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Planning for the Long Term Starts with You

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Long-term care is different for each individual and ideally should be tailored to a person's needs and preferences. Long-term care does not start with a place or a payment mechanism or a set of services; it starts with a person.

  • Many conventional definitions, however, start with a different focus — what services are included, who provides them, where they are provided, and, most important, who pays (or won't pay) the bill. These factors are obviously important, but they should not overshadow the person at its center.

  • In addition to being person-centered, planning should start early — at a point when various options for living at home or in a community can be arranged that prolong independence and make it less likely that institutional care will be needed.

  • From that perspective, modifying your home to make it safer and more accessible is part of a long-term care plan. So is considering the possibility of multigenerational living and various forms of group residence in the community.

  • Then you will want to take up the important issue of paying for care. Coordinating one's healthcare needs with other kinds of assistance is a critical element because staying healthy is a good way to avoid the need for heavy-duty long-term care.

  • Finally, look at the special issues you may face if you're part of a specific group, such as family caregivers or veterans of military service. Specifically, analyze common myths about aging and long-term care and one on using websites with state-by-state information, valuable because so much of long-term care is determined by state, not federal policies.

What Is Long-Term Care?

Defining long-term care is, perhaps surprisingly, not straightforward. Many people in the field of aging consider long-term care to be services that are nonmedical, such as personal care (bathing, dressing, feeding) or household tasks (shopping, cooking, transportation).

Although these aspects of assistance are essential, take a broader view to include factors like medical care, housing options, financial considerations, advance care planning, and the community environment. When considering long-term care, most people should look at the whole spectrum of need rather than only specific segments.

How many people need long-term care?

In its 2013 overview of long-term care service providers, the National Center for Health Statistics found that about 58,500 providers served about 8 million people in the United States. These included 4,800 adult day services, 12,200 home health agencies, 3,700 hospices, 15,700 nursing homes, and 22,200 assisted living and other residential care communities.

The majority in four of these five sectors were for-profit organizations. Only adult day services were mostly nonprofit. While these numbers may seem large, they do not include the family caregivers who provide unpaid care to the vast majority of older adults who need long-term assistance.

Long-term care includes the various kinds of assistance a person needs to maintain the highest possible level of health and quality of life over time. As the population ages and increasingly more people face chronic illnesses, which often diminish the ability to function independently, long-term care needs to encompass and integrate a broader range of services to meet complex needs.

Some aspects of planning concern immediate or foreseeable needs, for example, for a person with chronic illnesses or disabilities. Other aspects might fall under the heading of long-range planning, for example, considering long-term care insurance or establishing a regular savings plan. Some aspects of planning, such as preparing a will and advance directive, should be done by everyone, even those in excellent health.

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