The prospect of needing long-term care services concerns many older people. The likelihood of needing long-term care increases greatly as people age. Older people are more likely to develop chronic disorders and to have problems functioning. Learning about the many types of long-term care can help people choose the right time and place for this care. How long care is needed varies from weeks to years to indefinitely.

The focus of long-term care is on helping people function. It helps them do the activities necessary to care for themselves and to live as independently as possible. These activities include basic daily activities (such as eating, dressing, bathing, grooming, and walking) and other activities (such as shopping, balancing a checkbook, doing laundry, and cleaning). Long-term care usually includes help with health care. Most long-term care facilities also provide social and recreational activities.

Many people have their first experience with long-term care after a hospital stay. During an illness or after an injury, many older people lose some or all of the ability to care for themselves. Thus, although they may be well enough to leave the hospital, they may need to go to a long-term care facility for rehabilitation and recovery. This move can be physically and psychologically demanding. People have to adjust to many new faces and to new routines for sleeping, bathing, dressing, eating, and other daily activities. The move happens quickly, with little time to adjust.

Most people associate long-term care with a change in residence:

• To the home of a family member
• To a retirement community
• To an assisted living community
• To a board-and-care facility
• To a life-care community
• To a nursing home

However, only one third of older people who receive long-term care live in an institutional setting. The others receive care in their own home or in the home of a family member. People who receive care in institutions are usually those who have more physical and thinking (cognitive) problems, less social support from family members and friends, or both.

What type of arrangement is possible depends partly on a person's needs (medical, functional, social, and emotional). However, it also depends on a person's preference, finances, and social support (for example, family members' willingness and ability to help). One person may be able to live at home with the help of a spouse. Another person with similar problems but without family support may need to go to a nursing home.

After the type of arrangement needed is determined, a particular facility must be carefully chosen. Within each type, facilities differ considerably in environment, services (including health care), activities, living arrangements, and rules. Sometimes the difference is simply a matter of what people can afford, but even within a price range, quality varies.

Delaying the Need for a Long-Term Care Facility
The idea of going to a long-term care facility, particularly a nursing home, does not appeal to most people. The following problems are common reasons for entering a long-term care facility. However, sometimes problems can be solved, and the need for a long-term care facility can be delayed or avoided. Urinary incontinence: People with urinary incontinence may be hard to care for at home. However, urinary incontinence may be caused by a disorder that can be treated. Treating the disorder may cure the incontinence. People with urinary incontinence, their family members, or their caregivers should talk with a doctor to find out whether treatment is possible. Problems with doing daily activities: Certain devices can help people function better. A physical or occupational therapist or a home health nurse can observe people in their home and can sometimes help them choose appropriate devices that will enable them to continue to function safely at home. Dementia: Taking care of people with dementia is difficult and frustrating. However, family members can learn ways of dealing with the behavior. For example, to deal with wandering, family members can place an identification bracelet on the person or purchase or rent a monitoring device. Learning more about how to care for people with dementia may delay the need for a long-term care facility. Caregiver burnout: Strongly motivated family members can usually provide elaborate and detailed care. However, providing such care can wear them out physically and emotionally. Talking with health care practitioners can help. They can provide information about caregiving support groups and about groups that provide temporary (respite) care.

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Types of Long-Term Care Type Services Typical Living Arrangement Funding Assisted living communities Meals (in a common dining room or in the person's room) Social and recreational activities Help with daily activities In some facilities, monitors for emergencies (such as intercoms and personal emergency response systems), services of nurses and physical therapists, and 24-hour supervision if needed Apartments or occasionally just a bedroom with a private bath Mostly private funds or long-term care insurance Help from Medicaid in some states Board-and-care facilities Meals (in a common dining room or in the person's room) Transportation to medical appointments or shops Social activities Help with personal care and sometimes some help with taking drugs (for example, reminding people to take their drugs) Rooms on a common hallway Mostly private funds Life-care communities Meals (usually in a common dining room, except for residents who need more care and who have meals in their room) Transportation Social and recreational activities As much help with daily activities and health care as needed Varied arrangement according to need Mostly private funds Help from Medicare and Medicaid for skilled nursing care when it is needed Nursing homes Meals Help with daily activities 24-hour skilled nursing care, rehabilitation (physical, occupational, respiratory, and speech therapy) Hospice care Oversight by a doctor Rooms on a common hallway Private funds Medicaid Medicare for skilled care for a short time in certified nursing homes if care is needed daily after a hospital stay lasting 3 days or more

Last full review/revision February 2009 by Paul R. Katz, MD