Long-term care

About one out of eight Americans is over the age of 65. While Americans are remaining active longer and living longer than in the past, aging and its attendant illness can make it difficult for a person to manage without help. The system of health care that takes care of the many varied needs of older Americans is long-term care.

In the past, long-term care meant simply a nursing home. As people remain vital longer and as the health care needs of the elderly change, however, new alternatives have sprung up in the field of long-term care.

Long-term care can mean a nursing home. Nursing homes provide variouslevels of care. Some facilities provide skilled nursing care, with care delivered by nurses (both registered nurses and licensed practical nurses), following the orders of a physician. Skilled nursing facilities are not limited tohelping elderly patients. Younger persons who have suffered debilitating illness or accidents may be placed in a skilled nursing facility for a short period of rehabilitation. Other nursing homes provide intermediate care (for patients who are more mobile but still need medical care from professionals), orcustodial care (for patients who do not need constant medical care but who can no longer live on their own).

Long-term care, however, includes more than just nursing homes. Elderly people have varying degrees of independence, which long-term care professional describe as their activities of daily living (ADLs). ADLs include bathing, preparing and eating meals, using the toilet, dressing and getting around.

Some elderly people may still be able to manage their ADLs on their own, butmay be finding a house too much to take care of. A person like this may findan ideal living situation in an independent living facility, where people live in their own apartments in a secure building.

A person who is able to live independently but needs nursing care may find home care to be the ideal solution. In home care, a nurse will visit every dayor every other day and provide medical care, such as changing the dressing onwounds.

A person who cannot quite manage his or her ADLs but doesn't need the constant nursing care that would be found in a nursing home can move into a relatively new kind of long-term care, an assisted living facility. Assisted living facilities provide residents with their own apartments and usually provide daily maid service and meals, which may be served in a communal dining room. Assisted living residents often have access to on-site medical care if they needit.

Other levels of care also exist. If an elderly person lives with an adult child who is uncomfortable with leaving Mom or Dad home alone during the day, adult day care can be the answer. At an adult day care facility, the elderly person can enjoy social activities and meals and return home at night. This isalso a good alternative for an older person who wants to live independently but needs some help during the day.

Continuing care retirement communities are seniors-only communities that provide a spectrum of care options from independent living to nursing home care.

Another form of long-term care is hospice care. Hospice care provides care and compassion to people who are dying, such as terminally ill cancer patients.The goal of hospice is to make patients as comfortable as possible, either in a home or a nursing-facility setting.

Paying for these many levels of care is a growing issue. In 1995,the U.S. General Accounting Office estimated that spending for long-term care totaled almost $91 billion. Of that amount, 60% was paid for by Medicaid, but 40% (over$36 billion) came out of the pockets of the elderly and their families, particularly their adult children. About 48% of people have done little or no planning for long-term care, and 80% of the post-World War II generation have little idea how long-term care is paid for. It is no wonder, then, that long-term care insurance is an area of increasing interest to both the elderly and their children.

However, a survey of Baby Boomers also indicated that a quarter of them werenot willing to pay for extra insurance to cover the expense of long-term care.

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