Long-term Care: Everything You Need To Know
Long-term care facility helps seniors live safely and independently when they are no longer able to perform their routine activities and take care of their health on their own.
But making the decision to move a loving elder to a long-term care facility is never easy. Finding the right facility can be even more challenging.
Fortunately, with some advance research and expert guidance, you can make the entire process of moving to a long-term senior care facility easy and smooth.
To ensure satisfactory care and well-being of your seniors, you may be looking for a long-term care community that best suits your needs. It is important to understand that every service provider is different and offers different services. So it is advised to explore as many options as possible before deciding on a long-term care facility for your senior loved one.
Here is a detailed guide on long-term senior care, involving care type, costs involved, services provided, and locating the best facility. Reading it carefully can help you make the right decision and navigate through the entire process smoothly.
Let’s have a look:
What is Long-term Care?
Long-term care (LTC) involves a variety of services designed to meet the medical and non-medical needs of people suffering from a chronic illness or disability. These individuals cannot care for themselves for a long period of time. This type of care is focused on individualized and coordinated services that promotes independence, quality of life and meet patients’ needs.
Though long-term care is not limited to the elderly, the vast majority of care recipients are seniors. Ovn average, 52 percent of people turning age 65 will need some form of long-term care in their lifetimes.[1]
Demographics in the US and Canada
Fifty-two percent of Americans – 47 percent of men and 58 percent of women – age 65 needs long-term care in their lifetime.[2]
Ten percent of Americans over age 65 are suffering from Alzheimer’s disease, and this increases to 33 percent among people ages 85 and older.[3] As the US population ages, demand for long-term care is increasing. As a result, national long-term care costs skyrocketed from $30 billion in 2000 to $225 billion in 2015.[4]
Similarly, as Canada’s baby-boom generation ages, the demand for long-term care systems will increase. In the 2016 census, the population aged 65 and up outnumbered the population aged 15 and under for the first time.[5]
According to the Conference Board of Canada, the country will need 454,000 long-term care beds by 2035 to accommodate new demand. The new beds will require about $64 billion in capital spending and $130 billion in operating spending between 2018 and 2035.[6]
Long Term Care Types
You can choose from different types of long-term care available with community-based care communities.
Most long-term care services and support is provided at home by an unpaid caregiver who can be a family member or friend. Caregivers can be skilled nurses, home health aide, or a therapist who come to your home.
You may also hire a professional home-based long-term care provider such as skilled nurses, therapists, homemakers, to assure satisfactory care of your seniors. You can hire them through senior care agencies.
Besides these, there are a variety of long-term care facilities that take full responsibility for caring for your seniors and provide the required level of care.
In-Home Care
You may enlist a professional and certified caregiver to provide housekeeping, home health aide, personal care, and nursing services to your aging seniors. Care providers may perform rehabilitation services in the home or at a long-term care facility depending upon circumstances. In-home care may not be feasible in the case you need medically intensive or extensive care.
In-home care is the option preferred by people who need assistance but don’t want to leave their home. Depending on the level of care needed, home care can be the most expensive option of various types of long-term care.
Assisted Living
Long-term care in an assisted living facility provides services and support with ADLs, housekeeping, basic healthcare, meals, and medication management.
Assisted living communities provide residents a high level of independence in a home-like setting. It is the intermediate step between independent living and skilled nursing.
Adult Day Health Care
Adult day health care facilities provide seniors with health services, therapeutic services, social activities, and meals at a community- or facility-based location during the day as a part- or full-time service. Care recipients return to their home in the evening.
Adult day health care allows the primary caregiver to keep up with other business and run his/her errands while providing required care to their parents or grandparents.
Long-term Memory Care
Memory care facilities provide vigilant care to recipients dealing with cognitive impairment, Alzheimer's, or any form of dementia. This care involves
This type of long-term care includes a structured environment with prefixed schedules, round-the-clock supervised care in a safe and locked-down facility.
