What is Long-Term Care?
Long-term care (LTC) is a term that encompasses a variety of services that are designed to meet someone's personal or medical needs. These services can either be performed at home, in the community, or at a professional facility. Long-term care services and facilities help people live as safely, comfortably, and independently as possible when they are no longer able to do so on their own in their current situation.
How to Discuss Long-Term Care with Your Loved One
It's best to begin the conversation of long-term care planning with your loved one before these services are needed. Click on the below dropdowns to learn how you can make this conversation simple, comfortable, and caring:
If possible, try to discuss and plan long-term care options with your loved one before these services are needed. This will allow you to involve them in the discussion and learn their preferences. Waiting until there is an emergency or until the need is urgent will make an already difficult discussion much more stressful, and may put strains on your relationship.
When considering speaking with your loved one about long-term care, there is a lot to consider. What is their current health status, and is that likely to change in the next few years? Are they able to care for themselves for the most part, and just need assistance with certain activities of daily living (ADLs)? Or do they need more professional, facility-based care? Make sure to think about your loved one's current situation when researching possible services, as well as what their future may look like.
Before discussing with your loved one, we recommend performing some background research and noting your concerns very clearly. This will help keep the conversation fact-based and solution-oriented. Educating yourself beforehand will also give you confidence, help your loved one see you as a trusted source of knowledge and support, and help you recommend an option or combination of options that will take care of your loved one's needs, while still allowing them to maintain the greatest amount of independence possible.
You will want to discuss this sensitive topic with your loved one as their partner – not as their decision-maker. Don't approach the conversation with a pre-determined plan, but rather with a few options that you believe will benefit them the most. Emphasize repeatedly throughout the conversation that the decision is theirs, and that you are there for support only.
Staying positive, listening, and showing empathy and support is very important during this conversation. Most likely, you won't agree on everything – which is normal. This is a big decision, and one that will impact their daily life.
Give them time after your discussion to make a decision. You won't be able to have their whole future planned out after one conversation; the goal is to have multiple productive conversations throughout this process.
Learn more tips and information for having this discussion from the National Center for Assisted Living (NCAL) and Where You Lives Matters.
Get Help From a Geriatric Care Manager
Geriatric care managers are professional, licensed specialists who can assist families and caregivers in creating a customized long-term care plan to meet your loved one's needs. They can suggest services that may help your loved one, address emotional concerns, evaluate in-home care needs, coordinate medical services, and more.
Learn more about what geriatric care managers are from NIA, or learn how geriatric care managers help family caregivers from AARP.
Advanced Care Planning
Advanced care planning is helpful at any age, as it makes clear a person's preferences for how they will be cared for should they not be able to communicate this information themselves due to an injury or illness. These preferences are usually placed into an advanced directive, which is a legal document that becomes effective only if a person is unable to speak for themself. While you are discussing long-term care plans with your loved one, encourage them to also consider advanced care planning. You can complete this for yourself as you assist them. Working through advanced care planning together shows that you are partners for each other's care.
The National Institute on Aging (NIA) has articles and resources that may be helpful in advanced care planning, including information about advanced directives and other legal documents that will be helpful as a person ages, as well as legal and financial planning for people with Alzheimer's disease.
At Bassett Healthcare Network, we also offer information and resources about advanced care planning, including our partnership with the 5 Wishes advanced directive, our Medical Orders for Life-Sustaining Treatment (MOLST) program, and information on how to appoint a health care agent in New York State and complete a health care proxy consent form.
How to Know When It's Time for Long-Term Care
Knowing when "it's time" is difficult, and will be different depending on your and your loved one's situation. Generally, it's time to move forward with some form of long-term care when you as the caregiver can no longer provide the level of care that your loved one needs. This can mean hiring a professional to assist with ADLs or other aspects of in-home or community care, arranging adult day health care so that your loved one receives the care they need during the day and can return to their home in the evening, or moving into an assisted living facility or nursing home. Each facility offers different services, so make sure that you understand their capabilities before making a decision.
