What type of care is needed?

Before contacting a care provider, determine the amount and type of care needed. Usually, an elder's physician or other health care provider can provide advice on the level of care required. A determination by a physician that services are medically necessary is required to obtain coverage through the Medicare or Medicaid programs.

Who Pays for Long Term Care?

Long term care is paid for with personal assets, health or long term care insurance, or government programs such as Medicaid and Medicare.

For information about long term care insurance, contact the Executive Office of Elder Affairs at (800)-822-2003 or the Division of Insurance at (617)-521-7777.

For more information about Medicare, contact Medicare at (800)-822-1228, or your local area agency on aging. For the name of your area agency on aging, contact the Executive Office of Elder Affairs at (800)-882-2003. For information on Medicaid coverage, contact the Massachusetts Health Customer Service Center at (800) 682-1062.

For elders with insurance or who are eligible for Medicare or Medicaid, be sure to verify coverage in writing before services are provided.

Home-Based Care

Home-based services help older people live independently at home. Home-based services are provided by home health agencies, visiting nurse associations and state-funded home care corporations. They include the following:

Homemaker Services to maintain household functioning by providing help with:

  • Home Management, including shopping, meal preparation and light housekeeping; and
  • Personal Care, including bathing, dressing, grooming and toileting.

Home Health Care Services to manage health and medical conditions which can be treated at home. These services are provided by:

  • Home Health Aides, who provide basic health care services such as personal care, recording temperatures and pulses, changing simple bandages and assisting with self-administered medications; and
  • Licensed Nurses & Therapists, who provide skilled nursing care and restorative and therapeutic services.

Many, but not all, home care agencies are certified by the Department of Public Health to provide basic health care and physician-authorized services. Certification is required to have services covered by Medicare and Medicaid, and also shows that the agency meets certain minimum standards.


ADULT DAY HEALTH PROGRAMS provide supervision, recreation and health and personal care services during the day to older people so that family caregivers can work or attend to other responsibilities. Adult day health programs must meet minimum standards established by the state Division of Medical Assistance.

ADULT FOSTER CARE PROGRAMS match elders who are no longer able to live alone with families willing to provide room and board, meals and personal care. Families are paid a stipend by the State Division of Medical Assistance for elders who are Medicaid-eligible.

RESPITE CARE is short-term care provided at home, in a long term care facility or at a community-based center to give families caring for elders some time off in their caregiving responsibilities.


A wide variety of supportive housing options exist for elders who no longer wish or are able to live alone, but do not need 24-hour care. Since the nature of these facilities varies greatly, it is important for elders and their families to get detailed information on the services offered and have a clear understanding of how services are financed. In addition, elders should always consult a trusted family member, friend or financial advisor before signing any contract.

Congregate Housing Facilities provide a living arrangement in which elders have a private bedroom and share common space with others. Support services are also usually available to help elders maintain their independence. Most congregate housing facilities are sponsored by local municipalities or nonprofit organizations.

Continuing Care Retirement Communities (CCRCs) offer a continuum of housing and support services that enable older people to have their changing needs met in one location. Many CCRCs offer independent and assisted living housing as well as nursing facility care, all on one campus. As a resident's needs change, he or she can choose from among the range of services offered.

Assisted Living Residences combine apartment-like living with a variety of support services, including meals, assistance with personal care, 24-hour security and on-site staff to respond to emergencies, help with medications, housekeeping and laundry services, and social and recreational programs. All assisted living facilities must be certified by the Executive Office of Elder Affairs (EOEA), which is required to conduct reviews of facilities every two years. By state law, assisted living residences are prohibited from admitting or retaining individuals who need skilled nursing care for more than 90 days in any 12-month period.

Rest Homes provide housing, meals, 24-hour supervision, administration of medications and personal care to individuals who do not require extensive nursing or medical care. Rest homes are licensed by the Department of Public Health.


Nursing facilities provide a wide range of services, from subacute care to rehabilitative care to their more traditional role of providing long term care to the chronically ill and disabled. Among the services provided by nursing facilities are 24-hour nursing care; rehabilitative services. Such as physical, occupational, and speech therapy; as well as assistance with the activities of daily life such as eating, dressing, toileting and bathing; activities; and social services. Some facilities specialize in the care of certain types of patients, such as those with Alzheimer's disease, while others offer extensive rehabilitation programs to ease the transition from hospital to home.

All nursing facilities are inspected annually by the Department of Public Health to ensure that they meet state and federal quality standards. In addition, a growing number of facilities are seeking accreditation from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), a private accreditation organization.

Coverage for nursing facility care is available under both the Medicare and Medicaid programs. Medicare beneficiaries are eligible for up to 100 days of skilled nursing or rehabilitative care. Medicaid coverage is available for those who have exhausted their own resources and require public assistance to help pay for their care.


Choosing the Best Long Term Care Option

- A Guide for Elders & Their Families

Presented in cooperation with:

The Massachusetts Attorney General's Office



Public Protection Bureau
One Ashburton Place
Boston, MA 02108

617.727.8400 Consumer Hotline


One Ashburton Place, Fifth Floor
Boston, MA 02108

617.727.7750 Ombudsman
1.800.882.2003 Information & Referrals
1.800.992.2275 Elder Hotline with TTD

Division of Health Care Quality

10 West Street
Boston, MA 02111



600 Washington Street
Boston, MA 02111



2310 Washington Street
Suite 300
Newton Lower Falls, MA 02162


Publishes a Guide to Extended Care Facilities and a Guide to Assisted Living and Continuing Care Retirement Housing. Both are free.


20 Park Plaza, Suite 620
Boston, MA 02116



VISIT the facility on several occasions and at different hours of the day.

CONSIDER how close the facility is to friends and family, and to a hospital if needed.

READ and ask questions about recent state inspection reports on the facility. Federal law requires nursing facilities to make these reports available.

ASK about the staff-to-resident ratio. How many hours of nursing or personal care are provided per resident per day?

LISTEN for the content and tone of the staff as they speak with residents.

SMELL for any strong odors which may indicate poor assistance with personal hygiene or other unsanitary conditions.

LOOK at how residents are dressed and groomed, and whether they are sitting alone or interacting with other residents or staff.

LOOK for restraints on residents. Federal law prohibits restraints unless medically necessary and ordered by a physician. Ask how many residents are in restraints and why.

TALK to current residents and their families and ask for their opinions about the facility.

LOOK at and sample the food. What is the quantity and quality? Are special diets available?

GET DETAILS IN WRITING on what services will be provided and living arrangements.

ASK if the services to be provided are covered by Medicare and/or Medicaid, and if any changes in coverage are anticipated.


Is the provider (long term care facility or home care agency) certified or licensed by the state? If yes, ask to see the most recent inspection report.

How will the provider assess the services you need? Will the assessment be performed by a medical professional? What happens if your needs change in the future? Will you be allowed to remain at the same facility of served by the same agency if your care needs change?

Will an experienced medical professional supervise your care plan? Will she/he ask for your input on your care plan?

How does the provider screen and hire caregivers? Does the provider check caregivers' references and background, including for any past criminal conduct?

What is the training and experience of caregivers? Does the provider require continuing education? What does that continuing education consist of?

Do caregivers have experience or receive training in the type of care you need? Are caregivers trained to report changes in your health condition? Who will be supervising your caregiver and with what frequency?

How does the provider assure continuity of care? How long do caregivers stay with the agency/facility, and what is the turnover rate?

What are your options if you are not happy with your care plan or caregivers? Is there a grievance procedure or client committee?

Are there any additional or hidden costs? What services, if any, are not included in the daily or hourly rate?