Congregate Care

Consider this scenario, a composite of actual circumstances.

Bob and Mary were happy when their military service ended, they married and embarked on their civilian careers. Bob and Mary were healthcare professionals; Bob was a professor at the local medical school and Mary was a hospice nurse. Bob and Mary were always active in their church and volunteered their time in the community. They both retired at age 65 to pursue their dream of domestic and international travel. During the early years of their retired life, the couple continued to work part time, travel extensively, and spend time with their grandkids. When Mary turned 78 years of age Bob noticed that she was having memory problems.

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Mary always kept up on the latest topics and was always the first to complete the crossword puzzles and other logic games in the newspaper. However, Mary seemed to become increasingly forgetful; she would run errands to purchase specific items and return home empty-handed. The couple decided to seek help from a gerontologist. An extensive battery of cognitive and neuropsychological tests determined that Mary’s language skills and mental abilities had markedly diminished. Mary was diagnosed with Alzheimer’s disease, an incurable terminal brain disease. After the initial shock of the diagnosis, the couple developed a plan that included Bob serving as Mary’s sole caregiver.

Over time, the disease progressed making it difficult for Bob to meet Mary’s needs. In addition, the progression of the disease was tough for both Bob, the children and grandchildren to witness. At first Mary became confused, then she became progressively irritable and aggressive. Five years after the diagnosis, Mary became almost totally withdrawn. Her appetite was nonexistent, and she became incontinent. Additionally, Mary was diagnosed with “sundowners’ syndrome” – a phenomenon whereby the individual experiences confusion and exasperation during the late afternoon or early evening hours.

Bob struggled to care for her and keep an upbeat attitude; however, he too was experiencing health issues due to aging . Bob was a competitive runner for years which impacted his knees and other joints. At times, this condition prevented him from daily activities, self-care and taking care of Mary.

Bob eventually hired a home health aide to visit daily to assist Mary and also do some light household chores. As Mary’s condition grew more serious, he had to make a decision. He was no longer able to care for her, and his own ailments were starting to severely impact his ability to take care of himself.

Bob and Mary had no assets and their retirement savings was gone. They were forced to ask for financial assistance from their children. Luckily, their children were professionals and able to assist Bob and Mary financially. The family had a meeting and agreed that Bob and Mary need to move into a home where they can both get the care that they need.


1. What long-term care options should be considered by Bob and his family for both himself and Mary?

2. What are the requirements necessary to access the care you have chosen in Question 1?

3. What funding mechanisms are available to Bob and Mary, and how does this affect the choice of their care options?

4. What could Bob and Mary have done to plan their care during their later years?

5. What is your plan to prepare for the possibility of your need for long-term care?

Your discussion should be in the form of a case study analysis. Here is an example of how to format one: You can use another similar approach or a variation of this example.

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