Many people think of caregivers as professionals who are employed to take care of others. But in reality, a caregiver is anyone who regularly helps someone else — often without pay.

Who is a caregiver?

Today’s caregivers are predominantly family members. Partners, spouses, adult children, parents or other relatives are the most common caregivers. In fact, 37 percent of those providing care are providing it to a parent, according to the U.S. Centers for Disease Control and Prevention. But friends and neighbors — or others concerned about the well-being of an older person — may qualify as caregivers as well.

The caregiver often is someone who has a job and other commitments but makes time to help the individual in need. Regardless of the relationship between the person providing care and the person receiving care, a caregiver is often untrained to do the work they do as a caregiver.

Tasks completed by caregivers

At first, the tasks completed may be quick and relatively small: buying groceries, providing companionship, offering rides or helping with home maintenance. But other more complex tasks may arise over time. These include but are not limited to:

o Bathing, dressing, offering medication

o Mobility assistance

o Wound, IV or other medical care

o Arranging medical care, sitting in during appointments, taking notes

o Managing bills, organizing finances and overseeing legal matters

o Being on call 24/7 for any type of assistance

Caregivers should make a list of the assistance they provide. It can help them understand how to budget time, finances and emotional resources, as well as provide a foundation for others who may be able to help.

How caregiving sneaks up

Support roles like those provided by a caregiver often start out small. Helping Mom clean the fridge every month slowly grows into weekly shopping trips to stock it. Mowing the lawn for a neighbor turns into year-round yard maintenance. By the time a caregiver realizes that errands and assistance are a regular thing, they are already immersed in the work of caregiving.

How crisis creates a caregiver

Sometimes, the role of caregiver comes on quickly, such as when a friend or family member experiences a debilitating event such as a broken hip or stroke.

No matter the crisis that occurs, when a caregiver is catapulted into the work of caregiving, his or her life changes.

Why is it difficult to accept the title?

For some, taking the title of caregiver may feel burdensome. Others may worry it implies a stripping away of their loved one’s independence or could alter their relationship.

It’s important to remember that caregiving is meaningful work — and that caregivers also need help and support.

Each year, more than 48 million Americans provide uncompensated care for an older adult, according to the U.S. Bureau of Labor Statistics. Many of these caregivers are blindsided by the role and take it on in an emergency, such as when a loved one falls or becomes ill.

Regardless of whether the caregiver is thrust into the role in a crisis or gradually, most do not know what to expect.

What is caregiving?

Caregiving is different for everyone, but some common situations include:

• Caring for someone with a chronic illness or disease

• Caring for someone as they recover after illness or surgery

• Managing medications or talking to doctors and other health care providers

• Assisting with bathing, dressing and eating

• Managing household chores and bills

• Providing transportation

When does it start?

New caregivers may not realize they are now caregivers because they believe they are simply helping out. But any time someone begins to consistently assist someone with the tasks above, or others, they become a caregiver. Regardless of how the role enters one’s life, there are several stages a caregiver and care recipient may move through.

The stages of caregiving

Stage 1

The caregiver prepares to take on care, or is now defined as a caregiver, in relationship to the care recipient. Both individuals are adjusting to the new relationship. It is a good time to put legal documents in place, organize finances, and specify desires for medical care.

Stage 2

The caregiver begins to understand the magnitude of the role and may begin to look for additional assistance, such as an adult day care center or respite provider.

Stage 3

The care recipient may worsen or decline, requiring more care. Caregiver stress may increase, leading to burnout and personal health issues. Conflict may arise within families.

Stage 4

This is often a period of mourning, as the caregiver realizes they can no longer provide the care needed, or the care recipient is no longer alive.

Evaluating the impact of caregiving

The responsibility of caregiving can affect the caregiver, too.

Physical health

Assessing the physical ability to care for someone is a primary concern, as lifting, transferring and other physical demands may lead to strains or pain in someone who is unable to safely care for another person.

Mental health

Anxiety, anger, depression, grief and guilt are common challenges faced by caregivers.

Time

It’s important for a caregiver to determine how much time he or she can give to a loved one so that the caregiver also is able to have time for a partner, children, friends and other commitments.

Finances

According to a report from AARP, caregivers often spend more than $7,000 out of pocket to care for a loved one. This goes up to $12,000 for long-distance caregivers who must travel more or pay for more additional services.

Relationships

Caring for another person can lead to conflict among family members, friends, co-workers and others. Talking with these people ahead of time and being honest about current responsibilities may help caregivers avoid some of these conflicts.

It’s important to consider each area individually, and as a whole, as these spheres of life influence an individual’s well-being.

Caregiving requires a lot of mental, physical and emotional energy. For caregivers who provide care 24/7, this level of being “on” all the time can lead to burnout.

In fact, a 2020 report from AARP noted that about a quarter of caregivers say their own health has declined since taking on this duty. And one out of five caregivers report feeling alone. “Feelings of loneliness are associated with fairly strong feelings of stress and strain as well as decreased health for caregivers,” the report notes.

What is caregiver burnout?

Burnout is defined as stress that has been unsuccessfully managed. It is most often discussed in workplace settings, but it also often takes place at home.

Donna Benton, PhD, is the director of the USC Family Caregiver Support Center in Los Angeles. She says that today’s caregivers are experiencing stress and burnout that previous generations didn’t because of a two-fold problem: Most informal family caregivers don’t identify as such, and most caregiving responsibilities fall on women. With more women working today than ever before, this has become a problem.

“Women entered the workforce in the 1960s, and that population has gone up,” she says. “More and more are in the workforce, but the roles for women, in terms of care, have not changed.”

Karla Salem, a therapist with Sanford Health and a longtime caregiver herself, says the following list can help you determine if you’re suffering from burnout.

What are signs of burnout?

• Negative emotions such as frustration, anger, depression, dissatisfaction and anxiety, with increased frequency until they become chronic

• Moodiness and irritability over trivial provocation

• Frustrations that result in continual and unsolvable feelings of futility, such as “Why bother,” or “There’s no point” or “It’s hopeless.”

• Emotional withdrawal from social interactions

• Health problems due to the decline of physical resilience

• More frequent complaints like colds, headaches, insomnia, backaches and a general feeling of being tired and rundown

• The “mores”: More alcohol, more food, more medications, more smoking, more caffeine, more sugar, more shopping, more working

• Poor concentration: Waning enthusiasm and decreased reliability

• Interpersonal problems caused by emotional outbursts; intense hostility

• Constant feelings of negativity and futility creating emotional and spiritual exhaustion

• Physical changes: Gaining or losing weight, feeling ill

How to avoid burnout

Dr. Benton stresses the importance of identifying as a caregiver.

“[Caregiving] has always been viewed as a family issue, so there’s no self-identification as a caregiver,” she says. “You’re just a daughter, son, sibling, spouse or a good neighbor. So the expectation that it is is something you’re ‘supposed to do’ makes it difficult for people to see that this is a different role than what they are as a sibling or spouse or parent.”

By understanding personal stressors, caregivers can find strategies for coping with the responsibilities they have as a caregiver and as an individual.

How to manage burnout

Take care of yourself. Here are some ideas:

• Consider using respite care to give yourself a break

• Look into optional services that can help with things like housework, meal preparation and more

• Maintain your personal health as much as possible – take a walk, spend time in nature, call a friend or a professional

• The national suicide prevention hotline is 1-800-273-8255 – there is hope and help available

Michelle’s journey

In the fall of 2013, Michelle D. watched her oldest son launch a career from afar. She had just sent a second child off to college and was enjoying her youngest’s final year of high school. It seemed as if the bulk of her caregiver days were over.

And then, Betty, her mom, fell.

Michelle became a caregiver in a new way, and like nearly 45 million other unpaid family caregivers in the United States, this meant checking in on her mom and helping her as she recovered. It meant stopping by Betty’s home after work to do laundry and take stock of the fridge, the bills on the table and her mother’s overall health.

