, while being careful not to take all control away from a parent. Once again, it is important to start talking, making suggestions and guiding early, do not wait for a crisis.

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Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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