Long-Term Care: Choices and Options

As you grow older, you may be concerned about your housing options. Will you be able to take care of the family home, mow the grass, and rake the leaves? Will you be able to take care of your own personal needs, cook your meals, and bathe yourself? If you think you might need long-term personal care in the future, now's the time to consider your options.

In-home Care

If you need personal or health-care assistance but want to remain as independent as possible, you might consider in-home care as an alternative to nursing homes or other facilities. In-home care may include health care (nursing services), household help (homemaker services), and personal care (companion or caretaker services). You can obtain these services by hiring private individuals or contracting with a home health agency, such as the local Visiting Nurse Association. Such agencies, if they are certified, comply with Medicare and Medicaid regulations.

Continuing care retirement communities

A form of assisted living, continuing care retirement communities (CCRCs) are also known as life care communities. They offer you housing, meals, social activities, and health care ranging from minimal personal assistance to skilled nursing care. Such communities may be ideal for you if you are in good health but are worried that you may need such care in the future.

In exchange for a one-time entrance fee (which can range from $50,000 to over $300,000) and a monthly maintenance fee ($800 to over $4,000), you're guaranteed that the CCRC will provide you with housing and nursing home care for the rest of your life. Depending on your contract with the facility, the CCRC may keep your entrance fee and then assign your apartment to someone else when you die.

Make sure the CCRC offers you the level of health-care coverage that you feel you may need, and find out if the cost of that coverage is included in your basic contract or is an additional expense. You should also find out how much say you have in decisions such as determining when you must leave your apartment and move into the nursing home portion of the facility.

If you choose a CCRC as a long-term care option, be sure to read the fine print of the contract. Make sure you understand the entrance and maintenance fee requirements. You'll also want to be aware of any additional requirements that the contract might impose on you. In some cases, you may have to purchase additional insurance to cover your short-term or long-term health-care costs. Because this is a long-term commitment, you need to check the financial stability of the facility and the company that operates it. For assistance, contact the Continuing Care Accreditation Commission.

Nursing homes

Generally speaking, nursing homes take care of you when you cannot care for yourself. Such care may be short-term while you recover from an illness or injury, or long-term because either physical or mental incapacitation makes it impossible for you to care for yourself. Nursing homes offer round-the-clock medical care. This care may be:

Skilled nursing care, which is ordered by a doctor and provided by qualified personnel such as registered nurses or professional therapists. Such care is designed to treat a medical condition from which you're expected to recover.

Intermediate care or nursing and rehabilitative assistance provided as you need it by qualified medical personnel under a doctor's supervision.

Custodial care or assistance with personal needs such as bathing, eating, or dressing. Such care is performed under a doctor's supervision but is provided by personnel without professional medical training.

If you're thinking of entering a nursing home, you'll have many factors to consider. If you'll need medical care (or think you might), find out if the nursing home provides the level of care you'll need. Beyond that, consider whether the facility itself is clean and well maintained, the environment is one that stimulates you, and the staff members are people whom you trust and enjoy. Take a family member or friend with you to visit the nursing home and ask for his or her honest opinion. If a nursing home is to be your home, you want it to be a place where you can feel at home. For more assistance with this search, contact your state department of elder services.

Paying for it

The choice you make from among these options may depend in part on what you can afford. Nursing homes typically charge a fixed daily rate, and the cost can vary widely, depending on the care you receive and the geographic location of the facility. You can pay the bill with private funds, the proceeds from long-term care insurance, or (if you're eligible) government assistance from Medicaid.

In most cases, you'll have to pay for a CCRC or other assisted-living option, either with your own funds or with the proceeds of a long-term care insurance policy. Medicare covers only your health-care-related expenses, and only at facilities licensed to provide medical care.

Under certain conditions, Medicare covers short-term in-home health care that's medically necessary. Most long-term care insurance policies now also cover in-home care. In many cases, you might elect to pay for in-home health care with your own funds; be aware that you may be able to deduct the expense on your tax returns.

Although long-term care isn't a topic most people are eager to consider, don't put off doing so until the last moment. The longer you wait to make a plan, the more likely you won't be able to afford one.