A nursing home is a place for people who don't need to be in a hospital but can't be cared for at home. Most nursing homes have nursing aides and skilled nurses on hand 24 hours a day.

Some nursing homes are set up like a hospital. The staff provides medical care, as well as physical, speech and occupational therapy. There might be a nurses' station on each floor. Other nursing homes try to be more like home. They try to have a neighborhood feel. Often, they don't have a fixed day-to-day schedule, and kitchens might be open to residents. Staff members are encouraged to develop relationships with residents.

Some nursing homes have special care units for people with serious memory problems such as Alzheimer's disease. Some will let couples live together. Nursing homes are not only for the elderly, but for anyone who requires 24-hour care.

A nursing home, also known as a skilled nursing facility, provides a wide range of health and personal care services.

These services typically include nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities. Rehabilitation services, such as physical, occupational, and speech therapy, are also available.

Some people stay at a nursing home for a short time after being in the hospital. After they recover, they go home. However, most nursing home residents live there permanently because they have ongoing physical or mental conditions that require constant care and supervision.

If you need to go to a nursing home after a hospital stay, the hospital staff can help you find one that will provide the kind of care that's best for you. If you are looking for a nursing home, ask your doctor's office for recommendations. Once you know what choices you have, it's a good idea to:

Consider what you want. What is important to you—nursing care, meals, physical therapy, a religious connection, hospice care, or special care units for dementia patients? Do you want a place close to family and friends so they can easily visit?

Talk to friends and family. Talk with friends, relatives, social workers, and religious groups to find out what places they suggest. Check with healthcare providers about which nursing homes they feel provide good care.

Call different nursing homes. Get in touch with each place on your list. Ask questions about how many people live there and what it costs. Find out about waiting lists.

Visit the facility. Make plans to meet with the director and the nursing director. The Medicare Nursing Home Checklist (PDF, 178K) has some good ideas to consider when visiting. For example, look for:

• Medicare and Medicaid certification
• Handicap access
• Residents who look well cared for
• Warm interaction between staff and residents

Ask questions during your visit. Don't be afraid to ask questions. For example, ask the staff to explain any strong odors. Bad smells might indicate a problem; good ones might hide a problem. You might want to find out how long the director and heads of nursing, food, and social services departments have worked at the nursing home. If key members of the staff change often, that could mean there's something wrong.

Visit the facility again. Make a second visit without calling ahead. Try another day of the week or time of day so you will meet other staff members and see different activities. Stop by at mealtime. Is the dining room attractive and clean? Does the food look tempting?

Carefully read your contract. Once you select a nursing home, carefully read the contract. Question the director or assistant director about anything you don't understand. Ask a good friend or family member to read over the contract before you sign it.

The Centers for Medicare and Medicaid Services requires each State to inspect any nursing home that gets money from the government. Homes that don't pass inspection are not certified. Ask to see the current inspection report and certification of any nursing home you are considering.

Long-term care involves a variety of services designed to meet a person's health or personal care needs during a short or long period of time. These services help people live as independently and safely as possible when they can no longer perform everyday activities on their own.

Long-term care is provided in different places by different caregivers, depending on a person's needs. Most long-term care is provided at home by unpaid family members and friends. It can also be given in a facility such as a nursing home or in the community, for example, in an adult day care center.

The most common type of long-term care is personal care—help with everyday activities, also called "activities of daily living." These activities include bathing, dressing, grooming, using the toilet, eating, and moving around—for example, getting out of bed and into a chair.

Long-term care also includes community services such as meals, adult day care, and transportation services. These services may be provided free or for a fee.

People often need long-term care when they have a serious, ongoing health condition or disability. The need for long-term care can arise suddenly, such as after a heart attack or stroke. Most often, however, it develops gradually, as people get older and frailer or as an illness or disability gets worse.

Home-Based Long-Term Care Services

Home-based long-term care includes health, personal, and support services to help people stay at home and live as independently as possible. Most long-term care is provided either in the home of the person receiving services or at a family member's home. In-home services may be short-term—for someone who is recovering from an operation, for example—or long-term, for people who need ongoing help.

Most home-based services involve personal care, such as help with bathing, dressing, and taking medications, and supervision to make sure a person is safe. Unpaid family members, partners, friends, and neighbors provide most of this type of care.

