Area IV Guide to Long-Term Care
What is Long-Term Care?
Long-term care (LTC) is medical and non-medical assistance for people who have an illness or disability and can no longer care for themselves. LTC helps people remain in their own home or where they are currently living and as independent as possible.
Long-term care is so much more than just getting care in a nursing home. It may be provided at home, in the community, in assisted living facilities or nursing homes, and includes activities of daily living, such as dressing, bathing, toileting, eating, preparing meals, or housekeeping.
When to Decide if You Need Long-Term Care
The time to explore LTC options is before they are needed. It could be too late to wait until you or a loved one experience problems caring for yourselves. Poor decisions are often made in a crisis or a rush to obtain care when there may be fewer options available.
Numerous options exist for LTC. A complete assessment of the individual’s and his or her caregiver’s needs are necessary to develop the best plan. The best outcomes occur when LTC professionals (such as Area IV Agency), the individual and caregivers work together to develop a plan.
Determining Long-Term Care Needs
Because there are many options to long-term care, a complete assessment of short and long-term needs is required. The assessment should be centered on the individual, his or her abilities, wants and needs. This assessment serves as a guide for planning and decision-making to meet the needs of the individual and caregiver.
The individual, caregivers and the primary care physician must be involved in developing a plan. It would be helpful to talk with family members, neighbors, friends, financial and legal advisors, and insurance carriers.
Click on the link for a printable version of the needs assessment: Individual Needs Table
|Does the person need assistance with:||No||Some||A Lot||Notes|
|Bathing and toileting|
|Personal care and dressing|
|Shopping, preparing meals, eating|
|Mobility (use of cane, walker or wheelchair) and fall prevention|
|Medical appointments, medical care, medication management|
|Participating in outdoor activities and programs|
|Housework, laundry, shopping, errands, home maintenance|
|Bill paying, debt management, finances|
|Home access, getting in and around the house|
Paying for Long-Term Care
The following are various means by which people pay for LTC:
- Bank accounts and investments (stocks, bonds, annuities, mutual funds, etc.)
- Family resources
- Home equity loan
- Insurance, such as long-term care, supplemental, accelerated death benefits and life settlements
- Personal savings
- Personal loans
- Private insurance
- Reverse mortgage
- Selling the home
- Social security, pensions, or other retirement funds
You may become eligible for assistance from one or more of the following state or federal programs:
- Veterans benefits
- Other state or federally funded programs
It is wise to consult a trusted professional, such as an elder law attorney, Area IV Agency’s Aging & Disability Resource Center (ADRC), a financial advisor, etc., when considering how to pay for long-term care.
Long-Term Care Options
Long-term care can be provided by a spouse, children or live-in caregiver, or at a skilled nursing care facility, with multiple options in between. This guide will define some choices.
Home and community options include a wide range of personal and health services to help individuals stay at home and live as independently as possible. These services often are provided by family caregivers but also can be provided by others, including:
- Adult day service programs
- Case managers or geriatric care managers
- Emergency response systems
- Friendly visitor and companion services
- In-home healthcare providers
- Homemaker or home chore services
- Home modifications, maintenance and repairs
- Meals programs
- Respite care (caregiver time off)
- Senior centers
- Transportation services
Facility or institutional options are personal and health services provided in a residential facility. This may include housekeeping services, medication management, assistance with personal care, oversight supervision, special programs for people with dementia, or 24-hour nursing care.
Facilities options include:
- Adult day care
- Residential and group care homes
- Assisted living
- Continuing care retirement communities (CCRCs)
- Nursing homes
Your next step is choosing the best LTC option to meet your needs with the resources available to you and your family.
Choosing a Long-Term Care Provider
Choosing long-term care is a process of matching personal needs to service providers to available funding. Be sure to talk with service providers, visit facilities of interest, and have a talk with staff, residents and other caregivers.
Take notes on the following:
- Did I like the people and the place?
- Was my interaction comfortable?
- Were my questions answered to my satisfaction?
- Did I feel understood?
- Was the program staff respectful and helpful?
- Does the facility or program meet my needs?
- Does the facility or service offer enjoyable activities or programs?
- Is the facility clean and pleasant?
- Do the costs fit my budget?
