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.
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,
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.