March 20, 2006

AMARILLO – The face of long-term care has changed significantly in recent years and continues to evolve to meet the needs of today's older adults, said a Texas Cooperative Extension specialist.

While many people wish to remain in their homes throughout their life, that is not always possible, Andrew B. Crocker, Extension gerontology specialist. It is important to make an informed decision when choosing a long-term care facility.

"Planning for long-term care is not easy," Crocker said. "Individual needs change over time as do the rules about programs and benefits. Be sure to include your family in your decision to move to a long-term care facility, no matter what the level of care."

By the same token, he said, "if you are a care giver considering placing a loved one in a facility, be sure to involve that loved one in the decision-making process as much as possible."

Several levels of long-term care are available and choices range from independent living facilities to nursing homes, Crocker said.

An independent living facility may resemble an apartment complex or a hotel, providing personal living spaces while accounting for some of the extra needs older people have, such as railings in the bathrooms and wider doorways, he said.

Many such facilities include a small kitchen and laundry room, and, depending on the facility, additional services may be provided at a premium, such as a meal service, Crocker said. Size of the units, cost of living and additional services offered will vary.

An assisted-living facility may be appropriate for those who need more help, Crocker said. Assisted living facilities may help as needed with daily living, but offer only some nursing care or none at all.

The facility usually will provide meals, cleaning services, activities and transportation, he said. Depending on the facility, living arrangements may be private or semi-private.

When more care is needed, the next choice is skilled nursing care – a nursing home, Crocker said. Nursing home care is for people who need help eating, bathing, with personal care, taking medications and mobility.

Nursing homes usually provide 24-hour services and supervision, including medical care and some physical, speech and occupational therapy, depending on the facility, he said.

One of the newer choices in long-term care is a continuing care retirement community. These communities often provide independent, assisted and nursing care in the same locale, Crocker said.

Multiple levels of care on the same "campus" provide many benefits to residents, including standardized services and ease of transition to more individualized care if a condition worsens, he said.

Choosing a facility may be the most difficult part. The American Association of Homes and Services for the Aging recommends:

– Ask questions. Talk to trusted friends, family, neighbors and health providers to determine their experiences with various facilities.

– Investigate. Texas maintains a "report card" for state-licensed facilities, the Quality Reporting System: http://facilityquality.dhs.state.tx.us/ . Use this site to obtain information about a facility or to compare facilities. – Call. Once you have a list of possible places, get in touch with each one. Ask basic questions about openings and waiting lists, number of residents, costs and methods of payment.

– Visit. Make plans to meet with the director of nursing and director of social services. Medicare offers a nursing home checklist: http://www.careplanner.org .

"Ask yourself if you would feel reassured leaving your loved one there," Crocker said. "And then visit again. Make a second visit without an appointment, maybe on another day of the week or time of day. See if your first thoughts are still the same."

Be aware that Medicare and Medicare supplemental insurance only cover short times of home health or nursing home care, typically for someone who is recovering after leaving the hospital, he said.

Medicaid may be used to pay for nursing home care, but only after certain income and asset requirements are met, Crocker said. Many people start paying for long-term care with their own money and later may become eligible for Medicaid.

Keep in mind that applying for Medicaid takes at least three months, he said. Also, new financial requirements for Medicaid allow a five-year look-back period for finances. This means assets and income from the last five years may be considered when determining eligibility.

Long-term care insurance can be bought years before it is needed, Crocker said, and is generally less expensive when purchased at a younger age.

The Texas Department of Insurance provides information for evaluating and purchasing a long-term care insurance policy at http://www.tdi.state.tx.us/ .

Additional information can be found on the Aging Service's site at http://www.aahsa.org .