A new role

Unpaid caregivers like Michelle frequently feel overwhelmed. Often, they are thrust into this position during a crisis, with no say in how to handle finances, medical care or even the level of care a loved one can receive.

But Michelle was prepared. When her mother began to decline, she made sure to set up a power of attorney, so when the time came, she could make financial decisions for her mother. She asked Betty to complete HIPAA paperwork, so when complex medical situations arose, Betty’s doctors could talk to Michelle about them. And she asked her mom to go over her living will again to clarify what kinds of medical actions Betty wanted.

Finding balance

Today, Betty lives in an assisted living community designed for people with dementia. It’s been difficult for Michelle to see her mom move from her home to a care setting, but she has peace of mind knowing her mom is getting the care she needs, and her affairs are in order.

Michelle doesn’t think of herself as “lucky,” just prepared. Unlike many other caregivers, she had time to plan.

Even if a loved one is happy aging in place, there may come a time when a transition to a nursing home or assisted living facility is necessary.

Many people put off having this discussion until it’s too late, but the tips outlined in this Q&A can make it easier.

How do I bring up the idea of moving?

• Give examples of how life may be easier and more fun in the new location. If the loved one has a friend who has made the move and is loving life, use him or her as an example.

• Nursing homes offer social events and activities, and there’s always someone around to help with mobility issues. This can foster a greater sense of independence.

• An assisted living facility will take care of household chores, leaving more time for hobbies, grandkids or recreation. There also will be medical assistance available as needed.

What if we’re avoiding the issue because we don’t know how to pay for it?

• Long-term care costs vary by location and the level of care and services chosen.

• It’s important to talk about payment options with loved ones. Be honest about the cost of long-term care, how much assistance is available and what they can afford.

• Explore various payment options and find out what is important to them.

• You can create a care budget to get a better understanding of where you are.

Questions could include:

• Do they want a full-sized kitchen to cook in, or would they rather have meals prepared for them?

• Is it important to have a second bedroom, or would a studio apartment be easier to maneuver in?

• Is there scheduled transportation to help them run errands, or is there a private parking lot for their car?

• Do they want help with housekeeping or laundry?

• Is there an on-site beautician? Wellness classes or equipment? A chapel? Social activities? A place to have coffee and snacks?

What do I say if my loved one feels like I’m taking control when I’m just trying to help?

• Find a time to talk when they are calm and feel in control, perhaps after they’ve made a decision they’re happy with.

• Use “what if…” language instead of “you should…” or “you need to…” These phrases can make anyone feel defensive and shut down.

• Offer observations without judgment, and state what’s needed, as a caregiver. Then, assure them it’s their decision.

Example statement:

“When I see the grass getting really tall, I worry that it’s hard for you to mow the lawn or that you’ll hurt yourself. I feel scared about that because I want you to be around for me and the grandkids. Would you be willing to look at independent living locations with me? You wouldn’t have lawn care anymore, but you could still come and go as you please. It’s your choice, but I think it could make life easier for you.”

What do I say if my parents still see me as a child and won’t discuss big decisions?

Ask if they would be more comfortable talking to someone else, like an older relative, a doctor or a social worker. Then, ask questions they might not have considered:

• Can you do everyday tasks easily? Do you need help with any of them?

• Do you feel safe in your own home and when you’re running errands?

• Do you wish more people were around to talk with?

When they answer, look at body language and other nonverbal cues, and repeat back to them what they’ve said.

Many caregivers fear upsetting their loved one, so they avoid these conversations or end them when they get uncomfortable. But by clearly stating needs and concerns, they become better advocates for their own health while also looking out for the care recipient.

It may take time to have this conversation in its entirety, but ultimately it will help caregivers and their loved ones find the best choice for their needs and desires.

Are you getting ready to have a challenging conversation? The following tips are good to review to make sure you make the most of your discussion.

Tips for talking — how to bring up difficult topics

Topics from taking away car keys to encouraging help at home to considering moving to assisted living can be challenging to broach. But it’s important to find a way. Here are some tips:

• Be straightforward and compassionate.

• Normalize the topic as a normal part of health care and well-being.

• Remember, sometimes your loved one has been wanting to talk about this, and he or she didn’t know how to bring it up.

• If you have another family member or friend with a better or different relationship with your loved one, maybe that person can begin the conversation.

• Sometimes it’s helpful to have someone in a neutral position or a position of authority bring up the topic – such as a doctor or other medical caregiver.

• Begin with a clear expectation – does your loved one understand what you’re REALLY talking about? When you say “hospice,” for example, does he or she understand what that is? You can eliminate a lot of early frustration by being clear and up front.

• A good opening line could be, “Hi, I’ve been a little worried that I don’t know what you would want to do in certain circumstances. It would be helpful if I knew what you wanted.”

• Make sure your loved one knows he or she is in control – you are just there to make sure their needs and wishes are met, not to tell them what to do.

• It’s important to remember this is all an ongoing dialogue – if wishes or medical needs change, these documents can be updated.

• If someone is very resistant to the conversation, don’t push. Instead, offer to share some information and allow them time to think about it, then try again at later date.

Tips for listening — how to ensure understanding and respect

Empathic listening is a gift you can give your loved one – and it can help you ensure you understand his or her wishes. One tip is to repeat back what you heard, to make sure you understand. Use phrases like:

• I feel like what I heard you say is … .

• I understand, but what I think you’re saying is … .

• Is this right?

• I want to make sure I know what you would like to happen.

• Make it personal: If someone has COPD, you say, “if you stop breathing, what would you want us to do?”

For caregivers and their loved ones, the key to all these conversations is straightforward, loving communication, and a knowledge that, above all, what matters most is how we make one another feel.

Are you worried about your loved one driving?

It can be a challenging topic to bring up. After all, suggesting that someone can no longer drive has both emotional and practical implications.

According to the U.S. Centers for Disease Control and Prevention, one in six drivers in the country is age 65 or older, and older adults are more than twice as likely to report having a medical problem that makes it difficult to travel as compared with drivers ages 24 to 64.

That doesn’t mean every senior driver is a risk or at risk, but it does mean caregivers may want to pay special attention to how their loved one is doing behind the wheel – and be prepared to have difficult conversations.

Thankfully, there are a variety of publicly available resources that can help.

What to look for

Make sure your loved one:

• Always wears a seatbelt

• Drives during the daylight and on dry roads

• Doesn’t drink and drive

• Receives regular checkups

• Knows how his or her medications affect the ability to drive

Notes on your loved one's driving

Observe your loved one driving, and look for things like:

• Driving too fast or too slow for no reason

• Following other cars too closely

• Getting lost on routine trips

• Confusion with road signs, construction zones or other markings

• Any recent tickets or warnings

• Unexplained scratches or dents on the car or in the garage

• Swerving within their lane

• Seeming to follow things like the curb too closely – as a guide for staying on the road

• Anxiety about driving, or making excuses for not making trip

How to bring up the topic of taking away the keys

The thought of having to rely on others for transportation can be upsetting for people. Your loved one may be worried he or she won’t see friends anymore, get to needed appointments or have the ability to run out for a quick grocery trip.

Or, your loved one may be embarrassed to bring it up – maybe he or she has been worried about driving but doesn’t want to be a burden.

Here are some tips to get started:

• Ask your loved one how she or she feels about driving.

• Ask others who drive with your loved one if they have any concerns.

• Begin gently and with respect to your loved one’s dignity and independence.

• Don’t begin the conversation in the car – you don’t want to further distract your loved one.

• Use specific reasons and examples.

• Be a good listener.

• You may need to bring this topic up more than once.

• If your loved one is arguing with you, consider the help of a third party, such as your loved one’s doctor.

• Remember that this is not only for the safety of your loved one but also for the other drivers on the road.

Offer alternatives

Your loved one’s independence is important – and you should take that seriously. Make two lists, together.

