Long-Term Care Options

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The growth of the senior population is calling attention to the rising demand for long-term services. Know the following terms related to long-term care courtesy of the Office of the Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services. From home health care to institutional care, seniors have a variety of services from which to choose depending on their state of health.


Long Term Care Options

Know your long-term care options.

SOURCE: www.cbo.gov

Activities of daily living (ADLs): Basic personal activities, including bathing, eating, dressing, moving around, transferring from bed to chair, and using the toilet.

Adult day care: A daytime community-based program for adults with functional impairments that provides health, social, and related support services in a protective setting.

Assisted living facility: Residences that provide a “home with services” and that emphasize residents’ privacy and choice. Residents typically have private rooms that lock (shared only by choice) and private bathrooms. Personal care services are generally available 24 hours a day. Assisted living facilities provide a broad range of residential care services, including some assistance with activities of daily living and instrumental activities of daily living but excluding nursing services (such as administration of medication). Assisted living facilities stress independence and generally provide less intensive care than that delivered in nursing homes and in other long-term care institutions.

Board and care home: A home that offers housing and personal care services. (Such a residence may also be called an adult care home or group home.) Services such as meals, supervision, and transportation are usually provided by the owner or manager.

Caregiver: A person who provides support and assistance with various activities. The person may provide emotional or financial support as well as help with different tasks. Caregivers may be unpaid (informal care) or paid (formal care).

Cognitive impairment: Deterioration or loss of intellectual capacity, as indicated by clinical evidence and standardized tests that reliably measure impairment in the areas of short- or long-term memory; orientation as to person, place, and time; and deductive or abstract reasoning. People with cognitive impairment require continual supervision to protect themselves and others from harm. Such loss in intellectual capacity can result from Alzheimer’s disease or from other ailments, such as vascular dementia, Parkinson’s disease, dementia with Lewy bodies, and fronto-temporal dementia.

Congregate housing: Individual apartments with which residents may receive some services, such as a daily meal with other tenants. Buildings usually have some common areas, such as a dining room or lounge, and additional safety measures, such as emergency call buttons. Rental payments for this type of housing may be paid in part by the government.

Continuing care retirement community: Communities that offer multiple levels of care (independent living, assisted living, and skilled nursing care) and that allow residents to remain in the same environment even if their needs change. These communities provide residential services (meals, housekeeping, and laundry), social and recreational activities, health care services, personal care, and nursing care. They require payment of a monthly fee and possibly a large initial lump-sum payment.

Custodial care: Assistive care for people with functional limitations that does not require specialized training or services. (See also personal care.)

Dementia: A group of diseases (including Alzheimer’s disease) that are characterized by memory loss and other declines in mental functioning.

Group home: See board and care home.

Home- and community-based services: Any care or services provided in a patient’s place of residence or in a non-institutional setting. Services may include skilled services, such as home health care and other medical services, and non-skilled services, such as personal care, adult day care or day treatment, and homemaking.

Home- and community-based waivers: Under section 1915(c) of the Social Security Act, state Medicaid programs may obtain a waiver to offer a wide array of home- and community-based services that an individual may use to delay or avoid institutionalization. Among the services offered are case management, homemaking, personal care, adult day care, habilitation, and respite care.

Home health agency: A public or private organization that provides health care services in a patient’s home.

Home health aide: A person who assists elderly, ill, or disabled people with household chores, bathing, personal care, and other daily living needs.

Home health care: Health care services provided in the home to aged, disabled, sick, or convalescent individuals who do not need institutional care. The care provided includes a wide range of health-related services, such as assistance with medications, treatment of wounds, and intravenous therapy, as well as help with basic needs, such as bathing, dressing, and mobility. The services may be provided by a visiting nurse association, home health agency, county public health department, hospital, or other organized community group and may be specialized or comprehensive. The most common types of home health care are nursing services; speech, physical, occupational, and rehabilitation therapy; homemaker services; and social services.

Homemaker services: In-home help with meal preparation, shopping, light housekeeping, money management, personal hygiene and grooming, and laundry.Impairment: Any loss or abnormality of psychological, physiological, or anatomical function.

Institutional care: People are considered to be receiving institutional care if they reside in facilities that provide long-term services and supports 24 hours a day, 7 days a week. Generally, two types of facilities provide such care to the elderly: nursing homes and residential care facilities.

Instrumental activities of daily living (IADLs): Tasks associated with running a household or living independently, such as using the telephone, taking medications, managing money, doing housework, preparing meals, doing the laundry, and shopping for groceries.

Long-term care: See long-term services and supports.

Long-term services and supports (LTSS): A category that encompasses a variety of supportive services provided to people who have limited ability to perform routine daily activities, such as bathing or dressing. LTSS typically exclude medical services that are needed to manage underlying health conditions. LTSS can be provided in nursing homes or other institutions, in people’s homes, or in community-based settings (such as adult day care centers). Medicaid is the primary government payer for most such services. The exceptions are skilled nursing facility services, hospice care, and home health care services, which Medicare pays for in some circumstances.

Nursing facility: See nursing home.

Nursing home: A facility licensed by the state to offer residents personal care as well as skilled nursing care on a 24-hour-a-day basis. Nursing homes also provide room and board, supervision, medication management, therapy, and rehabilitation. Many rooms are shared, and communal dining is common. Nursing homes may also be called nursing facilities or skilled nursing facilities.

Personal care: Services that enable individuals to perform routine daily activities that they would typically accomplish themselves if they did not have a disability. Also called custodial care, such services include assistance with activities of daily living as well as self-administration of medications and preparation of special diets.

Post-acute care: Recuperation and rehabilitation services provided to patients recovering after a stay in a hospital for acute care. Post-acute care is provided by skilled nursing facilities, home health agencies, and inpatient rehabilitation facilities, among others.

Residential Care Facility (RCF): A facility that provides room, board, and personal care services for people with functional or cognitive limitations or both but that is not licensed as a nursing home. The National Center for Health Statistics, in its National Survey of Residential Care Facilities, defines RCFs as “Facilities with four or more beds serving an adult population that are licensed, registered, certified, listed or otherwise regulated to provide housing services (i.e., room and board with at least two meals a day), 24 hour/7 day a week supervision, and help with personal care (e.g., bathing, dressing, or eating) or health-related services (e.g., medication management). Although Medicaid does not directly pay for room and board services provided in RCFs, the program covers long-term services and supports provided to RCF residents.

Skilled care: A level of care provided by licensed medical professionals, such as physicians, nurses, and physical therapists.

Skilled nursing care: Daily nursing and rehabilitative care that can be performed only by or under the supervision of skilled medical personnel. Skilled nursing care is a common form of skilled care.

Skilled nursing facility: A facility that is licensed to provide 24-hour nursing care and rehabilitation services in addition to other medical services. The term is usually used to describe facility-based post-acute care that is covered by health insurance, such as Medicare. A nursing home, or the part of the nursing home that delivers skilled nursing care, may be called a skilled nursing facility. (See also nursing home.)