Home-based long-term care services can also be provided by paid caregivers, including caregivers found informally, and healthcare professionals such as nurses, home health care aides, therapists, and homemakers, who are hired through home health care agencies. These services include: home health care, homemaker services, friendly visitor/companion services, and emergency response systems.

Home Health Care

Home health care involves part-time medical services ordered by a physician for a specific condition. These services may include nursing care to help a person recover from surgery, an accident, or illness. Home health care may also include physical, occupational, or speech therapy and temporary home health aide services. These services are provided by home health care agencies approved by Medicare, a government insurance program for people over age 65.

Homemaker Services

Home health agencies offer personal care and homemaker services that can be purchased without a physician's order. Personal care includes help with bathing and dressing. Homemaker services include help with meal preparation and household chores. Agencies do not have to be approved by Medicare to provide these kinds of services.

Friendly Visitor/Companion Services

Friendly visitor/companion services are usually staffed by volunteers who regularly pay short visits (less than 2 hours) to someone who is frail or living alone. You can also purchase these services from home health agencies.

Transportation Services

Transportation services help people get to and from medical appointments, shopping centers, and other places in the community. Some senior housing complexes and community groups offer transportation services. Many public transit agencies have services for people with disabilities. Some services are free. Others charge a fee.

Emergency Response Systems

Emergency response systems automatically respond to medical and other emergencies via electronic monitors. The user wears a necklace or bracelet with a button to push in an emergency. Pushing the button summons emergency help to the home. This type of service is especially useful for people who live alone or are at risk of falling. A monthly fee is charged.

Planning for Long-Term Care

You can never know for sure if you will need long-term care. Maybe you will never need it. But an unexpected accident, illness, or injury can change your needs, sometimes suddenly. The best time to think about long-term care is before you need it.

Planning for the possibility of long-term care gives you time to learn about services in your community and what they cost. It also allows you to make important decisions while you are still able.

People with Alzheimer’s disease or other cognitive impairmentshould begin planning for long-term care as soon as possible.

Housing Decisions: Staying in Your Home

In thinking about long-term care, it is important to consider where you will live as you age and how your place of residence can best support your needs if you can no longer fully care for yourself.

Most people prefer to stay in their own home for as long as possible. Learn about services, products, and resources that can help older adults stay in their homes.

Decisions About Your Health

Begin by thinking about what would happen if you became seriously ill or disabled. Talk with your family, friends, and lawyer about who would provide care if you needed help for a long time. Read about how to prepare healthcare advance directives.

You might delay or prevent the need for long-term care by staying healthy and independent. Talk to your doctor about your medical and family history and lifestyle. He or she may suggest actions you can take to improve your health.

Healthy eating, regular physical activity, not smoking, and limited drinking of alcohol can help you stay healthy. So can an active social life, a safe home, and regular health care.

Decisions About Finances

Long-term care can be expensive. Americans spend billions of dollars a year on various services. How people pay for long-term care depends on their financial situation and the kinds of services they use. Often, they rely on a variety of payment sources, including:

• Personal funds, including pensions, savings, and income from stocks
• Government health insurance programs, such as Medicare and Medicaid
• Private financing options, such as long-term care insurance
• Veterans’ benefits
• Services through the Older Americans Act

Paying for Care

Many older adults and caregivers worry about the cost of medical care. These expenses can use up a significant part of monthly income, even for families who thought they had saved enough.

How people pay for long-term care—whether delivered at home or in a hospital, assisted living facility, or nursing home—depends on their financial situation and the kinds of services they use. Often, they rely on a variety of payment sources, including personal funds, government programs, and private financing options.

Personal Funds

At first, many older adults pay for care in part with their own money. They may use personal savings, a pension or other retirement fund, income from stocks and bonds, or proceeds from the sale of a home.

Much home-based care is paid for using personal funds ("out of pocket"). Initially, family and friends often provide personal care and other services, such as transportation, for free. But as a person's needs increase, paid services may be needed.

Many older adults also pay out-of-pocket to participate in adult day service programs, meals, and other community-based services provided by local governments and nonprofit groups. These services help them remain in their homes.

Professional care given in assisted living facilities and continuing care retirement communities is almost always paid for out of pocket, though, in some states, Medicaid (see below) may pay some costs for people who meet financial and health requirements.

Government Programs

Older adults may be eligible for some government healthcare benefits. Caregivers can help by learning more about possible sources of financial help and assisting older adults in applying for aid as appropriate. The Internet can be a helpful tool in this search.

