With the pending and ongoing issue of Health Care Reform, one of the many issues this administration and well as those from the past, we need to be cognizant of the several key facts relative to the status of aging in America: According to the Administration on Aging, and based on data complied from the 2000 U.S. Census, life expectancy after the age of 65 has increased by almost 18 years, or to 83. In comparison, in 1940 people were expected to live only an additional 13 years, or to age 78. In addition, the American Council of Life Insurance (ACLI), predicts that one out of every 7 citizens will be over age 85 by the year 2030.
Why Would Someone Need Long Term Care?
Naturally, as we age we notice, perhaps over a period of time, a gradual decrease in the ability to do the things we have always be able to do such as dressing, walking, eating, bathing and toileting. Changes in our ability to perform these Activities of Daily Living (ADLs) may be due to just a natural aging process, but often are due to a prolonged illness, disability or, in many cases, cognitive impairment. Long term care, also known as “custodial care,” is care that enables a person to maintain his or her status quo, by assisting that person with his or her ADLs. Long term care is not designed to cure or necessarily improve the condition or disability. The National Insurance Association of Insurance Commissioners describes it as “help(ing) one as he or she is now.”
Degrees of Assistance With ADLs
There are varying degrees of assistance with long term care. One person may only need “stand-by assistance” when he or she walks, or dresses themselves, to ensure that the patient doesn’t fall. Others might need “hands-on” assistance which requires a more active involvement in for example, dressing, such as holding a blouse so that the person can put her arms into the sleeves, or buttoning a piece of clothing. “Completely dependent” care is just as the name implies, a complete dependence on someone else to eat, dress, bath and toilet oneself. Ambulation may not be possible at this stage.
Who Provides Long Term Care?
Long term care can be provided in a number of ways; home care, adult day care programs, respite or hospice care. Assisted living facilities and nursing homes also provide residential long term care.
As with normal aging, more often than not the need for long term care option is a gradual one and usually begins with home health care. This could be as little as two hours in the morning to get a person up and ready for the day, and to prepare the person for bed. The next step may be to enroll the patient in an adult day care program, which is in most cases, is a community based program. This type of long term care is ideal for someone needs some assistance or supervision during the day, but is able to be alone during the evening and night time hours.
Respite care, although geared toward providing relief to the regular caregiver, is still considered long term care. The respite worker, who can provide either long term care and/or companion services, relieves the caregiver for a specified period of time in either the home, adult day care center or a nursing home. Hospice care is a classic example of long term care that is provided to the terminally ill. The goal of hospice care is to keep the patient comfortable, clean and safe. It can be provided at the patient’s home, or in a facility.
Assisted Living Facilities, which have really come into focus over the last 20 years, as an alternative to nursing homes usually, have varying degrees of long term care options.
An assisted living facility is often the perfect fit for more independent senior as meal preparation; medication administration, entertainment, and socialization are all provided in a home-like setting, with the resident begin able to make their own choices about participation and care. Many facilities also provide increasing levels of care and, in the case of complete dependency, 24 hours supervision as would be provided in a nursing home.
Nursing homes used to be the primary option for long term care. According to the National Academy on Aging, even though 12.8 million Americans need long term care, only 2.4 million live in nursing homes. This is significant as it implies that people who need care prefer to live as independently as possible, for as long as possible. In another study cited by the National Association of Insurance Commissioners, 44% of people who reach age 65 are expected to use a nursing home at least once. Of those who do, 53% will stay for more than a year.
Long Term Care Options--What to do?
Fortunately, there are now many options for seniors to maintain their independence for as long as possible with varying degrees and types of long term care available. Whether someone needs a few hours of home care, or in the extreme, a full time supervised environment, there is something for every circumstance. Navigating through the options can be challenging. The AARP website offers an abundance of information and checklists that can be used in evaluating long term care options on its Caregivers page.
