A Guide to Long-Term Care for Seniors

Choosing a long-term care facility for older adults

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There's a good chance you won't be able to live fully independently forever. At a certain point, you'll need help taking care of yourself, managing an illness, or recovering after surgery. That's where long-term care services come into play.

Long-term care services help seniors safely age, whether they remain at home or move into a residential facility. Since everyone's needs, budgets, and lifestyles vary, there are a lot of long-term care services to choose from.

Frankly, it can feel overwhelming trying to navigate it all. To help, we're going to walk you through everything you need to know about long-term care, including the different types, how to decide if it's right for you, the cost, and how to pay for it.

What is Long-Term Care?

Long-term care is the umbrella term used to describe care or assistance you need if you can no longer do activities of daily living (ADLs) on your own. ADLs include bathing, dressing, eating, and using the bathroom.

Sometimes long-term care just means someone helps you get ready in the morning and at night. In other cases, it means moving into a nursing home while you recover from a fall or surgery or manage a chronic illness. On average, people use any mix of long-term care services for three years.1 Only 20 percent of seniors will need it for more than five years.

Long Term Care - Housekeeping

Types of Long-Term Care

All of your long-term care options fall into one of the following categories: personal care and skilled care.

Personal care, also called custodial care, is for older adults who need help with non-medical tasks like:

  • ADLs such as dressing, bathing, personal hygiene, and transfers
  • Instrumental activities of daily living (IADLS) such as grocery shopping, laundry, meal prep, and light cleaning
  • Non-medical care
  • Companionship
  • Housekeeping
  • Supervision
  • Transportation

Long Term Care - Food Prep

Skilled care, or skilled nursing care, is for seniors who need skilled medical care or rehabilitation services like:

  • Vital sign monitoring
  • IV treatments/feedings
  • Medication management
  • Wound care
  • Mobility assistance
  • Occupation, physical, and speech therapy

Long-Term Care at Home

Many seniors want to age in place. Home care is the type of long-term care that makes this possible. It's exactly what it sounds like: care provided right in your home. The type of care and how often depends entirely on your needs and budget.

Home care offers many benefits:

  • Lets you age in place and stay in your community
  • Keeps spouses who require different levels of care together
  • Often more affordable than other long-term care options
  • Provides companionship to ward off feelings of isolation and depression
  • Reduces stress for seniors
  • Supplements the care a friend or family caregiver provides
  • Family and friends can visit whenever they want (no strict visitation hours)
  • Even if you know you want to go the home care route, you'll need to determine what type of home care you want or need.

Personal Care

With personal care, a non-medical paraprofessional called a personal care attendant helps you with ADLs. Other names include home care companion, companion, caregiver, and personal care aide. This type of home care is helpful for older adults who need extra help to live safely at home but who do not need additional medical services

Types of Care and Assistance Provided

  • Dressing
  • Bathing
  • Personal hygiene
  • Toileting and toilet hygiene
  • Feeding
  • Mobility assistance
  • Transportation

Homemaker Services

A homemaker is a non-medical paraprofessional that assists more so with home management and IADLs. It's a good option for seniors who need extra help managing their home but who do not need additional medical services

Type of Care and Assistance Provided

  • Caring for your pet
  • Housekeeping
  • Meal preparation and clean up
  • Laundry
  • Shopping
  • Transportation
  • Companionship
  • Home and finance management

You Should Know: The terms “homemaker services” and “personal care attendants” are sometimes used interchangeably by home care agencies to describe home care paraprofessionals who only offer non-medical care.

Home Health Care

With home health care, a trained home health aide comes into your home to assist with basic medical care and monitoring. It's best for seniors who need help with ADLs and/or medical monitoring and basic medical care.

Type of Care and Assistance Provided

  • Assistance with ADLs
  • Vital sign monitoring
  • Medication assistance
  • IV treatments/feedings
  • Mobility assistance
  • Wound care
  • Monitor your physical and mental condition

Did You Know: Home health aides must meet state-set training requirements, which involves at least 75 hours of training with at least 16 hours being hands-on training.2

Nurse Care

The next level up from home health care is nurse care. With nurse care, a licensed medical professional (registered nurse, physical therapist, occupational therapy, speech therapist) comes into your home to provide more comprehensive medical care for ill or injured seniors.

