Long-Term Care

Long-term care facility used to mean nursing home, but increasing life expectancy and growth in the number of elders in need of care in recent years has changed all that. According to U.S. Census projections, by the year 2020 approximately 20% of the population will be 65 or older. That will be more than 50 million Americans, and more than 20 million of them will eventually need some type of long-term care.

Making arrangements for suitable long-term care can seem like a juggling act. In a nutshell, it requires finding a facility of desirable quality in an acceptable location that offers the level of care required at an affordable price. There's a lot to do, so it's best not to put off the search until the last minute. Here is a brief overview of what to look for and what to expect.

What kinds of long-term care are available?

The options for care fall into two major groups, nursing homes [link to nursing home article] and assisted living facilities [link to assisted living article], but these designations cover a lot of ground. Both nursing homes and assisted living facilities typically offer several levels of care. This is reflected in the fact that some assisted living facilities are known as senior care communities, residential care homes or personal care homes.

What about the quality of care?

Long-term care facilities are licensed and regulated, but quality of care varies from facility to facility. Friends, family, doctors and social workers with firsthand knowledge of facilities in your area can provide valuable insights, but the best way to learn about a facility is to visit. These are some things to look for:

• Staff should respect residents regardless of physical or mental status
• Staff should be supportive, caring and friendly to residents and their families
• Residents should be clean and appear well cared for
• Family and friends should feel welcome to visit at any time
• Residents should be treated like family, not just as paying customers

Other things to consider include available activities for residents for physical and mental stimulation, dietary provisions and general quality of food, aesthetics, safety, cleanliness and overall atmosphere.

How much does it cost?

Long-term care can be expensive. Skilled nursing facilities, for example, can range from $200 to $500 or more per day. Intermediate care facilities (offering care at a level between skilled nursing and assisted living) can range from $150 to $400 or more per day. Custodial or personal care facilities usually cost $100 to $250 per day. Senior care communities and other facilities that offer more luxurious accommodations will probably cost more.

Under current government programs, Medicare is aimed more at short-term skilled nursing care rather than any type of long-term care. Medicaid, on the other hand, will pay for long-term care, but it is a low-income benefit with very strict eligibility requirements. For these reasons, long-term care is very often paid for with private assets or through long-term care insurance. This type of insurance, by the way, is complex and should never be purchased without thorough research.

In any case, some facilities are private-pay only, meaning that the care recipient pays the full amount directly. Others accept insurance, both through private policies and through Medicaid.