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Some health conditions come with clear warnings, such as pain, coughs, or dizziness, that indicate something’s wrong. But the need for long-term care can be a slow build, showing up in the little things like missed medications, falls, or growing burnout from a caregiver. Recognizing that your loved one needs long term care can be one of the hardest parts of the journey. Maybe you will see yourself or your loved one in this fictional, yet relatable account of a family coming to this understanding...

My mom, Carol, who is in her late 70s, has always been fiercely independent. She’s lived in the same home for the last 35 years and has lived alone since my dad passed away about a decade ago. She loves to garden, craft, and bake her famous chocolate chip cookies.

Lately, though, our family has started to notice some changes. It started with forgetting about a doctor's appointment and mixing up her medications a couple of times. Then, the garden she cared for every summer became overgrown with weeds. We thought ‘it’s just a normal part of aging,’ but then we noticed a few dents on her car that she couldn’t explain...

She’s become a bit more withdrawn and doesn't seem to have the energy she used to. Last week, I stopped by mom’s house on my way home from work and found the stove had been left on and the kitchen smelled like smoke. She dismissed it, saying she just got distracted. But as I stood there, a knot formed in my stomach, and I realized we would have to face a difficult conversation about her healthcare soon. The final wake-up call came when she took her second bad fall in the middle of the night. Thankfully, she was not seriously injured either time.

While she can still do many things on her own, the risks of living alone will just keep growing. This is the point when our family needs to start exploring long term care options -not because we want to, but because we want to ensure she remains safe, healthy, and has the support she needs.

Many families face this moment: When the conversation about long-term care shifts from a distant concern to an urgent reality. While medical events are unpredictable, waiting until an emergency occurs can make long-term care planning more stressful. Keep reading to explore the various care options available, when it’s time to consider them, and why having a proactive conversation about your healthcare wishes is the most important step you can take to prepare for the future.

What is long term care?

When you hear 'long term care,' you might picture a nursing home, but it’s actually a broad term for a range of medical and non-medical services designed to help people who can no longer perform daily activities on their own. In fact, long term care comes in many forms to meet an individual’s unique needs. Common options include:

In-Home Care: This is often the first and preferred option, as it allows a person to stay in the comfort of their own home. Services provided at home could range from a few hours a week to 24/7 care and can include help with bathing, dressing, and eating, as well as light housekeeping and companionship. If someone has suffered a medical event like a stroke or fall, skilled care at home (nursing, physical, occupational, and speech therapy) are options as well.

Skilled Nursing Facilities: For those who need 24/7 medical care. Often used for short-term rehabilitation after a medical event, hospital stay, or long-term care for complex medical conditions.

Community-Based Care: A middle ground, offering support to individuals and caregivers, designed to allow a person to continue living in their own home or space. These options can help with meals, housekeeping, medication management, and social activities.

• Adult Day Centers: A place for seniors to socialize and get supervision during the day.

• Assisted Living: For individuals who need some help with daily tasks but don't require 24/7 medical supervision. These are often condos or apartments that provide a residential feel. While moving into one of these communities means leaving your current home, the setting is designed to offer a balance of independence and support.

Memory Care and Nursing Homes: When a loved one requires more consistent supervision, a nursing home facility may be the best choice. Memory care is a specialized, secure environment for people with Alzheimer's disease or other forms of dementia. They help people build a structured routine and offer activities designed to support cognitive function.

Great River Health provides a comprehensive range of these services, such as:

• Home Health Care: We offer custodial (non-medical support) and we also offer in-home skilled nursing and rehabilitation.

• Klein Center & Park Place (at Henry County Health Center): These are residential facilities offering services like short-term stays for rehabilitation with the goal of returning home; they both have memory care units and long-term stay options with assisted living support.

When to seek long term care?

Recognizing the signs that you or a loved one may need long-term care can ensure safety and well-being. Some changes are subtle and gradual, but others can be sudden and point to an immediate need for assistance. Some common indicators that it may be time to consider long-term care include:

• The presence or history of falling, a decline in mobility, or difficulty with balance.

• Medication errors- forgetting to take pills or taking the wrong one.

• Experiencing a recent hospitalization or a worsening of a health condition.

• When the primary caregiver is no longer able to manage the needs of their loved one.

• Increased isolation, social withdrawal, or lack of interest in activities once enjoyed.

• Difficulty with personal hygiene, such as bathing, dressing, and grooming.

• Struggling to prepare meals or a noticeable change in weight (loss or gain).

• An unclean or cluttered home, including unpaid bills or an overflowing trash can.

• Leaving the stove on, forgetting to lock doors, wandering, or other risky behaviors.

• Significant memory loss, confusion, or getting lost in familiar places.

The future need for long-term care is often an overlooked consideration, but the reality is: seven out of ten Americans aged 65 or older will eventually require some form of long-term care. Thinking ahead about this possibility, understanding your options, and communicating your wishes for long-term care, estate planning, and advance directives is crucial in protecting your finances, your healthcare wishes, and your family during difficult times.

For more on how to prepare your finances and health for retirement, be sure to read our blog on retirement planning. For guidance on the essential documents you should have, click here.

How to facilitate this conversation with a loved one:

When it comes to having this conversation with a loved one, remember that everyone may have different ideas about long-term care and what it is. Common reactions may include stubbornness, denial, sadness, or anger. These feelings and reactions are valid and natural.

