LONG-TERM CARE REPORT
Report from the Institute for Long-Term Care Policy, Inc.


The Institute produces a regular series of fact sheets called Long-Term Care Reports. These fact sheets explore issues that concern frail elders and describe the services that are available to them.


Long-Term Care REPORT: 
Care Options for Elders and Their Families 
May 1998, Vol. 1, No. 1


When does an elder need help?
What are the levels of care?
How do you choose a level of care? 
Who can help if you can't decide? 
What questions should you ask about costs? 
How do you choose among providers? 
What are resources for further information? 


When does an elder need help?

For many different reasons, such as an injury, Alzheimer's Disease, or a chronic health condition, an older person sometimes needs regular care. Usually this care is given when a person has difficulty with their activities of daily living (ADLs). These activities include the ability to bathe, dress and feed oneself, to use the toilet and get in and out of bed or a chair or the bath without assistance. There are a variety of resources available to help elders with their ADLs.

Family and friends often provide needed care, and paid caregivers are also available to help. Because their needs may range from minor to intensive, elders and their families can choose the level of care they need. The different levels are given in the home, in the community, or a variety of residential settings. 

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What are the levels of care?

Home care is provided in the elder's home and may include nursing, rehabilitative, homemaker, or companion care. It is licensed by the state.

Adult day care is a program in the community which elders attend during the day and then return home afterwards. Centers may offer nursing, social, recreational, rehabilitative and other services. Transportation to and from the program is usually available. Lunch and snacks are served. It is not licensed by the state, but it is certified by the adult day care association (CAADC).

Respite care describes services offered by different levels of care that give family caregivers a break in their duties. For example, a home companion may stay with the elder for a few hours so the caregiver can do errands. Respite care may be provided in the home, an adult day care center, or a nursing home. Licensing depends on the level of care that is used.

Congregate Housing, or retirement housing, offers services that may include meals, transportation and recreational activities. It is not licensed by the state.

Continuing Care Retirement Community (CCRC), also known as life care, offers private apartments within retirement communities. Social and recreational services may be offered. Some CCRCs offer life care contracts that guarantee lifetime medical care, including nursing home care. It is licensed by the state.

Assisted living provides personal care services, such as help dressing, and health care in private apartments in a congregate housing setting. It is licensed by the state.

Residential care home, formerly called homes for the aged, is congregate housing where seniors needing some daily assistance share meals and receive social and recreational services. Residents usually have a room, not a full apartment. It is licensed by the state.

Intermediate care facility is a nursing home level for individuals with fewer medical and nursing needs than skilled nursing. It is licensed by the state.

Skilled nursing facility is a nursing home where residents may live for long or short periods of time for rehabilitation. It gives 24-hour intensive care. It is licensed by the state.

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How do you choose a level of care?

How much help is needed with activities of daily living (ADLs)? The more help a person needs with their ADLs, the more intensive a level of care may be needed.

How much help can your friends and family give? Many people can remain at home only if caregivers provide services on a regular and continuing basis. Family and friends often can provide informal care that reduces the need for formal, paid care. 

How much money is available? When costs are a factor, families must consider how much long-term care may be needed and which services they can afford. State and federal programs provide funding for certain levels of care. Long-term care providers and local area agencies on aging can help you determine your eligibility for government funding. 

What are your care preferences? Frequently, frail elders prefer no care or no change from the status quo, even though family members and caregivers may disagree with this choice. When this is the case, family members should talk with the elder about the costs and benefits of appropriate care options. 

Personal preference is an important factor when the elder considers moving from home to another setting. Wherever possible, elders try to find placement near their friends and family members. Affiliations with religious or fraternal organizations may be important to some people, and individuals may have preferences about the size of the place they will be moving to, the decor, and the range of amenities offered.

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Who can help if you can't decide?

When there is conflict between family members about the best course of action, an objective professional such as a social worker who specializes in the needs of the elderly should be consulted. Another resource for families is a geriatric assessment, which involves evaluations by a team of medical and social work professionals. Call your local area agency on aging for referral information; the numbers are listed below.

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What questions should you ask about costs? 

What are the charges for services? What is included in the charges? Are other services available for an extra charge? Is a sliding-scale fee available? When must bills be paid? Is government funding available? What happens if you run out of money? Are services covered by long-term care insurance? Always read the disclosure statement thoroughly before signing anything!

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How do you choose among providers?

