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Nursing Homes and Assisted Living Facilities : Your Practical Guide for Making the Right Decision
Nursing Homes and Assisted Living Facilities
Are Tough Choices Ahead?
You love your parents and remember them as strong and in control. But now, they need your help. They cannot take care of themselves the way they once could and it is up to you to make sure they stay safe and healthy. Understanding the choices available to help you to help them is what Nursing Homes and Assisted Living Facilities is all about.
Depending on what your loved one needs, the many care options available are explored. Learn which type of care, from adult day care to home health care is best for your situation. If a greater level of need is required, the differences between assisted living facilities and nursing homes are explained.
Knowing your choices is only the first step. Making a decision and easing a loved one's pain into this new arrangement can be emotionally challenging. Use this book to help you and other family members:
--Discuss long-term care
--Ask the right questions
--Discuss financial arrangements
--Evaluate nursing homes
--Make the transition
Now is not the time for you to feel guilty. You are doing the right thing when you make a decision that best suits your loved one, your financial well-being and your family. Let Nursing Homes and Assisted Living Facilities make the process a little easier.
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July 31, 2004
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Excerpt from Nursing Homes and Assisted Living Facilities by Linda H. Connell
Options for Senior Living
Excerpted from Nursing Homes & Assisted Living Facilities by Linda H. Connell, Attorney at Law (c) 2004
There are a number of options available when choosing the living arrangement and type of care needed for a senior. What follows are very general descriptions of the various types of communities available to seniors.
Each state has its own legal definition of and regulatory scheme for these communities. Some types of communities are not licensed by every state--some are not licensed at all.
Federal regulations exist that govern long-term care facilities.
The United States Department of Health and Human Services has published regulations that apply to all skilled care facilities in this country. Each individual state must enforce the regulations in order to be eligible to receive various federal funds. As a result, each state has enacted its own set of regulations, which are at least as strict as, and in many cases more strict than, the federal regulations.
Active Adult Community
An active adult community generally describes a planned, age-restricted development. Residents own and maintain their own homes and are responsible for providing for their own needs. Such communities usually require that at least one homeowner be over a certain age, such as 55, and may or may not provide amenities for residents such as sports facilities, community centers, or scheduled social events. The advantages to a senior living in such a development are the ability to maintain a completely independent lifestyle and the opportunity to socialize with others in the same age group. There is no contract and residents may usually move elsewhere without penalty.
The disadvantage to living in this type of community is that, should the resident decide to relocate for whatever reason, the market for the home will be limited to a smaller section
of the general population--that is, other seniors.
Independent Living/Retirement Community
In some cases, a senior will decide that, although in good health, he or she would prefer to not have to worry about caring for a home and yard. He or she may not know many other seniors or simply may not wish to live alone. A lifestyle option known as either an independent living community or a retirement community may be most appropriate.
In this type of community, residents live in their own space, often either a room or apartment-style home. In some such communities, residents have meals together in a main dining room, while in others, residents provide their own meals. Housekeeping and laundry services may or may not be included. There may be an activity staff that runs regular social events for the residents. Skilled nursing care is not provided by these facilities, although a resident should be able to hire home health-care professionals as needed.
Home Health Care
As the name suggests, this lifestyle option allows a senior with health-care issues to live in his or her own home, thus allowing independence. Home health care refers to the hiring of health-care aides or professionals to attend to the senior's medical needs and daily living activities, without the senior having to relocate to a health-care facility. Such a lifestyle option would be best suited for the senior who has a fulfilling life at home, is satisfied with his or her opportunities to socialize, and has no major physical or mental health concerns that would require a skilled nursing facility.
The home health-care agency and its employees are subject to federal regulations only to the extent that the agency receives payment from the federal Medicare program. Otherwise, home health-care agencies are regulated, if at all, by the states in which they do business. Home health-care aides are generally subject to some regulations from the state, but that does not mean that a senior is required to have a caregiver who is subject to such regulations. Sometimes, the caregiver is a family member, friend, or other person who may not have any formal training.
Many seniors are fortunate enough to be in fairly good physical and mental health, able to perform some day-to-day activities, and not in need of constant medical oversight. However, sometimes these people have the need for some assistance, for example, with getting bathed, dressed, or even with walking to another room to eat a meal. Assisted living communities may provide the best lifestyle for these seniors. Such facilities generally do not provide skilled nursing care but do have staff to assist with grooming, housekeeping, and other daily activities. Some assisted living facilities are geared toward a specific group of seniors, for example, those suffering from Alzheimer's disease. These facilities provide specialized services to a particular segment of the senior population.
The advantage to placing a loved one in an assisted living facility is that the philosophy of such a community generally is to promote the independence of the residents and their freedom of decision-making as much as possible. If the senior is functionally able to live in an assisted living facility, the transition from his or her own home to the new surroundings is likely to be easier than if he or she had been moved into a skilled care facility.
As a general rule, Medicare does not cover assisted living expenses. Some facilities do accept Medicaid patients, but many do not. Assisted living facilities generally are not subject to federal regulation, unless they accept Medicaid patients. Many states regulate assisted living facilities, but some do not.
