Jan L. Warner & Jan Collins
Question: My mother is nearly 87, is no longer able to live at home alone, and agrees that she needs help. We have looked into "long term care" facilities, but the cost varies greatly and the type of care provided is confusing. Is there any secret to understanding what to look for and how to plan?
Answer: "Long-term care" generally means providing necessary assistance for a person who is mentally or physically incapacitated to the degree that he or she cannot function -- or perhaps live -- without help from others, whether the condition is likely to change in the foreseeable future or not.
"Long-term care planning" is the process by which families prepare to meet the medical, financial, and housing needs of an incapacitated individual who cannot function independently, but who does not need acute care in a hospital. Although not limited to the elderly, they most often require long term care planning.
The successful long term care plan must address four basic areas: (1) the level of care the incapacitated individual needs, (2) how and where that care can best be provided, (3) who should provide that care, and (4) how the care will be paid for. In addition to addressing the physical needs of the incapacitated person, the plan must consider the psychological needs of both the individual and family members.
To best serve the needs of the incapacitated person, it is essential to receive input from the family, the medical professionals, the financial advisor, and an attorney who understands the process. The appropriate type of care for those who cannot function or live without assistance from others is based upon the severity of the person's needs:
1. If an individual's needs can only be provided for in a hospital, that person requires "acute care" which is generally covered by health insurance and Medicare subject to certain co-payments and deductibles.
2. If, during or after hospitalization, the person requires rehabilitation (such as physical, speech, and/or occupational therapy), this is called "skilled care" which is provided in a sub-acute part of the hospital or a nursing home and is generally covered by health insurance and Medicare for limited periods of time.
3. If a person's medical needs are less intense, the person may require "intermediate care" which is traditionally provided by a nursing home. If the person can not afford to pay for this care privately or through long-term care insurance and require Medicaid assistance, he or she will have to meet strict "medical necessity" criteria established by the Medicaid Program.
4. "Residential Care" or "Assisted Living" is provided to those who do not meet nursing home care levels, but need a great deal of supervision and assistance (such as early stage Alzheimer's and dementia patients.) One of the primary differences between a nursing home and a residential care facility is the absence of nurses, but some facilities do offer nurses on staff. While some states provide optional payments to help very poor individuals meet the cost of residential care, most is paid for privately or by long-term care insurance.
5. "Home care" is generally limited to those who can operate with some degree of independence or who have a family situation that allows them to remain at home. It is possible to obtain nursing assistance through various Home Health Agencies which, if the person meets the strict criteria, may be covered by Medicare. Another way to keep an individual at home and lift some of the caregiving burden from the family is to use Adult Day Care and respite care. These facilities are located in most communities. Medicaid assistance for in-home assistance and adult day care may be available to some very ill persons under a Medicaid home and community-based waiver programs.
Taking The NextStep: Before making any decisions, get advice from private professionals who know the ropes based on your particular situation.