A nursing home may not be your only choice. Before you make any decisions about long term care, talk to your family, your doctor or other health care provider, a person-centered counselor, or a social worker to understand more about other long-term care services and supports like the ones listed below.
There are a variety of community services that might help you with your personal care and activities, as well as home modification and equipment to support you staying at home. Some services, like volunteer groups that help with 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. These home services and programs may be available in your community:
- Adult day care
- Adult day health care, which offers nursing and therapy
- 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
Depending on your needs, you may be able to get help with your personal activities (like laundry, shopping, cooking, and cleaning) at home from family members, friends, or volunteer groups. Home care agencies are also available to help with personal care, like help walking or bathing.
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. Medicare will only pay for these if you meet certain conditions.
There are also some home health care agencies that can help with nursing care in your home. Home health care agencies may also provide other services, like physical therapy, occupational therapy, and help bathing.
Medicare only covers short-term home health care if you meet certain limited conditions.
If you or a loved one owns a single-family home, adding an accessory dwelling unit (ADU) may help you keep your independence. An ADU (also called an "in-law" or "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. Sometimes people turn an upper floor, basement, attic, or space over a garage into an ADU, and sometimes people build somewhere else on the property.
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 the size and cost of building materials and workers.
There are federal and state 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, like housekeeping, shopping, and doing the laundry. People usually live in their own apartments in the complex and pay rent that's a percentage of their income.
Residential care facilities include board and care homes (sometimes called “group homes" or “personal care homes”), and assisted living. Board and care homes and assisted living communities are group living arrangements that provide help with some activities of daily living. Whether they provide nursing services or help with medications varies among states. In some states, board and care homes and assisted living mean the same thing.
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 to contact the facility and make sure they can meet your needs. In assisted living, people often live in their own room or apartment within a building or group of buildings and have some or all of their meals together with other residents. Social and recreational activities are usually provided. Some of these facilities have health services on site.
In most cases, board and care home and assisted living residents pay a regular monthly rent and pay additional fees for the services they get. Medicare doesn’t pay for assisted living facilities.
These facilities provide help with activities of daily living. Some help with care most people can do themselves (like taking medicine, using eye drops, 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. Not all assisted living facilities provide the same services. In most cases, assisted living residents pay a regular monthly rent, and then pay additional fees for the services they get.
Continuing Care Retirement Communities (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 people 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 needs, but usually stay within the CCRC. If you're considering a CCRC, be sure to check the quality of the nursing home.
Your CCRC contract usually requires you to use the CCRC's nursing home if you need nursing home care. Some CCRC's will only admit people into their nursing home if they've previously lived in another section of the retirement community, like their assisted living or an independent area.
Many CCRCs generally require a large payment before you move in (called an "entry fee") and charge monthly fees.
Hospice is a program of care and support for people who are terminally ill. Hospice helps people who are terminally ill live comfortably. The focus is on comfort, not on curing an illness.
Respite care is a very short inpatient stay given to a hospice patient so that their usual caregiver can rest.
Learn more about Medicare's coverage of hospice & respite care.
PACE (Program of All-inclusive Care for the Elderly) is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility. PACE covers adult day primary care, dentistry, emergency services, home care, hospital care, laboratory/x-ray services, meals, medical specialty services, nursing home care, nutritional counseling, occupational therapy, physical therapy, prescription drugs, Part D covered drugs, preventive care, social services, caregiver training, support groups, respite care, social work counseling, and transportation if medically necessary.
If you're already eligible for Medicaid (or would be eligible for Medicaid coverage in a nursing home), 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. For more information, visit The Eldercare Locator, or call your local Area Agency on Aging.
Visit www.longtermcare.gov for information and resources to help you and your family plan for future long-term care needs.
If you have limited income and resources, there may be state programs that help cover some of your costs in some long-term care choices. Call your State Medical Assistance (Medicaid) office for more information.