Long-Term Care: How to Decide Which Option Is Best for You
Key takeaways:
The best type of long-term care for you or your loved one depends on how much assistance is needed with daily activities and medical care.
Long-term care can be in a facility or at home. Depending on the type of care, health insurance may cover some or all of the costs.
Looking into long-term care insurance before you need it might help save on costly bills down the road.
Table of contents
It’s no secret that the U.S. population is aging fast. More than 20% of people will be 65 years old or older by 2040. With age comes wisdom (hopefully). But it also brings a higher risk for serious chronic health conditions. Many aging people will need a safe place to receive medical and personal care. And their needs might exceed what loved ones are able to provide.
This is where long-term care comes in. This care can be given in the home or at a designated facility. It’s important to figure out the best type of long-term care for you or your loved one. To do that, it helps to understand the available options and their pros and cons.
What is long-term care?
Long-term care refers to any services that help people with their daily activities, therapies, and medical care. It lasts longer than a regular hospital stay, sometimes for years. And it can occur in a variety of different settings. We'll review the range of options below.
Long-term therapies that are available in the home or a facility can include:
Home healthcare
Physical therapy
Occupational therapy
Speech therapy
Home nurse care
Hospice (all-inclusive care for people with a life expectancy of less than 6 months)
Adult day care or respite care
Additional services may also include:
Transportation services
Meal services (such as Meals on Wheels)
Recreational services
Legal aid services
Personal care
Custodial (non-medical) care, such as bathing and cleaning
Read more like this
Explore these related articles, suggested for readers like you.
Most people have a combination of different therapies and services to meet their individual needs. People who are permanently or temporarily living at a facility — such as a SNF or assisted-living community — can usually get any needed home services at that facility.
Long-term acute-care hospital (LTACH)
LTACH facilities are a little bit different than the other long-term care options. They are reserved for the most severely ill patients. They are meant for people who have complex medical needs that can’t be managed at a different facility.
Most people go to an LTACH when they are discharged from the hospital. They usually stay a few weeks.
People might need to stay at an LTACH if they:
Use a ventilator to breathe
Need regular dialysis
Have complicated wound care, or severe burns
Need several IV (intravenous) medications
LTACH facilities are expensive and involve complex medical care. So most people who go to an LTACH have a health insurance plan that has authorized it.
Benefits:
Highest amount of medical oversight and care
Daily physician visits
Specialized staff who have experience caring for people with complex medical care
Usually covered by insurance
Drawbacks:
Not meant as a permanent living facility
Very expensive (about triple the cost of a SNF)
Skilled nursing facility (SNF)
Skilled nursing facilities (SNFs) — sometimes called nursing homes — are another option that people often use when they are leaving the hospital but not quite ready to go home.
People staying at a SNF are treated by a variety of healthcare providers, depending on their needs. They may be treated by registered nurses and/or physicians. They may also get treatment from occupational therapists, physical therapists, and/or speech therapists. People stay overnight at a SNF, and all meals and therapies are provided there.
Like an LTACH, a SNF is not meant to be a permanent home. There may be separate levels of care at the same facility, once someone no longer needs regular oversight from nurses and healthcare providers.
Health insurance usually pays for SNF care for a specified amount of time if you meet certain criteria. For example, Medicare covers a maximum of 100 days of SNF care per year. Depending on the type of health insurance you have, you may be responsible for a copay or deductible.
Benefits:
Trained healthcare providers all in one place
Coordination of care among healthcare providers
Usually weekly physician visits
Can give medications, nutritional therapies, and basic wound care
Often covered by health insurance
Drawbacks:
Only covered by insurance for a certain number of days
Often can’t handle very complex care needs, like people on ventilators or with complex wound care
Only certain facilities may be “in-network” with your insurance plan, so you may not always get your choice of SNF
Usually can’t stay there long term, unless the facility also offers residential care
Residential care facility
Both SNFs and residential-care facilities can be called “nursing homes.” But residential care facilities are meant to be permanent homes. SNFs, on the other hand, are a temporary place to recover after a hospital stay or surgery.
Some facilities have both, offering the option to transition from SNF care to residential care. This is a good option for people who no longer have skilled nursing needs but who still need more assistance than they can get at home.
Benefits:
Intensive oversight and care for personal needs and hygiene
Medical staff usually on site
Meals and snacks included
Transportation services available
Usually fewer residents than assisted-living facilities
Drawbacks:
May not be able to provide all needed medical services
Not usually covered by health insurance, except for veterans’ healthcare or Medicaid
Memory care unit
A memory care unit is often the safest form of long-term care for people with advanced dementia. These facilities have special safeguards in place to protect people from injury when they have Alzheimer’s disease or other forms of dementia.
Some memory care units are stand-alone facilities. This means the whole building is dedicated to treating people with dementia. Other memory care units are part of a larger facility, such as a SNF or assisted-living facility. You can search for memory care units within your area under “Housing Options.”
Benefits:
24/7 monitoring to make sure residents stay safe
Specialized activities and treatments for people with dementia
Usually have physician oversight and nurses available as needed
Drawbacks:
Expensive
Often not covered by health insurance, except if the affected person has Medicaid or veterans’ health insurance
May not be able to handle complex medical needs (varies by facility)
Assisted-living community
This type of long-term care is often best for older adults who need some help but can do many activities on their own. Assisted-living communities are meant to be a permanent place to live. They may have apartments, condominiums, and sometimes detached homes.