Learn as much as possible about each provider. Visit and look for signs of quality and caring. Compare to see which services are available, their hours of operation, charges and what they include, management style, mission and philosophy, and waiting lists. Talk to participants and their families to learn their opinions about services and staff and whether they would recommend the provider and services.

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What are resources for further information?

Area Agencies on Aging: Area agencies on aging are private, nonprofit corporations that provide leadership and resources to meet elders' needs. They offer referrals and resources on all aging services in Connecticut, such as elder housing, community services, Alzheimer's care, state programs for elders, and meals programs. 

Website http://ctagingnetwork.org 
State-wide toll-free number 800/994-9422 
Eastern Connecticut 860/887-3561 
North Central Connecticut 860/724-6443 
Western Connecticut 203/757-5449 
South Central Connecticut 203/933-5431 
South Western Connecticut 203/333-9288 

Infoline 800/203-1234 
Infoline is available 24 hours a day and offers free listings of a wide range of human services in Connecticut. 

 This report has been sponsored by: 
HERBERT J. SIMS & CO. $ Established 1935 
Capital Financing for Organizations Serving Seniors

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Long-Term Care REPORT: 
Understanding Long-Term Care Insurance
June 1998, Vol. 1, No. 2

What is long-term care insurance?
How is it different from health insurance or Medicare and Medicaid? 
How expensive is it? 
Who needs long-term care insurance? 
What questions should you consider in deciding to buy long-term care insurance? 
How do you choose among insurers? 
What is the CT Partnership for Long-Term Care? 
What are resources for further information? 


What is long-term care insurance?

Long-term care insurance is a type of insurance that pays for part or all of the long-term care services a person may need. An example of what may be covered is a home health aide helping a person get dressed. Sometimes an older person needs help performing activities of daily living (ADLs), such as bathing or dressing or eating. Long-term care services, such as home health care, adult day care, and nursing homes, help elders with their ADLs. 

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How is it different from health insurance or Medicare and Medicaid? 

Long-term care insurance only pays for long-term care expenses. Short term medical problems would be covered by Medicare and other health insurance plans.

Medicare pays for doctor's fees, hospital care, short stays in nursing homes (up to 100 days per benefit period), and some home health care; it generally does not pay for care over a long time because Medicare is an acute care health insurance program. Medicaid will pay for some long-term care services, such as long stays in a nursing home, but to be eligible your income and assets must be below a certain level; if you have more than that level you must spend down your assets. Traditional health insurance plans usually do not pay for any long-term care services. 

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How expensive is it?

Premiums can range from several hundred dollars to several thousand dollars a year. The cost depends on several factors, including your age and health (the older or sicker you are when you first buy the policy, the more expensive the policy will be), the level of benefits you want, and the exclusionary period (the length of time you wait until benefits begin).

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Who needs long-term care insurance?

There is no easy answer to this question. First, it depends on whether you will need long-term care. There is no way to predict whether you will need long-term care in the future; however, the older you are, the greater your risk of needing long-term care. Your family history may be able to help you decide if you are at high risk.

Second, it depends on whether your family will be able to take care of your needs. If your family is unable to care for you or to meet all of your needs, you may need formal long-term care services. 

Third, it depends on your income and assets. If you are wealthy, you may be able to pay for your long-term care. If your assets are under a certain limit ($1600 per person in 1997), Medicaid may cover you. Generally, you should have at least $40,000 in assets when you buy long-term care insurance.

If you are concerned that you may need long-term care in the future, that your family may not be able to take care of all your ADL needs, and that you may lose your assets paying for long-term care, long-term care insurance may be for you. 

For help deciding what to do, you can call your local area agency on aging or speak with a trained long-term care information specialist from the CT Partnership for Long-Term Care. (Their numbers are listed below.) You may also want to discuss this with your family members, your attorney, and your financial advisor. 

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What questions should you consider in deciding whether to buy long-term care insurance?
What are the chances that I will need long-term care services? What services are available in my community and how much do they cost? How much help will my friends and family be able to give me? Will I have the resources to meet my long-term care expenses? Will I be able to pay the premiums of a long-term care policy without sacrificing essential needs, such as food, shelter, and medicine? Have I explored all of my options? 

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How do you choose among insurers? 

Since the coverage of long-term care services varies by policy, you need to make sure the policy you choose has the coverage you want (home care, adult day care, etc.). Ask the insurer if they offer automatic compounded inflation protection; this feature protects you from inflation. Make sure you understand the provisions that describe what triggers the payment of benefits and that they are not overly restrictive. Consider how much co-payment and deductible you think you will be able to afford. Find out what list of pre-existing health conditions they use to determine who can buy a policy. Ask whether the policy covers Alzheimer's disease. Make sure that the policy spells out what happens to you if the insurance company goes out of business after you bought the policy.

