Elder Care Options

When exploring care options for your loved one, you’re bound to run across a dizzying array of terms. Because many seniors bristle at the mere mention of the words nursing home, facilities and staff often resort to euphemisms in an effort to put families more at ease. In her book, Eldercare for Dummies, Dr. Rachelle Zukerman lists several of these synonyms: “old folks home, rest home, convalescent home, health center, rehabilitation center, home for the aged, living center, nursing center, care center.”

More directly, types of elder care generally fall into these categories:

Nursing Home. These facilities have with live-in residents who require constant care by licensed health care professionals.

Assisted Living. Usually apartment- or condo-type settings, seniors can live more independently than at a nursing home but still have access to care. They’re still seen on an as-needed basis by a network of providers and receive help managing medications and grooming. Many nursing homes also have independent living residences.

Independent Living. More like a retirement community, these facilities are for seniors who don’t need special care, just opportunities to socialize. Some also offer meals and transportation.

In-Home Elder Care Services. Services can consist of assistance at a senior’s own home with health care, meals preparation and transportation from a network of doctors or nurses. Care can range from round-the-clock in shifts to periodic checkups.

Adult day care. Programs provide supervision and activities during daytime hours to give the caregiver a break and peace of mind while at work or running errands.

The first three types follow a scale from a low to high level of independence for the senior. Nursing homes and assisted living facilities aren’t exclusive to the elderly, but often include younger people with other disabilities.

Assisted Living Options

Over the past few years, assisted living facilities have been the fastest-growing type of senior housing in the United States. Residents in these facilities don't require constant care, but they can’t live independently, like in a retirement community, or at home. In assisted living, they can receive round-the-clock supervision, personal assistance, social activities and health-related services or programs.

The types of living space in an assisted living facility vary widely: anything from large complexes housing several hundred people in self-contained suites to cottage-style residences that give all tenants their own space. Assisted facilities are managed at the state level by agencies that take care of all licensing and regulation. This means there is wide division among states about the quality of care provided, how it is monitored and what (if any) penalties are levied against providers who don't follow the rules.

The type of care offered also varies greatly. Typically, it is based on two factors: Staff available at the facility, and the needs of individual tenants. Some assisted living facilities have nurses available 24 hours a day, seven days a week, for example, whereas others have medical staff on-call as needed. Basic services common to the industry are apartment cleaning, turn-down service for bed linens, laundry and food service. Most facilities will also have common areas for socializing including patios, games rooms and a communal dining hall.

Amenities vary and affect the cost, which the resident, relatives or an insurance coverage plan pay monthly.

Activities of Daily Living

To determine what level of care is needed by an individual, doctors typically use what are known as the "activities of daily living." These include basic tasks such as bathing, dressing, eating, mobility and the ability to self-administer medication. Any person who cannot perform at least one of these activities reliably is a candidate for care; the fewer the person can complete, the more support he requires.

Some facilities address this range in needs by creating separate "wings," which house residents of varying ability. The most basic wing could consist of independent apartment suites complete with private washrooms and kitchenettes; here, a nurse might only be required to help manage medication, change an IV, or perform insulin injections. Other, more intensive-care portions of the residence could include full-time care and on-call doctors, allowing residents to smoothly transition from one type of living to another.

Aging in Place vs. Nursing Home

It's important to understand the difference between what's known as "aging in place" and the kind of care offered at an assisted living facility. Seniors who choose to age in place have the benefit of staying in their own homes or apartments and may have a nurse or caregiver check in daily. This allows the greatest amount of independence, while still offering access to some elder care services.

Managed facilities, meanwhile, mean moving out of a family home and into a communal residence but come with several important benefits. First is better access to care; even if staff isn't available 24/7, help is only moments away. In addition, the social aspect of assisted options can't be overstated, especially for seniors who have had to endure the passing of a spouse or other loved ones. Having friends just down the hall, rather than around the block or across the city, can help make a significant difference to any resident's quality of life.

Finding the Right Assisted Living Facility

Seniors (and their families) who choose assisted facilities are purchasing more than just a managed apartment: They are, in many respects, paying for a standard of care which puts respect and dignity at the forefront of resident/staff relationships. Because state regulations differ widely, however, and the term "assisted living" is often used as a marketing pitch, potential tenants must make sure to fully evaluate both the physical amenities and quality of care offered before signing a contract.

If you decide an assisted living facility is the best option for you or a family member, do your research. You can start by checking with Angie’s List to find the facilities in your area. Despite what they may call themselves, look at the descriptions for the term assisted living. Read through member ratings and reviews. The Assisted Living Foundation of America (ALFA) is a good resource. Every year, it runs a "best of the best" awards program, honoring those providers who are innovative or evolutionary in improving senior care.

Visit several facilities and talk to the staff and residents. Look for a pleasant atmosphere, adequate staffing and happy, engaged, well-groomed residents. Arrange for a tour of the facility, and ask to see a suite similar to the one you're considering. Ask what's included, and what costs extra. Three meals a day are typically parts of the basic price, but what about dietary restrictions or food preferences? Do these come with a bigger price tag? Are there private rooms? Do they have rooms with kitchen facilities? Is the bathroom private or shared? Are there private areas other than the bedroom for visits? Is there space for personal belongings?

Also ask about care. Ask how many full-time staff work at the facility, and how duties are handled. Will you see the same nurse from day to day, or can you expect a constantly changing staff? If applicable, find out if the facility accepts Medicare and Medicaid, and if it's Medicaid-certified. In addition, ask how the residence will liaise with your general practitioner. Does it have an in-house doctor, or will the facility call your physician in the event of an emergency? Find out if the state requires the facility to be licensed and ask to see the most recent inspection report. Check the facility for safety features including well-lit stairs and halls, handrails in the bathrooms, well-marked exits and a way to call for help if needed.

Last, you’ll need to determine how much you or your family will be involved in the care-planning process.

Above all, treatment as a person of value trumps low costs or value-added services. Assisted facilities are more than just a place to lay your head; ideally, they should provide peace of mind and body.

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