Seniors who are managing a chronic condition might need ongoing nurse care, whereas a senior recovering from surgery may just need in-home therapy services for a few weeks. Nurse care is best for older adults who need more advanced or specialized medical care, medical monitoring, or rehabilitation services.

Type of Care and Assistance Provided

  • Skilled nursing care
  • Intravenous treatments
  • Medical monitoring
  • Wound care
  • Diabetes care
  • Stroke management care
  • Physical therapy
  • Speech therapy
  • Occupational therapy

Hospice Care

Hospice is end-of-life care designed to make your loved one's remaining time with you as comfortable as possible. It prioritizes their quality of life and pain management over curing an illness. Hospice care is typically for seniors who received a fatal diagnosis or prognosis of six months or less.

Anyone, not just seniors, can use hospice care, but seniors account for 94 percent of recipients.3 We put it under home care because hospice care is most often provided in the home. However, you can turn to a nursing home for hospice care as well.

Type of Care and Assistance Provided

  • Doctor services and nursing care
  • Medical equipment and supplies like wheelchairs and catheters
  • Prescription drugs for symptom and pain management
  • Physical therapy, occupational therapy, and speech therapy services
  • Bereavement counseling
  • Dietary counseling
  • Social work services

Community-Based Care for Seniors

You don't need to let someone in your home or move into a facility to take advantage of long-term care services. Community-based care and services provide seniors and their caregivers with regular or as-needed support outside of the home. Some examples include adult day care centers, transportation services, and respite care.

Community-based care offers many benefits:

  • Helps seniors feel connected
  • Gives family caregivers time off
  • Enables seniors to run errands independently
  • Keeps you connected with your community
  • More affordable than other long-term care options

Community-based care is ideal for seniors who want to get out of the house and for caregivers who need a break. It's also a great option for seniors with a limited budget.

Adult Day Care

Some families decide to enroll their loved one in an adult day care program. This type of care is typically offered Monday through Friday from the morning until early evening. It gives family caregivers a break, especially if you work during the day. It's also great for older adults who want to get out of the house, seniors with Alzheimer's or dementia who need supervision, and those on a limited budget

At adult day care, seniors receive supervision and needed health services while also enjoying planned group activities. The level of care between facilities varies. Some specialize in memory care, where extra care is taken to monitor wandering-prone seniors and offer brain activities.

Long Term Care - Group Activities

Type of Care & Assistance Provided

  • Planned social, educational, and wellness activities
  • Nutritious meals
  • Supervision
  • Transportation
  • Counseling
  • Medical services: medication dispensing, hearing checks, symptom management
  • Rehab services: occupational therapy, speech therapy, physical therapy
  • Support services for caregivers: counseling, support groups, education

Pro Tip: Some adult day care providers offer extended hours or weekend hours. That's great news for caregivers who don't work a 9-to-5, Monday-Friday work shift.

Respite Care

Respite care gives primary caregivers a short break for just a day, a few days, or even weeks. Maybe you need to go on a work trip, take a vacation, or have time to yourself each week to attend appointments and see your kids. Whatever the reason, respite care can help.

Respite care is offered by several different types of senior living services. You can arrange respite care through:

  • Adult day care
  • Nursing homes
  • Personal care agencies
  • Home health care agencies

Transportation Services

Does your loved one need help getting to appointments or the store? Many communities offer transportation services for seniors at no or low cost. A bus or van picks your loved one up at their home, drops them off where they need to go, and picks them up afterward. This is a great option for seniors who can independently shop and attend appointments but who cannot or choose not to drive

Long-Term Care in a Facility or Residential Community

Seniors who want to or need to move out of their homes for care can move into a residential community or care facility. Here, you have access to staff 24/7, live amongst your peers, and enjoy scheduled activities.

Residential senior community benefits include:

  • 24/7 medical and personal care
  • Meets all of a senior's needs
  • Married seniors can often stay together
  • Opportunity to participate in social activities and outings
  • Provides safety and security
  • No more yard work, housework, or meal prep

Moving into a care facility is best for seniors who can no longer live alone, feel lonely, desire to live around their peers, or need care that cannot be provided in their current home.

