Comprehensive Overview Of Senior Care

Senior care is a broad term used to describe a variety of specialized services and supports designed to assist elderly individuals (usually defined as those aged 65 and older) with their medical and non-medical care needs. This comprehensive guide will provide an overview of the various short- and long-term care options available to seniors and their families and help guide you through the process of determining which type(s) of care may be most appropriate for your family member.

Care requirements and preferences vary greatly from person to person and the type of care that is appropriate for each individual will depend on a number of factors. In addition, it is not uncommon for a senior’s care needs to increase or evolve over time as they age or as family circumstances change. Therefore, it is possible for elderly individuals to require different levels and types of care at different stages throughout the aging process.

Most families are eventually faced with determining how best to care for an aging family member. The U.S. Department of Health and Human Services (HHS) estimates that more than half of all U.S. residents over the age of 65 will require some form of long-term care at some point in their lives. Senior care options range from basic in-home senior care assistance with daily chores and activities to round-the-clock skilled nursing for those with more serious and/or unstable medical conditions.

Receiving Care At Home

A recent study conducted by the American Association of Retired Persons (AARP) revealed that approximately 90% of people aged 65 and above would prefer to continue living in their current homes as they age. This process is often referred to as aging in place.

In-home senior care allows older adults who require medical care and/or assistance with activities of daily living (ADLs) such as eating, dressing, bathing, mobilizing, and toileting to receive the care they need in the comfort of their own home. There are a wide variety of services available to elderly individuals who wish to age in place and receive care in their homes.

To begin with, there are 2 main categories of senior home care: custodial care and home health care.

Custodial Care

Custodial care is a form of non-skilled care designed to help those who are able to continue living in their homes and who require assistance with ADLs. This type of home care is best suited to senior citizens who do not have significant medical care needs or those who are receiving their medical care at a hospital, clinic, or doctor’s office on an outpatient basis.

The services provided through custodial care are often customizable and providers will generally work with seniors and their families to develop a care plan that meets their unique needs and preferences.

Providers of in-home long-term care typically staff a variety of qualified, trained professionals. However, since this type of home care does not include specialized medical services or treatments, caregivers are not usually medically licensed. In-home long-term care providers offer some combination of the following non-medical services:

  • Assistance with the ADLs such as eating, dressing, bathing, and toileting
  • Meal preparation
  • Transportation to and from appointments
  • Assistance scheduling appointments
  • Shopping
  • Laundry
  • Light housekeeping services
  • Medication management
  • Companionship and socialization

For elderly or disabled individuals who require any of the above services, in-home long-term care may be a good option. Seniors who are currently living alone may require assistance on a daily basis while those living with a spouse, child, family member, or other caregiver may only require short, periodic visits.

To learn more about in-home long-term care and how to pay for these services, please see our comprehensive overview of home care.

Home Health Care

Like custodial care, home health care allows seniors to receive the care and assistance they need while continuing to live in their own home. However, Home health care requires an order from a doctor and includes medical services and equipment. In many cases, seniors who require home health care also receive assistance with non-medical tasks like ADLs.

Home health care may include skilled nursing and home health aide services and is best-suited to elderly individuals with shorter-term medical needs such as those recovering from an illness or injury, those with chronic medical conditions, and those suffering from terminal illnesses who wish to receive care in their home.

Home health care providers offer a variety of treatments and services that may include:

  • Wound care
  • Patient and caregiver education
  • Injections and intravenous (IV) therapy
  • Health monitoring
  • Pain management
  • Post-surgery care
  • Speech, physical, and/or occupational therapy
  • Mobility training

To learn more about home health care and how to pay for these services, please see our comprehensive overview of home health care.

Adult Day Care

Adult day care is another senior care service available to elderly individuals who are able to continue living in their own home but require assistance or supervision during the day. Adult day care differs from home care in that it is delivered at an adult day care facility rather than in the senior’s home.

Adult day care centers are usually open during regular business hours although some providers also offer evening and weekend hours. Adult day care tends to be more affordable than home care.

