• Understanding Options for Long-Term Care
  • November 28, 2014 | Author: Norman ("Gene") E. Richards
  • Law Firm: Foster, Swift, Collins & Smith, P.C. - Farmington Hills Office
  • Harry and Sally, a married couple, have lived in the same home on Chestnut Drive for over 30 years. They love their home, and want to live out their lives there. As time goes by, however, adjustments made in the home to accommodate Sally's arthritis and Harry's physical challenges from a stroke are no longer sufficient to meet their levels of need. They manage but realize that it's now time to think about other living options. They start researching and discover the many types of long-term care (LTC) available.


    Long-term care or LTC is a range of medical, nursing, supportive and community services that are provided over a period of time for people in need.

    Selecting the right care environment for a particular situation can be difficult. A team of family members and professional advisers such as the family doctor, a financial adviser, an elder law attorney and a geriatric care manager can help with the decisions.

    This post describes the pros and cons of the six most frequently referenced settings for long-term care.


    At-home care is the preferred option of most families. It is the most affordable and the least traumatic for the patient who continues to live in his or her own home. Generally a spouse and family members provide the care needed.

    There are problems with that plan, however, since the family is not qualified to give nursing care, there is considerable impact on the caregivers providing constant care, and the home environment is not appropriate for advanced degenerative illnesses.

    It is possible to add custodial or skilled home care to that provided by the family. Medicare Skilled Home Care can help in some situations. There are also numerous private home care agencies to choose from that will provide a variety of services and levels of assistance. Unfortunately, limited public assistance is available to help pay for private, at-home care. Private home care services usually average over $20 per hour.


    Transitioning to an assisted living facility may be an acceptable option since it is similar to a home environment. The resident remains independent while the facility provides concierge services such as meals, housekeeping, laundry and basic personal care. Assisted living also can be less stressful and traumatic for the patient and costs less than a nursing home.

    Concerns about an assisted living arrangement include:

    • Facilities are unlicensed,

    • Medical assistance is limited,

    • It is a rental relationship thus there is the risk of a one-sided lease,

    • The renter is vulnerable to eviction,

    • Costs are higher, and

    • There is limited public assistance available to cover costs.


    An Adult Foster Care Home is a family or group home setting with 20 or fewer residents, sometimes known as family or group homes, and do not exclusively serve the elderly. Homes for the Aged have 21 or more residents and are exclusively for persons over 60 years of age. These facilities are licensed and inspected by the Michigan Department of Human Services. They provide room, board and supervised personal care but can’t offer medical treatment or continuous nursing care.

    The home is required to have a written agreement with the resident. There are extensive patient bills of rights, a formal complaint process and procedures for eviction. Some public assistance such as Veteran’s Administration aid and attendance or Supplemental Social Security is available.


    Continuing Care Retirement Communities (CCRCs) promise residents the ability to receive care for life in one facility or campus. They offer a wide spectrum of levels of care ranging from independent to assisted living to nursing home care. In Michigan they are subject to the Living Care Disclosure Act.

    CCRCs usually attract people with enough money to pay substantial entry or membership fees. They involve complex admission and service contracts, and public assistance may or may not be available. Services offered by CCRCs are subject to the same licensing and regulation as they would be in other settings. Other concerns with CCRCs are:

    • Inadequate internal grievance procedures

    • The financial stability of the facility

    • Recovery of investment, and

    • The availability of a nursing home bed when and if it is needed.


    Nursing homes offer skilled nursing care and medical treatment for illness, injury or infirmity. They are highly regulated and scrutinized by both state and federal agencies and there are strict licensing requirements. A patient can only be discharged if the facility can’t meet the patient’s needs, the patient improves and no longer needs the services, the patient’s conduct endangers the other residents and staff or the bill is not being paid.

    Nursing homes are the costliest level of care—averaging over $7,500 a month in southeast Michigan. However, Medicare, Medicaid or VA is available to assist with costs of care if the resident is eligible and the facility accepts those benefits.

    While nursing homes present the most difficult transition for many patients and there are concerns about the quality of care, a nursing home is sometimes the only option. Those considering a nursing home should consider:

    • The location

    • Hiring a geriatric care manager who knows the local facilities, their staffing and any unreported issues, and

    • Advocating diligently for the family member in order to obtain good care.

    Your elder law attorney can help you with the nursing home documents. It is important to understand your rights and responsibilities before signing admission documents.

    Obtaining quality long-term care is a major undertaking for families. Couples like Harry and Sally should plan as early as possible, investigate the options, and consult with trusted advisers (doctor, family members, geriatric care planner and Elder Law Attorney). With proper planning, Sally and Harry will be assured of getting the best quality long-term care available to them.

    Gene Richards provides Elder Law services through comprehensive, holistic planning and precisely tailored estate plan documents. He helps clients evaluate their options and assists them with LTC planning strategies, bringing peace of mind to clients and their families.