Long-term care: Early planning pays off
It's best to talk about long-term care early — before medical or personal care is needed. 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 caring for themselves.
If you're considering long-term care options for yourself, a parent, or other friend or relative, start the research and discussions early. If you wait, an injury or illness might force your hand — leading to a decision that might not be best in the long run.
Here's help getting familiar with long-term care options.
Understanding types of long-term care
Learning about the various types of long-term care can help you choose the most appropriate options for you or the person you're supporting. Options include:
- 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. Meal delivery programs can provide hot meals to your home.
- Day programs. For adults who don't need round-the-clock care, day programs offer social interaction, meals and activities, often including exercise, games, field trips, art and music. Some programs provide transportation to and from the care center as well as medical services, such as help taking medications.
- Comprehensive at-home care programs. A Program of All-Inclusive Care for the Elderly (PACE) provides comprehensive medical care and support services, funded by Medicare and Medicaid, for older people living at home. Availability of PACE services varies by state.
- Senior housing. Many communities offer rental apartments intended for older adults, and rent may be subsidized for some residents. Some senior housing facilities offer meals, transportation, housekeeping and activities.
- Assisted living. Staff members at these facilities help residents with taking medication, bathing and dressing — as well as meals, transportation, housekeeping, laundry and social activities. Some assisted living facilities have on-site beauty shops and other amenities, too.
- Continuing-care retirement community. These communities offer several levels of care — 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 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 with eating, dressing, bathing and toileting, as well as rehabilitative therapy.
Choosing the right long-term care facility
Selecting a long-term care facility can be overwhelming. Consider the following questions for you or the person you are helping to make decisions:
- What level of service do you need? Do you need help with getting dressed or using the toilet? What regular medical care do you need? What type of help do you need with meals or housekeeping? What kind of care does your doctor recommend?
- What are your personal preferences? Would you prefer a smaller facility or certain living arrangements, such as a single room? Would you rather eat your meals in a community dining room or in your own room? What amenities are most important?
- What are the institution's 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 amenities are provided? What types of recreational or social activities are provided? Are there opportunities to participate in religious or cultural events? What types of transportation services are provided?
- 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 clean, 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? Make a second unannounced visit to confirm your first impression.
- How does the facility compare with others? Use tools such as Nursing Home Compare on the Medicare website. Ask a long-term care ombudsman — an 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.
Also, get opinions from friends and family who have experience with nursing homes. 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 might provide suggestions as well.
Paying for long-term care
Long-term care can be expensive. Typically, paying for long-term care begins as an out-of-pocket expense. Other financial options include:
- Medicare, a federal program for people older than 65 and those who have certain disabilities, doesn't generally pay for long-term care. Certain options under Medicare will cover doctor care, prescriptions and medical devices you need while in a long-term care facility. Medicare does cover short-term nursing home care for such needs as rehabilitation or nursing care after surgery or hospitalization.
- Medicaid, a joint state-federal program designed for people who meet certain income requirements, might be an option to cover long-term care for adults who have limited assets or those who've nearly depleted their assets.
- Long-term care insurance policies may cover long-term care at a facility or in your home. Premiums will depend on your age, your health and the type of benefits you want.
- Life insurance policies may include benefits that can be used to pay for long-term care or an option to sell your policy for its current value.
- A reverse mortgage is a loan against a portion of the value of a property. The payment of the loan, interest and fees is due when the borrower sells the house, no longer uses it as a main residence or dies. Fees and interests are generally much higher than other mortgages.
Consider consulting an attorney, accountant or a local agency on aging for help with financial decisions.
Discussing long-term care
If you're researching long-term care options for a parent, another relative or a friend, make sure the person needing care is involved in discussions and decision-making as much as possible. Consider these tips:
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- Plan ahead. Don't wait until a long-term care facility is necessary. 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, ask whether she could use help bathing or managing other aspects of personal care.
- Listen to preferences and concerns. Any person who's mentally competent has the right to make decisions about long-term care. Listen to questions, concerns and preferences that can help guide decisions and your search for the best options.
- Explain the need for care. Explain why you feel your relative needs long-term care. Is 24-hour safety a concern? Is it difficult to travel from home to medical care? Is it difficult to get healthy meals every day? These issues can help guide your conversation and explain the necessity of long-term care.
- Involve others. If efforts to talk about long-term care are not going well, you might involve trusted individuals, such as other relatives or friends, clergy, a doctor, or an attorney.
See more In-depth
- Aging in place: Growing older at home. National Institute on Aging. https://www.nia.nih.gov/health/aging-place-growing-older-home. Accessed March 24, 2020.
- Your guide to choosing a nursing home or other long-term care. Department of Health and Human Services. https://www.medicare.gov/pub/popular-medicare-publications. Accessed March 24, 2020.
- Adult day programs. Administration for Community Living. https://eldercare.acl.gov/public/resources/topic/Adult_Day_Programs.aspx. Accessed April 1, 2020.
- Programs of All-Inclusive Care for the Elderly benefits. Centers for Medicare and Medicaid Services. https://www.medicaid.gov/medicaid/long-term-services-supports/pace/programs-all-inclusive-care-elderly-benefits/index.html. Accessed April 1, 2020.
- Residential facilities, assisted living, and nursing homes. National Institute on Aging. https://www.nia.nih.gov/health/residential-facilities-assisted-living-and-nursing-homes. Accessed March 24, 2020.
- How to choose a nursing home. National Institute on Aging. https://www.nia.nih.gov/health/how-choose-nursing-home. Accessed March 24, 2020.
- Paying for care. National Institute on Aging. https://www.nia.nih.gov/health/paying-care. Accessed March 24, 2020.