As our population ages, many of us will need some type of long-term care. Studies show that by 2020, 12 million Americans will require assistance to live, and that most (about 70%) will be looked after at home by family and friends. (U.S. Department of Health and Human Services.) Long-term care covers a variety of different services, which include both medical and non-medical care for people who have a chronic illness or disability. Most long-term care is to assist people with activities of daily living, such as preparing food, dressing, or using the bathroom. It can be provided at home, in the community, in an assisted living facility, or in a nursing home.

Paying for Long-Term Care

The most important aspect of paying for long-term care is planning ahead. The options are government programs, like Medicaid, private insurance policies, reverse mortgages, help from family members and savings. Note that Medicare only pays for short-term medically necessary skilled nursing facilities or home health care, but not “custodial care” which is care that helps you with activities of daily living. Medicaid, on the other hand, is a state and federal government program that does pay for certain health services and nursing home care. In most states, Medicaid also covers some long-term care services at home and in the community. Services that are covered vary from state to state. Eligibility is based on your income and personal resources.

Choosing Long-Term Care

While it is difficult to think about possible future health care needs, especially if you are in good health right now, choosing long-term care is an important decision and requires some forethought. Below is a list of long-term care options and the services they generally provide.

• Community-Based Care

  Many communities provide services and programs (free or at a low cost) to assist seniors and people of any age with disabilities. Services may include Meals-on-Wheels (home meal delivery), para-transit (transportation), personal care, chore services, adult day care, senior centers, telephone reassurance, and others. Your Area Agency on Aging coordinates these services and you can find your local office by going to the Department of Health and Human Services website. If you qualify, Medicaid may pay for some community-based care services.

• Home Health Care

  Some health care agencies will provide a care worker in your home. Costs vary depending on where you live, the type of care you need, and how often you need such care. Usually home care is charged by the hour. It may or may not be covered by a long-term care insurance policy. Certain home care, however, can only be given by licensed health workers, such as skilled nurses. The cost of skilled nursing or other medical care varies greatly and may be covered by Medicare if you meet certain conditions. Go to the U.S. Department of Health and Human Services’ website for more information.

  To locate home health agencies that provide services in your area, a good resource is the National Association for Home Care. Click on “Consumer Information”, and then on “Agency Locator” to search for skilled nursing care, home health aids, personal care aids and hospice care.

• Housing for Aging and Disabled People

  Most states and the federal government have programs that help pay for housing for seniors and the disabled with low or moderate incomes— less than $46,000 if single or $53,000 if married. These are typically referred to as “Section 8 housing,” named for the law that created the program. Residents live in their own apartments in a housing complex. Rent is usually a percentage of your income. For more information, go to the U.S. Department of Housing and Urban Development’s website.

• Board and Care Homes

  Board and Care Homes are group living arrangements, sometimes called “group homes”, where the residents are assisted with activities of daily living. They are for people who can no longer live on their own, but do not need nursing home services. In some cases, private, long-term care insurance may help pay for this type of living situation. These homes are usually not regulated by the state or federal government and are not covered by Medicare or Medicaid. Find out more about Board and Care Homes in your community by visiting your Area Agency on Aging online.

• Assisted Living Facilities

  Assisted Living Facilities provide residential housing with support services, sometimes healthcare services, and recreational activities. They do not provide skilled nursing care. They offer apartment-style living, assistance with dressing, grooming, bathing, and other daily activities, meals, usually in a common dining room, linens and laundry service, and social activities such as classes, movies, and lectures. The cost is moderate to expensive and it is not covered by Medicare or Medicaid. Some long-term care insurance policies cover Assisted Living Facilities.

• Continuing Care Retirement Communities

  Continuing Care Retirement Communities (CCRCs) offer several different levels of care at one location. Where you reside in the community depends on the level of long-term care you require, and if your needs change, you can move up or down to a different level. There may be individual homes with 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 more care. Cost is based on the level of care you receive. Choose a CCRC by the reputation of its nursing home even if you may not need that much care initially. A good resource for information on CCRC’s is the Commission on Accreditation of Rehabilitation Facilities; also check with the Administration on Aging, and the American Association of Homes and Services for the Aging.

• Nursing Homes

  Nursing homes provide care for people who cannot be looked after at home, in the community, or at an assisted living facility due to physical, mental or emotional problems. They supply their residents with skilled nursing care, administration of medications, meals, assistance with feeding, physical and occupational therapy, respiratory therapy, ambulatory assistance devices, and more. Medicare does not pay for this type of long-term care, although it may cover the medical care portion for the first 100 days. Medicaid may cover it if you qualify. The cost is high depending on where you live and the level of care you require. For information on and assistance with searching for a home in your area, a good resource is The Joint Commission, which you will find online at http://www.jointcommission.org/. Go to “Information for the General Public” at the bottom of the home page and then “Quality Check” to search for providers.