The first list should be of places he or she wants or needs to go: doctors’ appointments, hair appointments, standing social functions, errands.

The second should be a list of alternative forms of transportation: family members who can help, ride shares, hospital shuttles, public transportation, carpool with friends. Whatever works for your family.

Then put those lists together and help show your loved one how he or she can maintain independence – and how you can help problem solve. It may take some stops-and-starts to get it all right, but you can help the situation by taking his or her needs into account and reassuring them that solutions are available.

Don’t forget to plan for the unexpected: It’s easy to coordinate known appointments or routine errands. But what about birthday parties, or visits with friends? Make sure you recognize those issues as they arise.

Other steps you can take

If you need to take more action than just a conversation, there are resources for you.

• Suggest your loved one take a driver-refresher course. Some insurers offer a discount on car insurance for that.

• Most states offer a Driver Evaluation Form, where you can request someone re-test your loved one. You can find this on your state department of transportation site or your local department of motor vehicles.

• Maybe it’s time for license renewal. States have varying requirements when it comes to older drivers, restrictions, tests and license renewals. You can find out what your state requires here.

• Share this list of medications that can increase the risk of a fall or a car crash. Knowing that some of this risk is beyond their control might make your loved one more open to the discussion.

• The National Highway Traffic Safety Administration offers free material for caregivers to talk about safe driving with loved ones. NHTSA also suggests helping make a list of where your loved one drives now, and then offer an alternative.

Four things to consider when looking at senior housing options.

Type of housing

Exploring all options ensures the best fit for the resident and his or her needs.

Costs

Understanding the costs and amenities for each option helps identify what they can afford.

Benefits

Reviewing all available benefits may identify additional funding options.

Support services

Support services can help caregivers manage various aspects of care for loved ones still living at home, but these services can also provide assistance to those who have transitioned to residential care settings.

Conversations

Tips on how to discuss the issue with loved ones.

Caring for a loved one might be an infrequent thing, like helping wash windows in the spring or picking up groceries on occasion. But as a loved one begins to need more help, caregivers may find themselves spread thin by managing their own responsibilities and those they’ve taken on for a loved one.

Putting together a care plan is a way for caregivers to track what they’re doing, find support and build in some time for self-care.

What is a care plan?

• A care plan is a list of needs, desires and goals developed by the care recipient and caregiver.

• Corresponding to each item should be a listing of who will help with that goal and how.

• The plan doesn’t need to include every situation that could arise, but it should cover immediate needs and any anticipated needs.

How to create a care plan

Start by having a conversation

• This includes talking with the care recipient about their needs and desires, but it should also include talking with other family members and potential caregivers, such as neighbors, support service providers or community resources such as meal delivery services.

• Caregivers who are working should also consider having a conversation with their employer about their caregiver responsibilities outside of work. This can help them find resources at work or discuss potential shift changes as needed.

What happens without a care plan?

• The greatest benefit of having a care plan is organization. Without one, needs could fall through the cracks, or caregivers may not notice changes to be addressed.

• Some care recipients may have several caregivers. A plan helps keep people organized and accountable.

• Others might have just one caregiver, and with multiple responsibilities, it could be difficult for that caregiver to keep track of everything.

• Without a plan, your loved one may be left guessing or trying to remember who helps with what.

What to do once it’s in place

• Post a copy where your loved one can view it. This can provide peace of mind, so your loved one knows what to expect.

• Provide all caregivers with a copy. Keeping it in a log book and asking all caregivers to add notes after providing care is a good method.

• Update as needed.

• Take to medical appointments.

What to Know

• A care plan is a fluid document. It can change with a change in diagnosis, increased care needs, change in finances, caregiver circumstances and other life changes.

• A care plan should be revisited whenever circumstances change or at a minimum on a yearly basis.

• A care facility or agency may create its own care plan, ensuring the family’s plan for care aligns with the outside caregiver’s plan for care. It is important to be part of this process to ensure that all parties hold the same expectations of care responsibilities.

The many details of caregiving can be overwhelming.

But managing them from a distance can complicate things even further. According to the AARP, about 11 percent of caregivers live more than an hour away from their loved one. That can make it difficult to help with daily tasks or respond quickly to emergencies.

Caregiver considerations: Roles, burnout, services

• Optional services include everything from home health care, which brings licensed health professionals into your loved one’s home, to homemaker services, such as laundry and meal prep.

• Are you worried about your loved one’s bills piling up? There are services that can help organize and manage automated payments – so you know your loved one is taken care of.

• Don’t wait to bring up difficult topics. Your loved one may be waiting for you to ask about how they imagine the rest of their life – and then helping them make a plan to make it happen.

• Make sure you take care of yourself. Caregiver burnout is real – and there’s help and hope.

• Are you working with other family members, neighbors or friends to take care of your loved one? About half of caregivers coordinate care with others.

Look around the house: How to keep your loved one safe

You’ll want to make sure your loved one is safe at home. That can include:

• Posting emergency phone numbers in prominent places – including family contact information, doctor’s office numbers and emergency services.

• Posting any medical emergency information, such as allergies or medications, in case someone needs to help your loved one.

• Is the bathroom accessible, with grab bars and non-slip surfaces?

• Are the locks on the house working and easy to use?

• Is there room to move around safely inside, and can anything be done to reduce the risk of falls?

• Is your loved one’s favorite chair or couch stable, so it doesn’t move when they try to sit down or stand up?

• Are valuables stored safely away?

Hiring help: Some questions to consider

It can be nerve-wracking trying to choose a person or service to come into your loved one’s home. There are questions to ask that can help you determine who and what is right for your family. That could include:

• What kind of training or licensing does your company ensure?

• What kind of employee screening do you do?

• What services do you provide?

• Is everything included in one cost?

• Who pays the employee – the agency or the caregiver?

• Whom do we contact if the employee doesn’t show up?

• Can we request certain employees if our loved one makes a good connection?

• What tasks are not included?

• It’s always a good idea to do your homework – ask for recommendations from medical providers and others you know. And then call and ask questions – most reputable companies will be happy to answer anything you ask. After all, they want to provide a good service. If you get a bad feeling from a company, consider that as well.

Stay connected: You can still keep in touch from far away

Caregivers can also stay in touch in many different ways, such as:

• Setting up a set time to call every week

• Using video-chats to connect with your loved one

• Sending cards or notes in the mail

• Regularly send updated photos to your loved one

• Sharing photos and videos through social media with your loved one

• Don’t forget – even young family members can color a picture or write a note in a card to brighten someone’s day

• Share your contact information with your loved one’s neighbors – so you have another set of eyes ensuring your loved one’s safety

According to a 2020 report from the AARP, about half of caregivers say someone else is working with them to coordinate care.

The following steps may be helpful in determining roles when that’s the case.

Developing a care plan

Sit down with the care recipient and any potential caregivers. Discuss what the care recipient needs and who is best able to address each area. Creating a care plan may be part of this step, but honest self-reflection should also take place at this point.

Areas to consider:

• Who has medical knowledge? Can they organize and be in charge of medical documents, appointments, paperwork?

• Who is good with financial matters? Are they able to focus on bills, reimbursements and tracking income?

• Does someone enjoy working with their hands and doing-task oriented work? Who enjoys shopping and preparing meals?

By discussing who is most equipped for or interested in the tasks needed to assist the care recipient, caregivers can be involved in ways that speak to their strengths.

Talk about time and money

Some care teams may find that the person best suited to handling medical information doesn’t have the flexibility to take the care recipient to doctor appointments. Is it possible that they are able to organize medications lists, medical bills and insurance statements so that this information is current but then rely on someone else to get a loved one to the appointment?

What if the person who can best track expenses and income lives out of state? How will they receive copies of the bills and track all income? Some of the best solutions may require creativity from the care team.

Being realistic about not only what each caregiver is good at but how much time, mental energy and financial assistance they can provide is important.

