Long-Term Care, Part 1: Beyond Nursing Homes

What does your ideal living situation look like in old age? There’s a good chance you want to stay in your own house or apartment, and that you want any help to be on your own terms.

Nursing homes are certainly not the only option!

Here are some services that enable people to stay independent for as long as possible:

Adult day centers Adult day social centers have structured activities and meals. Adult day health care also have medical services like skilled nursing and physical or occupational therapy.
Program of All-Inclusive Care for the Elderly (PACE) A program sponsored by Medicare and Medicaid that helps people who need nursing home-level of care stay in the home. Patients are taken care of by a team that includes doctors, nurses, home health workers, social workers, therapists, and nutritionists—all centered either in the home or adult day care. Interestingly, one study found that people in PACE lived longer than those in nursing homes.
Home personal care A personal care attendant through a home health agency can help with daily activities, like shopping, cleaning, and bathing. Some state Medicaid waivers will also let you choose and pay your own caregiver, including a family member. Check out what’s available around you.
Home healthcare Home healthcare is a growing trend where doctors can make home visits to people who have more difficulty getting to an office (including home and virtual palliative care!). Ask your doctor if home visits are a possibility.
Medicaid waiver programs Often provide people with a case manager to help coordinate services at home, such as personal care, nursing, and modifications to make your home safer and more accessible. Again the idea is to support senior citizens in the community with funds that might otherwise have gone toward nursing home care. A state-by-state listing of Medicaid waiver programs is available here.
Respite care Gives your primary caregiver, like a spouse or family member, a break. It’s temporary care for a few days in a nursing home or a hospice, which Medicare can pay for (up to 5 days), or services at home if you have Medicaid.

Looking for more flexibility and privacy, alongside community and support? Check out these innovative models of nursing home and assisted living. 

Green House Homes Featured in the media, the Green House projects transform the idea of a nursing home into something that feels like a real home. Each Green House home is unique and has 6-10 residents, with private rooms and bathrooms, plus a common living room, dining table, living room, and outdoor access. Residents can maintain their own schedules and enjoy shared activities. There are almost 200 of these homes now across the country.
Continuing care retirement community (CCRC) Different levels of care under the same roof. People can transition from an independent apartment to assisted living and then to a nursing home within the same community. (Nursing homes affiliated with a CCRC actually tend to have higher Medicare ratings.)
Medical Foster Homes for Veterans Approved by the VA, these homes have a trained caregiver available 24/7 to assist with daily activities. Residents are enrolled in home-based primary care to qualify so they receive both personal and healthcare services in a smaller setting.

(If you think an assisted living facility or nursing home would make more sense, check out Part 2.)

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