Sometimes, it's difficult to know when the care your loved one is currently receiving isn't enough. If you notice any of the below signs, it may be an indication that long-term care services (or additional services) may be needed:
- Physical signs, such as a bruise that might have resulted from a fall, or changes in strength, weight, balance, or energy.
- Personal care / hygiene signs, such as trouble dressing, bathing, going to the bathroom, or forgetting to take medication or brush their teeth.
- Mental signs, such as confusion or memory loss. These can also be signs of dementia or Alzheimer's disease, so schedule an appointment with your loved one's primary care practitioner if you are concerned.
- Lifestyle changes, such as an unusually messy home, mobility problems, decreased driving, or decreased driving confidence.
Types of Long-Term Care
There are many variations of available long-term care options, and which option you choose depends on your loved one's current needs (which may change over time), finances, and personal preference – as well as your own ability/availability as a caregiver.
Home-Based & Community-Based Long-Term Care
Community- and home-based long-term care services include a grouping of services that someone may receive either out in the community or in their homes, and take the form of either personal care or skilled care. These options allow for the greatest amount of independent living as possible, while still ensuring that daily personal and health needs are met.
There are many different types of home- and community-based long-term care services, and you may need to consider a variety of personal and professional services to meet your loved one's needs:
Most forms of long-term care are provided directly in the person's home by a family member (usually the primary caregiver). This is known as personal care. Personal care can also be provided by a professional or a paraprofessional, and generally involves helping individuals with activities of daily living (ADLs), which include the daily activities that are necessary for living at home. Helping with ADLs may involve assisting with household chores (such as general cleaning, laundry, or yard work), hygiene (such as dressing, grooming, or bathing), meal planning or preparation, or helping with errands or transportation.
Skilled care is performed by a licensed professional either at home or at a facility, and includes services such as physical therapy, occupational therapy, nursing, wound care, or medication management.
Learn more about home care services and available options from the below resources:
- Eldercare Directory – Home- and Community-Based Services
- New York State's Department of Health (NYSDOH) – Consumer Guide to Community-Based Long-Term Care
- National Institute on Aging (NIH) – Aging in Place: Growing Older at Home
Facility-Based Long-Term Care
Facility-based long-term care services include professional services that are performed outside of the home in a facility such as an adult day care, assisted living facility, or nursing home. This type of care is recommended when in-home personal care or skilled care is not sufficient.
Learn more about facility-based long-term care services:
A CCRC is a living environment for seniors who would like to continue living independently, but would like to live in a community of similar-aged individuals and couples. CCRC often provide basic care, along with the option of providing more advanced care as it becomes needed.
Learn more about continuing care retirement communities from FindingContinuingCare.com.
Adult day care centers can be a good solution for seniors who need assistance, companionship, or supervision throughout the day, beyond what a family caregiver can provide. They allow seniors to be cared for as needed during the day while their caregiver is at work or otherwise engaged, and return home at the end of the day.
There are different levels of adult day care, so check the location you're considering to ensure they perform the needed services. For example, some programs offer mainly social activities, recreation, meals, and some health-related services, while others offer more intensive health care services for those who may soon require nursing home care.
Learn more about adult day care services from Eldercare Locator, the National Caregivers Library, and the NYSDOH.
Assisted living facilities are housing options for seniors who need some assistance with ADLs or slight medical care, but would still like to live a relatively independent lifestyle. This often resembles a high-quality hotel where residents live in a private room, and the facility's staff provides meals, social activities, housekeeping, medication monitoring, laundry, and sometimes simple medical services. This type of care is often ideal for those who don't need the level of care provided in a nursing home and who would like to live independently, but it is difficult or unsafe to do so completely.
Learn more about assisted living facilities from Seniorliving.org and the Eldercare Directory.
