What Kind of Services are Available for Older Adults: Glossary of Terms

There is a wide range of services and housing options available for those in need of extra care. For example, an elderly person could live at home and take part in an adult day care program for an extended period of time, then move to an assisted living facility, and later transfer to a nursing home. The spectrum of care maximizes independence for as long as possible and allows for easier, more gradual adjustments.

This is a summary of the many categories on the long-term care spectrum. The brief descriptions accompanying each category will aid you in determining what degree of care or type of service you or your loved one need. Remember though, that foresight is key; it is never too early to look ahead and plan for later stages of life.

Terms

• Home and Community-based Services
• Senior Housing
• Continuing Care Retirement Communities
• Assisted Living
• Nursing Homes
• Long-term Care Insurance
• Medicaid
• Medicare

Home and Community-based Services
Like most older people, you may want to live in your own home. But you may also need help and support in order to stay there. Home and community-based services can help you with personal care (help with things like bathing, dressing, going to the bathroom, and more) or chores. They may include health care services, social activities, or even just someone to call and check on you if you live alone. Also, if you are taking care of a family member or friend, these services can give you the help and support that you need as well.

While there are many different community services for older people, not all are available in every community. Check with your local area agency on aging for what services are in your area.

The most common services are:

• Adult day care
• Care management
• Congregate meal programs
• Financial counseling programs
• Friendly visiting
• Home health care services
• Homemaker or chore services
• Hospice care
• Home-delivered meals
• Information and assistance services
• Personal care services
• Respite care
• Rehabilitation services
• Senior centers
• Telephone reassurance
• Transportation services

Senior Housing
You may want to think about senior housing if you want to live on your own, but do not want to have all the chores that go along with owning a single-family house. Senior housing works best for people who may not need as much help as assisted living or nursing homes provide. Most often these are apartments that you can rent. Often they are specially designed for your needs as you get older. This includes things like having railings in bathrooms or having power outlets higher up on the wall. They may also offer a 24-hour emergency call service if you need help right away. Some places may also offer different kinds of services to the people who live there. These include meals, transportation, social services, counseling, social activities and other programs.

Continuing Care Retirement Communities
Continuing care retirement communities, or CCRCs, provide many different types of services - skilled nursing, assisted living, and/or independent living - all in one location, which gives you the chance to stay in one place as your needs change. CCRCs offer a range of services such as: nursing and other health services; meals; housekeeping; transportation; emergency help; and personal care (help with things like bathing, dressing, going to the bathroom, and more). They also usually have lots of social and educational activities on site.

CCRCs are also different from other types of housing options for older people because they offer you a contract, a legal agreement that says the CCRC will provide you with housing and services for life. Most CCRCs require a one-time entrance fee and then monthly payments thereafter. These fees vary by community, depending on the type of housing and services they offer. Other CCRCs operate on a rental basis, in which you would make monthly payments, but would not have to pay an entrance fee.

Assisted Living
If you need some help every day but do not need constant nursing care, assisted living may be a good choice for you. Assisted living residences provide help with the things people need to do every day, such as bathing or getting dressed, taking your medicine, cooking, shopping, housekeeping, laundry, and getting around. But they do all of this while still giving you the chance to stay active and control your own life.

Assisted living facilities may be part of a retirement community or nursing home, or they may stand alone. They offer single or double rooms, or sometimes even suites or apartments, depending on what your needs are and how much you can afford.

Nursing Homes
Nursing homes offer round-the-clock care if someone is too sick to live on their own, or if they need to recover after having an illness or operation. Some people stay for a short time in a nursing home and then go home. Other people may be sicker and need more care for a longer period.

Nursing homes are licensed by the state to provide nursing care, personal care (help with things like bathing, dressing, going to the bathroom, and more), and medical services. They also offer different kinds of therapies (physical, occupational, and speech) to help you get back on your feet after you've been ill or had surgery. They provide your meals, and do your laundry and housekeeping. Finally, nursing homes offer different kinds of activities you can get involved with, including art classes, computer learning labs, parties, religious services, and more.

Long-term care insurance covers long-term care in a variety of settings, not just in nursing homes. Because long-term care insurance covers a broader scope of care, you will have greater freedom to choose a facility that matches your needs. For example, it may enable you to afford an assisted living facility, or a continuing care retirement community. Long-term care insurance typically pays a daily rate to your care provider. Because every policy is different, you will need to find out exactly what levels of care and services your potential insurers will cover.

Medicaid pays for the majority of nursing home costs, covering nearly 65 percent of all nursing home residents. Medicaid is a joint state-federal program that aids individuals who fall under a certain poverty level determined by the state. Medicaid was originally intended for low-income people, but because many private pay nursing home residents "spend down" their assets in under a year, it covers elderly people from all classes. Each state Medicaid office sets reimbursement rates that are lower than the nursing home private pay rates.

Medicaid does not cover assisted living or continuing care retirement communities (with the exception of their skilled nursing units). It pays for care only at nursing homes and Intermediate Care Facilities for the Mentally Retarded. In some states, however, Medicaid may cover home and community-based services.

Medicare is a health insurance program for people over the age of 65 and certain disabled individuals. There are a number of Medicare stipulations that limit its long-term care coverage.

• You are only eligible for Medicare nursing home coverage after a hospital stay of at least three days. In addition, this coverage requires substantial insurance co-payments after the first 20 days, and can be used for no more than 100 days.
• Medicare does not usually cover assisted living costs. However, if you contract short-term services through a home care agency while living in an assisted living, Medicare may cover this care.
• Medicare covers homecare only if the elderly individual is homebound and needs therapy or skilled nursing care, according to their physician's plan.

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