Understanding Alternatives of Nursing Homes Is Important.

Question: My aunt is nearing 85 and is no longer able to live at home, but her "long term care options" are very confusing to me and my sister who are her only living relatives. We see advertisements in the paper and on television about different types of nursing homes, but the cost seems to vary greatly and the care provided is confusing. Our aunt has agreed that she needs assistance, but we can't seem to get a handle on what will be best for her. Please help.

Answer: When we talk about "long-term care," we are generally speaking about care for a person who is mentally or physically incapacitated to a degree that he or she cannot function -- or perhaps live -- without assistance from others and that the condition is not likely to change in the foreseeable future.

When we refer to "long-term care planning," we mean the process by which families prepare to meet the medical, financial, and housing needs of an incapacitated individual who cannot function independently, but whose level of care requirement is "subacute" ? meaning that the individual does not need a hospital stay. While the need for long term care planning is not limited to the elderly, this group is most often in need of such a plan.

To be successful, the 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 the physical needs of the incapacitated person, the psychological needs of both the individual and his or her family must also be considered. To best serve the needs of the incapacitated person, it is essential that the family, the physician or nurse, the financial advisor, and an attorney who understands the process all have input into the plan.

The types of long-term care available for a person who is mentally or physically incapacitated to the extent that he or she cannot function -- or perhaps live -- without assistance from others include the following:

1. If a person's medical needs are such that can only be provided for in a hospital, that person needs "acute care." Acute care is generally covered by health insurance and Medicare subject to certain co-payments and deductibles.

2. If a person's medical needs are less intense, then that person may require "intermediate or skilled care" which is traditionally provided by a nursing home. If the person can afford to pay for his or her care privately, that person - or the family - and his or her physician can determine if this level of care is needed or desired; however, should Medicaid assistance will be sought, the affected individual will likely have to meet the "medical necessity" criteria established by the Medicaid Program.

3. "Residential Care" or "Assisted Living" is lower on the scale than skilled or intermediate care and is provided in a Residential Care or Assisted Living Facility (RCF). Generally, people who need this level of care do not meet the criteria for skilled or intermediate nursing care, but require a great deal of supervision and assistance ? such as early stage Alzheimer's or dementia patients. The primary difference between a nursing home and a residential care facility is the absence of nurses. Nursing homes must have nurses on staff while residential care facilities are not required to have a nursing staff.

The cost of Residential Care is moderate -- from a low of about $800.00 per month to a high of about $2,800 per month depending on the needs of the patient and where the patient lives. Medicaid does not cover Residential Care, but some states do provide optional payments ("supplementation") to help individuals meet the cost of residing in such a setting.

4. "Home care" is generally limited to those people who can operate with some degree of independence or who have a family structure that allows them to remain at home. It is possible to obtain nursing assistance through various Home Health Agencies for the person residing at home. And, if the person meets the proper criteria, Medicare may pay for this care ? although the requirements are very strict. An additional method of alleviating some of the burden on a family keeping a family member at home is to use Adult Day Care. These facilities are located in most communities. Medicaid assistance for services such as in-home assistance and adult day care may be available to some persons under a Medicaid home and community-based waiver programs.

Taking The NextStep: Before you make any decisions, you should get advice from private professionals who know the ropes.

Jan Collins is an award-winning writer and editor. Jan Warner is a matrimonial, elder law, and tax attorney. Both are based in Columbia, South Carolina.

Please send your questions to P.O.Box 11704, Columbia, S.C. 29211 or send your questions by email to janwarner@nextsteps.net.


Posted: August 1, 1999