Care Options

Matching Capability with Living Environment

Matching Capability with Living Environment

As you go through the site, you will learn how to find the best care environment for your elderly family member. Specifically, Care Options will help you understand what factors you may want to consider when deciding between home-based care, personal home care and nursing home care. Before viewing, please take a moment and review our user agreement if you haven’t already.

Why are you interested in this topic?

Betti’s Story

Betti was living in an independent living apartment in Florida near her son. The facility provided support in terms of getting to the doctor and preparing meals. One day she fell in her apartment. Luckily her son called her, did not receive an answer, and asked someone to check on her. Apparently she was having trouble keeping track of her medications and had not taken the right dose. Betti and her son knew that she needed more assistance, but were not sure what was the best care option.

Betti was able to move from independent living to assisted living. The assisted living facility gave her many advantages. She was able to live independently while having a reliable staff clean her apartment, and nurses monitor her medications. An on-site nurse addresses any medical problems. The staff also checks her every two hours to see if she is ok. She is now able to live safely with a little assistance while maintaining her independence.

Please answer the following questions.

The following questions will help you find the right living environment. You do not need to use the radio buttons ()
They are currently used to improve the look of the pages. In the future, your responses will more directly guide you to the best choice.
Where does you elder live now?
With me.
In his or her own home.
In a personal care home.
In a nursing home.
In an elderly retirement community.

Assessment Questions

Yes No
1. Do you live far away?
2. Can your elder walk without assistance?
3. If your elder fell, would he or she need help to get up?
4. Do you need physical help to care for the elder?
5. Does your elder need help to take care of himself or herself (i.e. hygiene, eating, etc.)?
6. Does your elder need help to understand how to take care of himself or herself?
7. Does your elderly family member have problems remembering?


If you answered “NO” to questions 2-4, you should check out the mobility assessment.
If you answered “YES” to questions 4-6, you should check out the personal care assessment.
If you answered “YES” to questions 6-7, you should check out the cognitive assessment.

I’d like help with an ongoing problem

Betti’s Story

Betti had been living in New York with her husband. After her husband died, she counted on her friends for support and companionship. Over the next few years, her friends became ill or moved out of the city. It become more and more difficult to go grocery shopping, cook all the meals and take trips to see her the doctor. While visiting her son in Florida, Betti realized that there was nothing keeping her New York and decided to move into an independent living facility. There, she was surrounded by people her own age and was close to her son. For her, moving to a new living environment with better supports and without the cold harsh winters of the north was all she needed.

Please answer the following questions.

The following questions will help you find the right living environment. You do not need to use the radio buttons ()
They are currently used to improve the look of the pages. In the future, your responses will more directly guide you to the best choice.
Where does you elder live now?
With me.
In his or her own home.
In a personal care home.
In a nursing home.
In an elderly retirement community.

Assessment Questions

Yes No

1. Do you live nearby?
2. Can your elder walk without assistance?
3. If your elder fell, could he or she get up or get help?
4. Are you physically capable of caring for anyone elder?
5. Can your elder take care of himself or herself (i.e. hygiene, eating, etc.)?
6. Does your elder understand how to take care of himself or herself?
7. Does your elderly family member have problems remembering?
If you answered “NO” to questions 2-4, you should check out the mobility assessment.
If you answered “YES” to questions 4-6, you should check out the personal care assessment.
If you answered “YES” to questions 6-7, you should check out the cognitive assessment.

I’d like to know about different care options.

Elderly Retirement Community
What is an elderly retirement community?

These types of communities provide a place for elderly people who are no longer able to manage or maintain their own home. The retirement community may provide meals, have nursing staff on the premise, maid service, etc. It offers socialization for elderly persons who may be isolated due to their disabilities.

