Publication : Brochures

Alternatives to Nursing Home Placement

Not too many years ago, if a person could no longer live safely at home, then the person’s only alternative was to either move in with family or to a nursing home.  Today there are many more options.  These options, called “long-term services and supports,” include, but are not limited to:  adult day care, home health aides, residential services agencies, congregate housing, home health nurses, assisted living homes, continuing care retirement communities, home delivered meals, respite care, and chore and transportation aides.  Like most options or choices, each has its pros and cons to consider.  How to pay for an option is one of those considerations, and an important consideration, because these services can be expensive.  The alternative ways of paying for a service can be quite complicated and are constantly changing.  The services and supports may or may not be covered by private or public insurance.  If you need help figuring out what services and supports you need and how to pay for them, contact Maryland Access Point.

Maryland Access Point (MAP) provides information and consultations about available long-term services and supports, particularly for older adults and individuals with disabilities.  If you or someone you know needs community services to avoid staying or living in a nursing home or needs help with shopping, chores or personal matters because of a disability, MAP is a guide to service providers in each local area.  For more information, access the MAP website at  Or for the location of the nearest MAP office go to

If you do not have access to the internet, take this information to your local librarian or MAP site.  They can help you access the information. 

The websites listed above are government websites.  There is also a lot of information about services and supports available on private websites.  Keep in mind, however, that private websites often are trying to sell something.

Paying for Long-Term Care Services and Supports

Paying for long-term care services and supports can be expensive.  The typical sources of payment are personal savings; Medicaid (called “Medical Assistance” in Maryland); Medicare; Veteran's Benefits; long-term care insurance; or some combination of these payments.

People are frequently surprised to learn that Medicare does not pay for long-term care.  While it will pay for rehabilitative care, which may take place in a nursing home, it is for a limited time (100 days at most). 

Medicaid and the Veterans Administration are working on ways to pay for more care in the home or community, rather than in a nursing home.  For example, Maryland Medical Assistance has two programs to help people with low income and assets to pay for long-term services and supports in the community.  One program is called Community First Choice (CFC) and the other one is called Home and Community Based Options Waiver.  What benefits are available, and how to access those benefits, is constantly evolving so call your local MAP office to see what payment resources might be available to help you or your loved one.    


Almost any provider of long-term services or supports is going to require you to sign a contract.  These contracts are significant because of the dollars involved.  Before signing any contract take the following steps:

  1. Ask for a copy of the contract well in advance of the date by which it must signed.  Read the contract very carefully.  If you have any questions about what any of the language in the contract means, contact an attorney to help you.  For help finding an attorney see the resources on this web page:
  2. There should be no blank spaces left in a contract when it is signed.  If the service provider says that a section “does not apply,” physically mark the section in writing as “N/A” or “not applicable.”  Every person signing the contract should initial and date each handwritten mark, change, or addition to the contract.
  3. After signing the contract, make sure the service provider signs it and gives you a copy of the complete contract, along with all the exhibits and attachments.

Alternatives to Nursing Home Placement © 1993, MSBA, Inc. Revised 2014
All rights reserved. No part of this work may be reproduced in any form without written permission from the Maryland State Bar Association.

Publication : Brochures

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