Long Term Care - Care in Your Home
Overview
Planning for Care
Care in Your Home
Home Health Services
Home and Community Based Waiver Services
Hospice
Long term care (LTC) is a phrase that describes health and personal services needed by people of all ages with ongoing health needs and those who are too frail to do essential things for themselves. Long term care takes many forms including nursing services, therapy, cooking or household chores, managing money and properties, shopping and transportation. Long term care may be provided by nurses, aides, family members, neighbors, volunteers, and others.
You can receive long term care services in your own home or in other settings such as nursing homes, homes for the aged, adult foster care homes, and other assisted living environments. These housing options offer a wide variety of care services. However, determining which service or setting best meets your particular needs and are available in your community can be difficult.
Just accepting that you or a loved one may need long term care sometimes is heart-rending. Using LTC services is often the best thing to do. Advancing smartly into this complicated area requires information -- and lots of it! Becoming familiar with available options paves the way to wise decisions.
[Back to Top]Most long term care is provided by family and friends. Families usually feel that they should provide the needed care. However, some people don’t have family members nearby. Others have no family at all. Sometimes, the family caregivers find the growing responsibilities too overwhelming and simply can’t continue.
Taking the time to plan care and tend to your personal feelings can help assure that good decisions are made. Talking with loved ones about what to do when you or they can no longer care for themselves is difficult. It’s sad. It’s frightening. But, it’s important. Many people plan for their funeral, but avoid planning for long term care.
Planning for care involves more than making a reservation at a nursing home or deciding to hire an in-home companion. It means sitting down with those you care about and involving them in your search for options and making decisions.
If you are the person needing care, consider how much your plans will help the people that love and care for you. Knowing what you really want, your family can help make sure that your plans are fulfilled even if you become too ill to make decisions or express yourself. Just as important, their knowing what you don’t want can help avoid pain and conflict down the road.
If you don’t have immediate family, you might rely on trusted friends for help. In this situation, it is even more important to write down your care choices and instructions. Your friends will have no other binding way to speak for you. Also, tell any distant relatives and your doctor what your plans are and who you have appointed to represent you.
There are many considerations to think about: your health status and prognosis, your personal preferences about health care and treatments, your financial resources, the availability of your family to be caregivers, their familiarity with your financial matters, health status, and doctors, available community resources and services, and lifestyle choices.
If you have the luxury of planning in advance, do it. Even if you don’t need it now, a long term care plan is like an insurance policy to be used if and when needed. Since few decisions in life are irreversible, remember that flexibility and adaptability are key ingredients to a workable planning process for successful long-term care.
Care in Your Home
Fortunately, it is often possible to get the long-term care services you need in your own home. While no government program or private insurance policy currently pays for 24 hour in-home care, there are programs that provide periodic visits and many kinds of assistance. Medicare, Medicaid, the Department of Human Services (DHS), and area Agencies on Aging, among others, fund these services. Each program has its own eligibility requirements.
The following list summarizes services that may be available to help you at home. Your local area Agency on Aging can help you find these services. Area Agency on Aging offices are listed in the Resource section of this website.
[Back to Top]Home Health Services
When ordered by a physician, Medicare, Medicaid, and some long term care insurance policies help pay for these services. Most government-funded home health services are usually time-limited, delivered and paid to help you restore your health and ability for self-care. Provided by home health agencies, two basic types of services are offered.
Home Nursing Care is provided by licensed nurses and therapists. Nursing services can include changing dressings, checking blood pressure, and giving medications or injections. Therapists provide physical, occupational, and speech therapy.
Personal Care Services include help with bathing, dressing, light meal preparation, light housekeeping, and monitoring medication intake. Nurse aides provide these services and are supervised by licensed nurses.
Home and Community Based Waiver Services
As discussed in the section on Medicaid, this is a comprehensive Medicaid-funded program that helps disabled adults avoid nursing home care. Medicaid pays for your care at home if your needs are comparable to people living in nursing homes. To qualify, you must also meet Medicaid’s nursing home income and asset qualifications.
Hospice
This is an expansive health and support program for you and your family if you are terminally ill. The emphasis is on palliative care, that is to make the dying person as comfortable and pain-free as possible. Added to the usual home health services are physician visits, prescription drug coverage, social work services to the entire family, religious and spiritual services, and bereavement services to the family following death. For Medicare hospice benefits, a doctor must certify that you are not expected to live more than six months, although services can continue beyond that time.
Respite Care A qualified person comes to the home for temporary relief of the family caregiver.
Homemaker and Home Chore Services These services help you with routine household duties like cooking, laundry, shopping, light housekeeping, essential errands, yard work, and other necessary tasks.
Home Delivered Meals Most often known as Meals On Wheels, this service provides one or more meals a day, five to seven days a week, delivered to your home.
Home Repair, Maintenance and Security This service provides minor home repairs and improvements such as constructing wheelchair ramps, reducing utility consumption, clearing drains, and repairing roof leaks, faucets, toilets, steps, furnaces, burglary damage, and adding security devices.
Friendly Visitor Program Someone comes to your home, usually weekly, to check on you. In some communities, the local police will make periodic visits.
Telephone Reassurance Program Someone calls you regularly to find out how you are doing. Some hospitals and agencies offer an emergency alert response system that allows you to signal for help using a small electronic device. If distressed, you activate the device, notifying the response center that help is needed. If the response center cannot reach you by telephone, someone is dispatched to your home.
Care Management Care management is a planning service offered by or through area Agencies on Aging and other agencies to help families identify and arrange needed long term care services. Generally, this service is offered to adults who have needs that are comparable to the type and degree of help needed by nursing home residents. Care management services are usually delivered by a small professional team, including a nurse and social worker.
This service starts with a thorough assessment of your needs. Assessment findings and your preferences guide development of a care plan. The care management team implements this plan by arranging needed services, periodically reviewing your needs and revising the service plan when appropriate.
It's a good idea to find out if the care manager you will be using is certified by a professional care management association, such as the National Association of Professional Geriatric Care Managers (520) 881-8008. It is one of several private trade groups that set professional standards for care managers and make referrals to their members.
