Long-term care can be:
- Skilled nursing care
- Custodial care to help with the activities of daily living
The settings for long-term care can be:
- Nursing home
- Assisted living facility
- Your own home
- An adult day care center
Nursing Facilities
Nationally, occupancy rates for nursing homes have been declining since 1985, from about 92% in 1985 to about 88% in 1997. This is a paradox since the population has been aging but the number of available beds only grew by 1% a year yet the numbers should be going up. Nursing home operators blame lower Medicare payments and the proliferation of assisted living facilities for the decline. Yet in most states the number of ALF residents has remained steady for a number of years. Many analysts suggest that people are living longer and staying healthier, and we need only wait 10 or 15 years for an onslaught of demand for nursing homes. The current decline in nursing home residents may only be the lull before a storm.
Assisted Living Facilities
Nursing homes are not the most desirable places to stay. A better alternative if the patient qualifies is assisted living. Assisted living is a marketing term used to describe a living arrangement that provides care services and sometimes limited medical services to residents in a home-like environment. These facilities are licensed by the state for 3 levels of service. The first is simply independent retirement living with only occasional monitoring by staff. The resident has his or her own apartment and all meals are served in a central dining room. Fancier units have kitchenettes. Levels II and III offer help with activities of daily living such as bathing, dressing or incontinence. Dementia and Alzheimer's patients are also accommodated. There is a limit to the services of an Assisted Living Facilities. They can't provide skilled nursing such as IV's, catheters, and other services requiring 24-hour supervision. Nor do they have staff to feed or provide ambulation to the severely disabled. But Assisted Living Facilities are more desirable if feasible.
In addition to providing meals, transportation for medical appointments, activities, and pleasure trips, assisted living may provide:
- Linens and personal laundry service
- Assistance with dressing and bathing
- Reminders regarding medication
- Assistance with eating
Assisted living with assistance may on average be only 60% of the cost of nursing homes. Medicare will not pay for ALF. Medicaid may cover it. Insurance will pay for all costs if a person qualifies for insurance.
Assisted Living Facilites:
Board and Care, Foster Care, Residential Care
Board and Care is offered in a homelike setting with medical care for 2-10 residents. Some are converted/adapted single family homes. The number of residents is a function of zoning regulations. They limit the number of unrelated occupants that can live in a single residence.
Foster care is sometimes limited to only 2 residents. Most designated converted homes offering care are allowed only 5 or 6 residents. Those that appear to be converted homes, but offer more beds are usually licensed as Assisted Living residences.
A Board and Care, Residential Care or Foster Care home may be able to provide residents the services found in an assisted living facility, a skilled nursing home or in some cases, an Alzheimer facility, depending on the goal and licensing of the individual facility. Many Board and Care Facilities have their own specialty or emphasis and the intensity or type of care needed by residents within a home may be similar. For instance, some specialize in care of seniors in the middle stages of Alzheimer's. Another may only take early stage Alzheimer's. Another home may only be licensed to accept those mildly impaired mentally, or needing "custodial" help (reminding, meal service, laundry, housekeeping help and driving services). In many states they would need to be licensed to hand out medications, assist with bathing or care for a patient who cannot turn themselves in bed.
Because there are so many Board and Care Homes, hundreds in a populated county, it is also unrealistic to think that licensing can monitor them all. Therefore, decisions should be made regarding placing a loved one in such a home after:
- Getting referrals
- Checking of referrals
- Unscheduled, unannounced visits at different hours
- Checking with the State Licensing Agency
NOTE: Even if you use a referral agency, do your own due-diligence before placing a loved one in a care home.
Alzheimer's Facilities
Alzheimer's facilities specialize in care of patients with dementia. Other senior living environments (Congregate, Assisted Living, Board and Care) may be appropriate for some residents in early, or even mid, stages of the disease. But unless the community has a specialized dementia unit, transfer to another facility will be required as the disease progresses. In fact, some Alzheimer's facilities accept patients only if they are mobile, or if they do not need to be treated for other ailments not normally treated at the Assisted Living level.
Adult Day Care, and Adult Health Care
This is a service for frail, physically or cognitively impaired, seniors and their caregivers. Stand alone facilities offering adult day care and adult day health care are cropping up in urban and suburban areas.
Congregate, assisted living, or nursing care communities may offer day care as an "outpatient" service to the neighboring population. Those that do, may also offer respite care for a weekend, or a week. Senior centers may also offer senior day care.
Senior day care and senior adult day care enables caregivers to:
- Retain a job outside of their home
- Have help with the physical part of caring for a loved one
- Avoid the guilt of putting a parent in a "home"
- Obtain respite from what can be a 24 hour responsibility
The three types of adult or senior day care can be broken down to meet the need for:
- Social interaction in a safe environment
- Medical care, therapy and socialization
- Alzheimer's or dementia care with all aspects of related attention
The inclusion of "health" in the type of day care a center provides should indicate that they provide elements of health care, and are not just a model for socialization and baby-sitting of seniors. The designation of Adult Day Health Care (ADHC) in many states is reserved for those centers that have been licensed by their state to provide health and medical-related care, similar to what might be provided by a state licensed assisted living community or by a state licensed nursing home. A senior or adult day care center that is not an ADHC, in most states will not be licensed to include, or have available on site, psycological evaluations, licensed social workers, administration of medications, assistance with bathing and hair washing, dressing of wounds and assistance with feeding. Their costs will also not be reimbursed by Medicaid (Medical in California).
Most states require a licensing process for ADHC and a state licensing process to be appoved for Medicare reimbursement and/or Medicaid (Medical in California)reimbursement. In some states the legislature has recognized the cost savings between supporting an indigent person in assisted living at $2,500 - $5,000 per month or in a nursing home at $3,500 -$6,000 per month and supporting them in an ADHC where they return home each night to live with family.
Medicare does not cover day care costs, but in a licensed medical or Alzheimer's environment Medicaid may pay all of the costs if the senior qualifies financially. Some day care centers offer need-based scholarships. Private medical insurance policies sometimes cover a portion of day care costs when registered, licensed medical people are involved with the care. Long Term Care Insurance policies can cover day care.
Receive information about long-term care insurance in your area:
For more information, visit these sites:
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