There are more options for elderly people than nursing homes, but what you can access may depend on your level of independence as well as your eligibility for Medicaid (or any long-term care insurance that you purchased). Certainly, what you choose will depend on your desired setting. In addition to nursing homes, long-term care is available at assisted living facilities, in the community, and at home.
Alternatives to nursing homes
Assisted living offers a balance of privacy and community, with such amenities as dining options and planned excursions. Many assisted living communities have nursing staff who can aid with medication, and communicating with physicians as needed, though they cannot provide round-the-clock care.
For adults with early cognitive decline, so-called bridges living environments offer targeted cognitive work. Unfortunately, these programs are not widely available. However, there are many options for people living with dementia; these memory care communities feature personalized interventions.
Some states offer adult foster care programs in which participants live in private residences of one to six seniors; assistance with medication, personal care, and household chores is provided.
Adult day care provides a structured day, complete with socialization and interaction as well as support for activities of daily living. The centers operate only during the day, allowing you to return home at night. These are good options for people who are lonely, who need only some support, or who wish to give family members some respite time.
Home care includes support for activities of daily living, help with meal preparation and light housekeeping, physical therapy, and/or wound care. Often, these services are enough that you can remain at home.
The Eldercare Locator at https://eldercare.acl.gov/Public/Index.aspx., a public service of the Administration for Community Living, is one way to find help within your community. It provides information about support services, housing, elder rights, insurance and benefits, and transportation.
PACE
If you’d prefer to meet your health care needs in the community instead of going to a nursing home or other facility, look into the Program of All-Inclusive Care for the Elderly. A Medicare/Medicaid program, PACE will connect you to a team of health care professionals who will work with you to coordinate your care. The program is not available in all states.
You can join PACE, even if you don’t have Medicare or Medicaid if you:
- Are at least 55 years old
- Are living in the service area of a PACE organization
- Need a nursing home level of care as certified by your state
- Are able to live safely in the community with help from PACE
PACE includes:
- Adult day primary care, including doctor and recreational therapy nursing services
- Dentistry
- Emergency services
- Home care
- Hospital care
- Laboratory/X-ray services
- Meals
- Nursing home care
- Nutritional counseling
- Occupational therapy
- Physical therapy
- Preventive care
- Social work counseling
- Transportation to the PACE center for activities or medical appointments
If you have Medicaid, you won’t pay a monthly premium for the long-term care portion of the PACE benefit. If you don’t qualify for Medicaid but have Medicare, you’ll pay a monthly premium to cover the long-term portion of the PACE benefit and a premium for Medicare Part D drugs. If you don’t have Medicare or Medicaid, you can pay for PACE yourself.
To find out whether you’re eligible and if there’s a PACE program near you, search for PACE plans in your area or call your Medicaid office.
Getting advice
For help planning long-term care, visit the websites of the Administration for Community Living, your state insurance department, your state medical assistance (Medi-cal) office and/or the National Association of Insurance Commissioners.
Your local Area Agency on Aging can offer a list of continuing care retirement communities in your area. Check the quality of nursing homes and CCRCs by reviewing the inspection report that is posted in each facility.
Medicare has programs to cover home health services, and some state and federal programs help pay for housing for some seniors with low or moderate incomes. Some programs help with meals, housekeeping, shopping, and laundry.
Adults who want to enhance their independence, cultivate wellness, and increase socialization into their later years have more alternatives to nursing homes these days. The variety of options provides personalized care for different levels of need.
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