Choosing Care Options
When an elder begins to need assistance with daily living, there are different types of long-term care options available. These include assisted living facilities, skilled nursing homes, continuing care communities and even home care. It is important to understand the difference between the various types to be able to help make the decision that best fits the needs of your family member.
Assisted Living Facility
Assisted living facilities offer apartments for couples or individuals who are fairly independent and who do not need significant medical care. These facilities usually provide an hour or so per day of assistance with various light household tasks. Limited meals may also be included in the fees. Medical or nursing care is not provided, so residents must hire home health care providers or nurses privately at their own expense, if such care is needed. The cost of an assisted living facility is not covered by insurance such as MassHealth or Medicare and is paid for privately on a monthly basis. For people of limited means, there may be government assistance available to help with payment for an assisted living facility if income and asset requirements are met, such as the PACE program in Massachusetts.
Skilled Nursing and Rehabilitation Facility
Skilled nursing homes provide twenty-four hour care for people who are medically needy and require assistance with all aspects of daily living. They often offer both long and short-term care. Typically, a hospital patient may be discharged to a skilled nursing facility for short-term rehabilitation after surgery or an injury if he or she is no longer in need of acute hospitalization but still requires further therapy or medical care to regain prior levels of functioning. Once the patient sufficiently improves, he or she returns home, sometimes with continuing therapy in the home.
Long-term care in a skilled nursing facility becomes necessary when the elder is no longer able to adequately care for him or herself at home and needs assistance with all areas of care. The elder may be diagnosed with dementia and cannot remain safely at home due to potentially dangerous behaviors such as forgetting to turn off the stove, self-neglect, or wandering. Skilled nursing facility units may be locked to prevent residents with dementia from roaming from the facility.
Payment for care at a skilled nursing facility may be sought from several different sources. Medicare may pay for a limited, short-term stay for therapy following a hospitalization provided that the patient qualifies. Medicare will not provide any payment for a long-term stay, which is either paid for privately by the patient or by MassHealth, the Massachusetts form of Medicaid (if the patient is approved for benefits – which is another blog topic in itself!). Additionally, long-term care insurance policies are an increasingly popular method of planning for payment of care at a skilled nursing facility.
Continuing Care Retirement Communities
Continuing Care Retirement Communities are designed to provide a continuum of care as residents age, allowing them to change their residence level as their health care needs increase. These communities offer independent living apartments for those people who are fully able to care for their own needs, as well as assisted living apartments (some of which may be specifically designed for residents with memory impairments) for those who need a minimum amount of assistance in the home and a skilled nursing unit. Each community sets its own payment policy, usually requiring a significant entrance fee and then a monthly fee for rent and a base level of services. As in an assisted living facility, if in-home medical care is needed for those residents living in the apartments, it must be paid for privately. The benefit of a continuing care community is the expectation that one facility will meet the resident’s needs for the remainder of life, without the stress or worry of searching for a new facility if the resident’s medical needs increase.
Care in the Home
Sometimes, it is possible to provide nursing and home health care in the elder’s home so that there is no need to move to a facility. As our elder population increases, home health care agencies have adjusted to provide more options for care than ever before. The cost of care varies with the specific health needs of each individual and the amount of care needed. Family members can often help lower the cost of home health care by pitching in to share some of the tasks. If the elder qualifies medically and financially, the MassHealth Frail Elder Waiver program provides payment for home care for an elder who otherwise would need to move to a skilled nursing facility. This program can be a great option for medically compromised elders who would prefer to remain at home.