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Settings of Long Term Care

Long-term care can be received in a variety of settings. The setting is usually determined by your support system (your family, attending physician, or someone qualified to develop a plan of care) that you have and the reason that you need long-term care. Some needs can easily be taken care of at home, while others would be better cared for in a nursing home.

Skilled Nursing Facilities

Skilled nursing facilities are usually comprised of two separate components. The first component is a unit that provides skilled nursing care that is paid for by Medicare (if the care meets the criteria that Medicare sets forth). The rest of the facility provides non-skilled (or custodial) care. The goal of the “Medicare” section of the skilled nursing facility is to provide services needed to rehabilitate the patient so they can return home. However, many times patients are unable to return home and are moved over to the non-skilled or custodial section of the facility. Usually in these cases the patient may not have any support services or family in the community that would allow them to leave the facility.

Example:
Mary Ann had a stroke 12 months ago. Immediately after her stroke she was admitted to a skilled nursing facility in the Medicare section and received rehabilitative therapy on a daily basis. After about 45 days, her therapists determined that she was not getting better 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-skilled wing of the skilled nursing facility where she will live the rest of her life.

Home Care
Home care is generally considered appropriate at the custodial and non-skilled care levels. Skilled care can be provided in the home, however it can be very expensive. Home care could consist of a weekly visit by a homemaker that performs housekeeping chores, a personal care attendant that provides assistance with bathing and dressing, or it may be a daily visit by a home health 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, Shirley, is currently helping her with these needs. Her daughter has to go back to work in order to save money for her two children that will be going to college in the next two years. Verna is now going to have to tap into her life savings and pay for a caregiver to come in and help her, instead of her daughter, so that she can stay at home.

Assisted-Care Living Facilities (ACLFs)
Assisted-care living facilities, otherwise known as assisted-living facilities, are also called residential care facilities for the elderly (In California, they are referred to as Residential Care Facilities). These facilities provide non-skilled care for people that need help with their activities of daily living but can also provide a lot of their own care and get through a daily routine with minimal assistance. Usually, skilled care is not provided in assisted-living facilities.

These facilities are an excellent alternative to a nursing home. The residents live in individual apartments that they can furnish and personalize 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 stand alone facility that only offers assisted living. There are also small board and care homes that care for anywhere from 3-10 people. These are homes that have been converted to a board and care.

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 issues. 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 will be caregivers ensuring her mother gets her medications and assistance with her personal hygiene. Her mother will be able to participate in the weekly activities so she will remain active socially.

Adult Day Care
Adult day care is a community-based service that was developed to keep people out of nursing homes and in their homes. Adult day care facilities offer custodial care during the weekdays (some provide weekend service). This care can be provided to people that need minimal assistance and have moderate impairments. Patients with Alzheimer’s or senile dementia are ideal candidates for this program.

Adult day care centers offer a form of support for those that live in their own homes, or maybe with their children. Adult day care centers offer family members who are providing care the much needed break during the day to continue to live their lives and provide care for their loved ones or it allows a caregiver to continue to work by providingthem with a safe place to leave their loved one during the day..

Example:
Lyle lives with his daughter, Sandy. Sandy 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 wants to take care of her father after work and on the weekends, but she needs help during the day. An adult day care would provide her with the solution she is looking for.