End-of-Life Care Topics
Other Care and Support Services
Living with a serious medical condition or caring for an ill loved one can often be challenging and emotionally draining. Meeting these physical and emotional needs in times of illness, combined with the demands of daily living, can become overwhelming. Community-based services are available to help those with serious medical conditions and their caregivers. Eligibility for these services may depend on the type and stage of illness. Some services may also have clinical and financial need criteria.
Home Care Services
Several types of agencies provide a range of health and support services in the home. Visiting nurse associations or community nursing agencies offer skilled nursing care. Individuals who require this skilled care may also be eligible for home health aides, homemaker services, social services, case management, and a range of therapies provided through the same agency. Medicare and many other insurers will pay for these services only if you are homebound. Talk with your doctor or other healthcare provider about which services might be appropriate.
In addition to skilled nursing care agencies, some home care agencies provide homemaker services to help with household tasks or someone to help coordinate needed services.
With some medical conditions, such as Alzheimer's disease, a person's physical or cognitive abilities may decline slowly, yet he or she may be relatively stable medically. In this situation, the person may have physical or cognitive difficulties that require more supervision or stimulation than is available at home. Community-based day care programs can provide needed supportive daytime care. These programs can usually arrange transportation to and from the program site.
Family caregivers of an ill or disabled person sometimes need a break, or respite, from daily caregiving demands. Respite care services offer the short-term (residential) placement of the person needing care in an appropriate setting. Typically, respite care placement may be from a few days to a week. Residential care facilities, hospitals, extended care facilities, and inpatient hospice houses sometimes offer this service. Talk with your healthcare provider if you anticipate a need for this kind of support.
Extended Care Facilities
As a person's health declines, it may be inadvisable or impossible to continue living at home. There are several types of extended care facilities that provide different levels of care for residents.
Nursing homes provide long-term care for the elderly, chronically ill, and disabled. Services include nursing care, personal care, and rehabilitative care, such as physical, occupational, and speech therapy. An increasing number of nursing facilities also provide specialized services for people with Alzheimer's disease and other forms of dementia.
Nursing homes may also provide short-term care for patients who have been hospitalized and need a brief period, usually up to a month, for rehabilitation or medical monitoring before returning home. Finally, some nursing homes provide respite care to enable caregivers to have time off.
Assisted living residences provide resources for the elderly or the disabled who need more supervision and services than living in a private home can provide, but who do not need 24 hour nursing or rehabilitative care. Assisted living residences are a special combination of housing and personalized support services designed to meet the needs - both scheduled and unscheduled - of those who require help with activities of daily living (ADLs) such as bathing, dressing, grooming, eating, and other similar personal care needs. Assisted living residences generally offer a range of services including meals, social activities, assistance with personal care, coordination of healthcare services, medication management, and emergency response.
Assisted living is a residential option that promotes self-direction and self-participation in decisions regarding care and services. As a model of supportive housing, assisted living emphasizes independence, individuality, privacy, dignity and choice. Assisted living can be found as freestanding residential complexes or within continuing care retirement communities that provide multiple levels of residential support and care.
While some people prefer to provide care at home rather than to place a loved one in a nursing care facility, the demands of a progressive or debilitating condition can eventually exhaust caregivers. The ill person's condition may also deteriorate to the point where a home setting is no longer safe.
Discussion of and planning for care options should occur before the situation becomes urgent. This should include investigating extended care options in your community, carefully choosing facilities that can meet your loved one's needs, adding your name to waiting lists, and exploring payment options.
Planning together for future needs will help to ensure that the best possible living setting for your loved one is available if he or she needs it.
The following organizations can provide you with the names of facilities in your area:
Massachusetts Assisted Living Facilities Association (Mass-ALFA)
460 Totten Pond Road, Suite 600
Waltham, MA 02451
Massachusetts Extended Care Federation
2310 Washington Street, Suite 300
Newton Lower Falls, MA 02462
Phone: 617-558-0202 or 800-CARE-FOR
246 Walnut Street, Suite 203
Newton, MA 02460
Massachusetts Long Term Care
Visiting Nurse Associations of America
99 Summer Street, Suite 1700
Boston, MA 02110
Home Care Association of Massachusetts, Inc.
31 St. James Street, Suite 780
Boston, MA 02116
Phone: 617-482-8830 or 800-332-3500