An Overview of Long Term Care Options

Elderly Clients are a primary practice area for Craige & Fox, PLLC. Both the North Carolina State Bar and the National Elder Law Foundation have certified Lawrence S. Craige as a specialist in Elder Law and Jennifer N. Marshall is also an experienced Elder Law attorney.

For the clients we serve and their families, long term care options are of great concern and are a very emotional topic between parents, children, and grandchildren. Planning for future long term care, however, empowers our clients and their families to make decisions now that will affect them and their loved ones in the future. This article will address the need to plan ahead for long term care and the different care options that are available to the elderly. It also offers some suggestions regarding the appropriate next steps and making decisions about long term care.

What is Long Term Care?

Long term care is a variety of services, including medical and non-medical services, for people who have a chronic illness or disability. Examples of chronic illness or disabilities are diabetes, hyperlipidaemia, Parkinson’s disease, multiple sclerosis, speech impairments, and cancer.

Long term care assists people with support services to help with activities of daily living. Some examples of activities of daily living include dressing, bathing, using the bathroom, feeding, or attending to personal hygiene or grooming. Long term care can be provided at home, in the community, in assisted living, or in a nursing home.

Why talk about Long Term Care now?

It is important to plan ahead for long term care as health declines with age and many older adults will need assistance with one or more activities of daily living as they age.

What Are Your Long Term Care Options?

There are several long term care options available to older adults. The appropriate long term care option depends on the older adult’s need for assistance. Older adults may choose from less invasive services like adult day care or home health care which allow the senior to remain at home, or the older adult may look to more invasive living arrangements like an assisted living facility or a nursing home.

Adult Day Care:

Adult day care services provide a support group for seniors with functional and/or cognitive impairments. According to the North Carolina Department of Health and Human Services, adult day care provides an organized program of services during the day with the purpose of promoting seniors’ social, emotional and physical well-being and supporting personal independence of seniors. Adult day cares must meet specific North Carolina State Standards for Certification and receive its certification from the Division of Health Service Regulation. These standards are enforced by the State Division of Aging and Adult Services.

Home Care:

Seniors may have the option of procuring services from a home health care provider. Home health care services may be personal care that is extensive and complex in nature requiring a certified nurse aide to help with bathing, dressing, toileting, feeding, and ambulation. These services are regulated by the North Carolina Division of Health Service Regulation. Home health care services may also be used for home management assistance like cooking, cleaning, laundry and shopping. These services are regulated by the North Carolina Division of Aging and Adult Services.

Assisted Living Facility:

Assisted living facilities allow provide older adults with a combination of housing and personalized care services to assist with activities of daily living. Assisted living facilities are designed to allow older adults to live in a home-like setting and maintain as much privacy and independence as possible while still receiving assistance with activities of daily living like bathing, dressing, meal preparation and housekeeping. Assisted living facilities are licensed in North Carolina by the Department of Health and Human Services through the North Carolina Division of Facility Services.

Nursing Home:

Nursing homes are the most invasive form of long term care. A nursing home will typically provide a secure environment and all services to meet the social, medical, and physical needs of older adults. Residents of nursing homes typically require assistance with multiple activities of daily living such as dressing, eating, toileting, and continence. Residents of nursing homes may also suffer from a form of dementia or other cognitive impairments. Nursing homes must be licensed and regulated by the North Carolina Division of Health Service Regulation.

How Does the Senior or the Senior’s Family Choose the Appropriate Long Term Care Option?

Older adults or their families should plan now for any future long term care needs. Older adults should discuss with their families their wishes to remain at home, move to an assisted living facility, or receive care at a nursing home.

Older adults and their families should be clear on what services are needed and review carefully any contracts provided by the service providers. It is imperative that the senior or the senior’s family or caregiver have a clear understanding of the servicer’s contracts, what services are provided, what services fall outside of the basic agreement, and who is obligated to pay for the services provided.

Older adults and their families should also consider the service provider’s policy regarding staff qualifications, staff training, and educational requirements.

Finally, older adults and their families should consider what long term care financing options are available to the senior. Will the senior pay for long term care out of pocket, through insurance, or with public assistance like Medicaid? An attorney may assist a senior or their family in determining the financing options available to the senior.


Craige & Fox, PLLC has helped numerous families face and overcome the challenges associated with long term care planning and financing through proper legal planning. If you or a loved one need assistance in determining the best course of action for long term care needs, please contact our office.