Long-term care

What Kind of Services Do I Need?

The first question to ask yourself when trying to decide what type of services are needed for you or for your loved ones is “what kind of services do I need?”. To help find out what kind of services you or a loved one need, check the items below that apply. Keep in mind that these needs may change over time.

Help With Daily Activities	Health Care Needs (as recommended by a doctor or other health care provider)
Shopping Preparing meals Eating Laundry and other housework Home maintenance Paying bills and other money matters Bathing Dressing Grooming Going to the bathroom Remembering to take medicines Walking Other ____________________	Physical therapy Speech therapy Occupational therapy Rehabilitation Medical nutritional therapy Oxygen Other medical services provided by a doctor or other clinician Care for pressure ulcers or other wounds Alzheimer’s disease care Health monitoring (for diabetes, for example) Pain management Nursing care services Other ____________________

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How Will I Pay for these Services?

The second question to ask yourself is “How will I pay for these Services?” Long-term care can be very expensive. In general, health plans and programs do not routinely cover long term care at home or in nursing homes. Here is some general information about long term care coverage:

Medicare is the Federal health insurance program for people age 65 and older and for some disabled younger people. Medicare generally does not pay for long term help with daily activities. Medicare pays for very limited skilled nursing home care after a hospital stay. If you need skilled care in your home for the treatment of an illness or injury, and you meet certain conditions, Medicare will pay for some of the costs of nursing care, home health aide services, and different types of therapy.
Medicaid is a Federal-State program that pays for health services and long term care for low- income people of any age. The exact rules for who is covered vary by State. Medicaid covers nursing home care for people who are eligible. In some States, Medicaid also pays for some home and community services.
Private Insurance. If you need long term care now, it is probably too late to be purchasing long term care insurance. In eight out of 10 couples aged 65 and older, at least one spouse will enter a nursing home (AHIP, "A Guide to Long Term Care Insurance", 2012). So, if it is not too late, you should be seriously considering long term care insurance. Insurance companies are becoming more and more aware of the growing need for long term care. Most insurance companies today offer long term care insurance policies. These policies may cover services such as care at home, in adult day care, in assisted living facilities, and in nursing homes. But plans vary widely. If you have such a policy, ask your insurer what it covers. If you think you may need long term care insurance, start shopping while you are relatively young and healthy, and shop carefully.
Personal Resources. You may need to use resources such as savings or life insurance to pay for long term care. Most people who enter nursing homes begin by paying out of their own pockets. As their personal resources are spent, many people who stay in nursing homes for a long time eventually become eligible for Medicaid.

How Can I Choose the Best Quality Services and Facilities?

The third question to ask yourself is “How do I find and choose the Best Quality Services and Facilities?” Here are some tips for choosing the kinds of long term care people most often use: home care (including home health care) and nursing homes.

In many States, home care agencies must be licensed. Check with your State health department to see if your State requires it. If so, be wary if an agency is not licensed.
Ask if the agency is certified by Medicare. Medicare inspects home health care agencies to assure they meet certain Federal health and safety requirements. Medicare will pay for services only if the agency is Medicare-approved and if the services are covered by Medicare.
If the home health care agency is certified by Medicare, you can review its survey report. Call the Medicare Hotline at 1-800-633-4227 and ask to be referred to the Home Health Hotline for your State. You can request a copy of the report from that hotline.
Find out if the agency has been accredited (awarded a "seal of approval") by a group such as the Joint Commission on Accreditation of Healthcare Organizations (630-792-5800); www.jcaho.org) or the Community Health Accreditation Program (1-800-669-9656; www.chapinc.org)
Contact your State or local consumer affairs office to see if any complaints have been filed against a home care agency. Also ask about the outcome of any complaint investigations.
Whether you work with an agency or hire someone yourself, carefully check the backgrounds of the people who will be coming into your home. Ask for references who have worked with the agency or person. Call them, and ask about their experiences. Would they use the agency or person again?
Does the home care worker have the necessary skills and training for your needs? Ask to see training certificates. Make sure the worker knows how to safely assist and care for patients.
Does the agency have supervisors who check on the quality of care its workers provide?
How does the agency follow up on and resolve complaints?

All nursing homes that participate in Medicare or Medicaid are visited about once a year by a team of trained inspectors. They check the home and the care provided and prepare a survey report. You have a right to review the report, which must be posted in the nursing home. Speak to the nursing home administrator to learn more about any problems that appear on the report. Ask if the problems have been corrected.
Call your State or local long term care Ombudsman. Ombudsmen visit nursing homes on a regular basis and know about each nursing home in their area. You can ask about the latest survey report and about complaints that have been filed. You can also ask what to look for when visiting local nursing homes.
Compare the inspection records of your top choices by visiting the "Nursing Home Compare" Web site: http://www.medicare.gov/nursinghomecompare/search.html. If you can not access the link above, call Medicare Hotline at 1-800-633-4227 to obtain the information you need.
Some nursing homes have been accredited by a national group such as the Joint Commission on Accreditation of Healthcare Organizations (630-792-5800). It may be helpful to find out if the home participates in the voluntary process and to learn the results.