Review your notes and observations with someone you trust to help you make a decision that is right for you.
Debunking the Myths of Older Adults Falls
Many people think falls are a normal part of aging. The truth is, they’re not. Most falls can be prevented—and you have the power to reduce your risk.
Exercising, managing your medications, having your vision checked, and making your living environment safer are all steps you can take to prevent a fall.
Every year on the first day of fall, we celebrate National Falls Prevention Awareness Day to bring attention to this growing public health issue. To promote greater awareness and understanding here are 10 common myths—and the reality—about older adult falls:
Myth 1: Falling happens to other people, not to me.
Reality: Many people think, “It won’t happen to me.” But the truth is that 1 in 4 older adults fall every year in the U.S.
Myth 2: Falling is something normal that happens as you get older.
Reality: Falling is not a normal part of aging. Strength and balance exercises, managing your medications, having your vision checked and making your living environment safer are all steps you can take to prevent a fall.
Myth 3: If I limit my activity, I won’t fall.
Reality: Some people believe that the best way to prevent falls is to stay at home and limit activity. Not true. Performing physical activities will actually help you stay independent, as your strength and range of motion benefit from remaining active. Social activities are also good for your overall health.
Myth 4: As long as I stay at home, I can avoid falling.
Reality: Over half of all falls take place at home. Inspect your home for fall risks. Fix simple but serious hazards such as clutter, throw rugs, and poor lighting. Make simple home modifications, such as adding grab bars in the bathroom, a second handrail on stairs, and non-slip paint on outdoor steps.
Myth 5: Muscle strength and flexibility can’t be regained.
Reality: While we do lose muscle as we age, exercise can partially restore strength and flexibility. It’s never too late to start an exercise program. Even if you’ve been a “couch potato” your whole life, becoming active now will benefit you in many ways—including protection from falls.
Myth 6: Taking medication doesn’t increase my risk of falling.
Reality: Taking any medication may increase your risk of falling. Medications affect people in many different ways and can sometimes make you dizzy or sleepy. Be careful when starting a new medication. Talk to your health care provider about potential side effects or interactions of your medications.
Myth 7: I don’t need to get my vision checked every year.
Reality: Vision is another key risk factor for falls. Aging is associated with some forms of vision loss that increase risk of falling and injury. People with vision problems are more than twice as likely to fall as those without visual impairment. Have your eyes checked at least once a year and update your eyeglasses. For those with low vision there are programs and assistive devices that can help. Ask your optometrist for a referral.
Myth 8: Using a walker or cane will make me more dependent.
Reality: Walking aids are very important in helping many older adults maintain or improve their mobility. However, make sure you use these devices safely. Have a physical therapist fit the walker or cane to you and instruct you in its safe use.
Myth 9: I don’t need to talk to family members or my health care provider if I’m concerned about my risk of falling. I don’t want to alarm them, and I want to keep my independence.
Reality: Fall prevention is a team effort. Bring it up with your doctor, family, and anyone else who is in a position to help. They want to help you maintain your mobility and reduce your risk of falling.
Myth 10: I don’t need to talk to my parent, spouse, or other older adult if I’m concerned about their risk of falling. It will hurt their feelings, and it’s none of my business.
Reality: Let them know about your concerns and offer support to help them maintain the highest degree of independence possible. There are many things you can do, including removing hazards in the home, finding a fall prevention program in the community, or setting up a vision exam.
Fall Prevention and Home Safety Tips
Falling, slipping or tripping around the house is a serious concern for seniors.
Each year, more than one out of four adults age 65 and older falls. These falls cause moderate to severe injuries such as cuts, broken hips or head traumas in 20 to 30 percent of people. Injuries from falls can make it hard to get around or live independently, and they can increase the risk of early death.
Facts About Falls
- Falling once doubles your chances of falling again.
- One out of five falls causes a serious injury such as broken bones or a head injury.
- Each year, 3 million older people are treated in emergency departments for fall injuries.
- Over 800,000 patients a year are hospitalized because of a fall injury.
- Among older adults, falls are the leading cause of both fatal and nonfatal injuries.
- Most fractures among older adults are caused by falls.
- The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.
- Falls are the most common cause of traumatic brain injuries (TBI).
