by Attorney Joseph L. Matthews

Understand the different types of long-term care facilities -- and how planning ahead can help you choose the best option.

Despite significant recent growth in home care and alternative seniors' residences, nearly one of every two women and one of four men over age 65 will enter a long-term care facility (a.k.a. "nursing home") at some time in their lives. Many nursing facility stays are short ones, to allow a senior to recuperate from an illness, injury, or surgery. But many other stays are extended: More than a third of all nursing facility stays last more than a year, and many last three years or more.

Many people would prefer to remain outside a care facility. However, some seniors, because of their condition, circumstances, or the unavailability of in-home services or affordable assisted living residences, can receive adequate care only in a residential care facility.

Most residents in long-term care facilities cannot function without 24-hour monitoring, extensive personal assistance, and nursing care because of illness or physical or mental limitations. Other residents are in relatively good physical and mental health, but too frail to live alone at home. If they had more family or resources, many of these people might be able to make do with home care or living in an assisted living facility. For lack of an alternative, they become long-term care facility residents.

Skilled nursing facilities provide short-term, intensive medical care and monitoring for people recovering from acute illness or injury. Other facilities -- called nursing homes, board and care homes, sheltered care homes, or something similar -- provide custodial care, long-term room and board, and 24-hour assistance with personal care and other health care monitoring, but not intensive medical treatment or daily nursing.

Your task is to find a good and affordable nursing facility that provides not just care, but the right type of care. For someone with severe physical or mental limitations, it is crucial to find a facility that provides the kind of attention and care that meets the individual's specific needs. For people who need little or no actual nursing care, the task is to find a facility that provides physical, mental, and social stimulation rather than merely bed and board.

Unlike other nursing facilities, hospital-based facilities are not for permanent residence, but for a short-term stay until a patient can be sent home or maintained elsewhere. Hospital-based facilities are very expensive ($300 to $500 per day), but the average stay is generally short (usually a matter of days or weeks) and, for those who qualify, is usually covered by Medicare or private insurance.

Around-the-clock nursing is available from licensed vocational or practical nurses, with at least one supervising registered nurse on duty at all times. In addition to nursing, most other prescribed medical services can be provided, including various rehabilitative therapies. An SNF is almost always for short-term recovery from a serious illness, injury, or surgery that required hospitalization. A few people may spend months in an SNF, but most stays last only days or weeks.

The cost of SNF care ranges from $200 to $500 per day. Medicare, Medicaid, and private insurance will pay for SNF care, but only up to specific coverage limits.

Staff is geared as much toward personal care and assistance as to medical care, although there is always a licensed vocational or practical nurse on duty. ICFs generally care for people who need a long recovery period from serious illness, injury, or surgery, but who no longer need the level of nursing care and high-tech monitoring that an SNF provides.