Long-term care can be received in a variety of settings. The setting is usually determined by you and your support team — your family, attending physician, and/or someone qualified to develop a plan of care. Some needs can easily be taken care of at home. Others are better cared for in an assisted living community, memory care community or skilled nursing facility.
Skilled nursing facilities are usually comprised of two separate areas. The first area provides medical care, defined as curative or rehabilitative care, that may be covered by Medicare. The other area provides non-medical care or custodial care. The goal of the Medicare section is to rehabilitate patients to return home. However, many times patients are unable to return home and are moved to the custodial section of the facility. In these cases the patient may not have any support services or family in the community that would allow them to leave the facility and return home.
Example:
Mary Ann had a stroke a year ago. After being hospitalized she was admitted to a skilled nursing facility and received rehabilitative therapy on a daily basis. After 45 days, her therapists determined that she did not need medical care daily and would need help with her activities of daily living for the rest of her life. Because she did not have anyone to take care of her at home, she was transferred to the non-medical wing of the skilled nursing facility where she will live.
Home care is generally considered appropriate at the custodial and non-medical care levels. Medical care can be provided in the home but it can be very expensive. Home care could consist of a weekly visit by a homemaker who performs housekeeping chores, a home health care aide who provides daily assistance with bathing and dressing and a bi-weekly visit by a registered nurse or therapist.
Example:
Verna was diagnosed with Parkinson’s disease two years ago. Now she is unable to walk without assistance. She cannot bathe or dress herself. Her daughter has to go back to work. Vera is now going to have to tap into her savings to pay for care so that she can remain at home.
Assisted living facilities may also be referred to as residential care facilities. These facilities generally have more than 10 residents and provide non-medical care for people who need some help with Activities of Daily Living but are able to manage on their own with minimal assistance. Usually, daily medical care is not provided in assisted living facilities.
These facilities are an excellent alternative to a nursing home. The resident may live in an apartment that can be furnished and personalized to make it seem more like home. Meals are usually provided in a community dining room and there are lots of activities and social events to attend. You can find these facilities as part of a larger independent retirement community or as a standalone facility that only offers assisted living. There are also small board and care homes or group homes that care for up to 10 residents.
Example:
Sara was 87 years old and living in her own home. She was not getting out of the house and not socializing with anybody. Her daughter, Joan, arranged to have her mother move to an assisted living facility after she realized that she was forgetting to take her medications and was not able to handle her own hygiene needs. She didn’t need skilled nursing care, but she did need help with her activities of daily living. Now Joan will not worry as much since there are caregivers ensuring her mother gets her medications and assistance with her personal hygiene. Her mother will also be able to participate in the weekly activities so she will remain active socially.
Adult day care is a community-based service developed to help keep people out of assisted living and remain in their homes. Adult day care facilities offer custodial care during the day. This care can be provided to people who need minimal assistance and have moderate impairments. This can be an ideal care venue for patients with dementia.
Adult day care centers offer a form of support for those who live in their own homes or with their children. Adult day care centers offer family members who work the assistance during the day to provide care for their loved ones.
Example:
Lyle lives with his daughter, Sandy, who works full time. Lately, she has noticed that Lyle has been forgetting to prepare and eat his meals during the day. One day she was called at work by a neighbor who found him wandering down the street. Sandy can care for her father after work and on the weekends, but she needs help during the day. An adult day care provides the appropriate care solution.