Nursing homes are for seniors who require 24/7 care and support due to physical disabilities or cognitive impairments that other long-term care facilities cannot provide. Depending on the facility, nursing home staff may mainly provide non-medical care called custodial care, which includes services such as assisting with dressing, bathing, feeding, and getting in and out of bed. Some nursing homes do offer medical care for their residents, which may include special care units for residents with memory issues, such as Alzheimer's disease or other forms of dementia. It's important to note that separate, specialized facilities exist for seniors needing extensive health or memory care, so be sure to consider all of your options before making a decision.
Learn more about nursing homes from the NYSDOH (including NYS nursing home profiles), AARP, MedlinePlus, and HelpGuide.
Like a nursing home, skilled nursing facilities (SNF) provide 24/7 care and support, but they focus on providing advanced medical care to their residents through licensed nursing professionals. The services provided at skilled nursing facilities typically involve treating and managing complex medical conditions and offering physical, occupational, and speech therapy. Seniors who require a high level of medical care on a regular basis due to a chronic medical condition, such as a stroke, typically receive long-term care at a skilled nursing facility.
Skilled nursing facilities also offer short-term care for those who require rehabilitation services. Because of this, many patients receive temporary care at a skilled nursing facility after being released from a hospital following an illness, injury, or emergency surgery.
Learn more about skilled nursing facilities from Seniorliving.org and SeniorCare.com.
Memory care is provided for seniors with Alzheimer's disease or another form of dementia, or for those who are otherwise cognitively impaired. Memory care is a type of skilled nursing care that focuses specifically on memory-related services. While some nursing homes and skilled nursing facilities provide memory care services, it is typically not the same level of comprehensive care that facilities specifically focused on memory care can provide.
Learn more about memory care facilities from Seniorliving.org and Caring.com.
Bassett Healthcare Network also offers and partners with local home care services and long-term care facilities. See the section at the bottom of this page for more information.
Find Long-Term Care for Someone with Dementia or Alzheimer's Disease
The type of long-term care services a person should receive is always different depending on the individual, and this is especially true for someone with Alzheimer's or another form of dementia. Eventually, someone with a form of dementia may require full-time care.
Visit NIA's finding long-term care for a person with Alzheimer's page for information.
Learn More About Your Long-Term Care Options from NIA, NYSDOH, Medicare.gov, and NYS Office for the Aging & NY Connects
The National Institute on Aging (NIA) offers many great resources for caregivers who are searching for more information about long-term care, including detailed descriptions of the various types of long-term care, what options there are for paying for long-term care, how to choose a nursing home, and information about residential facilities, assisted living, and nursing homes.
The New York State Department of Health (NYSDOH) also provides numerous resources for caregiving considering long-term care services or facilities, including general resources for the various types of long-term care and information on nursing homes in NYS. This contains information about nursing home services, selecting a nursing home (including medical need and admission requirements), nursing home profiles (finding and comparing nursing homes), and recommended federal remedies (includes a list of major and minor infractions that nursing homes in NYS have been cited for).
Medicare.gov offers Nursing Home Compare, a service that contains detailed information about every Medicare- and Medicaid-certified nursing home in the country. Visit their site for more information, including a guide to choosing a nursing home and a nursing home checklist.
The NYS Office for the Aging & NY Connects' goal is to improve access to, and availability of services that enable older New Yorkers to live, work, and age in their community of choice. Learn more about caring for a loved one and help for family caregivers in NYS, including information about the social model adult day services program, expanded in-home services, the long-term care ombudsman program, and more!
Bassett's Long-Term Care & Home Care Services
Bassett Healthcare Network has three long-term care facilities, including A.O. Fox Nursing Home, Valley Health Services (VHS), and Valley Residential Services (VRS).
For home care services, we provide quality home care equipment, supplies, and related services through First Community Care of Bassett. We also partner with At Home Care, Inc. (AHC), a home health agency that provides in home professional and paraprofessional services in Herkimer, Delaware, Otsego, Chenango, and Schoharie Counties.