The Final Cost: What to know before putting family in long-term care | How palliative medicine helps the chronically ill

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TWIN FALLS, Idaho (KMVT/KSVT) - Putting a family member in a longer term care facility can be a difficult decision, because there is a lot to think about.

Nurse with a patient at a nursing home (KMVT)

In the final installment of the Final Cost, KMVT takes a look into what it costs to put family in long-term care, and what palliative medicine is as it's making its round in the community.

Long-term care

Some families may not be prepared for estimated long-term care costs.

"They’re terribly shocked. We’ll get calls from the children of these people saying 'They’re going to take all of mom and dad’s money' and I kind of say 'Yeah, they are,'" said Shawna Wasko, with the College of Southern Idaho's Office on Aging.

Wasko works with a caregiver group and she's heard all the stories.

"I had one gentleman that had to have a surgery and he can't leave his wife alone, he's her caregiver," she said.

So the gentleman and his wife looked into going to assisted care for a short time.

"It was $6,000 a month for the both of them to be in that facility," Wasko said.

She said they've also heard prices for $10,000 a month or even more.

"That usually depends on ADLs, and ADLs are activities of daily living," she explained. "Can they manage their own meds, can they walk without assistance, can they bathe themselves, can they dress themselves?" she said. "Where the cost starts adding up, more and more of those ADLs are not capable of doing them themselves, are needed to be done by people that work there."

There is a difference between assisted living and a nursing home, too.

"When you’re in a nursing home, these are the people that need more help, more medication help, maybe physical activity where people go in and work with them," she said. "It’s just a level of care. Whereas assisted living, a lot of them can still be driving and a lot of them can still go out and about on their own."

Wasko said Medicare does not pay for long-term care, only Medicaid will.

"Medicaid is a, for the lack of a better word, a poverty program, means people wouldn’t have enough assets to go into long-term care and be able to pay for it," she explained.

So what could happen is what she calls spending down to Medicaid, so selling belongings and assets to get a person to qualify for Medicaid.

"These would be your assets, say a home, a vehicle, whatever that you would spend down and Medicaid would basically take over all your bills and you get a little bit of each month for personal things," she explained.

Wasko urges to go check out a facility before just putting a family member in a nursing home or assisted living.

"Talk to them, realistically, so you’re not absolutely shocked when you find out how much this will cost, because it will be expensive," she said.

She wants caregivers to not feel guilty for wanting to place a member in another's care.

"But, we cannot be very good at our job if we’re totally burnt out, resentful or their needs become more than we can handle, meaning it becomes a danger for them to be at home," she explained, adding that caregivers do need a break.

There are resources out there, such as CSI's Office on Aging, that can help caregivers and senior citizens navigate their options.

Palliative Care

There's a care program within the St. Luke's Health System called palliative care. It's for those who have a serious, chronic or terminal illness and helps patients stay comfortable through their sickness.

"Mainly what we do is we focus treating any symptoms that need to be managed," said Dr. Dan Preucil, the medical director for the palliative care program. "We look at advanced directives to make sure they have plans for the future, then we also make sure any decisions that’s being made for them is being made with their goals in mind and their beliefs in mind and also with their best understanding with what’s going on."

Those who want to be in the program have to go through consultation, either through inpatient or outpatient.

They help patients understand their illness and what the future holds for them. One example is a cancer patient.

"A lot of times people hear they’re getting treatment for their cancer, but they think that means the cancer is going to go away, but we want to make sure people have a good understanding of what that means," he said. "So, they can make plans. We tell them, take advantage of feeling good right now because down the road you may not be able to get out into the community, visit somebody or travel to the place you want to see."

Making a plan and enjoying good days will help people take advantage of the quality of life they have left when medicine isn't the answer.

"People think I'm going to the hospital and I'm going to get well. And there are illnesses, diseases like advanced cancer, heart failure and emphysema, chronic kidney disease that we don’t have cures to," Preucil said.

Sometimes, going in and out of the hospital doesn't help for someone with a disease or sickness, too.

"It's really to keep them at home, support them at home and manage it effectively as we can at home, hoping for a smooth transition to the hospice benefit, which every Medicare beneficiary has," he said.

He said there is growing evidence that some of those who do have a chronic illness that are at home — who also get help with hospice — actually live a little longer.

"It's probably because it’s less stressful," he said. "They’re with who they want to be, they have access to care through nursing, with good communications. These patients actually do well. They have less depression, live longer, less pain, so it’s starting to educate, not only our providers, but our patients that that maybe a better way."

Preucil said he also sees patients actually wanting to talk about what's to come after their health declines.

"What we find all the time is that patients are receptive to these discussions. Not all of them, but most of them. Most patients are willing to talk about dying. All they need is permission from providers to talk about it," he said.

For more information on palliative medicine, visit St. Luke's Magic Valley's website.

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