by Attorney Joseph L. Matthews

An open discussion can secure the right kind of long term care at the right time.

If you need long-term care, you may find it hard to raise the topic with others because it seems like a blow to your self-esteem -- a subject that means you are really "old." You may also be reluctant to begin the process of giving up some of your independence or surrendering full control over your life. And when you know you will need the help of your family, you may hesitate to raise the subject because you don't want to become a burden.

On the other hand, if you believe that someone else -- a family member or other loved one -- is in need of care, you may be reluctant to bring up the subject because it may seem like a challenge or an insult. And within the family there may be anxiety, guilt, and wide differences of opinion about what care is needed and who should provide it. The first step in getting necessary care is to overcome this reluctance to talk about it.

Here are some people who can help you begin to evaluate long-term care needs:

• Your personal physician is often a good place to start, not necessarily to moderate discussions but to define medical needs and refer you to others who may be helpful in making care arrangements.
  
  
• Traditional word-of-mouth is still one of the best ways to begin tackling any new problem. Friends and neighbors whose opinions you trust, and who may have already faced similar situations, are often a good source of information. The people at your local senior center may also know of sources for long-term care assistance. These word-of-mouth sources often let you know of "unofficial" personal care aides who would not be available through more formal channels.
  
  
• A clergy member may be able to help directly or to refer you and your family to professionals who can introduce alternatives and coordinate planning.
  
  
• County family service agencies, Area Agencies on Aging, or other senior information and referral services are experienced sources that can provide direct access to specific care providers and help you develop an overall care plan. These agencies can direct you to a counselor or social worker who specializes in long-term care for elders and can help you begin your discussions and planning.
  
  
• If residence in a nursing facility is not absolutely necessary, many people make use of the services of a professional geriatric care manager to see what at-home and other supportive services are available and to organize care from different providers.
  
  
• If your loved one has Alzheimer's disease or a similar mental impairment, you can turn to organizations that specialize in this disease.