Adult day care may be well-suited to seniors who live with a spouse, family member, or other primary caregiver but need care or assistance during the day or when their usual caregiver is unavailable to assist them. Adult day care may also serve as a form of respite care when an individual’s usual caregiver requires a break from caregiving.

As is the case with many types of senior care, adult day care providers differ in the levels of care and services they provide. According to the HHS, there are three general categories of adult day care, each of which serves a particular population of seniors:

  • Social adult day care – offers opportunities for socialization and recreation for seniors who are relatively independent and are still able to perform ADLs with minimal assistance.
  • Adult day health care (ADHC) – typically provides social and recreational opportunities similar to those offered at social adult day care but also provides assistance with ADLs and can accommodate seniors with serious medical conditions.
  • Alzheimer’s and dementia adult day care – specifically designed to address the unique needs of those suffering from Alzheimer’s disease and other forms of dementia.

All three types of adult day care centers typically provide meals, social and recreational opportunities, and medication management or reminders. Some providers also offer physical, occupational, and/or speech therapy, transportation to and from the facility, and scheduled group outings.

To learn more about adult day care and how to pay for these services, please see our comprehensive overview of adult day care.

Residential Long-Term Care Options

As noted earlier, studies indicate that a majority of seniors would prefer to continue living in their own home or in the home of a family member as they age. For some, however, this is not an option due to the nature of their physical, cognitive, or medical needs or due to other circumstances. In addition, some elderly individuals prefer to reside in senior living communities for the social and/or recreational opportunities they provide.

There are a wide variety of residential long-term care options that provide seniors with the assistance, support, and care they need. In 2014, the Centers for Disease Control and Prevention (CDC) estimated that there were approximately 835,200 senior living in residential long-term care communities in the U.S.

Residential long-term care facilities vary greatly from community to community and many facilities offer multiple levels of care and can accommodate seniors with a variety of care needs. There are residential communities tailored to:

  • Relatively independent seniors who wish to live in low-maintenance housing
  • Individuals who require various levels of assistance with ADLs
  • Individuals who require specialized medical services or care specifically designed to meet the needs of seniors suffering from Alzheimer’s disease or other forms of dementia.

Long-term care communities typically work closely with elderly individuals and their families to design customized care plans to meet the specific needs and preferences of each individual resident.

There are five main categories of residential long-term care: independent living communities, assisted living facilities (ALFs), continuing care retirement communities (CCRCs), memory care, and nursing homes.

Independent Living Communities

Of all the residential long-term elder care options, independent living communities are typically the least expensive and offer primarily social, recreational, and convenience-oriented services and amenities.

Many large facilities offering multiple levels of care usually offer independent living options. These types of communities may be a good option for seniors whose care needs are likely to increase over time. Independent living communities may also be stand-alone single-family home developments, condominiums, cottages, or apartments.

Because independent living communities provide fewer medical and non-medical care services than other forms of residential long-term care, the independent living model of care is designed for senior citizens who are still relatively mobile, healthy, and able to complete their ADLs with minimal or no assistance but wish to live in a senior community.

The services and amenities offered by independent living providers vary but most communities offer some combination of the following:

To learn more about independent living and how to pay for this type of long-term care, please see our comprehensive overview of independent living.

Assisted Living Facilities

Assisted living is similar to independent living in that it allows residents to maintain some level of privacy and independence while living among their peers and engaging in social and recreational opportunities. However, ALFs offer additional services and can accommodate seniors who require assistance with ADLs such as dressing, eating, bathing, and toileting. Some ALFs also offer health services on site.

Since ALFs generally have higher staff-to-resident ratios and staff members regularly interact with residents to assist them with their needs, assisted living apartments are often part of larger elder care facilities—those offering multiple levels of care—although assisted living services may also be offered by adult care/foster homes and other smaller senior care providers.

