Long-Term Care:
Choosing the Right Place
Many of us hope to stay in our homes as we grow older. Often we
are able to do that. But later in life—usually by our 80s and
90s—some of us need a hand with everyday activities like
shopping, cooking, or bathing. A few of us need more help on a
regular basis. Maybe that means it’s time to move to a place
where expert care is available around-the-clock.
Where to start Do you think that your family
member can’t live at home any longer? It might be your husband
or wife, a parent, aunt or uncle, or even a grandparent. You’ve
added a hand rail on the front steps and grab bars in the
bathroom. You made plans for a home health aide to come to the
house every day. You arranged for help with meals, and you visit
every day. But now you wonder if staying at home is the best
choice. Where do you go for help? Here are some answers to that
and other questions that you might have as you look for the best
place for you or your relative to live.
Sometimes the need for help grows over time. For example, Bob is
87 years old. He has lived alone since his wife died ten years
ago. For the last few years, he has needed more and more help
doing things for himself. First, he had trouble making meals.
So, he ate a big lunch at the local senior center until last
year when he gave up driving. Now sometimes his daughter drops
off meals. Other times meals are delivered by a local program.
The stairs in his house are getting too hard to climb. Bob also
forgets more and more things. He often forgets to take his blood
pressure medicine. He has also left the burner on the stove
turned on several times. He doesn’t want to move in with his
daughter and her family, so Bob and his daughter are looking for
a new place for him to live.
Over the last year Bob’s
daughter has been thinking this time might come. She knows
what’s available. She’s looked into how they will pay for the
care her dad needs. Bob too has been doing some planning. He is
sad about leaving his home, but he has been preparing for the
time when he’d need more help. He even put his name on a waiting
list for a nearby retirement community that he liked. Now they
have an opening there. The admission coordinator at the
community will help him decide if he can live in one of their
apartments or needs to be in their assisted living facility.
Bob and his daughter were lucky. Sometimes you need to make a
choice quickly. If you haven’t planned ahead, then making a
decision might not be so easy. For example, Alice and her
husband have lived in their house for 50 years. At 84, she still
loves to cook and work in her garden every day. Last week she
slipped in her bathroom, fell, and broke her hip. Now after an
operation to fix her hip, she needs to go somewhere for nursing
care and rehabilitation. Her doctors don’t know if she’ll ever
recover enough to go home again. Her children live hundreds of
miles away. But her husband and family only have a few days to
find a place. Alice and her family were not prepared like
Bob and his family. The social worker and discharge planner at
the hospital will help them find a place for Alice to go for
therapy after she leaves the hospital. But if she is too frail
to go home after her hip heals, she and her family will have to
choose a place for her to live permanently. What
the choices are There are two kinds of senior
living facilities based on how much help is needed: -
Assisted living facilities
- Skilled nursing
facilities or nursing homes.
You should think
about an assisted living facility if you or your
relative don’t need a lot of medical care but do need more help
than can easily be gotten at home. Assisted living homes can
give someone as much help as needed with daily living, but offer
only some nursing care or none at all. People often live
independently in their own unit. The place provides meals and
house cleaning, offers interesting things to do, and takes
residents wherever they need to go, like the doctor or the
shopping mall. They can also provide help with bathing,
dressing, and taking medicines, if needed. Some assisted
living facilities are part of a continuing care retirement
community or lifecare community. These communities
offer independent living and skilled nursing facilities as well
as assisted living. Sometimes assisted living help is set up in
a home with only a few residents. These are often called
board and care homes. If your relative becomes very
frail or suffers from the later stages of dementia, more care
could be needed. A nursing home or skilled nursing
facility may be necessary if someone: - needs
round-the-clock nursing care,
- might wander away
without supervision,
- needs help with meals,
bathing, personal care, medications, and moving around,
-
needs more help than the current caregiver can possibly
give, or cannot live alone.
These places supply
24-hour services and supervision, including medical care and
some physical, speech, and occupational therapy, to people
living there. They might also offer other services such as
social activities and transportation. As a rule, the rooms are
for one or two people. Some places want residents to bring some
special items from home to make their rooms more familiar. Some
even allow a pet or make it possible for couples to stay
together. Both assisted living and skilled nursing
facilities sometimes offer special areas for people with
dementia. These areas are designed to meet the special needs of
these people and to keep them safe from wandering.
How to choose
**Please see our
Needs Assessments and Information For Nursing Home Placement or
other Specialty Care
page . A Needs Assessment Survey
will assist you in your search and prepare you to answer the
many questions that will be posed by a facility's staff. We can
also refer you to many trusted providers across the state.
Ask questions. Find out about what is available in your
area. Is there any place close enough for family and friends to
visit easily? Doctors, friends and relatives, local hospital
discharge planners and social workers, and religious
organizations may know of places. Also, each state has a
Long-Term Care Ombudsman. They have information and may be
able to answer questions about a place you are considering. The
ombudsman is also available to help solve problems that might
come up between a nursing home and the resident or the family.