There is not even one single name or definition for such facilities. Sometimes they are called residential care facilities, retirement homes, or semi-independent communities. Because of this, it is difficult to pinpoint an exact definition of such a facility. Even more difficult may be comparing two or more such facilities and the services that they offer.
Long-Term Skilled Care (Nursing) Facility
A skilled care facility is the present-day term for what has traditionally been called a nursing home. It is a facility that not only provides living assistance for those who are not able to care for themselves, but also provides health care in the form of staff nurses, and often various types of therapy programs, such as physical and occupational. Physicians are usually required to be on call to respond to particular needs of skilled care facility residents. Health care is provided in these facilities around the clock.
Skilled care facilities are subject to a myriad of federal and state laws and regulations. Among the most important is the federal Nursing Home Reform Act. This Act provides a
uniform minimum standard for all such facilities across the country.
Continuing Care Retirement Communities
Continuing Care Retirement Community (CCRC) refers to a mixture of some of the living situations previously discussed. Usually, a resident will enter into a contract for continuing care and the facility will guarantee whatever level of care the resident needs, even as the need changes over the years. Such communities will often have an independent living facility, some type of assisted living facility, and skilled nursing care--all in the same building or complex. Many CCRCs also have specialized Alzheimer's disease units.
The senior may enter the community as an independent living resident, but may move over to the skilled care facility at a later time if the need arises. In some ways, CCRCs are the best of all worlds, because they allow a tailor-made solution for a senior who may have changing needs for care. If a move becomes necessary, it usually means relocating a few steps away in another building on the facility grounds. This makes adjusting to changing lifestyle needs much less stressful on the senior. On the other hand, CCRCs can be quite expensive and a very large up-front investment usually is required. Depending on the contract, a senior may end up paying for services that he or she never actually needs.
CCRCs are a newly expanding phenomenon based upon an ancient idea of providing a continuum of care for the changing stages of later life. Regulation of this type of community is evolving, but in general, it is left to the states.
The part of a CCRC that functions as a nursing home is subject to federal nursing home laws and any facility that receives Medicare or Medicaid funding is subject to those related laws. Because there is no uniform regulatory framework applicable to CCRCs, the best way to search for a community of high quality is to consult the Continuing Care Accreditation Commission (www.ccaconline.org or 202-783-7286), the only organization in the country that gives accreditation to CCRCs that meet certain standards of excellence.
Adult Day Care
Adult day care programs provide care and social activities to seniors on less than a 24-hour basis. Usually, seniors who live with their adult children who have to be at work during the day use this service. Adult day care allows seniors with elevated care needs to remain at home for the most part, when otherwise they would have to be placed in an assisted living or long-term care facility.
Seniors in adult day care settings receive meals and opportunities to socialize that they might miss if they were on their own all day. Often, adult day care is provided in an assisted living facility or nursing home, so that the senior can receive proper health care as well as take advantage of the activities that are scheduled for the facility's residents. In some cases, transportation may be provided so that the senior can go on recreational outings or to doctor's appointments and the like. Personal assistance with toileting, taking medications, and eating should be offered as well. Sometimes for an additional charge, the staff will also help the senior with grooming, bathing, and dressing.
Adult day care may be offered only during regular daytime business hours or may be available during evenings and weekends, depending on the center. Costs may be charged by the hour or by the day. Fees of $40 or $50 per day and up are to be expected. In-home day care may also be possible, but is likely to cost quite a bit more. At the present time, there appears to be a shortage of adult day care centers in this country--one study estimates that there are less than half as many as are needed to serve the current demand for services.
Respite care is similar to adult day care in that it is provided for less than twenty-four hours a day. Where adult day care usually is provided on a regular basis, for example, Monday through Friday, respite care is generally used less frequently. It is defined as care of a functionally impaired senior that is designed to provide the senior's regular caregiver some relief from the constant stress of his or her obligations. It is most likely to be utilized by an adult child of a cognitively or physically limited senior who lives with the adult child on a full-time basis. In other words, it gives the adult child a break. Families
often utilize respite care so that they may take a vacation or travel out of town for a family emergency without having to worry about their loved one.
Respite care may be provided by an adult day care center, an assisted living facility, a skilled care facility, or by a visiting nurse or other professional who comes to the senior's residence. Again, in-home care will come at a higher cost. Rates typically start at around $10 an hour for care in a center, depending on the amount of assistance the senior needs.
Hospice is not a lifestyle option per se, but it is important to have an understanding of hospice services when selecting a senior care facility. The American Academy of Family
Physicians (www.aafp.org) defines hospice simply as a program designed to care for the dying and their special needs. Hospice programs primarily provide pain and symptom relief for patients, through medication and other means, and assist the patient with the emotional issues of dying. Care is not geared toward curing the terminally ill patient but to providing palliative care to alleviate suffering.
Hospice services typically are available to those who are diagnosed as having less than six months to live. A team of professionals trained in handling end-of-life issues provides care. The team should include physicians, nurses, social workers, and counselors (who might either be laypersons or clergy).
Hospice is driven by a philosophy of death with dignity and as free of pain as possible. Care is geared not just toward the terminally ill patient, but also to the family members dealing with their loss. Hospice programs often provide care in the patient's home--this includes a nursing home. Medicare will pay for most hospice care, as will Medicaid in the majority of states.