Some assisted-living communities are part of a continuing care retirement community (CCRC) or continuing care senior housing community (CCSHC). These communities offer a range of living options. For example, they offer the least amount of assistance (independent living). They also offer the most amount of assistance (nursing home). People who live in a CCRC or CCSHC can transition to different levels of care if they need it, without needing to change communities.
Benefits:
Often have planned social and recreational activities for residents
Meals and snacks included
May offer transportation services
May be able to add more care services if new needs arise
Drawbacks:
Staff not always medically trained
Less supervision and oversight than in nursing home or memory care unit
Usually not covered by health insurance
Independent-living community
This is exactly what it sounds like: a community for older adults who can do all of their personal activities on their own. Homes may be apartments, condominiums, or detached houses.
Benefits:
Most flexibility and freedom
Might offer transportation services
Might offer social and recreational opportunities through the community
Might not have to do your own yard work or lawn care
Drawbacks:
May not be able to get future medical services at the facility
Not covered by health insurance
Home services
Many people can and want to live at home while still receiving medical care. Thankfully, there are many long-term care options that can be provided in the home environment. These include services that are also provided at a nursing home or other permanent living facility.
Some of these services are covered by health insurance, while others are not. In general, health insurance will cover services that are “medically necessary” and meet certain criteria. These services could include:
Physical therapy
Occupational therapy
Speech therapy
Home infusion services (for IV medicines)
Hospice care
Non-medical care is sometimes called “custodial” care. Custodial care is still necessary. But it does not necessarily need trained healthcare personnel. Some examples might be:
Grooming
Bathing
Preparing and cleaning up meals
Using the bathroom
Moving around or transferring from wheelchair to bed
Transportation
Custodial care can be provided by home health aides, certified nursing aides, and/or adult day-care services. It can also be provided by friends and/or family. It is not usually covered by private health insurance or Medicare. But Medicaid does cover it.
This type of care can get expensive. Because of this, it’s helpful to figure out a way to pay for it without straining your finances too much. There are several options available to pay for long-term care.
Is long-term care insurance worth it?
If you’re age 55 or older, long-term care insurance is something to consider. Almost 7 in 10 older adults will need long-term care at some point. But most health insurance plans for older adults in the U.S. don't cover long-term care. In fact, less than 3% of adults in the U.S. had long-term care insurance policies in 2020.
Some life insurance policies do cover long-term care, but not all of them.The American Association for Long-Term Care Insurance has a lot of helpful information about the average costs and how to decide on a long-term care policy. Some things you might not know:
Long-term care insurance can cover in-home care as well as care at nursing homes or other facilities.
Some long-term care insurance premiums are tax-deductible.
You have to qualify for long-term care insurance, based on different health and lifestyle factors.
It’s worth spending some time exploring the different options available. This will help you decide if long-term care insurance makes sense for your situation. Of course, there’s a chance you may not need as much long-term care as you pay for over the term of your insurance policy. For many people, however, it is worth the peace of mind knowing that they won’t be saddled with large care bills.
How do you decide which type of long-term care is the right choice for a loved one?
If you’re choosing a long-term care option for someone else rather than yourself, it can be hard to know which option is best. This should ideally be a joint decision among several people: the person who needs care, their caregivers, and those who have your loved one’s best interests in mind. You will probably want to talk with your loved one’s healthcare providers for their recommendation(s), as well as any current therapists they see.
If your loved one is in the hospital, a social worker or case manager can help you figure out the safest plan for them once they leave the hospital.
If they have health insurance, a case manager can help you figure out which options are covered by their insurance plan(s). They may have one or more of the following types of health insurance:
Medicaid
Medicare
Commercial health insurance policy
Medicare Advantage insurance policy
TriCare or veterans’ health insurance policy
In general, if someone has extra help and they can generally do their activities safely at home, home long-term care therapies are the least expensive option. People with complex medical needs often opt for a facility. If they’re recovering from an illness or injury and have the potential to improve, they might be able to transition to a home environment with home therapies.
With any of these long-term care environments, the quality can vary widely among facilities and providers within the same category. So it’s important to do your research on which particular option might be a good fit for your loved one. Care Compare is a useful way to research the quality ratings among different facilities and long-term home care options.
The bottom line
Long-term care options can be confusing to understand. The best way to figure out what you or your loved one needs is to consider the setting (home versus a facility). And think about the amount of care needed (medical versus non-medical help). Finally, it’s important to consider who is going to pay for it (health insurance, long-term care insurance, or personal savings).
In general, health insurance will cover medical needs up to a certain point. Meanwhile, non-medical care often requires long-term care insurance or personal savings. It is a complex and sometimes lengthy process. But finding the right long-term care for your loved one will ultimately give you peace of mind that they are safe and well cared for.
Why trust our experts?
References
American Association for Long-Term Care Insurance. (2020). Long-term care insurance facts - data - statistics - 2020 reports.
Centers for Medicare & Medicaid Services. (n.d.). Skilled nursing facility (SNF) care.
LongTermCare.gov. (2020). How much care will you need? Administration of Community Living.
LongTermCare.gov. (2020). State Medicaid programs. Administration of Community Living.
Ogunwole, S. U., et al. (2021). Population under age 18 declined last decade. U.S. Census Bureau.
Urban Institute. (n.d.). The US population is aging.