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What is the CT Partnership for Long-Term Care?

The Partnership is a program of the State of Connecticut, conducted in cooperation with the private insurance industry. Under the Partnership, private insurance companies competitively sell special long-term care insurance policies that meet stringent consumer standards. For example, all policies must include home and community-based services, automatic inflation protection, and Medicaid Asset Protection. (Medicaid Asset Protection allows you to protect some or all of your assets if you apply to Medicaid after your insurance is used up.) No particular insurance company is endorsed. 

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What are resources for further information?

Area Agencies on Aging (AAA): AAAs are private, nonprofit corporations that provide leadership and resources to meet elders' needs. They offer referrals and resources on all aging services in Connecticut. They also give free information and assistance on long-term care insurance and related programs through their CHOICES program. 

Website http://ctagingnetwork.org 
State-wide toll-free number 800/994-9422 
Eastern Connecticut 860/887-3561 
North Central Connecticut 860/724-6443 
Western Connecticut 203/757-5449 
South Central Connecticut 203/933-5431 
South Western Connecticut 203/333-9288 

Infoline 800/203-1234 
Infoline is available 24 hours a day and offers free listings of a wide range of human services in Connecticut. 

Department of Social Services 800/445-5394 
DSS will give information on various state programs that are available to help with long-term care at home, in the community, or in a nursing home. DSS programs include the CT Home Care Program for Elders. 

CT Partnership for Long-Term Care 800/547-3443 
website: http://www.state.ct.us/opm/pdpd/ltc/home/htm 

Thanks to the South Western CT Agency on Aging and the Connecticut Partnership for Long-Term Care for information contributing to this fact sheet .

 This report has been underwritten by a grant from: 
HERBERT J. SIMS & CO. $ Established 1935 
Capital Financing for Organizations Serving Seniors 

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Long-Term Care Report: 
Services for Alzheimer's Patients and their Families
August 1998, Vol. 1, No. 3

What is Alzheimer's disease (AD)? 
How can you tell if you have AD? 
Are there effective treatments? 
What services are available to help people with AD? 
What questions should you ask service providers? 
What should be done about legal and financial matters? 
What should families and care-givers do? 
What is the Alzheimer's Association? 
What are resources for further information? 

What is Alzheimer's disease? 

Alzheimer's disease (AD) is a disease of the brain which causes a steady decline in memory; it is not a normal part of aging. AD results in dementia, the loss of intellectual functions (thinking, remembering, and reasoning) severe enough to interfere with everyday life. 

AD usually begins gradually, causing a person to forget recent events and to have difficulty performing familiar tasks. It advances at different rates from person to person, causing confusion, personality and behavior changes, and impaired judgement. AD can make understanding and communication difficult. It can also be associated with periods of restlessness, agitation, and wandering. Sometimes persons with AD become totally unable to care for themselves. 

Scientists are not certain what causes AD. Age and a family history of AD are identifiable risk factors. 

Most people are diagnosed after they are 65 years old. However, in a small percentage of cases, AD can occur in younger people; this is called early-onset AD.

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How can you tell if you have AD?

Consult your doctor or go to a hospital or a geriatric assessment center. (The Alzheimer's Association can give referrals.) Because there is no single test for AD, a diagnosis should only be made after ruling out all other possible causes for the symptoms. Do not accept a diagnosis of AD without a complete medical evaluation.

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Are there effective treatments?

There are no medical treatments to cure or stop the progression of AD. However, some new drugs may temporarily improve symptoms, and medications are also available to reduce some of the behavioral symptoms associated with AD, such as depression, sleeplessness, and agitation. Talk with your doctor about these medications.

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What services are available to help people with AD?

While family and friends can provide care, there are also a number of services that can help individuals and families. 

Home care is provided in the person's home. A home health nurse provides ongoing skilled services, such as giving medications. A home-health aide provides help with personal care such as bathing and dressing. A homemaker helps with housework, shopping, and cooking. A friendly visitor or companion provides companionship. 

Adult day care is a program in the community which clients attend during the day, returning home afterwards. Centers may offer nursing, social, recreational, rehabilitative and other services. Lunch and snacks are served. Transportation to and from the program is usually available. 