Most often elderly retirement communities are apartment buildings, townhomes, or rooms which are set up for little or no maintenance. These homes often offer meals can be cooked in the person’s room, communal meals, social events such as parties, movies, bingo, etc., trips to shopping centers, etc. There is staff onsite 24 hours a day. The staff may or may not be a health care worker. The apartments are set up so that the elderly can get help easily should he or she need it, i.e. pull cords in the bathroom. There may be an onsite health care facility. Some facilities may also offer intermediate and skilled nursing care and assistance with personal care.

For whom is it intended?

It is intended for elderly people who are still active but no longer can or want to take care of home. People who live in these communities can take care of their daily care or needs without assistance. It is a great place for elderly people who are married and need a specially equiped home (e.g. no stairs) to maintain their independence. It is also intended for people who are becoming isolated because they are not able to manage stairs or drive.
What services are supplied by elderly retirement communities?

This is very dependent on the elderly retirement community. It can range from maintenance of the facillity to having nursing staff on duty 24 hours a day. Some meals may be provided in a restaurant atmosphere or the resident can cook his or her own meals. Trips to the doctor or shopping centers may be available. Maid service may be available to assist in weekly cleaning along with some laundry service. U.S. Post Office has mobile units (complete post office) which go to retirement communities.

What type of staff do they offer?

This varies from facillity to facillity. The community may offer just custodial or maintenance staff to a full health care clinic. This is an important question to ask when considering one of these facillites.

What is the cost?

Some elderly retirement homes, also called elderly high rises, are only available to the poor elderly and the cost is based on ability to pay. These types of homes have very long waiting lists, often people have to wait years to get into these types of homes.

When most people think of an elderly retirement home, they are thinking of the country club type of facility. These are very expensive – $2500/month and up but offer many amenities for the active adult..

Does insurance cover it?


Home Care


What is home care?
What is home care? It is taking care of a family member in your home either by yourself or with the assistance of outside agencies. Home care can be as simple as monitoring blood pressure or as complicated as administering intravenous chemotherapy. It involves assessing the elderly person’s condition, completing prescribed treatments, evaluating treatments and teaching the elderly person or family member how to do the treatment(s).Most agencies require that the elderly person be seen by a nurse to open the case and assess the needs of the elderly person. Other professionals come to the home after the initial care has been started.

The amount of care given by a home health agency is dependent not only on the elderly person’s need but also on the caregiver needs. Caregivers who feel they want to take care of their elderly family members at home can get assistance through home care agencies. This type of care can be gratifying to the family because their elderly family member is at home and the family can participate in his or her care. It can also be frustrating finding the right agency or people to help with the care. Caring for someone at home is often difficult and can easily exhaust the caregiver both mentally and physically.

Who needs home care?

Home care is available to people who feel that they are unable to care for themselves or are unable to care for their elderly family member. A typical home care patient is one who needs to have bandages changed or have a condition like hypertension monitored. This person may have some difficulty maintaining his or her hygiene or may be unable to fix his or her own meals. All he or she may need is an home health aide to assist with ADLs and a nurse to monitor the care or health condition and to do dressing changes or other treatments.
Health care professionals in home care
Home care can involve the entire health care team including

occupational therapists
physical therapists
social workers


There are several places you can find information about local home care agencies.

Local area Agency on Aging
Local Medicare Office
Social Workers
Local Better Business Bureau
Physician recommendation

Cost of home care

Home care can be least expensive way to care for your elderly family member especially if he or she doesn’t require extensive and complicated care. Often the cost of home care is covered to a great extent by Medicare or other insurance. Out of pocket expenses can be immense for certain types of care, especially if the elderly person requires live-in or 24 hour care or doesn’t meet the criteria for home care by the elderly person’s health care coverage. Most equipment used in home care is covered by insurance if ordered by a physician, but there are limits. Always check with Medicare or other insurance company about what is covered and what is not.
Medicare Coverage
Four of the following conditions must be met before Medicare will cover home visits (from Caregiver Practical Help):

Part-time skilled nursing or physical therapy is required.
Patient is confined to home.
Doctor determines need for care and sets up a care plan.
Home health agency is certified by the state department of health.

