Understanding Long Term Care
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:
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.
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."
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.
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.
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.
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
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.
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. If you can not access the link above, call Medicare Hotline at 1-800-638-6833 to obtain the information you need.
- 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
and other housework
bills and other money matters
to the bathroom
to take medicines
Health Care Needs
(as recommended by a doctor or other health care provider)
for pressure ulcers or other wounds
monitoring (for diabetes, for example)
medical services provided by a doctor or other clinician
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 (America's Health Insurance Plans (AHIP), "A Guide to
Long-Term Care Insurance", 2004). 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
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.
|Relative Costs Comparison
||Help with daily activities
||Help with health
|Low to High
||Low to Medium
|Supportive Housing Programs
||Low to Medium
||Medium to High
|Continuing Care Retirement Communities
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.
Nursing 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
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?
- 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.
If you can not access the link above, call Medicare Hotline at 1-800-638-6833 to obtain the information you need.
- 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.
Texas Insurance services Inc.
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