Getting to Know Your Long-Term Care Options

Nearly three-quarters of the population over 65 will require some form of long-term care during their lifetimes and more than 40 percent of them will need long-term care in a nursing home according to the Department of Health and Human Services. While families and friends usually try to provide long-term care needs for their loved ones, the extent of that care and the time-period over which it is given will depend on the availability, capability and willingness of those individuals. Most often, a professional caregiver of some kind will need to be part of the long-term care plan.

What is long-term care?
Long-term care is care provided for a wide range of personal, medical and social services for an extended period-of-time. Determining needs for long-term care is often done by a health professional who can assess the level of disability and recommend the level and duration of care needed. The ultimate goals of long-term care are to help an individual maintain his or her existing level of health, avoid further decline, or to manage a deteriorating condition as safely as possible.

Once the level of care surpasses that which the family and friends can provide, it is time to consider bringing in support from the outside. If there is a natural progression and increase in the extent of assistance needed, family members have time to consider their options for how to proceed. If the decision needs to be made quickly, finding the right kind of care with the right care company or facility can be even more difficult to navigate.

National average costs
for long-term care in 2010

Source: Genworth 2010 Cost of Care Survey

Homemaker Services $18/hour
Home Health Aide Services $19/hour
Assisted Living Facility
(1 bedroom / single occupancy)
Nursing Home
(semi-private room)
Nursing Home
(private room)

Assessing the need for careThe first step is to determine the appropriate level of care the individual may require. A full assessment of what current daily needs are should be made. Observe the daily activities that the person is involved with and see which ones they are struggling to accomplish. A professional, such as your doctor, nurse, geriatric care manager, or hospital discharge planner may be helpful in this exercise. A ‘Daily Activities Assessment Form’ can guide you. Find one here.

Finding the right company to provide in-home care services
Once you have determined which daily activities need support and that the individual is able to stay in the home, a few choices for care are possible. Family and friends can pitch in to cover certain needs and/or a homemaker service or home health aide can come in and offer support for those areas.

Homemaker services companies help seniors who are able to function in their homes but need some assistance with household duties such as cooking, cleaning and running errands. A home health aide provides more extensive personal care than family and friends typically engage in. Assistance at this level is mainly to help a senior with Activities of Daily Living such as bathing, dressing, eating, and transferring, among other support.

In either case, someone you don’t know will be coming into the home regularly and caring for someone you love. Finding the right person or company takes lots of research and many questions. Here are some to get you started:

  • Is the agency licensed by the state?
  • Is the agency certified by Medicare to meet federal requirements?
  • Can the agency provide references from doctors, hospital discharge planners, and clients and their families?
  • What qualifications and credentials does the care provider have?
  • Can the care provider supply references?
  • What are the hiring practices of the agency? How do they find their care providers? What are their requirements for employment with the agency? Do they do background checks on all applicants?
  • How does the agency train caregivers? Do they provide continuing education?
  • Are the caregivers licensed in their fields and insured? Are they certified in CPR and first aid?
  • How do the supervisors monitor and evaluate the quality of care given by the care provider?
  • Will you get to interview and choose the people/person providing the in-home care prior to them starting?
  • How does the agency handle billing?
  • Does the agency provide a detailed written care plan before care begins?
  • What is the procedure for changing caregivers should you feel uncomfortable with the one that is assigned to you?
  • You can find more questions through the

Facilities that support long-term care needs
An outside-of-the-home alternative to the homemaker and home health aide is the assisted living facility. In this case, the individual moves out of his or her home and into an apartment-style setting. The person has access to consistent support with Activities of Daily Living or some kind of supervision while still maintaining a level of independence.

When a person needs more medical assistance, a nursing home is the next option. Nursing homes offer shelter and care for seniors who have more serious health problems, functional impairments or cognitive deficits. Services include personal care, room and board, supervision, medication, therapies, rehabilitation, and 24-hour skilled nursing.

To find the right assisted living facility or nursing home, it takes more than the right questions. Tours of the facilities and talking to other residents’ families are necessary to determine if that particular facility is a good match for your loved one.

The questions you should ask and the observations you should make include:


  • Is this facility Medicare/Medicaid certified?
  • Are the home and the current administrator licensed?
  • Ask the staff for the latest Quality of Care report. If there are deficiencies mentioned, ask if all of them have been taken care of?
  • Does the home conduct background checks on all staff?
  • Does the home have abuse prevention training?
  • Is it easy for friends and family to visit?
  • Do residents have choices at mealtimes?
  • Is there water readily available at all times of the day?
  • Are nutritious snacks available at all times of the day?
  • Can residents make choices about their daily routine?
  • Are there enough appropriate activities?
  • Is there enough staff at night and on weekends to cover the needs of each resident?
  • How does the home respond to emergency situations? What is the home’s arrangements with nearby hospitals?


  • Are residents clean, appropriately dressed and well groomed?
  • Are hallways clear of clutter and wide enough for wheelchairs and walkers?
  • Does the facility appear and smell clean, have good lightning, and is it maintained at a comfortable temperature?
  • Does the staff treat residents well? Are they warm, friendly and responsive?
  • Does the food look and smell good, and is it served at appropriate temperatures? Ask to try some samples.
  • Are there handrails in the hallways and grab bars in the bathrooms?
  • Are exits marked clearly?

More questions for care facilities can be found at

In any long-term care situation, it is a good idea to observe the caregivers in action, preferably before you hire them or before a senior moves into a facility. Work with the company or facility to determine how to accomplish that. The more questions you ask and the more information you can get from the company or facility itself and from others who have used it, the more the final decision will align with the senior’s care needs and provide a safe and comfortable living situation for the senior.