Choosing Long-Term Care
Contents
"Long-term care" means helping people of any
age with their medical needs or daily activities over a long
period of time. Long-term care can be provided at home, in the
community, or in various types of facilities. This section
deals mainly with older people who need long-term care.
However, the information also may be useful for younger people
with disabilities or illnesses that require long-term care.
When you look for long-term care, it is
important to remember that quality varies from one place or
caregiver to another.
It is also important to think about
long-term care before a crisis occurs. Making long-term care
decisions can be hard even when planned well in advance.
Quick Check for Quality
Look for long-term care that:
●
Has been found by State agencies,
accreditors, or others to provide quality care.
●
Has the services you need.
●
Has staff that meet your needs.
●
Meets your budget.
Research shows that to make the best
choices, you need to think about:
●
What your options are.
●
Whether they meet your or your family
member's needs (physical, medical, emotional, financial,
etc.).
●
How to find the highest quality care.
Types of Long-Term Care
Research shows that many people do not know
about or understand long-term care options. Following are
brief descriptions of the major types of long-term care:
Home care can
be given in your own home by family members, friends,
volunteers, and/or paid professionals. This type of care can
range from help with shopping to nursing care. Some
short-term, skilled home care (provided by a nurse or
therapist) is covered by Medicare and is called "home health
care." Another type of care that can be given at home is
hospice care for terminally ill people.
Community services
are support services that can include adult day care, meal
programs, senior centers, transportation, and other services.
These can help people who are cared for at home-and their
families. For example, adult day care services provide a
variety of health, social, and related support services in a
protective setting during the day. This can help adults with
impairments—such as Alzheimer's disease—continue to live in
the community. And it can give family or friend caregivers a
needed "break."
Supportive housing programs offer low-cost housing to older people with low to moderate
incomes. The Federal Department of Housing and Urban
Development (HUD) and State or local governments often develop
such housing programs. A number of these facilities offer help
with meals and tasks such as housekeeping, shopping, and
laundry. Residents generally live in their own apartments.
Assisted living
provides 24-hour supervision, assistance, meals, and health
care services in a home-like setting. Services include help
with eating, bathing, dressing, toileting, taking medicine,
transportation, laundry, and housekeeping. Social and
recreational activities also are provided.
Continuing care retirement communities
(CCRCs) provide a full range of services and care based on
what each resident needs over time. Care usually is provided
in one of three main stages: independent living, assisted
living, and skilled nursing.
Nursing homes
offer care to people who cannot be cared for at home or in the
community. They provide skilled nursing care, rehabilitation
services, meals, activities, help with daily living, and
supervision. Many nursing homes also offer temporary or
periodic care. This can be instead of hospital care, after
hospital care, or to give family or friend caregivers some
time off ("respite care").
Another type of long-term care takes place
in home-like settings called Intermediate Care Facilities for
the Mentally Retarded. They provide a wide variety of services
to mentally retarded and developmentally disabled people from
youth to old age. Services include treatment to help residents
become as independent as possible, as well as health care
services.
You can learn about long-term care options
in your area by contacting:
●
The Eldercare Locator (1-800-677-1116,
weekdays, 9.00 a.m. to 8.00 p.m., EST). This service can
refer you
●
to your Area Agency on Aging.
●
Area Agencies on Aging provide
information on a wide variety of community-based services.
Examples are
●
meals, home care, adult day care,
transportation, housing, home repair, and legal services.
●
Your State or local Long-Term Care
Ombudsman (call the Eldercare Locator for the number).
Ombudsmen
●
visit nursing homes and other long-term care
facilities to check on and resolve complaints, protect
residents'
●
rights, and give emotional support to lonely
older people. A call to your area Ombudsman can give you
●
information on: the most recent State survey (inspection)
report of the facility; the number of outstanding
●
complaints; the number and nature of complaints lodged in
the last year; and the results of recent complaint
●
investigations.
●
"Nursing Home Compare"
http://www.medicare.gov/nhcompare/home.asp—a Web
site created by the
●
Centers for Medicare & Medicaid
Services -
http://cms.hhs.gov, which runs Medicare and Medicaid. This
site
●
helps you locate nursing homes in your area. It also
has inspection records for nursing homes that receive
●
Medicare or Medicaid funds.
●
Hospital discharge planners.
●
Social workers (some can be "case
managers" or "care managers," who can help you coordinate
long-term
●
care services).
●
Doctors and other health care
professionals.
●
Local nursing facilities.
●
Volunteer groups that work with older
people.
●
Clergy or religious groups.
●
Family and friends.
There are three important questions to
ask yourself when deciding about long-term care for yourself
or a loved one:
1. What kind of services do I need?
2. How will I pay for these services?
3. How can I choose the best quality
services?
Back to Contents
What Kind of Services Do
I Need?
Think of long-term care as a menu of
services. A person may need only one or a few kinds of
services. Or, several kinds may be needed over the course of a
person's older years.
To help find out what kind of services you
or a loved one need, check the items below that apply. Keep in
mind that these needs may change over time.
