When you hear that someone you love needs long-term care, you probably assume that means going into a nursing home. While that may be the right choice for a medically fragile person, long-term care actually encompasses a range of services. Below, we discuss the difference between long-term care and a nursing home.

What is long-term care?

“When many people hear the phrase ‘long-term care,’ their mind leapfrogs over a number of other options that offer a high quality of life and goes straight to assuming the person is very ill and can’t do anything,” says eldercare expert Joy Loverde.

But in reality, many people don’t end up in a nursing home unless they need skilled nursing care on an ongoing basis. “Many times, it’s not even medical needs that drives someone to need extra care. They may need intellectual or social needs tended to,” Loverde points out.

The primary criteria for whether people require long-term care is whether they can perform activities of daily living (ADLs), which involve tasks around mobility, eating, personal hygiene and managing household tasks.

“My criteria for any kind of need for long-term care is based on ability, never age,” Loverde says. “Can they manage their own medications? Can they get from the living room to the bedroom and back? Can they interact with others, and can they have their social needs met on their own?” Some younger people may have ailments that cause them to deteriorate physically or mentally quicker than someone who’s far older but in good health.

Options for long-term care and their costs

Long-term care can range anywhere from someone who assists with chores a few times a week to 24/7 medical care in a nursing facility. Here are a few ways long-term care services can be provided.

Family and friends

Often friends or family members will step in to help with cleaning, cooking, bathing, dressing and other basic needs on a regular basis, particularly if the person who needs care moves in with them. If a family member agrees to be a caretaker, it’s vital to be realistic about what they are capable of. “Assess the situation to make sure you can balance it with your other responsibilities, whether it’s work, school or taking care of your own family,” Loverde says.

Home-based professional care

A home health aide is someone who can come to someone’s home and assist with ADLs like light housekeeping, grocery shopping and transportation to and from doctors' appointments so that the person who needs care can continue to live independently. According to Northwestern Mutual’s 2020 Cost of Care study, the average national rate for a home health aide is more than $25 an hour.

While a home health aide may be able to help with taking vital signs or keeping track of medications, if a loved one needs more advanced medical help, a visiting nurse may be more in line with their needs. A licensed practical nurse costs an average of $139 per visit, while a registered nurse averages $147.

Assisted living facilities

Assisted living facilities provide a middle ground between independent living and nursing homes. Residents of assisted living facilities can live in their own apartments, but share common and social spaces, and receive meals along with help for other activities of daily living. Assisted living facilities offer some medical care, but not to the level as is provided in a nursing home. Prices can range depending on the size of the apartment, from an average of $4,166 for a studio to $5,227 for a two bedroom.

Nursing home

A nursing home provides room and board along with 24/7 medical and personal care for people who have physical or mental conditions that require more care and supervision that can be provided in assisted living or at home. The national median cost for a semi-private room is $254 a day (or almost $93,000 a year), while a private room is $312 a day (or nearly $114,000 a year).

Use this long-term care calculator for more detail on how much long-term care services might cost in your state.

What to know before choosing an assisted living facility or nursing home

If you think an assisted living facility or nursing home might be the right answer for your loved one’s needs, Loverde advises looking into the following to see if the place would be a good fit and can provide a good quality of life.

  • What care can be provided if needs change? Is the facility, for instance, certified for dementia? You don’t want to have your loved one getting comfortable with the staff and surroundings only to have to move.

  • For couples, what happens if one spouse needs more care than the other? Consider what life may be like for both people if they are separated.

  • Ask if there is a resident or family council and how they resolve problems or handle requests.

  • Verify the pet policy. Do you prefer pets being allowed, or would you prefer a pet-free facility?

  • Observe any social programming to see how residents are engaged, no matter what their capabilities are.

  • Ask about COVID-19 policies and make sure the guidelines align with your expectations.

  • Have an attorney look over any contracts before signing.

Preparing financially for long-term care

Whatever path you choose when it comes to long-term care planning is bound to involve a financial commitment. Loverde recommends talking to an elder-law attorney and financial advisor before you make any moves. “It’s never too early or late to get good information. There are always financial strategies available, but these issues won’t solve themselves,” she says. “Talk to professionals about the big picture, both financially and legally.”

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