Several federal and state programs provide help with healthcare-related costs.

Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS) offers several programs. Over time, the benefits and eligibility requirements of these programs can change, and some benefits differ from State to State. Check with CMS or the individual programs directly for the most recent information.

Medicare

Medicare is a Federal Government health insurance program that pays some medical costs for people age 65 and older, and for all people with late-stage kidney failure. It also pays some medical costs for those who have gotten Social Security Disability Income (discussed later) for 24 months. It does not cover ongoing personal care at home. Here are brief descriptions of what Medicare will pay for:

Medicare Part A:

• Hospital costs after you pay a certain amount, called the "deductible"
• Short stays in a nursing home for certain kinds of illnesses
• Hospice care in the last 6 months of life

Medicare Part B:

• Part of the costs for doctor's services, outpatient care, and other medical services that Part A does not cover
• Some preventive services, such as flu shots and diabetesscreening

Medicare Part D:

• Some medication costs

Medicaid

Some people may qualify for Medicaid, a combined Federal and State program for low-income people and families. This program covers the costs of medical care and some types of long-term care for people who have limited income and meet other eligibility requirements. Who is eligible and what services are covered vary from State to State.

Program of All-Inclusive Care for the Elderly (PACE)

Some States have PACE, Program of All-Inclusive Care for the Elderly, a Medicare program that provides care and services to people who otherwise would need care in a nursing home. PACE covers medical, social service, and long-term care costs for frail people. It may pay for some or all of the long-term care needs of a person with Alzheimer’s disease. PACE permits most people who qualify to continue living at home instead of moving to a long-term care facility. You will need to find out if the person who needs care qualifies for PACE. There may be a monthly charge. PACE is available only in certain States and locations within those States.

State Health Insurance Assistance Program

SHIP, the State Health Insurance Assistance Program is a national program offered in each State that provides counseling and assistance to people and their families on Medicare, Medicaid, and Medicare supplemental insurance (Medigap) matters.

Department of Veterans Affairs

The U.S. Department of Veterans Affairs (VA) may provide long-term care or at-home care for some veterans. If your family member or relative is eligible for veterans’ benefits, check with the VA or get in touch with the VA medical center nearest you. There could be a waiting list for VA nursing homes.

Social Security Disability Income

This type of Social Security is for people younger than age 65 who are disabled according to the Social Security Administration's definition.

For a person to qualify for Social Security Disability Income, he or she must be able to show that:

• The person is unable to work
• The condition will last at least a year
• The condition is expected to result in death

Social Security has "compassionate allowances" to help people with Alzheimer’s disease, other dementias, and certain other serious medical conditions get disability benefits more quickly.

National Council on Aging

The National Council on Aging, a private group, has a free service called BenefitsCheckUp®. This service can help you find Federal and State benefit programs that may help your family. After providing some general information about the person who needs care, you can see a list of possible benefit programs to explore. These programs can help pay for prescription drugs, heating bills, housing, meal programs, and legal services. You don’t have to give a name, address, or Social Security number to use this service.

Private Financing Options

In addition to personal and government funds, there are several private payment options, including long-term care insurance, reverse mortgages, certain life insurance policies, annuities, and trusts. Which option is best for a person depends on many factors, including the person's age, health status, personal finances, and risk of needing care.

Long-Term Care Insurance

Long-term care insurance covers many types of long-term care and benefits, including palliative and hospice care. The exact coverage depends on the type of policy you buy and what services are covered. You can purchase nursing home-only coverage or a comprehensive policy that includes both home care and facility care.

Many companies sell long-term care insurance. It is a good idea to shop around and compare policies. The cost of a policy is based on the type and amount of services, how old you are when you buy the policy, and any optional benefits you choose.

Buying long-term care insurance can be a good choice for younger, relatively healthy people at low risk of needing long-term care. Costs go up for people who are older, have health problems, or want more benefits. Someone who is in poor health or already receiving end-of-life care services may not qualify for long-term care insurance.

Reverse Mortgages

A reverse mortgage is a special type of home loan that lets a homeowner convert part of the ownership value in his or her home into cash. Unlike a traditional home loan, no repayment is required until the borrower sells the home, no longer uses it as a main residence, or dies.

