Back in the 1960s and 1970s, when grandparents were unable to manage in their own homes, and didn’t have children they could live with, there was only one kind of facility that offered assistance with daily activities and medical support—a nursing home. But a search for ‘nursing home’ on today’s internet pops up all different kinds of terms that can be confusing to individuals and their families.
Most people only start to explore these options when there is some kind of a problem. Mom is in the hospital and the staff says it is not safe for her to go home. Dad is starting to get a little forgetful and then gets in a fender bender. Grandma keeps falling in her house. And then, in the midst of one of these stressful situations, there is a scramble to understand all the different terminology and senior living options. There are many different types of living spaces, care levels, services, and payment models, and an educated consumer needs to know and understand all their options. Assisted living. Rehab facility. Senior Living Community. Continuing Care Community. Independent living. Retirement Community. Long-term care. What does it all mean?
Assisted Living Facilities provide many of the services that used to be provided by ‘nursing homes’, including hands on personal care, medication management, assistance with meals, help with walking and moving, and safety monitoring for individuals with dementia (Memory Care). There is 24-hour staff on-site at Assisted Living facilities, with specific ratios mandated by state laws. Staff are trained as ‘med techs’, nursing assistants, and resident assistants, under the supervision of a ‘delegating nurse.’ Assisted livings provide a home-like, comfortable environment. They provide medication supervision and health monitoring, but not intensive or acute medical care. Rehabilitation services can be provided at Assisted Living Facilities, but not at the intensive level of an inpatient rehabilitation facility. Most assisted living facilities are private pay, although some accept a waiver through Medicaid for individuals who do not have any remaining assets. Some assisted living facilities charge multiple add-on fees for different aspects of housing and amount of care services, while others charge a set monthly fee depending on level of care need.
Long-term Care Facilities are a more intensive and expensive option, for residents who have a high level of medical complexity that cannot be managed in an Assisted Living. They take care of individuals who require things such as ventilators, or intravenous medications that are beyond the scope of an assisted living facility. Medicare will sometimes provide funds toward payment for long-term care, depending on the complexity of the individual’s medical condition.
Rehabilitation facilities ‘Rehabs’ are focused on helping individuals recover their strength and functioning following a hospitalization or a surgery. Frequent physical and occupational therapy treatments, up to 4 hours a day in some cases, are a standard part of Rehab. Like long-term care facilities, they provide a more intensive level of medical care, and many facilities offer both ‘Rehab’ and Long-term care in the same building. After a hospitalization or surgery, Medicare will generally cover the fee for a brief Rehab stay, typically 21 days or less.
Independent Living Facilities function like large apartment complexes, with the add-ons of community meals, social activities, and some minimal level of emergency care available to come if a call button is pulled. Seniors rent their units and then pay additional fees for meals and other services. Often, independent living facilities will offer one to one caregivers that can be hired at an hourly rate to provide additional services, but when residents develop extensive care needs, they typically need to move out to receive a higher level of care. These facilities have the right to end a lease if they determine that a resident has a cognitive impairment or medical condition that would make it dangerous to continue living in an unsupervised setting. In this case, residents would need to transition to an Assisted Living.
Continuing Care Retirement Communities (CCRC) require a large upfront fee, often hundreds of thousands of dollars, for the ‘purchase’ of a unit, and then residents pay additional fees for meals, activities, and when higher levels of care are needed. As they age and require more help, residents progress through levels of care, typically starting out at the Independent Living level of care, and then to Assisted Living and Long term Care facilities on site.
Retirement Community and Senior Living Community are general terms that could be used to apply to any of the above.
As you and your family explore these options, to determine what will be the best fit, it will be important to understand the nuances and specifics of all these different terms. Most areas have a Department of Aging that can answer questions and guide families in the right direction as they review the options in their region.