I can’t tell you the times I heard someone tell me they couldn’t get their mom/dad/wife/husband to move into a senior community because, “I promised I would NEVER put them in a home.” That last word was usually whispered. No one wants to be put in the home.
Here’s the question: What, exactly, is “the home?” The question is especially difficult to answer when you recognize the vast array of options available to someone needing support. While labels are never (ever, ever) clear cut, there are some basic hallmarks. Let’s unpack a few.
Typically, these communities are for seniors who have no current or expected imminent need for any support systems. They could be single family homes, cottages, or apartments, reserved solely for people who are over age 55. Younger folks need not apply. A clubhouse may be available, and the property management company will regularly host or facilitate events. Attending those events may come at a cost. Included amenities are limited, if they exist at all.
These communities offer standard amenities such as weekly housekeeping, scheduled transportation, several daily facilitated activities (most at no additional cost), and daily meal service, sometimes offered with several meal options. Adult Day Care, though not a residential model, would typically consist of similar amenities but offered during the day, often as respite to a family caregiver.
Assisted living and memory care communities add non-medical “personal care” services — things like medication reminders and assistance with bathing and dressing. Those services are typically offered at an additional cost, wrapped into your single monthly payment; and the cost of care will vary depending upon the level of care needed. A care plan is created and services are provided according to the plan. Spontaneous care, when needs arise outside of the care plan, may be provided; but, it may come at an additional cost. Virtually all assisted living and memory care communities will have care providers such as a CNA available around the clock to respond to emergencies.
Independent Living communities, though they don’t include personal care services, will often have a relationship with an outside personal care provider which has the effect of creating an assisted living-style environment. Often, because care is not offered by the community, no staff is in the building overnight. However, someone is at least available on call to respond to emergencies.
The vast majority of care and services offered in Senior Living Communities is paid privately. There are some long-term care insurance policies which will cover all or a part of the fees, but those policies aren’t standardized. It’s best to reach out to the insurer, or read the policy yourself, to see what may be covered. And, although it varies widely by state, sometimes Medicaid will cover residency for those who qualify. In those instances, individual communities may or may not accept Medicaid payment.
These facilities offer full care — both the personal care described above, and medical care such as wound care, medication administration, injections, etc. Physical, occupational, speech therapies are typically provided in a rehab hospital. Generally, stays in a sub-acute unit are shorter-term, lasting only until the patient is able to be discharged to a residential environment, even if some periodic care is still needed, such as in-home care.
Spontaneous care in these facilities is available around the clock, generally at no additional fee. Most of the costs are covered by Medicare, long-term care insurance, or Medicaid. Private pay is an option for those instances when other insurance will not cover the stay.
CCRC’s (Continuing Care Retirement Communities) offer the full gamut, from zero services to full-care, essentially offering a retirement community, plus senior living community, and a long-term care facility all in one campus. While residents stay on the same campus, transitions in needs will likely require a move to a different building/wing/area where those care services are provided.
Services provided in your own home is a continually emerging option. Virtually all of the amenities provided in a residential community or facility can be brought right to your door; and, in-home care can be tailored to fit your unique needs exactly. Hospice and palliative care are always brought to the patient, wherever they reside.
Personal care providers offer assistance with “activities of daily living” — the types of services provided in an assisted living community. Home health providers (sometimes the same company which provides personal care services) will add nursing care. Most in-home providers have a minimum time period charge — two or three hours, for instance — regardless of the amount of time required. If you only need assistance with a shower on Tuesdays, Thursdays, and Saturdays you’ll likely pay the full minimum charge for each of those days, regardless of how long your shower takes. Good providers make up for the difference by providing additional services which are helpful, even if not strictly required, such as doing some light housekeeping.
Aside from care, service providers abound for providing transportation, managing home repairs and lawn care, housekeeping, delivering groceries, even ensuring your bills are paid on time. If you need it done, you’ll likely be able to find someone to help!
Further, technology can offer fairly simple solutions to help manage your medications, connect you with your doctor’s office, order groceries and prepared meals, monitor your safety and contact emergency services, schedule and pay for transportation, and even connect you to others for socialization.
While I have used some terms to describe a category, and others to describe the type of environment supported, it’s important to know that ALL of these options are sometimes referred to as Senior Living or Retirement Communities, or Long-Term Care Facilities. Memory care is also offered in skilled nursing facilities and nursing centers. In-home services may be provided in virtually all of the environments — not just a single family home.
Given the overlap of services from one type to another, the differing naming conventions, and the myriad options available, it’s time to stop making promises about avoiding “the home” and start talking about what’s important, what’s needed, and how we want to get it.
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