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As baby boomers get older, long term care is one of the biggest challenges facing America. The implications are immense -- financially, socially and psychologically. It will help to learn the kinds of services that are available in your community. Find out about nursing homes and assisted living. Also, look into the type of home care you can get and whether there's a PACE program in your area. There are a number of resources to help you study the options for long term care and a good place to start is your local office of the Department of Aging. It is so important to know all of the possibilities out there, so you can make the best possible decision for yourself or your loved one.

Expert: Heidi Muir, MSW, CSW

A social worker specializing in geriatric health care, Heidi Muir, MSW, CSW, of Clifton Park, New York, has worked with older adults and their families for more than twenty years. She has practiced in public and private hospitals as well as nursing home, out-patient and home care settings. From 1988 to 2002, Ms. Muir was Director of Social Work at Eddy Cohoes Rehabilitation Center and Eddy-Ford Nursing Home in Cohoes, New York, a geriatric rehabilitation hospital and skilled nursing facility affiliated with Northeast Health. Here she oversaw admissions, discharge planning, and social work services to residents, patients, and families.

Ms. Muir attended Clark University and received a Master of Social Work degree from Boston University in 1981. She completed a post-graduate fellowship in geriatric mental health at Harvard Medical School in 1985. Ms. Muir has extensive experience in program management, social work supervision, teaching, community education, and public speaking in the area of geriatrics and health care. She is also a consultant in the nursing home, rehabilitation and home care fields.

Some tips from Heidi on how to decide that a nursing home is right for you:

• Nursing home care is usually selected only when other options, such as assisted living or home care, have been exhausted or are not feasible. Look into these other resources. If possible, discuss your concerns about remaining at home with a trusted family member or loved one. Talk to your primary care doctor about your plans.
• Familiarize yourself with the sources of payment for nursing homes as well as your own financial situation. Medicare pays for only a small part of all the nursing home care delivered in the United States. Most care is paid for by Medicaid or by the residents' private resources. Many nursing homes will want to be assured of a source of payment for care before they can admit someone.
• Generally speaking, nursing homes are not appropriate living situations for people who can take care of themselves. Along with multiple medical problems, most people opting for nursing home care have limitations in two or more major areas of their everyday functioning, such as walking, standing, getting into and out of a chair or a bed, using the bathroom, bathing, dressing, and eating. You may hear these referred to as "Activities of Daily Living" or "ADL's." These functional deficits may be the result of physical or cognitive problems. If you live alone, and you require help with these things every time you attempt them, or if you live with someone else but it takes more than one person to assist you every time, you may be safer and healthier living in a nursing home.
• Each state has a different requirement about what documentation is required for an application to a nursing home. Some may require an official assessment. Call your state health department, a local nursing home admissions office, or a hospital discharge planning department for the specific requirements in your state.

Once you've made the decision, you might want some help in choosing the right facility. Take the following actions to ensure that you or your caregiver finds the proper nursing home environment for your needs.

• Familiarize yourself with nursing homes. A good place to start is the Federal government's website, www.medicare.gov. Lots of information is available here, including federal standards for nursing homes and nursing home care, how nursing homes are licensed and monitored for compliance with these standards, as well as a review of Medicare and Medicaid's roles in paying for nursing home care. Numerous links to other helpful websites are also included.
• Obtain as much information as you can about nursing homes in your area. The Federal government's website: www.medicare.gov, has a section called "Nursing Home Compare". This excellent resource allows you to search for any nursing home in the country, and contains information about the home's latest state/federal survey results as well as a review of key items that are used to measure quality of care. Staffing ratios, which are a critical concern to consumers, are also included. All nursing homes have profile information including sponsor or owner, number of beds, and occupancy rates.
• Talk to your friends and family. A recommendation made by someone you trust may be a good place to begin. Ask your doctor about facilities he/she has been to.
• Visit the nursing homes that you select. Call each home and ask for the admissions coordinator. Make an appointment for a "tour and talk." Contrary to advice you may see elsewhere, it is not a good idea to drop in unannounced or to tour yourself. It isn't fair to the residents, and you will not have the opportunity to have your questions answered.
• Ask questions during your tour. Take the time to get all the information you need. Take notes. Review admissions material and contracts. A good nursing home will honor your requests for this information.
• Pay attention to the feeling you get in a nursing home. There is more to good quality care than pretty furniture. Do you see staff communicating in a genuine way with residents? Do they make eye contact, address residents respectfully, and seem to know them well? Do residents look well-tended? Does staff appear friendly and accessible? Do they seem open to your questions? Environmentally--Is there plenty of light and color? Do residents have their own belongings in their rooms? Is the facility free of objectionable odor? Does the place look clean and tidy? Ask about food service, special diets, and preferences. Does the home conduct resident satisfaction surveys? What are the results like?
• Once your have narrowed your choices, let the staff at your first choice of facility know that their home is in fact your first choice. Inquire about openings. Keep in touch with admissions staff.

Expert: Deborah Hanish-Schreyer

Deborah Hanish Schreyer graduated from S.U.N.Y. Binghamton with a Bachelors degree in Sociology and University of Oklahoma with a Masters Degree in Social Work. She has been in the field of elder services for 23 years, starting out in the senior center environment as a center director and agency social worker for five years. Deborah then came to The Eddy, now Northeast Health, in 1985 to serve as an adult day services program manager. From then until 2002, Deborah developed and oversaw 5 adult day programs 4 medical and 1 social model, for the Eddy. Last June she took over as VP/Director of Eddy SeniorCare, a program of all inclusive care for the elderly (PACE) in Schenectady.

Many families choose to keep their functionally impaired loved ones at home, avoiding nursing home placement entirely. For those that wish to do this, a realistic assessment of the needs of the impaired elder and the ability of the caregiver, usually spouse or child, to provide that level of care is essential. Once that has been done and the commitment is made, there are a host of community based services that can assist.

• Adult day services these programs provide a day of recreational and social activity, and the supervision and assistance an individual may need to remain as independent as possible. Health care services, transportation to and from program and meals are also available in many of these centers.
• Home care services assistance with personal care in the home, such as bathing, dressing, making a meal, etc. is available from most agencies. Skilled nursing care is also available.
• Various kinds of supportive housing exist in most communities. Assisted living allows a couple to live together in a setting where the services the impaired elder may need can be provided. Adult homes and enriched housing are other housing options that can be explored. In all of these settings, assistance with personal care as well as meals, laundry, and housekeeping are available.

For assistance in finding services and determining what is right for you and your loved one, a geriatric care manager can be of tremendous value. This service is available in many communities across the country.

Expert: Kirk Panneton, M.D.

Dr. Kirk Panneton is Vice President of Medical Affairs for The Eddy Network in Troy, NY. He is also Medical Director of several regional affiliates in Upstate New York, including Eddy SeniorCare, Marjorie Doyle Rockwell Center, and Heritage House Nursing Center, as well as for the Eddy VNA, a home-based medical service organization. Dr. Panneton was in the private practice of medicine for almost 20 years. Dr. Panneton obtained his degrees in medicine from Harvard and Boston University, and underwent post graduate training at Albany Medical Center. Dr. Panneton became board certified in Geriatrics in 1988 and was re certified in 1998.

• Remain both physically and mentally active...this helps immensely to keep the mind and body feeling better and more vigorous.
• Be sure to be properly immunized. Discuss which vaccines are best for you with your doctor and be sure to stay on schedule.
• Try to limit the number of medications you take. Drug interactions and side effects account for a great number of the problems we see in the elderly. Be careful also of over the counter and herbal meds since these too can cause potential side effects.