- Many people who fall, even if they’re not injured, become afraid of falling. This fear may cause a person to cut down on their everyday activities. When a person is less active, they become weaker and this increases their chances of falling.
- The chances of falling and of being seriously injured in a fall increase with age.
- Men are more likely than women to die from a fall. After taking age into account, the fall death rate is approximately 40% higher for men than for women.
* According to the Centers for Disease Control and Prevention
Five Steps to Prevent Falls
- Remove Tripping Hazards One in four older adults falls every year, and 75 percent of falls occur inside or just outside the home. Make your home safer by removing tripping hazards like throw rugs and clutter. Outside the home, repair uneven steps and broken concrete.
- Increase Lighting As you age, you need brighter lights to see well. Use bulbs with higher lumens and add lighting to reduce shadows in hallways, stairs, and dark corners.
- Install Handrails Install handrails on both sides of all stairs, inside and outside the home.
- Make Bathrooms Safer Grab bars are a must in showers, tubs, and next to toilets. Shower curtains are safer than shower glass. Also, use non-slip mats in the bath and shower.
- Reorganize Storage Put things you use often in an accessible location that you can get without reaching overhead or having to use a step stool or ladder.
Glossary of Terms
Adult Day Service (ADS): Site-based service which can provide supervision, meals, social activities, and personal care assist. Some providers offer transportation to and from the site.
Adult Family Care (AFC): Supervised living with 24-hour care provided in a home either owned, rented, or managed by an AFC provider. Care for up to three unrelated (to care provider) individuals. Service cost of AFC is covered through waiver. Consumer is responsible for room and board. Reimbursement is based on level of service (LOS) assessment.
Assisted Living (AL): Supervised Facility setting. Service cost of Assisted Living is covered through waiver. Consumer is responsible for room and board. Reimbursement rate for AL is based on the Level of Service (LOS) assessment. Must be over 18 and cannot have skilled needs to qualify
Assistive Technology (ATCH): Used to promote independence in the home and community. Includes devices such as a grabber, shower chair, lift chair or raised toilet seat.
Attendant Care (ATTC): Can provide limited personal care. May assist with bathing, dressing, and basic hygiene activities. May also assist with light homemaking activities related to the care of the client.
Homemaker (HMK): Can do light housekeeping, meal prep, shopping, and errands. HMK’s may not do any hands-on personal care or provide services for anyone other than the client.
Home-Delivered Meals (HDM): Nutritionally balanced meal delivered to the client’s home.
Home Health Aide (HOHE): Can provide direct personal care. May provide bed bath, non weight bearing transfer, assist with range of motion exercises, assist with oral feeding and take vitals. May not dispense meds, apply dressings, provide tube feedings, or other skilled needs.
Home Modifications (EMOD/HMOD): Provided to make client’s home more accessible. Common Home Modifications include wheelchair ramps, widened doorways, handrails, grab bars, etc.
Integrated Health Care Coordination (HCC): To promote improved health status and quality of life, delay/prevent deterioration of health status, manage chronic conditions in collaboration with physicians, and intergrate medical and social services.
Personal Emergency Response System (PRSM): Device which enables client to secure help in an emergency.
Respite: For relief of or in the absence of the unpaid primary caregiver. May be provided as respite home health aide (RHHA) or respite nursing (RNUR).
Skilled Nursing (SKNU): Provided by LPN or RN for clients with skilled medical needs including feeding tubes, I.V.’s, decubitus ulcers, and other unstable, acute conditions.
Structured Family Caregiving (SFC): Living arrangement in which a participant lives in their private home or the private home of a principal caregiver who may be a non-family member or a family member. Reimbursement is based on level of service (LOS) assessment.
How to Select a Residential Facility
When selecting a healthcare facility, assisted living facility or continuing care retirement community, consider the following questions:
What do you see?
- Does the landscaping look neat and clean?
- Is the parking lot clean?
- Are the residents dressed in street clothes?
- Are the residents engaged in various one-on-one and/or group activities? Do the activities you see occurring match the activities listed on the posted monthly activity?
- If visiting during a meal time, does the food look appetizing?
- Are the employees dressed neatly? Are they wearing uniforms? Can you tell who is an employee and who is a visitor?
