Choosing Long-term Care
Contents
> Types of Long-term Care
> What Kind of Services Do I Need?
> How Will I Pay for these Services?
> How Can I Choose the Best Quality Services?
> Sources of Additional Information
"Long-term care" means helping people of any age with their medical
needs or daily activities over a long period of time. Long-term care
can be provided at home, in the community, or in various types of
facilities. This section deals mainly with older people who need
long-term care. However, the information also may be useful for
younger people with disabilities or illnesses that require long-term
care.
When you look for long-term care, it is important to remember that
quality varies from one place or caregiver to another.
It is also important to think about long-term care before a crisis
occurs. Making long-term care decisions can be hard even when planned
well in advance.
Quick Check for Quality
Look for long-term care that:
[x] Has been found by State agencies, accreditors, or others to
provide quality care.
[x] Has the services you need.
[x] Has staff that meet your needs.
[x] Meets your budget.
Research shows that to make the best choices, you need to think about:
* What your options are.
* Whether they meet your or your family member's needs (physical,
medical, emotional, financial, etc.).
* How to find the highest quality care.
Types of Long-term Care
Research shows that many people do not know about or understand
long-term care options. Following are brief descriptions of the major
types of long-term care:
Home care 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. Some short-term, skilled home
care (provided by a nurse or therapist) is covered by Medicare and is
called "home health care." Another type of care that can be given at
home is hospice care for terminally ill people.
Community services are support services that can include adult day
care, meal programs, senior centers, transportation, and other
services. These can help people who are cared for at home-and 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."
Supportive housing 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.
Assisted living 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.
Continuing care retirement communities (CCRCs) provide a full range of
services and care based on what each resident needs over time. Care
usually is provided in one of three main stages: independent living,
assisted living, and skilled nursing.
Nursing homes 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 care").
Another type of long-term care takes place in home-like settings
called Intermediate Care Facilities for the Mentally Retarded. 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 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" http://www.medicare.gov/nhcompare/home.asp
--a Web site created by the Centers for Medicare & Medicaid Services,
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.
* 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.
There are three important questions to ask yourself when deciding
about long-term care for yourself or a loved one:
1. What kind of services do I need?
2. How will I pay for these services?
3. How can I choose the best quality services?
What Kind of Services Do I Need?
Think of long-term care as a menu of services. A person may need only
one or a few kinds of services. Or, several kinds may be needed over
the course of a person's older years.
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.
Do you or your loved one need help with daily activities? Health care
needs? Both? You can use the following chart to help you identify the
type(s) of long-term care that meet your needs. This chart shows which
types of long-term care services offer which kinds of help. The
"Relative Costs" information shows how costly the settings can be when
compared with each other.
Help With Daily Activities
[_] Shopping
[_] Preparing meals
[_] Eating
[_] Laundry and other housework
[_] Home maintenance
[_] Paying bills and other money matters
[_] Bathing
[_] Dressing
[_] Grooming
[_] Going to the bathroom
[_] Remembering to take medicines
[_] Walking
[_] Other _______________________
[_] Other _______________________
Health Care Needs*
[_] Physical therapy
[_] Speech therapy
[_] Occupational therapy
[_] Rehabilitation
[_] Medical nutritional therapy
[_] Oxygen
[_] Care for pressure ulcers or other wounds
[_] Alzheimer's disease care
[_] Health monitoring (for diabetes, for example)
[_] Pain management
[_] Nursing care services
[_] Other medical services provided
by a doctor or other clinician
[_] Other _______________________
* as recommended by a doctor or other health care provider.
_________________________________________________________________________
Relative Costs Comparison
_________________________________________________________________________
Supportive
Home Community Housing Assisted Nursing
Care Services Programs Living CCRC* Homes
_________________________________________________________________________
Help with
daily
activities X X X X X X
Help with
health care
needs X X X
_________________________________________________________________________
Relative Low to Low to Low to Medium High High
Costs High Medium Medium to High
* Continuing Care Retirement Communities
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. Medicare beneficiaries may supplement their
policy with insurance purchased from private organizations. Most
of these policies-often called Medigap insurance or by a similar
name- will help pay for some skilled care, but only when that care
is covered by Medicare. Medigap is not long-term care insurance.
