Many elders and/or their family members looking at potential care communities do not know what the options are for different types of care. Below we have compiled descriptions of the different options for care for in-home care and long-term living.
Everyone ages differently. Many elders live independently. Others need help with their physical care and ability to manage in their homes. In the past, a person who needed help had few options outside of their family or a nursing home. But now, because of nursing home cost and consumer demand, a full range of care options and services are more available so that people are able to remain in their own homes longer. If health declines and help is needed that cannot be provided in the home, there are now different types of living arrangements and housing settings available.
Many of us are faced with making long-term care decisions during a time of crisis, when we are under stress. Long-term care is at times a complicated “puzzle.” It helps to spend time learning about all of the options and the “vocabulary” of long-term care before you need it. The illustrations on the next page summarize the options that are currently available.
Options and Services If You Are In Your Own Home
If you are still living in your own home and you need additional help, click below for descriptions of care options and services that may be available to you:
Meals on Wheels
Meals brought to people who cannot prepare their own meals or are homebound (cannot leave their homes).
Housekeeping
Any cleaning service can provide housekeeping, although if a person has dementia, it is best to hire a housekeeper from a home health agency that has a significant level of training in dementia care. If any acute illness is present, it is best to hire housekeeping from a home health care agency.
Adult Day Care Senior Centers
Centers that provide services to senior citizens, aged 60 and over. They may offer social activities (like music or crafts), meals, health screenings (such as blood pressure checks, diabetes monitoring), learning programs, creative arts and exercise classes.
Home Health Aide
A person trained to provide basic health care tasks for older adults and persons who are disabled in their home. Tasks include personal care, light housecleaning, cooking, grocery shopping, laundry and transportation. Tasks may also include taking vital signs (such as heart rate and blood pressure) or applying a “dry dressing” for certain kinds of wounds. They are supervised by a registered nurse when they are employed by a home health agency.
Companion Services
Many home health agencies will provide companion services to elders, such as assisting with shopping trips, engaging in hobbies together, reading, etc…
Telephone Reassurance Program
A service that provides reassurance calls to check on the safety and well-being of older adults at home. These calls can also offer reminders (such as when to take medication). This type of service may be purchased, or volunteer service organizations may provide it.
Home Health Care
Services given to patients at home by registered nurses, licensed practical nurses, therapists, home health aides or other trained workers. Certified home health agencies often provide and coordinate these services. These services, provided on a short-term basis and ordered by a physician, are usually covered by Medicare and Medicaid. With Medicaid, there are differences in coverage between states.
Hospice
A program of medical and social services for people diagnosed with terminal (end-stage) illnesses that focuses on comfort, not curing an illness. Hospice services can be given at home, in a hospital, hospice residence, assisted living community or nursing home. They are designed to help both the patient and his or her family. Hospice care stresses pain control and symptom management. It also offers emotional and spiritual support. Medicare will pay for hospice if a doctor states that a person probably has six months or less to live. Hospice care can last longer than six months in some cases.
Meal Preparation
Many home health care agencies have employees who will come into the home and prepare meals and do light cleaning for you.
Respite Care
Temporary (a few hours or up to a few days) care to offer relief for the family caregiver. Respite care may be given in the elder’s home, a community-based setting such as adult day care, an assisted living facility or a nursing home. It can be scheduled regularly (for example, two hours a week) or provided only when needed. This service can be particularly valuable for family members taking care of persons with dementia.
Transportation Services
Many cities have senior transportation services to transport elders to stores, doctors’ appointments, and events.
In-Home Continuing Care Retirement Community
An option that offers a range of services and levels of care, often found in Continuing Care Retirement Communities, but in your own home.
Options and Services to Help You Feel “At Home” in Nursing Home or Long-Term Living
If the time comes when you need, or choose, to move from your home to a different care setting, you click below for descriptions of care options and services that may be available to you:
Senior Retirement Housing
Housing communities for elders who are very independent with few medical problems. Housing is in individual apartments.
Nursing Homes/Skilled Nursing Communities
This level of care includes help with more complex nursing tasks, such as monitoring medications, giving injections, caring for wounds and providing nourishment by tube feedings (enteral feeding). It also includes therapies, such as occupational, speech, respiratory and physical therapy. This care can be given in a patient’s home or in a care setting. Most insurance plans require at least some level of skilled care need, requiring the services of a licensed professional (such as a nurse, doctor or therapist) before they will cover other home-care services.
