Choosing a Long-Term Care Facility for Older Adults

Although it may be preferable for older adults to end up in an assisted care facility or retirement home, many people over age 65 end up in long-term care facilities. This is typically due to a medical condition or care needs outside their control.

Long-term care facilities are for older adults who require 24-hour monitoring, personal assistance, or nursing care because of a physical or mental condition.

Choosing a long-term care facility for a loved one can be difficult. Family members and caregivers can follow these steps to make the process easier.

Long-Term Care Services: Types of Care

Long-term care takes many forms. It can occur at home, in an assisted living facility, in special retirement communities, senior centers, or nursing homes.

Keep in mind that hospice care is considered short-term care. Older adults enter hospice care if they are predicted to live for six months or less. Long-term care options span six months or longer.

Long-term care also generally falls into two categories:

• Medically necessary care
• Custodial care

It's important to know the difference between medically necessary care and custodial care within long-term elder care. Medically necessary care refers to treatments and services deemed essential for a person's medical condition. These services often require skilled medical professionals. On the other hand, custodial care involves assistance with daily living activities and does not necessarily require medical expertise.

Medicare covers medically necessary care, but custodial care is not covered. The two different categories greatly impact the next step: financing the cost of long-term care.

Establish the Level of Care Required

Make a checklist of all the things you expect an older adult will need help with. Consider consulting with the older adult's healthcare team or a senior healthcare professional for help determining this. It can be emotional to try and figure this out on your own for a loved one. Non-biased opinions can be valuable.

Here are some potential items, often called activities of daily living, that most older adults may need help with:

• Eating or remembering mealtimes
• Preparing meals or following specific diets
• Dressing
• Laundry
• Bathing
• Getting in and out of bed
• Using the bathroom
• Remembering to take medicine
• Remembering medical care or physical therapy appointments
• Shopping
• Paying important bills
• Transportation
• Housework (cleaning, repairs, etc.)
• Memory care for Alzheimer's disease or dementia

This is only a partial list to cover basic well-being. You should list all the everyday items where your loved one may require assistance.

Evaluate the Financial Situation

Ultimately, the choices may be limited by how much money there is to finance long-term care. People are often shocked at the high cost of long-term health care, so make sure to plan well in advance if you can.

Quality of care is important, as well as staffing, the quality of residents' rooms, and skilled nursing care. The quality level and type of facility you choose can vary in cost.

Ways To Pay For Long-Term Care

Luckily, there are many ways to pay for long-term care. Here are examples of how people fund long-term healthcare:

• Personal Savings: This can be extremely helpful in financing long-term care but is only an option for some.
• Long-term Care Insurance: This can be effective, but health insurance coverage varies widely. Be sure to read the policy's coverage carefully. Some plans only include nursing home care. Others may include medical equipment, in-home special needs care, or in-home nursing assistants.
• Medicare: Will only pay for certain skilled nursing care or home health care if you meet certain conditions. Otherwise, Medicare does not pay for daily living care.
• Medicaid: Varies from state to state, and the human services Medicaid covers also vary greatly. In general, eligibility is based on income and resources. Help is often offered only to those with low incomes and limited resources.
• Programs of All-inclusive Care for the Elderly (PACE): A benefits program designed to offer in-home care integrated with Medicare and Medicaid, PACE is only available in some states. Check to see if your state has PACE.
• Social Security: Many long-term care facilities can be paid for, in part, by using Social Security benefits.
• Veterans Benefits: The Department of Veterans Affairs (VA) may offer long-term care for eligible veterans. If you are a veteran, definitely explore this option.
• Accelerated Death Benefits: This can be added to a life insurance policy and can provide cash advances against death benefits while the policyholder is still alive.
• Reverse Mortgages: A reverse mortgage allows a homeowner to convert a portion of the equity in their house into cash. The Department of Housing and Urban Development insures certain reverse mortgages.

Research Your Long-Term Care Facility Options

There are as many types of long-term care facilities as there are types of patients in need. You should research the different types of care provided in your area.

Here are some of the most common forms of long-term care:

• Home Care: Keep in mind that family, friends, volunteers, and professionals can provide an older person with various services in their own home. Typically, this help is limited to older adults who only need help with shopping, transportation, and more mundane day-to-day activities.
• Community Services: Most communities provide care like meal programs, adult daycare centers, and transportation services. These services can augment other services you may use and help keep costs down.
• Assisted Living Facilities: These facilities provide 24-hour assistance and health care in a home-like setting. They help with everything from bathing to eating to dressing to taking medicine.
• Continuing Care Retirement Communities (CCRCs): CCRCs provide a full range of services and base the services on what each resident needs over time. CCRCs generally break their care plans into three stages depending on the resident's level of need. The stages, from less assistance to more assistance, are: independent living, assisted living, and skilled nursing. These are often the most expensive options for long-term health care.
• Nursing Homes: Nursing homes provide care to people who cannot be cared for at home or in a community setting. They provide skilled nursing and rehabilitation services, meals, and help with activities of daily living.

Types of Nursing Home Care Providers

There are several nursing homes for the care your loved one needs. You can choose the right facility for the older adult's particular needs:

• Skilled Nursing Facilities: These nursing homes provide 24-hour nursing and monitoring. They should only be used when necessary due to the expense.
• Intermediate Care Facilities: These nursing homes are designed for intermediate-term health care for residents with chronic illnesses. They don't require the 24-hour attention that may necessitate a skilled nursing facility.
• Custodial Care Facilities: These nursing homes are built more for true long-term care. It is for patients who don't need 24-hour care and aren't suffering from debilitating chronic illnesses. They tend to offer social, educational, and physical activities as part of the overall care.

Once you've decided on the kind of long-term care you need, ask for advice and referrals, preferably from people who have dealt with the institutions in question.

Good sources of information include your friends and family, your doctor, your church, government agencies (Medicare, Health Departments, etc.), and national organizations such as the AARP and the National Association for Area Agencies on Aging.

Visit Your Best Options

Finally, nothing beats an in-person inspection. Review your checklist of expected needs before you visit potential facilities. Write down any questions that you can think of.

Don't just follow staff around, as they are essentially salespeople. You should ask about anything you don't understand, but don't be afraid to speak with willing residents.

Questions To Ask Healthcare Facility Staff

Below are some questions to get you started. It's certainly not an exhaustive list, but it should point you in the right direction:

• Who responds to emergency calls, and how long does it take?
• Are there any physicians on staff or on-call?
• What is the ratio of staff to residents?
• How does visitation work, can only family visit or anyone?
• Are staff members trained in first aid and CPR?
• What is the cost, and are there extra charges for specific services?
• Is the facility covered by Medicare or Medicaid?
• Does the facility have liability and/or malpractice insurance?

Questions to Ask Yourself About Long-Term Care Facilities

As you tour or visit any long-term care facility, ask yourself these important questions afterward:

• Did I feel comfortable there?
• Did they listen to me?
• Did I get answers to my questions?
• Did I understand their explanations?
• Was the facility clean and professional?
• Did the staff seem professional?
• Does the facility meet my requirements?

If you have legal concerns about long-term care planning or other older adult legal issues, speak with an elder law attorney for legal advice. An elder law attorney can help assist with issues ranging from special needs planning and Medicaid planning to estate planning and power of attorney issues.