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Choosing a Long-Term Care Facility

Although it may be preferable for seniors to end up in an assisted care facility or retirement home, many seniors end up in long-term care facilities due to a medical condition or circumstances outside of their control. Long-term care facilities are for seniors who require 24 hour monitoring, personal assistance or nursing care because of a physical or mental condition. Choosing a long-term care facility can be difficult, so follow these steps to make the process a little easier.

Step 1: Establish the Level of Care Required

Long-term care takes many forms, and can take place at home, in an assisted living facility, special retirement communities, senior centers, or nursing homes. Long-term care also generally falls into two categories, which greatly impact the next step, financing the long-term care. Those two categories are "medically necessary" care and "custodial" care. Medically necessary care is covered by Medicare, but custodial care is not.

As a result, make a checklist of all of the things you expect that the person seeking long-term care will need help with. Here are some potential items that a senior may need help with:

  • Eating
  • Dressing
  • Bathing
  • Getting in and out of bed
  • Using the bathroom
  • Remembering to take medicine
  • Shopping
  • Paying important bills
  • Transportation
  • Housework (cleaning, laundry, etc)

That is only a partial list, so make a list of all of the day-to-day items where you think assistance may be required.

Step 2: Evaluate the Financial Situation

Ultimately, the choices may be limited by how much money there is to finance the long-term care. People are often shocked at the expense of long-term health care, so make sure to plan well in advance if you can. There are many ways to pay for long-term care; here are some examples of the ways in which people fund long-term healthcare.

  • Personal savings: obviously, personal savings can be extremely helpful in financing long-term care.
  • Long-term Care Insurance: long-term care insurance can be effective, but insurance coverage varies widely, so be sure to read the policy's coverage carefully. Some plans only include nursing home care, whereas others may include medical equipment and in-home care.
  • Medicare: Medicare will only pay for certain skilled nursing or home health care if you meet certain conditions, otherwise they do not pay for daily living care. Visit Medicare to see if you meet the eligibility conditions for coverage at www.medicare.gov.
  • Medicaid: Medicaid varies from state to state and what it covers also varies greatly. Generally, eligibility is based on income and resources with help generally being offered only to those with low incomes and limited resources.
  • PACE: The Programs of All-inclusive Care for the Elderly (PACE) is a benefits program designed to offer in-home care that is integrated with Medicare and Medicaid and is only available in some states, so check to see if your state has a PACE program.
  • Veterans benefits: the Department of Veterans Affairs (VA) may offer long-term care for eligible veterans, so 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 policy holder is still alive.
  • Reverse Mortgages: a reverse mortgage allows a homeowner to convert a portion of the equity in his or her house into cash. The Department of Housing and Urban Development insures certain reverse mortgages, so visit www.hud.gov for more information.

Step 3: Research Your Options

There are as many types of long-term care provided as there are types of patients in need, so 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 as well as professionals can provide an elderly person with a variety of services in his or her own home. Typically, this kind of help is limited to seniors who only need help with shopping, transportation, and more mundane day-to-day activities.
  • Community Services: most communities provide some sort of care including meal programs, senior centers and transportation services. These services can augment other services you may be using and help keep costs down.
  • Assisted Living Facilities: these facilities provide 24-hour assistance and health care in a home-like setting, and help with everything from bathing and eating, to dressing and 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 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 generally the most expensive option 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 and provide skilled nursing and rehabilitation services as well as meals and help with daily living. There are several types of nursing homes.
    • Skilled Nursing Facilities: these nursing homes provided 24 hour nursing and monitoring, and generally 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, but don't require the 24-hour attention that may necessitate a skilled nursing facility.
    • Custodial Care Facilities: these nursing homes are more built for true long-term care, for patients who don't need 24-hour care and aren't suffering from debilitating chronic illness. 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, ask around for advice and referrals, preferably from people who have actually 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.

Step 4: Visit Your Best Options

Finally, nothing beats an in person inspection. Make sure to review your checklist of expected needs before you visit potential facilities and write down any questions that you can think of. Don't just follow staff around meekly, they are essentially sales people, so ask about anything you don't understand. Here are some questions to get you started. It's certainly not an exhaustive list, but it should point you in the right direction.

Questions for Healthcare Facility Staff:

  • 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:

  • 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?
Next Steps
Contact a qualified elder law attorney to help you
and loved ones plan care and address problems.
(e.g., Chicago, IL or 60611)

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