Don’t forget long-distance caregivers

While it’s easy to think of caregivers as those who are involved on a physical, day-to-day basis, don’t discount the value of a family friend, former co-worker or relative who lives at a distance.

• Could this person check in with a daily or weekly phone call?

• Could they organize transportation for doctors’ appointments and regularly scheduled appointments such as getting groceries?

• Maybe they are able to set up and monitor an online bill pay service, thus taking on a responsibility that doesn’t need a physical presence.

• Maybe they can work with the loved one to create a grocery list and then order the groceries online and have them delivered.

Finding unique ways to incorporate the help of someone from afar can give everyone on the team more room to focus on their role and their own personal responsibilities.

Caring with siblings – tips

The Family Caregiver Alliance suggests rethinking how old roles can be reimagined and offers these and other tips:

1. Accept siblings and parents for who they are, not who they could be.

2. Remember that each sibling and each parent has their own relationship to each other.

3. Determine what is personally needed from each sibling — and what the care recipient needs.

4. Check criticism. Is it that they’re doing things “wrong,” or is it that more support is needed?

5. Don’t use guilt and anger.

6. Seek professional mediation if needed.

7. Discuss parents’ estate plans with them, not with siblings.

8. If a sibling is taking advantage of a parent financially, contact an attorney.

Setting up support services

For many families, an aging parent may be the primary caretaker of another aging parent or relative. Even with additional assistance from friends and family, the daily work of caring for another person can wear on their health as well. It’s important to watch for signs of caregiver burnout.

As part of this effort to coordinate care, caregivers should look for local services that can come into the care recipient’s home and help with a variety of tasks. Supplemental service programs today can even offer much-needed breaks to a primary caregiver.

For caregivers who need time for themselves, to work or unwind, adult day programs can provide this and ensure a loved one’s safety.

What is it?

According to the Centers for Medicaid and Medicare, there are two main types of adult day programs.

One is a general socialization and care program providing “recreational programs, activities and meals.”

The other, known as “adult day health care,” offers services such as assistance with daily living, help with medication, and physical, occupational and speech therapy.”

Both are considered to be forms of respite care.

Care is provided in licensed and regulated facilities that typically operate during business hours Monday through Friday, which can give caregivers who work during these hours a chance to maintain their careers. It can also allow a caregiver time to run errands or take time for themselves. Some nursing homes offer adult day programming, which may include extended hours.

Who is eligible?

Most states determine who can be served in an adult day care setting by looking at the participant’s abilities and needed care. An application and assessment must be completed before enrolling in the service.

Where to find it

Ask the care recipient’s doctor for recommendations. Or contact local nursing homes and senior centers to find options.

• Visit the National Adult Day Services Association for state listings.

• Search the Yellow Pages and internet, and use the Eldercare Locator to find local providers.

What does it cost?

Costs for this care vary based on the amount and type of care needed. In 2019, according to the Genworth Cost of Care survey, adult day care cost on average $1,625 per month.

How to pay for it

Adult day care care providers may charge by the hour or the number of days care is needed. Insurance and Medicare do not cover these costs.

Other payment options include

• Long-term care insurance

• Medicaid

• VA benefits

• Private pay

What to know

• Different states have different terms and regulations in place for the level of care that can be provided by an adult day care center. Get a state-by-state list from National Adult Day Services Association.

• Touring a location is the best way to get a feel for the program and participants.

• Adult day care may be considered a tax-deductible medical expense. A tax preparer can help make this determination.

• Some locations may charge enrollment fees on top of other rates.

Questions to ask provider

1. Do you offer transportation?

2. What certifications are required of staff?

3. How much ongoing training do staff receive?

4. Can you administer medication?

5. Is there an additional charge if the care recipient is picked up late?

Palliative care and hospice are two terms caregivers may hear as they care for their loved one.

This goes beyond information on basic legal documents — which should already be in place. This explores the more personal elements of what makes life worth living, such as physical comfort, mental and emotional needs, spiritual concerns and any final tasks, while also managing end-of-life expectations.

What is the difference between palliative care and hospice?

Palliative care, which helps manage the physical symptoms associated with illness, can begin upon diagnosis and continues until death. Hospice care, which can include additional emotional and spiritual support, begins when someone will no longer benefit from treating that illness.

Addressing physical comfort

Pain is taxing on even the best days, so helping a loved one avoid discomfort can ensure final moments are as pleasant as possible. Discussing a loved one’s pain tolerance can also help care teams understand whether hospice is a good option.

• Where would you like to die?

• What would be too much to endure?

• Would you like medication for pain management?

• What level of lucidity would you like to maintain?

• What other forms of comfort would you like?

Addressing mental and emotional needs

When family and friends are unsure of what to say to a dying person, they may avoid that person, leading to increased feelings of isolation or fear. Sometimes simply sitting with a person can help them feel better, but asking questions about their emotional needs may be beneficial.

• Do you have any specific fears or concerns?

• Would you like to have someone with you 24/7 at the end?

• If possible, is there a certain person you’d like here?

• Is there music or a favorite book you’d like to hear?

Addressing spiritual concerns

Not everyone follows a spiritual practice, but if caregivers are unaware of what their loved one believes about the end of life, this is a good time to ask. Bringing in a social worker or spiritual counselor could also be beneficial.

• What does a good death look like to you?

• What are you most proud of in life?

• Are there any prayers or religious texts you’d like to hear?

• Has faith played a role in your life?

• Addressing any final tasks

If legal documents are already in place, the caregiver likely knows what if any level of life-prolonging treatment is desired, and the care recipient has already designated how their estate will be settled.

But perhaps there are other final tasks to be completed, such as reconnecting with an old friend, or visiting a favorite place. For those who had limited time to prepare, such as someone diagnosed with a rapidly-advancing illness, addressing final tasks should include writing a will or trust and providing access to other accounts.

What to know

• Palliative care is paid for through private insurance, Medicare, Medicaid and private pay, subject to the eligibility requirements of those individual programs.

• The Medicare hospice benefit pays for most hospice needs, but hospice patients must meet Medicare’s eligibility requirements to qualify for this program. Medicaid also pays for hospice benefits in full.

What to do next

Share any care plans or wishes with medical care teams.

Some people might not want to talk about hospice. That’s OK — simply learning how someone feels about these areas can help the caregiver uphold their loved one’s wishes for end-of-life care.

Whether an older loved one no longer wants to tackle things like home maintenance or laundry, or they can no longer safely do these things on their own, there are many options for them to receive help wherever they live — in a way that preserves their dignity.

The following support services can help caregivers manage various aspects of care for loved ones still living at home, but these services can also provide assistance to those who have transitioned to residential care settings.

Options exist even for those whose loved ones live at home with them but need a higher level of supervised care at times.

Home health care

This service brings licensed health professionals to wherever the care recipient lives, saving time and often money on health care services that could be administered at a clinic.

Home care

Often called “homemaker services,” home care provides assistance with tasks in the home, including housekeeping, laundry, meal prep and, in some cases, personal hygiene care.

Respite

Respite care provides caregivers with a safe place for their loved ones to go for an extended period of time, in some cases up to 30 days.

Adult day programs

These programs typically run during business hours and offer safe and stimulating care when a caregiver needs time away for work or personal care.

Meal delivery programs

Nutritional concerns may arise when a loved one is no longer able to shop for groceries or prepares meals for themselves. Meal delivery programs provide hot meals and companionship for eligible community members.

Automated bill-pay services

These services can help manage finances.

Sometimes health challenges or other issues make it impossible for someone to drive. When that happens, it can feel devastating.

According to research published by Transportation for America, nearly 7 million older adults in 2010 were no longer driving but needed access to transportation for everyday activities.

If a caregiver lives near a loved one and has a flexible schedule, they may be able to help the older adult get to the store, doctor appointments and other errands. If not, a lack of transportation is a big issue for older adults.

Here are some services that provide transportation for those who cannot drive:

• Paratransit services are independent agencies that offer transportation via bus or van to older adults and those with disabilities. The Federal Transit Administration offers more information about this service and eligibility. services and grocery and pharmacy delivery.

