How to Plan for Long-Term Care

Long-term care planning is not only about choosing a nursing home. It means preparing for the possibility that a person may need ongoing help with personal care, household tasks, transportation, supervision, health-related support, or housing.

Services may be provided:

• At home
• In the community
• Through adult day services
• In assisted living
• In a nursing home
• Through a combination of family, paid, public, and nonprofit support

Planning early gives a person more opportunity to express preferences, compare costs, organize legal and financial information, and make changes to the home. It does not require predicting exactly what will happen.

Coverage warning: Medicare generally does not cover ongoing custodial long-term care. Coverage depends on the service, eligibility, setting, insurance, and state programs. Verify benefits through official sources.

What long-term care means

Long-term services and supports can include help with activities of daily living:

• Bathing
• Dressing
• Toileting
• Eating
• Walking
• Transferring between bed and chair

They can also include instrumental activities:

• Preparing meals
• Shopping
• Transportation
• Housekeeping
• Managing medication
• Managing money
• Using communication technology
• Scheduling appointments

The need may develop gradually because of chronic illness, mobility changes, sensory loss, or cognitive impairment. It may also begin suddenly after a stroke, fall, surgery, or hospitalization.

Start with goals, not facilities

Ask the person:

• Where do you want to live?
• What activities matter most?
• Who do you want involved in decisions?
• What help would you accept?
• What would make home unsafe?
• Which cultural, language, religious, food, or community preferences matter?
• How close should care be to family and friends?
• What tradeoffs are acceptable?

A plan should respect the person's preferences while also addressing realistic safety, health, caregiver, and financial constraints.

Assess the current situation

Health and function

Review:

• Mobility
• Falls
• Vision and hearing
• Memory
• Medication management
• Nutrition
• Continence
• Pain
• Sleep
• Ability to summon help
• Ability to remain alone safely
• Recent hospitalizations

A professional assessment may be helpful when needs are unclear.

Home environment

Check:

• Stairs
• Bathroom access
• Lighting
• Handrails
• Door width
• Floor hazards
• Kitchen safety
• Heating and cooling
• Emergency exits
• Distance to services
• Internet and phone reliability

Some changes are inexpensive; others require renovation or relocation.

Social support

Identify:

• Nearby family
• Friends
• Neighbors
• Faith community
• Senior center
• Transportation
• Meal programs
• Home care
• Adult day services
• Area Agency on Aging
• Emergency contacts

Do not build a plan that depends on one caregiver being available indefinitely.

Understand the service options

Community supports

These can include:

• Senior centers
• Transportation
• Congregate meals
• Home-delivered meals
• Benefits counseling
• Caregiver programs
• Friendly visiting
• Home modification assistance

These services may help someone remain independent but usually do not provide continuous personal care.

Home care

Paid caregivers may assist with personal care, meals, housekeeping, companionship, or transportation. Agency requirements and licensing vary.

Home health

Home health refers to skilled clinical services delivered at home when eligibility requirements are met. It is different from ongoing nonmedical home care.

Adult day services

Adult day programs provide daytime structure, supervision, meals, personal care, and sometimes health services.

Assisted living

Assisted living provides housing, meals, and help with daily activities. Services and pricing vary substantially.

Nursing homes

Nursing homes provide 24-hour nursing and extensive help with daily needs. They may also provide short-term rehabilitation.

Plan for changing needs

Use stages rather than one permanent solution.

Current plan

What support is needed now?

Trigger plan

What events would cause the plan to change?

Examples:

• Two falls
• Hospitalization
• Wandering
• Missed medication
• Weight loss
• Caregiver burnout
• Inability to transfer safely
• Loss of driving
• Increasing nighttime needs

Backup plan

Who steps in when a caregiver is ill, traveling, or unavailable?

Crisis plan

Where should important documents, medications, contacts, and preferences be found during an emergency?

Understand Medicare, Medicaid, and payment

Medicare

Medicare states that it generally does not cover ongoing long-term custodial care. It may cover limited skilled nursing facility care, home health, hospice, or other medically necessary services when specific requirements are met.

Medicaid

Medicaid is a major payer of long-term services and supports. Eligibility and available home- and community-based services differ by state.

Personal funds

People may use:

• Income
• Savings
• Retirement accounts
• Home equity
• Family contributions

Financial decisions involving a home, investments, gifts, trusts, or eligibility rules should be reviewed with qualified professionals.

