Many of us hope to stay in our homes as we grow older. Often we are able to do that. But later in life—usually by our 80s and 90s—some of us need a hand with everyday activities like shopping, cooking, or bathing. A few of us need more help on a regular basis. Maybe that means it’s time to move to a place where expert care is available around-the-clock.

Where to start

Do you think that your family member can’t live at home any longer? It might be your husband or wife, a parent, aunt or uncle, or even a grandparent. You’ve added a hand rail on the front steps and grab bars in the bathroom. You made plans for a home health aide to come to the house every day. You arranged for help with meals, and you visit every day. But now you wonder if staying at home is the best choice. Where do you go for help? Here are some answers to that and other questions that you might have as you look for the best place for you or your relative to live.

Sometimes the need for help grows over time. For example, Bob is 87 years old. He has lived alone since his wife died ten years ago. For the last few years, he has needed more and more help doing things for himself. First, he had trouble making meals. So, he ate a big lunch at the local senior center until last year when he gave up driving. Now sometimes his daughter drops off meals. Other times meals are delivered by a local program. The stairs in his house are getting too hard to climb. Bob also forgets more and more things. He often forgets to take his blood pressure medicine. He has also left the burner on the stove turned on several times. He doesn’t want to move in with his daughter and her family, so Bob and his daughter are looking for a new place for him to live.

Over the last year Bob’s daughter has been thinking this time might come. She knows what’s available. She’s looked into how they will pay for the care her dad needs. Bob too has been doing some planning. He is sad about leaving his home, but he has been preparing for the time when he’d need more help. He even put his name on a waiting list for a nearby retirement community that he liked. Now they have an opening there. The admission coordinator at the community will help him decide if he can live in one of their apartments or needs to be in their assisted living facility.

Bob and his daughter were lucky. Sometimes you need to make a choice quickly. If you haven’t planned ahead, then making a decision might not be so easy. For example, Alice and her husband have lived in their house for 50 years. At 84, she still loves to cook and work in her garden every day. Last week she slipped in her bathroom, fell, and broke her hip. Now after an operation to fix her hip, she needs to go somewhere for nursing care and rehabilitation. Her doctors don’t know if she’ll ever recover enough to go home again. Her children live hundreds of miles away. But her husband and family only have a few days to find a place.

Alice and her family were not prepared like Bob and his family. The social worker and discharge planner at the hospital will help them find a place for Alice to go for therapy after she leaves the hospital. But if she is too frail to go home after her hip heals, she and her family will have to choose a place for her to live permanently.

What the choices are

There are two kinds of senior living facilities based on how much help is needed:

• Assisted living facilities
• Skilled nursing facilities or nursing homes.

You should think about an assisted living facility if you or your relative don’t need a lot of medical care but do need more help than can easily be gotten at home. Assisted living homes can give someone as much help as needed with daily living, but offer only some nursing care or none at all. People often live independently in their own unit. The place provides meals and house cleaning, offers interesting things to do, and takes residents wherever they need to go, like the doctor or the shopping mall. They can also provide help with bathing, dressing, and taking medicines, if needed.

Some assisted living facilities are part of a continuing care retirement community or lifecare community. These communities offer independent living and skilled nursing facilities as well as assisted living. Sometimes assisted living help is set up in a home with only a few residents. These are often called board and care homes.

If your relative becomes very frail or suffers from the later stages of dementia, more care could be needed. A nursing home or skilled nursing facility may be necessary if someone:

• needs round-the-clock nursing care,
• might wander away without supervision,
• needs help with meals, bathing, personal care, medications, and moving around,
• needs more help than the current caregiver can possibly give, or cannot live alone.

These places supply 24-hour services and supervision, including medical care and some physical, speech, and occupational therapy, to people living there. They might also offer other services such as social activities and transportation. As a rule, the rooms are for one or two people. Some places want residents to bring some special items from home to make their rooms more familiar. Some even allow a pet or make it possible for couples to stay together.

Both assisted living and skilled nursing facilities sometimes offer special areas for people with dementia. These areas are designed to meet the special needs of these people and to keep them safe from wandering.

How to choose

Ask questions. Find out about what is available in your area. Is there any place close enough for family and friends to visit easily? Doctors, friends and relatives, local hospital discharge planners and social workers, and religious organizations may know of places.

