When your grandmother starts forgetting things, like her checkbook or the names of close friends, it’s easy to chalk it up to expected signs of aging. It might take a sudden hospital admission or a fall leaving her stranded to realize how quickly a loved one can become vulnerable in their old age.
The time to start researching eldercare facilities, experts recommend, is before you need one. There are numerous options for eldercare, and you don’t want to be caught flat-footed in the event of an unexpected health crisis.
Understanding the Different Types of eldercare: Custodial vs. Skilled Nursing Care
There are many options for care for older adults. Before understanding the types of senior living facilities, it’s important to establish the kinds of care that can take place in these facilities:
— Custodial care. This is any type of care that can be done by nonmedical or unlicensed assistive personnel. This may involve assisting older adults with activities of daily living, such as bathing, dressing or eating. Or, it could be helping an older person with grocery shopping and bills. Custodial care is a primary offering at nursing homes and is generally not covered by Medicare.
— Skilled nursing care. Skilled nursing care requires trained or licensed personnel to perform a task, such as IV therapy, wound care or medication administration. Medicare Part A, which covers inpatient care, offers some coverage of skilled nursing after a qualifying hospital stay.
[READ: Identifying the Right Time for Senior Care.]
Home-Based Senior Care
Many older adults 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 with Cozen O’Connor who practices in Florida, New York and Pennsylvania. He’s also past president of the National Academy of Elder Law Attorneys.
The biggest setback to home care is the cost, due to several reasons:
— Lack of personal support. Many older people do not have support from adult children or other friends and relatives to help with shopping, cleaning, driving and other activities of daily living. If not, they need to enlist services provided by a home care agency or hire an eldercare aide.
— Minimal Medicaid coverage. Home care is often not fully covered due to state policies and budget constraints, leaving families to pay out of pocket. “Some states have a waiting list, and in many cases, the number of hours approved by Medicaid are insufficient for the proper care of a loved one,” Krooks says.
— No Medicare coverage. 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 low, and the hours approved must be adequate to safely care for the individual in the home.”
[READ: Assisted Living Checklist.]
Home health eldercare
Home health is one of the most common options for eldercare at home. The biggest benefit to home health is that the older individual gets to stay in the comfort of their own home and maintain a sense of routine.
Home health care may refer to an umbrella of services, including:
— Personal care, such as assistance with a morning routine or cooking meals
— Skilled nursing care, such as catheter changes
— Therapy, such as speech, physical or occupational therapy
Medicare Part A covers home health that involves skilled nursing or therapy care as part of a care plan, but it does not cover assistance with activities of daily living or homemaking services.
[READ: Home Safety Checklist for Seniors]
Facility-Based Senior Care Options
For a long-term eldercare option, a senior care facility is often the most economical choice. All senior living facilities provide custodial care, but many also provide additional care, such as skilled nursing and therapy.
These care options include:
— Continuing care retirement communities
— Assisted living facilities
— Board and care homes
— Skilled nursing facilities
Continuing care retirement communities
Continuing care retirement communities, sometimes called life care communities, are “full-service” communities that include most or all of the services offered in assisted living facilities.
Thus, seniors in continuing care retirement communities 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, a campus of comprehensive senior services 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.”
Aging in place prevents transfer trauma, or the stress of continually having to keep moving.
“Having to do that all over again is challenging,” Ferri says.
Assisted living
Assisted living, as the name implies, is an option for eldercare that provides assistance to residents with their activities of daily living. These facilities are an option for older adults who can still take care of themselves most of the time but could use some help with tasks such as:
— Housecleaning
— Household chores
— Laundry
— Cooking
— 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 such as dining rooms, a gym and community rooms. Most offer three meals a day, 24-hour security and recreational events within the facility or to places like museums, the movies or other locations. Residents can even keep pets at some facilities.
An assisted living community, however, does not offer and cannot provide more intensive medical or daily living care. For older adults who need a higher level of care, a skilled nursing facility is a better option. Some assisted living facilities might have a nursing home wing for higher levels of eldercare.
Board and care homes
Board and care homes are sometimes known as residential care facilities or group homes. These services are also similar to those offered at assisted living facilities. However, these eldercare locations are smaller, typically residences of 20 or fewer seniors 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.
Nursing homes and skilled nursing
A skilled nursing facility, sometimes also known as a nursing home, provides 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 it also has trained and registered nursing staff for:
— Nursing care
— Rehabilitation services, such as physical, occupational and speech therapy
— Custodial care, such as aid getting dressed or in and out of bed
— Frequent or daily medical management for chronic conditions
Some older adults 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. A 2019 study in JAMA Internal Medicine reports that, among Medicare beneficiaries with an average age of 80 1/2, those who opt for skilled nursing after a qualifying hospital stay have lower rates of readmission compared with those who were discharged home. 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.
How to Choose the Right Type of Senior Care
To choose the right type of senior care, start by asking questions, such as:
— When can we visit the facility in person?
— What level of care and services do you provide?
— Do you offer any specialized medical equipment, such as Hoyer lifts?
— Do you offer any therapeutic recreation or rehabilitation programs?
Ferri advises starting the process as soon as possible, even before you or a loved one needs senior care.
“You might consider filling out some applications if facilities are in high demand,” she says. “Many have wait lists. Stay in touch with the admissions office to show your continued interest while you research your options.”
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Start the process of finding the right senior care today.
“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,” Ferri says.
Explore U.S. News and World Report’s top-rated senior living communities, assisted living communities, nursing homes and CCRCs near you.
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Understanding the Different Eldercare Options originally appeared on usnews.com
Update 10/09/24: This story was previously published at an earlier date and has been updated with new information.
