For many years, long-term care (LTC) was essentially defined as "nursing home care." But most people have a strong desire to recover from illness or to grow old in their own homes if at all possible. This has created a trend toward medical treatment and LTC provided in the home by family, visiting nurses, or aides.

A variety of other important community-based services have also become available, including home-delivered meals and adult daycare centers. In many cases, the appropriate level of care can now be arranged at home so that a person can remain there much more economically than by going into a nursing home.

Long-term care can be many things, but it is not exclusively medical care. LTC is not intended to make you "better." Rather, it can make your life better. In the situations we are focusing on here, the need for care is simply the result of the aging process and its associated ailments and conditions.

For those who develop a severe mental impairment such as Alzheimer's disease or senile dementia, the appropriate LTC would involve supervision to protect against threats to their own health and safety. In the case of a chronic physical illness or disability, LTC could mean assistance with the essential functions and activities of everyday life.

Six of the most basic of these functions have been widely recognized:

These constitute the activities of daily living (ADL) used by insurance companies to measure the need for long-term care. There are a myriad of other functions that have become practically essential, such as using the telephone, paying bills and managing money, going to the grocery store, etc. Assistance with these kinds of tasks is certainly part of long-term care needs, but it is important to note that the ADLs are of primary importance in insurance matters.

Because LTC is distinct from healthcare, it does not always require a medical setting. Care can be given in the home, out in the community, or in a residential facility. When money is not the predominant concern, it is the individual's own circumstances and preferences that should dictate where and how the care will be delivered.

Until recently, the nursing home occupied center stage as our aging society turned its attention to the issue of LTC. This was never because anyone liked the idea, but because there weren't many alternatives.

Today, the traditional nursing home has been moved to the periphery of a wide assortment of much-preferred LTC services the public has demanded. Together these services form a graduated progression in the level of care available as we make our way through the aging process. It is a continuum.

On one end is personal (non-medical) care in the home using family or aides, when only minimal or occasional assistance is sufficient. On the other end is the nursing home, which can provide skilled care and a level of supervision that cannot be rendered in the home or on an outpatient basis. The broad middle of the continuum is itself a range of home healthcare options, resources in the community, and residential arrangements outside the nursing home.

Here is a brief list of the settings in which LTC is now being delivered. Keep in mind, however, that a given level of required care can be found in more than one setting.