Do you or your loved one need help with
daily activities? Health care needs? Both? You can use the
following chart to help you identify the type(s) of long-term
care that meet your needs. This chart shows which types of
long-term care services offer which kinds of help. The
"Relative Costs" information shows how costly the settings can
be when compared with each other.
Help With Daily Activities
[_] Shopping
[_] Preparing meals
[_] Eating
[_] Laundry and other housework
[_] Home maintenance
[_] Paying bills and other money matters
[_] Bathing
[_] Dressing
[_] Grooming
[_] Going to the bathroom
[_] Remembering to take medicines
[_] Walking
[_] Other _______________________
[_] Other _______________________
Health Care Needs*
[_] Physical therapy
[_] Speech therapy
[_] Occupational therapy
[_] Rehabilitation
[_] Medical nutritional therapy
[_] Oxygen
[_] Care for pressure ulcers or other wounds
[_] Alzheimer's disease care
[_] Health monitoring (for diabetes, for example)
[_] Pain management
[_] Nursing care services
[_] Other medical services provided
by a doctor or other clinician
[_] Other _______________________
* as
recommended by a doctor or other health care provider.
Relative Costs Comparison
|
|
Home
Care |
Community Services |
Supportive Housing Programs |
Assisted Living |
CCRC* |
Nursing
Homes |
|
|
|
|
|
|
|
|
Help with daily activities |
X |
X |
X |
X |
X |
X |
|
|
|
|
|
|
|
|
|
Help with health care needs |
X |
|
|
|
X |
X |
|
|
|
|
|
|
|
|
Relative Costs |
Low to
High |
Low to
Medium |
Low to
Medium |
Medium
to High |
High |
High |
* Continuing Care Retirement Communities
Select for Text Version -
http://www.ahcpr.gov/consumer/qnt/qntltctx.htm
Back to Contents
How Will I Pay for these
Services?
Long-term care can be very expensive. In
general, health plans and programs do not routinely cover
long-term care at home or in nursing homes. Here is some
general information about long-term care coverage:
●
Medicare is
the Federal health insurance program for people age 65 and
older and for some disabled younger
●
people. Medicare
generally does not pay for long-term help with daily
activities. Medicare pays for very limited
●
skilled nursing
home care after a hospital stay. If you need skilled care in
your home for the treatment of an
●
illness or injury, and you
meet certain conditions, Medicare will pay for some of the
costs of nursing care,
●
home health aide services, and
different types of therapy.
●
Medicaid is
a Federal-State program that pays for health services and
long-term care for low- income people
●
of any age. The exact
rules for who is covered vary by State. Medicaid covers
nursing home care for people
●
who are eligible. In some
States, Medicaid also pays for some home and community
services.
●
Private Insurance.
Medicare beneficiaries may supplement their policy with
insurance purchased from private
●
organizations. Most of
these policies—often called Medigap insurance or by a
similar name—will help pay for
●
some skilled care, but only
when that care is covered by Medicare. Medigap is not
long-term care insurance. ●
Commercial insurers offer private
policies called long-term care insurance. These policies may
cover services
●
such as care at home, in adult day care, in
assisted living facilities, and in nursing homes. But plans
vary
●
widely. If you have such a policy, ask your insurer
what it covers. If you think you may need long-term care
●
insurance, start shopping while you are relatively young and
healthy, and shop carefully.
●
Personal Resources.
You may need to use resources such as savings or life
insurance to pay for long-term
●
care. Most people who enter
nursing homes begin by paying out of their own pockets. As
their personal
●
resources are spent, many people who stay in
nursing homes for a long time eventually become eligible for
●
Medicaid.
●
Your State Health Insurance Program (SHIP)
can give you general information about Medicare, Medicaid,
●
managed care plans, and the types of health insurance that can
supplement Medicare, including Medigap and
●
long-term care
insurance. Counselors also can help you with questions about
your medical bills, insurance
●
claims, and related matters.
These services are free. To find the phone number of the SHIP
office in your
●
State, call the Medicare Hotline at
1-800-633-4227. Or, look at the consumer Web site for Medicare
services,
●
http://www.medicare.gov.
Back to Contents
How Can I Choose the Best
Quality Services?
Here are some tips for choosing the kinds of
long-term care people most often use: home care (including
home health care) and nursing homes.
Home Care
●
In many States, home care agencies must
be licensed. Check with your State health department to
●
see
if your State requires it. If so, be wary if an agency is
not licensed.
●
Ask if the agency is certified by
Medicare. Medicare inspects home health care agencies to
assure
●
they meet certain Federal health and safety
requirements. Medicare will pay for services only if the
●
agency is Medicare-approved and if the services are covered
by Medicare.
●
If the home health care agency is
certified by Medicare, you can review its survey report.
Call the
●
Medicare Hotline at 1-800-633-4227 and ask to be
referred to the Home Health Hotline for your State.
●
You can
request a copy of the report from that hotline.
●
Find out if the agency has been
accredited (awarded a "seal of approval") by a group such as
the Joint
●
Commission on Accreditation of Healthcare
Organizations (630-792-5800);
http://www.jcaho.org) or
the
●
Community Health Accreditation Program (1-800-669-1656;
http://www.chapinc.org).
