Long-Term Care Options

As the American population grows older, the need for long-term care continues to increase. The Department of Health and Human Services has estimated that 70 percent of people 65 and older will need some form of long-term care services during their lifetimes. In addition, more than 40 percent of people 65 and older will need care in nursing homes sometime during their lifetimes, and about 10 percent will stay there five years or longer.

When hearing the term “long-term care,” many of us automatically think of nursing homes, which are extremely expensive and offer 24-hour care. However, there are many different types of long-term care available. In fact, 40 percent of those receiving long-term care are younger than 64, and most are receiving care in their own homes. Understanding your long-term care options is the first step in creating a long-term care plan for you and your loved ones.

Continuing care retirement communities (CCRCs) are retirement communities that offer more than one kind of housing and different levels of care. In the same community, there could be individual homes or apartments for people who still live on their own, an assisted-living facility for people who need some help with daily care, and a nursing home for those who require higher levels of care. Residents might move from one level of care to another based on their needs, but they usually stay within the CCRC.

A CCRC contract usually requires residents to use the CCRC’s nursing home if they need nursing-home care. Some CCRCs will only admit people into their nursing home if they’ve previously lived in another section of the retirement community, like an assisted-living or an independent area. Many CCRCs generally require a large payment before you move in (called an “entry fee”) in addition to charging monthly fees. If you’re considering a CCRC, you can go to www.medicare.gov/nursinghomecompare to check the quality of a nursing home.

The Program of All-inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that helps people meet their health care needs in the community, instead of going to a nursing home or other care facility. PACE covers: adult day primary care, dentistry, emergency services, home care, hospital care, laboratory/X-ray services, meals, medical specialty services, nursing-home care, nutritional counseling, occupational therapy, physical therapy, prescription drugs, Part D-covered drugs, preventive care, social services, caregiver training, support groups, respite care, social-work counseling, and transportation if medically necessary.

Residential care facilities include group homes and personal care homes, as well as assisted-living communities. These facilities are group living arrangements that provide assistance with some daily living activities. Please note that not all assisted-living facilities provide the same services. Residents often live in apartments within a building or group of buildings. Meals and social and recreational activities are usually provided, and some facilities provide health services on their campuses. In most cases, board-and-care home and assisted-living residents pay a regular monthly rent and additional fees for the services they receive. Medicare does not pay for assisted-living facilities.

For those who would prefer to stay in their homes, there are a variety of community services that help with personal activities. Services vary in cost, depending on geographic location and services required (some services might be offered by volunteer groups at little or no cost). Some home services and programs that might be available include:

• Adult day care
• Meal programs (like Meals on Wheels)
• Visitor programs
• Shopping and transportation assistance
• Senior centers
• Assistance with paying bills, taxes,and answering legal questions

In addition to community services available to those staying in their homes, there are also some home health-care agencies that can help with daily activities, such as bathing, dressing, and taking medication. Home health-care agencies may also
provide other services, like physical and occupational therapy.

An “in-law suite” (a semi-private space attached to a family member’s house) could help some people needing long-term care to keep their independence. An in-law suite has a separate living and sleeping area, kitchen, and bathroom from the main home.  This allows a level of independence while providing convenient access to the loved ones assisting with long-term care needs.

Before selecting a long-term care facility, you must first understand what level of care different facilities provide and what services are available. Once you have an understanding of the types of long-term care available, you can then evaluate the
level of care you or your loved one would require. Once you’ve determined what level of care is needed and which facilities could adequately provide the required care, the next step is to determine how to pay for long-term care. We will address this topic in next quarter’s Advisor newsletter.