OpenPlacement Community > OpenPlacement Blog > Senior Care – A Detailed Look

Senior Care – A Detailed Look Alyssa Chan

December 18th, 2013

Searching for Senior Care for yourself or a loved one can be a very difficult task and more often than not is during a difficult period of time.  It is extremely important to find the perfect fit with comfort, care and most importantly safety in mind. That said, it is critical to consider all the options that are available as well as the specific level of senior care and services they provide.

Below you will find a graphic that helps visualize all the key senior care types available.  As you move from the bottom of the graphic to the top the level of care increases.  Non medical home care provides the most basic form of senior care services in the comfort of ones home.  On the other side of the spectrum is a hospital which provides the highest level of services and senior care for a loved one.  As we move from left to right the graphic illustrates the spectrum of consumer choice moving from meeting ones wants relative to their needs.  Below the graphic you will find a detailed description of each senior care option. We hope this can be a powerful resource to our #OpenCommunity! Please also let us know if you know of any other resources we should know about in the comments section!

OpenPlacement-Blog-Spectrum-of-Senior-Care

Senior Care Options

 

Non-Medical Home Care

Non-medical home care focuses on helping seniors with the daily activities they need to engage in to remain safe and healthy. Many seniors need help to get their day started with assistance showering, preparing breakfast and taking their medications. Likewise, help before bedtime, or even overnight, can be an important safety net for seniors at home who often are more apprehensive at nighttime. However, one of the most important needs of a senior who lives alone is often simple companionship. The companionship component of a professional caregiver’s job can be just as vital as the physical assistance a professional will provide. Seniors need conversation and one-on-one contact to keep their minds alert. They can thrive with someone to participate in their favorite activities such as gardening, baking or woodworking, or someone to go to the grocery store or attend a family event.

A reputable non-medical caregiving company will provide caregivers who can meet all of those needs and provide tailored senior care. Examples of services and senior care provided by non-medical home care providers include assistance with: eating, dressing, bathing, toileting, transferring, continence, companionship, meal preparation, light housekeeping, medication management, errands, shopping, transportation, hobbies and laundry.

Home Health Care

Home health care is defined as rendering predominantly medically-related senior care services to patients in a home setting rather than in a medical facility. Basically, the home care practitioner will help patients increase their ability to tend to their everyday needs at home. Home health care may include skilled nursing in addition to speech, occupational and physical therapy. In many cases, it includes assistance with cooking and other household chores. It also includes monitoring the patient’s prescriptions.

If your loved one requires care that requires a doctor’s prescription, then you should contact a home health agency. Keep in mind, however, that home health aides generally are only authorized to perform senior care tasks described in the prescription. If your senior needs assistance getting to and from doctor’s appointments, cleaning the house, or simply having someone to spend time with, you should contact a non-medical home care agency. Examples of services and care provided by home health care providers include but are not limited to assistance with: post-op rehab, skilled assessments and teaching, occupational therapy, speech therapy, wound care, mobility training, pain management and intravenous therapy and injections.

Independent Living

Independent living is defined as any housing arrangement designed exclusively for seniors, generally those aged 55 and older. Housing varies widely, from apartment-style living to freestanding homes. In general, the housing is friendlier to older adults, often being more compact, with easier navigation and no maintenance or yard work to worry about. While residents live independently, most communities offer amenities, activities, and services. Often, recreational centers or clubhouses are available on site to give seniors the opportunity to connect with peers and participate in community activities, such as arts and crafts, holiday gatherings, continuing education classes, or movie nights.

Independent living facilities may also offer facilities such as a swimming pool, fitness center, tennis courts, even a golf course or other clubs and interest groups. Other services offered in independent living may include onsite spas, beauty and barber salons, daily meals, and basic housekeeping and laundry services. Since independent living facilities are aimed at older adults who need little or no assistance with activities of daily living (ADLs), most do not offer medical care or nursing staff. As with regular housing, though, you can hire in-home help separately as required to provide any essential senior care for your loved one.

