Long-Term Care Explained: 7 Main Types of Care

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

When most people hear the phrase “long-term care,” they think of a nursing home. Long-term applies to many different kinds of settings. Seniors and developers are coming up with creative ideas for senior housing all of the time.

Jump ahead to these sections:

Not everyone wants the traditional medical model of care. However, there is more than one kind of care available—and most people end up in those common types of care.

When it comes to paying for long-term care, some people think that Medicare pays for senior housing. It does not. The only type of care that Medicare pays for is short term skilled nursing care following a hospitalization.

The only other way to pay for assisted living or a nursing home residency is to have a long-term care insurance policy. Even then, the policy may not cover the full cost. If you’re unsure of what to look for, keep on reading to learn more about long-term care.

What is Long-Term Care?

Long-term care is an overarching term used to describe care for someone who requires help in different areas of their life. This care is provided in several settings with varying levels of support. As the name implies, assistance is ongoing, although your loved one’s needs could change over time.

The best approach to long-term care is to plan before you or a loved one needs it. It’s hard to plan for the future when you don’t know what might happen, but pre-planning can ultimately reduce stress and lead to better decisions. 

ยป MORE: Don't skip these commonly forgotten post loss tasks. View our guide.

 

Who Usually Needs Long-Term Care?

Older or disabled adults need long-term care. As people age, they are more prone to falls, chronic medical conditions, and general decline. Sometimes a sudden accident or illness precipitates the need for care.

Other times, a slow decline can lead to increasing frailty. Giving assistance to your loved one with activities of daily living may be a temporary situation or permanent, depending on the situation.

People who need help with activities of daily living

The things we do on a daily basis are typically described by those in the caring industry as “Activities of Daily Living,” or ADLs. Assisting with ADLs typically consists of the following:

  • Bathing
  • Dressing
  • Grooming
  • Using the toilet
  • Transferring in and out of bed or a chair

People who need help with instrumental activities of daily living

Instrumental Activities of Daily Living (IADLs) are activities that require a higher level of cognitive function. IADLs are generally thought of as the following:

  • Budgeting and paying bills
  • Going to doctor’s appointments and managing medications
  • Shopping and planning and preparing meals
  • Organizing transportation
  • Managing the household including maintenance, and housekeeping

For some, dementia or other kinds of cognitive impairment make it difficult to keep up with these tasks. For others, multiple medical conditions make it hard to manage the responsibilities of a household.

People who have medical needs

People who have medical needs cover a broad spectrum. Family caregivers, as well as healthcare professionals, are expected to attend to complex medical problems.

Here are some needs that require medical care:

  • Incontinence and catheter care
  • Diabetic care
  • Injections
  • Would care
  • Medication management and dispensing
  • Preparation of special diets

Medical needs can arise from chronic health conditions, an acute illness, or an accident. With conditions like these, safety should be the first concern.

If your loved one has complicated medical issues, it is best to arrange for healthcare professionals to deal with those. Once your family member is stable, you or someone else can take over.

What Are the Main Types of Long-Term Care?

Long-term care involves a diverse and flexible array of services and supports. When making choices regarding advance care planning, many people fluctuate between types of care or combine several to provide the support that people need.

Families usually choose the least restrictive environment that offers the most independence. If and when the situation changes, more help is added through home-based services or a move to a higher level of care. 

1. Family caregivers

According to the Family Caregiver Alliance, “about 44 million Americans provide 37 billion hours of unpaid, ‘informal’ care each year for adult family members and friends with chronic illnesses or conditions that prevent them from handling daily activities such as bathing, managing medications or preparing meals on their own.”

Whether in conjunction with other support services or not, family caregiving is the backbone of long-term care in this country. Family caregivers provide support at home, and in all the different types of long term care we identify. The sacrifice caregivers make for their families is significant and sometimes takes an enormous toll, financially and otherwise.

All generations are involved in caregiving, from millennials to baby boomers. Although women are thought of as being primary caregivers, up to 40 percent are men

2. Home-based care

Along with family caregiving, home-based care comprises several services that keep people safe and in their homes.

Many times, people may hire private caregivers. These caregivers, hired through an agency,  can do tasks like helping with bathing, dressing, transportation, cooking, cleaning, and shopping. They are paid by the hour unless you have long-term care insurance that might help with the costs.

For those who have Medicare, they could use it to cover home health. Time-limited home health paid by Medicare offers nursing and therapies to homebound seniors with a skilled nursing need. At times, this short term intensive intervention might be enough to help someone regain their independence.