Skilled Nursing
In a skilled nursing facility, seniors received round-the-clock skilled nursing care by licensed and trained nurses. Residents at these facilities often require intensive medical care. A doctor is also available on call at all times, and ambulances remain on site to transport patients to hospitals in the event of an emergency.
Skilled nursing care facilities offer services ranging from short-term rehabilitative care to long-term extended stays.
Services Offered in Long Term Care Facilities
Long-term care can include living accommodations and medical care by a skilled team of healthcare professionals who are proficient in addressing some of the common issues the elderly experience.
Most long-term care is not medical care, but rather assistance with activities of daily living (ADLs), such as:
- Bathing
- Dressing
- Toileting
- Eating
- Caring for incontinence
- Navigating
Other common services and supports include assistance with instrumental activities of daily living (IADLs), such as:
- Housekeeping
- Money management
- Taking medication
- Meal preparation
- Shopping
- Pets caring
- Using communication devices
- Responding to emergency alerts
Long-term care may be temporary (lasts for weeks or months) or permanent (months and years).
Whether you choose temporary or permanent care depends on the underlying reason for the care. Reasons for temporary care can include:
- Rehabilitation after a surgery
- Rehabilitation after a hospital stay
- Recovery from an illness or injury
- End of life medical support
Reason for permanent care can include:
- Permanent disabilities
- Chronic medical conditions
- Need for supervision or assistance with ADLs
- Cognitive impairment such as dementia Alzheimer's disease
Ready to Search for a Long-Term Care Facility?
Long-Term Care Costs
The cost of long-term care depends on the type and duration of care you need, the provider you use, and where you live. Home care services that involve visits of a physician, nurse or therapist are generally more expensive in the evening, on weekends, and on holidays.
Though most long-term care facilities may have “all -inclusive” fees, some facilities may charge extra for care beyond basic services and support. Some community programs provide care at variable rates, depending on the level of care, extra events, and activities.
Use the following tool to figure out long-term care cost details by state and region. The tool displays average costs for different types of long-term care services.
| Type of care | Average Cost in Region |
|---|---|
| Skilled Nursing Facilities Private Room Annual Rate: | $91,279.20 |
| Skilled Nursing Facilities Semi-Private Room Annual: | $77,573.45 |
| Assisted Living Facility Monthly Rate (2 bedroom): | $5,699.17 |
| Assisted Living Facility Monthly Rate (1 bedroom): | $5,048.10 |
| Assisted Living Facility Monthly Rate (Studio): | $4,361.03 |
| Registered Nurse Per Visit Rate: | $134.31 |
| Licensed Practical Nurse Per Visit Rate: | $121.60 |
| Home Health Aide Hourly Rate: | $22.63 |
In the USA, long-term care in a nursing home costs about $230 per day or $6,840 every month for a semi-private room, while a private room costs about $250 a day or $7,700 per month. An assisted living facility costs $120 per day or $3620 monthly for one-bedroom units long-term facility. The cost is $20.50 hourly for a health aide and $20 hourly for homemaker services.[7]
Most Affordable States for Long-Term Care:[8]
| US States | Average Annual Cost | Adult Day Care | Licensed Home Care | Assisted Living | Nursing Home |
|---|---|---|---|---|---|
| Kentucky | $46, 450 | $17,500 | $46,900 | $42,200 | $91,200 |
| Iowa | $49,300 | $16,230 | $57,200 | $46,150 | $77,740 |
| North Carolina | $49,000 | $14,300 | $45,180 | $44,300 | $92,500 |
| Kansas | $48,550 | $21,120 | $48,040 | $54,670 | $70,370 |
| Utah | $48,460 | $12,090 | $50,360 | $40,200 | $91,200 |
| Tennessee | $47,940 | $17,400 | $45,180 | $47,000 | $82,120 |
| South Carolina | $47,460 | $15,590 | $45,700 | $42,000 | $86,500 |
| Georgia | $44,940 | $15,600 | $45,750 | $37,200 | $81,200 |
| Texas | $44,700 | $9,000 | $45,700 | $45,500 | $78,470 |
| Mississippi | $43,730 | $9,000 | $38,890 | $41,900 | $85,040 |
| Alabama | $44,700 | $9,000 | $38,890 | $39,250 | $79,900 |
| Arkansas | $43,090 | $20,800 | $43,300 | $36,400 | $71,800 |
| Missouri | $42,600 | $21,800 | $48,000 | $34,100 | $66,500 |
| Oklahoma | $421,80 | $15,600 | $49,700 | $39,900 | $63,500 |
| Louisiana | $40,500 | $16,300 | $36,600 | $42,600 | $66,500 |