To find your state long-term care ombudsman, contact the
Administration on Aging’s Eldercare Locator at
1-800-677-1116 or
www.eldercare.gov. Is the person in need of long-term
care a military veteran? They might be able to get help through
the Department of Veterans Affairs programs. You can check by
going to www.va.gov, calling the
VA Health Care Benefits number, 1-877-222-8387, or contacting
the VA medical center nearest you. Call.
Once you have a list of possible places, get in touch with each
one. Ask basic questions about openings and waiting lists,
number of residents, costs and methods of payment, and their
link to Medicare and Medicaid. Take a few minutes to think about
what’s important to you or your relative, such as
transportation, meals, activities, connection to a certain
religion, or special units for Alzheimer’s disease.
Visit. Make plans to meet with the director of nursing
and director of social services. Medicare offers a nursing home
checklist to use when visiting (see Help in Planning).
Some of the things to look for include certification for
Medicare and Medicaid, handicap access, no strong odors (either
bad or good ones), contact between staff and current residents,
volunteers, and the appearance of residents. If the nursing home
is a member of the Joint Committee on Accreditation of
Healthcare Organizations, ask to see that group’s review of the
home. Ask yourself if you would feel reassured leaving your
loved one there. Visit again. Make a
second visit without an appointment, maybe on another day of the
week or time of day, so you will meet other staff members. See
if your first thoughts are still the same.
Understand. Once you or your relative have made a
choice, be sure to understand the facility’s contract and
payment plan. If you don’t understand it, you could have a
lawyer look them over before signing. How to pay
There are several ways to pay for nursing facility care for
people over age 65. They are: - Medicare
-
Private pay
- Medicaid
- Long-term care
insurance.
**Elder Law attorneys are
very helpful when it comes to structuring a plan to pay for
nursing facility care or any other type of specialty care. Go to
our South Carolina
Elder Law Section
and we can help you find someone to make this planning easy for
you from a number of trusted providers around the state.
Let’s see what happened after Alice left the hospital. She went
directly to a skilled nursing facility. It had a rehabilitation
unit where she began to receive physical therapy. Medicare
covered most of her costs for the first few weeks as she got
better. Then she had a stroke which left her unable to move her
left arm and leg. While she was in the hospital for the stroke,
her doctors decided Alice should probably not return home. She
no longer qualified for Medicare to pay for her nursing home
care. - Many people believe that Medicare will pay for
long stays in a nursing home, but
it doesn’t. The Federal
Medicare program and private “Medigap” (Medicare
supplemental) insurance only cover short times of home
health or nursing home care. They pay for a short stay in a
nursing home for someone who is getting better after leaving
the hospital, but still needs nursing care and therapy.
Alice’s husband started to pay for her care on his own, but they
didn’t have a lot of savings. When they had used most of their
savings, her husband arranged for her to apply for Medicaid.
The good news about Medicaid is that her husband did not have to
sell their home for her to qualify for this support. -
Many people start paying for long-term care with their own
money (private pay). Later they may become eligible for
state-run Medicaid. Each state decides who qualifies for
this program. Contact your state government to learn more.
Keep in mind that applying for Medicaid takes at least 3
months.
Alice’s children are now looking into
buying long-term care insurance for themselves. They don’t want
to have the same worries if they need nursing care when they are
older. - Long-term care insurance is a private
insurance policy you can buy years before you think you
might need it. Each policy is different. Your state’s
insurance commission can tell you more about private
long-term care policies. They can also offer tips on how to
buy long-term care insurance. These agencies are listed in
your telephone book, under “Government.”
Help in planning Planning for long-term care is
not easy. People’s needs change over time. So do the rules about
programs and benefits. What someone qualifies for may change
from one year to the next. There is some help. The following
resources are online. If you or your relative don’t have a
computer, there may be one at your local library or senior
center. Care Planner from Medicare is online at
www.careplanner.org. It has details about different care
options. You can answer questions online about needs and
resources to get a list of suggested services, as well as
helpful resources. Medicare has two resources on its
website, www.medicare.gov,
which may be useful. First, Nursing Home Compare helps
you learn more about nursing homes you may be interested in.
They also have a Nursing Home Checklist with tips to use when
visiting homes. Second, many states have State Health
Insurance Counseling and Assistance Programs (SHIPS).
These programs can help you choose the health care plan that is
right for you and your family. Making a smooth
transition Moving to a care facility can be a big
change for 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 can make this move easier.
This reassures and comforts the person getting used to a new
place. Visits are good, too, for keeping an eye on the care that
is being given. They also help family to develop a good
relationship with the staff caring for their loved one.
Other Resources Other sources of information on
long-term care and other issues of interest to older people
include: FirstGov for Seniors
www.seniors.gov American Association of Homes
and Services for the Aging
2519 Connecticut Avenue,
NW
Washington, DC 20008
202-783-2242
www.aahsa.org Assisted Living Federation of
America
11200 Waples Mill Road, Suite 150
Fairfax, VA 22030
703-691-8900
www.alfa.org | 
