BY VALERIE HOPSON-BELL
For many years, when the term “long-term care” was mentioned, it referred to placing your loved one in a nursing home. Not anymore.
“Long-term care” refers to a lifestyle of sorts for those needing more assistance. It may mean living indefinitely in a nursing home or an assisted-living facility, or it may mean “aging in place” in your own home or the home of a loved one.
Long-term care is needed when someone with an extended physical illness, a disability, or a cognitive impairment (such as Alzheimer’s disease) requires assistance in activities of daily living (toileting, bathing, transferring, feeding and ambulation). It helps individuals to live as they are now; it may not help to improve or correct health issues.
Nursing homes generally have two levels of care: skilled nursing, also referred to as rehab or sub-acute care, and intermediate care, which is considered long-term care.
Skilled care provides physical therapy, occupational therapy, speech and skilled nursing care. Skilled care is usually ordered by one’s physician after a three-day stay in the hospital. Skilled care services, whether provided in the nursing home, rehab hospital or on an outpatient basis, are covered under Medicare.
Intermediate care in a nursing home is when individuals must reside there indefinitely due to limitations in their physical or cognitive functions that need nursing supervision. Along with the health care component, nursing homes provide 24-hour supervision, medication management, meal preparation and assistance with activities of daily living. These services are covered only on a private-pay basis (including long-term care insurance) or through long-term care Medicaid.
Assisted-living facilities can look very different in size and populations, but they are considered more of a residential environment than nursing homes. They are nonmedical residential settings that provide or coordinate personal and health care services, 24-hour supervision, medication management, meal preparation, socialization and assistance with activities of daily living for those who are aged, infirm or disabled.
It is important to note that nursing facilities are regulated by federal law, while assisted-living facilities are under state mandate. Both are monitored by the long-term care ombudsman program, which can be found through your local area agency on aging.
The ombudsman can investigate complaints in an attempt to resolve issues and to restore quality of life to residents in facilities. The ombudsman also has the responsibility to educate the community on concerns affecting local long-term care facilities by sharing factual information regarding those facilities.
“Aging in place” is the term for allowing someone to remain in one living environment no matter what his or her needs may be as time goes on.
Oftentimes homes, especially those in 55-and-over communities, are built with this concept in mind. Wider doors with lever door handles rather than twist knobs; bathrooms with grab bars and built-in seats in the shower area; and smooth surface flooring, such as low pile carpet, hardwood, tile or linoleum all make a home more accessible. Lower countertops, lever handles on faucets, and cabinets and drawers with easy-pull hardware allow for functionality in the kitchen. Some homes are equipped with ramps to allow easy access.
In addition to the physical modification of the home, services are needed to complete the “aging in place” model. If the caregiver is still working or needs time to run errands and/or care for themselves, adult day care may be an option. This is where you can drop your loved ones off in the morning and pick them up in the evening.
The staff provides supervision, medication management, activities and meals. Some centers will also provide transportation and an aide to accompany your loved ones to medical appointments.
Home health care or home care is usually needed to offer support to the caregiver in the home environment. Determining which agency depends on the level of health care service needed.
The home health agency provides skilled or medically trained personnel such as nurses; physical, occupational and speech therapists; respiratory caregivers; nutritionists; and certified nursing assistants to assist in maintaining or improving clients’ health situations while keeping them in the home.
Home care agencies, often referred to as “nonmedical care,” offer companion aide and personal care services (hygiene), which provide for a greater quality of life by assisting with transferring, bathing, dressing, toileting, walking, keeping appointments, meal preparation, light housekeeping, socialization, transportation and running errands.
Hospice is another service that is often used to assist in meeting your loved ones’ needs either at end of life or with advanced dementia. Hospice emphasizes palliative rather than curative treatment. It focuses on quality of life rather than longevity. People can be on hospice from weeks to years depending on their situations and needs.
Although there are many ways to provide long-term care, individual choices are important to achieving a quality of life. Consider all of your options and map out a plan that’s right for you and your loved one.
Valerie Hopson–Bell is a geriatric care adviser at ElderCare Connections LLC. She can be reached at 540/419-4387 or vhb@eldercare