Client Education

Care Planning

The Long and the Short of Long-Term Care

By: The Long Term Care Group

What Is Long-Term Care?

Long-term care describes a wide range of supportive, medical, personal and social services for people who need assistance for an extended period of time. The purpose of long-term care is to maintain or promote well being and one, ability to care for oneself.

Often, long-term care is provided at home by family or friends, visiting nurses, therapists and home-health aides. Outside the home, it is offered in adult-day-care centers, nursing homes and other settings, such as a group residence specifically for older people.

People require long-term care when they can no longer perform routine activities of daily living without another person? help. The inability to perform these basic, everyday activities can arise suddenly from an illness or injury. More frequently, the need for long-term care can result gradually as the natural consequence of the aging process, or as the result of the worsening of multiple medical conditions.

Typically, recipients of long-term care are older adults. People in their 70s and 80s are most likely to need long-term care. But the need for long-term care can arise at any age. Younger people might need long-term care because of an accident, heart attack, stroke, Alzheimer's disease or another reason. In fact, of the 13 million Americans currently in need of long-term care, nearly 40 percent of them are working-age adults, who are between 18 and 64.

About Activities of Daily Living and Cognitive Impairment

Activities of daily living are the basic human functions required for an individual to remain independent. ADLs are not a new concept. They have been used by specialists in aging as a measure of loss in the ability to function and to live independently for more than 25 years.

The need for long-term-care services is strongly related to loss of ability to perform these everyday activities. As people age, they are more likely to need such services because of limitations in their ability to perform ADLs, rather than an as a result of an injury or illness.

The six basic ADLs are:

Bathing: Getting into and out of the tub or shower. Wash oneself in the tub or shower or by sponge or bed bath.

Dressing: Getting, putting on and taking off all necessary clothing, including braces and splints.

Toileting: Getting to and from and on and off the toilet. Caring for clothing and performing related personal hygiene.

Transferring: Moving between a bed and a chair.

Continence: Voluntarily control of bowel and bladder function or caring for oneself and devices such as a catheter or continence pad.

Eating: Getting food into one? own body by any means once it has been prepared and made available.

Cognitive impairment: Cognitive impairment is a deterioration or loss of intellectual capacity. Someone who has a cognitive impairment might have problems with memory or reasoning, or may be disoriented about people, places or time. Often, people with a cognitive impairment require continual supervision to protect themselves or others. The most well-known example of a cognitive impairment is a condition like Alzheimer? disease. Cognitive impairment can also result from other similar forms of brain disorders.

While the problems and needs we describe as long-term care are not new, we are seeing a dramatic increase in the number of people who need such care. Several factors have come into play:

Population growth: Seniors are a large and rapidly increasing portion of the U.S. population. The over-50 population represents 25 percent of all people today and will represent more than 40 percent of all people in 30 years. Those older than 65 account for over 13 percent of all people today and will represent 18 percent of all people in the next 30 years. (This compares with 8 percent in 1950.) The group most at risk of needing long-term care ? those older than 75 ? is growing at nearly four times the rate of the general population.

Longer lifespans: Advances in medical care and improved nutrition mean that more people live long enough to reach the point at which they will need long-term care.

Social changes: Adult children are less likely to live near their aging parents. Women have historically taken care of family members who need long-term care, and many continue to do so. But because more women are working outside of the home and may also be raising children, they are less likely to be able to provide the care that family members might need. More people who need long-term care will have no choice but to turn to paid services (formal care), rather than relying on family members to provide care (informal care).

Rising costs: We hear more concern about long-term care today because the cost of care for those who rely on paid services continues to rise dramatically. Today's nursing home costs an average of $110 per day. In some parts of the United States, nursing homes cost more than $200 a day or more. In 20 years, at 5 percent annual inflation rate, a day of care in a nursing home could cost close to $300. Long-term care already poses a significant financial risk, which will only increase as these costs rise.

When most people think of long-term care, they think only of nursing care. But long-term care is much more than that. There are three types of long-term care:

Skilled care is medical or nursing care (such as help with medications, caring for wounds, applying bandages) and therapies (such as occupational, speech, respiratory and physical). Skilled care is usually delivered by a nurse, therapist or other trained professional. Most people think of skilled services when they think of long-term care. But the reality is that less than 15 percent of all people who need long-term care need skilled care.

Personal care is help with activities of daily living, such as bathing and dressing, which you are unable to perform on your own. Most people who need long-term care need personal care, not skilled care.

Supervisory care provides monitoring and supervision, a safe or controlled environment, and stand-by help with ADLs to ensure that people do not harm themselves or others. Supervisory care is often needed because of a severe cognitive impairment.