Loneliness and social isolation among seniors is more than just a feeling.

It’s a health concern that can increase someone’s risk of dementia and other medical conditions by 50 percent, according to the U.S. Centers for Disease Control and Prevention.

Not every older adult who lives alone feels lonely. Recent research suggests that nearly a quarter of adults ages 65 and older are socially isolated. Immigrant, LGBT populations and minorities are at higher risk, according to the CDC.

If you’re worried that your loved one feels isolated, there are resources that can help. Here are some to try.

Try local groups

Senior Companions. This is a national income-based service that provides free companionship to seniors.

Senior centers. Your local senior center may have day programs or social programs available. That can include everything from book or card groups to adult day-care services.

Tip: To find like-minded social groups, look through the events calendar for activities your loved one enjoys.

Familiar places. Did your loved one enjoy meeting friends for coffee or cards at a local café? You can help them continue that tradition by taking advantage of transportation programs.

Local churches or cultural groups. These local groups often have volunteers who visit with members of the congregation. You can contact them to have your loved one added to their list.

Tip: If the church or group doesn’t have a formal visitation program, ask if it has any volunteers who may be willing to provide some companionship.

Veterans’ organizations. If your loved one is a veteran, reach out to your local VSO to inquire about any veterans groups your loved one may be interested in joining.

Tip: Some veterans programs may also pay for some types of companionship care, so be sure to inquire about these opportunities with your VSO.

Meals on Wheels. It’s not a companionship program, but having a daily meal delivered provides an opportunity to socialize and serves as a daily check-in. Enter your loved one’s ZIP code to find out if the service is offered where they live.

Consider a home care company. Some offer companionship services.

Consider a pet. Not everyone can or should own a pet, but if your loved one is able and willing, consider adopting a pet. Local agencies and shelters can help you find the right fit for your loved one.

Medicaid programs. While still uncommon, some state’s Medicaid programs cover home care companionship services. Call your local State Health Insurance Assistance Program (SHIP) office to see what your state covers.

Lean on friends and family

Rotate duties with familiar faces. Reach out to neighbors, grandkids or other trusted adults and ask them to stop by once a month or every two months or to make a regularly scheduled video call.

Tips: Ask those planning to visit to schedule a time, so the caregiver can add it to the loved one’s calendar. It’s a great visual reminder that he or she is not alone — and it helps them know what to expect each day.

Let technology help

Try technology. There are a ton of options to have video calls with your loved one. That includes special products, as well as just asking others to use the video feature on their phones if they call. That face-to-face time can make a huge difference for someone, especially if he or she is hard of hearing.

Tips: Set any device up completely, and make sure it works, before showing it to your loved one. That can avoid a lot of frustration for both of you.

Look at safety features — such as if the device can be programmed to only receive video calls from certain numbers.

Invest in noise-canceling wireless headphones to help your loved one hear the video calls better.

Think outside the age group. Kids do especially well on video calls — and your loved one may enjoy seeing a child’s smiling face and feeling their energy and excitement. Could your little one share a book over video with your loved one? Or could your loved one tell a favorite story? All of this is much easier when you can see one another.

Find friends. If your loved one previously was part of a club such as a quilting club, encourage the club to use a video-enabled device so your loved one can participate.

Have dinner together. Set up a video-enabled device at the end of the table, and have your loved one share a meal with family or friends.

Bring the fun to your loved one. Consider livestreaming events for your loved one — such as the school play or a baby shower or other event.

Play a game. You can play lots of games without being in the same room, such as Yahtzee, Farkle or Scattegories. Use the video feature.

Moving can be stressful.

For seniors, many of whom are experiencing cognitive or physical changes, decreased mobility or a reduction in finances, the fear of a move may be even more stressful.

For caregivers, helping parents or grandparents plan for housing options while they are able to do so can ease the burden of an estate sale or a hasty decision made during a health emergency.

Considering the following options can help an older adult make the right choice for their wants and needs:

Aging in place

Aging in place is exactly what it sounds like. In this option, people continue to live wherever they are – in an apartment, a house, a condo or with family members.

Independent living

Also called “senior housing” or “senior living,” this housing option may include condominiums, apartments, townhomes and more. The one thing this option has in common across all providers is that residents live independently and enjoy the perks of living in a community with older adults. Meals are often included, and services such as housekeeping and laundry are also common. Residents are able to take care of themselves, however.

Assisted living

Amenities are similar to those of senior housing, but residents typically require some assistance with activities of daily living.

Nursing home

Also called “skilled nursing” and “rehabilitation centers” or “extended care facilities,” a nursing home provides a private or semi-private room, meals and personal care. Skilled care staff members, including nurses and other health professionals, are available 24 hours a day.

Although residents may stay in a nursing home for long-term care, temporary care can be provided to people recovering from illness or surgery. This is the highest level of care offered outside a hospital.

Other options

Affordable housing

Federal programs lock in rent rates or offer financial assistance in other ways to older adults who qualify for affordable housing options.

Memory care

A memory care community may be a wing of a building or a standalone community. To address the needs of people with dementia, these spaces are designed with lighting, patterns, colors and layout in mind. Socialization and entertainment options tailored to the residents’ needs are offered, as is exercise, assistance with daily activities and medical care.

Age changes everybody. Regardless of physical, financial or mental health enjoyed when younger, as people age, these things change, too.

One way older adults can manage some of the change that comes with age is by making a decision to age in place.

What is aging in place?

Aging in place allows a person to remain in the place they call home without losing their quality of life as they grow older. This also includes improving quality of life whenever possible.

Who is eligible?

Anyone who can afford to safely live in the place they call home.

What does it cost?

Aging in place is the most cost-effective residential option for older adults, but costs will vary based on the types of support services they require. This could include anything from yard maintenance to mental health support and more.

How to pay for it

• Many states now recognize the benefit of financial support for those aging at home. This support often includes free home safety checks and renovations to make the home safer as residents age. Some states even offer financial assistance to pay for support services.

• Long-term care insurance may also pay for support services such as maintenance, home care services or in-home health care.

• In some cases, Medicare or Medicaid may cover support services used at home.

What to know

The challenges and changes that come with aging include addressing safety and accessibility issues, but there are programs and services available to help a senior safely age in place.

Services for aging in place

• Meal delivery services

• Companionship programs

• In-home health care

• Services to help manage bills

• Other support services

Questions to ask

1. Is the home safe? AARP offers this checklist and this guide to assess home safety.

2. Are family members prepared in case of an emergency?

3. Is there a plan of action if aging in place is no longer safe?

More than three quarters of Americans ages 50 and older want to remain at home as they age, according to recent data from AARP. Home health care, which also is known as home health care skilled services, or in-home skilled nursing, is a convenient, affordable option for those who need some medical care but are unable or unwilling to leave their homes for the care.

What is it?

According to Medicare.gov, “home health care is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient and just as effective as the care you get in a hospital or a skilled nursing facility.”

Examples of skilled home health care

• Wound care for pressure sores or a surgical wound

• Patient and caregiver education

• Intravenous or nutrition therapy

• Injections

• Monitoring serious illness and unstable health status

• Physical, occupational or speech therapy

People who are aging and need assistance with managing chronic health issues, disability or recovery from illness, injury or surgery may benefit from these services. Home health care staff members include skilled professionals such as nurses and nursing assistants. This service often takes place in a patient’s home, but is also available in group home settings, which may be more appropriate for patients with traumatic brain injuries or dementia.

Who is eligible?

