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.

When an older person needs more help than a family member or friend can provide, it may be time to consider moving to a residential (live-in) facility, such as assisted living or a nursing home. Choosing a place to live for long-term care is a big decision. It can be hard to know where to start.

The following are some steps you can take to help find the right place for yourself or a loved one.

Consider the person’s needs and wants

What services are needed now and might be necessary in the future? For example, an older adult may need assistance with everyday activities, physical therapy, nursing care, hospice care, or a special unit for people with memory problems or dementia. If you are unsure, ask a health care provider which services may be most helpful.

What features are important to the person? For example, they may care about meals, social and recreational activities, a religious connection, or staying close to family and friends so they can easily visit.

Talk to friends, family, and others in your area

Ask about their experience with particular long-term care facilities. Were they happy with the care? Health care providers, social workers, religious groups, and support groups in your community may also be able to suggest quality places.

Call and visit different facilities

Once you’ve identified a few possibilities, get in touch with each place on your list. Ask questions about how many people live there and what it costs. Mention any special needs or preferences. Find out whether there is immediate availability or a waiting list.

Before deciding, it’s a good idea to visit several facilities in person. Make plans to meet with the director, nursing director, or other key staff members. Take a copy of the Medicare Nursing Home Checklist to fill out during each facility’s visit. For example, look for:

• Medicare and Medicaid certification
• State licensing
• Accessibility for people with disabilities
• Residents who look appropriately dressed and well cared for
• Warm and respectful interaction between staff and residents
• A clean, fresh-smelling, comfortable, and well-maintained facility

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 have an opportunity to attend different activities. Stop by at mealtime. If there is a dining room, is it attractive and clean? Does the food look appetizing, and can you sample it?

Ask questions during your visits

Don’t be afraid to ask questions. Ask about anything that is important or concerning. Here are a few ideas for questions to ask the staff:

• How many care providers are there per resident? What kind of training do they have? How many of them are trained to provide medical care if needed?
• How long have the director and heads of nursing, food, and social services departments worked at the facility? How often do key staff members turn over?
• Is there a doctor who checks on residents on a regular basis? How often?
• What activities are planned for residents during the week and on weekends? Can you attend activities yourself to see what they’re like?
• Is there a safe place for residents to go outside?
• How do residents get to medical appointments?
• If you need it, does the facility have a special unit for people with Alzheimer’s disease or another form of dementia? If so, what kinds of services does it provide?
• Is there information on state regulations for how care is provided? For example, what happens when there is an infectious disease outbreak requiring quarantine?

Find out about costs and contracts

Each facility is different, so get detailed information about costs and which services are included. Find out if Medicare, Medicaid, or long-term care insurance will pay for any of the costs. The facility may have a financial office that can help you determine what assistance is available.

Once you select a facility, read the contract carefully. Make sure all the agreements are clear and ask questions about anything you don’t understand. Read over the contract again before signing it.

Resources for choosing a long-term care facility

Do you want to learn more about the options for long-term residential care? These resources can help you get started:

• Search the Eldercare Locator or call 800-677-1116 for help finding care in your area.
• Visit LongTermCare.gov for information about housing options for older adults and finding local services.
• Call your local Area Agency on Aging or department of human services from your state or local government.
• Use Medicare’s Care Compare tool to find and compare nursing homes and other health care facilities in your state or territory.
• Check the quality of nursing homes and other health care facilities with the Joint Commission’s Quality Check .

Long-term care involves a variety of services designed to meet a person’s health or personal care needs when they can no longer perform everyday activities on their own. This article provides an overview of long-term care planning, services, and costs, as well as other resources.

Who needs long-term care?

Many people will need long-term care at some point. However, it can be difficult to predict how much or what type of care a person might need.

The need for long-term care can arise suddenly, such as after a heart attack or stroke. More often, however, the need for long-term care develops gradually. People require more care as they get older and frailer or as a serious, ongoing illness or health condition gets worse.

Healthy habits can reduce the risk of many diseases and may help delay or prevent the need for long-term care. Good nutrition, 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. Talk to your health care provider about your medical and family history and lifestyle. They may suggest actions you can take to improve your health.