Like independent living providers, assisted living communities vary in the nature and scope of the services and amenities they provide. Assisted living providers will also typically work with residents and their families to develop customized care plans specifically tailored to meet their needs. Most assisted living communities to provide some combination of the following services and amenities:

  • Assistance with ADLs such as eating, bathing, toileting, and mobilizing
  • Medication management
  • Appointment management and transportation
  • Physical, occupational, and/or speech therapy
  • Added security
  • Housekeeping and laundry services
  • Three meals daily and snacks in-between meals (in a dining room or in the resident’s unit)
  • Access to emergency services
  • Organized social and recreational activities
  • Library, barber shop/salon/spa, communal areas, etc.
  • Individual or family counseling

To learn more about assisted living and how to pay for this type of long-term care, please see our comprehensive overview of assisted living.

Continuing Care Retirement Communities (CCRCs)

Although some seniors only ever require one level of care, many elderly individuals find that their needs increase or change over time. Due to changing personal and medical needs, many seniors are eventually faced with having to move to a new community, sometimes more than once.

Continuing care retirement communities (CCRCs) provide a tiered or layered approach to residential long-term care by offering more than one level of care, typically on the same site. These kinds of communities differ in terms of the specific services they offer at each level of care but generally include independent living houses, cottages, condominiums, or apartments, assisted living apartments or rooms, and nursing home or skilled nursing home care. Additionally, some CCRCs also have a designated memory care unit for seniors suffering from dementia and other cognitive impairments.

CCRCs allow residents to move from one level of care to another as their needs increase over time and with age. It is common for residents to enter these communities when they are still relatively mobile and healthy and move from independent living to assisted living, nursing home care, or memory care over time. In this way, CCRCs allow seniors the opportunity to “age in place” and remain in the same location for the rest of their lives. Therefore, CCRCs may be a good option for those who wish to plan their retirement and prepare for potential changes in their care needs ahead of time while avoiding unnecessary moves in the future.

Administrators at CCRCs may also keep copies of residents’ living wills and power of attorney documents so they are able to follow the particular wishes of residents should a time come when they are unable to make their own medical decisions. CCRCs tend to be the most expensive form of long-term care and usually require substantial entry fees in addition to monthly payments.

The particular services and amenities offered at CCRCs vary greatly and services also vary within a CCRC at different levels of care. Generally, the services offered at each level of care are similar to those at stand-alone facilities. For example, the services offered at a nursing home in a CCRC are likely to resemble those offered at a stand-alone nursing home facility.

Providers at CCRCs also tend to work closely with each resident and their family to develop a customized care plan designed to meet the unique needs of the individual and these care plans are typically reassessed and updated periodically to accommodate changing needs and preferences.

To learn more about CCRCs and how to pay for this type of long-term care, please see our comprehensive overview of CCRCs.

Memory Care

Memory care is a form of residential long-term care designed to meet the particular needs of elderly individuals who suffer from Alzheimer’s disease and other forms of dementia or cognitive impairment. Dementia is a broad term used to describe a decline in cognitive functioning and Alzheimer’s disease is the most common form of dementia. Symptoms of dementia vary greatly from patient to patient and tend to worsen over time and with age but often include some combination of the following:

  • Memory loss
  • Difficulty with speech and verbal communication
  • Problems with concentration and attention
  • Social and behavioral changes
  • Difficulty with reasoning and judgement
  • Problems with visual perception

Memory care facilities may operate as stand-alone communities or may exist as units within larger ALFs or CCRCs and usually provide additional security and higher staff-to resident ratios than other forms of residential long-term care.

Seniors suffering from dementia typically require specialized care and benefit from increased social interaction and recreational activity, smaller units, and familiar staff members. This kind of specialized care tends to be more expensive than assisted living and may be a good option for seniors who require 24-hour supervision, one-on-one assistance specifically designed to accommodate those with dementia, and additional security.

