The Personal Cost of Long-Term Care: Having the Discussion with Older Adults

• Nurses are in a unique position of discussing the cost of long-term care, financially and otherwise, with patients who might be better helped in such a facility. 
• Older adults who display physical or mental deterioration or have increased difficulty with daily activities might need to consider a long-term care facility. 
• Discussing long-term care with an older adult can be intimidating, so you should navigate the conversation with empathy and respect. 

From my experience in long-term care, I can say discussing long-term care with older adults is one of the most important and most difficult conversations you will ever have.

I have engaged in several discussions about this subject, and it can be especially tough for nurses to know the best way to approach this subject with an older adult and their family. It’s hard for anyone to face the idea they are no longer able to care for themselves on their own.

Let’s discuss how to make this conversation easier.  

How to Determine if an Older Adult Needs Long-Term Care 

If the older adult is displaying any of the following signs, they might need long-term care: 

• Physical deterioration: increased difficulty walking and getting from place to place; and an increase in falls and/or balance issues.  
• Mental deterioration: memory loss, confusion, or other behavior changes unusual for the older adult. 
• Environmental deterioration: Increased difficulty maintaining a clean, safe environment that is free from debris and other obstacles that pose safety risks. 
• Loss of two or more activities of daily living (ADLs): increased difficulty in completing laundry, brushing their teeth, or getting dressed.  

How to Start the Conversation About Transitioning to Long-Term Care

To prevent unfavorable outcomes, initiate conversations about a transition to long-term care at the first signs of deterioration.

The nurse and older adult’s family should also agree on how to move forward when discussing long-term care with the older adult. Then, according to Retirement Genius, “discuss ways they can help with finding home care or assisted living.” Remeber to lead with sensitivity and let the older adult share any concerns they might have.  

It’s also helpful to list some advantages of the transition to long-term care, such as how it will improve their lifestyle and safety. You may even want to suggest touring some facilities to put them more at ease with the idea. If the older adult reacts negatively, be patient, empathize, and support them.

Exploring Long-Term Care Options

There are many options for geriatric care, and the best choice will depend on the older adult’s needs, including the personal and medical assistance they require. It will also depend on the family members’ preferences. According to Retirement Genius, long-term care is available in the following forms: 

• Assisted living facilities: Housing for older adults who might need assistance with dressing, bathing, eating, and toileting, but don’t require the medical and nursing care nursing homes offer. 
• In-home care: Professional support services that allow a person to live safely in their home while receiving the medical and nursing care they need. They may also receive assistance with activities of daily living. 
• Nursing homes: these facilities provide 24-hour skilled nursing care to those who need more intensive care such as medication administration, catheter changes, dressing changes, etc. In addition, nursing homes provide assistance for all activities of daily living the individual may need. 
• Independent living communities: Ideal for those who can still live independently but would like access to assistance when needed. They may have access to dining, medical care, entertainment and more.  

What if the Older Adult isn’t Ready for Long-Term Care?

Try to understand their decision and respect it. The older adult will likely appreciate your concern but express to you they feel capable of performing activities of daily living for now. You may disagree with their decision; however, it is important to maintain a supportive and understanding relationship. This approach will make it more likely they are receptive to revisiting the conversation at a later time.  

The Bottom Line

Discussing long-term care with an older adult can be intimidating, and you should navigate the conversation with empathy and respect. Try to put yourself in their shoes as much as you can. Ultimately, you want what is best for the older adult. You can communicate that message while maintaining boundaries and keeping the relationship intact. I hope you find these tips useful when navigating this transition with the older adult and their families. 

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