A Guide to Different Levels of Elder Care

Before you can even begin the process of evaluating assisted living, it’s im- portant to familiarize yourself with all the terms. There are many types of care ranging from skilled nursing to senior living. They all vary based on the level of assistance required by the resident. What is the difference? Let’s find out.

Senior Communities

Senior housing is designed for high-functioning elders, defined as those not requiring assistance with ADLs. Senior communities are usually neighborhoods or towns (consider Sun City, the nation’s “first and finest” senior community) that are limited to people of a minimum age. They are designed for active seniors and have a variety of social clubs such as golf, arts and crafts and cards.

While some senior communities offer additional levels of care, many are not equipped for individuals who require assistance with ADLs. Some senior communities require the resident move on, should they require this level of care.

Continuing Care

Continuing care communities are sometimes called “step care” or “progressive” care facilities. They offer a wide range of options, all the way from independent living to special care. Residents are usually admitted when they live independently. As their needs increase, they are guaranteed vacancies in the lower level of care. An entry fee is often required, making this option quite expensive.

Assisted Living

Assisted living offers the elderly a place to live outside of their own home, where they can receive basic assistance in one or more of the following areas: housekeeping, meal preparation, 24-7 monitoring, shower assistance, toileting, medication assistance or reminders, transportation, eating, dressing, activities or socialization.

In assisted living, your loved one will likely have their own apartment, unless you or your loved one consents to sharing a room with someone. A private bathroom is most often in the apartment to allow for privacy and dignity. Most facilities will have a kitchenette in the apartment with a sink, microwave, refrigerator, and cupboard space. Each apartment will likely be climate controlled individually. There will be access to common areas such as a TV room, an activity room, dining room, library, and communal sitting areas.

Assisted living facilities are designed for people who need help with complex ADLs on a daily basis. If you remember from the previous chapters, basic ADLs include eating, bathing, dressing and hygiene. More complex ADLs include cooking, shopping and money management. Assisted living aims to be the mid- point between independent living and long-term care.

Most assisted living facilities have a dining room decorated like a restaurant as well as a variety of activities. Most assisted living facilities are not licensed to administer IVs, requiring patients who need IVs to temporarily relocate to a skilled nursing facility.

Board and Care

Board and care is similar to assisted living in terms of care, although some group homes work with lower functionality seniors than those found in assisted living. A woman I spoke with recently had placed her mother, suffering from Alzheimer’s disease, in a board and care facility, sometimes known as a ‘group home.’ This is usually a single-family dwelling which has been converted into a residence for elderly and disabled residents. The monthly rent paid commonly includes room, three meals a day, laundry services, and some transportation – in addition to a 24-hour staff person. While basic medical care can be attended to, residents who have serious medical conditions will be expected to move into a more suitable facility.

Skilled Nursing

Skilled nursing (also called SNF or “sniff”) is the first level of care that is licensed to administer medical treatment with nurses. In fact, there are strict regulations that require nurses to be on duty and to regulation the nurse-patient ration.

As the name denotes, such a facility offers extensive nursing services for the residents. Admission must be initiated by a person’s physician, who recommends that a patient enter either ‘rehab care’ or a ‘special care’ facility.

  • Rehab care. Located in hospitals or nursing homes, rehab care programs are sometimes called “Level 1” or transitional care. They provide intensive medical care for patients who are expected to regain functional capacity and return home in a relatively short time.
  • Special care. There are two types of special care facilities: those involved with unique medical issues (sometimes called “Level 2” care), and those which manage behavioral problems that may arise from dementia.

Many patients are admitted to skilled nursing to address an acute condition such as rehabilitating a broken hip, or treating an infection with IV antibiotics.

Many skilled nursing facilities have a portion of their residents who are long- term care patients. These are patients who require the treatment capabilities of a SNF, yet their condition requires that level of care permanently. Long-term care includes nursing supervision, but it is custodial in nature – focused on maintenance as opposed to curative care. Here the condition is not expected to improve, and the nursing activities are focused on keeping the person healthy and safe. The table below summarizes the differences between the levels of care and residential options.

