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.
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.
- 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
- 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.
A Need for More
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
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
- 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.
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
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
The following organizations and agencies can provide information about
assistance and long-term care:
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
The American Association of Homes and Services for the Aging ,
901 E Street, N.W., Suite 500, Washington, D.C. 20004-2011; call 202-783-2242.
Visit their website at http://www.aahsa.org.
The Assisted Living
Federation of America , Suite 400, 10300 Eaton Place, Fairfax, VA
22030; call 703-691-8100. Visit their website at http://www.alfa.org.
The American Health
Care Association ,1201 L Street, N.W., Washington D.C. 20005; call
The National Citizens'
Coalition for Nursing Home Reform's 1publications list is available
from Suite 202, 1424 16th Street, N.W., Washington, D.C. 20036-2211; call
Education and Referral (ADEAR) Center
P.O. Box 8250
Silver Spring, MD 20907-8250