Assisted living provides personal care services, such as help dressing, and health care in private apartments in a residential setting. Twenty-four hour security, social and recreational activities, and on-site staff to respond to emergencies are also provided. 

Residential care homes, formerly called homes for the aged, offer congregate housing where persons needing some daily assistance share meals and receive social and recreational services. Residents usually have a room, not a full apartment. 

Nursing facilities (also known as nursing homes) are institutions where residents may live for long or short periods of time with 24-hour availability of nursing care. Help with bathing, dressing, eating, and toileting are provided.

(For more information about these services and how to choose them, see the May, 1998 issue of the Long-Term Care Report, "Care Options for Elders and Their Families.")

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What questions should you ask service providers?

How are they equipped to deal with AD? Do they have wander guards, such as buzzers on the doors to prevent AD clients from wandering off unnoticed? What activities are offered for people with AD? Are there permanent assignments of staff to individuals or are they changed periodically? Who develops the plan of care? Are they licensed by the state or certified? How much experience have they had caring for people with AD? 

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What should be done about legal and financial matters?

Legal planning should begin soon after a diagnosis is made. Planning should include setting up documents that authorize another person to make health care and financial decisions, as well as financial plans for coverage of services. If the person with AD has legal capacity--the level of mental functioning needed to sign legal documents--he or she should actively participate in the legal planning process. Speak with an attorney about options for health care decision-making, coverage of services, and property management for the person with AD.

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What should families and caregivers do?

Family caregivers have been described as the silent victims of AD. Caregiving can make recreation, chores, and even employment difficult or impossible to maintain. To help them cope, families and caregivers should: 

Get a diagnoses as soon as possible in order to plan for the future. Find out what resources are available to help. Learn about care techniques that can help them better understand and cope with AD. Try not to do everything themselves. Consider joining a support group. Discuss legal and financial plans for the future. Give themselves permission to grieve for their losses.

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What is the Alzheimer's Association?

The Alzheimer's Association is the oldest and largest national voluntary organization dedicated to researching the causes, cures, and prevention of AD and to providing education and support services to Alzheimer's patients, their families, and caregivers. Local chapters can also give referrals to services that care for people with AD.

Alzheimer's Association: Northern CT Chapter 800/356-5502 South Central CT Chapter 203/230-1777 

Fairfield County Chapter 203/845-0010

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What are resources for further information?

Area Agencies on Aging (AAA): AAAs are private, nonprofit corporations that provide leadership and resources to meet elders' needs. They offer referrals and resources on all aging services in Connecticut. Website http://ctagingnetwork.org 
State-wide toll-free number 800/994-9422
Eastern Connecticut 860/887-3561
North Central Connecticut 860/724-6443
Western Connecticut 203/757-5449
South Central Connecticut 203/933-5431
South Western Connecticut 203/333-9288

Infoline 800/203-1234
Infoline is available 24 hours a day and offers free listings of a wide range of human services in Connecticut.

Thanks to the Northern Connecticut Chapter of the Alzheimer's Association for assistance with this fact sheet. Much of the information was taken from pamphlets written by the Alzheimer's Association.

 This report has been underwritten by a grant from: 
HERBERT J. SIMS & CO. $ Established 1935
Capital Financing for Organizations Serving Seniors

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Long-Term Care REPORT: 
CCRCs: More Than Just Housing for Seniors
October 1998, Vol. 1, No. 4

What are continuing care retirement communities (CCRCs)?
What is the difference between CCRCs and assisted living?
Who should live in a CCRC?
What information do CCRCs have to give you?
How much do CCRCs cost?
How do you select a CCRC?
What other questions should you ask a CCRC?
Who regulates CCRCs?
What are resources for further information?

What are continuing care retirement communities (CCRCs)? 

CCRCs are communities that, for an entry fee and monthly charge, provide older persons with housing, housekeeping, meals, a variety of other social services, and a range of health care services for the rest of their lives.

The health care services are packaged in three types of agreements: 1) life care agreements provide various health and long-term care services with little or no increase in costs; 2) partial health care agreements may include some home health services, assisted living, and/or nursing home care with little or no additional costs; 3) unbundled agreements make health care and long-term care services available, but at an extra charge. 

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What is the difference between CCRCs and assisted living?

CCRCs offer a continuum of care, in which residents can receive a variety of health care services or move from independent living to higher levels of care, such as skilled nursing. Assisted living, on the other hand, offers care and services within parts of the continuum, primarily through home care type services; it emphasizes health and personal care services for frail older persons who do not need 24 hour skilled care but are chronic and stable. Many CCRCs offer assisted living in addition to other services.

