Navigating the Health Care System

As our population ages, many of us will need to find long-term care for a family member, a loved one, or even ourselves.

There are many different options for long-term care. They range from community services and home care to assisted living facilities, continuing care communities, and nursing homes. Choosing one option over another will depend on several factors: physical and mental health, finances, and preferences. If you are helping someone make long-term care decisions, the choice should be based on what that person needs and prefers.

Keep in mind that, for the most part, Medicare does not pay for long-term care. Medicare pays for some things, such as services that are needed for medical reasons, such as physical therapy. Medicare will pay only if therapy is provided in a certain type of facility (called a skilled nursing facility) but only after a patient has been in the hospital.

Medicaid, a health insurance program that is provided through a partnership of the Federal and State governments, pays for most nursing home costs but only after patients have spent most of their savings. However, not all nursing homes accept patients whose care is paid for under Medicaid.

Before you make a decision on long-term care, get as much information as you can about all the options. A good place to start is your local area agency on aging, which can help you if you are over 50 or if you provide care to the elderly.

Another resource is your State medical assistance office, which can direct you to local programs for people with limited resources. In addition to these resources, many support and discussion groups on the Internet can provide helpful advice.

Below are basic points about long-term care options that can help guide your search. More information is available on Medicare's Web site:

Community services: Community resources can include adult day care, meal programs (Meals on Wheels), senior centers, and transportation and shopping assistance. Some services may be free or low cost to people with limited incomes.

Home care: These services can include help with personal activities, such as laundry, cleaning, dressing, and cooking. Home health care agencies hire people who provide these services, but they charge daily or weekly fees. Go to Medicare's free booklet to see if you qualify for home care services that Medicare covers.

Assisted living communities: These communities typically offer residents their own room or apartment and help them with activities such as bathing, dressing, and taking medicines. Residents typically pay a monthly rent and additional charges for some services. Not all assisted living communities offer the same services, so be sure to find out if what they offer meets your needs.

Nursing homes: If you or a loved one is in the hospital before moving to a nursing home, ask for the "discharge planner" or social worker. This person can help you make arrangements for when you or your loved one is ready to leave the hospital, including giving you a list of local nursing homes.

Medicare's new Medicare's Nursing Home Compare tool can help you find and compare nursing homes. You can search by nursing home name, city, State or ZIP code. Talk to your doctor about your choices and visit the nursing home before making a decision.

Continuing care retirement communities: These communities, called CCRCs, offer more than one type of housing, and people can get different types of care as their needs change. Individual homes or apartments are available for people who don't need health care or other special services. Assisted living and nursing homes are available when more care is needed.

Check on the CCRC's quality from Medicare's Nursing Home Compare tool before making a decision. Most CCRCs require a large up-front payment in addition to monthly fees. Find out if the CCRC you are interested in is accredited, which means that they meet certain quality standards.

In addition to these resources, many support and discussion groups on the Internet can provide helpful advice.

In the past, people have had to make decisions about long-term care without having a lot of essential information. I'm glad to see this is changing.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

AHRQ Podcast
Choosing Long-Term Care  (Transcript)

Department of Health and Human Services
U.S. Administration on Aging
Eldercare Locator
http://www.eldercare.gov/Eldercare.NET/Public/Index.aspx

Department of Health and Human Services
Nursing Home Compare: Alternatives to Nursing Home Care
http://www.medicare.gov/NHCompare/Static/tabSI.asp?language=English&activeTab=3&subTab=3

Department of Health and Human Services
Centers for Medicare and Medicaid Services
Medicare and Home Health Care
http://www.medicare.gov/NHCompare/static/Interim/PDF_Interim.asp?Language=English&Type=Pub&PubID=10969

Department of Health and Human Services
Centers for Medicare and Medicaid Services
Nursing Home Compare
http://www.medicare.gov/NHCompare/Include/DataSection/Questions/ProximitySearch.asp?bhcp=1

Commission on Accreditation of Rehabilitation Facilities
Consumer Services
http://www.carf.org/consumer.aspx?content=ConsumerSearch