- Is the facility well-lighted?
- Are the floors clean – carpet or tile?
- Is the furniture in the lounge areas, dining room, and resident rooms clean?
- Are the bathrooms clean? Are the bathing areas clean? Are there grab bars?
- Does each resident have a water pitcher and a glass in his or her room?
- Does the facility have working smoke detectors? Does the facility have a sprinkler system?
What do you hear?
- Are residents talking to each other? Are the residents and employees talking to each other in a caring manner?
- Do you hear residents participating in the various activities? Are they having a good time?
- Do you hear call lights buzzing? How long does it take for an employee to reach the resident who is calling for assistance?
What do you smell?
- Can you smell aromas from the facility kitchen? Are there food aromas coming from the activities room?
- Do you smell fresh flowers?
- Is the facility free of unpleasant odors? If you do smell an odor, is it fresh or stale?
- Do you smell smoke? Does the facility allow smoking? If so, where is the designated smoking area?
What do you feel/touch?
- How does the facility’s atmosphere feel (calm, soothing, uplifting, etc.)?
- Is the room air temperature comfortable throughout the building?
- Is the furniture in the lounge areas, dining room, and resident rooms clean to the touch?
- Are the handrails clean?
What do you taste?
- How does the food taste?
- Is the food served at the appropriate temperature?
- Does the facility serve food from different cultures?
- Shop for the facility that meets the needs of your loved one. Visit various facilities more than once and at different times of the day and evening.
- Talk to the residents and staff. What do they like about this facility? What concerns do they have about the facility?
- Ask about the pre-admission screening process that is conducted by the local Area Agency on Aging. Pre-admission screening is required for healthcare facility admission. A person can decline to participate in this process, but this will make him or her ineligible for Medicaid for one year.
- Ask to see the most recent Indiana State Department of Health survey report.
- Ask for a copy of the Resident Rights (includes state and federal rights).
- Ask for a copy of the Resident Admission Agreement.
- Ask for a copy of the current monthly activity calendar.
- Ask if your loved one’s physician will visit residents at this facility. Ask how often a physician must see your loved one while they live in the facility.
- What types of care are available? Does the facility provide nursing care, skilled care, assisted living (residential care), and/or independent living apartments?
- Is the facility state licensed and/or Medicaid/Medicare certified?
- Does the facility have special care units – Alzheimer’s disease, hospice, home care, etc.? What are the admission requirements for these units?
- If spouses need different levels of care, are they able to live together?
- Ask about the resident care plan meetings. Who is invited? What information is discussed? How often do the meetings occur?
- Ask for a copy of the weekly menu. If visiting during a meal time, does the meal being served match the posted menu? Are the food preferences of each resident honored? Is there an alternate food item available, if the resident does not want a food item listed on the menu?
- How many residents live in each room? How are roommates selected? Are private rooms available?
- How much does it cost to live in the facility? What is the charge for a private room or apartment versus a room with one or more residents? Are residents expected to pay a daily or monthly rate? Is there an entry fee? If so, are there situations where a resident or his or her estate could receive a full or partial refund? What happens when a resident runs out of money?
- Ask if the facility accepts Medicare and/or Medicaid. Please note that not all facilities accept Medicare and/or Medicaid. If the facility does participate in these payment programs, how much does the resident pay out-of-pocket for his or her care?
- What situations would necessitate the facility to discharge a resident?
- How does the facility screen potential employees? Ask about in-service training for employees. What topics are discussed?
- Ask about the facility’s security system. Are the housekeeping and maintenance supply rooms locked? Does the facility have secured outdoor areas or courtyards? Are the exit doors locked? If so, what time are the doors locked?
- Ask about the facility’s disaster plans – fire, tornado, bomb threat, etc. If a disaster occurs that requires resident relocation, where will the residents be taken?
How to Select an In-Home Care Services Provider
Home healthcare services include:
- Home Health Aide—provides bathing (including bed bath) and personal care
- Attendant care—provides bathing and personal care
- Nurse—provides set up or administration of medication, monitoring of health and vital signs, etc.
- Physical Therapy—provides exercises to improve, maintain, and/or restore strength and movement (arm and leg movements, walking, etc.)