It’s important to note that just as the need for long term care can develop gradually, so can the conversation around it. It’s rarely a one-time talk, and it often unfolds over several months or even years, especially if there isn’t an immediate need to make decisions. If you’ve been needing to have this conversation, choose a quiet, private time when neither of you feels rushed and approach the conversation with empathy, love, and patience.

Dr. David Carlson, Medical Director of Home Health and Hospice at Great River Health, offers helpful advice on starting difficult discussions. He shared that when he first brought up the idea of completing an advance healthcare directive with his own parents, they weren’t open to talking about it. But over the next two years, they revisited the topic and felt comfortable enough to move forward.

“A good opportunity to bring up these hard conversations is often when someone you know is going through a similar situation,” Dr. Carlson explained. “You might say, ‘Hey Mom, what do you think about that? What would you want in that situation?”

Remember, this is still their decision—you’re simply there to guide the conversation. Some of the things you might want to discuss include:

• Daily needs: What activities or tasks are becoming more difficult? What kind of help would make those easier?

• Preferences for care: Would they feel more comfortable receiving support at their current home, or would they consider an assisted living or long-term care facility? If so, where would they prefer to be? Close to family, or staying in the same community they are already in?

• Financial and practical planning: Have they thought about how they’d like to manage the costs of care or who should help with those decisions?

• Health wishes: What kind of medical treatments or support would they want or not want if their condition changed?

• Emotional and social well-being: What matters most to them in maintaining a sense of purpose, connection, and independence?

By approaching these questions gently and focusing on their feelings and goals, you create space for trust and understanding. The goal isn’t to make all the decisions in one talk; it’s to open an ongoing dialogue that honors their choices and values.

Taking the next step:

Once you’ve opened the conversation and begun to understand your loved one’s wishes, the next step is turning those discussions into action. Here’s a list of actions you can take to empower your family to make a thoughtful choice rather than a rushed one:

Research Care Options: Begin by learning about the different types of care available in the location that you and your loved one discuss, and consider your loved one’s health, independence, and social needs. To research care options like nursing homes and home health services, use trusted resources like Medicare.gov’s Care Compare tool to evaluate quality and reputation.

Narrow Down Choices: Make a list of potential facilities or services that align with your loved one’s preferences. Read reviews, talk to friends, or healthcare providers. All nursing homes listed on the Compare Care Tool are Medicare-certified, meaning they offer services that have passed certain inspections. You can find important information there, like:

• Star ratings of 1 to 5 stars

• Health and safety inspection reports

• Quality measures

• Staffing levels of each facility
  
  
• Nursing homes that have been cited for abuse

It's important to understand that only about 10% of facilities in Iowa earn A 5-star rating. Henry County Health Center's Park Place earned a 5-star rating earlier this year. "I’m so proud of our team at Park Place. Every day, they show up with compassion, dedication, and a genuine commitment to our residents. This rating reflects the heart and effort they put into caring for our community," said Tara Pope, Park Place Administrator.

Explor Financing: Understanding costs upfront can prevent surprises later. Review insurance coverage, veterans’ benefits, long-term care policies, and any available assistance programs. Some facilities also offer financial counselors who can help you plan. To learn more about ways to pay for nursing home care, click here.

Take Virtual and In-Person Tours: Many facilities now offer online tours that allow you to get a feel for the environment before visiting. When possible, schedule in-person visits, observe how staff interact with residents, the cleanliness of the space, and whether it feels welcoming and safe. Try to involve your loved one in these visits to help them feel more comfortable and empowered in the decision.

Ask Questions and Take Notes: Bring a checklist of questions about staff-to-patient ratios, daily activities, meal options, medical support, and visiting policies.

Revisit the Conversation Often: Remember, your loved one's needs and preferences can change over time. Continue to check in regularly and adjust plans as needed.

Our approach to long term care

Moving a loved one into a long-term care facility can be an emotional decision, often bringing up feelings of guilt and fear. These emotions can be linked to outdated stereotypes of sterile hallways, loneliness, and residents who have lost their independence and the very things that bring them joy. However, modern long-term care takes a different approach. At Klein Center & Park Place, we believe that long-term care should be about living a full, active life, not just receiving medical assistance. We achieve this by having dedicated individuals who are known as 'life enhancement specialists.' These staff members ensure that there is never a shortage of opportunities for residents to stay active and engaged. Their roles involve planning events, activities, and outings -ensuring our residents always have something to do.

“Our commitment to an active, independent lifestyle is reflected in the many activities and forms of entertainment we provide. We’ve had residents ride their scooters to the local Rec Plex to watch a ball game or catch a ride to lunch with a family member; others spend the afternoon fishing in our pond. We host a weekly happy hour with cards and bingo; we bring in special entertainment, whether it’s an Elvis impersonator, a choir, a car show, a pageant, crafts, puppies, or karaoke. With the help of the community, we also recently purchased an electronic bike that residents will get to enjoy riding," said Brenda Fenton, Life Enhancement Specialist at Klein Center.

Residents make the transition to living at Klein or Park Place full-time in different ways. Some come to skilled care with the goal of going home. Our therapists and providers respect every patient's goal and strive to help them be as independent as possible to return to their home. Gina McSorley, manager of skilled care at Klein Center, explained that “if a patient’s medical or physical status does not allow them to go home, we often find that the transition from skilled nursing to living at a facility full-time is not as resisted as one might think. Some patients have been at home alone, isolated from others, and struggling with just day-to-day tasks. Once they come to a facility from home, many of them find that having the extra help, social connection, daily interactions, and activities is not just a relief but enjoyable.”