Planning for Long Term Care

Planning now for long term care will help you make decisions later in life. Here's a look at your options and how to share your wishes with your loved ones.

If you're considering long term care options for yourself, your parents, or a loved one, start the discussions early. If you wait until you're injured or sick, you might find yourself under pressure to make a hasty decision that everyone may later regret.

Get to know your long term care options now and start the discussions with your family.

Types of long term care

Long term care ranges from some scheduled help around the house to 24-hour care in a nursing home. The purpose of long term care is to help you maintain as much independence as possible without compromising safety. A long term care facility or home health care aide can help with the weekly shopping or bathing and dressing that you may be unable to do as well as you used to. In addition, knowing that someone's there to help can relieve stress.

Several levels of long term care exist. When choosing long term care, get to know what to expect from each level of care. This will help you pick the type of long term care that's most appropriate.

  • Home care. Home care includes medical care — usually nurses who come to your home if you can't go out. But this category of long-term care can also include help around the home. Home health aides or personal care service workers can visit daily or as needed to help you bathe and get dressed. They can also assist with housekeeping, meals and shopping.
  • Adult care. Adult care programs are a type of long term care that offers social interaction and meals from one to five days a week, depending on the program. Some adult care programs provide transportation to and from the care center. Activities often include exercises, games, trips, art and music. Some adult care programs offer medical services, such as help taking medications or checking blood pressure.
  • Senior housing. If you or a loved one can no longer live in a house but doesn't need continuous long term care, you might consider senior housing or retirement housing. This type of housing is often rental apartments that have been adapted for seniors, including railings installed in the bathrooms and power outlets placed higher on the walls. Other services offered by senior housing communities include meals, transportation, housekeeping and activities.
  • Assisted living. Consider assisted living if you need more help than senior housing offers but still want to remain as independent as possible. Assisted living staff can help residents take medications on schedule, help with bathing and dressing, and provide some medical care. Some assisted living facilities also have on-site beauty shops and health services such as a medical clinic.
  • Nursing home. Nursing homes offer 24-hour nursing care if you or a loved one is recovering from an illness or an injury. They also offer end-of-life care. Nursing home services are for those who need more medical care than other long term care options can offer, such as wound care, rehabilitative therapy, and help with respirators or ventilators. Personal care for bathing, dressing and going to the bathroom also is available at nursing homes.

How to choose the right long term care facility

Most everyone wants to stay at home. The main reason why people move into a facility is they cannot afford that level of care at home. With all the options available, selecting a long term care service can be overwhelming. If this is the case then following these steps to make the process easier:

  • Decide what level of service you or a loved one might need. Do you or does your loved one need help with everyday chores? Nursing care? Determining your specific care needs can help you decide what type of facilities to look into.
  • Figure out your preferences. Would you or your loved one prefer a smaller facility, a certain location or living arrangements such as a single room? Is there an exercise room or physical therapy available? Can you eat your meals in a cafeteria setting or your own room?
  • Consult your doctor. To ask a loved one's doctor for recommendations, you'll need to obtain your loved one's permission. Your doctor may put you in touch with agencies that help you identify your needs or the needs of a loved one and make recommendations based on the care needed.
  • Decide how much you can afford. Will you be paying for the long term care out-of-pocket? Do you need facilities that will accept Medicare or Medicaid?
  • Make a list of facilities within a half-hour's drive of your home. Call the facilities nearest to you first. Being close to friends and family can make the transition to long term care easier.
  • Call to ask about prices, services and vacancy. Ask about monthly fees for care. Find out what services are currently available and if you'll have to pay extra for them. Planning ahead may enable you to be put on a waiting list, which can help if your need for long term care becomes immediate.
  • Visit. Schedule a tour of the facility. Gather first impressions: Does the facility seem safe and friendly? Does it smell OK? Is the temperature comfortable? Do the residents seem happy? Are there enough caregivers on staff? What are the rooms like?
  • Ask questions. What are the rules? Can you choose when to get up and go to bed? When can you visit? What social activities are offered? How often will you receive care? Can you continue to see your personal doctors? How many people are on staff during the day and overnight? What type of training does the staff have?
  • Visit again. Observe staff members while they're working. Talk with residents. Visit at different times of the day. Make an unscheduled visit.