- Occupational Therapy—provides exercises to improve, maintain, and/or restore the ability to perform activities of daily living (dressing, bathing, eating, etc.)
- Speech Therapy—provides exercises to improve, maintain, and/or restore speech
- Homemaker—provides housekeeping tasks including house cleaning, laundry, changing linens, possible shopping
- Companion—provides companionship from a visitor
- Respite Care—provides services to relieve a caregiver (home health aide, attendant care, nursing care, homemaker, companion)
Helpful questions to ask when selecting a home healthcare agency:
- Shop for a home healthcare agency that will meet the needs of your loved one. Call or visit various home health agencies to compare services and prices.
- Who owns the home healthcare agency? Is the agency owned by a national corporation or is it locally owned?
- Talk to the agency’s clients and staff. What do they like about this home health care agency? What concerns do they have about the agency? (Ask the agency for references.)
- What types of in-home health services does the agency offer? (Ask for a written list of the agency’s services.)
- Will the home care services be provided consistently by the same employee?
- Are employees allowed to run errands for the client? Are they allowed to take the client with them as they run errands? Will the client be charged for the employee’s mileage while completing the errands?
- What is the cost of the requested services? Are services billed at an hourly rate or a per visit rate? Is there a contract?
- Does the home health care agency accept private insurance, Medicare, and/or Medicaid? How long would home healthcare services be provided under private insurance or Medicare? How long would home healthcare services be provided under Medicaid Prior Approval?
- Does the agency require a minimum number of service hours?
- Who should be contacted when the caregiver needs to change the service schedule? Can the cancelled dates of service be made up?
- Will the client be charged if the employee is late or does not show up for the scheduled visits?
- Who should be contacted regarding concerns about the provided services?
- What situations would necessitate the home healthcare agency discharging a client on a temporary or permanent basis?
- How does the agency screen potential employees?
- Are reference checks and criminal background checks performed regarding employees prior to their employment?
- Are employees bonded?
- Are employees allowed to accept food or items from the client while they are performing the home healthcare services?
- Are employees allowed to smoke while they are performing the home healthcare services?
- Ask about in-service training for employees. What topics are discussed?
- Have the employees received training in dementia care?
Medicare covers many of your healthcare needs. Medicare works with approved private companies that provide healthcare and prescription drug coverage.
The Medicare plan that you choose affects many things like cost, benefits, doctor choice, convenience, and quality.
Your Medicare plan choices include:
The Original Medicare Plan
This is a fee-for-service plan that covers many healthcare services and certain drugs. You can go to any doctor or hospital that accepts Medicare. When you get your healthcare, you use your red, white, and blue Medicare card. The Original Medicare Plan pays for many healthcare services and supplies, but it doesn’t pay all of your healthcare costs. There are costs that you must pay, like coinsurance, copayments, and deductibles. These costs are called “gaps” in Medicare coverage. You might want to consider buying a Medigap policy to cover these gaps in Medicare coverage. You can also add prescription drug coverage by joining a Medicare Prescription Drug Plan.
Medicare Advantage Plans
Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered healthcare through that plan. This coverage can also include prescription drug coverage. Medicare Advantage Plans include:
- Medicare Health Maintenance Organization (HMOs)
- Preferred Provider Organizations (PPO)
- Private Fee-for-Service Plans
- Medicare Special Needs Plans
To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. These plans may cover more services and have lower out-of-pocket costs than the Original Medicare Plan. Some plans cover prescription drugs. In some plans, like HMOs, you may only be able to see certain doctors or go to certain hospitals to get covered services.
Medicare Prescription Drug Plans
Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs or from unexpected prescription drug bills in the future.
You may sign up when you first become eligible for Medicare (three months before the month you turn age 65 until three months after you turn age 65). If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments. If you don’t sign up when you are first eligible, you may pay a penalty.
Want More Information About Medicare?
Area IV Agency offers free, unbiased help for people in the West Central Indiana area to make decisions about their Medicare health insurance coverage. Our counselors are certified through Indiana’s State Health Insurance Assistance Program (SHIP).
Area IV Agency provides expert SHIP counseling through phone or face-to-face appointments. Our counselors are available Monday through Friday, 8:00 a.m. to 4:00 p.m.