Assisted Living Communities

An assisted living community is a senior residential community with staff members who can assist you with ADLs. You live in your own room, apartment, cottage, or small home, but you have access to 24/7 supervision and assistance. It's best for seniors who want to remain as independent as possible yet still need help with some or many ADLs.

Types of Care and Services Provided4

  • Supervision and assistance with personal care tasks and ADLs
  • Scheduled recreational, wellness, educational, and social activities
  • On-campus amenities like a gym, library, movie room, game room
  • Access to three meals a day
  • Laundry, housekeeping, linen, and maintenance services
  • Medication management
  • Transportation

Continuing Care Retirement Communities

Also called a life plan community, a continuing care retirement community (CCRC) provides seniors with continuous care as they age. You enjoy independent living with plenty of amenities and activities, but you also have on-site access to higher-level personal and medical care should you need it. CCRCs are excellent for older adults who want to spend their retirement years in a community that will meet their changing needs as they age, and couples who need different levels of care but want to live together.

Types of Care and Services Provided

  • Various residential options: condos, cottages, apartments, duplexes
  • On-site medical care available, including assisted living, memory care, and skilled nursing care
  • Physical therapy, occupational therapy, speech therapy
  • Indoor and outdoor recreational activities and facilities
  • Scheduled social, wellness, and educational opportunities
  • Community book clubs or crafting clubs
  • Transportation
  • Housekeeping, linen service, laundry
  • Home repairs and maintenance

CCRCs tend to have lots of amenities too. These could include a beauty salon or barber, a coffee shop, retail and food shops, an art and music studio, and a golf course.

Nursing Homes

Does your loved one need more care than you're able to provide at home? A nursing home might be their best option. Nursing homes are residential facilities for seniors and those with disabilities that provide medical care, help with ADLs, meals, and laundry. They're best for older adults who need 24/7 medical monitoring, those who are recovering from a hospital stay, injury, or illness, or seniors with Alzheimer's or another type of dementia. Think of a nursing home as a step above assisted living.

Types of Care and Services Provided

  • 24/7 supervision and on-site assistance
  • On-site medical services (vary depending on the facility)
  • Rehabilitation services: occupational therapy, physical therapy, speech therapy
  • Help with ADLs
  • Shared or private rooms
  • Meal service, housekeeping, linen service, laundry
  • Social activities like game nights or book clubs
  • On-site religious services
  • Senior-friendly exercise facilities and opportunities

Long Term Care - Socializing

How to Decide if It's Time for Long-Term Care

Seven out of 10 people will require long-term care at some point in their lifetime.5 So, even though you may think you don't need long-term care now, there could very well come a time when you do.

It's important to understand some signs that can help you know when that time's coming (or if it's already here) for you or the senior you care for.

  • Physical signs: Experiencing weight loss, worsened balance, decreased energy, or mobility difficulties.
  • Mental signs: Memory loss or confusion, feelings of isolation or depression, or forgetting to take medications.
  • Other medical signs: New or worsened health conditions, unexplained bruising, or frequent falling or almost falling.
  • Visible signs: House is always messy and cluttered, burn marks in the kitchen from leaving the stove or oven on, or damage to a house's exterior from a car hitting the home, garage, or fence.
  • Hygiene: Unable to safely use the shower, forgetting to brush teeth and wash hands, looking disheveled, or wearing the same clothes day after day.

As you've learned so far, you have many long-term care options available to you. So, don't stress if you notice that independent living isn't as easy as it used to be. Just because you're struggling to get ready in the morning doesn't mean you need to move out of your home.

Talking with your spouse, loved ones, and medical team is an important part of this decision process too. They may notice changes in you that you don't see or have recommendations based on your health or financial situation.

Maybe your long-term care plan is your adult child stepping up as your primary caregiver. Or maybe your doctor knows of an adult day care facility specializing in memory care that they think you'd benefit from. You won't know if you don't talk to them.

How Much Do Long-Term Care Services Cost?

We'll cut to the chase. Long-term care services are pricey. Of course, the exact cost varies since you have several different options and may or may not need full-time care. To help give you an idea, we've created this chart showcasing the median national cost by service type.

