Page Reviewed / Updated - Aug. 2019
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. For example, some government programs will help pay for a skilled nursing facility, but not in-home care. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Regardless of the location in which assistance is provided, at the highest level there are two types of care, skilled care (medical care) and custodial care (non-medical care). Skilled care describes medical services, such as physical therapy, catheter care, and administering medications via IV, that can be provided only by skilled or licensed medical personnel. Custodial care (also called non-skilled care) helps with activities of daily living (ADLs), such as bathing, dressing, and eating, and sometimes with instrumental activities of daily Living (IADLs), like light housecleaning, laundry, and preparing meals. Custodial care is typical for seniors with Alzheimer's or dementia, as well as for frail, elderly adults. Both skilled and custodial care can be provided at home, in adult day care, or in a residential care setting, such as a nursing home, an assisted living community, or an adult foster care home.
Both assisted living and memory care are residences that offer 24-hr supervision and personal care assistance, as well as meals, social activities, and other amenities. However, memory care is intended only for persons with dementia, usually related to Alzheimer’s Disease, but also dementia from Parkinson’s, Huntington's, and most other forms of dementia. There are several differences between assisted living and memory care. Typically, the staff-to-resident ratio in memory care is lower, allowing residents a higher level of care. In addition, the staff is specifically trained to handle the cognitive, behavioral, emotional, and physical needs and issues associated with dementia. Security in memory care is increased and external access is restricted to prevent wandering. Different types of recreational activities are organized with fewer offsite outings. Consequently, memory care is more expensive than assisted living by approximately 25%. State and regional costs are available here.
These terms, “home care” and “home health care”, are sometimes used interchangeably, but there is an important distinction. While both types of care are provided in the individual's home, home care generally means custodial or unskilled care is being provided. For example, assistance is provided with bathing and dressing the individual, doing the laundry, cooking, and accompanying the care recipient to doctors’ appointments or on other errands. One may also hear this type of care referred to as personal care or attendant care, although those terms are not exclusively for care provided in the home.
Home health care refers to a higher level of care, which requires medical training. This includes procedures such as checking the individual's vitals and respiration, and assisting with braces, artificial limbs, and other medical equipment, such as ventilators. To be clear, it is not unusual for home health care providers to also provide custodial care during their home visits.
The term “adult day care” is used interchangeably and can refer to adult day social care or adult day medical care. Adult day social care provides seniors with supervision and care in a structured setting during daytime hours, usually only on weekdays. This type of care is often used to allow informal (unpaid) family caregivers to go to work or is utilized as respite care (temporary care that allows primary caregivers a break from their caregiving responsibilities). A variety of social / recreational activities, meals, personal care assistance, and some therapies are offered. In addition, some adult day care centers specialize in dementia care. With this type of care, extra safety measures have been taken to prevent wandering and the staff specializes in caring for persons with Alzheimer’s disease and related dementias.
Adult day health care typically provides everything adult day social care does, but also offers medical services equivalent, or almost equivalent, to those found in nursing homes.
Virtual companion care is a way of providing home care using Internet technologies. Elderly persons living at home alone are provided with a tablet computer through which their safety and mood can be monitored, medication reminders provided, and most importantly, they can interact with others, reducing feelings of loneliness and isolation. Although hands-on care is not provided, virtual companion care holds great promise for reducing the cost of care and improving the lives of elderly persons living at home alone. Read more.
Palliative care is a type of care that focuses on relieving patients of their pain and suffering, instead of medical care, which has the objective of curing or treating the underlying conditions. Hospice care, on the other hand, is an encompassing approach to treating terminally ill patients in the last weeks or months of their lives. While hospice care very often includes palliative care, not all persons receiving palliative care are in hospice.
Geriatric Care Managers (GCMs) help families create and implement long term care plans for their loved ones. Stated differently, they provide care management services instead of providing hands-on care themselves. Typically, this includes an in-person needs assessment, the development and review of a care plan, and arranging and monitoring care services. Approximately one third of care managers also offer financial planning for eldercare.