Board and Care

Board and care homes are houses in residential neighborhoods that are equipped, adapted and staffed to care for a small number of seniors. The defining characteristics of board and care homes are that they are regular houses in residential neighborhoods rather than purpose-built facilities, and also that they have a limited number of residents, though, can provide senior care. The term “board and care home” is most commonly used in California, and in other states these homes may go by other names including “residential care home”, or “group home.”

Board and care homes provide senior care that’s comparable to what’s offered at assisted living communities, but below the level of what at a nursing home can provide. That is to say that board and care homes are able to help with daily activities but do not provide skilled nursing assistance. They prepare the residents three home cooked meals daily, and are typically able to provide help with senior care activities such as: bathing grooming and hygiene, dressing, eating and toileting. Board and care homes are required to be licensed in most states. In California, for example, board and care homes are licensed by the Community Care Licensing Division – California Department of Social Services.

Assisted Living

An assisted living facility is a senior care living option for those who are in need of some assistance with daily living yet aim to live as independently as possible. There are many defined types of senior care living, and assisted living would fall between an independent living community and a skilled nursing home. A typical assisted living home might offer 24-hour monitoring of its residents and various senior care support services such as medication administration or bathing, while providing the resident with more freedom and privacy than a nursing home. No federal standard for assisted living facilities exist, so each state defines an assisted living residence along with the senior care they provide differently. There are some federal laws that exist that impact assisted living communities but most oversight occurs at the state level.

Many states are moving towards defining their assisted living facilities as such, but others use different terms such as residential care facilities or personal care homes. Two thirds of states use the term assisted living. It is also important to note that some licensed assisted living facilities may care for other residents besides seniors, such as mentally challenged and those with special needs.

Memory Care

Although assisted living communities may have memory care units on the premises, the two types of care are not synonymous. Memory care is a distinct form of long-term skilled nursing senior care that specifically caters to patients with Alzheimer’s disease, dementia, and other types of memory problems. Also called special care units (SCUs), memory care units usually provide 24-hour supervised care within a separate wing or floor of a residential facility where they can administer the senior care required.

As with assisted living, if your loved one is no longer able to care for him- or herself due to progressive impairment, memory care offers a residential senior care solution. In addition to providing assistance with activities of daily living as described above, the staff in memory care are specially trained to assist people with dementia or impaired cognition. Also, the physical layout and security of memory care wards is designed to better suit Alzheimer’s and dementia patients, so that wandering behavior is minimized and the environment is pleasant and easy to navigate and provide the necessary senior care.

In addition to the general state-level licensing of senior care facilities, memory care is further regulated in 23 states by special senior care unit disclosure laws requiring care providers to disclose the special services they offer. However, because these laws are not yet universal, it is critical for caregivers to research facilities well before making a decision of the best option that will provide the needed senior care.

Skilled Nursing Facility (SNF)

Skilled Nursing Facilities (commonly called “Sniffs” in short) are defined as a health-care institution that meets federal criteria for Medicaid and Medicare reimbursement for nursing care including especially the supervision of the senior care of every patient by a physician, the employment full-time of at least one registered nurse (RN), the maintenance of records concerning the care and condition of every patient, the availability of nursing care 24 hours a day, the presence of facilities for storing and dispensing drugs, the implementation of a utilization review plan, and overall financial planning including an annual operating budget and a 3-year capital expenditures program outlining the senior care provided.

Skilled nursing facilities, often times referred to as “nursing homes”, are residential facilities where patients can receive skilled nursing services 24 hours a day. Medicare will pay for skilled nursing facility services if a physician has deemed that a patient requires skilled nursing care. Please visit Mediare.gov as more information can be found here.

Skilled nursing does not include palliative or hospice care services or long-term senior care needs.

Continuing Care Retirement Community (CCRC)

Part independent living, part assisted living, part memory care and part skilled nursing facility, Continuing Care Retirement Communities (CCRCs) offer a tiered approach to the aging process, accommodating residents’ changing senior care needs. Upon entering, healthy adults can reside independently in single-family homes, apartments or condominiums. When assistance with everyday activities becomes necessary, they can move into assisted living or nursing care facilities. These communities give older adults the option to live in one location for the duration of their life, with much of their future senior care already figured out. This can provide a great level of comfort to both your loved one and you and take much of the stress out of the caregiving relationship.

