Care of Love One's
17. What is long-term care?
Whether the condition of patients is reversible or irreversible, both convalescence (gradual healing that occurs with curative care) or the provision of symptom care during the dying process often require long-term care. Such care cannot be provided in a hospital because of the high cost. Accordingly, long-term care is defined as the extended provision of health care and other forms of care to patients whose conditions require some form of care beyond hospitalization. Four of the major categories of long-term care are nursing home care, hospice care, home health care, and home care.32
Nursing home care operates at three levels, depending on the needs of patients. Patients who need twenty-four-hour attention receive skilled nursing care from a registered nurse under the supervision of a physician who is available in the event of an emergency. Patients whose care does not require round-the-clock monitoring receive intermediate nursing care. Finally, those who require only room and board and occasional personal care receive custodial care. This third group of patients generally do not require health-care services. Be sure to visit your local nursing home to see how it manages each of these levels of care and to determine the exact cost for each level.
Hospice care offers physicians, skilled nursing, and a variety of volunteer assistance to meet the needs of terminally ill patients, typically those whose death will likely occur within six months. This care takes place in specialized hospice facilities or at home. Hospice care considers the needs of the whole person: physical, mental, emotional, and spiritual. Federally certified hospices receive government funding. For further details, see question 29.
Home health care covers a wide variety of services offered at home, sometimes under a physician’s supervision. Nurses, physical therapists, and personal-care assistants work together to provide medical services and assistance with grooming and dressing—all in the comfort of the patient’s home. Costs are based on an hourly rate for personal-care assistants and per visit (one to two hours) for a registered nurse or a therapist. Check with Medicare to determine which medical services received at home qualify for financial aid.
Home care offers only nonmedical services in a home setting. These services include assistance in minor household maintenance as well as cleaning and yard work. The cost for these services is minimal (hourly rates) and includes materials. Local programs such as Meals on Wheels will provide food service once or twice a day directly to the home of patients. These meals can be delivered five days a week and are generally under $5 per meal. Other home-care programs include the services of volunteers who will visit patients at home, help them with errands around town, and assist them in writing letters. Local religious or volunteer groups often offer these services. Your community may have a telephone reassurance program run by volunteers who make or receive daily calls from elderly patients living alone. Finally, to protect your loved one, you may want to look into acquiring an emergency response system that is operated by telephone or by an electronic device.
Check with your physician about long-term care that may be available in your community. Check also with your pastor to learn if any churches in your community provide long-term care services. You can locate information for many of these services in the Yellow Pages or on the Community Services page in the front of your phone book. Patients don’t have to be alone. There are numerous local civic, religious, and government programs working to make life at its end humane, comfortable, and even enjoyable.
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32 For further information, contact the American Association of Retired Persons (AARP), Health Advocacy Services, 1909 K Street NW, Washington, D.C. 20049. A helpful guide from AARP is entitled, The Right Place at the Right Time: A Guide to Long-Term Choices.
[1]Stewart, Gary P. ; Cutrer, William R. ; Demy, Timothy J. ; O'Mathúna, Dónal P. ; Cunningham, Paige C. ; Kilner, John F. ; Bevington, Linda K.: Basic Questions on End of Life Decisions. Kregel Publications, 1998; 2004, S. 51