Step 2 - Long-Term Care Options

Until recently, few alternatives to nursing homes existed for people who could no longer take care of themselves. Even today, some people are placed in nursing homes simply because neither they nor their family know about the alternatives to nursing homes. Today, people who cannot live completely independently may choose from a variety of living arrangements that offer different levels of care. For many, these alternatives are preferable to nursing homes. 

Home and Community Care 
Most people want to remain at home as long as possible. A person who is ill or disabled and needs help may be able to get a variety of home services that might make moving into a nursing home unnecessary. Home services include meals on wheels programs, friendly visiting and shopper services, and adult day care. In addition, there are a variety of programs that help care for people in their homes. Some nursing homes offer respite care-when they admit a person for short period of time, to give the home caregivers a break. Depending on the case, Medicare, private insurance, and Medicaid may pay some home care costs. 

Subsidized Senior Housing 
There are Federal and State programs that subsidize housing for older people with low to moderate incomes. A number of these facilities offer assistance to residents who need help with certain tasks, such as shopping and laundry, but residents generally live independently in an apartment within the senior housing complex. In this way, subsidized senior housing serves as a lower cost alternative to assisted living - though assisted living communities are frequently newer and more luxurious. 

Assisted Living (Non-Medical Senior Housing) 
Some people need help with only a small number of tasks, such as cooking and laundry. Some may only need to be reminded to take their medications. For those people who need only a small amount of help, assisted living facilities may be worth considering. Assisted living is a general term for living arrangements in which some services are available to residents (meals, laundry, medication reminders), but residents still live independently within the assisted living complex. In most cases, assisted living residents pay a regular monthly rent, and then pay additional fees for the services that they require. 

Board and Care Homes 
These are group living arrangements (sometimes called group or domiciliary homes) that are designed to meet the needs of people who cannot live independently, but do not require nursing home services. These homes offer a wider range of services than independent living options. Most provide help with some of the activities of daily living, including eating, walking, bathing, and toileting. In some cases, private long-term care insurance and medical assistance programs will help pay for this type of living. 

Continuing Care Retirement Communities (CCRCS) 
CCRCs are housing communities that provide different levels of care based on the needs of their residents -- from independent living apartments to skilled nursing in an affiliated nursing home. Residents move from one set- ting to another based on their needs, but continue to remain a part of their CCRC's community. Many CCRCs require a large payment prior to admission, and then charge monthly fees above that. For this reason, many CCRCs are too expensive for older people with modest incomes. 

What Is A Nursing Home? 

A nursing home is a residence that provides room, meals, recreational activities; help with daily living, and protective supervision to residents. Generally, nursing home residents have physical or mental impairments which keep them from living independently. Nursing homes are certified to provide different levels of care, from custodial to skilled nursing (services that can only be administered by a trained professional). Before deciding which care setting is most appropriate for you or your relative, talk to your doctor or a social worker and get a realistic assessment of care needs. If you are considering home care, be sure you understand all the work that comes with caring for a chronically ill person. If you are considering independent living, consider the risks associated with an unsupervised environment. Be sure to discuss long-term care options with the family members who will be the main home care givers and/or visitors to your new home. Consider how you will pay for your own long-term care (for information on how people usually pay for long-term care, see page 6).

Remember that caring for someone who is very sick requires a lot of work. Nursing homes are designed to meet the needs of the acutely or chronically ill. The options discussed above may work for people who require less than skilled care, or who require skilled care for only brief periods of time, but many people with long-term skilled care needs require a level and amount of care that cannot be easily handled outside of a nursing home.