Prepare now for your health needs in the future

The last thing most of us want to face in old age is being unable to take care of ourselves. Unfortunately, it's a likely possibility. At age 65, we have a 70% chance of needing some type of long-term care services and supports in our remaining years. Thinking about it can be unsettling, and planning for it can feel overwhelming.

"What I see is that most people do very little to prepare. They don't want to talk about it, and their kids don't want to hear about it. Everyone winds up scrambling when a caregiver is needed," says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center.

She recommends preparing for potential caregiving needs today, while you're healthy and can make your own decisions. To help you begin, we've created the following guide, plus a checklist of important steps.

Get certain legal affairs in order

If you haven't already, it's time to choose the person or people who will one day make decisions for you when you can't, as well as the type of care you'd like.

"Have a frank conversation with your partner, grown kids, family members, or friends. It's best if they live in your vicinity, but they don't have to. They do need to be reliable and available when you need them, and they must understand what you want," Dr. Salamon says. "Will they be able to talk to your banker, attorney, doctors, or hospital and long-term care facility workers? Will they carry out your wishes? Don't limit their decision making by saying 'Don't put me in a nursing home.' You never know what will be best for you."

You'll need two legal documents to make your designees official:

• a power of attorney, designating the person who can make your legal and financial decisions
• a health care proxy, designating the person who can make your health care decisions.

In addition, consider drawing up other advance directives, such as a living will, to clarify your wishes for your future care. Seek out an estate attorney to draw up the paperwork or download the forms for free from your state. The AARP offers handy links.

Learn about housing options

Are you planning to stay in your own home for as long as possible? Are you thinking you'll live with family members? Have you discussed it with them, to confirm the option? Or are you figuring you'll move to a retirement facility with independent living, assisted living, a nursing home, or all three (a combination described as the "continuum of care")? Start investigating all of the options, even if you don't think you'll need them.

If you plan to "age in place" at home or live with a relative, the home may need some adjustments. You'll need a bedroom, a bathroom with a walk-in shower, a kitchen, and a door to the outside, preferably all on the same floor. If you have stairs, be sure to have handrails and consider options for installing a stair lift. Make home renovations, if necessary, as soon as possible; waiting until the last minute might not be realistic.

If you think a retirement facility is in your future, familiarize yourself with local options. Make appointments to visit them and to ask about amenities, costs, the ratio of nurses or health aides to residents, and how often they have availability for new residents. Look up their safety records using the Medicare comparison tool. "I have some patients who've already moved into independent living facilities with the entire continuum of care. They like the idea of having everything on the same campus," Dr. Salamon says. "But other people prefer waiting until it's clear what they need."

You might also investigate residential care homes (which have a dozen or fewer residents and a small staff that might live on the premises) and memory care facilities, which are tailored to people with various forms of dementia.

Knowing what's available to you in your community will give you a greater ability to make decisions later, if necessary.

Investigate support services

Whether you live in a private home or a retirement facility, you might still need to hire outside services such as transportation, grocery and pharmacy delivery, or private duty care (a companion or health aide). Dr. Salamon recommends learning about those services now, before you need them.

For example, if you've never ordered groceries for delivery, give it a try. Find out which apps your grocery store uses (such as Instacart), sign up, and get a delivery. Download a transportation app (such as Uber or Lyft), order a ride, and test it out. That will give you a better idea of whether you'll be able to take advantage of those services in the future. If that doesn't seem feasible for you, you'll need to make other arrangements.

Contact local private duty care agencies to learn about the levels of care provided by home companions, certified health aides, and nurses. For example, companions can do anything a friend would do (keep you company, cook, clean, or drive), except help you physically; a health aide can cook, clean, and drive for you, and legally "lay hands" on you, helping you bathe and get in and out of a car; a nurse has specialized training and can take care of wounds and dispense medications. Ask how much these services cost (the national average starts at $33 per hour) and the minimum number of weekly hours required for service.

Another option is to contact your local Area Agency on Aging, part of a network of more than 600 agencies that receive federal funding to coordinate older adult support services and provide referrals to them. You can get a free consultation and a personalized list of services in your area that might address your needs, including nonprofit groups that pro-vide free or low-cost services such as meals, transportation, and exercise classes tailored to specific health problems (such as Parkinson's disease). To find your Area Agency on Aging, go to the federal Eldercare Locator.

Start downsizing

Even if you feel you're years away from needing caregiving of some kind, it will help if you can downsize your belongings — and even your home — now.

Moving to a smaller home makes sense if it's too large and no longer suits your needs, and if you can cash in some of its value. "But you still might want to have enough room for family visits or for a caregiver, if you'll ever need someone to live with you. When my mother downsized, she looked for a two-bedroom condo for that very purpose," Dr. Salamon points out. This might be a good time to start getting recommendations from friends for real estate agents.

You'll also need to downsize the contents of your home so they'll fit into a smaller place. This removes a burden on your family; it can be a painful process to try to determine what to do with someone else's treasures.

Downsizing is an enormous task that can take months. Consider hiring a professional organizer (costs start at about $60 per hour) to assist you. If you'd like to try it on your own, organizing pros suggest doing it gradually, going through one drawer or room at a time; dividing things into "keep," "discard," and "donate" piles; and devoting a set amount of time to the job, such as one day per week. "Take breaks so you don't become physically or emotionally exhausted. Our ability to handle stress declines as we get older," Dr. Salamon says.

Get financial advice

Paying for caregiving is unimaginable for most people. The average assisted living care facility charges $5,900 per month. A semiprivate room in a nursing home averages $9,277 per month. Private duty care easily runs over $1,000 per month if you receive three hours of care, three days per week. And Medicare doesn't pay any of those costs.

"You must also consider the costs of drugs and equipment you might need, such as wheelchairs or medical beds. Medicare might pay for only a portion of those," Dr. Salamon says.

The best way to tackle huge expenses starts with planning. Consider working with a financial planner who can look at your projected income, assets, and expenses, and help you come up with creative ways to address costs, such as getting a reverse mortgage (which lets you convert your home equity into cash before you move). If you're a veteran, you might qualify for benefits that pay for part of your private duty care or assisted living facility costs.

And though it may seem hard to believe, the time to do all of this is now. "It's never too early to start thinking about these costs or the possibility that you'll need caregiving," Dr. Salamon says. "We can't predict that it will be necessary, but statistics and health problems — especially major chronic diseases such as heart disease, diabetes, and neurological conditions — increase your risk. The more you can do now, the better off you'll be later on."

Image: © alvaro gonzalez/Getty Images