Independent Living
Residential location that may or may not provide hospitality or supportive services. Includes rental-assisted or market-rate apartments or cottages. Residents can choose which services they want. There may be an additional fee for some services.
The GREEN HOUSE® Model
A small, intentional (“purpose-built”) community for a group of elders and staff. A Green House residence is designed to be a home for six to ten elders needing skilled nursing or assisted living care. The purpose of the Green House is to be a place where elders can receive assistance and support with activities of daily living and clinical care, without the assistance and care becoming the focus of their existence.
Health Care Practitioner
A professional providing medical, nursing and other healthcare related services.
Hospice
A program of medical and social services for people diagnosed with terminal (end-stage) illnesses that focuses on comfort, not curing an illness. Hospice services can be given at home, in a hospital, hospice residence, assisted living community or nursing home. They are designed to help both the patient and his or her family. Hospice care stresses pain control and symptom management. It also offers emotional and spiritual support. Medicare will pay for hospice if a doctor states that a person probably has six months or less to live. Hospice care can last longer than six months in some cases.
Assisted Living/Personal Home Care
A state-regulated and -monitored residential long-term care option that may have different names depending on the state. Assisted living provides or coordinates oversight and services to meet residents’ individualized, scheduled needs, based on the residents’ assessment and service plans, and their unscheduled needs as they arise. There are more than 26 designations that states use to refer to what is commonly known as “assisted living” There is no single uniform definition of assisted living, and there are no federal regulations for assisted living. In many states, most assisted living is private pay. Be sure to check with your state about any waiver programs that might be available through Medicaid to pay for the care provided in assisted living.
HUD Housing/Affordable Housing
The U.S. Department of Housing and Urban Development (HUD) 202 Program offers subsidized housing and rental assistance for low-income individuals over 62 years of age who meet the eligibility requirements of the federal program. These housing communities often help residents access a variety of healthcare and supportive services as well as transportation.
Small House
A small group of residents living within a physically-defined environment that “feels like home” and that has a kitchen (with a wide variety of food accessible to residents around the clock, including breakfast-to-order and on demand), a dining room and a living room. Staff is consistently assigned so they can develop meaningful relationships with the residents, work in self-led teams and perform a variety of tasks. The sense of being at home is expressed in recognizing and honoring the rhythm of each individual’s life. All residents in the household have opportunities to participate in the daily life of the household in a manner and to the extent they choose.
Sub-Acute Care/ Rehabilitation
Services to help restore mental and physical (bodily) functions lost due to injury or illness. Rehabilitation may be given at the hospital or in a nursing home, some assisted living residences, or a special facility. The types of services offered generally include physical therapy, occupational therapy, speech therapy, social services and nursing.
Telephone Reassurance Program
A service that provides reassurance calls to check on the safety and well-being of older adults at home. These calls can also offer reminders (such as when to take medication). This type of service may be purchased, or volunteer service organizations may provide it.
Continuing Care Retirement Communities (CCRCs)
A housing option that offers a range of services and levels of care. Residents may move first into an independent living unit, a private apartment or a house on the CCRC campus. The CCRC provides social and housing-related services and might have an assisted living residence and a nursing home, often called the health care center, on the campus. If and when residents can no longer live independently in their apartment or house, they move into assisted living (unless it is provided in their apartment or house) or the nursing home.
For information about how to access these services and to find out what is available in your area, contact your local Area Agency on Aging. For contact information, call the Eldercare Locator at 1-800-677-1116 or go to www.eldercare.gov.
As mentioned before, culture change and person-directed values are applicable for care delivered in all settings. Although most of the emphasis has been on nursing homes, change needs to happen throughout the array of long-term care services. Providers in various settings, such as assisted living, adult day services, and home care are assessing where they are when it comes to person-directed care. They are exploring how they can do a better job in ensuring that individuals receiving care in those settings have as much control over their daily lives as possible, and the ability to develop meaningful relationships and enjoy life to the fullest extent possible.
Click here to read or download Creating Home: A Guide to Better Care Options.