This table is an updated, compiled version of those found in both offline and online sources, many of them listed in the resources section, the Book Club listings or 2008 Long-Term Care Cost Study, The Prudential Insurance Company of America, 751 Broad Street, Newark, NJ 07102-3777.

Photo Credit: gilbert928.

Tips for Managing Caregiver Stress

Chances are that, to some degree, you been a family caregiver for your loved one for some time now. To one degree or another, you’ve been tending to their needs: taking frequent phone calls, grocery shopping with (or without) them, and performing chores around their home.

Whether you are the child, sibling, or the spouse of your loved one, you’ll be feeling the emotional and physical strain of the role you’re playing. There’s an uncomfortable shift in the dynamics between you.

If you’re the child, you’ve become a parent of sorts. If you’re the spouse, you’re forced into a new and often unwelcome level of intimacy. And, if you’re a sibling, it’s imperative that your decisions not be clouded by childhood memories or resentments.

Being aware of these shifts in roles and responsibilities is the first step in self- care for the caregiver (that’s you, remember). The second step could be to seek support and assistance. One great resources is National Caregiver Support Groups. These groups can put you in touch with their local chapters. In addition, you can get information regarding support groups in your area from local nursing homes or eldercare agencies.

The Effects of Caregiver Stress

Dealing with the health problems of someone you love naturally produces stress in your life. It can wear you down, both emotionally, and physically.

I mentioned in my opening story that at one point in my mother’s illness, I was driving hundreds of miles each week to visit her in the hospital or skilled nursing facility. My mother’s condition was the result of a sudden event – which is different from the lingering decline described as part of the assessment process. With such a dramatic event comes shock, guilt and acute sorrow.

The time spent on the road gave me hours to think about how things could have been different; the traveling to and from her bedside took time away from my work, and my relationships. The stress of my mother’s illness was dominating my life and had manifested itself in many ways.

Stress manifests itself in three ways: physically, cognitively and emotionally. Below is a list of stress symptoms. Looking back at that period in my life, I realize stress has manifested itself in many of those symptoms.

Physical Symptoms

  • Headaches
  • Sore back / stiff neck
  • Teethgrinding
  • Sexual dysfunction
  • Heart palpitations
  • Restlessness
  • Shortness of breath
  • Heartburn
  • Diarrhea/constipation
  • Jumpiness
  • Chronicinsomnia

Cognitive Issues

  • Difficulty in making decisions
  • Decreased problem-solving ability
  • Obsessive thinking
  • Short-term memory loss
  • Decreased concentration
  • Drop in organization skills
  • Limited attention span

Emotional Signs

  • Loss of interest in hobbies or recreational activities
  • Frequent crying or tearfulness
  • Persistent sadness or depression
  • Irritability
  • Chronic anxiety

Are you currently suffering from one or more of these symptoms of caregiver stress? I’m not surprised! Even in the early stages in dealing with the chronic health issues of a loved one – whether parent, sibling or spouse – you’ll find that you’ve become (more or less) tolerant of many of these manifestations of stress.

What I’ve learned is simple: taking care of yourself is essential to the well-being of your loved one. Here’s a short list of some of the things you can do to support yourself during the coming weeks:

Seek support from others. Turn to your loved one’s neighbors and friends; or other family members. They may be able to spend a few hours caregiving while you run errands, or even just take a short nap. Don’t feel you have to do it all alone!

Find a way to release your emotions. If you’ve got a pastor, spiritual advisor, close friend, or a therapist – someone you can trust 100% – be sure to reach out to them. They will be able to listen to you lovingly, and keep what you tell them to themselves.

Take time for yourself. If you like to walk on the beach, go shopping, take your dog to the park, or simply go see a movie – do it! Do not procrastinate on this: taking time for simple pleasures every day is critical to your well-being.

Simplify your life. Ask yourself this question: What can I let go of right now? Maybe you shouldn’t tackle new projects at work; maybe you should let go of hunting for that new house – whatever you can put ‘on the back burner,’ now is the time to do just that.