There are no income or medical requirements to get a reverse mortgage, but you must be age 62 or older. The loan amount is tax-free and can be used for any expense, including long-term care. However, if you have an existing mortgage or other debt against your home, you must use the funds to pay off those debts first.

Life Insurance

Some life insurance policies can help pay for long-term care. Some policies offer a combination product of both life insurance and long-term care insurance.

Policies with an "accelerated death benefit" provide tax-free cash advances while you are still alive. The advance is subtracted from the amount your beneficiaries (the people who get the insurance proceeds) will receive when you die.

You can get an accelerated death benefit if you live permanently in a nursing home, need long-term care for an extended time, are terminally ill, or have a life-threatening diagnosis such as AIDS. Check your life insurance policy to see exactly what it covers.

You may be able to raise cash by selling your life insurance policy for its current value. This option, known as a "life settlement," is usually available only to people age 70 and older. The proceeds are taxable and can be used for any reason, including paying for long-term care.

A similar arrangement, called a "viatical settlement," allows a terminally ill person to sell his or her life insurance policy to an insurance company for a percentage of the death benefit on the policy. This option is typically used by people who are expected to live 2 years or less. A viatical settlement provides immediate cash, but it can be hard to get.

Annuities

You may choose to enter into an annuity contract with an insurance company to help pay for long-term care services. In exchange for a single payment or a series of payments, the insurance company will send you an annuity, which is a series of regular payments over a specified period of time. There are two types of annuities: immediate annuities and deferred long-term care annuities.

Trusts

A trust is a legal entity that allows a person to transfer assets to another person, called the trustee. Once the trust is established, the trustee manages and controls the assets for the person or another beneficiary. You may choose to use a trust to provide flexible control of assets for an older adult or a person with a disability, which could include yourself or your spouse. Two types of trusts can help pay for long-term care services: charitable remainder trusts and Medicaid disability trusts.

Assisted living is for adults who need help with everyday tasks. They may need help with dressing, bathing, eating, or using the bathroom, but they don't need full-time nursing care. Some assisted living facilities are part of retirement communities. Others are near nursing homes, so a person can move easily if needs change.

Assisted living costs less than nursing home care. It is still fairly expensive. Older people or their families usually pay for it. Health and long-term care insurance policies may cover some of the costs. Medicare does not cover the costs of assisted living.

Assisted living is for people who need help with daily care, but not as much help as a nursing home provides. Assisted living facilities range in size from as few as 25 residents to 120 or more. Typically, a few "levels of care" are offered, with residents paying more for higher levels of care.

Assisted living residents usually live in their own apartments or rooms and share common areas. They have access to many services, including up to three meals a day; assistance with personal care; help with medications, housekeeping, and laundry; 24-hour supervision, security, and on-site staff; and social and recreational activities. Exact arrangements vary from state to state.

Home care is care that allows a person with special needs stay in their home. It might be for people who are getting older, are chronically ill, recovering from surgery, or disabled. Home care services include

• Personal care, such as help with bathing, washing your hair, or getting dressed
• Homemaking, such as cleaning, yard work, and laundry
• Cooking or delivering meals
• Health care, such as having a home health aide come to your home

You can get almost any type of help you want in your home. Some types of care and community services are free or donated. Many other types you have to pay for. Sometimes government programs or your health insurance will help cover the cost of certain home care services.

Health facilities are places that provide health care. They include hospitals, clinics, outpatient care centers, and specialized care centers, such as birthing centers and psychiatric care centers.

When you choose a health facility, you might want to consider

• How close it is to where you live or work
• Whether your health insurance will pay for services there
• Whether your health care provider can treat you there
• The quality of the facility

Quality is important. Some facilities do a better job than others. One way to learn about the quality of a facility is to look at report cards developed by federal, state, and consumer groups.

Many Americans die in facilities such as hospitals or nursing homes receiving care that is not consistent with their wishes. It’s important for older adults to plan ahead and let their caregivers, doctors, or family members know your end-of-life preferences in advance. For example, if an older person wants to die at home, receiving end-of-life care for pain and other symptoms, and makes this known to health care providers and family, it is less likely he or she will die in a hospital receiving unwanted treatments.

If the person is no longer able to make health care decisions for themselves, a caregiver or family member may have to make those decisions. Caregivers have several factors to consider when choosing end-of-life care, including the older person's desire to pursue life-extending treatments, how long he or she has left to live, and the preferred setting for care.

What is palliative care?

