The blessing and curse of senior care options is that over the last 30 years the number and diversity of these options has increased dramatically. Although government programs have driven a portion of these phenomena, at least equal credit belongs to consumer demand which has shaped the continuum of long term care (LTC) a great deal. When I use the term “senior care options” it includes housing for both practical and technical reasons. Once the senior care focus is upon care other than acute hospital based care, the housing or shelter portion remains critical. This is true whether the person’s condition is medically chronic or episodic and/or whether the focus in upon supportive services to assist with activities of daily living (ADL). There are numerous, excellent sources for both a glossary and detailed descriptions of the full continuum. It will not be duplicated here but only briefly described.
As one navigates the aging maze knowledge of available options is not only helpful, but essential. Common pitfalls or false assumptions that consumers as well as consultants make about the LTC continuum include:
1) the LTC continuum and related senior care options are a smooth or fixed progression;
2) certain housing or shelter settings necessarily define the level of services or resident needs;
3) the care or scope of services in each segment of the continuum is the same;
4) staying at home with either spousal or family caregiving or home health care is always the best and/or the least expensive option; and
5) a certain diagnosis consistently predicts a person’s care needs.
Embrace the notion that a declining parent’s senior care options are as individualized and variable as the service industry that has grown to meet those needs. This element of unpredictability, however, is a poor excuse to avoid legacy planning and adopt an approach of “we will deal with things when they happen.”
Sample LTC continuum:
- Home care: Options that allow a senior to prudently remain in their home are understandably preferred in many cases. However, what may appear to be the low care and low cost end of continuum, particularly if evaluated over time, may not necessarily be so. Needs and services can vary widely and are met through a combination of technology, family and/or home and community based services. This category includes unlicensed homemaker services and licensed home health agency support. The latter can, depending upon circumstances and qualification, be as intense as episodic skilled nursing or even short term hospice staff intervention. It can also be supplemented with therapy, adult day care as well as respite care.
- Unlicensed independent living: This ranges from small, private home-based provision of housing, meals and limited activities; active adult communities and senior apartments. Also included are large scale retirement communities for people needing only limited supportive services short of assisted living but with a wide range of non-care related services. The term “congregate” is used to refer to large, communal structures which may have cottages nearby.
- Licensed assisted living: This component of continuum is very consumer driven, diverse in offerings and regulated at the state level. Generally speaking, state regulations require, among other things, admission criteria based upon a need for protective oversight and assistance with at least two ADLs, care plans, varying degrees of nursing and medication assistance as well as 24/7 staffing to meet the needs of residents. Specialty units or free-standing facilities specializing in dementia care, on locked or secure basis, have become common. These are subject to further regulation. Medicare does not apply. Some facilities are Medicaid certified.
- Licensed skilled nursing facility. Key distinguishing features from that of assisted living are that they are regulated at the federal level (national standards) as well as by the state and require that the resident be certified to need 24 hour skilled nursing care. Medicare does apply when admission is for rehabilitation following a qualified hospitalization. Dementia care may be facility-wide or in a separate secure unit.
- Continuing Care Retirement Community (CCRC). A CCRC typically has some or all of the LTC continuum on a single campus: independent living cottages and/or apartments, assisted living, frequently skilled nursing and more recently, also a specialty dementia unit. Fee and service models vary and include issues of buy-ins, their degree of refund upon departure, transfer between levels of care and included or a la carte fees for higher acuity needs.
Residential hospice and naturally occurring retirement community concepts (NORC) are not addressed.
During the course of family facilitation’s by Savvy Aging these senior care options as well as any assumptions, fears, questions or prior experiences will be addressed.