It is provided in many settings. While most of us think mainly of nursing homes, there is a rapidly growing array of alternative services and settings that provide long-term care outside of the traditional nursing home. It is estimated that less than 20 percent of all people who require long-term-care assistance live in nursing homes. The rest receive care at home or in the community. Where care is provided depends on a person? condition, preferences and family circumstances, the care options available in the community, and the person's ability to afford various types of care.

Home care consists of a broad range of services delivered in the home. These services might include skilled-nursing services; speech, occupational, physical and respiratory therapy; nutrition/medical services; help taking medications; personal care; and chore and homemaker services.

Care at home can be provided by family or friends (informal caregivers) or by paid workers from a home-health-care agency or who are independent providers. Care provided in the home can be either skilled care provided by a registered nurse, therapist or physician, or personal care provided by a personal care worker or home-health aide.

Although a great deal of care at home is provided by informal caregivers, family members may not be able to provide all the needed care. A spouse may not be physically able to provide all the needed care, and children may not be able to meet all their parents?needs because of work and their own family responsibilities. Also, informal caregivers may be able to provide personal care, but cannot perform skilled procedures such as changing bandages or giving physical therapy. The emotional and physical demands on the family of caring for someone with severe cognitive impairment, such as Alzheimer's disease, can be overwhelming.

How much at-attendant & personal care do people typically need? The number of home-care visits required can vary from once a week to every day. Typically, people begin receiving care only a few times a week, either because their care needs are less complex, because they also have informal caregivers available, or both. Over time, as care needs increase, services may be provided more frequently. When daily services are needed, some people consider a nursing home, assisted-living facility or an adult-day-care center.

Adult-day-care centers are community-based settings that provide care and support during the daytime. They care for people who need assistance or supervision but who do not need round-the-clock care. Adult-day-care services can be provided on a regular basis or part time to provide a break to family members. A typical center provides meals, help with medication, personal care, counseling, occupational/speech/physical therapy, recreational activities and transportation to and from the center. Most people who receive care during the day at a center will be cared for at night at home by family or friends.

Nursing homes provide care to people who are chronically ill or recuperating from an illness and need regular nursing care and other services but not hospitalization. They also provide support, supervision and assistance to people who may not be ill but who are cognitively impaired or who need help with activities of daily living. Nursing homes usually provide basic room-and-board services; help with activities of daily living; nursing-care, rehabilitation and therapy programs; social activities; and supervision.

There are different types of nursing homes. Skilled-nursing facilities deliver skilled and personal or custodial care. Skilled care is the highest level of care and the most expensive, although about only 20 percent of nursing-home residents ever require skilled care. Sometimes these are also called convalescent-care facilities. Intermediate- or custodial-care facilities provide mostly personal and supervisory care, although they may also provide some skilled care.

Assisted-living facilities provide an alternative living arrangement for people who do not need nursing-attendant & personal care, but who may need more support, assistance or supervision than is available at home. These facilities are often smaller and are more home-like than a nursing home. They generally care for people who are less disabled, and they typically cost less than a nursing home. Most assisted-living facilities provide housing; help with personal care or supervision, with household activities like meal preparation and transportation, and with managing medications; social and recreational services; and other services. Other names for assisted living facilities include residential care facilities, personal care home, and board and care homes.

Most people will need some form of long-term care at some point. The type and amount of care needed is different for different people and may change with time. The circumstances that make long-term care necessary, such as the inability to dress or bathe without help, are often the result of chronic illness, an accident, cognitive impairment, or simply the natural process of aging.

Even though many of us know people who have needed long-term care, we often believe that it won? happen to us. But consider the following. Of all people older than 65:

About 60 percent will need some type of long-term care. Not all of them, however, will need to use paid services, they may instead receive care from their family or friends.

About 40 percent will need some nursing attendant & personal care during their lives.

How Long Do People Stay in a Nursing Home?

How long someone might need to receive care in a nursing home depends on factors such as age, sex, medical condition, and the nature and severity of disability. Generally, people who need long-term care fall into one of two categories: short-term and long-term users.

Short-term users are mostly people who require post-hospital care for an acute illness or sudden injury. Their need for long-term care may end when they recover, when their condition stabilizes or if they die. About one-fourth of all seniors who enter a nursing home are "short stayers." The remaining three-fourths are long-term users. They tend to have chronic illnesses or injuries or a cognitive impairment like Alzheimer? disease that often require care for extended periods.

The average nursing-home stay for all people 65 and older is 2.6 years. This includes both the short stayers and the long stayers. Long stayers spend an average of 3.5 years in a nursing home.