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NEW YORK (Reuters) - As so often happens, a fall changed it all for Wendy Greeley's 95-year-old mother, Edith Blodgett.
In 2011, Blodgett suffered a head injury that left her unsteady on her feet and her dementia more pronounced. The independent living community where she lived told her she was too sick to return on her own, even though she didn't want to move.
Call it the care gap: that space between needing basic household help and full nursing care. The issue looms large because nearly three in four Americans over age 65 will require some form of long-term care during their lives, according to the National Clearinghouse for Long Term Care Information. And as many as 12 percent of nursing home residents are considered "low need" who could live in the community if they had the right support at home, according to the journal Health Affairs.
The long-term care industry is figuring out how to fill this care gap, but the price is not cheap. Licensed home health aides earn a median $19 per hour. Adult day care services average $61 per day. A one-bedroom apartment in an assisted living facility runs about $3,300 per month, according to the 2012 Genworth Cost of Care Survey.
Greeley, now 62, had two options: Either move her mother to a nursing home or hire home health aides to provide round-the-clock care in her independent living community.
"My mother would have had to have been completely unaware for us to admit her to a nursing home," says Greeley. "She was absolutely adamant about that."
And so, with the help of Homewatch CareGivers, a Denver-based home care company that specializes in clients with dementia, Greeley arranged for round-the-clock help. They used $175,000 of Greeley's mother's money in one year.
To meet needs like this, assisted living facilities are adding "memory units" that offer the safety features needed by people with dementia. They are also contracting with hospice programs to provide palliative care and with local hospitals to provide in-house access to registered nurses, podiatrists and geriatric psychiatrists.
"Our long-term care model is evolving away from a continuum of care to a place where the senior can receive care and services no matter where they want to live," says Jamison Gosselin, senior vice president of marketing and communications for the Assisted Living Federation of America.
It can be hard for families to assess when the assisted living model - even with increased services - is inadequate, and some people stay in those settings for too long.
"Some places are holding on to people maybe for too long or accepting them when they shouldn't," says Byron Cordes, president of the National Association of Professional Geriatric Care Managers.
He recommends that families use an independent care manager to assess whether mom needs more care than the facility can provide and whether and how extra help can be brought in.
"If you've got enough money, you can build a nursing home in your home," says Cordes. "You can have access to a nurse 24 hours a day and an aide. This can cost $12,000 to $15,000 a month, but sometimes that's what folks want."
But if your parent doesn't yet need round-the-clock care, there are other options.
When her father begged to leave his nursing home following his second stroke, Felicia Hudson moved him from Atlanta into her apartment in San Diego. But Hudson was going into debt, raiding her 401(k) and risking trouble at work for taking time off to shuttle him to thrice-weekly dialysis and other appointments.
Her father, who lives on Social Security and a small pension, couldn't afford to hire in-home care. Instead, Hudson brought him to St. Paul's Program for All-Inclusive Care for the Elderly (PACE).
PACE operates in 28 states, bills Medicare (or Medicaid) for most medical services, and charges on an income-dependent sliding scale for other fees. For Hudson's father, PACE provides on-site dialysis treatment, adult day care and a full-time medical staff to address everything from new eyeglass prescriptions to foot care. PACE also provides transportation to and from the facility.
Technology can also help monitor seniors for safety while saving families the expense of hiring someone to be in the home.
"There are a lot of remote care technology solutions you can bring into the home and offset the cost of 24-hour care," says Leann Reynolds, president of Homewatch CareGivers. These include devices that remind the elderly when to take their medications, can detect falls and summon emergency assistance, and can contact you if mom or dad did not get out of bed at the regular time.
Costs range from $50 for medication reminders to several hundred dollars for motion detectors and associated monthly monitoring fees.
Except in rare instances, Medicare does not cover any of these long-term care solutions. But Medicaid covers people with low income and few assets. Some states have established Medicaid Managed Long-Term Care programs to provide care in the home instead of in nursing homes.
Veterans are eligible for the "Aid and Assistance" pension benefit. The income limits are higher for this program than the basic pension, so even if your parent earns too much for a military pension, he or she might still qualify.
And the right long-term-care insurance can cover the cost of in-home, assisted living and nursing home care. But policies vary. In the end, much of the cost of a custom-crafted care gap solution will likely come out of your parent's, or your, pocket.
"We were fortunate that my mother could cover the cost," says Greeley, whose mother passed away in April. "I know a lot of people struggle with this because the cost is so great."
(The author is a Reuters contributor.)
Editing by Linda Stern, Beth Pinsker Gladstone and John Wallace