Although people may pay for home health care out of their own pocket, to qualify for assistance through Medicare, an individual must meet the following requirements:

• Be homebound, based on Centers for Medicare & Medicaid guidelines

• Require the care part-time or as needed in order to maintain, improve or prevent health conditions

• Receive care from a doctor who completes an in-person visit with the person requiring care three months before home health care begins, or within one month of starting this care

Where to find it

• Try the online Centers for Medicaid & Medicare agency locator tool

• Doctors can make recommendations based on patient needs, and friends and family also may have suggestions

• Local senior centers and the local Area Agency on Aging might have suggestions

• The Yellow Pages or an Internet search will list local providers

• No matter how care is found, interview candidates with the person who will receive care, if possible

What does it cost?

Costs for this type of care vary based on the amount of time the care worker spends with the patient and the types of services provided. Supplies and equipment needed may also impact the cost. On, average, home health care services in the US cost less than $90 per visit, according to Genworth’s 2019 Cost of Care Survey.

How to pay for it

If the care recipient is enrolled in traditional Medicare or a Medicare Advantage plan, home health care services are covered if requirements are met.

Other options include:

• Private pay

• Long-term care insurance

• Veterans benefits

What to know

• Skilled nursing care is only covered by Medicare on an “intermittent” basis. This means the care recipient will be limited on the number of hours a day and the number of days a week they can receive this care.

• Medicare will not pay for homemaker services such as laundry or meal prep if it is the only care needed.

• Ask the recipient’s provider what is covered and not covered by Medicare, as some agencies recommend services not covered. Home health care agencies must notify patients of the cost in writing before starting care.

• If services not recommended by the doctor appear in the paperwork, question them before signing.

• Any durable medical equipment needed may require payment of 20 percent of the Medicare-approved amount of the equipment. Check with the recipient’s plan to find out what Medicare-covered home health care benefits apply.

• Agencies may want to send their most available care provider, rather than one who is most qualified for patient needs. Review/interview multiple candidates.

Questions to ask

1. How much training has the provider had? How recent is it?

2. Are resume, references and any reviews or testimonials from former clients available?

3. What is the backup plan in case the care provider can’t work when needed?

4. What is the turnover rate?

5. Is a care plan available, and who has input in creating it?

Get the most out of home health care

The goal of home health care is to help an individual age or recover in place with as much activity and independence as possible. Being honest about the care recipient’s needs will help locate the best care provider.

The terms “independent housing” and “independent living” include age-restricted communities that offer residential options but don’t offer health care services. Sometimes these services are called continuing care communities because options such as assisted living or nursing home facilities are available within the same community.

This residential service generally offers private housing in apartments, condos, town homes or duplexes, all of which are maintained by the housing provider. This allows for an active, independent lifestyle without the hassles of home repair or yard maintenance.

In the community setting, services such as a fitness center, pool, dining and entertainment options often are available. Linen services, transportation and housekeeping also may be part of the lifestyle.

Who is eligible?

People ages 55 and older are eligible for many independent housing options. Since independent living centers serve those who need little or no assistance with personal tasks such as bathing or eating, most do not offer medical care or nursing staff. However, residents can pay for home health care or other services if needed.

Those who qualify for affordable senior housing also are eligible for low-income options.

Questions to ask when considering this option

• How easy is it for a loved one to maintain his or her home?

• Could they benefit from social or transportation opportunities?

• What size community appeals to them?

• What options are available for more care, if/when it is needed?

• Is staff available 24/7?

How to pay for it

• Private pay, using personal finances, is the largest source of funding.

• Medicare and Medicaid do not pay for this service.

• A financial planner can help weigh the risks and benefits of this option.

Older adults who struggle to pay rent each month also may fall behind in medical and self-care.

Research published in 2019 by Health Affairs notes that in the next decade, more than 14 million middle-class seniors will be in this position — and they won’t have enough income to pay for the housing and care they need.

What is affordable housing?

Affordable housing also is known as “income-based housing.” Either financial assistance is available, or rent prices remain fixed for residents. This type of property benefits from federal programs that ensure housing exists for people of all ages with limited income.

For older adults in particular, affordable housing properties offer private apartments as well as additional services such as socialization opportunities, social service and in-home care. Meals or transportation may also be included.

Defining HUD and Low-Income Housing Tax Credits

HUD

The U.S. Department of Housing and Urban Development (HUD) subsidizes these not-for-profit communities. Rental properties in this program offer an income-based rent, which is generally no more than 30 percent of a person’s monthly income.

To qualify for HUD housing, applicants must be between ages 55 and 62, although there are some exceptions for people with disabilities. An income limitation is the other component. Limits on income are calculated by comparing the area median income to the applicant’s income. The number of people who will live in the household also affects this amount.

LIHTC

The Internal Revenue Service (IRS) oversees this program, which develops affordable rental housing for those with limited incomes. These communities may be managed by for-profit or not-for-profit organizations, which receive a tax credit to establish these locations.

Typically, an LIHTC community for older adults will establish a minimum age of 55 or 62. If another housing program is also used, this may vary.

Other benefits of affordable housing

• Safety

• Financial stability

• Privacy and community in one location

• No more yard work or home repairs

How is eligibility determined?

• Age:

o For many senior-based properties, 62 is the minimum age requirement, but some locations offer exemptions or waivers that enable people as young as 50 to move in.

o In many cases, only one member of the household must meet the age requirement.

o People with disabilities may qualify before they reach 50.

• Income guidelines:

o These depend on the federal program in which the property participates.

o Limits are set by matching an applicant’s income to the area’s average income.

• Personal history:

o Background and credit checks are required of all applicants.

If your family decides to seek outside caregiving help, it’s important to understand the differences between an independent, private caregiver and a caregiver hired through an agency.

When hiring privately, the family serves as the employer and will be responsible for hiring and vetting an independent caregiver, managing the caregiver tasks and schedule, and all aspects of payroll. Using an agency shifts those duties to that company, but it costs more and removes some flexibility.

As for paying for it, here are some options:

• In some situations, home care may be covered through private insurance, Medicare Advantage plans or Medicaid. Some agencies and most private caregivers will not accept these types of payments.

• Medicare does not cover home care, so it should not be considered when deciding between an agency or private caregiver.

• Medicare may cover home health care, when medically necessary, but it will pay either type of caregiver.

Here are some things to keep in mind when choosing which route to go for your loved one.

Agency caregiver

Caregivers are already screened and vetted.

Ease of hiring is a difference between using an agency and a private hire caregiver. It is a simple process to find a home care agency. However, finding an independent caregiver isn’t as easy. The work and time of finding and hiring an independent caregiver is the equivalent of finding and hiring a new employee.

Background, drug screens and department of motor vehicle checks are run for you when you use a caregiver from an agency.

Checking references and verifying experience are time-consuming tasks that are completed by an agency prior to hiring an employee. When hiring privately, you will need to find the time to complete these tasks.

The agency handles payroll, benefits and liability.

To avoid the hassle of collecting and paying employee taxes, many families will hire a private caregiver as an independent contractor. However, there is an income limit, so anything over that amount requires the caregiver to be hired as an employee. Check with the IRS or your accountant for the latest figure.

When hiring the caregiver as an employee, you will need to understand the state and federal laws around their employment because you will be required to withhold and pay taxes. Some other things to consider:

• Paying an independent caregiver under the table is illegal and is not in the family’s best interest. It is considered tax evasion and if caught, you may have to pay back taxes along with penalties.

• It may complicate getting accepted into Medicaid and could result in being delayed or denied acceptance for a period of months or years.

• If a caregiver gets hurt, there will not be disability insurance in place and may result in the family becoming involved in a lawsuit.

• Properly paying the caregiver might make you eligible for tax credits.

• In the event of fraud, theft, abuse or exploitation, you will want liability insurance to have protection in place in the event of legal action or accusations.

• It will be up to the family to manage accusations of physical, sexual, emotional, medical or financial abuse by the care recipient or the caregiver and to respond appropriately when hiring independently.

• It’s important to understanding the state laws where your loved one lives on what caregivers can and cannot do. For example, some states allow a caregiver to dispense medications while others do not.

Caregivers are trained and certified.

Up-front and ongoing training is provided through the agency to ensure their caregivers are trained to provide the care and services they promise. This often includes requiring their staff to obtain and hold certain certifications and licenses.

