Long term care: Early planning pays off

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Long term care: Early planning pays off

Long term care is a general term used to describe various home and community-based services for people 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 everyone may later regret. Instead, get familiar with long term care options now.

Understanding types of long term care

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 may 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.
  • 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. Assisted living facilities offer staff members to help with medications, bathing, dressing and basic medical care — as well as meals, transportation, housekeeping and activities. Some assisted living facilities have on-site beauty shops and other amenities.
  • Nursing home. Nursing homes offer 24-hour nursing care for those recovering from illness or injury. Nursing homes also offer end-of-life care. Services may include help bathing, dressing and toileting, wound care, rehabilitative therapy, and help with respirators or ventilators.
  • Continuing-care retirement community. Continuing-care retirement 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.

Choosing the right long term care facility

With all the options available, selecting a long term care service can be overwhelming. Ask yourself these questions to make the process easier:

  • What level of service do you need? Do you or does your loved one need help with everyday chores? Nursing care? What does the doctor say? Determining specific care needs can help you decide what type of facilities to consider.
  • What are your personal preferences? Would you or your loved one prefer a smaller facility, a certain location 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? 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? Does it smell OK? Is the temperature comfortable? Are the residents treated respectfully? Do they seem happy? Are there enough caregivers on staff? What are the rooms like? 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? Call the 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 Web site. 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.

Paying for long term care

Long term care can be expensive. If you don't expect personal savings to cover the cost of long term care, you may 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.
  • Medicaid. This joint state-federal program is designed for people who meet certain income requirements. Medicaid typically covers nursing home care, but only after an illness or injury. Whether Medicaid covers home care services, assisted living or placement in a continuing-care retirement community varies by state.
  • Medicare. This federal program is for people older than age 65 and those who have certain disabilities. Although Medicare doesn't generally pay for long term care, it may cover nursing home care for a certain number of days in specific situations. Medicare may cover some types of home care services as well, but Medicare doesn't cover assisted living.

Other options may include reverse mortgages, annuities or trust funds for long term care. These options may carry risks or impose fees, however. Discuss the options with a lawyer, accountant, social worker or local agency on aging.

Discussing long term care with a loved one

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, 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.
  • Involve others. If your loved one doesn't respond well to your efforts to talk about long term care, involve trusted contacts — such as other loved ones, clergy, a doctor or an attorney.

The idea of leaving home or receiving in-home help for everyday activities can be distressing. The more you know about the options, however, the better choices you can make.

Last Updated: 2010-01-16
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