What Are Alternative Long-Term Care Choices?

A true nursing home provides 24-hour-a-day care to its patients. This may be simply assistance with the activities of daily living (in an intermediate care facility) or ongoing medical care (in a skilled nursing facility). Since not every patient will require such a high level of services, it may be possible to use less-expensive options.

Skilled nursing facilities are often used to provide transitional care, such as rehabilitation or following a hospital stay. The goal is to enable the patient to either return home or step down to a less-intensive level of care. That being the case, the purpose of this guide is to explain alternative long-term care choices that you may need to consider once your loved one has completed care in a skilled nursing facility. We'll look at these alternatives in order from least intensive to most intensive care levels, and then consider two alternatives for different situations.

The least intensive level of care is provided by community-based services. These services allow the patient to remain in their own home while assisting with certain aspects of daily life or providing opportunities for social interaction and activity:

• Meal programs (Meals-on-Wheels being the best-known)
• Friendly visitor programs
• Shopping and transportation assistance (for example, to reach medical appointments)
• Financial and legal advice and assistance (handling monthly bill payments, for example)
• Senior centers
• Adult day care

The next level is home care. Home care may or may not involve home healthcare, which is provided by a nurse or certified nursing assistant. Home care also allows the patient to remain at home, but whereas community-based services assist primarily with external activities, home care also assists with internal activities-mostly the requirements of maintaining a household, such as cooking, cleaning, and laundry. Both community-based services and home care can be provided by family members or friends, and in some areas volunteer groups will also assist.

When more frequent care is needed, or for a patient whose medical condition might warrant assistance at any time, an accessory dwelling unit (ADU) is a possibility. If the patient or a family member owns a single-family home, it may be possible to add an ADU-separate living space commonly called a "mother-in-law apartment." An ADU can be created from a garage or basement renovation, built from scratch, or modified from existing spaces; it may already exist if the home includes a rental apartment. Living in an ADU at a family member's home, or having a family member live in an ADU at the patient's home, can allow a high degree of independence while still making care available all or nearly all of the time. Of course, this has the potential to be an expensive project if the ADU must be created, and not every home's layout or lot will permit the addition of an ADU.

Subsidized senior housing is available through various state and federal programs for low to moderate-income seniors. Usually in the form of an apartment, such housing programs include assistance with housekeeping and shopping and/or meal services.

Board and care homes, sometimes called group homes, bring together a group of patients who require a degree of assistance with household and daily living activities that precludes living independently. Such facilities don't rise to the level of a nursing home because medical care is not provided and medical staff is not present.

Very similar to group homes are assisted living facilities. These facilities are generally more expensive and offer nicer living conditions, but overall the type and level of care provided is very similar. Additional amenities typically include social and recreational activities and, in some cases, limited health care facilities on-site.

Continuing care retirement communities (CCRCs) are larger and typically bring together a variety of facilities, giving the resident the option to transition to higher levels of care as their health condition requires (hence the term "continuing care" in the name). A CCRC might offer apartment residences for those still living independently, an assisted living facility for those who need it, and a full-fledged nursing home, all on the same site. Not surprisingly, CCRCs do tend to be one of the most expensive options.

Finally, there are two forms of alternative care intended for specific situations.

A hospice is for terminally-ill patients with a life expectancy of less than six months. Hospice care is focused not on disease treatment but rather on pain management and other comfort issues (for the patient) and on counseling (for the family).

Respite care is for patients currently under the care of a family member. It is short-term care (generally a few days at most) to give the full-time caregiver an opportunity to rest. Respite care is typically offered as an additional service by a traditional nursing home or hospice. It may also be provided as an in-home service, though this option is typically more expensive.