Nursing Homes and Alternatives: Options for Long-Term Care

Housing options for senior citizens range from living independently at home to living with daily support in a nursing home. Choosing the right option for an aging loved one involves many factors, including cost, level of care needed, and location. Sometimes the decision is dictated by a medical situation, but many older adults and their families are planning ahead to decide how their housing choice will best fit their lifestyle and needs as they age. Important considerations include care services such as specialized Alzheimer’s care, type of accommodations, such as individual or shared rooms, suites, or apartments, and activities offered. For shared facilities, such as nursing homes or hospice care, ensure that your loved one will be comfortable with the level of privacy afforded patients, the type of intimate personal care provided, and the caregivers providing it. Facilities should be licensed or certified to provide the type of care required and healthcare staff trained to manage conditions or diseases affecting your loved one should be on staff and available. The following options for senior housing offer different types of amenities; some may be suitable for certain individuals and situations while others may not be. Investigating all options, even if nursing home care or hospice does not seem necessary at present, can help seniors and their families plan ahead for changes in the level of care required and benefit fully from each option. 

Retirement Communities

Retirement communities offer independent, private living for seniors with added amenities such as group activities and health care facilities located on-site. Retirement communities frequently offer different levels of assistance to residents, from housekeeping assistance to dining room meal plans. Seniors may live in apartments, small single-family homes, or larger group settings. Continuing care retirement communities, or CRCs, offer active seniors relief from housekeeping and yard duties associated with owning a home. CRCs can provide couples with different levels of care and a shared residential social outlet for both couples and singles. CRCs are designed to meet residents’ changing needs by providing increasing levels of care, both medical and non-medical. When choosing a CRC, potential residents should examine the breath of its medical and non-medical care offerings, its facilities and amenities, and make sure that the staff is equipped to handle their changing needs.

Assistive Technology & Home Modifications

Many seniors choose to “age in place” and stay in their own home. Home modifications and assistive devices can make this process safer and more comfortable for seniors. Simple modifications, such as installing bathtub or shower seats or benches and using higher wattage light bulbs to help those with limited vision, can help a loved one remain independent longer and avoid injury. If seniors have the time and financial ability to plan major modifications, such as adjusting counter heights and installing ramps or elevators, they can increase their comfort and the amount of time they can safely remain in their homes. Aging in place may be appropriate for an individual who has good general mobility and few serious medical problems. Modifications and assistive devices should be tailored to meet the needs of individual seniors and their caregivers.

  • Home Design: Home modification checklist to meet the changing needs of aging residents.
  • Universal Design: Information on universal design and how to incorporate it into home layouts.
  • Lighting: The importance of correct lighting for older adults, with information on how to choose and install various kinds of fixtures to minimize accidents and maximize comfort.
  • Assistive Devices: Searchable database provides information on assistive devices. Includes sections on environmental adaptations, housekeeping, and safety devices.

Housecleaning and Meal Services

For seniors who choose to remain in their own homes or move to adult communities that do not offer a full range of amenities and services, some extra help can increase their comfort. Cooking meals can take a great amount of time and effort for many seniors and housecleaning may exacerbate pain and medical conditions. There are services that can provide both cooked meals and housekeeping to alleviate stress and difficulty for seniors. Many of these services are provided by local companies, groups, or non-profits.

  • Meals on Wheels: Low-cost or free meals for seniors. Includes a local program directory.

Adult Day Care

Adult day care or adult day services can provide seniors with a social outlet that meets their care needs. Adult day care allows caregivers a respite to recharge and rest or to shop and do errands. Adult day care also allows caregivers to continue to work outside the home and to keep their loved one at home longer. For seniors who live at home with their families, their social circles may constrict as their mobility declines or their illness progresses. Adult day care allows them to interact with their peers and participate in different activities at the day care. Depending on the needs of the caregiver and the older adult, services can last from a few hours to a full day, a few days a week or every day.

Respite Care

Caring for a loved one is an intensive undertaking and respite care provides short breaks for caregivers to recharge from their caregiving duties. Caregivers who use respite services report improved help and decreased stress, which allows them to continue providing loving care to their family member. Respite care may be provided in the home by respite caregivers who come to the car receiver’s home or by a sitter-companion who provides a helping hand and conversation a few days a week. Specialized respite facilities may offer overnight or multi-day stays. Emergency respite services are available on short notice to care for an older adult in the home or at a specialized center. Respite caregivers and services should be able to provide the level of care required by the care receiver and be properly trained and licensed, if applicable.