Also ask for advice from friends and relatives who have experience with long term care facilities in your area. Call the Better Business Bureau to check whether any complaints have been filed against the facility. You can also find out what government agency in your state monitors long term care facilities and ask for the agency's guidance or advice.

The federal government uses surveys to monitor nursing homes. To find survey results, use the Nursing Home Compare tool on the Medicare Web site. It's best to compare facilities within a region with one another. This gives you the best view of nursing homes in your area.

Check for the most current data and keep in mind that the types of information you can gather are limited. Over time, most every facility is bound to have a deficiency. Determine which deficiencies are minor and acceptable versus those that are life-threatening.

In the end, follow your instincts. Choose a facility that treats residents respectfully and makes them feel comfortable. If the rooms are nice but the staff isn't caring, it's likely not the facility you'll choose.

Paying for long term care

Long term care can be expensive. The national average is over $72,000 per year. There are multiple sources that provide funds to pay for long term care. Options include:

  • Self-pay. Paying for long term care from savings and investments. This can be financially devastating to a family. Costs can be double if both spouses need care.
  • Long term care insurance. You pay an annual premium for long term care insurance. In exchange, when you or a loved one needs care, the insurance provider pays a daily rate to the long term care facility. Daily rates differ, depending on the insurance policy. If long term care is needed immediately, it may not be possible to get long term care insurance. However, if you or your loved one is currently healthy you might want to consider this option. Get an insurance quote.
  • Medi-Cal/Medicaid. Medicaid is a joint state-federal program for people who meet certain income requirements. Medicaid usually covers nursing home care only after an illness or injury.
  • Medicare. This federal program is for people over age 65 and those with disabilities. Although Medicare doesn't cover assisted living, it covers very limited home care services in some cases. Medicare covers nursing home care for up to 100 days, but only if you have recently been in the hospital for at least three days.

Other options that may carry a risk or charge fees include reverse mortgages, annuities or setting up a trust fund for long term care. Deciding how to make payments for these options can be difficult. Overall insurance will be cheaper over the long run and will provide for the most care options.

Discussing long term care with a loved one or parents

The idea of leaving home or receiving in-home help for everyday activities can be distressing. That's why it's important for you to include your loved one as much as possible in the selection of a long term care service. Try these tips for talking about long term care:

  • Plan ahead. Waiting until a loved one needs a long term care facility isn't the best time to bring up the subject. If a loved one becomes ill or injured, it may be difficult for him or her to participate in the selection of the facility.
  • Take opportunities to talk. Your loved one might mention a problem around the house that you can relate to his or her need for long term care. For example, if your aunt mentions a problem turning on the faucet, you could ask whether she could use help with managing bathing and other personal care.
  • Listen to your loved one's or parent's concerns. Let them know you understand their concerns. Point out the benefits of long term care services. Remind your parents that their safety is your primary concern.
  • Listen to your loved one's or parent's preferences. Include your loved one or parents in the decision-making process. Find out what kind of facility they would prefer, but also recognize their ability to make decisions on their own. You might encounter some resistance from your loved one or parents, but stay positive. Keep in mind that if your loved one or parents are mentally competent, they have the right to decide whether they need long term care services or a long term care facility.
  • Involve others. If your loved one doesn't respond well to your efforts to talk, involve someone else that can be trusted, such as clergy, a doctor or an attorney.

You may feel anxious about leaving home to live in a long term care facility. Involving family and friends in the decision-making process might help you feel better about your choices for long term care.

Next: Who pays for long term care?