Physician-prescribed services which Medicare may cover are:

Occupational therapy,
Speech therapy,
Part-time home health aides,
Medical social services,
Medical supplies,
Durable medical equipment (80% of approved costs).

Medicare won’t cover…
What Medicare won’t cover:

won’t pay for managment of a chronic illness unless the elderly person is unable to manage it for him or herself (a diabetic who has difficulty seeing the lines on an insulin syringe when preparing the dose and has no one else to help either prepare or give the dose).
live-in help, or 24 hour nursing care.
Drugs or biologicals
Meals delivered to your home
Blood transfusions.

Private insurance

Insurance companies (also known as third party payers) and Managed Care – Medicare have different qualifications for home care than Medicare Part B. Often home care is time limited and care must be recertified by a physician. If you are thinking about taking your elderly family member home and want to have home care, check with your insurance carrier to determine what is covered and what is out of pocket expenses. If you are unsure about what Medicare or third party payers will cover, contact them directly. Medicaid also pays for home care for the elderly who are poor and unable to pay for their care. Contact your local area agency on aging about qualifications for Medicaid.

What is respite care?

Care giving can be very time consuming and stressful for the caregiver. To remain healthy and prevent burnout or stress, the caregiver must have time to participate in self-fulfilling activities. Respite care is a system that supplies trained people monitor your elderly familiy member while caregivers are free ti participate in their own activities. Click here to learn more about respite care.

What is Adult Day Care?

Adult day care also offers respite care for the caregivers. They can do important errands, or just get away from all the strife of caring for someone else, knowing that their family member is safe and being taken care of. Click here to learn more about finding an adult day care.

Respite Care

What is respite care?

Caregivers who provide constant care for their elderly family member need time away from their care duties to take care of their own needs. Respite care allows caregivers this time by providing a trained worker (or in some cases a volunteer) to be with the elderly family member while the caregiver is away. This helps caregivers avoid burnout, stress and fatigue. Respite gives caregivers time to relax and come back to to their role revitalized and better able to care for the elderly family member.

Respite care can occur in several forms. If the caregiver needs a few hours to run errands and his or her family member can not be left alone, a person can come to the home and stay with the elderly person. This person can be another family member, a neighbor or friend, a volunteer from a church or local organization, or a hired aide. If the caregiver needs to be away for more than a few hours, overnight, or even longer, the caregiver may arrange for another family member or hire an aide to stay with the family member.

Respite care does not always need to take place in the home. Community agencies sometimes have a day care for respite care. This type of respite care is for elderly persons who to some degree are able to take care of themselves. It involves activities designed to help decrease isolation through socialization, increase movement through exercise, and maintain mental status through stimulation for the mind.

For longer term respite care should the caregiver need to leave town, personal care and nursing homes offer short term stays.
What services are provided by respite care?

Caregiver relief

Support and companionship to the elderly family member
Safe environment
Physical and mental stimulation

Who supplies respite care?

Local agencies on aging is a good starting point for looking for respite care. They sometimes have their own programs for respite care. Some programs are managed by affiliates or chapters of national organizations. Many other programs are provided by local organizations such as churches, schools and other non-profit groups. Sometimes families arrange for care with neighbors or other people they know.

Some questions to ask about a respite care program?

How are care providers screened?
What is the training and level of experience of the care providers?
How, and by whom, are the care providers supervised?
What happens during the time the elderly family member is receiving services? Are there organized activities? How are meals handled?
Does the program maintain current information about each elderly family member’s medical and other needs? Is there a written care plan?
What procedures does the program have for emergencies?
Can family members meet and interview the people who care for the elderly family member?
How far ahead of time do people need to call to arrange for services?
Are families limited to a certain number of hours of services?
Does the program provide transportation?
What is the cost of services? How is payment arranged?

What is the cost of respite care?