Avoid excessive alcohol or drugs. Ah, the temptations of self-medication. Don’t give into them. It’s not the wise path; ultimately, the care you are trying to provide suffers, and you’re less able to take care of the other things in life. Your job, marriage or parenting duties will suffer. That’s why I highly recommend the next tip:

Continue or begin an exercise program. It’s been clearly proven: aerobic exercise causes the brain to produce endorphins, which are your body’s natural way to enhance your mood and relieve your stress. Find a way to build regular exercise into your week: walk, run, practice T’ai chi; go bowling or play a round of golf with friends. Note: Always check with your doctor before beginning a new exercise program!

Do yoga. Yoga can be a fantastic stress reliever which providing a great deal of exercise and better flexibility. I cannot recommend Yoga enough, as it alone helps me reduce my stress level and irritability. A note for the men reading this book: Yoga can be hard work, very challenging and a great way to relax and build muscle. Don’t think Yoga is effeminate or too easy!

In the wonderful book, When Someone You Love Needs Nursing Home Care, the authors, Robert Bornstein and Mary Languirand help their readers to build a long-term plan, based on six principles:

  • Plan ahead. It may be a difficult subject to broach with your loved one, but planning ahead provides them with the opportunity to fully participate in the decision-making process.
  • Get advice. Don’t discount the value of speaking with those people who have been down this same road. Join a support group (online or offline), and speak with doctors, nurses and health care professionals. When it’s financial or legal advice you need, turn to attorneys and accountants.
  • Get others involved. Share the workload with family members, co- workers, and friends. Remember they care about you, and would love to help when they can – so don’t hesitate to ask!
  • Keep colleagues informed. Those people in your workplace need to be taken into your confidence; they’ll want to know why you’re frequently absent from your desk, or unable to take on additional work.
  • Take care of yourself. We’ve already touched upon ‘self-care’ as being critical not only to your well-being but to the well-being of your loved one as well.
  • Put things in perspective – and keep them there! Short-term thinking (“Things are falling apart and will never get better”) is a trap. As I’ve learned so clearly, people grow through adversity, and you’ll never be able to know just how this growth will manifest itself. Remember that change is inevitable…“this too shall pass.”

Photo Credit: lululemon athletica.

Is it Time for A Geriatric Screening?

With elder care, there are rarely black and white answers to your concerns. Do you believe that your loved one is exhibiting behaviors that indicate their inability to perform basic or complex tasks? If you find yourself answering “yes,” then you should consider a geriatric screening for your loved one. You can arrange for a geriatric screening through your local hospital or social service agency.

To have a productive conversation with the healthcare worker or elder care provider, be sure to gather enough information about your loved one’s medical condition, legal status and personal preferences.

What is Geriatric Screening?

A geriatric screening is a comprehensive assessment designed to optimize an older person’s ability to enjoy good health, improve their overall quality of life, reduce the need for hospitalization and/or institutionalization, and enable them to live independently for as long as possible. An assessment consists of the following steps:

1. An examination of the older person’s current status in terms of:

  • Their physical, mental, and psycho-social health
  • Their ability to function well and to independently perform the basic activities of daily living such as dressing, bathing meal preparation, medication management, etc.
  • Their living arrangements, their social network, and their access to support services.

2. An identification of current problems or anticipated future problems in any of these areas.

3. The development of a comprehensive “Care Plan” which addresses all problems identified, suggests specific interventions or actions required, and makes specific recommendations regarding resources needed to provide the necessary support services.

4. The management of a successful linkage between these resources, the older person and that person’s family so that provision of the necessary services is assured.

5. An ongoing monitoring of the extent to which this linkage has or has not addressed the problems identified, and modification of the Care Plan as needed.

Who Performs a Geriatric Screening?

A geriatric screening can be done in many different settings such as:

  • a hospital
  • a nursing home
  • an outpatient clinic
  • a physician’s office
  • the patient’s home

Because a geriatric screening is so comprehensive in scope, it can only be successfully conducted by a multi-disciplinary team of experts. This team might include:

  • physicians
  • ancillary personnel
  • social workers
  • physical and/or occupational therapists
  • dieticians
  • psychologists
  • pharmacists
  • geriatric nurse practitioners

You can request a referral for a geriatric screening from a primary care physician. Also, check with any large hospital or university to see whether they have a geriatric assessment unit.

