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.

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    [...] mom had been in skilled nursing for more than five months. As dicussed in the previous blog post, skilled nursing is a mix between a hospital and an apartment. Patients usually share a room, and nearly all require [...]

  • Cheryl Spencer

    A very nice summary of a topic that is can be very confusing and stressful. Thank you

  • http://www.ryanmalone.com Ryan Malone

    Glad you liked it Cheryl.

  • http://pulse.yahoo.com/_FWYWCAPS7HOQ2MND5SRAO4CFVU Christina Moore

     Ryan – great read.  Where does my mom’s caretaker fall? They provide non-medical in-home care: http://carecorner.net/

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  • Anonymous

    What are ADLs?

  • http://www.phnxboards.com/ James McAllister

    ADLs are Activities for Daily Living, and include some of the basics – feeding, dressing, using the bathroom, etc. This site has the full list – they provide home care in Concord NH. Hope it helps!

  • Fred Miller

    My dad is new to his Assisted Living in Tuscon AZ. He has difficulty walking. He needs help getting in and out of bed and on to his electric scooter. He needs help getting on the toilet and off. He wears adult diapers to help with his urination issues. Is this within the realm of assisted living? Incontenence is being poorly handled by the staff. His bed for some reason had the plastic cover removed and is soaked with urine. He has fallen three times and is now afraid of the staff. Is this an issue with the staff versus what was promised by the sales agent? Or does my Dad need a higher level of care? The cost is $5,000.00 per month! One would think this would cover old men with incontinence! Are we being unreasonable or should we call someone to complain or get an attorney? Does my Dad belong in a higher level of care facility? He basically is not a problem and just watches TV all day. He still goes out with my Mom to lunch in restaurants etc. He does have difficulty talking due to a stroke several years ago. Going through yes/no questions he seems to have most of his mental faculties appropriate for 86.

  • eric

    Old question… But ADLs are activities of daily living and include – Transferring, Continence, Toileting, Bathing, Dressing and Eating.

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    [...] these items should fit in a small carry-on bag. If your loved one lives in a facility, regardless of the level of care, make sure the staff is aware of the kit’s existence and [...]

  • Missy Johnson

    Adult daily live skills

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