Aggregate Canadian data show that the average annual cost of long-term residential care is more than $50,000. In the provinces with the highest patient charges on well-off patients, monthly costs were a little more than 3 000$ in 2011, or nearly 36 000$ per year. In Alberta and Ontario, the monthly costs were about 1 400$, or nearly 17 000$ per year.[9]
The following table shows the average cost of care in different types of facilities:
| Type of Care | Average Cost in Canada |
|---|---|
| Private 24/7 care by professional caregivers | 200K $ |
| Assisted living | 40K - 100K $ |
| Government-run nursing home | 20K- 40K $ |
| Caregiving family member | 35K $ |
Free Long-Term Senior Care Resources
There are many government as well as non-government financial aids and resources available for long-term care for seniors.
AHRQ’s Safety Program for Nursing Homes: On-Time Prevention
This program provides a prevention strategy for adverse events in senior nursing homes. It uses electronic medical records to generate weekly reports to identify residents at risk and help staff intervene early. A facilitator helps the team to integrate the report’s finding into clinical decision-making and improve senior care planning.
The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities
This manual assists nursing facilities in providing personalized care and improves their fall care processes through educational tools.
Elderly Pharmaceutical Insurance Plan (EPIP)
EPIC is a NYS sponsored prescription plan specifically designed for older adults who need help paying for their medical prescriptions. With this resource, around 100,000 seniors already are saving half the cost of their medicines. [10]
Healthfinder
This government website provides links to numerous senior care resources available on the web.
SeniorCare.org
This website is a free and highly-reliable resource that answers all your questions related to senior living, assisted living, long-term senior care and much more.
AdvantAge Ontario Resources
This useful resource provides reliable information on long-term and other types of senior care programs.
Long Term Care Laws and Regulations
In the USA, both the federal and state governments regulate long-term care communities and services. Agencies that pay for services and outline rules for licensing staff set the standards. Thus, laws and regulations for long term care vary for each state.
In Canada, you are eligible to apply for long term, you must be age 18 or older and hold a valid Ontario Health Card. You must care care needs, including:
- 24-hours nursing care and personal care
- Frequent assistance with activities of daily living
- On-site supervision or monitoring to ensure your safety or well-being
In addition to these, you must have care needs which can’t be met through publicly-funded community-based services and other caregiving support.[11]
Choosing an Assisted Living Facility
Live your retirement offers detailed information of more than 80,000 senior care options, including long-term care facilities in your area. It is recommended to consider the following criteria when searching for the right long-term care facility for your seniors:
Location
Choose a location depending on whether your senior loved one may want to stay close to his or her current home or have to move to another city or state for the required care.
Location of care also impacts the cost. The average cost varies from state to state and province to province. Although the cost of living in long-term care seems high, it often comes out to be less expensive, especially in comparison to in-home care.
Type of care needed
Does the elderly need personal care assistance or medical care? Is s/he dealing with dementia and need special care and round the clock supervision?
Not all long-term facilities may provide all types of senior care. So before finalizing with a facility, you must check if they provide the type and level of care needed for your loved one.
Services
Different long-term care communities offer many different personal and health care services. So it is important to find out the one that provides services you are seeking for senior.
While some services are crucial for the resident, others may just help to improve their quality of life. For example, the dining experience can make a huge difference in the overall satisfaction of the residents.
During your visit to the facility, ask if they take care of special dietary needs, and offer nutritious snacks on demand. Also, check if they offer socializing and recreational activities that can make the residents’ feel healthier and happier.
