With an aging population growing each year in America, long-term care facilities are meeting that need.

America is aging.

The U.S. Census Bureau reports that people 65 and older comprise 13.7 percent of the U.S. population, or 43.1 million persons, as of late 2012. That’s up from 35 million in 2000.

As baby boomers retire, an aging nation means a greater need for accessible, affordable long-term care for individuals who lose their ability to meet their own basic care needs, or are without family able or willing to provide care assistance. Assistance can be as minimal as cleaning the house and cooking and serving meals, or more extensive with bathing, dressing, personal hygiene needs and help with medication and mobility. With several categories of care providers available to meet individual needs, medicare.gov provides ratings, reviews and information on some facilities, along with the Department of Health or Department of Social Services at an individual state level.

In-home care

This type of care can be provided by a private agency that hires vocational or registered nurses to provide medical care, but can also employ caregivers without medical training who perform basic, non-medical services. This care is frequently called home health or in-home care. The rates of these services are frequently billed by the hour with a minimum contractual rate. Depending upon the state and locale, the rates can be as little as $15 per hour to as high as $50 or more per hour. In-home care is preferred by those who have care requirements but do not want to leave their homes.

Pros:
Assistance is provided in the seniors home, allowing them to age in place, and costs can be more affordable.

Cons:
In many cases, it is only a short-term solution that will require a change in care as a person’s health profile changes.

Assisted living

This category is also called board and care, residential care or social care. These facilities are licensed by a states department of health or social services, and they require a person to move into either a small residential home or a large-scale facility that resembles a quality hotel. Rooms may be both unshared (private) or shared with another person. The larger the facility, the greater the services and activities that are offered, with prices varying based upon location, room size and care needs. Smaller residential facilities employ caregivers that provide basic homemaker services combined with personal grooming tasks and medication assistance, but no medical care. Prices can range from a room and board chargeroom, meals and housekeeping to varying levels of care ranging from minimal to extensive. Government assistance rarely pays for any of these costs, and long-term care insurance companies may restrict the source of care to only skilled care (see below). For residents who choose to move or who are compelled to move from their homes because of care needs, the expenditures are mostly private and out-of-pocket. Depending upon the state and the locale, fees can range from $1,500 per month to as much as $10,000 or more per month.

Pros:
Assistance with daily activities, meals, transportation, medication management and housekeeping in a social, secure environment.

Cons:
Some seniors may feel uncomfortable living in a facility that houses many other people, and cost can be prohibitive.

Care for life

Assisted living facilities throughout the country usually do not provide nursing or medical care even if a vocational or registered nurse is on staff. However, there is a growing trend in services called care for life, which are specialty facilities referred to as continuum care residential communities or CCRCs; terminology can vary by state. These innovative facilities have a buy-in fee ranging from $50,000 to as much as $1 million or more that guarantees care is provided on one campus without having to be relocated from facility to facility to meet individual care needs. The setting can be compared to independent living in a private apartment with no care, but also providing access to skilled or convalescent nursing care. Private pay or long-term care insurance is the main source of payment. However, Medicare or Medicaid may pay for limited stays in the community’s skilled nursing facility on the same campus.

Pros:
A continuum of services at a single location, along with a wide variety of accommodations.

Cons:
Can be too costly for some and require a long-term financial commitment.

Skilled nursing facilities

Nursing or convalescent homes specialize in medical care provided by certified nursing assistants, along with vocational (practical) and registered nurses. Medicare does not pay for long-term, permanent placement in skilled nursing facilities, but may pay for short stays if a patient was discharged from the hospital and needs convalescence or nursing services. Medicaid administered through state payment services will pay for skilled and/or long-term care once the individual qualifies financially, typically by reporting little to no assets; an individual frequently must spend down their assets to qualify. Again varying by state and locale, these expenses can range from $4,000 to $8,000 per month even more if the level of care requires frequent nursing and physician interventions, with the cost of medication being a significant portion of the monthly fee.

Pros:
Full-time medical supervision and specialized care by a trained clinical staff that can’t be administered by a family member or caregiver.

Cons:
Can be very expensive if not subsidized by funding; level of care can vary greatly depending on the facility.

Michael S. Goryan, MA, is the owner and operator of Resources For Continuing Education, Inc., a California-based continuing education vendor to administrators and licensees of residential care facilities, nursing homes, adult care homes, and registered and licensed vocational nurses. Certified by California’s Department of Social Services, Board of Registered Nurses and Department of Public Health Services, he has served as the Executive Director of the Riverside/ San Bernardino County Alzheimer’s Association.