Community care alternatives for older adults

Abstract

Older adults often have multiple chronic comorbidities and functional impairments, necessitating care models that address both medical and custodial care needs. The majority of older Americans prefer to avoid institutional care, creating a need for high-quality, cost-effective, community-based models of long-term care. Community-based care exists along a continuum ranging from care provided in the home to daytime-only care for individuals who continue to live in private homes to residential care options. Patients and their families can choose home-based care, adult day care, Programs of All-Inclusive Care for the Elderly (PACE), independent living senior housing, assisted living, adult foster care, or continuing care retirement communities (CCRCs), depending on how much assistance they need. Medicare and private health insurance have a limited role in financing long-term care, so most of these options are paid either out of pocket or by Medicaid. There is limited high-quality evidence that any one model is superior to another or to nursing home care with regard to quality of care, patient outcomes, or cost. Choosing a setting of care is an opportunity for shared decision-making. Primary care providers who have an understanding of the available options in their communities can help patients and their caregivers choose the most appropriate setting for long-term care.