Also, each state has a Long-Term Care Ombudsman. They have information and may be able to answer questions about a place you are considering. The ombudsman is also available to help solve problems that might come up between a nursing home and the resident or the family. To find your state long-term care ombudsman, contact the Administration on Aging’s Eldercare Locator at 1-800-677-1116 or www.eldercare.gov.

Is the person in need of long-term care a military veteran? They might be able to get help through the Department of Veterans Affairs programs. You can check by going to www.va.gov, calling the VA Health Care Benefits number, 1-877-222-8387, or contacting the VA medical center nearest you.

Call. Once you have a list of possible places, get in touch with each one. Ask basic questions about openings and waiting lists, number of residents, costs and methods of payment, and their link to Medicare and Medicaid. Take a few minutes to think about what’s important to you or your relative, such as transportation, meals, activities, connection to a certain religion, or special units for Alzheimer’s disease.

Visit. Make plans to meet with the director of nursing and director of social services. Medicare offers a nursing home checklist to use when visiting (see Help in Planning). Some of the things to look for include certification for Medicare and Medicaid, handicap access, no strong odors (either bad or good ones), contact between staff and current residents, volunteers, and the appearance of residents. If the nursing home is a member of the Joint Committee on Accreditation of Healthcare Organizations, ask to see that group’s review of the home. Ask yourself if you would feel reassured leaving your loved one there.

Visit again. Make a second visit without an appointment, maybe on another day of the week or time of day, so you will meet other staff members. See if your first thoughts are still the same.

Understand. Once you or your relative have made a choice, be sure to understand the facility’s contract and payment plan. If you don’t understand it, you could have a lawyer look them over before signing.

How to pay

There are several ways to pay for nursing facility care for people over age 65. They are:

• Medicare
• Private pay
• Medicaid
• Long-term care insurance.

Let’s see what happened after Alice left the hospital. She went directly to a skilled nursing facility. It had a rehabilitation unit where she began to receive physical therapy. Medicare covered most of her costs for the first few weeks as she got better. Then she had a stroke which left her unable to move her left arm and leg. While she was in the hospital for the stroke, her doctors decided Alice should probably not return home. She no longer qualified for Medicare to pay for her nursing home care.

• Many people believe that Medicare will pay for long stays in a nursing home, but it doesn’t. The Federal Medicare program and private “Medigap” (Medicare supplemental) insurance only cover short times of home health or nursing home care. They pay for a short stay in a nursing home for someone who is getting better after leaving the hospital, but still needs nursing care and therapy.

Alice’s husband started to pay for her care on his own, but they didn’t have a lot of savings. When they had used most of their savings, her husband arranged for her to apply for Medicaid. The good news about Medicaid is that her husband did not have to sell their home for her to qualify for this support.

• Many people start paying for long-term care with their own money (private pay). Later they may become eligible for state-run Medicaid. Each state decides who qualifies for this program. Contact your state government to learn more. Keep in mind that applying for Medicaid takes at least 3 months.

Alice’s children are now looking into buying long-term care insurance for themselves. They don’t want to have the same worries if they need nursing care when they are older.

• Long-term care insurance is a private insurance policy you can buy years before you think you might need it. Each policy is different. Your state’s insurance commission can tell you more about private long-term care policies. They can also offer tips on how to buy long-term care insurance. These agencies are listed in your telephone book, under “Government.”

Help in planning

Planning for long-term care is not easy. People’s needs change over time. So do the rules about programs and benefits. What someone qualifies for may change from one year to the next. There is some help. The following resources are online. If you or your relative don’t have a computer, there may be one at your local library or senior center.

Care Planner from Medicare is online at www.careplanner.org. It has details about different care options. You can answer questions online about needs and resources to get a list of suggested services, as well as helpful resources.

Medicare has two resources on its website, www.medicare.gov, which may be useful. First, Nursing Home Compare helps you learn more about nursing homes you may be interested in. They also have a Nursing Home Checklist with tips to use when visiting homes. Second, many states have State Health Insurance Counseling and Assistance Programs (SHIPS). These programs can help you choose the health care plan that is right for you and your family.

Making a smooth transition

Moving to a care facility can be a big change for the whole family. Some facilities or community groups have a social worker who can help you prepare for the change. Allow some time to adjust after the move has taken place.

Regular visits by family and friends can make this move easier. This reassures and comforts the person getting used to a new place. Visits are good, too, for keeping an eye on the care that is being given. They also help family to develop a good relationship with the staff caring for their loved one.

