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Weigh Your Options Before Choosing Long-Term Care

More families find alternatives for loved ones

Dan Nainan moved back in with his parents earlier this year to supervise their care, after food poisoning and dehydration sent his 81-year-old father to the hospital.

It quickly became clear that a part-time nurse was not enough, especially since Nainan, a comedian and actor, was often away for performances and auditions. The family faced a confusing array of long-term care options: home health aides, adult day care, a nursing home, assisted living or some combination of care.

"It's been stressful," said Nainan, of Chevy Chase. "It's really important to get as much information from as many sources as you can, even if you don't think it will be useful."

A good place to start is AARP's Caregiving Resource Center, which offers information on housing and other topics.

"Too many people continue to think that their only choice is to stay in their current living situation or to go into a nursing home," said Alice H. Hedt, the state long-term care ombudsman. "The truth is that in Maryland there are a wide number of options that individuals and their families should consider before they make the decision about where to go next for their care."

The number of Marylanders age 85 and older, those most likely to need long-term care, is expected to nearly double by 2030. While the state's average rate for home health aides mirrors the national average ($19 per hour), nursing homes cost an average of $221 a day for private-pay residents in 2008, the 13th highest rate in the nation. About 600,000 Marylanders care for a loved one at home.

One of them is Etta Beckett. A fall sent her mother to the hospital, and then to a nursing home for physical therapy and rehabilitation. Beckett's mother hated the nursing home and assisted living, so the family moved her to their Baltimore-area home and enrolled her in adult day care.

"It's kind of stressful. I can't leave her alone without reliable help," said Beckett, and the help is usually Beckett's husband or teenage children.

Hank Greenberg, AARP Maryland director of advocacy, participated in a study group that reviewed continuing care retirement communities. Its recommendations will likely form the basis of a legislative proposal next year. A continuing care retirement community provides housing and other amenities, with access to on-site health care as residents progress from independence to assisted living and then nursing home care if needed. Greenberg said the financial commitment and fees should be clear before people buy into a community, and residents should be adequately represented on the governing boards of these communities.

"The growing senior population must feel safe and secure in their ability to age with dignity and receive appropriate services at home and in their community for as long as possible," he said.

As for Nainan, he searched the Internet and consulted a social worker, doctors, the Montgomery County Area Agency on Aging and Meals on Wheels. He hired a nurse for four to eight hours a day, so his parents can stay in their home for now.

For help, contact the Maryland Department of Aging at 1-800-243-3425 or visit. The website also lists, by county, the Area Agencies on Aging.

If you would like to work on long-term care and other issues as an AARP volunteer advocate during the Maryland General Assembly, register for an upcoming training session by calling 1-877-926-8300 toll-free or by e-mailing

Katherine Lewis is a freelance writer based in Maryland.

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