The particular services and amenities offered by memory care providers vary significantly. In addition, memory care units within larger ALFs are likely to differ from smaller, stand-alone memory care facilities in that residents from other levels of care within the community (such as those in independent or assisted living) are sometimes able to be slowly introduced to memory care services prior to becoming a memory care resident. Most memory care providers will also work with individuals and their families to develop and periodically update customized care plans. Most memory care facilities provide some combination of the following services and amenities:

  • Assistance with the ADLs such as eating, bathing, toileting, and mobilizing
  • Added security (passcode or lock-and-key) to limit wandering and prevent residents from getting lost
  • 24-hour supervision
  • Medication management
  • Appointment management and transportation to and from appointments
  • Emergency call buttons
  • Three meals daily and snacks between meals (in a dining room or in the resident’s room)
  • Access to emergency services
  • Organized social and recreational activities
  • Housekeeping and laundry services
  • Scheduled outings and activities (families are often welcome)

To learn more about memory care and how to pay for this type of long-term care, please see our comprehensive overview of memory care.

Nursing Homes

Nursing homes are residential long-term care facilities that provide custodial and personal care as well as some basic health care services to seniors who cannot perform ADLs independently and who may have additional needs beyond what can be provided for at an ALF.

Unlike many other forms of residential long-term care, nursing homes typically have skilled nurses and nursing aides on staff 24 hours a day and are able to provide medical monitoring and administer some medical care and treatments.

It is worth noting that, although the terms “nursing home” and “skilled nursing facility” (SNF) are often used interchangeably, they are not the same thing. Nursing homes are designed to provide ongoing care to long-term residents while SNFs are most often used as short-term solutions for those recovering from an injury or following hospitalization.

As with other forms of senior care, nursing homes differ greatly in the services they provide, however, most provide some combination of the following:

  • Assistance with ADLs such as eating, dressing, bathing, toileting, and transferring
  • Skilled nursing
  • Incontinence care
  • Physical, occupational, and/or speech therapy
  • Three meals daily and snacks in-between meals
  • Medication management
  • Access to emergency services
  • Dietary and nutritional counseling
  • Emergency call buttons

In addition, some nursing homes have specialized care units specifically designed for residents suffering from Alzheimer’s disease and other forms of dementia.

As with other forms of long-term senior care, nursing homes will work with residents and their families (as well as residents’ physicians when appropriate) to develop customized care plans specifically designed to meet the individual care needs of each resident.

To learn more about nursing homes and how to pay for this type of long-term care, please see our comprehensive overview of nursing homes.

Skilled Nursing Facilities And Rehabilitation Centers

SNFs provide many of the same services as nursing homes; however, SNFs and rehabilitation centers offer these services for a limited period of time usually following an injury, surgery, or a medical event such as a stroke or heart attack.

In many cases, patients are referred to a SNF or rehabilitation center following a hospital stay. In such cases, the referring physician may be involved in developing the patient’s customized treatment/care plan. In other cases, the patient’s primary care physician or specialist or a physician at the SNF will oversee their care.

Like nursing homes, SNFs provide custodial care and assistance with the ADLs in conjunction with nursing services and medical treatments. However, the goal of SNFs is to improve the patient’s condition so they can return home or to a long-term care facility.

The services provided by SNFs and rehabilitation centers differ greatly and the services and treatments are usually patient-specific. The following is a list of services and treatments offered by many SNFs and rehabilitation centers:

  • Physical, occupational, and/or speech therapy
  • Visits from onsite specialists or transportation to and from appointments
  • Dietary and nutritional counseling
  • Wound care
  • Medication management
  • Skilled nursing care
  • Specialized medical equipment and supplies
  • Three meals daily and snacks in-between meals
  • Pain management
  • Emergency call buttons
  • Assistance with the ADLs such as eating, bathing, toileting, and mobilizing
  • Education, healing, and healthy lifestyle programs

To learn more about SNFs and how to pay for this type care, please see our comprehensive overview of the difference between nursing homes and SNFs.

Respite Care

As previously discussed, most elderly and disabled individuals who require daily living assistance prefer to continue to live at home with a spouse, child, or other family member who can act as their primary caregiver. Caring for an elderly individual typically requires a great deal of time and effort, particularly if 24-hour around-the-clock care supervision or substantial assistance with the ADLs are necessary.