Staffing
The staff members at a long-term facility are responsible for ensuring the safety and wellbeing of your loved one. Thus, their attitude, expertise, and professionalism are very important.
It is recommended to ask plenty of questions to observe the staff before making your final decision. A good staff may possess great nursing and personal care skills, but also demonstrate a polite and respectful relationship with residents.
Independence
While it is true that seniors moving to long-term care facilities may not be able to do so many things at their own, their facility community can still give them a sense of freedom. These facilities provide residents with choices for food, activity, lifestyle, and more.
You may include these factors during the decision-making process. The right long-term facility is one that provides a home-like comfortable and healthy environment to your senior.
Questions to Ask A Long-Term Care Facility
As the selection process beings, it is recommended that you visit several facilities and ask as many questions as you want to clear your doubts. You may inquire about key factors, such as cost, location, space availability, and everything you want.
Key Questions
- What kinds of recreational and social activities do they arrange?
- Are residents allowed to bring their own furniture and belongings?
- Does the facility provide transportation?
- Can they accommodate special dietary needs?
- Can a senior go into hospice in this long-term care facility?
- How often do they conduct disaster drills?
- What are the rules for family visits?
When the senior has Alzheimer’s or Dementia
- Is the staff train to deal with persons with dementia?
- What is the staff to resident ratio?
- How often are the facility’s residents bathed?
- Do they provide special assistance to seniors with feeding problems?
- Do caregivers speak the resident’s native language?
- Are their personalized care plans for each resident?
- Is there a doctor available in the facility?
- Is the facility safe for wandering residents?
Checking the staff and atmosphere
- Is the staff polite and pleasant?
- Does the staff treat residents with respect?
- Are the residing seniors clean and well groomed?
- Is the facility clean and well maintained?
- Are fire escapes and ramps designed to be suitable for wheelchairs?
- Are there handrails in the hallways?
- Do the showers and toilets have grab bars?
- Are the floors non-slippery?
Licensing-related questions
- When was the last state or province inspection conducted?
- Have there been any complaints against the facility? If yes, how have these been resolved?
It is important to pay attention to your doubts and uncertainties. There are lots of choices for long-term care facilities, but it is recommended to keep searching until you find the right one.
Long-Term Care Facilities by State or Province
United States
Long-Term Care Facilities by Popular Cities
The Most Affordable Cities For Long-Term Care
| Rank | City | State | Cost |
|---|---|---|---|
| 1 | Wilmington | NC | $3,692 |
| 2 | Tucson | AZ | $3,774 |
| 3 | Tampa | FL | $3,812 |
| 4 | Mesa | AZ | $3,856 |
| 5 | Orlando | FL | $4,132 |
| 6 | Baltimore | MD | $3,950 |
| 7 | Fayetteville | NC | $4,045 |
References
- Vivian Nguyen, MPA AARP Public Policy Institute. March 2017. Long-Term Support and Services, aarp.org
- Christine Benz. August 20, 2018. 75 Must-Know Statistics About Long-Term Care: 2018 Edition, morningstar.com
- Alzheimer's Association. 2019. Alzheimer’s & Dementia: Facts and Figures, alz.org
- October 3, 2018. Long-Term Care Statistics You Need To Know In 2018, ltccs.com
- Statistics Canada. May 3, 2017. Age and sex, and type of dwelling data: Key results from the 2016 Census, statcan.gc.ca
- Robyn Gibbard. November 2017. Meeting the Demand for Long-Term Care in Canada, cma.ca
- October 10, 2017. Costs of Care: Long-term Care, longtermcare.acl.gov
- Marlene Satter. November 01, 2018. Top 15 Cheapest States for Long-Term Care: 2018, thinkadvisor.com
- Åke Blomqvist and Colin Busby. 2014. Paying for the Boomers: Long-Term Care and Intergenerational Equity, cdhowe.org
- Department of Health, New York State. December 2018. Elderly Pharmaceutical Insurance Coverage (EPIC) Program, health.ny.gov
- Government of Ontario. June 21, 2019. Long-term care overview, ontario.ca