Making the decision to move from home to a senior care facility can be emotionally and physically challenging, whether one is making the decision for themselves or for a family member. When costs are factored in, the decision can sometimes be overwhelming, especially when the decision has to be made quickly. The good news is that there are many options available for all different stages of senior care, ranging from independent living to skilled nursing care. Taking into account mental and physical health, level of physical ability, and ability to take care of one’s daily needs is a good place to begin to find the best match for seniors transitioning from home to a senior care facility.
Navigating Your Choices
By Rebecca Rochat
Independent living facilities provide an environment most like living in one’s home and are designed for seniors 55 and older. They are best suited for seniors who no longer want the responsibilities of maintaining a home while catering to seniors who are oriented to an active lifestyle. There are several types of independent living facilities to choose from, ranging from apartment style living to free standing homes.
Senior housing complexes are subsidized by the U.S. Department of Housing Urban Development (HUD) and are for low-income seniors. Senior apartments are apartment complexes where rent may include recreational programs, transportation services, and dining room meals while providing freedom from home and yard maintenance. Retirement communities can be made up of single family homes, duplexes, mobile homes, townhouses or condominiums. Monthly fees may cover services such as outside maintenance, recreation centers or clubhouses. Seniors considering independent living other than subsidized housing should be prepared to handle the initial investment and monthly fees.
Continuing Care Retirement Communities
Retirement communities known as continuing care retirement communities (CCRC) offer packages that allow transition from independent living to assisted living to memory care, also known as “special care” in some cases, to skilled nursing care if needed. The purpose is to provide every level of care so residents can easily move without drastically changing their environment or lifestyle.
Within the Continuing Care industry, there are three types of CCRC contracts: extensive, modified and fee-for-service. These three contracts differ according to the type of housing, services, amenities and care the individual community provides. Of the three types of contracts, the modified contract offers several advantages. It offers residents lower up-front entry fees than extensive contracts, and it offers inclusive skilled nursing care at rates lower than those offered by fee-for-service contracts. Although fee-for-service contracts do offer nursing care, the cost for such care is significantly higher than that provided with a modified contract.
The Assisted Living Federation of America defines assisted living as a longterm care option that combines housing support services and health care, as needed. Assisted living is designed for individuals who require assistance with everyday activities such as meals, medication management or assistance, bathing, dressing and transportation. Unlike nursing homes, assisted living facilities do not offer complex medical services. Residents live as independently as possible, knowing that personal care and support services are available if needed. Assisted living communities provide more personal care services than an independent living retirement community.
Some facilities provide apartmentstyle living with kitchenettes, while others provide rooms. In some, you may need to share a room unless you’re willing to pay higher costs. Most facilities have a group dining area and common areas for social and recreational activities.
Congregate care facilities have the advantages of a home but with other services for seniors who enjoy good health and who want both independence and companionship. Congregate care facilities combine private living quarters with centralized dining services, shared living spaces and access to social and recreational activities. Other services may be available such as transportation, personal care, rehabilitative services and spiritual programs.
Assisted living is typically paid for from private funds; however, some long-term care insurance policies cover licensed assisted living, which is regulated at the state level. Costs of assisted living care depends greatly on the level of service a resident requires.
When a person remains at home but cannot live independently, there are two options depending on level of care necessary: basic (non-medical) and skilled in-home care. Basic in-home non-medical care services provide personal care, companionship, supervision and help with daily tasks such as light housekeeping, meal preparation, medication reminders, laundry, errands and transportation. In some cases, non-medical care services are combined with skilled health care services. Skilled in-home care is provided by a medically trained and licensed caregiver. Skilled in-home care services can include insulin injections, IV therapy, wound care and dressing changes, catheter care, tube feeding assistance, ventilator care, and bed-side intensive assistance.
People with dementia or Alzheimer’s have different facility options available, depending on the level of care needed. Those include assisted living for patients who can still function but require assistance with daily activities; nursing homes (also called skilled nursing facility, long-term care facility, or custodial care) for patients who need long-term care and ongoing nursing care and supervision; and Alzheimer special care facilities designed for the specific needs of Alzheimer’s patients and other dementia. Alzheimer special care facilities are most often cluster settings in which patients are grouped together on a floor or unit within a larger residential care facility. The layout of the unit is designed or modified for Alzheimer’s patients. The staff is trained to meet the specific challenges of Alzheimer’s disease and should be with patients unless they are in their room. Physically, the facility must have a method of preventing patients from wandering and likely have an indoor and outdoor wander path. Lighting should be constant, the sound mellow, the temperature comfortable, and the walls decorated with color-coding signs, memory aids, and interesting activities. Besides the basics, the best facilities will have sunrooms, private dining areas and a family atmosphere.
At some point, a skilled nursing facility may become necessary to take adequate care for elderly seniors. The label “nursing home” often has a negative connotation. However, nursing homes are an important component of senior housing options because they typically provide the highest level of care for older adults outside of a hospital. Nursing homes are not temporary or rehabilitation facilities; they are permanent residences, which is why it is important for families to do research on the types of nursing home facilities and what they offer as well as the fi nancial requirements. The decision to move a family member to a skilled nursing facility may be a sudden one due to a recent event or the result of a worsening progressive disease. In any case, choosing a skilled nursing facility is not an easy decision, and often emotions such as guilt, sadness, frustration and anger come into play during the decision making process. Research on nursing homes should begin before an emergency arises in order to prevent making split-second or emotional decisions.
Nursing homes are not one-size-fits all. They tend to fall into three general categories that address different patient needs:
• Custodial care is designed to help patients who can no longer bathe, eat, dress or get in and out of bed without assistance. Custodial care does not require targeted medical care, so trained medical personnel are not necessary.
• Intermediate care is designed to treat patients whose conditions are stable and do not require 24-hour attention. The patient’s regular physician oversees treatment, which can be carried out by skilled nurses or nurse’s assistants who also provide custodial care.
• Skilled nursing care is designed for conditions that require 24/7 medical attention by trained nurses, therapists or other health care professionals. This care may be temporary or last indefinitely.
Lastly, some other considerations when choosing a nursing home include checking to see if they are properly licensed, whether they have been sanctioned or fined, have passed state inspections, have complaints filed against them, and whether there is a waiting period.
Options in senior care are diverse, and financial planning is absolutely necessary when weighing options. Each type of care differs in services and amenities covered by Medicare and Medicaid. Understanding the many options available for senior care is an important step in finding the right setting for you or your loved one. Today, there are a wide variety of housing and care options available for seniors that offer a wide array of lifestyle and setting choices. From total independent living to communal living to a minimum or high level of skilled care, there is an option for the specific needs of most individuals. As with any change in where or how you live, it is important to be educated on a new place of residence so that you and your family are prepared financially and emotionally.
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