Long-term care insurance

Policies vary widely in:

• Covered settings
• Benefit amount
• Waiting period
• Duration
• Inflation protection
• Exclusions
• Eligibility triggers

Review the actual policy, not a general description.

Veterans' programs

Eligible veterans and families may have access to certain benefits. Confirm eligibility through the Department of Veterans Affairs or an accredited representative.

Estimate the full cost

Include more than the advertised monthly or hourly rate.

Possible costs:

• Base fee
• Care-level fee
• Medication management
• Transportation
• Supplies
• Meals
• Incontinence care
• Nighttime care
• Home modifications
• Agency minimum hours
• Move-in fee
• Community fee
• Laundry
• Personal items
• Insurance premiums
• Legal and financial planning
• Unpaid caregiver time

Ask how often rates change and what circumstances trigger higher fees.

Organize legal and decision documents

Depending on state law and personal needs, discuss:

• Advance directive
• Healthcare proxy
• Durable financial power of attorney
• Will
• Trust
• Beneficiary designations
• Property documents
• Digital account access
• Funeral or burial preferences

Use a qualified attorney for legal advice. Forms and terminology differ by state.

The person should participate while able. Documents should not be used to remove control unnecessarily.

Make a caregiver plan

Caregiving can involve:

• Personal care
• Transportation
• Medication support
• Appointments
• Meal preparation
• Financial tasks
• Nighttime supervision
• Emotional support
• Coordination among providers

Write down:

• Who is responsible
• How often
• What training is needed
• What the caregiver cannot do
• How expenses are handled
• What respite is available
• What happens in an emergency

Caregiver burnout can make an otherwise workable plan unsafe.

Review housing choices

Remaining at home

Consider:

• Accessibility
• Maintenance
• Transportation
• Cost of paid help
• Safety
• Social connection
• Availability of caregivers

Moving closer to support

A move may improve access to family, services, transportation, or healthcare but can disrupt community ties.

Independent or assisted living

Review contracts, fees, care limits, discharge rules, and the process for changing levels of care.

Nursing home

Use when 24-hour nursing or extensive support is required. Compare official inspection, staffing, and quality information as well as the person's specific needs.

Avoid crisis-driven decisions

Planning can reduce pressure, but not every crisis is preventable.

Prepare:

• A current medication list
• Insurance information
• Emergency contacts
• Preferred hospital
• Healthcare proxy
• Provider list
• Home-care information
• Short list of possible facilities
• Pet-care plan
• Transportation plan

Questions for professionals

Healthcare professional

• What changes are likely?
• What support is needed now?
• What warning signs matter?
• Is rehabilitation possible?
• Is a functional assessment appropriate?

Care provider

• What services are included?
• What cannot be provided?
• How are staff trained?
• What happens after hours?
• How are concerns reported?
• How do fees change?

Financial professional

• What costs are sustainable?
• How should assets be organized?
• What insurance benefits exist?
• What tax consequences may apply?

Attorney

• Which documents are needed?
• Who should have authority?
• How can preferences be protected?
• How do state rules affect planning?

Review the plan regularly

Review after:

• Hospitalization
• Fall
• Diagnosis
• Death of a caregiver
• Move
• Major financial change
• Medication problem
• Driving change
• Noticeable functional decline

Even without a major event, review annually.

Frequently asked questions

When should long-term care planning begin?

Before a crisis. Planning can begin at any adult age and become more detailed as circumstances change.

Does planning mean someone must leave home?

No. Many long-term services are provided at home or in the community.

Does Medicare pay for assisted living?

Medicare generally does not pay the residential and custodial costs of assisted living.

Can Medicaid pay for care at home?

State Medicaid programs may cover eligible home- and community-based services, but rules and availability differ.

Is family care free?

Unpaid caregiving has real time, income, health, and opportunity costs. Include these in the plan.

Where can I find local help?

The Eldercare Locator connects people with local aging services and Area Agencies on Aging.

Suggested internal links

• /resources/different-options-for-senior-care
• /resources/tips-on-choosing-the-best-nursing-home
• /senior-centers

Sources

• Administration for Community Living — Long-Term Care Planning
• Administration for Community Living — Long-Term Care Pathfinder
• Medicare — Long-Term Care Coverage
• Medicaid — Long-Term Services and Supports
• Medicaid — Home and Community-Based Services
• Eldercare Locator

This article provides general information and is not medical, legal, financial, insurance, tax, Medicaid, or Medicare eligibility advice.