If you hear long-term care facility and automatically think nursing home, it's not surprising. However, long-term care encompasses a spectrum of options and a progression of choices.
If you hear long-term care facility and automatically think nursing home, it’s not surprising. However, long-term care encompasses a spectrum of options and a progression of choices.
Early on, the “facility” where an older adult receives treatments, help with medications or personal care is often his or her home. Nursing homes represent a traditional solution when home care is no longer enough. But they’re not the sole solution.
Alternatives such as assisted living and continuing care retirement communities attract many older residents, including some who are still healthy and want to remain active. For seniors who crave a more family-like atmosphere, out-of-the box options like adult foster homes exist.
Of course, payment is a major limiting factor in long-term care choices. For many families, assisted living facilities and CCRCs are prohibitively expensive. The issue of how to pay for long-term care, and what is and isn’t covered by Medicare or Medicaid, is a huge decision element.
Long-term care decisions rarely involve a sudden crisis followed by a parent’s dramatic uprooting to a supervised facility. “It’s usually not ‘Mom’s fine’ and then the next day she needs to go to a nursing home,” says Sandy Markwood, CEO of the National Association of Area Agencies on Aging. “It’s a continuum.” Long-term care options fluctuate as people develop mobility issues or chronic conditions gradually worsen.
In many cases, long-term care starts at home. Family caregivers and home health aides, often in combination, can help make it possible. For adult children who aren’t certain what kind of assistance a parent needs, particularly when they live at a distance, geriatric care managers — also called aging life care managers — can assess people in their home environments, says Nancy Avitabile, owner of Urban Eldercare, a geriatric care management practice in New York City.
These professionals determine and manage appropriate services, and also may make suggestions on reducing potential safety hazards in the home, says Avitabile, who is president of the board of directors of the Aging Life Care Association.
Markwood notes that local services can extend the interval an aging adult is able to manage at home. “Look up your Area Agency on Aging and find the plethora of resources that are out there in your community,” she advises.
At some point, in-home caregiving and community services combined may no longer suffice to meet an older adult’s changing health, safety or personal care needs. In other cases, seniors who can still live independently, or with minimal assistance, realize they’re ready to move into a residential setting where they can socialize with peers.
The following continuum of long-term facilities appears in mostly ascending order of how much care and supervision their residents need.
Retirement living/independent living. Independent or retirement living focuses on a self-sufficient lifestyle for seniors. These residences might be part of self-contained retirement communities or high-rise apartment complexes, among other models. Costs vary widely based on location, services (like housekeeping) and activities offered. Wellness centers may be available on-site.
“You’re really looking at a situation that’s very light on care,” Avitabile says. People considering these options might prefer a more “hotel-like” environment, with congregate meals in attractive dining rooms. “There are a lot of planned outings and activities, sometimes of a very high caliber,” she says.
With home care agencies sometimes right on the premises, Avitabile says, someone who wants to age in place in independent living, but who eventually needs more care, could hire that type of assistance as if he or she were in their own home.
Assisted living. Assisted living facilities offer services such as medication management and light personal care within a supervised setting. Housekeeping, prepared meals and assistance with daily personal care are available. Assisted living is known for its focus on group and individual activities and efforts by staff to prevent residents from feeling isolated.
Medical services, such as nurse practitioners who follow residents, are available. “Assisted living also has different levels of care that someone would buy into,” Avitabile says. Residents who need lighter care might opt for medication management, check-in services and morning assistance getting out of bed and showered.
With assisted living, “you really need to look into what is covered,” Markwood says. “And how often: What’s the breadth of that service? So if they provide meals, is it one meal a day? Is it weekly? Is it daily housekeeping? If they say they provide transportation, what does that mean? Are there any additional charges? It’s really delving into and not just taking things on the surface level.”
Continuing care retirement community. CCRCs offer a tiered approach for aging adults. Typically, residents move into single-family apartments or condominiums designed for independent, healthy adults. As their needs change, they can transition to on-site assisted living or nursing home facilities. Continuing retirement care communities represent a significant financial investment, with hefty upfront entrance fees and monthly charges.
Medical foster care. Also known as adult foster care or residential care homes, medical foster homes are private homes that are run by a trained caregiver. For military veterans with chronic medical conditions that meet the nursing-home level of care, the Department of Veterans Affairs oversees its Medical Foster Homes Program. Availability is limited, although the VA is working to expand the program.
Other older adults who have chronic physical or cognitive health needs and require assistance in daily living activities — yet prefer a noninstitutional setting — can seek adult foster arrangements, too. Adult foster care homes are not covered by Medicare.
Nursing homes. Nursing homes provide medical and personal care services beyond what’s available in assisted living. Nursing care, 24-hour supervision, assistance with activities of daily living and three daily meals are standard. Most nursing home residents have chronic physical or mental health conditions, or both. Nursing home residents can receive prescribed treatment and personal care as needed.
As with any type of long-term care facility, it’s essential to do some research and ask critical questions before choosing a nursing home. You can explore U.S News’ Best Nursing Homes ratings and also find information on Medicare- and Medicaid-certified nursing homes on the Medicare.gov website.
Memory care. For people with Alzheimer’s disease, other types of dementia or serious memory problems, memory care involves an extra level of care and supervision. Secured memory care units are located within many nursing homes and assisted living facilities. Staff members receive special training to provide 24-hour care and daily assistance to this group. Memory care typically costs more than non-memory care.
“Some individuals do extremely well in memory care,” Avitabile says. “And then for some, it doesn’t work at all. There’s always that trial period.”
In nursing homes, memory care usually goes by a different name, such as the Alzheimer’s unit. The atmosphere can differ by type of facility. “In general, a memory care unit attempts to be kind of more normalizing — a little bit more humanistic and kind of person-centered,” Avitabile says. “It doesn’t have that institutionalized feeling.”
Skilled nursing facilities. The terms nursing home and skilled nursing facility are often used interchangeably, because the types of care involved often overlap, but they aren’t identical. Skilled nursing facilities are more likely to have a consistent presence of nurses or physicians and offer rehabilitation services such as occupational, physical and speech therapy. SNFs and nursing homes fall under different sets of regulations.
An individual who truly qualifies for SNF care “needs a lot of assistance,” Avitabile says. “Typically [they require] the assistance of two individuals to move them. Typically, they’re bedbound and they have other skilled care needs.” For example, she says, an SNF resident might require dialysis or have a tracheostomy tube.
It’s never too soon to plan ahead for long-term care, whether for yourself or a family member. “People underestimate the cost and they underestimate the amount of time they may need services,” Markwood says.
Learn what Medicare and Medicaid cover, as well as long-term care insurance, if you have it. “Also make sure your family knows you have long-term care insurance,” says Markwood, who has heard of families not realizing a parent had this coverage until after he or she died.
Family decisions on long-term care should include adult children and significant others, Markwood says. “Spending down” to Medicaid eligibility means someone has paid out of pocket for care and exhausted their personal savings. A parent’s home may need to be sold to make long-term care affordable.
Although Medicare provides coverage for up to 100 days of rehabilitation or convalescent care in a nursing home, it doesn’t cover long-term care. Medigap, long-term care insurance and employer-provided or private health insurance plans can help defray long-term care costs if plans are already in place before a major health event occurs.