Anyone with a loved one who has dementia knows how complicated and emotional the situation can be. When does one seek help? And how? Accustomed to living independent lives, we sometimes hesitate to ask for—and to offer—help. But dementia compromises the ability to perform even basic tasks, making it unsafe for a person to continue living independently. While no effective therapies currently prevent dementia, such as that caused by Alzheimer’s disease (one type of brain disorder than can lead to dementia), elderly patients can benefit from experienced dementia care.

Diagnosing Dementia. Generally, persons with dementia may ask the same questions repeatedly, may become disoriented even in familiar locations such as their own homes, may neglect personal care such as bathing and eating properly, and may be confused about events from their own lives that they have previously remembered clearly. Physicians diagnose dementia based on evidence such as that given by care-givers, and via office exams, which may require the patient to remember a set of words, for instance, or subtract numbers.

Dementia Stages. A patient in the early or mild stages of dementia may be able to live at home with the help of family-members and care-givers. This assistance may include using calendars to help a person with dementia remember the date, giving reminders about medication, and providing help with financial record-keeping. Because some forms of dementia, such as Alzheimer's disease, are progressive, an individual may soon need a higher level of care; this care is often given in an assisted living facility (ALF) or a skilled nursing facility (SNF). The end stages of dementia may mean that a person is relatively bed-bound and may not recognize most, if any, visitors. The individual may depend completely on others for personal hygiene, feeding help, and other types of self-care. Such people may still enjoy—intermittently—seeing  family-members, watching television, and interacting with others. However, these patients are usually cared for in SNFs, which offer a higher level of care than ALFs.

Care Facilities. ALFs and SNFs employ experienced health-care workers who specialize in working with patients who have dementia. For example, care-givers learn to communicate effectively and compassionately with patients who have the symptoms described above, and who may deny having Alzheimer’s or exhibit paranoid and aggressive behavior due to their dementia. They emphasize familiar routines, which are important in dementia care because variations are usually unsettling to patients. Some facilities provide special wings for patients who “wander,” providing secure rooms and garden access.

Training for Care-givers.  Those who work directly with patients who have dementia should be trained carefully. This may include classroom work and role-playing with ALF or SNF staff-members who act the role of a person with dementia. Dementia care training is important because individuals can exhibit varying levels of cognition and emotion within short time-periods, and care-givers need to understand how cognitive functions and emotions may “cycle.” A person with dementia may seem normal, talking about past events with great clarity, for instance, and then minutes later start a grease fire on their stove and walk away from it, with no sense of anything being wrong. Care-givers must be prepared for these variations.

Choosing an ALF/SNF.  Assisted living facilities are often able to help those with early dementia who can still coordinate many of their own activities of daily living (ADLs) such as bathing and self-care. However, even though a facility may be listed as an ALF, the range of care they provide can vary a great deal. Relatives considering a particular ALF should visit more than once and ask many questions. Exactly what types of help are given (and how many times a day)? Do the patient’s medical issues warrant a SNF? What level of dementia do other patients have? As the level of care needed increases, do costs escalate? What type of training do facility personnel have?

Medicare and Medicaid pay for skilled nursing homes for the indigent. However, many nursing home residents will use up their own savings to pay for SNF care. Only after their savings are exhausted, do they become beneficiaries of Medicaid and Medicare insurance coverage for the remainder of their SNF care. Medicare Supplemental Insurance is a private insurance that helps pay some of the expenses not covered by Medicare. Those who want more coverage than Medicare and Medicaid provide to pay for their SNF care, should buy (private) long-term care insurance.

What is Long-term Care Insurance? Long-term care insurance is a type of insurance designed especially for seniors. It covers the costs of long-term care and health care services, which include daily activities such as bathing, eating, dressing, skilled nursing care, and rehabilitation training (often referred to as “activities of daily living” or ADLs). Long-term care insurance also deals with care-oriented activities for people with cognitive impairments such as Alzheimer's or Parkinson’s. Long-term care insurance covers services provided in your home, or in a nursing home, assisted living facility, or adult day-care facility.

Common Misconceptions. Many people believe Medicare, Medicaid, or other health plans pay for their long-term care costs. However, these plans typically do not cover ongoing chronic health care, or help people with ADLs over a long period of time. Medicare has eligibility requirements for skilled nursing care only, and is for a limited time period. Medicaid is a welfare program, and will not cover long-term health care costs. Regular health insurance and medical supplements also do not cover nursing home care. Care expenses can add up quickly and end up costing individuals and families their savings and assets.

Why Get It? If you have assets of $30,000 or more (excluding your house), you want to choose where to receive long-term care (in your home or in a facility), and you do not want the financial and day-to-day burden of your care to fall on your family, you may want to consider a long term care policy.

When To Apply. Apply While You’re Still Healthy. Getting long-term care insurance is not always easy. To qualify for a policy, you must pass medical underwriting standards. Certain pre-conditions could disqualify you, such as having had a stroke recently, or having been diagnosed with dementia. Also, certain combinations of conditions may preclude your approval. So, it is very important to apply for long-term care insurance while you’re in good health. Different insurance companies may evaluate conditions differently so check with more than one insurance company. If one company denies your application, another might accept it. Lower Age = Lower Premiums. Since the cost of insurance is generally based on your age when you apply, the younger you are when you apply, the lower your premiums. So, both to ensure coverage, and to pay less, find out sooner rather than later if you are eligible to enroll. If you are approved for coverage, always pay your premiums on time to meet the insurance carrier’s criteria for payment of benefits later.

Costs. Numerous companies all over the country provide long-term care insurance. Rates can vary greatly, depending on your age, where you live (long-term insurance is state-regulated so policies vary from state to state), and whether you choose a comprehensive, nursing home, or home care package. The average cost for an individual policy for a senior between the age of 65 and 69 is around $212 per month. (This would cover approximately 5 years of coverage at about $160 per day.) Although this may seem costly, long-term care insurance policies that meet certain standards receive favorable tax benefits. You can deduct long-term care insurance premiums as medical expenses for income tax purposes.  Make sure you find a plan that covers the kind of long-term care you want. Long-term care insurance is not for everyone: if you are worried you can’t afford the premiums, if your income comes solely from Social Security, or if you’re struggling to meet your basic monthly living expenses, coverage may not be the right choice for you.

Your Home or a Nursing Home? If you want to receive long-term care in your own home, or want family members or friends to help as care-givers, consider a “comprehensive” option: this provides benefits for both facility care and in-home care. If lower premiums are your priority, then consider a “facilities-only” option, which is less expensive.

Research your coverage options as soon as possible, so you can find the appropriate plan for you, obtain coverage while you’re eligible, and purchase coverage at the right age to ensure the lowest price.