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Help in Your Home When You Need It

Long-term care in the home may include both medical and nonmedical services.

Nonmedical care

Nonmedical personal assistance in the home may include:

• Help with bathing and dressing
• Help with using the bathroom
• Help with household chores, such as meal preparation, cleaning and dusting, washing dishes, and doing laundry
• Help with simple errands, such as grocery shopping

These services are usually offered by home-care agencies in the community. Normally, the person requiring care (or the person's family) pays directly for these services. However, long-term care insurance policies often cover these types of services. It is important to note that long-tem care insurance is different from health insurance and must be purchased separately.

Medical care

Medical care services provided in the home may include:

• Professional nursing services, such as wound care, feeding tube and IV line management, medication management, medical equipment management, and other services
• Physical therapy services, which may include strengthening and balancing exercises after a stroke or surgery
• Occupational therapy services, such as helping a person relearn to perform basic self-care tasks (such as teeth brushing or meal preparation), recommending adaptive equipment (such as a walker or bathroom grab bars), helping a person learn to use adaptive equipment, and helping to arrange the living space to minimize the risk of falls
• Social work services, which may include helping to connect a person's family with appropriate community resources and teaching family members how to care for their loved one

These services are normally ordered by a doctor and are often short-term, depending on the person's needs and how much they may be able to recover from an illness or injury.

Usually, these types of services are covered by Medicare, Kaiser Permanente, or other insurance, with certain limitations.

Living Arrangements

There are several types of living arrangements available that provide varying degrees of long-term care. These include:

• Assisted living facilities offer apartment living where a person can remain as independent as possible while receiving assistance with meals, housekeeping, and transportation. Some facilities also provide recreational programs and social events. Assisted living may or may not include nursing or other medical services.
• Board and care homes, also called residential care facilities (RCFs) or group homes, are small private homes, usually with 10 or fewer residents. Board and care homes are designed for people who can no longer live alone but want to retain some independence. Rooms may be private or shared. Residents receive meals, companionship, and help with daily tasks. Staff is on call around the clock. However, no skilled nursing is provided.
• Continuing care retirement communities (CCRCs), also called life care communities, offer several levels of care in one location. A CCRC may include independent housing for people who need little or no care, assisted living for those who require some help, and a nursing facility for residents who need continual care, all on one campus. People who become unable to live independently can move to the assisted living area or receive home care in their independent living unit. When necessary, residents can enter the onsite nursing facility. Fee arrangements vary. There is normally a monthly fee, and there may also be an entrance fee.
• Adult day service (ADS) programs are designed to meet the needs of adults with cognitive or functional impairments, as well as adults who need social interaction and a place to go when their family caregivers are at work. These programs provide a variety of health, social, and other support services in a protective setting during part of the day. Adult day centers typically operate programs during normal business hours 5 days a week, and some have evening and weekend hours. These programs do not provide 24-hour care.
• Skilled nursing facilities provide extensive rehabilitative medical care, including medication management, physician care, physical and occupational therapy, and other services.
• Nursing homes provide medical and personal care for people who cannot manage by themselves at home but do not require hospitalization. Medical services include medication management, physical therapy, occupational therapy, speech therapy, and other treatments. Personal services include help with getting in and out of bed, eating meals, and getting dressed. There may be a nurse's station on each floor. Some nursing homes have a more homelike feel with no fixed daily schedule and with kitchens that are open to residents.
  

Palliative Care

The purpose of palliative care is to relieve the pain and discomfort of advanced life-limiting illness such as cancer, heart failure, or emphysema.

Palliative care at Kaiser Permanente is provided by a team dedicated to ensuring that you have the highest possible quality of life, according to your values and your wishes. If you are receiving medical treatment for a serious illness, that care will continue. Our palliative care team works together with the medical team and with your family to relieve symptoms such as pain, constipation, nausea, loss of appetite, respiratory problems, and fatigue.

Palliative care providers may also ask about how you are feeling emotionally and discuss medical and palliative treatment options with you. They will help you to understand your illness so that you can make clear and informed decisions about your treatment.

Ask your physician about how you might benefit from palliative care.

Hospice Care

Hospice care is designed for people in the final stages of a terminal illness. Treatment is focused on relieving symptoms, helping a person to be physically comfortable, and providing emotional and spiritual support.

Hospice care allows a person to remain at home or in another personal, comfortable setting that they and their family may choose, such as a relative's home, during their last days of life. 

Hospice care also helps to support caregivers and families, with bereavement counseling and other services.

Hospice at Kaiser Permanente

Kaiser Permanente's Hospice Program is a Medicare-certified program providing end-of-life and palliative care services to Kaiser Permanente members and their families. Services include physician treatment, nursing, social work, and chaplain consultation.

Admission to the Hospice Program requires written certification from the attending physician and a medical director of hospice or physician member of the hospice interdisciplinary team.

Long-term Care Insurance

Long-term care is generally not covered by Medicare or Kaiser Permanente. If you have limited resources, you may qualify for Medicaid (also known as Medi-Cal in California) to pay for your care. 

To find out if you are eligible to receive Medi-Cal, contact a financial counselor at your medical center or at your local office of the California Department of Social Services.

Other ways to pay for long-term care include:

• Long-term care insurance can be purchased from private insurance companies. Insurance premiums vary depending on your age, health status (generally, you must be in good health to qualify for long-term care insurance), and the level of coverage you desire. Benefits can include home care services as well residential care in an assisted living or other type of facility. Policies specify either a benefit period of a certain number of years or a lifetime maximum benefit.
• Reverse mortgages are special types of home loans that allow homeowners to exchange equity in their homes for cash, usually paid out in monthly installments.
• Charitable remainder trusts allow you to use income from property or other assets for your long-term care, while reducing your taxes. With a charitable remainder trust, you donate property to a charity but continue to receive income from that property (or other income-generating asset) as long as you live, while avoiding capital gains taxes on the donated property.
• Medicaid disability trusts are trusts that may be established by a parent, grandparent, or legal guardian on behalf of a disabled person under the age of 65. Medicaid disability trusts are not a government program. There are different types of Medicaid disability trusts, with different rules that can be somewhat complex. In some cases, Medicaid disability trusts are pooled together and managed by nonprofit organizations.
• An accelerated death benefit (ADB), which is a benefit that can be attached to a life insurance policy, provides cash advances against the death benefit if the policyholder develops a terminal illness. The purpose of an ADB is to help pay for nursing home care or other treatment.
• Viatical settlement involves the sale of your life insurance policy to a third party, for (usually) 50 to 80 percent of the policy's full face value. The advantage of a viatical settlement is that you can obtain money immediately to help pay for your care. The disadvantage is that your life insurance policy will not benefit your family or other loved ones after you die.

These and other long-term care financing options should always be discussed with insurance, tax, and eldercare specialists.

The Partnership for Long-Term Care, an organizational alliance between Medicaid and long-term care insurers, provides alternatives to spending down or transferring assets and is currently available in New York, California, Indiana, and Connecticut.

The Federal Long-Term Care Insurance Program (FLTCIP) provides opportunities to buy long-term care insurance at a group rate for federal and U.S. Postal Service employees as well as current and retired members of the Uniformed Armed Services. These policies can include spouses and other qualified relatives.

The Department of Veterans Affairs (VA) provides some long-term care for eligible veterans. In lieu of home care, the VA's Housebound and Aid and Attendance Allowance Program provides cash grants to disabled veterans and/or to their surviving spouses.