When Care At Home Is No Longer Possible

While you and other families provide 75 percent of long-term care in this country, at some point it may become impossible to provide care in the home. Necessary care may be too specialized, too expensive, or may be required 24 hours a day. For many families, moving a loved one to a residential care setting is the most difficult decision they will ever face.

Residential Care May Be The Right Decision If:
  •  The person has health needs that can’t be met at home.
  • The caregiver is emotionally and physically exhausted and family and community resources have already been tried.
  • The person can’t be safely cared for at home.
  • The caregiver’s safety is at risk.
  • Although the person you care for may not need residential care now, it’s smart to prepare for that possibility. It’s stressful to arrange for care during a crisis; you may find yourself with care you would not have chosen if you had more preparation time.

Key Points
  • Learn about all your options for residential care. This article describes many care settings in addition to nursing homes.
  • Plan ahead. Many homes have waiting lists.
  • Visiting a home doesn’t mean you have to choose or decide now. Putting your name on a waiting list isn’t an obligation either.
  • What Are Your Options For Residential Care?
No two individuals have the same needs.
The following section describes several types of residential care.
  • Adult Family Homes are residential homes licensed to care for up to six residents. They provide room, board, laundry, necessary supervision, assistance with activities of daily living, personal care, and social services. Some provide nursing care.
  • Assisted Living is a licensed boarding home that offers private apartments. This service emphasizes privacy, independence, and personal choice. Services include meals, personal care, medication assistance, limited supervision, organized activities, and limited nursing services.
  • Adult Residential Care facilities are licensed boarding homes. They provide room and board and help with medications and personal care. Residents may have limited supervision.
  • Enhanced Adult Residential Care also offers limited nursing care.
  • Nursing Homes provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, social services, room, board, and laundry.
How Will We Pay For Residential Care?
  • Private payment accounts for about one-half of all nursing home payments, and an even greater percentage of other types of residential care.
  • Medicare is a federally funded health insurance program for people 65 and older, and for some people under the age of 65 who are disabled.
  • When program requirements are met, Medicare will pay for a limited number of days in a skilled nursing facility (presently 100 days) and it covers only “reasonable and necessary” care.
  • Medicare does not cover custodial care (care that helps with activities of daily living) which is the majority of nursing home care. If a person requires long-term or custodial care, they will need to pay for it privately or through one of the other payment options listed below.

Medicaid is a state/federal program that pays for some long-term care services if you meet the program eligibility and financial need requirements. Eligibility rules are very complex and change frequently.
Veteran’s Benefits for residential care may be available if the person is a wartime veteran or surviving spouse (married at the time of the veteran’s death.)
Long-term care insurance policies are varied and some policies pay for nursing home services. Check your policy carefully to see what is covered.

How Will We Decide Which Home Is Best?
  • Whenever possible, involve the future resident in the decision-making process. The decision will take time and may seem overwhelming at first.
  • But after you narrow down the list to places that meet all your requirements, trust your feelings. If you feel comfortable and secure there, chances are the resident will, also.
  • Make a list of the care needed (meals prepared; laundry; bathing; help with medications, dressing, eating, or going to the bathroom).
  • Talk to other people. Ask friends, acquaintances and support group members about resources they know. Get referrals from professionals like social workers or members of the clergy.
  • Visit more than one type of facility.
When You Visit A Residential Care Setting
  • Include the future resident when you visit.
  • Visit more than once and visit at different times of the day. Try to schedule one visit at mealtime, perhaps another visit in the evening.
  • Visit on a weekday and on the weekend. Is there adequate staff? Are activities available at different times of the day? Are residents out of bed for most of the day?
  • Talk to residents and staff. Find out what they like about the home.
  • What concerns do they have?
  • Is the home clean and in good repair? Do residents have an outdoor area for recreation?
  • Are the daily schedules flexible or do all residents have to get up or eat at the same time?
  • Is the food appealing? Are snacks or specially requested foods available?
  • Ask to see a copy of the resident rights and the house policies.


Originally written and published by the Aging and Adult Services Administration Department of Social and Health Services, State of Washington. Reprinted with permission.

© Washington State Department of Social and Health Services

For more information on caregiving, visit: www.CaregiversLibrary.org

Michelle Nash
Legacy Care Home
14900 Crown Dr.
Minnetonka, MN 55345