The time to start researching elder care facilities, experts recommend, is before you need one. For one thing, you don’t want to be caught flat-footed in the event of an unexpected health crisis that forces you to make a quick decision without the knowledge to make an informed choice. And for another reason, the choices are numerous, and if you don’t fully understand the differences among your options, you risk making the wrong choice for your loved one.
There are basically four different types of long-term care facilities, according to the National Institute on Aging:
— Skilled nursing facilities.
— Board and care homes.
— Continuing care retirement communities.
A fifth option, of course, is to provide care for the elder in his or her home. Let’s take a look at each option.
Many elders prefer to remain at home as long as possible. In fact, “99% of the people I meet say they want to stay at home,” says Howard S. Krooks, an elder law attorney practicing in Florida and New York and past president of the National Academy of Elder Law Attorneys.
That’s great if the elder has enough support from adult children or other friends and relatives to help with whatever needs they have, such as shopping, cleaning, driving and other so-called activities of daily living. If not, they may need to enlist a home care agency or hire an eldercare aide. That, of course, costs money. “The problem with home care is that it’s an optional service under Medicaid. Some states have a waiting list,” Krooks says.
Medicare typically doesn’t cover home care at all. That means paying out of pocket or with a long-term care insurance policy. “Home care is an option if you can pay yourself or with a combination of Medicaid and self-pay,” Krooks says. But to qualify for Medicaid, one’s assets must be so low that an adult child or other person has to pick up the cost.
[READ: Assisted Living Checklist.]
Assisted Living Facility
Assisted living facilities, as the name implies, offer some assistance to residents in their activities of daily living. These facilities are an option for seniors who can still take care of themselves most of the time, but could use some help with things like:
— House cleaning.
— Household chores.
— Bathing or showering.
— Medication management.
— Transportation to medical appointments or stores.
A typical assisted living facility includes a few support services in its basic agreements, and the resident can then sign up for additional services a la carte at an additional cost. Many of these facilities are like high-end apartment complexes or housing developments, in that they include common areas like dining rooms, a gym and community rooms. Most offer three meals a day for those who don’t want to cook, 24-hour security and socializing and recreational events within the facility or to places like museums, movies or other locations. Residents can even keep pets at some facilities.
An assisted living facility does not offer and cannot provide more intensive medical or daily living care, however. For elders who need a higher level of care, a skilled nursing facility is a better option.
Skilled Nursing Facility
Skilled nursing facilities, also known as nursing homes, do provide state-licensed higher-level care, especially medical care that an assisted living facility cannot deliver. A skilled nursing facility offers the same services for daily living that assisted living can provide, but they also have trained and registered nursing staff for:
— Nursing care.
— Rehabilitation services, such as physical, occupational and speech therapy.
— Aid getting dressed or in and out of bed.
— Frequent or daily medical management for chronic conditions.
According to the National Institute on Aging, part of the National Institutes of Health, some seniors need skilled nursing care for a short period, such as after an unexpected event like a heart attack or surgery, and are able to return home after they recover. However, the majority of those who enter a skilled nursing facility have reached the stage where physical or mental health impairments require professional care and supervision for the rest of their lives.
Board and Care Homes
Board and care homes, the National Institute on Aging says, are sometimes known as residential care facilities or group homes. These are similar to an assisted living facility, but are smaller residences of 20 or fewer who live in private or shared rooms. These facilities have staff available 24/7 to help with activities of daily living, and they usually include meals, but not skilled nursing or medical care.
Continuing Care Retirement Communities
Continuing care retirement communities, sometimes called life care communities, are “full service” communities that include most or all of the above options all in one location. Thus, seniors can “age in place” as their needs change. The resident can, for example, first move into an independent housing unit — a house or apartment — and then transition into assisted living housing when some daily activities become difficult. Later, when health deteriorates, there is skilled nursing care right next door.
Grace Ferri, chief marketing officer for United Hebrew of New Rochelle, a continuing care retirement community in Westchester County, New York, believes “it’s really important to go to a facility where your loved one can age in place. Change is hard. When people come to assisted living, they may have come from a home they lived in for 40 or 50 years. Now they are in a new environment, they have made friends, and when their health deteriorates, acclimation is far more difficult and challenging, even for the family. They make rapport with the staff, and having to do that all over again is challenging.”
Ferri advises families to plan ahead because “no one makes good decisions in crisis mode. Think broadly. We are all prone to resolving a problem at hand, but not thinking about what could be coming in the future.”
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