Types of care
Adult Day Services
Adult day services are programs that help a family’s caregivers keep their loved ones at home. The
services typically are offered in three ways: social, medical, and dementia-specific.
- The social programs include activities and meals with minimal medical support.
- In a medical program, loved ones require health services and sometimes even therapies.
- Dementia-specific programs include care for loved ones with Alzheimer's disease or a related dementia. They may need a combination of social and medical services.
Payment for Adult Day Services usually comes from private sources. In some cases, long-term care insurance
covers Adult Day Services. Consult your local Agency on Aging to see if there are funds available to
help with this. If your loved one has intensive medical needs, Medicare part B (or their health insurance)
may help cover skilled services and therapies. Also, be sure to ask your tax advisor about whether the care
you provide to a family member or loved one satisfies the criteria to get a Dependent Care tax credit.
Independent living facilities are available in forms that range ranging from 55+ apartment communities to
freestanding homes in retirement village or a continuing care community. This option is for those who can
perform their own basic ADLs (activities of daily living) and require little or no medical assistance.
Independent living facilities help seniors live on their own with security and peace of mind. Most such
seniors seek social, educational, and recreational opportunities to enrich their lives, without the worries of
home maintenance, housekeeping, meal preparation, or transportation. Very often, distinct amenities are
an important part of making a choice, as is the need for security. A congregate senior community provides
a physically safer environment (including handrails and 24-hour emergency response systems) and emotional
security as well.
Independent living is usually paid for from private funds. Some communities are subsidized by government
programs. Those communities offer fees at a sliding scale based on income. Talk to someone at your local
Agency on Aging to find out about such communities.
Assisted living is an ideal solution for many seniors who need help with some activities of daily life (ADLs),
such as such as bathing, grooming, and dressing. In assisted living facilities, residents combine independence
with the peace of mind that personal care and support services are there if needed. Some states
also sanction medication assistance or reminders to residents, but assisted living communities are much
different from nursing homes that provide more comprehensive medical services.
Many assisted living communities offer a home-like atmosphere with apartment styles that include studio
and one-bedroom models. Kitchenettes usually feature a small refrigerator and microwave.
Most often, assisted living is paid for from private funds, but there are some exceptions, such as coverage
from long-term care insurance policies. In a few states, Medicaid funds and waivers can help with these
Alzheimer’s and Dementia
There are three common settings for your loved one who is no longer safe living at home: 1) Some
Assisted Living Centers and 2) some Nursing homes have Memory Care programs, which include secure
units that meet the special needs of people living with dementia. 3) A more recently-available option is a
community dedicated solely to dementia.
When evaluating communities for dementia care, consider the two areas where most experts agree you
should place your focus: 1) resident safety and supervision, and 2) whether there is there is a structured
routine for residents. Safety and supervision are essential: Wandering is a part of the disease process, and
other behaviors such as impaired judgment and disorientation must be provided for. Structured routine is
also important: It helps decrease agitation, as do things like regular caregiving, consistent meal times and
place, and an environment that gives visual cues to help with disorientation.
The cost of Alzheimer’s and dementia care depends upon the level of care provided. Fees for care in
assisted living facilities typically comes for from private funds, but there are exceptions such as long-term
care insurance. In some states, Medicaid funds can help with these costs. Reimbursement for dementia
care in a nursing home comes from private funds, long-term care insurance or Medicaid.
Respite care is one or more of a variety of services for caregivers and families, often availed of by those who care for seniors due to their illness or injury. Respite care takes place both in-home and out-of-home and in-home and can be for periods as short as a few hours at day-care facilities, or up to a week or more at assisted living or similar centers. This depends on the need and the resources available. Besides care for the patient, there are therapy services and online support groups for the caregivers themselves.
Home care services help caregivers keep loved ones at home as long as possible. Such services can
include both custodial and skilled health care services.
Skilled home health care is a regulated service that permits licensed agencies to provide nursing care,
home health aides, and therapy. Many agencies are certified by Medicare and/or Medicaid. Private duty
agencies help clients with personal care (dressing, meals, bathing, etc.) and sometimes with household
duties such as shopping, laundry—but not with nursing or therapy.
Medicare (or their private health insurance) may pay for home health services on a short-term basis— the
patient must be homebound and under a physician’s care, and the agency must be Medicare certified.
Private duty or homemaker services generally are paid for from private funds. Some local Agencies on
Aging make available funds to assist with this.
Continuing Care Retirement Communities
These communities are also called retirement villages. A continuing care retirement community (CCRC)
provides a wide range of care, from independent living apartments or freestanding homes to assisted living
and long-term care, sometimes all on one campus. Some also provide short-term rehabilitation services
and specialized dementia care. A CCRC offers residents peace of mind in knowing that whatever level of
care they may need in the future, it will be available. Residents usually join a CCRC while they are still
active and independent. They take advantage of lifestyle programs including social, recreational and educational
As they begin to require more assistance, residents move through a CCRC’s levels of care without the
need to arrange for separate outside services with each change in need.
The contracts, fees and payment structure for CCRC’s can be confusing. Most commonly, payment comes
from private funds. Some CCRCs require a non-refundable entrance fee or equity payment, while others
do not (or make them refundable). In some states these care communities accept Medicaid in their
assisted living (depending upon the state) and in their long-term care, while others do not. Most CCRCs
have a short-term rehab program that is Medicare certified.
Nursing Care Communities
These communities are commonly called skilled nursing, rehab centers, or nursing homes. They are residences
for people who need either long-term care or skilled nursing. They offer the services of an assisted
living facility, and add 24-hour nursing care. This more complex medical care is typically for patients who
have had an injury, acute illness or a surgery, or who require the services of a licensed nurse or therapist.
Residents live in private or shared accommodations. Sometimes this means that bathrooms are shared
between patients or even between two rooms.
Reimbursement for nursing care community residents/patients can be complex. For a short-term rehabilitation
stay, Medicare and/or private insurance typically covers the cost. If a patient continues to meet the
“skilled criteria” during a rehabilitation stay, Medicare covers the first 20 days at 100 percent, then 80 more
days at 80 percent. Many secondary insurance policies pay the 20 percent not handled by Medicare.
For long-term care residents, private funds, Medicaid, and long-term care insurance are the common
sources of funds for payment.