Understanding Long-Term Care Options: A Guide for Michigan Families
For many Michigan families, the prospect of long-term care for themselves or a loved one can feel daunting. From assisted living facilities to in-home care services, the landscape of senior care options can be both vast and confusing. Whether you are caring for a parent, planning ahead for yourself, or navigating the Medicaid eligibility process, knowing the different types of long-term care is essential. In this article, the Michigan Estate Planning Attorneys of Thompson Legal will explore key long-term care options, discuss how to plan for them, as well as highlight legal tools available to protect assets and ensure your loved one’s quality of care.
Please note that this post is not exhaustive, and every situation is unique. In the event that you have legal questions it is advisable to speak with a licensed attorney. Contact Thompson Legal to speak with a Michigan Estate Planning Attorney today.
What Is Long-Term Care?
According to the National Institute on Aging, long-term care involves a range of services and supports to meet personal care needs of an aging individual over the course of their lifetime. This care is most often not just medical services, but rather helps with activities of daily living (ADLs) such as bathing, dressing, or eating. While many assume that Medicare will pay for these services, it typically does not cover non-medical long-term care.
Types of long-term care can include:
In-home care (e.g., home health aides, visiting nurses),
Adult day care services,
Assisted living facilities,
Skilled nursing care (nursing homes), and
Memory care units.
Understanding the Different Types of Eldercare: Custodial vs. Skilled Nursing Care
Before choosing a type of long-term care or planning for these expenses, it’s important to understand the two primary types of elder care that can be provided. These categories of elder care services include:
Custodial Care: This type of care is non-medical and can be provided by unlicensed caregivers. It includes assistance with activities of daily living (ADLs) like dressing, eating, bathing, and grocery shopping.
Skilled Nursing Care: Skilled care involves medical services that must be performed by licensed nurses or therapists. This includes services such as wound care, IV therapy, medication administration, and physical therapy.
Home-Based Senior Care: Comfort with Limitations
Most older adults want to stay in their homes as long as possible, and for good reason. Home-based care allows seniors to maintain their routines, independence, and comfort in familiar surroundings, which can significantly improve quality of life. However, while it’s often the preferred option, home care brings a number of challenges.
One of the biggest limitations is cost. Medicare typically does not cover non-medical personal care services, such as assistance with bathing, cooking, or cleaning. Medicaid may offer some coverage, but benefits vary by state, and many families face long waitlists or approval for only a limited number of hours—often insufficient to meet full-time care needs. Additionally, not all seniors have the support of nearby family or friends, which means they must rely on home care agencies or hire private aides—adding to the expense. Without adequate planning or long-term care insurance, families are often left to cover the costs out of pocket.
Facility-Based Senior Care: Structured Support and Medical Oversight
When living at home becomes unfeasible, various residential options provide different levels of care and supervision. As care needs increase, facility-based care may offer more stability, cost-efficiency, and oversight. Key facility-based options include:
Adult Foster Care (AFC) Homes: These are licensed residential settings, often in a home-like environment, that provide supervision, personal care, protection, and room and board for up to 20 residents. Many AFC homes specialize in caring for individuals with specific needs, such as developmental disabilities or memory impairment.
Homes for the Aged (HFAs): Licensed for 21 or more residents (typically aged 55 or older), HFAs offer room, board, supervised personal care, and assistance with ADLs. While often marketed as "assisted living," HFAs generally do not provide continuous skilled nursing care on-site unless arranged through a third-party home health provider.
Assisted Living Facilities (ALFs): The term "assisted living" is widely used in Michigan, but facilities using this designation are typically licensed as either AFC homes or Homes for the Aged. They offer a range of services designed to help residents maintain independence while receiving assistance with daily tasks.
Memory Care Units: Many AFC homes and HFAs offer specialized memory care units for individuals with Alzheimer's disease or other dementias. These units are designed with features to enhance safety, reduce wandering, and provide structured routines with staff specifically trained in dementia care.
Nursing Homes (Skilled Nursing Facilities): Nursing homes provide the highest level of long-term care, offering 24-hour skilled nursing care, medical supervision, rehabilitation services (physical, occupational, speech therapy), and assistance with all ADLs. They are appropriate for individuals with significant medical needs or those recovering from acute illnesses or injuries.
Continuing Care Retirement Communities (CCRCs): With the “Aging in place” model—residents can transition between independent living, assisted living, and skilled nursing within the same community. This combination minimizes the stress of relocating as care needs increase.
Choosing the Right Type of Senior Care
Selecting the appropriate type of senior care involves evaluating both current needs and future possibilities. Begin by considering the senior’s medical conditions, mobility, cognitive status, and level of independence. A senior who is mostly independent but needs occasional help may thrive in an assisted living facility, while someone with complex medical issues might require the round-the-clock care of a skilled nursing facility.
Cost, insurance coverage, proximity to family, and waitlists are also important factors. Touring facilities in advance, speaking with staff, and asking detailed questions—such as whether the facility offers aging-in-place options or specialized care for dementia—can help avoid last-minute decisions in a crisis. Families should also assess whether the facility supports social engagement, therapeutic services, and safety features such as emergency call systems or fall-prevention programs.
Most importantly - start planning before a crisis arises. A fall, hospitalization, or cognitive decline can rapidly change a loved one's needs. It is always best to avoid rushed decisions by considering multiple options, visiting different facilities, asking questions, and consulting with elder law professionals. Key questions to ask during your research should include:
What levels of care are offered?
Are there waitlists?
What is included in the base fee?
Are pets allowed?
Can you transition into skilled care later?
Conclusion: Plan Today to Protect Tomorrow
Long-term care is a personal, financial, and emotional journey. By understanding the diverse options available in Michigan, from in-home assistance and community programs to various residential facilities, you can make choices that truly reflect your loved one's needs and wishes. From Medicaid eligibility to asset protection, Thompson Legal helps Michigan families prepare for every stage of eldercare. Contact Thompson Legal today to discuss how we can help your family plan for tomorrow, confidently.
This article is for informational purposes only. It is not intended as legal advice. In the event you would like to speak with an Estate Planning Attorney, please Contact Thompson Legal at (734) 743-1646 to schedule a consultation.