For more information on geriatric screenings, I recommend you review The Geriatric Patient: A Systematic Approach to Maintaining Health. This article by the American Association of Family Physicians provides a detailed review of the standardized assessment tools typically used in an outpatient setting.

Photo Credit: simaje.

3 More Signs of Functional Decline

elder careIn the last blog, I discussed some of the warning signs that your loved one could be experiencing functional decline, including difficulty communicating and the disturbance of everyday functions and tasks. These kinds of hardships may be symptoms of a more serious functional decline, in which your loved one is losing the skills needed to maintain basic independence.

In the previous blog, I gave a detailed account of physical, perceptual and cognitive changes that can indicate a functional decline. Now here are three more areas to monitor if you believe your loved one may be experiencing functional decline.

1. Hearing and Vision Loss

Hearing loss is hard to hide; it’s often one of the first indications your loved one is in need of assistance. Here’s a list of things to note:

  • Saying “What?” over and over again during conversations, or repeating what you just said, as if to confirm what they heard.
  • Turning the volume up on the television repeatedly, until the neighbors may be able to hear it – while your loved one still complains it’s ‘too low.’
  • An inability to distinguish certain sounds, such as f, t, and z, resulting in misunderstandings and miscommunication.
  • Nodding frequently during conversations, as if to confirm that they are participating fully in the dialogue.

And then there is eyesight – often the first of the senses to be noticeably affected by age. Focusing on small details becomes difficult; self-grooming becomes challenging – and who can write out the checks to pay bills when you can’t see the numbers?
As with hearing loss, compromised vision is also a safety issue. What are some of the signs of decreased visual acumen? Just ask yourself these questions:

  • Has your loved one lost interest in reading, playing cards, or other hobbies where clear vision is required (embroidery or television viewing, for example)?
  • Are their clothes, shoes or socks frequently mismatched?
  • If they still drive a car, are they getting lost more often (because they can’t see the street signs)?
  • Has your loved one started to fall, trip or bump into things more frequently?

Once again, a primary concern here is one of safety. How safe can your loved one be, if they can’t clearly hear or see the world around them? And if they’re driving, it can be catastrophic.

3. Frequent Falling

Certainly, frequent falling may not be related simply to poor eyesight; it could be the result of medical conditions related to poor physical health. Or repeated falling in the home environment could be the result of poor safety habits: loose throw rugs, a cluttered living space, exposed wiring, no handrails or poor lighting. There are also those elderly who refuse to use their assistive devices such as canes, walkers and wheelchairs – even refusing to wear their eyeglasses!

Whatever the causes, the consequences are serious – and should be addressed by your family or geriatric physician. Here are some things to watch out for:

  • Unexplained cuts and bruises, or explanations for these injuries that seem far-fetched or implausible.
  • Hesitancy when walking or climbing stairs.
  • Reticence to leave the familiarity and relative safety of their home.

4.  Psychological Changes

May Lamberton Becker – the journalist and literary critic once said, “We grow neither better nor worse as we get old, but more like ourselves.” What she’s describing is the process called disinhibition, where those personality traits that may have once been charming or quirky slowly become exaggerated as we age. Aunt Rosemary used to be rather bossy, but now she’s dictatorial; your father, who used to simply be self-reliant, is now completely resistive and argumentative.

It seems that the natural process of disinhibition is magnified when aging is coupled with fear and unhappiness. If it is complicated even further by depression or anxiety, your loved one will completely cling to those coping strategies that served them so well in their younger days – to the point they completely interfere with an independent life.

So, whatever you do, don’t delay in taking action. Start actively assessing all six areas of your loved one’s strengths and abilities as soon as possible. If there are signs of a serious functional decline, then you may want to consider a transition to assisted living.

Photo Credit: Flickr user One From RM.