If you're considering long term care for your parents, don't wait too long to start the discussions. If you wait until one of your parents is injured or sick, you might find yourself under pressure to make a hasty decision that everyone may later come to regret. Get to know your long term care options now and start the discussions with your parents early.

Long term care ranges from some scheduled help around the house to 24-hour care in a nursing home. The point of long term care is to help your parents maintain as much of their independence as possible by helping them with the things they can't do any more, whether it's the weekly shopping or bathing and dressing. This independence is balanced with keeping your loved ones safe. Knowing that someone's there to help can take stress off them and you, too.

Several levels of long term care exist. When choosing long term care for your parents, get to know what to expect from each level of care. This will help you pick the type of long term care that's most appropriate.

• Home care. Home care includes medical care — usually nurses who come to your parents' home if they can't go out. But this category of long term care also includes help around the home. Home health aides or personal care service workers can visit daily to help your parents bathe and get dressed. These aides can also assist with housekeeping, meals and shopping. How often these services are needed is up to you and your parents.
• Adult care. Adult care programs are a type of long term care that offers social interaction and meals from one to five days a week, depending on the program. Some adult care programs provide transportation to and from the care center. Activities often include exercises, games, trips, art and music. Some adult care programs offer medical services, such as help taking medications or checking blood pressure.
• Senior housing. If your parents can no longer live in their house but they don't need continuous long term care, you might consider senior housing or retirement housing. These are often rental apartments that have been adapted for seniors, including railings installed in the bathrooms and power outlets placed higher on the walls. Other services often offered by these senior housing communities include meals, transportation, housekeeping and activities.
• Assisted living. Consider assisted living if your parents need more help than senior housing offers, but they still want to remain as independent as possible. Assisted living staff can help your parents take their medications on schedule, help them with bathing and dressing, and provide some medical care. Some assisted living facilities also have on-site beauty shops and health services, such as a medical clinic.
• Nursing home. Nursing homes offer 24-hour nursing care if your parent is recovering from an illness or an injury. They also offer end-of-life care. Nursing home services are mostly for people who need more medical care than other long term care options can offer, such as wound care, rehabilitative therapy and help with respirators or ventilators. Personal care for bathing, dressing and going to the bathroom are also offered at nursing homes.
• Continuing-care retirement community (CCRC). CCRCs offer several levels of care in one setting. The idea is that your parents can stay in one place for the rest of their lives rather than moving each time they need a new level of care. Your parents might choose to move into a senior housing apartment while they're still healthy and independent. When they need more help with daily activities, they can move to the assisted living area of the complex. For more care, they can go to the nursing home, which is also located in the building. You usually pay a fee or endowment to enter the CCRC, rather than paying monthly for rent and services.

With all the options available, selecting a long term care service can be overwhelming for you and your parents. Follow these steps to make the process easier:

• Decide what level of service your parents need. Will your parents need help with everyday chores, or will they need nursing care? This can help you decide what type of facilities to look into.
• Ask your parents what they would prefer. Would your parents prefer certain options, such as a smaller facility, a certain location or certain living arrangements, such as a single room?
• Consult with your parents' doctors. You'll need your parents' permission to do this. Your parents' doctors can also put you in touch with agencies that can help you identify your parents' needs and make recommendations on their care.
• Decide how much you can afford. Will you be paying for the long term care, or will your parents be paying? Do you need facilities that will accept Medicare or Medicaid?
• Make a list of facilities within a half-hour's drive of your home. Call the facilities closest to you first. Being close to your parents can make the transition to long term care easier for them and for you.
• Call to ask about prices, services and vacancy. Ask about monthly fees for care. Find out what services are available at the moment and if you'll have to pay extra for them. If you have to find a long term care facility right away, it won't do you any good if the facility has no vacancies. If you're planning ahead, you might be able to put your parents on a waiting list.
• Visit. Schedule a tour of the facility for you and your parents. Gather first impressions: Does the facility seem safe and friendly? Does it smell OK? Is the temperature comfortable? Do the residents seem happy? Are there enough caregivers on staff? What are the rooms like?
• Ask questions. What are the rules? Can your parents choose when to get up and go to bed? When can you visit? What social activities are offered? How often will your parents receive care? Can your parents continue to see their personal doctors? How many people are on staff during the day and overnight? What type of training does the staff go through?
• Visit again. Observe staff members while they're working. Talk with the residents. Visit at different times of the day. Make an unscheduled visit.

Also ask for advice from friends and relatives who have experience with long term care facilities in your area. Call the Better Business Bureau to find out if any complaints have been filed against the facility.

In the end, follow your instincts. Choose a place that treats your parents with respect and makes them feel comfortable. If the rooms are nice but the staff isn't caring, don't let your parents go to that facility.

Long term care can be expensive. In many cases, it will be up to you or your parents to pay out-of-pocket for the services. However, you do have other options, including:

• Long term care insurance. Your parents pay an annual premium for long term care insurance. In exchange, when they need care, the insurance provider pays a daily rate to the long term care facility. The daily rate differs, depending on the insurance policy. If your parents need long term care now, it might not be possible to get insurance. But if your parents are healthy and could need care in the future, you might want to suggest it to them.
• Medicaid. Medicaid is a joint state-federal program that helps your parents if they meet certain income requirements. Medicaid usually covers nursing home care only after an illness or injury. Whether Medicaid covers assisted living or a continuing-care retirement community depends on what state you live in. Medicaid coverage differs in each state, and some states might cover home care services.
• Medicare. This federal program is for people over age 65 and people with disabilities. It doesn't cover assisted living, but in some cases it will cover home care services. Medicare covers nursing home care for up to 100 days, but your parents qualify only if they've recently been in the hospital for at least three days.

Deciding whether your parents qualify for any of these payments can be difficult. Discuss your options with your lawyer, accountant, a social worker or an area agency on aging. Also talk to your parents' doctors, who might be able to connect you to community resources.

The idea of leaving their home or receiving in-home help for everyday activities can be distressing for your parents. That's why it'll be important for you to include them as much as possible in the selection of a long term care service. Try these tips for talking with your parents about long term care:

• Plan ahead. Waiting until your parents need long term care isn't the best time to bring up the subject. If your parents are sick or injured, it may be difficult for them to participate in the selection of the facility.
• Listen to your parents' concerns. Let your parents know you understand their concerns. Point out the benefits of long term care services. Remind your parents that their safety is your primary concern.
• Listen to your parents' preferences. Include your parents in the decision making. Find out what kind of facility they would prefer.

It might not always be your decision whether your parents leave their own home. If they're mentally competent, they have the right to choose where they want to live. Your parents' doctors can decide whether they're competent to make the decision to move.

Understand the anxiety your parents might have about leaving their home. Involve them as much as possible in the decision-making process to help them feel better about where they'll be living.