Planning for Long Term Care
Most older people are independent. But later in life--especially
in the 80s and 90s--you or someone you know may begin to need
help with everyday activities like shopping, cooking, walking,
or bathing. For many people, regular or "long-term" care may
mean a little help from family and friends or regular visits
by a home health aide. For others who are frail or suffering
from dementia, long-term care may involve moving to a place
where professional care is available 24 hours a day.
The good news is that families have more choices in long-term
care than ever before. Today, services can provide the needed
help while letting you stay active and connected with family,
friends, and neighbors. These services include home health care,
adult day care, and transportation services for frail seniors as
well as foster care, assisted living and retirement
communities, and traditional nursing homes.
Planning Ahead
The key to successful long-term care is planning. You or your
family may need to make a decision in a hurry, often after an
unexpected emergency like a broken hip. Be prepared by getting
information ahead of time. That way, you will know what's
available and affordable before there is a crisis. To start:
- If you are having trouble with things like bathing, managing
finances, or driving, talk with your doctor and other health care
professionals about your need for help. A special type of social
worker, called a geriatric case manager, can help you and your
family through this complex time by developing a long-term care
plan and locating appropriate services.
Geriatric case managers can be particularly helpful when family
members live a long distance apart.
- If you are helping a family member or friend, talk about
the best way to meet his or her needs. If you need help for
yourself, talk with your family. For instance, if you are
having trouble making your meals, do you want meals delivered
by a local program or would you like family and friends to help?
Would you let a paid aide in your home? If you don't drive,
would you like a friend or bus service to take you to the doctor
or other appointments?
- Learn about the types of services and care in your community.
Doctors, social workers, and others who see you for regular care
may have suggestions. The Area Agency on Aging and local and state
offices of aging or social services can give you lists of adult
day care centers, meal programs, companion programs, transportation
services, or places providing more care.
- Find out how you may--or may not--be covered by insurance.
The Federal Medicare program and private "Medigap" insurance only
offer short-term home health and nursing home benefits. Contact
your state-run Medicaid program about long-term nursing home
coverage for people with limited means. Also, your state's
insurance commission can tell you more about private long-term
care policies and offer tips on how to buy this complicated insurance.
These agencies are listed in your telephone book, under "Government."
Be aware that figuring out care for the long term isn't easy. Needs
may change over time. What worked 6 months ago may no longer apply.
Insurance coverage is often very limited and families may have problems
paying for services. In addition, rules about programs and benefits
change, and it's hard to know from one year to the next what may be
available.
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A Need for More Care
At some point, support from family, friends, or local meal or
transportation programs may not be enough. If you need a lot
of help with everyday activities, you may need to move to a
place where care is available around-the-clock. There are two
types of residential care:
- Assisted living arrangements are available in large apartment
or hotel-like buildings or can be set up as "board and care" homes
for a small number of people. They offer different levels of care,
but often include meals, recreation, security, and help with bathing,
dressing, medication, and housekeeping.
- Skilled nursing facilities--"nursing homes"--provide 24-hour
services and supervision. They provide medical care and
rehabilitation for residents, who are mostly very frail or suffer
from the later stages of dementia.
Sometimes, health care providers offer different levels of care at one
site. These "continuing care communities" often locate an assisted living
facility next to a nursing home so that people can move from one type of
care to another if necessary. Several offer programs for couples, trying to
meet needs when one spouse is doing well but the other has become disabled.
Finding the Right Place
To find the residential program that's best for you:
- Ask Questions. Find out about specific facilities in your area.
Doctors, friends and relatives, local hospital discharge planners
and social workers, and religious organizations can help. Your state's
Office of the Long-Term Care Ombudsman has information about specific
nursing homes and can let you know whether there have been problems
at a particular home. Other types of residential arrangements, like
"board and care" homes, do not follow the same Federal, state, or
local licensing requirements or regulations as nursing homes. Talk
to people in your community or local social service agencies to find
out which facilities seem to be well run.
- Call. Contact the places that interest you. Ask basic questions
about vacancies, number of residents, costs and method of payment,
and participation in Medicare and Medicaid. Also think about what's
important to you, such as transportation, meals, housekeeping,
activities, special units for Alzheimer's disease, or medication
policies.
- Visit. When you find a place that seems right, go talk to the
staff, residents, and, if possible, family members of residents.
Set up an appointment, but also go unannounced and at different
times of the day. See if the staff treats residents with respect
and tries to meet the needs of each person. Check if the building
is clean and safe. Are residents restrained in any way? Are social
activities and exercise programs offered--and enjoyed? Do residents
have personal privacy? Is the facility secure for people and their
belongings? Eat a meal there to see if you like the food.
- Understand. Once you have made a choice, be sure you understand
the facility's contract and financial agreement. It's a good idea to
have a lawyer look them over before you sign.
A Smooth Transition
Moving from home to a long-term care facility or nursing home is a big
change. It affects the whole family. Some facilities or community groups
have a social worker who can help you prepare for the change. Allow some
time to adjust after the move has taken place.
Regular visits by family and friends are important. They can be
reassuring and comforting. Visits are necessary, too, for keeping an eye
on the care that is being given.
Resources
The following organizations and agencies can provide information about
assistance and long-term care:
The Eldercare Locator (1-800-677-1116) can direct you to your Area
Agency on Aging. They will give you information on local long-term care
resources and programs. Visit their website at http://www.aoa.dhhs.gov.
The Nursing Home Information Service at the National Council of Senior
Citizens, 8403 Colesville Road, Suite 1200, Silver Spring, MD 20910
(301-578-8938) has information on community services and offers a free
guide on how to select a nursing home. Visit their website at
http://www.ncscinc.org.
The Health Care Financing Administration publishes the "Guide to
Choosing a Nursing Home" and the annual "Guide to Health Insurance for
People with Medicare." The nursing home guide includes a detailed checklist.
Call 1-800-638-6833. Visit their website at http://www.hcfa.gov.
Each state Office of the Long-Term Care Ombudsman visits nursing homes
on a regular basis and handles complaints. Find your ombudsman by calling
the National Association of State Units on Aging at 202-898-2578. The
association has publications about long-term care and can provide a list
of facilities.
Other sources of information include:
The American Association of Homes and Services for the Aging
901 E Street, N.W., Suite 500
Washington, D.C. 20004-2011
202-783-2242
http://www.aahsa.org
The Assisted Living Federation of America
Suite 400, 10300 Eaton
Place
Fairfax, VA 22030
703-691-8100
http://www.alfa.org
The American Health Care Association
1201 L Street, N.W.
Washington
D.C. 20005
202-842-4444
The National Citizens' Coalition for Nursing Home Reform's
publications list is available from Suite 202, 1424 16th Street, N.W.,
Washington, D.C. 20036-2211; call 202-332-2275.
For more information about health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg, MD
20898-8057
1-800-222-2225
1-800-222-4225 (TTY)
http://www.nih.gov/nia
Alzheimer's Disease Education
and Referral (ADEAR) Center
P.O. Box 8250
Silver Spring, MD 20907-8250
1-800-438-4380
http://www.alzheimers.org
Source: National Institute on Aging
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