Nursing home might a best option for the patient, or it
may be definitely not. Before starting the search for suitable accommodations,
get familiarized with other alternatives to the nursing home dispatching.
Discuss all the available approaches in the given situation and patient state
with your family, your doctor or other health care provider, or a social worker
for help deciding what kind of long-term care you need.
If you have limited income and resources, there may be
state assistance programs that help cover some of your costs in some of the
long-term care choices. Call your State Medical Assistance (Medicaid) office
for additional information.
Community services
A variety of
community services might help with your personal care and activities, if these
services aren’t covered by your health insurance. Some services, like volunteer
groups that help with things like shopping or transportation, may be low cost
or the group may ask for a voluntary donation. Some services may be available
at varied costs, depending on where you live and the services you need.
Below is a list of home services and programs that are
found in many communities:
* Adult day care
* Meal programs (like Meals-on-Wheels)
* Senior centers
* Friendly visitor programs
* Help with shopping and transportation
* Help with legal questions, bill paying,
or other financial matters
For detailed information about available community
services, call your local Area Agency on Aging, Aging and Disability Resource
Center, or Center for Independent Living.
Home Care
Depending on your needs, you may be able to get help with
your personal care activities (such as laundry, shopping, cooking, and
cleaning) at home from family members, friends, or volunteer groups. If you
think you need home care, talk to your family to see if they can help with your
care or help arrange for other care providers. There are also some home health
care agencies that can help with nursing or attendant care in your home. If
you’re eligible for Medicaid, personal care services in your home may be covered.
Not all in-home services are the same. Some in-home
services provide non-medical help, such as assistance with daily living. Other
in-home services involve medical care given by a licensed health professional,
such as a nurse or physical therapist.
Common types of
in-home services:
* Companion services:
Help with supervision, recreational activities or visiting.
* Personal care services:
Help with bathing, dressing, toileting, eating, exercising or other personal
care.
* Homemaker services:
Help with housekeeping, shopping or meal preparation.
* Skilled care: Help
with wound care, injections, physical therapy and other medical needs by a
licensed health professional. Often times, a home health care agency
coordinates these types of skilled care services once they have been ordered by
a physician.
Accessory dwelling
units (ADUs)
If you or a loved one owns a single-family home, adding
an ADU to an existing home may help you keep your independence. An ADU,
sometimes called an “in-law apartment,” an “accessory apartment,” or a “second
unit,” is a second living space within a home or on a lot. It has a separate living
and sleeping area, a place to cook, and a bathroom. Space such as an upper
floor, basement, attic, or space over a garage may be turned into an ADU.
Family members might be interested in living in an ADU in your home, or, you
may want to build a separate living space at a family member’s home.
The common
features of all accessory units are that they are self-contained (they provide
complete living facilities for the use of one or more individuals, with
permanent provisions for living, sleeping, eating, cooking, and sanitation) and
subordinate to the existing dwelling. The approach used by most municipalities
for accessory units is a zoning bylaw that permits the additional, but
accessory unit, allowing certain improvements to be made to the existing
dwelling. Restrictions that may be considered include whether the dwelling
existed as of a certain date, the maximum allowed building and site
modifications, the options for choosing inhabitants, whether the owner must
occupy the main unit, and minimum lot sizes.
Check with your local zoning office to be sure ADUs are
allowed in your area and find out if there are special rules. The cost for an ADU
can vary widely depending on how big it is and how much it costs for building
materials and workers.
There are state and Federal programs that help pay for
housing for some older people with low to moderate incomes. Some of these
housing programs also offer help with meals and other activities, such as
housekeeping, shopping, and doing the laundry. Residents usually live in their own
apartments within an apartment building. Rent payments are usually a percentage
of your income (based on a sliding scale).
Board and care
homes
Board and care homes are group living arrangements
designed to meet the needs of people who can’t live independently but don’t
need nursing home services. Most board and care homes provide help with some of
the activities of daily living, such as bathing, dressing, and using the
bathroom. Board and care homes are sometimes called “group homes.” Many of
these homes aren’t paid for by Medicare or Medicaid. The monthly charge is
usually a percentage of your income (based on a sliding scale) that covers the
cost of rent, meals, and other basic shared services.
Assisted living
facilities
These facilities vary from state to state, but generally
they provide help with activities of daily living, such as bathing, dressing,
and using the bathroom. They may also help with care most people do themselves,
like taking medicine or using eye drops, and additional services, like getting
to appointments or preparing meals. Residents often live in their own room or
apartment within a building or group of buildings and have some or all of their
meals together. Social and recreational activities are usually provided. Some
of these facilities have health services on site.