Even the most devoted caregiver needs a break from time to time, and in most cases, there are other times that caregivers cannot provide assistance to the individual due to other obligations. Respite care allows those who require assistance to continue to receive care for a short period of time while their primary caregiver takes a break. Respite care is designed to provide temporary assistance for those who require supervision, care, and/or assistance.

Respite care is generally used on a short-term, temporary basis and services may be delivered in the home or in a facility such as an adult day care center, an ALF, or an adult foster care home. Most commonly, those who use respite care live with a spouse or family member who acts as their primary caregiver most of the time, therefore, respite care may last anywhere from a few hours to a few weeks, depending on the needs of the caregiver and the individual requiring care.

Respite care services vary greatly depending on the needs and preferences of the elderly or disabled individual, the needs of their family member or other caregiver, whether the care is delivered in-home or at an adult day care center or other facility, and the frequency and duration of respite care visits. In addition to standard respite care services, there are providers who deliver respite care specifically for those suffering from Alzheimer’s disease and other forms of dementia or cognitive impairment.

Respite care providers offer some combination of the following services:

  • Assistance with the ADLs such as eating, bathing, dressing, toileting, and mobilizing
  • Medication management
  • Companionship and socialization
  • Recreational and/or social activities and outings
  • Help with housekeeping and laundry
  • Transportation to and from social or recreational engagements or appointments
  • Assistance with wound care, recovering from surgery, etc.

To learn more about respite care and how to pay for this type care, please see our comprehensive overview of respite care.

Hospice And Palliative Care

Hospice care is a non-curative form of care that focuses on caring for patients nearing the end of their lives to help make them as comfortable as possible rather than attempting to cure their condition.

Hospice care is typically provided to those with a life expectancy of 6 months or less. The primary purpose of hospice care is to help patients pass away with dignity while reducing discomfort, pain, fear, and stress during the process. Hospice care also focuses on providing grief and loss counseling and guidance to the patient’s family members during this difficult time.

While hospice care is designed to provide services to those who are no longer being treated using curative methods, palliative care is a broader term that covers all forms of care that focus on making a patient as comfortable as possible and reducing pain, discomfort, and stress. Palliative care is always a component of hospice care, but palliative care services can also be provided to those undergoing treatment for a curable condition.

Hospice and palliative care are administered by a team of professionals who work with patients and their family members, other caregivers, and other medical professionals (if palliative care is being provided in conjunction with curative care) to reduce pain, discomfort, and stress. Hospice and palliative care teams are comprised of a variety of medical and non-medical home care professionals and may include some combination of the following:

  • Physicians
  • Nurses
  • Individual or family therapists and counselors
  • Social workers
  • Physical, occupational, or speech therapists
  • Hospice aides
  • Trained volunteers

Hospice and palliative care services vary greatly depending on the individual’s medical and non-medical home care needs as well as their preferences and wishes which may be communicated verbally by the patient or family member or through an advance directive. Since hospice and palliative care are designed to reduce stress and pain, care plans are highly customizable and designed to accommodate the unique needs of each patient and their family.

Most hospice and palliative care providers will work with patients and their spouses and/or families to provide some combination of the following services:

  • Physician care, skilled nursing, and other medical care
  • Prescription medications to cope with pain and other symptoms
  • Hospice aide services
  • Home health, housekeeping, and laundry services
  • Physical, occupational, and speech therapies
  • Social work services
  • Individual and family counseling and therapies
  • Spiritual and grief counseling
  • Short-term respite care

To learn more about hospice and palliative care and how to pay for these services, please see our comprehensive overview of hospice care.

FAQs About Long-Term Care Options For Seniors

1.  How do I go about determining the best level of care?

Choosing the right level of care for your family member can be challenging, particularly for those who have never gone through the process before. Determining the right type and level of care starts with a thorough assessment of your needs or those of your family member or other seniors. It is a good idea to sit down and make a comprehensive list of an individual’s current needs. It is best to include the daily tasks they require assistance completing as well as any current medical diagnoses or concerns.

