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Types of Long Term Care
 Long-term care can be received in a variety of settings. The setting is usually determined by you and your support system -- 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 facility or nursing home.
Skilled nursing facilities are usually comprised of two separate components. The first component is a unit that provides skilled nursing care that may be covered by Medicare. The rest of the facility provides non-skilled or custodial care. The goal of the Medicare section is to rehabilitate the patient so he/she can return home. However, many times patients are unable to return home and are moved to the non-skilled or 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. 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 from now on. |
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 who 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 has to go back to work. Vera is now going to have to tap into her savings and pay for a caregiver to help her, so that she can remain at home. |
Assisted living facilities may also be referred to as residential care facilities. These facilities provide non-skilled care for people who need some help with Activities of Daily Living but are able to manage on their own 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 may 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 or group homes that care for anywhere from three to 10 people.
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 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 is a community-based service developed to help keep people out of nursing homes and 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. Patients with Alzheimer’s or senile dementia are ideal candidates for this program.
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. 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 provides the appropriate care solution. |
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