Long-term care has changed significantly in recent years and continues to evolve to meet the needs of today’s older adults. While many people wish to remain in their homes throughout their lives, that is not always possible. It is very important to make an informed decision when choosing a long-term care facility.
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Independent Living
An independent living facility may resemble an apartment complex or a hotel. These facilities provide personal living spaces while taking care of some of the extra needs you may have as you get older. For example, they may have railings in the bathrooms and wider doorways to accommodate wheel chairs and walkers. Many independent living units include a small kitchen and laundry room. Some offer additional services, such as meals, at an additional cost. The size of individual units, the additional services available, and the cost will depend on the particular facility you choose.
Assisted Living
An assisted living facility may be appropriate for people who need more help than can easily be gotten at home or in an independent living setting. Assisted living facilities may help as needed with daily activities, but offer only some nursing care or none at all. These facilities usually provide meals, cleaning services, social activities and transportation services. Depending on the facility, living arrangements may be private or semi-private.
Skilled Nursing Facility
When more care is needed, the next choice in long-term care is a skilled nursing facility or nursing home. Nursing home care is usually reserved for people who need help with meals, bathing, personal care, medications and moving. Nursing homes usually provide 24-hour services and supervision, including medical care and some physical, speech and occupational therapy, depending on the facility. A doctor's order is required for an individual to qualify for a skilled nursing facility.
Continuing Care Retirement Community
One of the newer choices in long-term care is a Continuing Care Retirement Community (CCRC). CCRCs often provide independent, assisted and nursing care living in the same locale. Having multiple levels of care on the same “campus” can be very beneficial for residents because services are standardized and one can transition easily to the next level of care when that becomes necessary.
Tips for Choosing a Facility
Choosing a facility may be the most difficult part. The American Association of Homes and Services for the Aging (AAHSA) recommends:
- Ask questions. Find out what is available in your area. Talk to trusted friends, family, neighbors, health care providers, etc., to determine their experiences with various facilities.
- Investigate. Most states maintain a "report card" for residential facility inspections that identifies deficiencies, corrections and other information that might be important. Contact your state's department of health or department on aging to see how you may access that information.
- Call. Once you have a list of possible places, get in touch with each one. Ask basic questions about openings and waiting lists, number of residents, costs and methods of payment.
- Visit. Make plans to meet with the director of nursing and director of social services. Medicare offers a nursing home checklist: http://www.careplanner.org. Ask yourself if you would feel reassured leaving your loved one there.
- Visit again. Make a second visit without an appointment, maybe on another day of the week or at a different time of day. See if your first impressions are still the same.
For additional information on choosing a facility, specifically a nursing facility, click here.
Financial Issues
Many people believe that Medicare will pay for long stays in a nursing home, but it does not. Medicare and Medicare supplemental insurance cover only short periods of home health or nursing home care, and to be eligible the individual must meet certain qualifications. These plans do pay for a short stay in a nursing home for someone who is getting better after leaving the hospital.
Medicaid may be used to pay for nursing home care, but only after certain income and asset requirements are met. Many people start paying for long-term care with their own money and later may become eligible for Medicaid. Keep in mind that applying for Medicaid takes at least three months. Also, new financial requirements for Medicaid allow a five-year look-back period for finances. This means that assets and income from the last five years may be considered when determining eligibility.
Long-term care insurance is a private insurance policy you can buy years before you think you might need it. While each policy is different, long-term care insurance is usually less expensive when purchased at a younger age. Contact your state's department of health or department of insurance for more information.
Summary
Planning for long-term care is not easy. Individual needs change over time as do the rules about programs and benefits. Be sure to include your family in your decision to move to a long-term care facility, no matter what the level of care. By the same token, if you are a caregiver considering placing a loved one in a facility, be sure to involve that loved one in the decision-making process as much as possible.
For more information, visit AAHSA: www.aahsa.org.