The most expensive of all senior care options, CCRCs require a hefty entrance fee as well as monthly charges. Entrance fees can range anywhere from $100,000 to $1 million — an upfront sum to prepay for senior care as well as to provide the facility money to operate. Monthly charges can range from $3,000 to $5,000, but may increase as senior care needs change. These fees are dependent on a variety of factors including the health of your loved one, the type of housing they choose, whether they rent or buy, the number of residents living in the facility and the type of service contract. Additional fees may be incurred for other options including housekeeping, meal service, transportation and social activities.

Sub-Acute

Sub-acute care is comprehensive inpatient senior care designed for someone who has an acute illness, injury, or exacerbation of a disease process. It is goal oriented treatment rendered immediately after, or instead of, acute hospitalization to treat one or more specific active complex medical conditions or to administer one or more technically complex treatments, in the context of a person’s underlying long-term conditions and overall situation.

An interdisciplinary approach is used to formulate a goal-oriented plan of senior care for each resident. The sub-acute care team is dedicated to providing appropriate interventions to avoid unnecessary and frequent hospitalizations. A true sub-acute care provider should focus on training patients to achieve their highest level of independence as quickly as possible.

Sub-acute care is generally more intensive than traditional nursing facility care and less intensive than acute care. Nursing facilities are now dedicating entire wings, even entire facilities to provide high-tech medical care. Sub-acute care also merges the sophisticated technology of a hospital with the efficient operation of a skilled nursing facility. Sub-acute patients require highly-skilled care. Therefore, the nursing facilities that serve them should use a team approach to senior care treatment. Doctors, therapists, nurses and other health professionals should all work in concert with the patient and his or her families to assure the most affordable and efficient senior care for the patient.

Hospitals

Hospitals provide the highest level of senior care an ultimately cater to all the critical needs of a patient.  ”Hospital” means a facility with an organized medical staff, with permanent facilities that include inpatient beds and with medical services, including physician services and continuous nursing services under the supervision of registered nurses, to provide diagnosis and medical or surgical treatment primarily for but not limited to acutely ill patients and accident victims, to provide treatment for patients with mental illness or to provide treatment in special inpatient care facilities.

Other Key Senior Care Options to Know About

 

Case Management Services

There are organizations as well as individuals who provide case management services.  Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive senior care needs through communication and available resources to promote quality, cost-effective outcomes.

The underlying premise of case management is based in the fact that when an individual reaches the optimum level of wellness and functional capability, everyone benefits: the individuals being served, their support systems, the health care delivery systems and the various reimbursement sources. Case management serves as a means for achieving client wellness and autonomy through advocacy, communication, education, identification of service resources and service facilitation. The case manager helps identify appropriate senior care and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source.

Program of All-inclusive Care for the Elderly (PACE)

The Program of All-inclusive Care for the Elderly (PACE) model was created in the state of California but is quickly gaining popularity and support from other states.  The PACE model is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in their community whenever possible. The PACE model serves individuals who are 55 years of age or older, certified by the State of California to need nursing home care, able to live safely in the community at the time of enrollment, and live in a PACE service area.

Hospice

Hospice is not a place, but a concept for senior care delivery to those dealing with life-limiting illness. Hospice focuses on creating a natural and comfortable end-of-life experience for those confronted with a terminal condition. Through a range of palliative, medical, nursing, psychosocial, and spiritual care provided by an interdisciplinary team of experts, hospice seeks to manage symptoms and provide comfort when cure is no longer possible.

As part of the continuum of care, hospice is designed to provide comfort and support for hospice-appropriate patients and their families in order to improve quality of life. Hospice services and the manner in which they are provided are determined by an interdisciplinary team (IDT) of healthcare professionals who are specially trained in working with dying patients and their families. These physicians, nurses, social workers, chaplains, certified home health aides, volunteers, and ancillary therapists work together with the patient and family to develop the hospice plan of care.

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