  • Respite Care Checklist: A form to fill out and give to respite caregivers to detail the patient’s condition and needs.

Home Health Care

Home health care includes personal care services and medical services. Home health care is appropriate and often necessary for those with chronic illness and patients recovering from surgery. Home health care can supplement the personal care given by a family caregiver. Home health care services include professional nursing care, occupational therapy, respiratory and speech therapies, nutritional care, and other medical services. Physicians, nurses, physical therapists, social workers, speech language pathologists, occupational therapists, dietitians, home health aides, and volunteers provide different types of home health care. Home health care agencies should be properly licensed, accredited, and certified and should provide references of satisfied clients and doctors who have worked with the service. Ensure that the aide who will provide your loved one’s care is certified and trained to provide the exact type of care required and check his or her references.

  • Home Care: Information on home care services and how to evaluate them.
  • Hiring Home Care Professionals: Site includes an informational article on how to hire home healthcare professionals and information on how to find them.
  • Health Care at Home: A resource written by health professionals for caregivers caring for aging adults at home.

Assisted Care Living Facilities

Assisted care living facilities, or assisted living, may be an appropriate option for independent seniors who value a sense of home and privacy but who need 24-hour assistance and supervision. Assisted living facilities provide home-like accommodations, such as private rooms or apartments. Services include personal care services such as help with bathing or dressing, transportation, laundry services, and housekeeping. Many provide nursing care and some provide specialized Alzheimer’s or dementia care. Most facilities provide recreational and social activities on-site and organize trips to off-site events. Some assisted living facilities are located within continuing care retirement communities or nursing homes.

  • Assisted Living Questions: Overview of assisted living, a list of questions to ask when considering assisted living facilities, and a directory of facilities.

Nursing Homes

Nursing homes provide medical and personal care for patients whose conditions do not require hospitalization but are too complicated for home care. Nursing homes may be a long-term option for a loved one with a chronic illness or a short-term one for a patient recovering from surgery or an accident. Most nursing homes have nurses on staff 24 hours a day and some may have physicians. Some nursing homes have a hospital-like appearance and others appear more home-like. Nursing homes provide some social activities but these may be limited by the abilities of the patients at the home. Nursing homes provide occupational and physical therapy, respiratory and speech therapy, and may include special units for patients with Alzheimer’s or dementia. When evaluating a potential nursing home, consider the number of patients and beds, the type of accommodations available, such as shared or private rooms, and the characteristics of the residents, such as the percentage of long- and short-term patients. Other important considerations include the number of nursing staff and other caregivers, the type and frequency of social activities, and the home’s amenities, such as gardens, indoor gathering spaces, and patios.

  • Nursing Home Care: Tips to ensure quality care, how to find a nursing home, and tips for caregivers and patients on moving to a nursing home.

Hospice

Hospice provides care and counseling to patients whose illnesses cannot be cured, treated, or slowed. Hospice does not provide treatment for an illness or disease but instead focuses on palliative care, which seeks to relieve or sooth the patient’s symptoms and pain. Although many patients receive hospice care only in the final days or weeks of life, most hospices will accept patients whose doctors estimate they have up to six months to a year to live, if treatment is not given. Many patients choose hospice care when the aggressive treatment needed to slow their disease proves too burdensome and provides little perceived benefit. Hospice makes patients comfortable, allows them to enjoy their final months with friends and relatives, and helps them and their families come to terms with death and the dying process. Hospice usually allows patients to continue treatments that maintain or improve patient’s quality of life. Hospice care may be provided in a hospital, a free-standing hospice center, a nursing home, or other facility.

  • Hospice: Information on when hospice care starts, how to choose a hospice, and answers to frequently asked questions about hospice.
  • When to Seek Hospice Care: Information about hospice and palliative care, when to seek care, and what hospice can do for patients and their families.
  • Hospice Directory: A nation-wide directory of hospice facilities. Site also includes answers to frequently asked questions, information on choosing a hospice, and information for caregivers.