Independent caregiver

Your family manages the logistics.

Without an agency’s help, scheduling and care plan creation is the responsibility of the family. If a caregiver doesn’t show up, calls in sick or needs to take vacation time, you will have to have someone cover care for your loved one. And if the hours you agreed to no longer work for the caregiver’s situation or yours, the family may have to find someone else.

Also, handling caregiver job performance isn’t easy, especially when a caregiver isn’t performing the tasks in the manner to which you agreed. Another challenge arises if the caregiver decides they no longer want the responsibility of a task. That means you must be prepared to let the caregiver go and find replacement help until you can find a new person.

You have more flexibility.

When hiring privately, the family has more freedom in determining caregiver duties. Agencies tend to have stricter rules and regulations on what their caregivers can and cannot do. An independent caregiver has more flexibility and can provide a broader range of support services and tasks.

A private caregiver is considerably less expensive than an agency.

You will typically pay more for caregivers through an agency. Hiring a private caregiver can save 20-30% on home care costs.

You maintain control.

When using an agency, there is no guarantee you will have the same caregiver every day. Your loved one also may not like the caregiver that’s sent to provide care. Since you are not the one doing the hiring and firing, you turn over control to the agency.

Direct communication with the caregiver is possible when you privately hire a caregiver, rather than having to go through the agency.

Nursing homes and retirement centers are no longer the only option for older adults who need daily help. Today, numerous home care services are available to help people age in place with personalized assistance and a great sense of independence.

The National Prevention Council finds that people who are able to remain at home as they age are happier and healthier than those who can’t.

What is it?

Home care, sometimes referred to as non-medical care, custodial care or homemaker services, helps with daily tasks such as running errands, making meals, cleaning and companionship. It also might include help with activities of daily living, such as eating, bathing, toileting and dressing.

Home care is not medical, or home health care, but it may include medication reminders. These services can be provided privately by an individual or through an agency.

Individual

An individual caregiver is someone who has been hired privately to care for a person in need. Although they may have training as a nurse or nurse’s assistant, not all states require background checks and licenses. The person who hires the caregiver becomes their employer and is responsible for conducting background checks, training, discipline and payroll management.

Agency

A home care agency is a licensed business that sends employees to homes to care for people. These employees may be trained as nurses or nurse’s assistants, and the agency will offer training and serve as an intermediary between the person needing care and the employee. Agencies also oversee background checks, taxes and liabilities for the person providing care. Working with an agency is typically more expensive, but there is more oversight in place.

Who is eligible?

Anyone can receive home care by paying out of pocket. For those who need financial assistance, states set requirements for eligibility, and may consider:

• Age

• If assistance is required for activities of daily living

• Location (living at home vs. in a care facility)

• Medicaid status

What does it cost?

According to the Genworth Cost of Care survey, in 2019, the average monthly cost for non-medical care was nearly $4,300.

How to pay for it

Many people are shocked to learn that Medicare does not cover non-medical home care if it is “the only care” needed.

Other payment options include:

• Long-term care insurance

• Medicaid

• VA benefits

• Social Security

• Private pay

What to know

• Start by assessing needs. Is home care the right choice, or is more medical care needed?

• If a family hires an individual, they become the employer and are responsible for taxes and work-related injuries sustained on the job. If the family hires through an agency, the agency is responsible for these things.

• Agencies may send whomever is available, rather than someone best suited to the care recipient’s needs.

• Highly trained providers such as nurses will cost more, as will receiving help during weekends and holidays.

Questions to ask

1. Do you offer a free consultation?

2. How do you credential employees?

3. What is the backup plan in case the worker can’t work?

4. What if the caregiver and care recipient don’t get along?

5. What services are included in fees?

Get a checklist from AARP here.

Caregivers want their aging loved ones to continue to live fulfilling lives. But between work, maintaining their own home and caring for their kids, these “sandwich generation” caregivers may lose the time to interact with their loved ones.

Assisted living can make a difference.

What is it?

Along with providing housing for the elderly or disabled, assisted living offers nursing, meals or housekeeping as needed. This option is great for those who are independently mobile but need help with some parts of their day or activities of daily living (ADLs).

This includes things like cooking meals, cleaning, transportation and even toileting and bathing. This level of care is a great choice for people who do not need around-the-clock care but do need a little more help than they can get at home or in a retirement community.

Who is eligible?

To qualify for assisted living, individuals typically need help with at least two activities of daily living. Those include:

o Meal preparation

o Personal care (including hygiene)

o Managing medication

o Other necessary daily activities

What does it cost?

According to Genworth’s 2019 Cost of Care Survey, the median annual average cost of assisted living in the United States is $48,612. This is less than half the cost of a nursing home, according to the same survey, and assisted living can offer a greater sense of independence.

How to pay for it

Assisted living can be expensive, and most people pay for part or all of this care on their own. However, some financing options may be available to the individual needing care:

• Long-term care insurance

• Medicaid

• VA benefits

• Private pay

What to know

• The financial realities. The average person can afford only about a year of assisted living. Be sure it’s the best financial choice for the person needing the care.

• Caregivers need to make sure the care recipient gets what he or she expects, and what they’re paying for.

• The National Center for Assisted Living recommends multiple visits before making a decision.

• Caregivers and care recipients should visit during different times and get residents’ opinions on life there.

• Older adults might balk at the idea of leaving home or having a stranger help them. But the social aspect of assisted living can make a big difference. According to the American Psychological Association, social seniors face less depression and illness than those who are isolated.

Questions to ask

1. What kind of units are available, and how big are they?

2. Do they include kitchens or kitchenettes?

3. Are rooms private or shared?

4. Are bathrooms private?

5. If the resident’s needs change, are other services available?

When a caregiver is responsible for a loved one’s safety and well-being 24/7, finding personal time can be difficult. Enlisting the help of a respite care provider can ease this burden while also offering an example of what long-term care might look like for the care recipient.

What is respite care?

Respite care can provide a temporary break from caregiver responsibilities by bringing a home care aide into the home for a few hours.

In a facility setting, respite care can provide around-the-clock assistance for a person on a short-term basis, typically more than 24 hours but less than two weeks. Some locations may offer up to 30-day stays. A facility setting may offer the same long-term care services one might expect at a nursing home, such as assistance with activities of daily living and companionship.

Who is eligible?

For people seeking respite care in the home, the rules of home care services may apply.

Anyone who qualifies for admission to a skilled nursing center is a good candidate for respite care in a facility. The same forms are required for each and may include medical records and medication lists.

Where to find it

• Ask the care recipient’s doctor for home care recommendations or contact local nursing homes and senior centers to find options.

• Search the Yellow Pages and internet, and use the Eldercare Locator to find local providers.

What does it cost?

Costs for this care vary based on the amount and type of care needed. According to Caring.com, the cost of respite care ranges from $100-$250 per day depending on the amount of care needed.

How to pay for it

Respite care providers may charge by the hour or the number of days or weeks care is needed. Typically, insurance does not cover these costs, and Medicare will only cover respite for those in hospice,

Other payment options include

• Long-term care insurance

• Medicaid

• VA benefits

• Private pay

What to know

• Determining both caregiver and care recipient needs is a good first step in planning the amount and level of respite care needed.

• Respite care is a general term describing assistance so caregivers can take a break, but it is also a medical care term.

• All personal items sent to a respite center should be labeled.

Questions to ask a provider

1. What accommodations are available?

2. What is the staff-to-care recipient ratio?

3. Is there consistency in staff?

4. Who is involved in creating the care plan?

5. Is more advanced care available if needed?

Skilled nursing facilities have the services to ease a caregiver’s mind if their loved one can no longer live at home. This page can help caregivers understand how nursing homes work.

What is it?