If neither private care nor Medicare-paid home health can help, there are also community-based services. Communities help cover a wide range of volunteer and federal or state programs for seniors. Some of these programs have criteria for participation.

You may recognize well-known programs, such as Meals on Wheels and senior transportation. Other lesser-known supports include caregiver respite and companionship services. 

3. Independent senior living

Independent senior living covers a wide range of communities, from separate housing units to large congregate settings with assisted living attached. The name independent living implies total independence, but in most cases, it is not.

A “light” level of support allows for freedom with some assistance. Most independent senior living communities can have amenities such as:

  • Housekeeping
  • Meal service
  • Transportation
  • Leisure and recreational activities
  • Salon services for hair

Many people consider independent living a stepping stone to more care later. An example would be assisted living, although remaining in independent senior care with home care services is possible.

Other independent settings include: 

  • Communities for those 55 and over, where each family has their own home grouped together on the same parcel of land. 
  • Cohousing developments where common spaces and responsibilities are shared.
  • Home-sharing, where several people share one home to reduce costs. 
  • Board and care which are larger homes with several rooms. Depending on the state, board and care homes are licensed under assisted living.

Many of these communities are genuinely independent but offer socialization and activities. They also maintain the grounds and usually do minor household repairs. If a person needs personal care assistance, they can get it through home-based services such as home care or home health.

4. Adult day care

Adult day care programs are designed to take care of older adults during the day and evening. Each adult day care program will be different, but they all strive to relieve the burden of family caregivers while giving seniors a safe, therapeutic environment. 

Adult day care centers offer meals, therapies, exercise, recreation activities, socialization, and health screenings. The cost of adult day care may be less than hiring caregivers to come to a home. The other advantage of adult day care are the health services that might be available. 

5. Assisted living

Assisted living is one of the more popular long-term care options. For many older adults, this is where they will spend their remaining years and with good reason. Assisted living has a lot to offer. Levels of care allow people who have higher needs to pay more for that assistance.

As the number of older people increases, assisted living has added more services to their menu of options:

  • One person help with transfers from the bed and to and from the toilet
  • Assistance with Activities of Daily Living (ADLS) such as getting to bed, dressing, showering, and other activities.
  • All meals and snacks
  • Transportation to doctor’s appointments
  • Health providers on-site in some communities
  • Part-time nursing
  • Meal reminders
  • Medication management and dispensing

Assisted living also includes memory care, which consists of specialized, secure units for people with dementia and other mental health problems.

The staff to resident ratio is higher, and staff is trained to handle confused and disoriented people. The same support services offered in assisted living are available in memory care, but with more individualized attention.

6. Nursing home care

Nursing home care is the highest level of care someone can receive outside a hospital setting. Most people would prefer to avoid nursing home care due to their institutional environment and high cost.

At times, however, there is no other choice. A nursing home has specific characteristics that separate it from all other long-term care options:

  • 24-hour nursing
  • Experts that can handle complex medical issues including IVs, injections, and catheter care
  • Two-person transfer capability, which is something many assisted living communities will not do
  • Special diets with staff oversight while eating if swallowing is a concern
  • Aides available 24 hours a day to assist with Activities of Daily Living (ADLs)
  • Respiratory therapy
  • Experienced staff working with people who have dementia and other neurological disorders

Nursing home residency is not paid for by Medicare. Payment is either by qualifying for Medicaid, paying privately, or using a long term care insurance policy.

7. Hospice care

Hospice care is end-of-life care for people who have a terminal condition. Hospice care is provided in all of the long term care settings mentioned above, along with specialized hospice residential units. 

Services under hospice can go on for months, and some people recover sufficiently to be discharged from hospice. Hospice is covered under Medicare. 

Long-Term Care: Something for Everyone

As you research the available options for long-term care, planning is critical.

Finding care for aging adults can be done with patience, as long as you are willing to be open and communicative with your family and other loved ones. Be flexible as you piece together safe, and affordable care for your loved one.

If you're looking for more information on long-term care planning, read our guides on respite care and memory care.


Sources

  1. “Caregiving.” Family Caregiver Alliance, www.caregiver.org/caregiving 
  2. Kerr, Nancy. “Family Caregivers Who Perform Medical Tasks Need More Support.” AARP, 17 April 2019, www.aarp.org/caregiving/health/info-2019/medical-tasks-study.html
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