Commercial insurers offer private policies called long-term care
insurance. 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 Medicaid.
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 1-800-633-4227. Or,
look at the consumer Web site for Medicare services,
http://www.medicare.gov.
How Can I Choose the Best Quality Services?
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.
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
1-800-633-4227 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 (1-800-669-1656; 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 person again?
* 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?
Nursing Home Care
* 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.
* 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 this voluntary process and to learn the
results.
* Location is very important. Is the nursing home close enough so
that family and friends can visit? Close enough for the resident's
personal doctor to visit?
* The most important step is to visit-more than once-and look
around. Go at different times of the day-for example, first thing
in the morning and at mealtimes.
* Do residents seem to enjoy meals? Is there help for those who
cannot eat on their own? If possible, eat a meal at the facility.
* Is the home clean and free of odors? Is it pleasant?
* Are residents clean, well groomed, and dressed appropriately for
the season and time of day? Are they involved in activities?
* Are staff friendly, helpful, and respectful?
* Talk to staff, residents, and families to find out what they think
of the facility.
* Ask to see the area where physical therapy and other
rehabilitation services are provided.
* Is the nursing home experienced with special needs-for example,
problems with swallowing?
* Who provides the medical care?
* Which hospital(s) does the nursing home use?
_________________________________________________________________
Sources of Additional Information
A Guide to Choosing a Nursing Home
Has sections on gathering information, visiting nursing homes, and
residents' rights and quality of life. Includes phone lists for State
ombudsmen, State survey agencies, and insurance counseling. 47 pages.
Free.
Medicare: 1-800-633-4227
Web site: http://www.medicare.gov/Publications/Home.asp
Resource Directory for Older People
The Administration on Aging and National Institute on Aging offers
lists of hundreds of organizations, names, and phone numbers,
including State agencies on aging and State long-term care ombudsmen
programs. Not available in print.
Web site: http://www.aoa.gov/eldfam/eldfam.asp
American Association of Homes and Services for the Aging
Offers a series of pamphlets on nursing homes, assisted living,
continuing care retirement communities, community services, housing
options for older people, and understanding Medicare managed care.
Free.
Telephone: 1-800-675-9253
Web site: http://www.aahsa.org
How to Choose a Home Care Provider
Explains who provides what kind of care, the various services offered,
who pays for services. Has billing and payment information. Lists
patients' rights, accrediting agencies, and State resources and
information. Free.
National Association for Home Care
Telephone: (202) 547-7424
Myths and Realities of Living in a Nursing Home, How to Pay for
Nursing Home Care, What Consumers Need to Know About Private Long-term
Care, and Circle of Care.
A series of six pamphlets on selecting and paying for long-term care.
Free. For more than one copy: 1-800-321-0343 (packets of 25).
The American Health Care Association
1201 L St., NW
Washington, DC 20005-4014
(202) 842-4444
Web site: http://www.ahca.org/info/informat.htm
Nursing Home Life: A Guide for Residents and Families
Includes first-hand accounts from residents and family members. Topics
include adjusting to nursing home life; services and staff; getting
what you need; and dealing with poor care. Has useful appendices and
resource lists. 44 pages. Free.
The American Association of Retired Persons
601 E. St., N.W.
Washington, DC 20049
1-800-424-3410
Web site: http://www.aarp.org
Choosing a Nursing Home and All About Home Health
Available online from Health Pages.
Web sites: http://www.thehealthpages.com/articles/ar-nrshm.html
http://www.thehealthpages.com/articles/ar-homeh.html
healthfinder®
Provides a gateway to reliable consumer health information from the
Federal Government and other organizations.
Web site: http://www.healthfinder.gov
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_________________________________________________________________
Current as of July 2001
Send Questions & Comments to: info@ahrq.gov
_______________________________________________________________
Internet Citation:
Choosing Long-term Care. Your Guide to Choosing Quality Health Care.
AHCPR Publication No. 99-0012, July 2001. Agency for Healthcare
Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/qntascii/
qntltc.htm
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