A skilled nursing facility is a licensed health care residence for people who need more assistance than can be provided in an assisted living setting. They typically include three types of care:

• Skilled nursing, which covers medical and related care

• Rehabilitation from illness, injury or disability

• Medical care, long-term care and services that go beyond residential care and are needed regularly because of a physical or mental condition

Staff members at a nursing home include registered nurses, licensed practical nurses, and physical, speech and occupational therapists. Certified nursing assistants (CNAs) provide another level of around-the-clock care to ensure residents’ safety and well-being. Today’s nursing homes are alive with activities, games, music and movement.

Who is eligible?

The need for nursing home care is determined by a doctor and a completed evaluation. Generally, an individual qualifies when he or she needs some of the following:

• Skilled nursing care, rehabilitation services or health-related services

• Daily care

• Care as an in-patient

• 24/7 supervision

• Some assistance with activities of daily living (bathing, eating, walking, personal hygiene, etc.)

Those with a serious mental illness or intellectual disability must also be assessed by the state’s Preadmission Screening and Resident Review program.

Where to find it

• Every Medicaid and Medicare-certified nursing home in the United States is tracked by Nursing Home Compare, a service of the federal government. It is a good place to begin research. The site compares skilled care centers by listing their ratings in three categories: health inspections, quality measures and staffing.

• Doctors, friends and family can provide recommendations based on personal experience and knowledge.

• For more recommendations, contact a local senior center, the Area Agency on Aging or the Administration for Community Living.

What does it cost?

According to Genworth’s Cost of Care Survey, on average, a private room in a United States nursing home costs more than $100,000 annually. A semi-private room costs roughly $90,000 a year.

How to pay for it

Perhaps one of the greatest concerns for a family or loved one seeking nursing home care is how to pay for it. There are several options available that may pay for some or all of the costs.

• Medicare

• Medicaid

• Long-term care insurance

• Life insurance

• Social Security disability income

• VA benefits

• Reverse mortgage or home equity line of credit

• Programs of All-Inclusive Care for the Elderly (PACE)

• Private pay

What to know

• Caregivers who start the process before care is needed have more time to find location and financing options in line with their desires and abilities.

• Gaining eligibility in one state does not guarantee eligibility in another state.

• Many caregivers find that their loved one requires more care than they can provide, but their loved one doesn’t need enough assistance to be eligible for skilled care. This in-between care can be offered by assisted living, but for those on Medicaid, assisted living coverage is offered only in very limited situations.

• Some nursing homes are state-funded, while others are privately operated.

• Some facilities have waiting lists.

• It is important to visit each location multiple times before signing any contracts. Caregivers and their loved one must get a feel for the location, the staff members and other residents.

Questions to ask

1. What kind of options exist for social, recreational, religious or cultural activities?

2. Is transportation provided to community activities? What about to medical appointments?

3. Can the resident still see his or her personal doctors?

4. Will the same nursing home staff take care of the resident day-to-day or do they change?

5. How many residents is a CNA assigned to work with during each shift (day and night) and during meals? What are the staff-to-resident ratios?

It is devastating to hear that a loved one has been diagnosed with Alzheimer’s disease or dementia.

Despite the uncertain future, Michelle Kutner, dementia and memory care consultant at The Evangelical Lutheran Good Samaritan Society, says caregivers and family members can empower themselves to help their loved one with care.

First, educate

Caregivers should learn as much as they can about the disease so they know how to help. This includes learning about the progression, symptoms and stages of the disease and behaviors common in each stage. Asking the patient’s doctor for this information and visiting the Alzheimer’s Association website are good starting points. Joining a support group also can help.

Prepare for change

• Caregivers observe and experience changes in their loved one’s personality.

• These changes can affect relationships with family members and friends.

• Support can help manage negative experiences. The Family Caregiver Alliance offers more information about support groups.

Plan for the future

Caregivers helping those with dementia face high rates of burnout. Outside help, such as an adult day care program with a focus on memory care, can ease the burden. Other options include:

• Finding respite care providers. Respite care, according to the National Institute on Aging, provides short-term relief for primary caregivers – from just an afternoon to several days or weeks.

• Investigating long-term care options that offer memory care programs.

• Organizing financial paperwork and preparing legal documents.

Explore support services

The following and other services can help families dealing with dementia or Alzheimer’s no matter where they are on that journey:

• Medication reminders.

• Meal preparation and feeding.

• Dressing and toileting.

• Errands and other non-medical assistance.

The U.S. Department of Veterans Affairs upholds President Abraham Lincoln’s promise to “care for him who shall have borne the battle, and for his widow, and his orphan.”

There are many services available to veterans through the VA, and those who served active military duty may be eligible to receive health care benefits and long-term care benefits.

Options include:

• Find your local USO. You can do that here.

• You can find a local list of Veteran Service Officers here, and they can help you complete the needed paperwork and identify available benefits.

• You can also contact the National Veterans Foundation at 888-777-4443 for vet-to-vet assistance for veterans and their families.

• VA Burial Benefits are available here.

Medical care options

Eligibility and coverage may vary, but VA benefits typically cover

• Prescription drugs through VA clinics

• Preventive care

• Inpatient care

• Specialty care

• Emergency care

While basic medical care may be offered through the VA, long-term care benefits such as financial support for housing may be available, and medical care can be received in a variety of locations, such as

• Nursing homes

• Assisted living facilities

• Private home care

• Adult day care centers

This doesn’t necessarily mean the veteran is eligible for support with the costs of room and board in such locations, but it might mean that medical care received there is covered. To verify eligibility, check with a benefits eligibility specialist.

Long-term care

A more pressing concern for many veterans and their caregivers is whether the VA will pay for a long-term care stay — the room and board — not just the medical services needed. The answer depends on eligibility and if the veteran is able to use any of these three options:

• VA owned and operated Community Living Centers

• State Veterans Homes, owned and operated by the states

• The Community Nursing Home program in which the VA contracts with community nursing homes to provide care to veterans

Each program has admission and eligibility criteria specific to the program. Check with a local VA office, or connect with someone virtually for assistance.

Other programs to consider

• The Housebound Aid and Attendance Allowance Program

o As a supplement to a veteran’s pension benefits, this program provides money to eligible disabled veterans and their surviving spouses to purchase home and community-based long-term care services. Personal care assistance and homemaker services are examples of eligible services.

• A Veteran-Directed Home and Community Based Services program (VD-HCBS).

o This program provides eligible veterans of any age a flexible budget to purchase care such as counseling through the Aging Network in partnership with the VA.

o This program is no longer available in some locations; check with a local VA office to learn more.

Caregivers also might qualify for some support.

Assistance for caregivers

The Aid and Attendance Pension can help offset some expenses if the veteran requires help with Activities of Daily Living or is homebound. Activities of daily living include tasks such as eating, bathing and personal hygiene.

Qualifying veterans of all eras are eligible for the Program of General Caregiver Support Services, which offers education, training and support for those who care for a disabled veteran. The use of telehealth and other technologies may be included, as well as counseling and respite services.

For disabled veterans who served after Sept. 11, 2001, the Program of Comprehensive Assistance for Family Caregivers is available. This program provides caregivers with training in how to care for the veteran, monthly compensation, health care benefits and respite care.

The Caregiver Coordinator Support Tool can help individuals find other programs.

There are several options for seniors who need help with meal or grocery delivery.

Meals on Wheels

Meals on Wheels is known for providing lunch and dinner to older adults who are unable to prepare meals or leave the house to acquire food. For some, this service is a lifeline.

According to 2019 data released by Meals on Wheels America, 1 in 5 seniors feels lonely, and nearly 9.5 million older adults are at risk of going hungry.

But this service, and others like it, affects more than nutritional needs. Research has found that meal delivery services also support recipients’ overall well-being.

This program, or other food-delivery services in your area, could help someone you love with the following:

• Ready-to-eat meals delivered to the participant’s door

• Socialization

• Safety checks

• Community connection

• Fewer hospital visits

To learn about signing up for Meals on Wheels services, click here to find a location near you.