Aging IQ is a news aggregate designed to create a location for all of your senior news from holiday meal ideas to cutting edge research. The below article was originally posted on their website by the author below.
Lisa Esposito | Feb. 7, 2022
Long-term senior care encompasses a spectrum of options and a progression of choices. At first, the “facility” where an older adult receives treatments, help with medications or personal care is often their own home.
Nursing homes and assisted living represent traditional senior care options when home care is no longer enough. But they’re not the sole solutions.
Independence is a priority for most adults of any age. Alternatives such as independent living and continuing care retirement communities attract many older residents, including some who are still healthy and would benefit from remaining active. For seniors who need more help and crave a family-like atmosphere, options like group homes exist.
Payment is a major limiting factor in long-term care choices. For many families, assisted living facilities and CCRCs are prohibitively expensive. The issue of how to pay for long-term care, and figuring out what is and isn’t covered by Medicare or Medicaid, is a huge element of the decision.
The pandemic has brought major changes in long-term care, and facilities don’t look or feel like they used to. COVID-19 outbreaks in nursing homes forced drastic changes in infection control measures, resident activities and visitor restrictions.
Staffing shortages continue to strain facilities’ ability to provide care. It’s important to ask questions about all these issues if you’re exploring potential facilities for a loved one.
Long-term care decisions rarely involve a sudden crisis followed by a parent’s dramatic uprooting to a supervised facility. “It’s usually not ‘Mom’s fine’ and then the next day she needs to go to a nursing home,” says Sandy Markwood, CEO of USAging (formerly the National Association of Area Agencies on Aging). “It’s a continuum.”
Long-term care options fluctuate as people develop mobility issues like being able to transfer in and out of bed, or chronic conditions or disabilities like chronic obstructive pulmonary disease gradually worsen. In many cases, long-term care starts at home with senior home care.
Family caregivers and home health aides, often in combination, can help make it possible. For adult children who aren’t certain what kind of assistance a parent needs, particularly when they live at a distance, geriatric care managers – also called aging life care managers – can assess people in their home environments, says Nancy Avitabile, owner of Urban Eldercare, a geriatric care management practice in New York City.
These professionals determine and manage appropriate services, and also may make suggestions on reducing potential safety hazards in the home, such as slippery floors or difficulty navigating stairs, says Avitabile, who is past president of the Aging Life Care Association.
The Eldercare Locator offered by the Administration on Aging can help you get started on search for facilities in your area. Markwood notes that local services can extend the interval an aging adult is able to manage at home. “Look up your Area Agency on Aging and find the plethora of resources that are out there in your community,” she advises.
8 Types of Long-Term Care Facilities
At some point, the combination of in-home caregiving and community services may no longer suffice to meet an older adult’s changing health, safety or personal care needs. In other cases, seniors who can still live independently, or with minimal assistance, realize they can benefit by moving into a residential setting where they can socialize with peers.
The following continuum of long-term facilities appears in mostly ascending order of how much care and supervision their residents need.
- Retirement living/independent living.
- Assisted living.
- Continuing care retirement community.
- Adult family homes.
- Medical foster care.
- Nursing homes.
- Memory care.
- Skilled nursing facilities.
Retirement Living/Independent Living
Independent or retirement living focuses on a self-sufficient lifestyle for seniors. These residences might be part of self-contained retirement communities or high-rise apartment complexes, among other models.
Costs vary widely based on location, services and benefits (like housekeeping) and activities offered. Wellness centers may be available on-site.
“You’re really looking at a situation that’s very light on care,” Avitabile says. People considering these options might prefer a more “hotel-like” environment, with congregate meals in attractive dining rooms. “There are a lot of planned outings and activities, sometimes of a very high caliber,” she says.
Someone who wants to age in place in independent living, but who eventually needs more care, could hire that type of assistance as if he or she were in their own home, Avitabile says.
Assisted living facilities offer services such as medication management and light personal care within a supervised setting. Housekeeping, prepared meals and assistance with daily personal care are available. Assisted living is known for its community-based approach, with a focus on group and individual activities and efforts by staff to prevent residents from feeling isolated.
Medical services, such as nurse practitioners who follow residents, are available. “Assisted living also has different levels of care that someone would buy into,” Avitabile says. Residents who need lighter care might opt for long-term services medication management, check-in services and morning assistance getting out of bed and showered. These are usually available at different prices.
With assisted living, “you really need to look into what is covered,” Markwood says. “And how often: What’s the breadth of that service? So if they provide meals, is it one meal a day? Is it weekly? Is it daily housekeeping? If they say they provide transportation, what does that mean? Are there any additional charges? It’s really delving into and not just taking things on the surface level.”
Respite units are a recent innovation in some assisted living facilities, Avitabile says. In these transitional units, residents can benefit from medical services such as physical therapy and nursing care, while still experiencing the amenities and attractive setting of assisted living. These units may serve residents coming from a hospital or rehabilitation center, for example.
