How to Choose Long-Term Care

Reviewed by Jennifer Robinson, MD on February 22, 2015

You've got a number of options when you look for long-term care for your loved one. But first you need to answer some key questions about their health and finances.

"Ask yourself, 'What type of help does my loved one need to live as independently as possible?'" says Leah Eskenazi, director of operations at Family Caregiver Alliance in San Francisco.

Then figure out how much of that care you can provide, how much friends and relatives can pitch in, and how much you and your loved one can afford to pay to get extra help.

Medicare, the federal health insurance program for people over 65, doesn't cover long-term care. Your loved one may need to use their personal savings or benefits from long-term care insurance, if they have got it.

If your loved one spends all their savings on care, they could be eligible for Medicaid, a joint federal-state program that pays some medical costs for people with low incomes. It covers some types of long-term care.

If your loved one lives in your home or their own, you'll need to make a caregiving plan using a variety of sources.

"That's what caregiving is: scheduling, coordinating, and providing care," says Nancy Wilson, assistant director of the Huffington Center on Aging at Baylor College of Medicine in Houston.

Make a list of everything your loved one needs that you can't handle on your own. Ask friends and family to take on some of these tasks and find services for the others.

Here are some services you might find in your area:

Transportation. Services from public transit might be able to help your loved one get around.

The Americans with Disabilities Act requires public transit agencies to offer door-to-door service for people with disabilities in their area who can't use regular public transportation.

Private agencies and nonprofit groups can also help get your loved one to doctor appointments.

Meal programs. You can find them at senior centers, churches, housing projects, community centers, and schools. Your loved one may be able to get lunches on-site for a small fee.

"Those meals are usually paired with some sort of activity, so it also lets them get out and get social interaction with peers," Eskenazi says.

Programs such as Meals On Wheels can deliver meals to your loved one if they can't get out of the house. The cost of these meals is often based on their financial needs.

Home health care providers and companions. If your loved one needs nursing care, home health care providers can help. You can find them through agencies or registries.

Companions are people you hire to help with cooking and housekeeping. They also keep your loved one company.

Adult day care programs. These often run Monday through Friday during business hours and include lunch. It's a "great way to make sure your loved one is getting stimulating social activities and meals," Eskenazi says.

"Social" day programs include activities and health screenings. "Health" day programs offer daily health care to seniors who need more regular monitoring of their condition.

Program for all-inclusive care (PACE). It's a Medicare and Medicaid benefit that brings the right services to elderly people in order to help keep them in their homes. Most people in PACE are eligible for Medicaid.

Caregiving in some type of residential community gives your loved one more social opportunities than you can provide at home. The services can vary a lot from place to place. Get the specifics when you visit or call the facility.

Your options for residential care include:

Retirement communities. They can provide your loved one with social activities, transportation, meals, and housekeeping. Some have a nurse on-call and offer the option to add care as you need it. You can also bring in your own additional care.

Residential care. It's usually a home in a residential neighborhood, whose owner has a license to care for a small number of older adults. You might also hear them called personal care homes, adult foster homes, and board and care homes.

It's a good option for your loved one if they doesn't need 24-hour nursing care but can't live alone. Besides meals and social activities, services sometimes include help with dressing, grooming, walking, and using the toilet.

Assisted living. These apartment-style places can offer your loved one meals, housekeeping, help with personal care, grooming, and medication. On-site or on-call medical help is often available.

Intermediate care. It offers regular nursing care but not 24-hour care. People who live here need help with daily activities and need regular nursing, but they usually do not need the same level of care that people in nursing homes need.

Nursing homes. They can provide your loved one with round-the-clock care at a higher level than assisted living. People who live in nursing homes need help with most of their self-care and activities of daily life.

Continuing care retirement communities. These offer your loved one many levels of care in one community. If their needs change, they can move smoothly to the next level of care without making a major move from one community to another.

Show Sources


Leah Eskenazi, MSW, director of operations, Family Caregiver Alliance, San Francisco.

Nancy Wilson, MSW, assistant director, Huffington Center on Aging, Baylor College of Medicine in Houston.

Family Caregiver Alliance: "Community care options."

U.S. Department of Health and Human Services: "What is long-term care insurance?"

Centers for Medicare and Medicaid Services: "Medicaid," "PACE."

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