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Who should live in a CCRC?
CCRCs are designed for older people who want to live independently, but also want to feel secure knowing that services and health care are assured if their health declines. A person should be healthy and able to live independently when entering a CCRC; many CCRCs require a medical exam before admission. Most CCRCs in Connecticut require an individual to be at least 62 years old upon admission. 

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What information do CCRCs have to give you?

Before signing a contract or receiving any money, a Connecticut CCRC must give the prospective resident a current disclosure statement. The CCRC contract, also called a residency agreement, is a legal agreement guaranteeing the CCRC's provision of housing and various services for the life of the resident. 

The contract must describe the living unit, the services offered, including the health care package, and specify the financial obligations of the resident. It also outlines provisions for termination of residency, conditions for temporary or permanent transfer to the CCRC health care center, and terms for entry fee refund.

CCRC contracts must also identify circumstances under which a resident is permitted to receive housing, health care, and other services in the event the resident has financial difficulties. 

Always review a sample contract with a knowledgeable attorney before putting down a deposit. 

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How much do CCRCs cost?

CCRCs require a significant initial entry fee and monthly fees. The entry fee is a lump-sum payment at the time of admission. Entry fees in Connecticut range from as low as $40,000 to as high as $600,000, while most residents can expect to pay between $100,000 and $250,000. In 1997, monthly fees ranged from $850 to $3,292 for a single person to $1,060 to $4,117 for a couple. 

Some CCRCs require additional fees for individual services. There may be additional costs associated with a stay at the health center. 

Many CCRCs offer a partial refund of the entry fee upon the death of a resident or the termination of the contract. Always ask the CCRC for its policy in writing on refunds and the terms of reimbursement. 

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How do you select a CCRC?

CCRCs have marketing staffs which can give you information and a tour. Look for signs of quality and caring, such as pleasant surroundings, cheerful residents, attractive meals, and helpful staff. Compare contracts, services, costs, waiting lists, and management policies of several CCRCs. Talk to residents about the services, staff, and whether they would recommend the CCRC. 

Visit the CCRC's nursing and health care facilities and the on-site clinic. Meet the medical director. Notice whether staff seem attentive and the residents are well cared for. Ask about provisions for residents who later develop conditions such as Alzheimer's and Parkinson's disease. 

Verify the CCRC's financial strength and stability. Obtain a copy of the CCRC's disclosure statement and review it with a qualified financial advisor or a knowledgeable attorney. If you have any questions, ask for a meeting with the CCRC's chief financial officer or CEO.

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What other questions should you ask a CCRC?

What specific health care services require additional charges? Are there any limitations or restrictions in service? What is the history of rate increases over the last five years? Is scheduled transportation provided? If the CCRC does not have health care facilities on site, what arrangements are made to provide these services? What kinds of care will be provided to me in my apartment? What insurance will I be required to maintain? Can I use my own doctor? What security and emergency systems are in place? Who sponsors the CCRC? Does the sponsoring organization have financial responsibility?

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Who regulates CCRCs?
CCRCs in Connecticut are not regulated. However, they must register with the Connecticut Department of Social Services by filing a current disclosure statement and annually submit a revised disclosure statement with financial and actuarial information for their most recently ended fiscal year. Various components of a CCRC's health-care package, such as nursing home beds or home care services, are licensed and inspected by the Connecticut Department of Public Health. 

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What are resources for further information?

CT Dept of Social Services (DSS) 800/443-9946
The Elderly Services Division of DSS ensures that Connecticut's elders have access to the supportive services necessary to live with dignity, security, and independence. Staff can answer many questions about CCRCs and provide referrals. 

Area Agencies on Aging (AAA): AAAs are private, nonprofit corporations that provide leadership and resources to meet elders' needs. They offer referrals and resources on all aging services in Connecticut. 

Website http://ctagingnetwork.org
State-wide toll-free number 800/994-9422
Eastern Connecticut 860/887-3561
North Central Connecticut 860/724-6443
Western Connecticut 203/757-5449
South Central Connecticut 203/933-5431
South Western Connecticut 203/333-9288

Material for this fact sheet was drawn from the Connecticut Department of Social Services 1997 CCRC booklet and the 1994 Consumer's Directory of CCRCs published by the American Association of Homes and Services for the Aging (202.783.2242).

 This report has been underwritten by a grant from: 
HERBERT J. SIMS & CO. $ Established 1935 
Capital Financing for Organizations Serving Seniors



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