It's best to talk about long term care early — before the need for medical or personal care is imminent. Here's help understanding, choosing and financing long term care.
By Mayo Clinic Staff
Long-term care is a term used to describe home and community-based services for adults who need help taking care of themselves.
If you're considering long-term care options for yourself, a parent or another loved one, start the research and discussions early. If you wait, an injury or illness might force your hand — leading to a hasty decision that might not be best in the long run.
Here's help getting familiar with long-term care options.
Understanding the various levels of long-term care can help you choose the type that's most appropriate for you or your loved one. For example:
- Home care. Personal or home health aides can help with bathing, dressing and other personal needs at home, as well as housekeeping, meals and shopping. Home health nurses provide basic medical care at home, such as helping with medications.
- Day program. Day programs for adults offer social interaction, meals and activities — often including exercise, games, field trips, art and music — for adults who don't need round-the-clock care. Some programs provide transportation to and from the care center as well as certain medical services, such as help taking medications or checking blood pressure.
- Senior housing. Many communities offer rental apartments intended for older adults. Some senior housing facilities offer meals, transportation, housekeeping and activities.
- Assisted living. These facilities offer staff members to help with activities such as taking medication, bathing and dressing — as well as meals, transportation, housekeeping and social activities. Some assisted living facilities have on-site beauty shops and other amenities.
- Continuing-care retirement community. These communities offer several levels of care in one setting — such as senior housing for those who are healthy, assisted living for those who need help with daily activities, and round-the-clock nursing care for those who are no longer independent. Residents can move among the various levels of care depending on their needs.
- Nursing home. Nursing homes offer 24-hour nursing care for those recovering from illness or injury and serve as long-term residences for people who are unable to care for themselves. Nursing homes also offer end-of-life care. Services typically include help eating, dressing, bathing and toileting, as well as wound care and rehabilitative therapy.
Selecting a long-term care facility can be overwhelming. Ask these questions to ease the process:
- What level of service do you need? Do you or does your loved one need help with everyday activities, such as getting dressed or walking to the bathroom? Nursing care? What about physical or occupation therapy? What does the doctor say? Determining specific care needs can help you decide which type of facility to consider.
What are your personal preferences? Would you or your loved one prefer a smaller facility or certain living arrangements, such as a single room? Would you rather eat your meals in a cafeteria setting or in your own room? What amenities are most important?
Also consider the rules. Can residents choose when to get up and go to bed? When are visitors allowed, and what social activities are offered? Can residents continue to see their personal doctors?
- What can you afford? Get the details on prices, fees and services. Know what's included in the monthly fee and what costs extra.
- What's available close to home? Being close to friends and family can ease the transition to long-term care. If vacancies are an issue, ask about waiting lists.
What's your first impression? Schedule a tour of the facility. Does the facility seem safe, and are residents treated respectfully? Do they seem happy?
Does the facility smell OK, and is the temperature comfortable? Are there enough caregivers on staff? Later, make unscheduled visits to make sure your first impression was accurate.
How does the facility compare with others? What have you heard about the facility? Contact your local Better Business Bureau to check whether any complaints have been filed against the facility, and use online applications such as the Nursing Home Compare tool on the Medicare website.
Ask a long-term care ombudsman — on official who investigates complaints against long-term care facilities — about the strengths and weaknesses of specific facilities. To find a local ombudsman, use the Eldercare Locator, an online service of the U.S. Administration on Aging.
Get opinions from friends and family who have experience with nursing homes. Also, ask your doctor for a recommendation and if he or she sees patients in any nursing homes. Social workers, hospital discharge planners and local agencies on aging may provide suggestions as well.
Long-term care can be expensive — and, typically, it's an out-of-pocket expense.
Medicare, a federal program for people older than 65 and those who have certain disabilities, doesn't generally pay for long-term care. Medicaid, a joint state-federal program designed for people who meet certain income requirements, might be an option for adults who have limited assets or those who've nearly depleted their assets. However, who's eligible for Medicaid and which services are covered varies by state.
If you don't expect personal savings to cover the cost of long-term care, you might be able to finance long-term care through long-term care insurance. In exchange for monthly premiums, long-term care insurance covers nursing home care or other long-term care services.
Premiums generally increase with the person's age, and coverage benefits vary significantly. If you're considering long-term care insurance, make sure the policy covers any pre-existing conditions as well as conditions that could develop later, such as dementia. Also check whether you can reduce coverage if the premiums become too expensive.
Other options might include a reverse mortgage — in which you convert part of the equity in your home into cash — or the sale of a life insurance policy for the present value of the policy (life settlement).
Be wary of risks and fees, however. Discuss the options with a lawyer or accountant. You might also contact a social worker or the local agency on aging.
If you're researching long-term care options for a parent or other loved one, include your loved one in the process as much as possible. Consider these tips:
- Plan ahead. Don't wait until a loved one needs a long-term care facility. Start planning early so that you have time to evaluate the options together.
- Work long-term care into everyday conversation. If your mother mentions a problem turning on the faucet, for example, you might ask whether she could use help bathing or managing other aspects of personal care.
- Listen to your loved one's preferences and concerns. If your loved one is mentally competent, recognize his or her right to make decisions about long-term care. Stay positive as you remind your loved one that his or her safety is your primary concern.
- Explain the need for care. Let your loved one know why you feel he or she needs long-term care. Is 24-hour safety a concern? Is it difficult to transfer your loved one from home to medical care? These issues can help guide your conversation, and help your loved one understand why you feel long-term care is necessary.
- Involve others. If your loved one doesn't respond well to your efforts to talk about long-term care, involving trusted contacts — such as other loved ones, clergy, a doctor or an attorney — might help.
The idea of leaving home or receiving in-home help for everyday activities can be distressing. The more you know about the options, the better choices you can make.
March 20, 2015
- Garavan R, et al. When and how older people discuss preferences for long-term care options. Journal of the American Geriatrics Society. 2009;57:750.
- Your guide to choosing a nursing home or other long-term care. U.S. Department of Health and Human Services. http://medicare.gov/Publications/Search/results.asp?PubID=02174&PubLanguage=1&Type=PubID. Accessed Feb. 24, 2015.
- Nursing homes: Making the right choice. National Institute on Aging. http://www.nia.nih.gov/health/publication/nursing-homes. Accessed Feb. 24. 2015.
- Understanding long-term care insurance. AARP. http://www.aarp.org/health/health-insurance/info-06-2012/understanding-long-term-care-insurance.html. Accessed Feb. 24. 2015.
- Takakashi PY (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 27, 2015.