It is also helpful to consider what kinds of help your family member may require in the future. Although it is often difficult to foresee future changes in care needs, it may be helpful to consider current symptoms and how they may have evolved over time as well as family medical history. For example, those with immediate family members who have suffered from Alzheimer’s disease or other forms of dementia are at greater risk of developing the disease themselves.

Physicians, nurse practitioners, social workers, counselors and/or other professionals with experience working with seniors or in the senior care industry may also be able to help assess the symptoms and particular needs of elderly individuals and aide in determining appropriate next steps for you and your family.

For more information, please see our comprehensive guide on how to determine the right senior care service.

2. How do I choose between in-home care and residential care?

Deciding whether to access in-home or residential care is very much based on individual needs, preferences, and circumstances. Many elderly individuals prefer to remain in their homes or the home or a family member as they age, although this is not the case for all individuals. Some seniors like the idea of living in a senior residential community for the social and recreational opportunities they may offer, or for the added security and easy access to emergency services.

Whether in-home or residential care is the best option for your family member will depend on a variety of factors including the following:

  • The particular preferences and needs of the individual, including whether or not they require 24-hour supervision, medication management, and assistance with some or all of the ADLs.
  • The elderly individual’s current living situation and whether or not they are able to maintain a home or apartment.
  • The availability of family members or other caregivers to provide certain types of care and assistance (in some cases, it is possible for family members to be paid to act as caregivers for seniors who require assistance).

Seniors who require more frequent or extensive assistance, 24-hour around-the-clock care supervision, added security, and those who suffer from severe chronic medical conditions are likely to be better suited to residential long-term care options while those who require help less often or only require assistance with certain tasks or certain medical services may be able to get the help they require through adult day care or senior home care services.

3. How do I choose the right provider once I’ve decided on the appropriate level of care?

Finding the right senior care provider is extremely important, perhaps particularly for those who require residential care. Moving at any stage of life is often difficult and even traumatic and tends to be more difficult for elderly individuals, especially when moving from home to a residential care facility. Choosing the right care provider by conducting thorough research, understanding the needs and preferences of your family member, and asking the right questions before making a decision can minimize the risk of having to go through the process of moving again in the future.

Most senior care providers offer a list of services on their websites which may provide a general idea of what to expect. Scheduling a meeting with an in-home care provider or residential care facility’s administrators to discuss you and your family’s particular needs and expectations is an important step in the process. It is a good idea to interview multiple in-home care providers or visit several residential long-term care communities to get an overall idea of the options. It is also helpful to conduct some additional research to determine whether or not a provider is approved by Medicare and understand how your state regulates senior care providers.

Most residential facilities offer guided tours and these tours commonly provide a meal and allow visitors to tour residential living spaces and communal and recreational areas. These tours and meetings also give visitors an opportunity to ask any questions they may have and discuss individual needs, preferences, and concerns.

4. How do I pay for care?

The cost of senior care is a major concern for most individuals and families. The HHS estimates that the average American turning 65 years old this year will incur $138,000 in future long-term care costs over their lifetime. While most families will pay some of the costs associated with senior care out-of-pocket, there are a variety of public and private options available to elderly individuals who require assistance paying for senior care. Some of these options are listed below:

  • Long-term care insurance – long-term care insurance policies are designed to cover the long-term care needs of seniors, including assistance with the ADLs and personal and custodial care, in both in-home and residential care settings. To learn more about how to pay for care using long-term care insurance, please see our comprehensive overview of long-term care insurance.
  • Home equity – Older adults who own their own homes may choose to leverage the equity in their property to finance the cost of care. This kind of financing is generally used to cover the cost of long-term (as opposed to short-term) care, and there are a variety of ways to use home equity to help cover long-term care costs, including the following:
    • Reverse mortgages
    • Traditional home equity loans or home equity lines of credit (HELOCs)
    • Cash-out refinancing
    • Selling or renting out a home

For additional information about how to pay for care, please see our list of senior care resources which includes a comprehensive list of financial resources and details about the various options.