Long term care comes in many forms, from in-home care, to hospice (short term) care, to retirement communities and beyond.  What level of care, and what type of facility meets both your short term and long term goals, needs careful assessment and choices before a crisis occurs, when the decision could put in the hands of your children or physician.

One of the most comprehensive options available is to find a community or facility that offers a continuum of care option.  These retirement communities cover a broad range of services and amenities, and vary greatly with what may or may not be available.

A facility with a full continuum of care option has three primary components:

• Independent living;
• Assisted living; and
• Full care.

Independent Living

The independent living component of these facilities either have rental apartments or condominiums on-premises, which are completely independent living, but offer a service package such as maid service, meal service, laundry service, etc.  Each facility will have different policies on which services are optional and which are mandatory, and generally offer an option to pay a flat monthly fee, or to get services “a la carte” from a selection.

This type of service should border on living in a hotel, with an in-house maintenance crew, concierge and package services, transportation services, and in larger facilities, on-site hair salons, barbers dry cleaning, et al.

In a full continuum of care facility, in-home medical assistance may also be available.

Assisted Living

As the name implies, in the assisted living component, the residents are receiving assistance with their day-to-day living, but under the supervision of trained medical personnel.  Meals in a common service area and maid service are generally included in a flat monthly fee, as well as for providing such services as monitoring medication, regular checks on blood pressure, heart rate, blood sugar, etc.  Some assistance with mobility issues are generally provided, such as helping with bathing and movement around the facility.

Each state monitors and regulates assisted living facilities as a medical facility to provide assurance that certain minimum certifications and supervision is being provided to the residents.

Full Care

A full care unit, or nursing care unit, is a licensed medical facility, with doctors and nurses on staff, as well as various support personnel such as licensed practical nurses and certified nurse’s assistants.

These facilities resemble hospitals in many instances, with either private or semi-private rooms.

Other Considerations

Long Term Care Insurance:  Many long term care facilities are covered under the provisions of long term care insurance, but a pre-determination of benefits should be made, and no assumption made about whether a particular facility will meet the requirements for the insurance company to provide payments to cover the costs.

Endowments:  Many long term care facilities, especially those with a full continuum of care option, will require an upfront endowment when a person or couple moves in to any segment of the community.  The endowment process should provide that the resident will receive preferred access, if not guaranteed access, to the various levels of care available in the facility.

Medicare:  Like long term care insurance, some portions of the care received at a long term care facility may be eligible for Medicare benefits.

Age Restriction:  Most long term care facilities, even independent living communities, will have a minimum age requirement before permitting someone to occupy the premises.  The owner of the facility may receive favorable tax treatment by restricting access to people over a certain minimum age (usually 55), or who have a physical condition that requires some assistance in their day-to-day living, regardless of age.