Continuing Care Retirement Community
CCRCs offer a tiered approach for aging adults. Typically, residents move into single-family apartments or condominiums designed for independent, healthy adults. As their needs change, they can transition to on-site assisted living or nursing home facilities.
Continuing retirement care communities represent a significant financial investment, with hefty upfront entrance fees and monthly charges.
Adult Family Homes
Also known as group homes or residential care homes, these neighborhood-based dwellings are run by licensed caregivers. “Essentially, what’s on offer is the living space,” says Dr. Ardeshir Hashmi, Section Chief at Cleveland Clinic’s Center for Geriatric Medicine. Group homes have far fewer residents than nursing homes, perhaps four to 10 at a time.
Unlike nursing homes, he notes, “they’re not promising any medical or skilled nursing coverage.” Instead, he says, “You may just be there because you need care with your day-to-day activities of living: eating, bathing, dressing, toileting.”
Medical Foster Care
For military veterans with chronic medical conditions that meet the nursing-home level of care, the Department of Veterans Affairs oversees its Medical Foster Homes Program.
Nursing homes provide medical and personal care services beyond what’s available in assisted living. Nursing care, around-the-clock supervision, assistance with activities of daily living and three daily meals are standard. Most nursing home residents have chronic physical or mental health conditions, or both. They stand to benefit from this level of care. Nursing home residents can receive prescribed treatment and personal care as needed.
As with any type of long-term care facility, it’s essential to do some research and ask critical questions before choosing a nursing home. You can explore U.S News’ Best Nursing Homes ratings and also find information on Medicare- and Medicaid-certified nursing homes on the Medicare.gov website.
For people with Alzheimer’s disease, other types of dementia or serious memory problems, memory care involves an extra level of care and supervision. Memory care offers a safe, structured environment with more gentle sensory stimulation that people with dementia can benefit from.
Secured memory careunits are located within many nursing homes and assisted living facilities. Staff members receive special training to provide 24-hour care and daily assistance to this group. Memory care typically costs more than non-memory care.
“Some individuals do extremely well in memory care,” Avitabile says. “And then for some, it doesn’t work at all. There’s always that trial period.”
In nursing homes, memory care usually goes by a different name, such as the Alzheimer’s unit. The atmosphere can differ by type of facility. “In general, a memory care unit attempts to be kind of more normalizing – a little bit more humanistic and kind of person-centered,” Avitabile says. “It doesn’t have that institutionalized feeling.”
Skilled Nursing Facilities
The terms nursing home and skilled nursing facility are often used interchangeably because the types of care involved often overlap, but they aren’t identical.
Skilled nursing facilities are more likely to have a consistent presence of nurses or physicians and offer rehabilitation services such as occupational, physical and speech therapy. SNFs and nursing homes fall under different sets of regulations.
An individual who truly qualifies for SNF care “needs a lot of assistance,” Avitabile says. “Typically (they require) the assistance of two individuals to move them. Typically, they’re bedbound and they have other skilled care needs.” For example, she says, an SNF resident might have a disability or require chronic medical care like dialysis or having a tracheostomy tube.
It’s never too soon to benefit from planning ahead for long-term care, whether for yourself or a family member. “People underestimate the cost, and they underestimate the amount of time they may need services,” Markwood says.
Learn what Medicare and Medicaid cover, as well as long-term care insurance that can be applied toward nursing home costs, if you have it. “Also make sure your family knows you have long-term care insurance,” says Markwood, who has heard of families not realizing a parent had this coverage until after he or she died.
Family decisions on long-term care should include adult children and significant others, Markwood says. “Spending down” to Medicaid eligibility means someone has paid out of pocket for care and exhausted their personal savings. A parent’s home may need to be sold to make long-term care affordable.
Although Medicare provides coverage for up to 100 days of rehabilitation or convalescent care in a nursing home, it doesn’t cover long-term care. Medigap, long-term care insurance and employer-provided or private health insurance plans can help defray long-term care costs if plans are already in place before a major health event occurs.
Certain trends are reshaping the long-term care landscape in the wake of outbreaks and lockdowns, particularly early in the pandemic. “There’s been a change in how liberalized the access was to families, to their loved ones in the facility,” Hashmi says. Now it’s getting better, he says, “but it’s still far different from what it was pre-pandemic.”
High-end assisted living is becoming increasingly popular, Avitabile says. “The luxury market has kind of exploded – partially as a result of nursing homes being so costly,” she says. In the metro New York region where she’s based, she says, nursing home care costs about $20,000 monthly with private pay. “Then compare that to luxury assisted living, which is also somewhere between $17,000 and $20,000 a month.”
For those who can afford it, “You’re finding assisted living that has all of the amenities,” Avitabile says. In addition to upscale design and construction, amenities include “white-glove service with a concierge, all the car service, concierge medical on the premises, as well as built-in swimming pools, state-of-the-art gyms, spas, yoga studios, art studios, movie theaters and multiple dining options.”
For more affordable, homelike options, “More and more states are licensing group homes,” Markwood notes. “Typically, they’re privately owned so you really need to dig in to find out what services and supports they offer.”
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