Post-Acute Care Guide

Learn more about the range of care options for your loved one and get answers to common questions about post-acute care.

What are typical long term care costs?

The average costs for long term care in the United States (in 2010) were:

  • $205 per day or $6,235 per month for a semi-private room in a nursing home
  • $229 per day or $6,965 per month for a private room in a nursing home
  • $3,293 per month for care in an assisted living facility (for a one-bedroom unit)
  • $21 per hour for a home health aide
  • $19 per hour for homemaker services
  • $67 per day for services in an adult day health care center

However, the costs of long term care greatly vary based on time of day in home caregivers are needed (higher during evenings, weekends, and holidays), amount of care needed in a facility (such as whether a person lives independently in an assisted living home or needs help with daily activities), and location (state, city, or even placement on the facility grounds).

What criteria should I use to pick a long term care home?

Here is a list of questions that you should consider when choosing a long term care home:

  • What is the quality of the staff? - including skills, low turnover, and great management
  • Is it a Medicare/Medicaid Certified Provider? Is it a safe and clean environment?
  • Does it have a clean violation history?
  • What is the cost? - Create a clear and concise list of questions to determine what is covered and what is extra and compare expenses.
  • Is the room comfortable and attractive? –How big is it? What does the view look like? Is there storage space? Does it come furnished? Is it a shared space? Does it feel cold and industrial or intimate and homey?
  • What activities are available?
  • What’s on the menu? Does it look and smell good?
  • What professional services are available? – From social workers to number of LVN’s per shift, are your loved one’s needs adequately going to be addressed by the staff?
  • Do the staff and residents look happy?

What is dementia?

Dementia is actually not a disease but a variety of symptoms associated with a decline in memory or other thinking skills which has a large impact on a person's ability to perform everyday activities. If these symptoms persist for six months or longer, than it is given the diagnosis of dementia.

Alzheimer's disease accounts for 60 to 80 percent of cases. Vascular dementia (which occurs after a stroke), thyroid problems, and vitamin deficiencies also may cause problems in cognitive behavior under the umbrella of dementia, but these account for less than 10% of patients with this disorder.

Dementia usually starts with problems involving short term memory and tends to progress inhibiting routine activities and independence. The later stages of dementia are characterized by depression, anxiety, psychosis, being easily agitated, or being disoriented about the present time, surroundings, or people they are interacting with. For 90% of cases, there is no reversal.

What is the difference between alzheimer's and dementia?

Dementia is a series of symptoms such as memory loss, problems with processing information, and an impaired ability to perform daily functions. Alzheimer’s is the most common form of dementia and is a degenerative brain disease. While patients may experience dementia, it does not mean they have Alzheimer's. However, if someone has Alzheimer's, they will experience most of the symptoms under the category of dementia.

What are causes of dementia?

There are many factors that cause dementia in different patients:

  • Diseases such as Alzheimer’s, Parkinson’s, or Huntington’s that cause degeneration or loss of nerve cells in the brain
  • Diseases or conditions such as a stroke that affect blood vessels;
  • Toxic reactions to excessive drugs or alcohol usage;
  • Nutritional deficiencies like not having enough B12;
  • Having an infection that affects the brain or spinal chord;
  • An accumulation of fluid in the brain that can result from developmental abnormalities, infections, injury, or brain tumors;
  • A head injury, whether severe or ongoing (such as in the sport of boxing);
  • Kidney, liver, and lung diseases, can all lead to dementia.

What is frontotemporal dementia?

Frontotemporal dementia (FTD) is the progressive deterioration of the frontal lobe of the brain which controls planning and judgment, emotions, speaking and understanding speech, and certain types of movement. Although there is no cure, there are some medications available to help aid in behavioral difficulties. FTD accounts for approximately 10 – 15% of dementia cases.

What are symptoms of dementia?

The common symptoms of dementia include:

  • Memory loss which tends to be the earliest and most noticeable symptom;
  • Trouble remembering recent events or recognizing people and places;
  • Trouble finding the right words and expressing oneself;
  • Problems planning and carrying out tasks including balancing a checkbook, following a recipe, or writing a letter;
  • Difficulties in judgment, such as knowing what to do in an emergency;
  • Trouble controlling moods or behaviors (depression being a common symptom);
  • Not keeping up personal care such as grooming, bathing, or other daily routines.

What are some signs of dementia in seniors?

There are four basic warning signs of dementia in seniors: memory lapses, difficulty performing common tasks, misusing terms or a disruption in language skills, and orientation problems such as forgetting where the bathroom is in their home.

What are the stages of dementia?