Other Resources

Other sources of information on long-term care and other issues of interest to older people include:

FirstGov for Seniors
www.seniors.gov

American Association of Homes and Services for the Aging
2519 Connecticut Avenue, NW
Washington, DC 20008
202-783-2242
www.aahsa.org

Assisted Living Federation of America
11200 Waples Mill Road, Suite 150
Fairfax, VA 22030
703-691-8900
www.alfa.org

Commission on Accreditation of Rehabilitation Facilities
4891 E. Grant Road
Tucson, AZ 85712
1-888-281-6531 (toll-free)
www.carf.org

Alzheimer’s Disease Education and Referral Center (ADEAR)
PO Box 8250
Silver Spring, MD 20907-8250
1-800-438-4380
www.alzheimers.org

The National Institute on Aging (NIA) has free information on health and aging. Call or write:

NIA Information Center
PO Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225
1-800-222-4225 (TTY)
www.nia.nih.gov
National Institute on Aging
U. S. Department of Health and Human Services
National Institutes of Health
September 2003

Glaucoma is an eye disease caused by high pressure in the eye. It can cause you to gradually lose sight without warning and often without symptoms. The best way for people at high risk for glaucoma to protect themselves is to have regular eye exams.

How often is it covered?

Once every 12 months

For whom?

People with Medicare at high risk for glaucoma

Your costs in the Original Medicare Plan?

You pay 20% of the Medicare-approved amount after the yearly Part B deductible.

Are you at high risk for glaucoma?

Your risk for glaucoma increases if you…

• have diabetes
• have a family history of glaucoma
• are African American and age 50 or older

Other Web Resources for Glaucoma Information

This fact sheet is designed to provide you with background information concerning Social Security’s role in the Medicare Modernization Act (MMA). On January 1, 2006, a new program began providing prescription drug coverage under Medicare. People who have limited income and resources may be able to get help paying for monthly premiums, annual deductibles and co-payments under this prescription drug program.

Congress has given Social Security the responsibility to help the public understand that they may be eligible for extra help with their prescription drug costs under this program. Social Security’s role is to help people apply for this extra help and to process their applications. A person may qualify for extra help if they have:

• Limited income (below $14,700 for an individual or $19,800 for a married couple living together). Even if their annual income is higher, a person still may be able to get some help with monthly premiums, annual deductibles and prescription co-payments. Some examples where income may be higher include if a person or their spouse:
  

  —Support other family members who live with them;

  —Have earnings from work; or

  —Live in Alaska or Hawaii; and

• Resources limited to $10,000 for an individual or $20,000 for a married couple living together. These resource limits can be slightly higher (an additional $1,500 per person) if a person will use some money for burial expenses.

Social Security designed a simplified application to ease the filing process so that caregivers and third parties could assist people when they apply for the extra help. Social Security did not want this population to have to travel to a Social Security field office. There are several ways for people to apply:

• Apply online at www.socialsecurity.gov.
• Get an application or apply over the phone by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
• Attend a community event sponsored by Social Security or a civic or service organization where they can complete an application. Questions about extra help will be answered at these events. Staff from Social Security’s 1,300 field offices has been out in local communities taking applications at locations such as senior centers, libraries and places of worship.
• Visit a local Social Security field office.

You can help a Medicare beneficiary that you care for or care about by contacting Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or by obtaining additional information through our website at www.socialsecurity.gov/prescriptionhelp/.

To learn more about Medicare prescription drug plans, call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov.

Diabetes Screening

Diabetes is a medical condition in which your body doesn’t make enough insulin or has a reduced response to insulin. Diabetes causes your blood sugar to be too high because insulin is needed to use sugar properly. A high blood sugar level is not good for your health. For people with Medicare at risk for getting diabetes, Medicare covers a screening blood sugar test to check for diabetes. You are considered at risk if you have any of the following: high blood pressure, dyslipidemia (history of abnormal cholesterol and triglyceride levels), obesity, or a history of high blood sugar. Other risk factors may also qualify you for this test and based on the results, you may be eligible for up to two screenings each year. Medicare also covers certain supplies and self-management training to find and treat diabetes.

Diabetes Screening (Fasting Plasma Glucose Test) beginning January 1, 2005

How often is it covered?

You may be eligible for up to two screenings each year.

For whom?

Individuals at increased risk for diabetes that have any of the following: high blood pressure, dyslipidemia (history of abnormal cholesterol and triglyceride levels), obesity, or a history of high blood sugar.

