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Choosing Long-term Care

"Long-term care" means helping people of any age with their medical needs or daily activities over a long period of time. Long-term care can be provided at home, in the community, or in various types of facilities.

When you look for long-term care, it is important to remember that quality varies from one place or caregiver to another.

It is also important to think about long-term care before a crisis occurs. Making long-term care decisions can be hard even when planned well in advance.

Quick Check for Quality
Look for long-term care that:

Types of Long-term Care
Research shows that many people do not know about or understand long-term care options. Following are brief descriptions of the major types of long-term care:

Home care can be given in your own home by family members, friends, volunteers, and/or paid professionals. This type of care can range from help with shopping to nursing care. Some short-term, skilled home care (provided by a nurse or therapist) is covered by Medicare and is called "home health care." Another type of care that can be given at home is hospice care for terminally ill people.

Community services are support services that can include adult day care, meal programs, senior centers, transportation, and other services. These can help people who are cared for at home—and their families. For example, adult day care services provide a variety of health, social, and related support services in a protective setting during the day. This can help adults with impairments—such as Alzheimer's disease—continue to live in the community. And it can give family or friend caregivers a needed "break."

Supportive housing programs offer low-cost housing to older people with low to moderate incomes. The Federal Department of Housing and Urban Development (HUD) and State or local governments often develop such housing programs. A number of these facilities offer help with meals and tasks such as housekeeping, shopping, and laundry. Residents generally live in their own apartments.

Assisted living provides 24-hour supervision, assistance, meals, and health care services in a home-like setting. Services include help with eating, bathing, dressing, toileting, taking medicine, transportation, laundry, and housekeeping. Social and recreational activities also are provided.

Continuing care retirement communities (CCRCs) provide a full range of services and care based on what each resident needs over time. Care usually is provided in one of three main stages: independent living, assisted living, and skilled nursing.

Nursing homes offer care to people who cannot be cared for at home or in the community. They provide skilled nursing care, rehabilitation services, meals, activities, help with daily living, and supervision. Many nursing homes also offer temporary or periodic care. This can be instead of hospital care, after hospital care, or to give family or friend caregivers some time off ("respite care").

Another type of long-term care takes place in home-like settings called Intermediate Care Facilities for the Mentally Retarded. They provide a wide variety of services to mentally retarded and developmentally disabled people from youth to old age. Services include treatment to help residents become as independent as possible, as well as health care services.

You can learn about long-term care options in your area by contacting:

The Eldercare Locator (1-800-677-1116, weekdays, 9.00 a.m. to 8.00 p.m., EST). This service can refer you to your Area Agency on Aging.

Area Agencies on Aging provide information on a wide variety of community-based services. Examples are meals, home care, adult day care, transportation, housing, home repair, and
legal services.

Your State or local Long-term Care Ombudsman (call the Eldercare Locator for the number). Ombudsmen visit nursing homes and other long-term care facilities to check on and resolve complaints, protect residents' rights, and give emotional support to lonely older people. A call to your area Ombudsman can give you information on: the most recent State survey (inspection) report of the facility; the number of outstanding complaints; the number and nature of complaints lodged in the last year; and the results of recent complaint investigations.

"Nursing Home Compare"—a Web site created by the Centers for Medicare & Medicaid Services, which runs Medicare and Medicaid. This site helps you locate nursing homes in your area. It also has inspection records for nursing homes that receive Medicare or Medicaid funds.

There are three important questions to ask yourself when deciding about long-term care
for yourself or a loved one:

  1. What kind of services do I need?
  2. How will I pay for these services?
  3. How can I choose the best quality services?

What Kind of Services Do I Need?
Think of long-term care as a menu of services. A person may need only one or a few kinds of services. Or, several kinds may be needed over the course of a person's older years.
To help find out what kind of services you or a loved one need, check the items below that apply. Keep in mind that these needs may change over time.

Do you or your loved one need help with daily activities? Health care needs? Both? You can use the following chart to help you identify the type(s) of long-term care that meet your needs. This chart shows which types of long-term care services offer which kinds of help. The"Relative Costs" information shows how costly the settings can be when compared with each other.

Help With Daily Activities
[_] Shopping
[_] Preparing meals
[_] Eating
[_] Laundry and other housework
[_] Home maintenance
[_] Paying bills and other money matters
[_] Bathing
[_] Dressing
[_] Grooming
[_] Going to the bathroom
[_] Remembering to take medicines
[_] Walking
[_] Other

Health Care Needs*
[_] Physical therapy
[_] Speech therapy
[_] Occupational therapy
[_] Rehabilitation
[_] Medical nutritional therapy
[_] Oxygen
[_] Care for pressure ulcers or other wounds
[_] Alzheimer's disease care
[_] Health monitoring (for diabetes, for example)
[_] Pain management
[_] Nursing care services
[_] Other medical services provided by a doctor or other clinician
[_] Other * as recommended by a doctor or other health care provider.

How Will I Pay for these Services?
Long-term care can be very expensive. In general, health plans and programs do not routinely cover long-term care at home or in nursing homes. Here is some general information about long-term care coverage:

Medicare is the Federal health insurance program for people age 65 and older and for some disabled younger people. Medicare generally does not pay for long-term help with daily activities. Medicare pays for very limited skilled nursing home care after a hospital stay. If you need skilled care in your home for the treatment of an illness or injury, and you meet certain conditions, Medicare will pay for some of the costs of nursing care, home health aide services, and different types of therapy.

Medicaid is a Federal-State program that pays for health services and long-term care for low-income people of any age. The exact rules for who is covered vary by State. Medicaid covers nursing home care for people who are eligible. In some States, Medicaid also pays for some home and community services.

Private Insurance.
Medicare beneficiaries may supplement their policy with insurance purchased from private organizations. Most of these policies—often called Medigap insurance or by a similar name—will help pay for some skilled care, but only when that care is covered by Medicare. Medigap is not long-term care insurance. Commercial insurers offer private policies called long-term care insurance. These policies may cover services such as care at home, in adult day care, in assisted living facilities, and in nursing homes. But plans vary widely. If you have such a policy, ask your insurer what it covers. If you think you may need long-term care insurance, start shopping while you are relatively young and healthy, and shop carefully.

Personal Resources
You may need to use resources such as savings or life insurance to pay for long-term care. Most people who enter nursing homes begin by paying out of their own pockets. As their personal resources are spent, many people who stay in nursing homes for a long time eventually become eligible for Medicaid.

State Health Insurance Program
Your State Health Insurance Program (SHIP) can give you general information about Medicare, Medicaid, managed care plans, and the types of health insurance that can supplement Medicare, including Medigap and long-term care insurance. Counselors also can help you with questions about your medical bills, insurance claims, and related matters. These services are free. To find the phone number of the SHIP office in your State, call the Medicare Hotline at 1-800-633-4227. Or,look at the consumer Web site for Medicare services,

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