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Most long-term care is provided at home. Other kinds of long-term care services and supports are provided by community service organizations and in long-term care facilities.

Examples of home care services include:

  • An unpaid caregiver who may be a family member or friend
  • A nurse, home health or home care aide, and/or therapist who comes to the home

Community support services include:

  • Adult day care service centers
  • Transportation services
  • Home care agencies that provide services on a daily basis or as needed

Often these services supplement the care you receive at home or provide time off for your family caregivers.

Outside the home, a variety of facility-based programs offer more options:

  • Nursing homes provide the most comprehensive range of services, including nursing care and 24-hour supervision
  • Other facility-based choices include assisted living, board and care homes, and continuing care retirement communities. With these providers, the level of choice over who delivers your care varies by the type of facility. You may not get to choose who will deliver services, and you may have limited say in when they arrive.


For many, a blended approach to long-term care works best. Most consumers want to remain in their homes for as long as possible and delay facility care until they need it. Plan early and look for flexible options that give you more say.

Participant Directed Services are a way to provide services that lets you control what services you receive, who provides them, and how and when those services are delivered. They provide you with information and assistance to choose and plan for the services and supports that work best for you including:

  • Who you want to provide your services (can include family and friends)
  • Whether you want to use a home care service agency

In facility-based services you generally don't have the option to hire someone independently, but you should have choices about:

  • Which staff members provide your care
  • The schedule you keep
  • The meals you eat

In home and community-based settings, you should have the ability to participate or direct the development of a service plan, provide feedback on services and activities, and request changes as needed.


Many publicly funded programs that provide home and community services, such as Medicaid, are using this approach because it is more what people want.

Last modified on 02/18/2020