Respite care is only partially taken care of by Medicare and is often paid for by the family. The cost of respite care often depends on the type of respite care. If the elderly person just requires some to be available to provide supervision, the cost may be minimal or may be done by volunteers. If higher amount of care is needed, the cost rises. Another variable of the cost of respite care is the location of the care. Home respite care may not be the least expensive. You may want to investigate all of the alternatives available including local centers for aging, churches, organizations or associations, or health care agencies. Check into the local day care facilities.

Many programs receive public funding for their services. Some charge fees on a sliding scale based on the family’s income. Other programs may be operated by non-profit organizations which receive funding from donations or other sources. Many programs must use a combination of funding sources in order to meet their financial needs.

Does insurance cover respite costs?

Medicare only covers in home respite care and limits the amount of paid respite care to 80 hours per year.


Personal Care Home

What is personal care home?

A personal care home is a facility which offers assistance to people who require help with personal care or who can not safely stay by themselves. This involves hygiene, grooming, meal preparation, medication supervision, etc. There is a wide range of facilities which call themselves personal care. Some personal care homes are actual homes where three or four people are cared for. Larger facilities offer more services than smaller ones which might include transportation to doctor appointments or shopping centers, recreational activities, beauty/barber shops, religious services, etc. Meals may be in a common dinning room or in the person’s room depending on the state regulations or facility. Personal care homes are usually licensed by the state.

Who needs personal care home?

A person who has difficulty caring for him or herself. It is mainly for people who need assistance in bathing and dressing, meal preparation, and medication supervision. Personal care home provides a safe and supportive environment for the semi-independent elderly person. The range of care is dependent on the needs of the elderly person. They may be able to bathe and dress themselves but are not able to fix a meal. Personal care home is not for individuals who need skilled nursing or are dependent on another person for all of their care.
What services are supplied by personal care home?

Assistance in…


What health professionals are involved in personal care home?

Most of the care is provided by nursing aides. The aides are usually supervised by a licensed personnel such as an LPN but this might not be the case in all situations. In larger facilities, a registered nurse is usually available 24 hours a day. Other health professionals such as physical and speech therapists may be available on site (larger facilities or facilities connected to a nursing home) or by visit status.

What is the cost of personal care home?

This is usually dependent on the amount of care required by the elderly person and the type of facility the person is in.
Does insurance cover personal care home?

Check with your insurance company to see if you have long term care insurance. This type of care is not covered by Medicare.

Nursing Home
What is a nursing home?

Nursing homes are usually reserved for those elderly people with chronic illnesses or recovering from an acute illness who need skilled nursing care that can not be taken care of in the home and do not need to be hospitalized. Nursing homes can also be where elderly people who are no longer able to care for themselves and have no one else to help them are cared for stay. Nursing homes are also known as long term care facilities.

Who needs nursing home care?

Elderly persons who are very ill and/or need constant monitoring, or who do not have a caregiver who is able to care for him or her need to be in a nursing home. Sometimes elderly people are sent to hospitals for evaluation or inpatient care of an acute health problems such as heart attack, phlebitis, difficulty breathing, or swallowing, etc. After the evaluation, the doctor determines that the person is not ill enough to be admitted to a hospital but needs more care than can be given at home, he or she may recommend that the person be admitted to a nursing home.

Some elderly people with memory impairment who have difficulty with problems wandering, agitation, or behavior problems that the caregiver can no longer manage are residents of nursing homes.
What services are supplied by nursing homes?

Nursing homes offer a professional staff which can care for most illnesses or conditions.Some nursing homes offer specialized services for people with memory impairment and dementia. Most nursing homes offer the following services:

24 hour professional nursing care
wound management (wounds that don’t heal quickly)
respirator/venilator (some nursing homes are not equipped for ventilators)
occupational therapy (rehabilitation)
physical therapy (rehabilitation)
recreational therapy
hospice care (care for the terminal ill)

Since not all homes offer all types of care, ask the facility what types of services the facility offers. Also ask about long and short term stays.