In most cases, assisted living residents pay a regular
monthly rent and pay additional fees for the services they get. Assisted living
facilities aren’t paid for by Medicare. The term “assisted living” may mean
different things in different facilities within the same state. Not all
assisted living facilities provide the same services. It’s important that you
contact the facility and make sure they can meet your needs.
Continuing Care
Retirement Communities (CCRCs)
CCRCs are retirement communities that offer more than one
kind of housing and different levels of care. In the same community, there may
be individual homes or apartments for residents who still live on their own, an
assisted living facility for people who need some help with daily care, and a nursing
home for those who require higher levels of care.
Residents move from one level to another based on their
individual needs, but usually stay within the CCRC. If you’re considering a
CCRC, be sure to check the quality information and inspection report (posted in
the facility) of its nursing home. Your CCRC contract usually requires you to
use the CCRC’s nursing home if you need nursing home care. Some CCRCs will only
admit people into their nursing home if they are already living in another
section of the retirement community.
Many CCRCs generally require a large payment before you
move in (called an entry fee) and charge monthly fees. To find out if a CCRC is
accredited and get advice on selecting this type of community from the
Commission on Accreditation of Rehabilitation Facilities and the Continuing
Care Accreditation Commission (CARF-CCAC), visit http://www.carf.org or call
1-202-587-5001.
Hospice care
Hospice is a special way of caring for people who are
terminally ill (expected to have 6 months or less to live) and for their
families. Hospice care includes physical care and counseling. The goal of
hospice is to provide comfort for terminal patients and their families, not to
cure the illness.
If you qualify for hospice care and you choose hospice,
you can get medical and support services, including nursing care, medical social
services, doctor services, counseling, homemaker services, and other types of
services. As part of hospice care, you will have a team of doctors, nurses,
home health aides, social workers, counselors, and trained volunteers to help
you and your family cope with your illness. In many cases, you and your family
can stay together in your home.
Medicare covers hospice care if you qualify. Depending on
your condition, you may get hospice care at home, in a hospice facility, hospital,
or nursing home. Medicare doesn’t cover room and board if you get general
hospice services while you’re a resident of a nursing home or a hospice’s
residential facility. If you’re eligible, Medicaid may pay for some services
that Medicare doesn’t cover, such as personal care assistance at home. Medicare
doesn’t pay for 24-hour assistance if you get hospice services at home.
Alzheimer’s Disease Special Care
Communities (nursing home-based)
These facilities
are characterized by high level of medical assistance, offering housing
designed to accommodate the special needs of those with Alzheimer’s
Disease. All support services are available, including 24 hour medical
staff trained in understanding Alzheimer’s Disease and its progression.
Residences are
usually private or semi private rooms. Payment is usually by private
pay, Medicaid or Medicare.
Respite care
Some nursing homes and hospice care facilities provide
respite care. Respite care is a very short inpatient stay in a nursing home or
hospice care facility for a hospice patient so that the usual caregiver can
rest. Medicare covers inpatient respite care for up to 5 days if you’re getting
covered hospice care services. Room and board are covered for inpatient respite
care and during short-term hospital stays. If you’re eligible, Medicaid will
pay for some of these services at home that aren’t covered by Medicare.
Respite care can provide the caregiver with:
* A chance to spend time with other friends and family,
or to just relax
* Time to take care of errands such as shopping,
exercising, getting a haircut or going to the doctor
* Comfort or peace of mind knowing that the person with
dementia is spending time with another caring individual
The person with dementia is experiencing many changes and
challenges, too, and may also need variety in his or her routine and social
interactions. Respite care services can give the person with dementia an
opportunity to:
* Interact with others having similar experiences
* Spend time in a safe, supportive environment
* Participate in enjoyable activities designed to match
personal abilities and needs
Programs of All-inclusive Care for the Elderly (PACE)
PACE is a Medicare and Medicaid Program that manages all
of the medical, social, and long-term care services for older people with
multiple care needs. It allows people to remain in their homes and maintain
their quality of life. PACE is available only in states that have chosen to
offer it under Medicaid. The goal of PACE is to help people stay independent and
living in their community as long as possible, while getting the high quality
care they need.
To be eligible for PACE, you must meet the following
conditions:
* Be 55 or older
* Live in the service area of a PACE
program
* Be certified as eligible for nursing home care by the appropriate
state agency
* Be able to live safely in the community
To find out if there is a PACE program in your area, visit
http://www.cms.hhs.gov/PACE or call your State Medical Assistance (Medicaid) office.
Home and Community-Based
Waiver Programs
If you’re already eligible for Medicaid (or, in some
states, would be specifically eligible for Medicaid coverage for nursing home
services), you may be able to get help with the costs of some home and
community-based services, like homemaker services, personal care, and respite
care. States have home and community-based waiver programs to help people keep
their independence while getting the care they need outside of an inpatient facility.
Sources and
Additional Information:
