When Your Loved One Needs Skilled Care
While, as discussed earlier, you may gradually notice changes in your loved one that lead to the need for long-term care, in other instances the need may arise without warning. Sometimes a sudden event, such as a hip fracture or stroke, will lead to the need for long-term care for an individual who had previously been independent. Sometimes the worsening of an existing medical condition, such as heart disease or diabetes, will result in the need for long-term care, where previously the individual required no assistance.

In each instance, a loved one may first require "skilled care," which is care delivered by professional staff, such as nurses and therapists. Often a hospital stay followed by a period of rehabilitation or treatment in a short-term rehabilitation facility or nursing home is needed to treat and stabilize the medical condition or injury. For some, rehabilitation may take place at home. Medicare or other insurance may cover care for rehabilitation either at home or in a nursing facility. Services might include nursing care, therapy services and home health aide services as long as the person meets Medicare criteria for receiving skilled care. A referral for these services would likely be to a Medicare certified home health care agency or skilled nursing facility.

When Your Loved One Needs Long-Term Care
Some individuals will return to independent living following a period of rehabilitation or treatment, but some will continue to need care with daily activities on an ongoing basis. This long-term care, often referred to as "custodial care" may be provided in one’s home or at another location. Whether the need for custodial care arises gradually or suddenly following an episode of skilled care, the goal is to help the person remain as independent as possible with the help of supportive services. These may include help with the activities of daily living (ADLs) such as bathing, dressing, and toileting and/or assistance with what are called instrumental activities of daily living (IADLs) such as shopping, transportation, laundry and finances. These services may be provided by family members—who may require training for certain activities such as assistance with getting someone in and out of bed following a stroke—or by paid caregivers.

Decisions will need to be made based on family preferences and availability, the financial situation, and the amount and type of care needed. You will have to look at the costs for custodial care services and determine how they will be covered. Costs will vary depending upon the type of care your family member requires. Some agencies may have a sliding fee schedule or there may be other resources in the community that would be available to provide some services. Medicare as well as most health insurance policies do not cover long-term care services.

It is important to understand that some individuals who need long-term custodial care may also need some skilled services on an ongoing basis. Others may need skilled care intermittently to treat an illness or injury. Their long-term care needs will continue to need to be addressed and perhaps re-evaluated following episodes of skilled care, as needs may have changed.

Needs may also gradually change over time and the care plan will need to be adjusted to meet changing needs. Sometimes care providers who had been assisting may no longer be available. If your loved one’s need for care increases, you could find that informal caregivers are no longer able to meet all the care requirements. In this situation, you may need to increase the amount of service given by paid care providers. Or you may find that your loved one’s needs may best be met in another location such as your home, an assisted living facility or a nursing home.

The various types of long-term care services and resources to help you locate needed care are described in this brochure. The information looks at what could be called a "continuum" of long-term care services which are available based on the needs of the individual requiring the care. It provides options to consider as your loved one’s needs change over time.