Long-term care services are available in many communities.

These programs try to support older people in the most independent living situation possible. These "home care" services include:

• Home health care: from a nurse or other medical personnel;

• Personal care: help with bathing, grooming and transferring from chair to bed;

• Homemaker services- housekeeping, cooking and grocery shopping;

• Hospice: support for people with terminal illnesses;

• Respite care: temporary relief to caregivers;

• Adult day health care: day care that provides some medical care, plus physical, occupational and speech therapy;

• Adult day support centers: day care that provides recreation and social stimulation; and

• Special day care: for persons with special needs.

Home care services assume that a person receiving these services has additional assistance from family or friends. When such support is not available, the individual may need to move to an assisted living facility or residential care facility to have his or her needs met. These facilities provide room and board plus personal care (help with bathing, grooming and medications) in a supervised environment. If a higher level of long-term care is needed, the individual may have to be cared for in a skilled nursing facility. These types of facilities are discussed later in this guide.

Note: The availability of home care services varies greatly from community to community, as does the cost of these services.

Information about services in your local area is available through the network of Information and Assistance (I & A) programs throughout California. These programs are funded through California's 33 Area Agencies on Aging (AAAs). The AAAs are responsible for the planning and delivery of services for older persons and persons with disabilities. (All states and U. S. territories have similar aging networks.)

Area programs are designed to fit the needs of older people in each specific region. Through your local I & A program, you can find out about the location of senior centers, senior nutrition sites, adult day support centers and adult day health care centers, Alzheimer's resource centers, "Meals on Wheels" programs, transportation, care management programs, home health agencies, hospice programs, legal services and health insurance counseling.

Note: To find out about services where you live, check the telephone directory for the Area Agency on Aging (AAA) nearest you. If you are looking for services for a relative who lives out of state or in another city, the Eldercare Locator, a nationwide toll-free information and referral service, can give you telephone numbers for programs in all areas of the United States. From the West Coast, this information is available Monday through Friday between 8 a.m. and 5 p.m. by calling 1-800-677-1116.

Depending on your preference and the state of your health, you may want to stay in your home, or you may be happier living in a retirement community or apartment. If you choose to stay in your own home, it is not enough just to locate the services you need, you may also need to adapt it to your changing needs.

Safety is a prime concern. Take a look around your home. Do you need to make changes in the physical environment to ensure safety? All staircases should have handrails that are sturdy and easy to grasp. Bathtubs should have grab bars and nonskid mats. Sliding glass doors on the bathtub add another inch or so over which you must step. Removing the glass doors or installing a bath tub that is much lower may be beneficial. Grab bars by the toilet may also be helpful.

If climbing stairs becomes difficult, you may want to move your living functions to the first floor. Falls are a major cause of disability and/or death in the home. Throw rugs are a prime suspect in many falls and should be discarded.

If you find that you forget to turn off the burners on your stove occasionally, try using a timer as a reminder or only use the microwave when you are alone.

Many older people begin to limit their activities when they develop problems with their eyesight. Steps can be taken to reduce hazards caused by changes in eyesight. Even without eye injury or disease, an 80 year-old needs three times the intensity of light to see as well as a 30 year-old in similar situations. Therefore, lighting should be more intense, but without glare. Hallways, staircases and entry ways should be well-lit.

Hearing losses can be minimized by installing amplifiers on telephones and by using drapes and carpets to deaden external noise. Phones should be located in areas where they are easy to reach. A cordless phone may be one solution. Anyone living alone should have a phone by the bedside in case of emergency!

Another consideration for people who live alone is an emergency response system. A small unit attaches to your clothing. If you should fall or need assistance in any way, you press the alarm and a signal shows up on a screen in the emergency room of the local hospital. Some systems require a call-in by a certain time each day. If a phone call is not received, someone comes out to check on you. These systems are inexpensive.

Note: Your Area Agency on Aging (AAA) should know which hospitals have emergency response systems. Before leasing or purchasing a system, talk with other users to see if they are satisfied with the product.

Many older people develop support systems with their neighbors. A signal, such as raising the blinds by a certain hour each day, can alert a neighbor to a problem. Most postal workers are trained to report mail that has not been picked up and other signs that a problem may exist. You can find many ways to make your environment safe, allow you to remain at home and delay the need for long- term care.

If your health remains good and the neighborhood remains vital, staying in your home has many rewards. And, there are some financial advantages to continuing to own your own home. However, the positive aspects of staying in your home can sometimes be outweighed by the responsibilities of home maintenance and repairs. If your health begins to fail, cherished neighbors move away or the neighborhood deteriorates, the emotional cost and worry may not make this an ideal living situation.

Independent living includes senior retirement communities, retirement apartment buildings, mobile home parks and independent single family dwellings with no built-in services.

Congregate facilities are retirement apartments where housekeeping, meals, laundry and other amenities are available.

Residential care facilities provide room and board, assistance with personal care and any necessary supervision. They range in size from the small, two- to six-bed, "mom and pop" operations to facilities with over 200 living units. They are licensed by the California Department of Social Services.

Assisted living facilities are often a wing of a congregate facility. They provide assistance with personal care in addition to the services provided in the congregate facilities. These facilities are licensed by the California Department of Social Services as Residential Care Facilities for the Elderly.

Continuing care retirement facilities are retirement communities where an individual purchases his or her own housing unit. Residents pay a large one-time entry fee plus a monthly maintenance fee in exchange for the assurance of lifetime long-term care. Upon entering a CCRC, a resident is required to sign a legally binding contract. Since this contract has serious financial implications, this decision should be discussed with your financial planner and the contract reviewed by your attorney. These facilities are licensed by the Departments of Social Services and/or Health Services.

Nursing facilities are licensed by the California Department of Health Services to provide both skilled nursing and custodial care. Residents receiving skilled nursing care usually are convalescing from serious illness or surgery and require continuous observation and rehabilitation. The most common type of care given in nursing homes is custodial care and provides assistance with activities of daily living (ADLS) such as bathing, grooming and toileting. Most residents who are receiving custodial care have cognitive impairments such as

Alzheimer's disease, or they are extremely elderly and can no longer care for themselves safely at home.