GCMs are also referred to as elder care managers, case managers, and service or care coordinators. In addition to a certification from the Aging Life Care Association, many are licensed by their different professional backgrounds; which include social workers, nurses, therapists, and assisted living or home care professionals.
There are both public and private care managers. Those who work in the public sector are usually referred to as benefits counselors or case managers, while those who work in the private sector are called care managers. Medicaid will sometimes provide for care management services under a HCBS (home and community based services) Waiver program. Some long-term care insurance policies include coverage of care management as well.
In addition to the convenience, time-savings, and security they provide, care managers can save families money because their needs assessments align an individual’s present condition with only those services that are necessary at that time.
There are four categories of residential care communities, and each is referred to by many different names.
1) Independent Living / Senior Living – homes within a complex that offers transportation, security, and recreational activities, but no health care services. There is sometimes a strict minimum age requirement.
2) Assisted Living – residences provide help with activities of daily living, including basic health services, recreational and social activities, but not skilled nursing care.
3) Skilled Nursing Homes – residences with 24/7 care by licensed health professionals, including all housekeeping, medical, and social needs.
4) Continuing Care Retirement Communities – residences that provide a continuum of care from independent living to assisted living to memory care to skilled nursing. These communities are designed to enable seniors with progressively declining health to remain in a single residential location or give healthy seniors the peace of mind that all their future needs are covered.
|Residence Type||Independent Living||Assisted Living Communities||Nursing Homes||Continuing Care Retirement Communities|
|Description||Single family homes or townhomes for self-sufficient seniors that offer the security and social activities of a community living environment.||Communities, typically of 2-3 story apartments, that provide 24 hour assistance with activities of daily living, such as eating, bathing, and using the bathroom, but do not offer 24 hour medical services.||Communities, typically of private and shared rooms, which provide 24 hour assistance with activities of daily living and medical care by nurses and therapists.||Campus-like communities that provide a continuum of care, from private residences to assisted living to memory care to skilled nursing care; designed for individuals with declining conditions and those that want to remain in a single location.|
|Services||-Laundry / linen service -Meals -Transportation -Social activities Note there are also more expensive communities that have all the luxuries of country clubs.||-Laundry / linen service -Meals -Transportation -Social activities -Bathing / Dressing -Toileting -Housekeeping -Medication assistance -Security and emergency calls||-Laundry / linen service -Meals -Transportation -Social activities -Bathing / Dressing -Toileting -Housekeeping -Medication assistance -Security and emergency calls -24 hour nursing care -Condition specific care -Hospice / end of life services -Doctors on call||-Laundry / linen service -Meals -Transportation -Social activities -Bathing / Dressing -Toileting -Housekeeping -Medication assistance -Security and emergency calls -24 hour nursing care -Condition specific care (such as Alzheimer’s care) -Hospice / end of life services -Doctors on call|
|Regulation||Not Regulated||State Regulations||State & Federal Regulations||Some State Regulations|
|Also Known As||-Retirement Communities -Retirement Homes -Senior Apartments -Senior Housing -Senior Living Communities -Active Adult Communities||-Assisted Living Facilities -Personal care Homes -Eldercare Facilities -Domiciliary Care -Board and Care -Residential Care Facilities -Community-Based Retirement Facilities, -Adult Living Facilities -Adult Foster Care -Sheltered Housing -Community Residences -Group Homes -Adult Family Homes||-Skilled Nursing Facilities -SNF -Nursing Home Care and Rehabilitation -Convalescent Hospital -Rest Home||-CCRCs -Continuing Care -Retirement Facilities -Life Care Facilities -Life Care Communities -Life Plan Community|
|Approximate Costs||Market rate to rent or buy a home plus community fees from $700 – $6,000 / month||$2,844 to $9,266 / month||$4,639 - $12,623 / month||Varies with breadth of services required.|