What are the different types of long-term care services?

Long-term care involves a wide variety of support services to help people live as independently and safely as possible. It is provided in different places by different caregivers, depending on a person’s needs.

Home-based care

In many cases, long-term care is provided at home by informal caregivers, such as family members, friends, and neighbors. Most home-based care services involve personal care — help with everyday activities, also called “activities of daily living.” These activities include bathing, dressing, eating, and taking medications, as well as supervision to make sure a person is safe.

Home-based care can also be supplemented by formal caregivers who are paid for their services. These caregivers include nurses, home health care aides, therapists, and other professionals. They can help older people with many aspects of health care, including giving medications, caring for wounds, helping with medical equipment, and providing physical therapy.

Get detailed information about in-home support services, including suggestions for arranging them, information about costs, and additional resources.

Community and residential care

Some aspects of long-term care can be provided in a person’s community, such as in an adult day care center or senior center. Care in these settings may include meals, exercise, social activities, personal care, and transportation. These services may be provided at no cost or for a fee.

Long-term care can also be given in a residential facility, such as assisted living or a nursing home. Some facilities offer only housing and housekeeping, but many also provide personal care, social and recreational activities, meals, and medical services. Some facilities offer special programs for people with Alzheimer’s disease and other types of dementia.

Long-term care planning

The best time to think about long-term care is before you need it. Planning for the possibility of long-term care gives you and your family time to learn about services available in your community and what they cost. It also allows you to make important decisions while you are still able.

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 and what kind of care you would want. People with Alzheimer’s disease and other types of dementia should begin planning for long-term care as soon as possible. Read more about advance care planning.

Most people prefer to stay in their own home for as long as they can. Staying in your own home as you get older is called “aging in place.” But living at home as you age requires careful consideration and planning. There may come a time when it’s no longer safe or comfortable to live alone. Be realistic and plan to revisit the decision as your needs change over time.

Paying for long-term care

Long-term care can be expensive. How people pay for care depends on their financial situation, their eligibility for assistance programs, and the kinds of services they use. People often rely on a variety of payment sources, including:

• Personal funds, including savings, a pension or other retirement fund, income from investments, or proceeds from the sale of a home.
• Federal and state government programs, such as Medicare, Medicaid, and the U.S. Department of Veterans Affairs (VA). Visit USA.gov for more information about government programs for health care and financial assistance.
• Private financing, including long-term care insurance, reverse mortgages, certain life insurance policies, annuities, and trusts.

ssisted living is housing and services for people who need some help with daily care. They may need help with things like dressing, bathing, taking their medicines, and cleaning. But they do not need the medical care that a nursing home provides. Assisted living allows the residents to live more independently.

Assisted living facilities sometimes have other names, such as adult care facilities or residential care facilities. They vary in size, with as few as 25 residents up to 120 residents or more. The residents usually live in their own apartments or rooms and share common areas.

The facilities usually offer a few different levels of care. Residents pay more for the higher levels of care. The types of services they offer may be different from state to state. The services may include:

• Up to three meals a day
• Assistance with personal care, such as bathing, dressing, eating, getting in and out of bed or chairs, moving around, and using the bathroom
• Help with medicines
• Housekeeping
• Laundry
• 24-hour supervision, security, and on-site staff
• Social and recreational activities
• Transportation

The residents are usually older adults, including those with Alzheimer's or other types of dementia. But in some cases, residents may be younger and have mental illnesses, developmental disabilities, or certain medical conditions.

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 to stay in their home. It might be for people who are getting older (aging in place). It could also be for people who are chronically ill, recovering from surgery, or have a disability. Home care services include:

• Personal care, such as help with bathing, washing your hair, or getting dressed
• Household chores, such as cleaning, yard work, and laundry
• Cooking for you in your home or delivering meals to you
• Money management, such as help filling out forms and making sure that your bills are paid on time
• Health care, such as having a home health aide come to your home or getting care from your provider through telehealth

You can get almost any type of help you want in your home. You have to pay for many of them. But some types of care and community services are free or donated. 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.