Most medical professionals agree that there are seven stages of dementia:

  1. No Impairment – In this stage, people function without any signs of dementia whatsoever. They are independent and no symptoms are present.
  2. Very Mild – Forgetfulness is present, but is attributed to a common symptom of aging. A person may lose their keys and then find it upon minimal searching.
  3. Mild – Symptoms are more noticeable at this stage and family members will probably show concern. A person still is able to be independent and can perform daily tasks such as using the bathroom and getting dressed. However, there is more memory loss, it becomes difficult to concentrate, and tasks such as balancing a checkbook seem more complicated. The average duration is 7 years before the onset of dementia.
  4. Moderate – At this stage, daily tasks are harder to perform (such as doing laundry or using the phone). Incontinence, memory loss of recent events, and struggling to find the right words are evident. Patients also tend to withdrawal from social situations at this point because their socialization skills are also becoming impaired. The average duration is two years.
  5. Moderately Severe – Help is needed to perform daily tasks. Memory loss includes not remembering home address, phone number, and other basic information. Judgment is lacking such as choosing the proper clothing to wear in different seasons. Help is required to assist with daily tasks such as bathing, getting dressed, and preparing meals. The average duration is a year and a half.
  6. Severe – At this point, a caregiver is necessary. Help with most daily tasks is needed from getting dressed to using the bathroom. Wandering from home is a common occurrence as is forgetting the names of caregivers and loved ones. Personality changes are present with the patient acting paranoid, having hallucinations, or acting on compulsions (like endless cleaning). The average duration is two and a half years.
  7. Very Severe – In this final stage of the disease, there is a loss of language skills, loss of awareness to the patient’s surroundings, no bladder control, and loss of muscle control so the patient needs help walking and eating. The average duration is two and a half years.

What is vascular dementia?

After Alzheimer's disease, vascular dementia is the second most common form of dementia and is caused by problems in the supply of blood to the brain. Some of the causes include having a stroke, being physically inactive, partaking in a fatty diet, being diagnosed with diabetes, having high cholesterol, or high blood pressure. The symptoms of vascular dementia begin suddenly, such as after a stroke. While vascular dementia has many similar symptoms of dementia, there are a few different symptoms to be aware of such as:

  • problems thinking quickly, concentrating, or communicating
  • depression and anxiety
  • physical weakness or paralysis (similar to symptoms of stroke)
  • memory problems
  • seizures
  • periods of acute confusion
  • changes in behavior
  • visual misperceptions (like seeing a rug and thinking it’s a pond)
  • difficulties walking due to unsteadiness
  • hallucinations
  • incontinence

While the brain damage that causes vascular dementia cannot be reversed, the patient can take medications to treat the underlying causes, they can partake of a healthier lifestyle, and different therapies (such as occupational and speech) can slow down the progress of the disease.

What is dementia with lewy bodies?

Dementia with Lewy bodies (DLB) is a type of dementia closely associated with both Alzheimer's and Parkinson's diseases. It accounts for around ten per cent of all cases of dementia in older people and tends to be under diagnosed. Lewy bodies are tiny, spherical protein deposits found in nerve cells. Their presence in the brain disrupts the brain's normal functioning, interrupting the action of important chemical messengers, including acetylcholine and dopamine.

Patients with DLB have similar symptoms as those with Alzheimer’s (such as memory lapses, difficulty performing common tasks, misusing terms or a disruption in language skills, and easily becoming disoriented), but will also have other symptoms unique to DLB such as:

  • Parkinson’s like symptoms (slowness, muscle stiffness, trembling of the limbs, a tendency to shuffle when walking, loss of facial expression, and changes in the strength and tone of the voice)
  • detailed and convincing visual hallucinations
  • abilities that fluctuate daily (or even hourly)
  • fall asleep very easily by day, and have restless, disturbed nights with confusion, nightmares and hallucinations
  • fainting or falling

What is hospice care?

Hospice care focuses on relieving a terminally ill patient’s pain and symptoms usually in the patient’s own home. When no cure is available and a patient is in his or her final days (6 months or less), a hospice nurse or volunteer’s primary concern is to make the patient as comfortable as possible and will neither prolong nor hasten death. Hospice care attends to pain management, the emotional and spiritual needs of the patient and their family, and provides grief counseling to families before and after the passing of their loved one.

What is a hospice?

Hospice is a special concept of care which is designed to console and support patients and their families when an illness no longer responds to cure-oriented treatments and the patient is entering into the final days of his or her life. Its goal is not to end or prolong life, but to ease suffering and keep the patient’s comfort and dignity at the forefront of care.

What is assisted living?

An assisted living facility combines residential housing, personalized support services, and health care for people who need some help with daily living activities. Residents have as much independence as they want with the knowledge that personal care and support services are available if they need them. These communities tend to be apartment homes that also provide housekeeping services, three meals a day, and social events. Assisted living communities may help with daily tasks such as bathing and grooming but their services do not include medical care (such as wound care, colostomy care, or IV maintenance).

What is the cost of assisted living?

The national average daily cost is $110 per day (or $3,300 per month) for a one-bedroom, single-occupancy assisted living apartment. These costs are considerably lower than nursing homes due to the absence of medical services. Moreover, the cost of an assisted living home also fluctuates depending on location, services needed, services offered, size of apartment, and location in the community.

What is palliative care?

Traditional palliative care can be given at any time during the course of an illness and in conjunction with curative and aggressive treatments. Palliative care differs from hospice care in that hospice care is given when treatments are no longer available to bring about a cure and is usually assigned within the last six months of life. Palliative care is a medical specialty that focuses on relieving pain, symptoms, and stress of a life-threatening illness and improving quality of life. It is appropriate at any point in an illness.

What is respite care?

Respite care is the provision of short-term, temporary relief to those who are caring for a family member who might otherwise require permanent placement in an assisted living or nursing home. Respite care can involve a caregiver coming into the home to give the primary caregiver a break or bringing a loved one to a nursing home or care facility for a time ranging from a few hours to less than 30 days.