Guide to Levels of Care

Guide to levels of care for moving a loved is confusing because each property or care level can have its own rules. Whether the person them self recognizes they need help or a family member, friend, banker, or doctor sees impairment or decline the first decision is to stay at home or move. When the choice is to move, is it to be closer to family or remain local but relocate into a more supportive environment.

Staying at home is most people’s choice and is known as “aging in place” To do this successfully, some home safety modifications are usually in order. This can be small such as grab bars or ramps, or more expensive when refitting a bathroom, kitchen or bedroom. Additionally, more services are brought into the home. You can have physical, occupational or speech therapy or RN visits – (all covered by Medicare) and an aide or caregiver work with you at home – (private pay or LTC insurance).  Hiring a caregiver is the easiest way to gain more time at home while being cared for.  An aide helps with personal care (ADLs), safety, transportation, companionship, and routine household chores. If the person is very ill, hospice care in the home can be an option.

Times Change

Placement is a dreaded word for many older adults. It may be a sacred promise made between spouses or children and parents to “never put you in a nursing home”. Well, times have changed! When your parents were dealing with care for their parents the choices were basically; stay home, go to a Retirement home or Nursing home. It often meant sharing a room and the food was so-so at best. Today, most places have individual apartments, transportation, bistros, gyms, chefs, and activates into the evening.  Keep in mind, that promise was probably made when they were younger, healthier and not in need of any level of care. When reality dictates the need for medical supervision and daily assistance with personal care then placement in the appropriate community or property (no one likes the word facility) becomes appropriate.

Placement Options

Synonyms for ‘facility’ and “facilities’ are words like “amenities’ and “abilities” We don’t think of those terms when considering a move to congregate senior living. Properties today resemble hotels but with health care staff, services and the guests are much older. People either choose to move into senior residences because they don’t want to be alone, like the amenities or need more of assistance. Choosing the right type of place is based on the person’s physical, cognitive and individual needs.

Independent Living – Geared to high functioning residents who are largely independent and ambulatory. There is a staff on premises and they provide at least one meal a day and activities.

Assisted Living – Residence providing housing, personalized care services (bathing, dressing) and health care (medication management) to folks needing help with the Activities of Daily Living (ADLS).  ALFs often have levels of care depending on the abilities of the individual. These are property specific and each level of services is likely to be an add-on fee. There will be a nursing staff. They serve 2-3 meals a day, housekeeping, transportation, activates, safety measures, emergency staff, laundry service and access to medical services.

Memory Care -These are specialized residences which provide care for residents who have Alzheimer’s disease or other dementia. They may be a standalone property or a unit of a larger facility. Memory care provides 3 meals, all ADL assistance, much more supervision and specialized programs. There is a higher staff to resident ratio with specialized training in dementia care. They will have a Registered Nurse on staff and are a secure environment. Residents aren’t able to come and go unaccompanied, unless the place also has a secure outdoor space.

Nursing Home – For people requiring regular nursing care. Residents may have cognitive or physical conditions or both which require a nursing staff and physicians who direct care for residents. They provide 3 meals a day, hands on assistance with ADL’s, specialized activates, safety measures and monitor medical conditions. A person must qualify for nursing home care.  This is the highest level of care, resembling a residential hospital.  They will also provide physical and occupational therapy. Rehab centers are viewed as short term or acute care nursing facilities.

Continuing Care Residential Communities – CCRCs are buy-ins and once accepted care for you the rest of your life. Starting with Independent living, they have on site all levels of care, including rehab services. Not all CCRC communities offer Memory care specifically. There are different contracts for varied categories of services.

Group homes – Are Assisted Living residences for up to ten residents. It is regular house with a visiting doctor and often owned and run by a Registered Nurse. They offer 3 meals, ADL assistance, activities and some transportation.

Buyer Beware

Deciding to move is a huge decision. Read contracts carefully and be very clear on what is and is not included in the monthly fee. Know what is refundable and what is not. Senior residences are big business and very often owned and run by a parent company, off site or even in another state. You meet with salespeople rather than clinical personnel. Once the decision to move or place into a senior residence, visit at different times of the day, speak to families of other residents and take notice of the residents themselves before signing any paperwork.

Independent and Assisted Living communities have sub-categories based on functional levels of residents. All licensed senior residences have laws and guidelines to follow and are monitored by governmental authorities. Even when living in a protected environment, none of the categories offer one-to-one care so you may wish to hire an aide for a few hours a day or week.