Your costs in the Original Medicare Plan?

You pay nothing

Diabetes Glucose monitors, test strips, and lancets

For whom?

All people with Medicare who have diabetes

Your costs in the Original Medicare Plan?

You pay 20% of the Medicare-approved amount after the yearly Part B deductible.

Diabetes Self-Management Training

For whom?

This training is for certain people with Medicare who are at risk for complications from diabetes. Your doctor must request this service.

Your costs in the Original Medicare Plan?

You pay 20% of the Medicare-approved amount after the yearly Part B deductible.

Other Web Resources with Diabetes Information

Medicare covers bone mass measurements to determine whether you are at risk for a fracture (broken bone). People are at risk for fractures because of osteoporosis. Osteoporosis is a disease in which your bones become weak. In general, the lower your bone density, the higher your risk is for a fracture. Bone mass measurement test results will help you and your doctor choose the best way to keep your bones strong.

How often is it covered?

Once every 24 months (more often if medically necessary)

For whom?

All people with Medicare who are at risk for osteoporosis.

Your costs in the Original Medicare Plan?

You pay 20% of the Medicare-approved amount after the yearly Part B deductible.

Are you at risk for osteoporosis?

Your risk for osteoporosis increases if you…

• are age 50 or older
• are a woman
• have a family history of broken bones
• have a personal history of broken bones
• are White or Asian
• are small-boned
• have low body weight (less than about 127 pounds)
• smoke or drink a lot
• have a low-calcium diet

Other Web Resources for Osteoporosis Information

National Osteoporosis Foundation

This section of The National Osteoporosis Foundations’ website contains patient information about medications, support groups, news, regional offices, fashion tips, fall prevention, and finding a doctor.

How often are they covered?

Three shots are needed for complete protection. Check with your doctor about when to get these shots if you qualify to get them.

For Whom?

People with Medicare at medium to high risk for Hepatitis B.

Your costs in the Original Medicare Plan?

You pay 20% of the Medicare-approved amount after the yearly Part B deductible.Are you at high risk for Hepatitis B?

Common factors that put you at medium to high risk for Hepatitis B include…

• hemophilia
• End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)
• a condition that lowers your resistance to infection

Other factors may increase your risk for Hepatitis B. Check with your doctor to see if you are at medium to high risk for Hepatitis B.

Who should receive one-time vaccination for pneumococcal pneumonia?

The groups at higher risk for invasive pneumococcal disease include those over 64 years old and others with increased susceptibility to this infection, such as patients with HIV, splenectomy, sickle cell disease, diabetes mellitus, chronic disorders of the lungs or heart, and cirrhosis. You can receive this vaccination on the same day that you get the flu shot, and for those covered under Medicare Part B, it is also free when ordered by a physician. However, the pneumococcal vaccine can be given at any time of year and is a once-in-a-lifetime vaccination for most people.

If you don’t have a spleen, or if you have chronic renal failure, HIV, cancer, or other diseases that compromise your immune system, ask your health care provider if a second pneumococcal vaccination is necessary.

How often is it covered?

Most people only need this shot once in their lifetime

For whom?

All people with Medicare

Your costs in the Original Medicare Plan?

You pay nothing

What is the Flu? How Serious is it?

Influenza, also called the “flu,” is a highly contagious respiratory infection.

• Symptoms.
  Flu can cause fever, chills, headache, dry cough, runny or stuffy nose, sore throat, and muscle aches. Unlike other common respiratory infections such as the common cold, influenza can cause extreme fatigue lasting several days to more than a week. Although nausea, vomiting and diarrhea can sometimes accompany influenza infection, especially in children, gastrointestinal symptoms are rarely prominent. The illness that people often call “stomach flu” is not influenza.
• Spread from person to person.
  Influenza is spread easily from person to person primarily when an infected person coughs or sneezes. After a person has been infected with the virus, symptoms usually appear within 2 to 4 days. The infection is considered often contagious for another 3 to 4 days after symptoms appear. Because of this, people used to think the flu was caused by the “influence of the stars and planets.” In the 1500s, the Italians called the disease “influenza,” their word for influence. Each year, an estimated 10 to 20 percent of the population contracts influenza.