What type of staff do nursing homes offer?


Nursing homes treat their patients with a variety of types of professional staff including:

Home Health Aides
Physical Therapists
Recreational Therapists
Speech Therapists
Occupational Therapists
Respiratory Therapists.

What is the cost of nursing home care?

Nursing homes can be one of the most expensive ways to care for your elderly family member. It can cost upwards to $30,000 per year (jules, source).

Does insurance cover nursing home costs?

There are three different types of insurance which can cover some of the costs of nursing homes, Medicare, Medicaid, Medigap, and Long Term Care Insurance.

Medicare pays for illnesses which the person has some potential for rehabilitation and require skilled nursing care, i.e. hip fracture but will be able to walk again even if it is with assistance. The coverage offered by Medicare is time limited and may require a co-payment after a certain amount of time ((full coverage for 20 days and then 80% for 90 days). Medicare doesn’t pay for custodial care or for personal care alone.

Medicaid may pay for some of nursing home care for those persons who are unable to pay for it themselves. Check with the local Agency on Aging for qualifications for participation.

Long Term Care Insurance is an insurance policy, usually purchased before one becomes ill, that covers care in a long term facility or nursing home. The amount of coverage differ between insurance companies and policy purchased. Contact the long term care insurance company about the coverage of a nursing home under the policy you own. Long term care insurance only pays for long term care.

Third Party Payors (also known as Medigap) are insurance companies which may pay a portion of nursing home. Most often they do not pay for custodial care but require some type of rehabilitation potential. There are limits to the coverage of most third party payors. Contact your third party payor to determine the types of care the insurance company will cover. This coverage is different than Long Term Care Insurance.

What is JCAHO?


Joint Commission of Accreditation of Hospitals Organization (check this out) is an independent organization which evaluates the care given by an organization or facility. It evaluates the facility on many different levels including nursing care, dietary, infection control, medical records, administration, specialty care, i.e. physical therapy, etc., building maintenance and upkeep, etc. For a facility to become JCAHO accredited they must have met or superseded JCAHO strict guidelines in all areas. Facilities are re-evaluated at least every three years, but usually more often than that. It is difficult to obtain JCAHO accrediation and so nursing homes strive to keep the accrediation.


The Health Care Financing Administration publishes a free booklet called How to Select a Nursing Home. Write to HCFA Publications Dept.,7500 Security Blvd., Room N1-26-25, Baltimore, MD 21244-1850.

AARP’s booklet, Nursing Home Life: A Guide for Residents and Families, gives information about getting good care and finding help when there are problems. Write for a free copy to AARP Fulfillment, 601 E St., NW, Washington, DC 20049.

The National Citizens’ Coalition for Nursing Home Reform has a 166-page book with advice for families and friends of nursing home residents.Called Nursing Homes: Getting Good Care There, it is $14, plus $3 for postage and handling, from NCCNHR, 1424 16th St., NW, Suite 202, Washington, DC 20036.

Hospice Care


What is a hospice care?

Hospice is a philosophy and concept of care available to those who have a terminal illness. Hospice recognizes death as the final stage of life and serves to enable hospice people to live their final days to the fullest, surrounded by their family and friends. One of the goals of hospice is to make the patient as comfortable as possible and not to artificially prolong life.

What services are provided by hospice care?

Medical Support – Caring for the physical needs such as dressings, ADLs, etc.
Medical Social Services
Respite Care
Bereavement Support
Spirituality care (often done by the clergy)
24-hour on-call availability of staff in hospice centers

Which medical professionals are involved in hospice care?

Medical Social Workers
Physical Therapists
Occupational Therapists
Speech Therapists

What is the cost of hospice care?

Hospice care can be less expensive than hospital or nursing home care if done in the home. The family supplies as much care as possible for the elderly family member; therefore, the expense can be less. If the elderly person requires that nursing personnel be available in the home for 24 hours a day, the cost can be quite high, sometimes greater than care in a nursing home or hospice center. Many associations assist with respite care of families who are taking care of a hospice person.