Median Cost of Long-Term Care Services in the U.S. by Type*

Type of care Daily median cost Monthly median cost Yearly median cost
Homemaker services $147 $4,481 $53,768
Home health aide $150 $4,576 $54,912
Adult day health care $74 $1,603 $19,240
Assisted living facility $141 $4,300 $51,600
Nursing home: semi-private room $255 $7,756 $93,075
Nursing home: private room $290 $8,821 $105,850

*All data for this chart comes from Genworth's Cost of Care Survey

Along with the type of care, several other factors influence the cost of long-term care services:

  • Number of hours of care required each week
  • Time of day that you need care
  • Geographic location
  • Your chosen service provider or facility
  • Whether you need extra services not included in the base price

Paying for Long-Term Care

Now that you've seen how much long-term care costs, you're probably wondering, how do I pay for it?

Just looking at the numbers, affording long-term care might feel impossible, but seniors and their families do it every day. The most commonly used payment methods are:

  • Medicare
  • Medigap (Medicare Supplemental Insurance)
  • Medicaid
  • Veteran's benefits
  • Private health insurance
  • Long-term care insurance
  • Personal savings
  • Home care loans
  • Reverse mortgages & HELOCs
  • Life insurance policy conversion
  • Annuities
  • Trusts
  • Social Security income

Just make note that not every payment option we listed above works for every type of long-term care service. For example, Medicare will only cover in-home skilled nursing care if you're under the care of a doctor and a doctor certifies that you're homebound.7

Long-Term Care Insurance

One way to help minimize your long-term care costs is to plan ahead and purchase a long-term care insurance policy. Just as health insurance helps you pay your medical bills, long-term care insurance helps to cover in-home or out-of-home care you may need as you age. Coverage varies depending on the policy.

Common covered expenses include:

  • Nursing home facilities
  • Memory care facilities
  • Assisted living facilities
  • In-home care, like skilled nursing care, therapy, and personal care
  • Hospice and respite care
  • Adult day care centers

Some policies even cover home modifications that make your home more accessible. Think wheelchair ramps or grab bars in your bathroom.

When to Take Out a Long-Term Care Insurance Policy

There isn't a magic age that indicates it's time to take out a long-term care (LTC) insurance policy. Instead, it's a personal decision that depends on several different factors, including your health and financial stability.

In general, the younger you are and the better your health, the more affordable your premiums will be. Why? Because the cost of long-term care insurance is partly determined by your age and your health.

That's why the American Association for Long-Term Care Insurance says the best age to apply is in your mid-50s.8 After that point, your health won't get any better, so you'll owe more in premiums.

If you're still working, you should check with your employer to see if they offer an employer-sponsored LTC insurance plan. These plans can save you a lot of money since they're offered at discounted group rates. Of course, you'll want to find out if you can keep the plan after you retire or leave. If so, it might be worth taking out a policy while you're still employed.

Want to learn more about long-term care insurance? In the video below, our editor-in-chief, Jeff Hoyt, will fill you in on everything you need to know.

Reviewed By

Scott Witt

Elder Home Care Expert

Scott founded Select Home Care Portland in 2009 and has been helping seniors live their best life at home or in their local senior community ever since. As an advocate for seniors, the primary philosophy has been to listen, educate and provide… Learn More About Scott Witt

Written By

Jeff Hoyt

Editor in Chief

Since graduating from Harvard with an honors degree in Statistics, Jeff has been creating content in print, online, and on television. Much of his work has been dedicated to informing seniors on how to live better lives. As Editor-in-Chief of the personal… Learn More About Jeff Hoyt

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Citations
  1. LongTermCare.gov. (2021). How Much Care Will You Need?

  2. AARP. (2019). Home Health Aides: When Your Loved One Needs Help With Personal Care.

  3. Centers for Disease Control and Prevention. (2021). Hospice Care.

  4. National Institute on Aging. (2021). Residential Facilities, Assisted Living, and Nursing Homes.

  5. Genworth. (2021). Cost of Care Survey.

  6. LongTermCare.gov. (2021). Costs of Care.

  7. Medicare.gov. (2021). Home health services.

  8. American Association for Long-Term Care Insurance. (2021). What’s The Best Age To Buy Long Term Care Insurance.