Palliative care is specialized medical care for people living with a serious illness, such as cancer or heart failure. Patients in palliative care may receive medical care for their symptoms, or palliative care, along with treatment intended to cure their serious illness. Palliative care is meant to enhance a person's current care by focusing on quality of life for them and their family.

Who can benefit from palliative care?

Palliative care is a resource for anyone living with a serious illness, such as heart failure, chronic obstructive pulmonary disease, cancer, dementia, Parkinson's disease, and many others. Palliative care can be helpful at any stage of illness and is best provided soon after a person is diagnosed.

In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their choices for medical treatment. The organized services available through palliative care may be helpful to any older person having a lot of general discomfort and disability very late in life.

Who makes up the palliative care team?

A palliative care team is made up of multiple different professionals that work with the patient, family, and the patient's other doctors to provide medical, social, emotional, and practical support. The team is comprised of palliative care specialist doctors and nurses, and includes others such as social workers, nutritionists, and chaplains. A person's team may vary based on their needs and level of care. To begin palliative care, a person's health care provider may refer him or her to a palliative care specialist. If he or she doesn't suggest it, the person can ask a health care provider for a referral.

Where is palliative care provided?

Palliative care can be provided in hospitals, nursing homes, outpatient palliative care clinics and certain other specialized clinics, or at home. Medicare, Medicaid, and insurance policies may cover palliative care. Veterans may be eligible for palliative care through the Department of Veterans Affairs. Private health insurance might pay for some services. Health insurance providers can answer questions about what they will cover.

In palliative care, a person does not have to give up treatment that might cure a serious illness. Palliative care can be provided along with curative treatment and may begin at the time of diagnosis. Over time, if the doctor or the palliative care team believes ongoing treatment is no longer helping, there are two possibilities. Palliative care could transition to hospice care if the doctor believes the person is likely to die within six months. Or, the palliative care team could continue to help with increasing emphasis on comfort care.

What is hospice care?

Increasingly, people are choosing hospice care at the end of life. Hospice care focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life.

At some point, it may not be possible to cure a serious illness, or a patient may choose not to undergo certain treatments. Hospice is designed for this situation. The patient beginning hospice care understands that his or her illness is not responding to medical attempts to cure it or to slow the disease's progress.

Like palliative care, hospice provides comprehensive comfort care as well as support for the family, but, in hospice, attempts to cure the person's illness are stopped. Hospice is provided for a person with a terminal illness whose doctor believes he or she has six months or less to live if the illness runs its natural course.

It's important for a patient to discuss hospice care options with their doctor. Sometimes, people don't begin hospice care soon enough to take full advantage of the help it offers. Perhaps they wait too long to begin hospice and they are too close to death. Or, some people are not eligible for hospice care soon enough to receive its full benefit. Starting hospice early may be able to provide months of meaningful care and quality time with loved ones.

Where is hospice care provided and who provides it?

Hospice is an approach to care, so it is not tied to a specific place. It can be offered in two types of settings — at home or in a facility such as a nursing home, hospital, or even in a separate hospice center.

Hospice care brings together a team of people with special skills — among them nurses, doctors, social workers, spiritual advisors, and trained volunteers. Everyone works together with the person who is dying, the caregiver, and/or the family to provide the medical, emotional, and spiritual support needed.

A member of the hospice team visits regularly, and someone is usually always available by phone — 24 hours a day, seven days a week. Hospice may be covered by Medicare and other insurance companies. Check to see if insurance will cover the person’s particular situation.

It is important to remember that stopping treatment aimed at curing an illness does not mean discontinuing all treatment. A good example is an older person with cancer. If the doctor determines that the cancer is not responding to chemotherapy and the patient chooses to enter into hospice care, then the chemotherapy will stop. Other medical care may continue as long as it is helpful. For example, if the person has high blood pressure, he or she will still get medicine for that.

Although hospice provides a lot of support, the day-to-day care of a person dying at home is provided by family and friends. The hospice team coaches family members on how to care for the dying person and even provides respite care when caregivers need a break. Respite care can be for as short as a few hours or for as long as several weeks.

What are the benefits of hospice care?

Families of people who received care through a hospice program are more satisfied with end-of-life care than those who did not have hospice services. Also, hospice recipients are more likely to have their pain controlled and less likely to undergo tests or be given medicines they don't need, compared with people who don't use hospice care.