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Long-Term Care Choices

Topic Overview

What is long-term care?

As you or a family member ages, you may have concerns about how to manage health problems. Most people would like to stay in their homes and have family members help them out.

But this isn't always possible. You or a loved one may not have training to provide some types of care. Or a family member may have financial or family concerns that make caring for someone else hard. Or it could be distance—family members may live far apart.

This is where long-term care can help. It can provide a safe and structured environment for you or your loved one.

Long-term care:

  • Provides a range of services and supports.
  • Can provide medical or nonmedical help.
  • Meets personal needs, such as dressing, bathing, grooming, and help using the bathroom.
  • Can help with everyday tasks, such as housework, making meals, and shopping.
  • Can be at home, in the community, or in a residence (such as a skilled nursing facility).

Why might you consider long-term care?

People may consider long-term care when a health condition makes meeting health and personal needs hard or impossible to do on their own. For example, you or a loved one may need long-term care because of:

  • Stroke.
  • Dementia, such as Alzheimer's disease.
  • Head injuries.
  • Broken bones or problems after joint replacement surgeries.
  • Frailty.

Some people also consider long-term care when they are planning their future or when they have concerns about their future health or their ability to live independently.

What are the types of long-term care?

There are several types of long-term care. Each provides different levels of care, assistance, and services. The quality and costs of care and services vary widely. Your community may not have all of these options.

Community-based services

Community-based services help older adults remain independent. These include meals at home, transportation, housework, help with shopping, and adult day care. These services are generally coordinated by a local organization.

Specific services may include help with using the bathroom and taking medicines, checking blood pressure and weight, and care for those with dementia.

Assisted-living and residential care facilities

Assisted-living and residential care facilities offer a range of services. These services may include meals, cleaning and laundry services, and help with personal needs such as bathing, grooming, and dressing.

Most of these facilities have oversight by a nurse. Your loved one may be able to receive help with basic care such as getting medicines, checking glucose levels, and checking blood pressure.

Assisted-living facilities usually provide private, apartment-style housing. In residential care, rooms may be private or shared. Residential care provides a greater level of supervision than assisted living. Examples of residential care include board-and-care homes, retirement homes, and foster-care homes.

These types of housing may work well for a person who needs daily help and supervision but doesn't need daily nursing care. These centers don't cost as much as skilled nursing facilities.

Skilled nursing facilities

Skilled nursing facilities (SNFs) provide skilled nursing care up to 24 hours a day and offer medical care and medicines. They provide meals and laundry and help with dressing, bathing, and using the toilet. This is a costly type of care. But it may be the best choice for many people who have a lot of trouble with daily tasks and need medical care.

Special care units

Special care units (SCUs) are offered at some residential care centers and skilled nursing facilities. They focus on the needs of people with dementia. They have staff trained to work with people who have dementia. They can cost more than other types of care. There are also facilities that accept only people with dementia.

Continuing-care communities

Continuing-care communities offer several levels of care. They offer assisted living up to full nursing care in the same center. These centers cost a lot. But they may be a good choice because they can meet the person's changing needs.

Home health care

Home health care may include physical and speech therapy and nursing care. Nursing care may include getting shots, using a feeding tube, and changing dressings. Home health aides may be available to help with bathing.

A family member could also provide home care. Family members can help with such things as bathing, dressing, and cooking. Some home health care can only by given by health professionals.

How do you decide what is best?

Choosing the right type of long-term care is a very personal process. Whether you are choosing for yourself or for a loved one, it's important to look carefully at your options. You want to be sure that the level of care is right and that you or your loved one will feel comfortable.

To get started, work with your doctor, social worker, hospital discharge planner, or geriatric care manager to help find which type of long-term care would be best for you or your loved one. Then see which types of care are available in your community.

Make a list of the places that interest you, and visit them. A visit is the best way to see if the facility, the residents, and the staff feel right to you. If you can, visit the facilities on your list with your family. It may be helpful to keep written notes about each one. You may want to visit each one more than once.

Talk things over with your family. Did the facility feel right to you? Were you comfortable with the people there? Do you feel it will give you or your loved one the right care? Does it make sense for you and your family financially? How much of the cost, if any, will your insurance cover?

Click here to view an Actionset.Aging Well: Choosing a Nursing Home
Click here to view a Decision Point.Alzheimer's or Other Dementia: Should I Move My Relative Into Long-Term Care?
Click here to view a Decision Point.Stroke: Should I Move My Loved One Into Long-Term Care?

Other Places To Get Help

Organizations

Centers for Medicare and Medicaid Services: Nursing Home Compare (U.S.)
Web Address: www.medicare.gov/NHCompare/home.asp

U.S. Department of Health and Human Services: LongTermCare.gov
Web Address: www.longtermcare.gov

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Carla J. Herman, MD, MPH - Geriatric Medicine
Current as of October 17, 2013

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