Many people do not know about or understand all the long-term care options that are available. The
following are brief descriptions of the major types of long-term care, the kinds of service you may
need, the ways of paying for long-term care and how to find the best services and facilities:

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. 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 programs can help people who are cared for at
home by 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's 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").

Intermediate Care Facilities for the Mentally Retarded: This is another type of long-term care for
the mentally retarded that takes place in home-like settings. 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.

Learn More: 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,1-800-677-1116,
    weekdays, 9.00 a.m. to 8.00 p.m. 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 Web Site" http://www.medicare.gov/Nursing/Overview.asp - a Web
    site created by the Health Care Financing Administration, 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.

What Kind of Services Do I Need?
The first question to ask yourself when trying to decide what type of services are needed for you or
for your loved ones is "what kind of services do I need?". 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.

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 (as recommended by a doctor or other health care provider)

[_] 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 _______________________


How Will I Pay for these Services?
The second question to ask yourself is "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. If you need long-term care now, it is probably too late to be purchasing
    long-term care insurance. In eight out of 10 couples aged 65 and older, at least one spouse
    will enter a nursing home (HIAA, "A Guide to Long-Term Care Insurance", 2002). So, if it is not
    too late, you should be seriously considering long-term care insurance. Insurance companies
    are becoming more and more aware of the growing need for long-term care. Most insurance
    companies today offer long-term care insurance policies. 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.
  •     Other Resources to Find Help. 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 1-800-638-6833. Or, look at the consumer Web site for
    Medicare services, http://www.medicare.gov.





















How Can I Choose the Best Quality Services and Facilities?
The third question to ask yourself is " How do I find and choose the Best Quality Services and
Facilities?" 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 1-800-638-6833 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 (1-800-669-9656; 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 the voluntary process and to learn the results.
Nursing
Help with
daily
activities
Help with
health care
needs
Relative Cost
Home Care
X
X
Low to high
Community Services
X
  Low to Medium
Supportive Housing
Programs
X
 
Low to Medium
Assisted Living
X
 
Medium to High
CCRC*
X
X
High
Nursing Homes
X
X
High
Relative Cost Comparison
Continuing Care Retirement Communities
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Understanding Long Term Care
Introduction to Long-Term Care | Long-Term Care Worksheet | Long-Term Care
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