Long-Term Care: Choosing the Right Place

by National Institute on Aging

Many of us hope to stay in our homes as we grow older. Often we are able to do that. But later in life - usually by our 80s and 90s - some of us need a hand with everyday activities like shopping, cooking, or bathing. A few of us need more help on a regular basis. Maybe that means it's time to move to a place where expert care is available around-the-clock.

Where to start

Do you think that your family member can't live at home any longer? It might be your husband or wife, a parent, aunt or uncle, or even a grandparent. You've added a hand rail on the front steps and grab bars in the bathroom. You made plans for a home health aide to come to the house every day. You arranged for help with meals, and you visit every day. But now you wonder if staying at home is the best choice. Where do you go for help? Here are some answers to that and other questions that you might have as you look for the best place for you or your relative to live.

Sometimes the need for help grows over time. For example, Bob is 87 years old. He has lived alone since his wife died ten years ago. For the last few years, he has needed more and more help doing things for himself. First, he had trouble making meals. So, he ate a big lunch at the local senior center until last year when he gave up driving. Now sometimes his daughter drops off meals. Other times meals are delivered by a local program. The stairs in his house are getting too hard to climb. Bob also forgets more and more things. He often forgets to take his blood pressure medicine. He has also left the burner on the stove turned on several times. He doesn't want to move in with his daughter and her family, so Bob and his daughter are looking for a new place for him to live.

Over the last year Bob's daughter has been thinking this time might come. She knows what's available. She's looked into how they will pay for the care her dad needs. Bob too has been doing some planning. He is sad about leaving his home, but he has been preparing for the time when he'd need more help. He even put his name on a waiting list for a nearby retirement community that he liked. Now they have an opening there. The admission coordinator at the community will help him decide if he can live in one of their apartments or needs to be in their assisted living facility.

Bob and his daughter were lucky. Sometimes you need to make a choice quickly. If you haven't planned ahead, then making a decision might not be so easy. For example, Alice and her husband have lived in their house for 50 years. At 84, she still loves to cook and work in her garden every day. Last week she slipped in her bathroom, fell, and broke her hip. Now after an operation to fix her hip, she needs to go somewhere for nursing care and rehabilitation. Her doctors don't know if she'll ever recover enough to go home again. Her children live hundreds of miles away. But her husband and family only have a few days to find a place.

Alice and her family were not prepared like Bob and his family. The social worker and discharge planner at the hospital will help them find a place for Alice to go for therapy after she leaves the hospital. But if she is too frail to go home after her hip heals, she and her family will have to choose a place for her to live permanently.

What the choices are

There are two kinds of senior living facilities based on how much help is needed: assisted living facilities, Skilled nursing facilities or nursing homes.

You should think about an assisted living facility if you or your relative don't need a lot of medical care but do need more help than can easily be gotten at home. Assisted living homes can give someone as much help as needed with daily living, but offer only some nursing care or none at all. People often live independently in their own unit. The place provides meals and house cleaning, offers interesting things to do, and takes residents wherever they need to go, like the doctor or the shopping mall. They can also provide help with bathing, dressing, and taking medicines, if needed.

Some assisted living facilities are part of a continuing care retirement community or lifecare community. These communities offer independent living and skilled nursing facilities as well as assisted living. Sometimes assisted living help is set up in a home with only a few residents. These are often called board and care homes.

If your relative becomes very frail or suffers from the later stages of dementia, more care could be needed. A nursing home or skilled nursing facility may be necessary if someone: needs round-the-clock nursing care, might wander away without supervision, needs help with meals, bathing, personal care, medications, and moving around, needs more help than the current caregiver can possibly give, or cannot live alone.

These places supply 24-hour services and supervision, including medical care and some physical, speech, and occupational therapy, to people living there. They might also offer other services such as social activities and transportation. As a rule, the rooms are for one or two people. Some places want residents to bring some special items from home to make their rooms more familiar. Some even allow a pet or make it possible for couples to stay together.

Both assisted living and skilled nursing facilities sometimes offer special areas for people with dementia. These areas are designed to meet the special needs of these people and to keep them safe from wandering.

How to choose

Ask questions. Find out about what is available in your area. Is there any place close enough for family and friends to visit easily? Doctors, friends and relatives, local hospital discharge planners and social workers, and religious organizations may know of places.

Also, each state has a Long-Term Care Ombudsman. They have information and may be able to answer questions about a place you are considering. The ombudsman is also available to help solve problems that might come up between a nursing home and the resident or the family. To find your state long-term care ombudsman, contact the Administration on Aging's Eldercare Locator at 1-800-677-1116 or www.eldercare.gov.

About the Author

www.nia.nih.gov
NIA, one of the 27 Institutes and Centers of NIH, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. In 1974, Congress granted authority to form NIA to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people.