Does insurance cover hospice care costs?

Medicare. Medicare will cover the cost of hospice under some conditions. First, a physician must certify that the patient has less than six months to live if the disease runs its normal course. The physician must recertify the individual at the beginning of each benefit period (two periods of 90 days each, one of 30 days, and an indefinite fourth period). If the elderly family member lives beyond six months, the physician must recertify that the elderly member is terminally-ill to continue care. Second, the elderly family member must sign a statement indicating that he or she understands the nature of the illness and of hospice care. By signing the statement, the elderly family member surrenders rights to other Medicare benefits related to the terminal illness. Medicare will only pay for care which will make the patient more comfortable and will not pay for life-prolonging treatment.

Medicaid. In general, Medicaid is designed to help poor elderly cannot pay for medical services. Thirty-eight states now offer the hospice benefit under Medicaid.

Private Insurance. Most private insurance companies include some type of coverage for hospice care. Make sure to to find out what your elderly family member’s insurance will cover.

Private Pay. If insurance coverage is not available or is insufficient, the patient and the family can engage providers and pay for services themselves. Some hospices provide services without charge if patients have limited or no financial resources.

Where can you go to get help?

Aging Resources

For more information about care for the elderly, click on the letter that corresponds to the first letter of your state or find your state by region. These agencies coordinate services for older Americans, providing information on services, programs, and opportunities.
A-C, D-I, J-M, N-O, P-T, U-Z.
* indicates in-state 1-800 numbers.

Resources: National Organizations

ElderCare Locator – 800-677-1116

Call the toll-free Eldercare Locator to link-up with services for older adults anywhere in the country. . The Eldercare Locator operator will provide the phone number of the information and referral organization serving the area where your relative or friend lives. You can then speak directly to the organization and get assistance and referrals in that community.
AARP Talent Bank
601 E Street, NW
Washington, DC 20036.
202/434-3219. American Cancer Society
1599 Clifton Road, NE
Atlanta, GA 30329
404-320-3333 National Hospice Organization
1901 North Moore Street, Suite 901
Arlington, VA 22209.
Age Pages (National Institute on Aging)
PO Box 8057
Gaithersburg, MD 20898-8057.
301/496-1752. American Diabetes Association
P.O. Box 25757
1660 Duke Street
Alexandria, VA 22314
703-549-1500 National Association for Home Care
519 C Street, NE
Washington, DC 20002.
Alzheimer’s Association
919 North Michigan Avenue, Suite 100,
Chicago, IL 60611-1676
800/272-3900. American Heart Association
727 Greenville Avenue
Dallas, TX 75231-4596
214-373-6300 National Institute on Adult Day Care (National Council on Aging)
Second Floor, 409 Third Street, SW
Washington, DC 20024.
American Association of Homes and Services for the Aging
901 E Street NW,
Washington, DC20004-2937.
202/508-9420. National Association of Professional Geriatric Care Managers
1604 North Country Club Drive
Tucson, AZ 85716
602-881-8008 National Meals on Wheels Foundation
2675 44th Street, SW, #305
Grand Rapids, MI 49509
National Citizens’ Coalition for Nursing Home Reform
1224 M Street, NW, Suite 301
Washington, DC 20005. 202/393-2018.

Call the toll-free Eldercare Locator to link-up with services for older adults anywhere in the country. 800-677-1116. The Eldercare Locator operator will provide the phone number of the information and referral organization serving the area where your relative or friend lives. You can then speak directly to the organization and get assistance and referrals in that community.

Product Resources
After Therapy Catalog
North Coast Medical
187 Stauffer Boulevard
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American Walker
742 Market Street
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608-835-9255 Fashion Ease
1541 60th Street
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Independent Living Aids Inc.
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1-800-222-6161 Sears Health Care Catalog
Sears Roebuck and Company
P.O. Box 804203
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