Most older people are independent. But later in life —
especially in the 80s and 90s -- you or someone you know may
begin to need help with everyday activities like shopping,
cooking, walking, or bathing. For many people, regular or
"long-term" care may mean a little help from family and
friends or regular visits by a home health aide. For others who
are frail or suffering from dementia, long-term care may involve
moving to a place where professional care is available 24 hours a
day.
The good news is that families have more choices in long-term
care than ever before. Today, services can provide the needed
help while letting you stay active and connected with family,
friends, and neighbors. These services include home health care,
adult day care, and transportation services for frail seniors as
well as foster care, assisted living and retirement communities,
and traditional nursing homes.
Planning Ahead
The key to successful long-term care is planning. You or your
family may need to make a decision in a hurry, often after an
unexpected emergency like a broken hip. Be prepared by getting
information ahead of time. That way, you will know what's
available and affordable before there is a crisis. To start:
If you are having trouble with things like bathing, managing
finances, or driving, talk with your doctor and other health care
professionals about your need for help. A special type of social
worker, called a geriatric case manager, can help you and your
family through this complex time by developing a long-term care
plan and locating appropriate services. Geriatric case managers
can be particularly helpful when family members live a long
distance apart.
If you are helping a family member or friend, talk about the
best way to meet his or her needs. If you need help for yourself,
talk with your family. For instance, if you are having trouble
making your meals, do you want meals delivered by a local program
or would you like family and friends to help? Would you let a
paid aide in your home? If you don't drive, would you like a
friend or bus service to take you to the doctor or other
appointments?
Learn about the types of services and care in your community.
Doctors, social workers, and others who see you for regular care
may have suggestions. The Area Agency on Aging and local and
state offices of aging or social services can give you lists of
adult day care centers, meal programs, companion programs,
transportation services, or places providing more care.
Find out how you may — or may not — be covered by
insurance. The Federal Medicare program and private
"Medigap" insurance only offer short-term home health
and nursing home benefits. Contact your state-run Medicaid
program about long-term nursing home coverage for people with
limited means. Also, your state's insurance commission can
tell you more about private long-term care policies and offer
tips on how to buy this complicated insurance. These agencies are
listed in your telephone book, under "Government."
Be aware that figuring out care for the long term isn't
easy. Needs may change over time. What worked 6 months ago may no
longer apply. Insurance coverage is often very limited and
families may have problems paying for services. In addition,
rules about programs and benefits change, and it's hard to
know from one year to the next what may be available.
A Need for More Care
At some point, support from family, friends, or local meal or
transportation programs may not be enough. If you need a lot of
help with everyday activities, you may need to move to a place
where care is available around-the-clock. There are two types of
residential care:
Assisted living arrangements are available in large apartment
or hotel-like buildings or can be set up as "board and
care" homes for a small number of people. They offer
different levels of care, but often include meals, recreation,
security, and help with bathing, dressing, medication, and
housekeeping.
Skilled nursing facilities — "nursing homes"
— provide 24-hour services and supervision. They provide
medical care and rehabilitation for residents, who are mostly
very frail or suffer from the later stages of dementia.
Sometimes, health care providers offer different levels of care
at one site. These "continuing care communities" often
locate an assisted living facility next to a nursing home so that
people can move from one type of care to another if necessary.
Several offer programs for couples, trying to meet needs when one
spouse is doing well but the other has become disabled.
Finding the Right Place
To find the residential program that's best for you:
Ask Questions: Find out about specific facilities in your
area. Doctors, friends and relatives, local hospital discharge
planners and social workers, and religious organizations can
help. Your state's Office of the Long-Term Care Ombudsman has
information about specific nursing homes and can let you know
whether there have been problems at a particular home. Other
types of residential arrangements, like "board and
care" homes, do not follow the same Federal, state, or local
licensing requirements or regulations as nursing homes. Talk to
people in your community or local social service agencies to find
out which facilities seem to be well run.
Call: Contact the places that interest you. Ask basic
questions about vacancies, number of residents, costs and method
of payment, and participation in Medicare and Medicaid. Also
think about what's important to you, such as transportation,
meals, housekeeping, activities, special units for
Alzheimer's disease, or medication policies.
Visit: When you find a place that seems right, go talk to the
staff, residents, and, if possible, family members of residents.
Set up an appointment, but also go unannounced and at different
times of the day. See if the staff treats residents with respect
and tries to meet the needs of each person. Check if the building
is clean and safe. Are residents restrained in any way? Are
social activities and exercise programs offered--and enjoyed? Do
residents have personal privacy? Is the facility secure for
people and their belongings? Eat a meal there to see if you like
the food.
Understand: Once you have made a choice, be sure you understand
the facility's contract and financial agreement. It's a
good idea to have a lawyer look them over before you sign.
A Smooth Transition
Moving from home to a long-term care facility or nursing home
is a big change. It affects the whole family. Some facilities or
community groups have a social worker who can help you prepare
for the change. Allow some time to adjust after the move has
taken place.
Regular visits by family and friends are important. They can
be reassuring and comforting. Visits are necessary, too, for
keeping an eye on the care that is being given.
Resources:
The following organizations and agencies can provide
information about assistance and long-term care:
The Eldercare Locator (1-800-677-1116) can direct you to your
Area Agency on Aging. They will give you information on local
long-term care resources and programs. Visit their website at
http://www.aoa.dhhs.gov.
The Nursing Home Information Service at the National Council
of Senior Citizens, 8403 Colesville Road, Suite 1200, Silver
Spring, MD 20910 (301-578-8938) has information on community
services and offers a free guide on how to select a nursing home.
Visit their website at http://www.ncscinc.org.
The Health Care Financing Administration publishes the
"Guide to Choosing a Nursing Home" and the annual
"Guide to Health Insurance for People with Medicare."
The nursing home guide includes a detailed checklist. Call
1-800-638-6833. Visit their website at http://www.hcfa.gov.
Each state Office of the Long-Term Care Ombudsman visits nursing
homes on a regular basis and handles complaints. Find your
ombudsman by calling the National Association of State Units on
Aging at 202-898-2578. The association has publications about
long-term care and can provide a list of facilities.
Other sources of information include:
The American Association of Homes and Services for the
Aging,
901 E Street, N.W., Suite 500,
Washington, D.C. 20004-2011;
call 202-783-2242.
Visit their website at http://www.aahsa.org.
The Assisted Living Federation of America,
Suite 400, 10300 Eaton Place,
Fairfax, VA 22030;
call 703-691-8100.
Visit their website at http://www.alfa.org.
The American Health Care Association,
1201 L Street, N.W.,
Washington D.C. 20005;
call 202-842-4444.
The National Citizens' Coalition for Nursing Home
Reform's publications list is available from:
Suite 202, 1424 16th Street, N.W.,
Washington, D.C. 20036-2211;
call 202-332-2275.
For more information about health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg, MD
20898-8057
1-800-222-2225
1-800-222-4225 (TTY)
http://www.nih.gov/nia
Alzheimer's Disease Education and Referral (ADEAR)
Center
P.O. Box 8250
Silver Spring, MD 20907-8250
1-800-438-4380
http://www.alzheimers.org
National Institute on Aging
U.S. Department of Health and Human Services
Public Health Service
National Institutes of Health
The address of this page
is: http://
www.pspinformation.com
/caregiving/longtermcare/longterm.shtml