●
Contact your State or local consumer
affairs office to see if any complaints have been filed
against a
●
home care agency. Also ask about the outcome of
any complaint investigations.
●
Whether you work with an agency or hire
someone yourself, carefully check the backgrounds of the
●
people who will be coming into your home. Ask for references
who have worked with the agency or
●
person. Call them, and
ask about their experiences. Would they use the agency or
person again?
●
Does the home care worker have the
necessary skills and training for your needs? Ask to see
training
●
certificates. Make sure the worker knows how to
safely assist and care for patients.
●
Does the agency have supervisors who
check on the quality of care its workers provide?
●
How does the agency follow up on and
resolve complaints?
Nursing Home Care
●
All nursing homes that participate in
Medicare or Medicaid are visited about once a year by a team
of
●
trained inspectors. They check the home and the care
provided and prepare a survey report. You have
●
a right to
review the report, which must be posted in the nursing home.
Speak to the nursing home
●
administrator to learn more about
any problems that appear on the report. Ask if the problems
have
●
been corrected.
●
Call your State or local Long-Term Care
Ombudsman. Ombudsmen visit nursing homes on a regular
●
basis
and know about each nursing home in their area. You can ask
about the latest survey report and
●
about complaints that
have been filed. You can also ask what to look for when
visiting local nursing
●
homes.
●
Compare the inspection records of your
top choices by visiting the "Nursing Home Compare" Web site:
●
http://www.medicare.gov/NHCompare/Home.asp.
●
Some nursing homes have been accredited
by a national group such as the Joint Commission on
●
Accreditation of Healthcare Organizations (630-792-5800). It
may be helpful to find out if the home
●
participates in this
voluntary process and to learn the results.
●
Location is very important. Is the
nursing home close enough so that family and friends can
visit?
●
Close enough for the resident's personal doctor to
visit?
●
The most important step is to visit—more
than once—and look around. Go at different times of the
●
day—for example, first thing in the morning and at
mealtimes.
●
Do residents seem to enjoy meals? Is
there help for those who cannot eat on their own? If
possible,
●
eat a meal at the facility.
●
Is the home clean and free of odors? Is
it pleasant?
●
Are residents clean, well groomed, and
dressed appropriately for the season and time of day? Are
they
●
involved in activities?
●
Are staff friendly, helpful, and
respectful?
●
Talk to staff, residents, and families to
find out what they think of the facility.
●
Ask to see the area where physical
therapy and other rehabilitation services are provided.
●
Is the nursing home experienced with
special needs-for example, problems with swallowing?
●
Who provides the medical care?
●
Which hospital(s) does the nursing home
use?
Back to Contents
Sources of Additional
Information
A Guide to Choosing a Nursing Home
Has sections on gathering information, visiting nursing homes,
and residents' rights and quality of life. Includes phone
lists for State ombudsmen, State survey agencies, and
insurance counseling. 47 pages. Free.
Medicare: 1-800-633-4227
Web site:
http://www.medicare.gov/Publications/search/view/viewPubList.asp?Language=English
Resource Directory for Older People
The Administration on Aging and National Institute on Aging
offers lists of hundreds of organizations, names, and phone
numbers, including State agencies on aging and State long-term
care ombudsmen programs. Not available in print.
Web site:
http://www.aoa.gov/aoa/default.htm
American Association of Homes and
Services for the Aging
Offers a series of pamphlets on nursing homes, assisted
living, continuing care retirement communities, community
services, housing options for older people, and understanding
Medicare managed care. Free.
Telephone: 1-800-675-9253
Web site:
http://www.aahsa.org
How to Choose a Home Care Provider
Explains who provides what kind of care, the various services
offered, who pays for services. Has billing and payment
information. Lists patients' rights, accrediting agencies, and
State resources and information. Free.
National Association for Home Care
Telephone: (202) 547-7424
Web site:
http://www.nahc.org
Myths and Realities of Living in a
Nursing Home, How to Pay for Nursing Home Care, What Consumers
Need to Know About Private Long-Term Care,
and Circle of Care.
A series of six pamphlets on selecting and paying for
long-term care. Free. For more than one copy: 1-800-321-0343
(packets of 25).
The American Health Care Association
1201 L St., NW
Washington, DC 20005-4014
(202) 842-4444
Web site:
http://www.ahca.org/info/informat.htm
Nursing Home Life: A Guide for Residents
and Families
Includes first-hand accounts from residents and family
members. Topics include adjusting to nursing home life;
services and staff; getting what you need; and dealing with
poor care. Has useful appendices and resource lists. 44 pages.
Free.
The American Association of Retired
Persons
601 E. St., N.W.
Washington, DC 20049
1-800-424-3410
Web site:
http://www.aarp.org
Choosing a Nursing Home and All About
Home Health
Available online from Health Pages.
Web sites:
http://www.thehealthpages.com/articles/ar-nrshm.html
http://www.thehealthpages.com/articles/ar-homeh.html
healthfinder®
Provides a gateway to reliable consumer health information
from the Federal Government and other organizations.
Web site:
http://www.healthfinder.gov
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