Lifespan's Eldercare Services

Frequently Asked Questions About Eldercare

What is the difference between assisted living and a nursing home?

(Click here for Definitions of Housing Terms - relative to NYS)

What should I do when I don't believe that my father/mother should be living alone?
We often hear from caregivers, “Mom is becoming more frail. What do I do?” There is typically not a dramatic single event that signals the shift from daughter/son to caregiver. It is a process. Some older adults resist the need for services and help. As you begin the process, we suggest:

• Sharing your concerns with the older relative
• Involving the rest of family (strength in numbers)
• Understanding normal aging vs. not normal
• Contacting a geriatric care manager (sometimes it is easier for an outsider to discuss these sensitive issues with the older adult) A care manager can also assess the risk to the older adult. Things like: A) available social supports; B) self-care ability (mobility); C) physical condition, health care link to get a doctor’s opinion and/or assessment; D) emotional/ mental/cognitive impairment. (See
• Listen to the older adult's preferences. It will help if the older adult feels he/she is being listened to. Suggest help for a “limited time” to help the older adult get used to the idea of assistance.
• Talk to the older adult’s doctor. Many older adults listen to doctors.
• As a caregiver, you have to take things slower than you would prefer.

Who should the family call first for assistance?
It depends. Typically the best place to start is with a social worker, a care manager, who can assess the entire psycho-social situation for the older adult and make recommendations. The assessment takes place in the person’s home so that the environment is evaluated. If the older adult resists, see above. Take it slow. You may have to implement some services to begin with in order to give the older adult time to adjust to the help. Your first call should be to Eldersource at 585-325-2800.

Getting Power of Attorney and Health Care Proxy are obviously very important; but can these agents impose their decisions on the aging parent, substituting their judgment for his? Does the authority of the agent become stronger if the parent is incapacitated?
Yes and no. A durable Power of Attorney allows the agent to act on the financial needs of the person even if they have become mentally incapacitated (obviously, the document must have been appropriately signed, witnessed and notarized when the person had capacity to understand the nature of this action). This gives the person tremendous power. We see this as a wonderful planning tool, but we also see Power of Attorney abuse — which is very difficult to prosecute.

Health Care Proxy is only utilized when the person cannot communicate their health care wishes. All health care decisions should still be the older adult's if he/she can communicate and is not incapacitated.

If the person becomes incapacitated, the agent’s powers become stronger because it is much more difficult to revoke the powers. (Could be revoked in a guardianship proceeding.)

Please comment on hospital discharge procedures and appropriate questions to hospital social service staff.
Hospitals must develop a safe discharge plan. The discharge planner should determine the older adult's needs after he/she leaves the hospital. Who is the caregiver? Can he/she transfer independently? Who will get the meals? Do you have transportation to get to the pharmacy, doctor? Do you have running water, heat? Do you want additional services?

Hospital social workers do a great job, but they are limited because they do not work in the home. They must rely on the information given to them by the older adult. They do not have time to verify support systems that might help in the transition.

Please discuss options for in-home care as an alternative to nursing home care.
There are many options depending upon the need. If the person is truly nursing home eligible, they could qualify for the Lombardi Program. The Lombardi Program allows the older adult to stay at home and receive services. These services are capped at 75% of the cost of Medicaid if the person were in a nursing home. People can be dually eligible or private pay. (Park Ridge at Home, Via Health, Visiting Nurse Service) If the cost of a persons’care exceeds the 75% cap, they can become ineligible for the program.

Many people may need services to stay at home. It can range from minor home repairs, home health care visits to the nursing home without walls. It is best to have a geriatric assessment to determine need. or call 585-325-2800.

(Note both Lifespan and Eldersource are services based in Rochester, NY.)


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