Where is Long-Term care provided?

Long-term care, often associated with institutional care, is provided in many different settings. But, most long-term care is actually provided at home – either in the home of the person receiving care or at a family member's home. It’s estimated that individuals currently turning 65 may need 3 years of long-term care in their lifetime, with almost 2 years of that care provided at home. The majority of care that is provided at home – about 80% - is provided by unpaid caregivers.
There is also an increasing amount of long-term care available in the community through programs such as adult day service centers, transportation services, and home care agencies that often supplement care at home or provide respite for family caregivers.

For people who cannot stay at home, but who do not need the level of care provided in a nursing home, there are a variety of residential care settings, such as assisted living, board and care homes, and Continuing Care Retirement Communities (CCRCs). Nursing homes provide long-term care to people who need more extensive care, particularly those whose needs include nursing care or 24-hour supervision in addition to their personal care needs.

There are many alternatives available to those with varying levels of Long-Term care needs. Home and community-based services (HCBS) describe a range of personal, support, and health services provided to individuals in their homes or communities to help them stay at home and live as independently as possible. Most people who receive long-term care at home generally require additional help either from family or friends to supplement services from paid providers. This is because so much of the care needed is personal care: help with activities such as bathing and dressing, help managing medications, or supervision for someone with a condition such as Alzheimer's disease.

Some of the most common home and community services are:

Adult Day Service (ADS) Programs, designed to meet the needs of adults with cognitive or functional impairments, as well as adults needing social interaction and a place to go when their family caregivers are at work. They provide a variety of health, social, and other support services in a protective setting during part of the day. Adult day centers typically operate programs during normal business hours five days a week; some have evening and weekend hours. These programs do not provide 24-hour care.

Case managers/geriatric care managers, health care professionals (typically nurses or social workers) who specialize in assisting you and your family with your long-term care needs. This includes, but is not limited to assisting, coordinating, and managing long-term care services; developing a plan of care; and monitoring your long-term care needs over extended periods of time.

Emergency response systems, which provide an automatic response to a medical or other emergency via electronic monitors. If you live alone, you wear a signaling device that you activate when you need assistance.

Friendly visitor/companion services, which are typically staffed by volunteers who regularly pay short visits (under two hours) to someone who is frail or living alone.

Home health care/home care are two different services, which may be provided by a single agency or separate agencies. Home health care typically includes skilled, short-term services such as nursing, physical or other therapies ordered by a physician for a specific condition. Home care services are most often limited to personal care services such as bathing and dressing, and often also include homemaker services such as help with meal preparation or household chores.

Homemaker/chore services, can help you with general household activities such as meal preparation, routine household care, and heavy household chores such as washing floors, windows or shoveling snow.

Meals programs, which include both home-delivered meals (so called “Meals-on-Wheels”) or congregate meals, which are provided in a variety of community settings.

Respite Care, which gives families temporary relief from the responsibility of caring for family members who are unable to care for themselves. Respite care is provided in a variety of settings including in the home, at an adult day center, or in a nursing home.

Senior Centers, which provide a variety of services including nutrition, recreation, social and educational services, and comprehensive information and referral to help people find the care and services they might need; and

Transportation services that can help you get to and from medical appointments, shopping centers and access a variety of community services and resources.

There are numerous types of facility-based programs that provide a range of long-term care services. Some facilities provide only housing and related housekeeping, but many also include help managing medications, assistance with personal care, supervision and special programs for individuals with Alzheimer's disease, or 24-hour nursing care. The services available in each facility are often regulated by the state in which the facility operates (for example, some states do not allow some types of facilities to include residents who are wheelchair bound or who cannot exit the facility on their own in an emergency). Facility-based care is known by a wide variety of names, including board and care, assisted living, adult foster care, Continuing Care Retirement Communities (CCRCs), and nursing homes.

Facility-based service providers include the following:

Adult Foster Care

Adult foster care can be provided for individuals or for small groups of adults who need help functioning or who cannot live safely on their own. The foster family provides room and board, 24-hour availability, help managing medications, and assistance with Activities of Daily Living. Licensure requirements and the terminology used for this type of facility vary greatly from state to state.

Board and Care Homes

Board and care homes, also called residential care facilities or group homes, are smaller private facilities, usually with 20 or fewer residents. Most board and care homes accept six or fewer residents. Rooms may be private or residents may share rooms. Residents receive meals, personal care and have staff available 24 hours a day. Nursing and medical attention are usually not provided on the premises. State licensure and the terminology used for this type of facility vary greatly.

Assisted Living

Assisted living is designed for people who want to live in a community setting and who need or expect to need help functioning, but who do not need as much care as they would receive at a nursing home. Some assisted living facilities are quite small – with as few as 25 residents – while some can accommodate 120 or more units. Residents often live in their own apartments or rooms, but enjoy the support services that a community setting makes possible, such as:

•up to three meals a day;
•assistance with personal care;
•help with medications, housekeeping, and laundry;
•24-hour security and onsite staff for emergencies; and
•social programs.
The cost of assisted living varies widely, depending in part upon the services needed by the resident and the amenities provided by the facility. Assisted living is regulated in all states, however, the requirements vary.

Continuing Care Retirement Communities (CCRCs)

Continuing Care Retirement Communities (CCRCs) are also called life care communities. They offer several levels of care in one location. For example, many offer independent housing for people who need little or no care, but also have assisted living housing and a nursing facility, all on one campus, for those who need greater levels of care or supervision. In a Continuing Care Retirement Community, if you become unable to live independently, you can move to the assisted living area, or sometimes you can receive home care in your independent living unit. If necessary, you can enter the onsite or affiliated nursing home. The fee arrangements for CCRCs vary by the type of community. In addition to a monthly fee, many CCRCs also charge a one-time “entrance fee” that may be partially or completely refundable (often on the sale of the unit).

Nursing Homes

Nursing homes, also called Skilled Nursing Facilities (SNF) or convalescent care facilities, provide a wide range of services, including nursing care, 24-hour supervision, assistance with Activities of Daily Living, and rehabilitation services such as physical, occupational, and speech therapy. Some people need nursing home services for a short period of time for recovery or rehabilitation after a serious illness or operation, while others need longer stays because of chronic physical, health or cognitive conditions that require constant care or supervision.

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