Planning for Long-Term Care
You can never know for sure if you will need long-term care. Maybe you will never need it. But an unexpected accident, illness, or injury can change your needs, sometimes suddenly. The best time to think about long-term care is before you need it.
(Watch the videos on this page to learn more about planning for long term care. To enlarge a video, click the brackets in the lower right-hand corner of the video screen. To reduce a video, press the Escape (Esc) button on your keyboard.)
Planning for the possibility of long-term care gives you time to learn about services in your community and what they cost. It also allows you to make important decisions while you are still able. You will need to make
- housing decisions
- health decisions
- legal decisions
- financial decisions.
People with Alzheimer’s disease or other cognitive impairment should begin planning for long-term care as soon as possible.
Housing Decisions: Staying In Your Home
In thinking about long-term care, it is important to consider where you will live as you age and how your place of residence can best support your needs if you can no longer fully care for yourself.
Most people prefer to stay in their own home for as long as possible. When planning to receive long-term care in your home, there are many things to consider including
- the condition of your home
- whether it can be modified, if necessary, to accommodate a wheelchair or other devices/equipment
- the availability of long-term care services in your area, such as adult day care or nearby medical facilities
- how “age-friendly” your community is. Does it offer public transportation, home delivered meals and other needed services?
- tax and legal issues.
Housing Decisions: Housing with Services
If it becomes necessary, several types of housing come with support services. Primarily, these are
- Public Housing for low-to-moderate income elderly and persons with disabilities. Typically assistance with services is provided by a staff person called a Service Coordinator
- Assisted Living or “board and care” homes are group living settings that offer housing in addition to assistance with personal care and other services, such as meals. Generally, they do not provide medical care
- Continuing Care Retirement Communities (CCRCs) provide a range of housing options, including independent living units, assisted living and nursing homes, all on the same campus. Nursing facilities, or nursing homes, are the most service-intensive housing option, providing skilled nursing services and therapies as needed.
Decisions About Your Health
Begin by thinking about what would happen if you became seriously ill or disabled. Talk with your family and friends about who would provide care if you needed help for a long time.
You might delay or prevent the need for long-term care by staying healthy and independent. Talk to your doctor about your medical and family history and lifestyle. He or she may suggest actions you can take to improve your health.
Healthy eating, 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.
Planning for long-term care includes legal planning. That means creating official documents -- often called "advance directives" -- that state your wishes for medical care in an emergency and at the end of life. You can also decide who will make health care decisions for you if you cannot make them yourself.
It is important to consider what you want before you need long-term care. Discuss the options with family members, a lawyer, and others. These discussions can be hard, but telling others your wishes ahead of time answers questions they might have later and takes the burden off your family.
Experts recommend creating three types of legal documents, or advance directives. These are
- a health care power of attorney
- a living will
- a do-not-resuscitate order, if desired.
Health Care Power of Attorney
A health care power of attorney, also called a durable power of attorney for health care, is a legal document that names the person who will make medical decisions for you if you cannot make them yourself. This health care "agent" or "proxy" is your substitute decision maker. The person you choose should understand and respect your values and beliefs about health care. Talk with that person to make sure he or she is comfortable with this role.
A living will, also called a health care directive, is a legal document that records your wishes for medical treatment near the end of life. It spells out what life-sustaining treatment you do or do not want if you are terminally ill, permanently unconscious, or in the final stage of a fatal illness. For example, the document can state whether or not you want to receive artificial breathing if you can no longer breathe on your own.
Do-Not-Resuscitate (DNR) Order
A do-not-resuscitate (DNR) order tells health care providers not to perform cardiopulmonary resuscitation (CPR) or other life-support procedures if your heart stops or if you stop breathing. A DNR order is signed by a health care provider and put in your medical chart. Hospitals and long-term care facilities have DNR forms that a staff member can help you fill out. You do not have to have a DNR order.
Getting Expert Advice
Lawyers and other professionals can help you create legal documents to ensure that your health care wishes are expressed. These experts understand state laws and how changes, such as a divorce, move from your home, or death in the family, affect the way documents are prepared and maintained.
Be sure to discuss your preferences and give copies of your legal documents to family members, your health care proxy, and your doctor. It's important to review documents regularly and update them as needed.
Financial planning is another important part of long-term care planning. Government health insurance programs, including Medicare and Medicaid, pay for some long-term care services but not others. Most people do not have enough money to pay for all of their long-term care needs, especially if those needs are extensive or last a long time.
Reviewing Your Resources
Think about your financial resources and how you feel about using them to pay for long-term care. These resources may include
- Social Security
- a pension or other retirement fund
- personal savings
- income from stocks and bonds.
Your home is another type of asset that could be used if needed.
It's a good idea to review your insurance coverage, too. Many health insurance plans provide little, if any, coverage for long-term care. Review any private health insurance, Medicare, and Medigap policies to learn exactly what is covered and what is not.
Consider other possible ways to pay for long-term care. An increasing number of private payment options are available. Two of the more common options are long-term care insurance and reverse mortgages. For details about paying for long-term care, see the chapter on "Paying for Long-Term Care."
The website www.LongTermCare.gov has information about long-term care planning and services. This Web site, run by the U.S. Administration on Aging, lists other sources of information and gives definitions of important terms.
To find out what long-term care services are in your community, call Eldercare Locator at 800-677-1116 or visit www.eldercare.gov