ElderCare – Residential Options
Usually, an Elder will prefer to stay in their own home and community as long as possible and your county or state will have an Area Agency on Aging (AAA), Aging Services Access Point (ASAP), Aging and Disability Resource Center (ARDC or ADRL) or a State Unit on Aging who can be unusually helpful developing a self needs assessment and then an options plan to achieve this goal.
Gradations of care LICENSES for facilities will vary State by State. These are somewhat general descriptions.
At some point one may decide that a different lifestyle may be a better option and there are a variety to choose from:
Independent Living - any housing arrangement designed exclusively for older adults, generally those aged 55 and over. As independent living facilities are oriented for older adults who need little or no assistance with activities of daily living, most do not offer medical care. Independent living often takes the form of low maintenance apartments, with maintained grounds, parking and amenities. A menu of optional services may be available which can include housekeeping, social activities, dining, transportation, and other conveniences. Apartments are more likely to have complete cooking facilities.
Assisted Living can take many forms:
- General Assisted Living - Assisted living is geared more towards helping aging adults who need some assistance with the “activities of daily living” (ADLs), such as bathing, dressing, laundry and managing medications.
- Memory Care: are oriented towards persons with Alzheimer’s and temporary or irreversible dementia who may wander or need to be confined to prevent injury or loss. Memory Care personnel will have special training in optimizing care for persons who have these conditions.
- Disability Assisted Living: may include specially trained personnel and programs for Developmental Disabilities, Mental Illnesses or Emotional Disturbances, Traumatic Brain Injuries (TBI) and other conditions which can have unique care requirements.
- Assisted Residential Care Homes (ARCH) or Adult Family Homes (AFH): These are typically 4 or fewer residents and may be state licensed for specific resident requirements (ie. Developmental Disability, TBI, etc). These are especially useful for persons with limited family support or special needs well beyond the capability of local family members. These tend to vary the most in terms of capabilities State by State.
- Respite Care: “Respite” care is where the caregiver may take the care recipient out of home to a facility, so that they can attend to their own needs temporarily. It is an underutilized, yet critical self-care component that actually can improve the overall care of the original care recipient. It is designed to reduce “care-giver burnout”. Respite Care can take the form of Adult Day services, for perhaps a 4- 8 hour period, or may last longer – perhaps a month or more, depending upon the need. Respite care is may also be medical and non-medical.
Skilled Nursing Facility: Skilled nursing care is a higher level of medical care that must be provided by licensed health professionals. These can include registered nurses (RNs) and physical, speech, and occupational therapists. Some Skilled nursing facilities may even have onsite kidney dialysis. These services can be necessary over the short term for rehabilitation from an illness or injury, or they may be required over the long term for patients who need a high level of care on more frequent or constant basis due to a chronic medical condition (s). Skilled nursing services may include wound care, intravenous (IV) therapy, injections, catheter care, physical therapy, and monitoring of vital signs and use of sophisticated medical equipment.
Skilled nursing facilities are often used for short-term non-acute rehabilitative stays, which are at usually partially covered by Medicare for up to 100 days in many cases. However, Medicare does not pay for long-term or permanent stays in nursing homes. Medicaid does cover extended stays in skilled nursing facilities for seniors with limited assets and low income who have a medical need for this high level of care, but details of this coverage vary by state and some facilities may not accept this form of payment.
- non-medical can include a campus which provides graduated care up to but usually not including much medical care. Some states limit medical care to under 30 hours a week of nursing care, before a nursing facility license is required. . Wisconsin limits it to 28 hours. A typical scenario is: Independent Living -> Assisted Living -> Memory Care
- a complete scenario, often referred to as a Continuing Care Retirement Community (CCRC) would add Skill Nursing to list of available options so that a senior could stay with the same basic provider throughout their later years. This can be especially appealing where spouses may age at different rates but prioritize living as close to each other as possible.
One of the key benefits to campus care is that once one is “in” they are usually prioritized for any needs at the next level of care over someone who is a new resident. Friends remain close as does the familiarity of the environment.
Again – these are generic descriptions of care levels and vary by state typically based on licensing requirements.