Flu Shot

How often is it covered? Once a year in the fall or winter

For whom? All people with Medicare

Your costs in the Original Medicare Plan? You pay nothing

Information you need to know about the Flu vaccine:

• What other steps can I take to prevent the Flu?
• What to do if you get the Flu.
• Frequently Asked Questions about the Flu and Flu Vaccine.
• To get additional information about the Flu (Influenza) to Protect Yourself and Your Loved Ones, please visit the www.cdc.gov website.

Medicare Demonstration Project Pays for Flu Medicines

Seniors who get the flu can get help paying for antiviral medicines under a new demonstration project. The Influenza Treatment Demonstration provides coverage to all Medicare beneficiaries for FDA-approved drugs for the treatment and targeted prevention of influenza. Under this demonstration project, Medicare will cover up to two prescriptions for certain anti-viral drugs for a person with Medicare

• with symptoms of influenza,
• or as a prevention measure for a person who has been exposed to a person with influenza, or
• in an institution where there has been an outbreak

For more information on the Medicare Influenza Treatment Demonstration please visit the www.cms.hhs.gov website.

Prostate cancer can often be found early by testing the amount of PSA (Prostate Specific Antigen) in your blood. Another way prostate cancer is found early is when your doctor performs a rectal exam. Medicare covers both of these tests so that prostate cancer can be detected and treated early.

How often is it covered?

• Digital Rectal Examination - Once every 12 months
• Prostate Specific Antigen (PSA) Test - Once every 12 months

For whom?

All men with Medicare age 50 and older (coverage for this test begins the day after your 50th birthday)

Your costs in the Original Medicare Plan?

Generally, you pay 20% of the Medicare-approved amount for the digital rectal exam after the yearly Part B deductible. There is no coinsurance and no Part B deductible for the PSA Test.

What factors increase risk for prostate cancer?

While all men are at risk for prostate cancer, your risk increases…

• If you have a father, brother, or son who has had prostate cancer, especially if your relatives were young when they got the disease
• If you are African American because prostate cancer is more common in this group for unknown reasons
• As you get older-about 2 out of every 3 prostate cancers are found in men over the age of 65

You may also be at risk for prostate cancer if you eat a lot of red meat or high-fat dairy products.

To learn more about prostate cancer, click on the following links:

http://www.cancer.org/docroot/CRI/CRI_2x.asp?sitearea=&dt=36

http://www.cancer.gov/cancertopics/types/prostate

Colorectal cancer is usually found in people age 50 or older, and the risk of getting it increases with age. Medicare covers colorectal screening tests to help find pre-cancerous polyps (growths in the colon) so they can be removed before they turn into cancer. Treatment works best when colorectal cancer is found early.

How often is it covered?

• Fecal Occult Blood Test - Once every 12 months
• Flexible Sigmoidoscopy - Once every 48 months
• Screening Colonoscopy - Once every 24 months (if you’re at high risk); once every 10 years, but not within 48 months of a screening sigmoidoscopy (if you’re not at high risk)
• Barium Enema - Your doctor can decide to use this test instead of a flexible sigmoidoscopy or colonoscopy. This test is covered every 24 months if you are at high risk for colorectal cancer and every 48 months if you aren’t at high risk.

For whom?

All people with Medicare age 50 and older, except there is no minimum age for having a screening colonoscopy.

Your costs in the Original Medicare Plan?

You pay nothing for the fecal occult blood test. For all other tests, you pay 20% of the Medicare-approved amount after the yearly Part B deductible. If the flexible sigmoidoscopy or colonoscopy is done in a hospital outpatient department, you pay 25% of the Medicare-approved amount after the yearly Part B deductible.

What factors increase risk for colorectal cancer?

Risk for colorectal cancer increases if…

• You have had colorectal cancer before, even if it has been completely removed
• You have a close relative, such as a sister or brother, parent, or child, who had colorectal polyps or colorectal cancer
• You have a history of polyps
• You have inflammatory bowel disease (like ulcerative colitis or Crohn’s disease).

Risk for colorectal cancer increases with age. It is important to continue with screening, even if you were screened before you entered Medicare.

Your risk for developing colorectal cancer may also increase if you…

• Have a diet high in fat, especially fat from animal sources
• Don’t exercise
• Are overweight or obese
• Smoke
• Have 2 or more alcoholic drinks every day

To learn more about colorectal cancer, click on the following links:

http://www.cancer.org/docroot/CRI/CRI_2x.asp?sitearea=&dt=10

http://www.cancer.gov/cancertopics/types/colon-and-rectal