When older adults need help with medical, physical, or emotional needs over an extended period of time, they need long-term care. Long-term care consists of different types of services, depending on a person’s needs and abilities. It can include help with any of the following.
Long-term care services can be provided in many different settings, from assisted-living facilities to the 24-hour medical care of a nursing home. Some older adults are able to stay in their own homes as long as they get help with certain services.
Paying for long-term care
Long-term care is a major expense. How you pay for it depends on your finances and the type of services you need. Many people end up using a few different payment sources, including their own income and savings, life insurance, long-term care insurance, and government programs. Medicare is a federal insurance program for people age 65 and older. It pays for certain types of long-term care in certain care settings, but there are rules and restrictions. Medicaid is a joint federal and state medical assistance program for people and families with low incomes. What is covered and who qualifies for Medicaid benefits varies from state to state, and often changes based on new legislation.
To learn more about resources in your area, visit Medicaid.gov or use the Eldercare Locator. Or see our related article Paying for Long-Term Care, Home Health Care, and Hospice Care.
Types of long-term care settings
Here is a look at the different types of long-term care settings, and the types of services that are provided there.
Home health care
Many older adults want to stay in their own homes as long as possible. But to do so, they often need some type of in-home services and supports. These services can also provide a helpful break for a family caregiver. In-home services can include help with personal care, such as bathing and dressing. It can also include help with cooking, laundry, and cleaning. Services such as nursing, speech therapy, occupational therapy, and physical therapy can also be provided in someone’s home. An older adult may also need senior transportation services to get to appointments or to the store.
Adult day centers
These centers provide a safe place to go during the day for older adults who live in their own home or in a family member’s home. Depending on the person’s needs and abilities, adult day centers provide meals, activities, therapy, and the chance to socialize with others. They also have trained staff who can help with eating and going to the bathroom. Transportation is often provided too. These centers can give family caregivers some much-needed personal time or allow them time to go to work, while knowing their loved one is getting supervised care.
Subsidized senior housing
This federal program helps older adults of low or moderate income pay for an apartment. The income limit to qualify changes depending on where you live. Rent is often based on a percentage of income. Some programs offer help with meals and daily tasks
Group homes (residential care facilities
This type of housing is for people who can’t live entirely on their own, but who don't need the full care provided in a nursing home. Group homes, also called residential care facilities, are smaller private centers. There may be 20 residents or less in one home. People in a group home get help with personal care tasks such as eating, bathing, dressing, and using the bathroom. The monthly charge may be a certain percentage of a person’s income on a sliding scale. This charge covers the cost of rent, meals, and other basic shared services.
This is a group living situation that offers help with personal care tasks and meals. A person in assisted living often has their own private room or apartment in the facility. Residents who are able to can take part in recreation and day trips. The cost varies according to the services provided and what part of the country the facility is located in. Generally, medical care is not provided. But services such as physical therapy and occupational therapy may be arranged for, if needed.
Adult family homes (certified family homes)
An adult family home, or certified family home, is operated by a care provider who is registered in their state to provide services in their home. They may also be called community residential homes. They accept fewer residents than a group home or assisted living—often only a couple of residents. The regulations vary by state. Adult family homes may be a good option for people who want a smaller facility with a home-like feel. The owners of the home live in the house and provide care.
Continuous care retirement communities (CCRCs)
These communities provide a mix of housing types, depending on someone’s needs. More independent residents have their own home or apartment. People with greater care needs may be in an assisted-living area or nursing home. Residents can move from one type of housing to another in the community as they require more care. Many CCRCs ask for a large entry fee before you move in.
These facilities can serve as permanent residences for people who are too frail or ill to live at home, and who require constant care. Nursing homes offer round-the-clock supervision, medical care, and rehabilitation.