Chapter 5

Considering Options for Care Needs

As a caregiver, you will likely have to make decisions regarding who will provide care, which type of assistance is best, and what living arrangement would be most appropriate for your elder’s needs. You will also likely worry about how your choices will influence him or her physically, emotionally, and psychologically.

Many seniors say that their quality of life is affected when they must ask for help or, worse, move to a care community and give up their independence. They feel they’ve lost something vital when they can no longer provide and care for themselves. While it’s a natural desire to want to see your loved one remain as self-sufficient as possible, it can lead to the problem of not ensuring adequate care.

As you watch your senior move through stages of decline, it’s important to familiarize yourself with the care options available and understand how they can facilitate independence while giving you the peace of mind that your loved one is receiving the support he or she needs, and are as safe and as content as can be expected. Options can range from the family providing assistance, to hiring care providers, to moving to a care community. In order to make the most appropriate decisions, you should be asking a variety of questions.

The wonderful thing is that there are options, and being armed with an understanding of what each offers can make the decision process so much easier.

The First Option: Family Caregivers

Most care situations begin with a family member stepping in and helping with chores or activities that are becoming too much for your senior to handle, like grocery shopping, cleaning the bathroom, or laundry. However, over time that person may find that so much has been taken on that it’s become a full-time job!

Naturally the First Choice, But Is It the Best Choice?

There are many reasons why family members want to assume the role of caregiver.

While these reasons are understandable, it doesn’t mean that family caregivers are the best choice for you, your loved one, or your family. Here are some signs that might indicate a different caregiving solution is called for.

If you are considering being, or find yourself becoming, the primary caregiver, give serious thought to your elder’s needs, your abilities to provide for those needs, and how it will affect the quality of life for all involved.

Not Everyone Is a Natural Caregiver

Most people hope they would be willing to care for a loved one in need, but the reality is that there are people who do not make good caregivers. Not everyone has the personality, skills, or talent to become a top-rate musician, politician, or accountant—why should we expect that all family members would make wonderful caregivers? If there is a situation where a family member is expected to provide care and that person is stressed, miserable, or resentful, both the caregiver and the care recipient are going to suffer. Think twice before forcing yourself or another to accept the role of caregiver. Consider the reasons why any person being considered may not be the best choice, learn about other available options, and be understanding when addressing that individual’s lack of interest or commitment.

The Role of a Health Care Advocate

As a caregiver, if you are insecure or unable to manage medical decisions or information, a health care advocate might be a valuable addition to your resources.

A health care advocate acts as a liaison between health care providers and your loved one. This includes medical personnel, insurance companies, facilities—virtually any person or organization providing health care services. Mary Jo Beardsley, RN and founder of Peace of Mind Professional HealthCare Advocacy, explains that an advocate will assist clients and their families by helping them navigate complex systems to receive optimal care and outcomes. Here are some examples of what those services might look like.

On average, rates for a health care advocate range from $75 to $250 per hour.

The benefits of having a health care advocate can be immeasurable because the advocate will allow you and your loved one to focus on obtaining and maintaining optimal health without having to worry about complicated details.

Choosing between Professional Home Health Care Agencies and Private Caregivers

There will be circumstances when caregivers decide they need to seek additional help. Perhaps they’ve realized they are missing too much work and their job is at risk, or they are ill or incapacitated, or the level of care required exceeds their capabilities.

Ralph Fern, owner of Homewatch Caregivers in Scottsdale, Arizona, offers valuable information concerning the decision as to whom to hire as a care provider, as well as on how to interview potential agencies and private individuals.

Professional Home Health Care Agencies

Professional agencies can be broken down into two separate types of care providers—home health care and home care. Both agencies will supply private caregivers (also known as home health or home care aides) who will assist your loved at home, but there are distinct differences between the types of care they deliver.

Home health care agencies provide skilled medical care in the home. Home health care may be necessary after a doctor’s visit, when it is noticed there is a need for physical therapy or there are problems recovering from an illness, or it could also follow a stay in the hospital when ongoing treatment is required. Services are provided by medical professionals such as nurses, doctors, and therapists or, at times, home health aides like certified nursing assistants. Home health aides are supervised by other medical professionals. Aides may provide basic health services such as checking vitals, administering medications, assisting with medical equipment, and changing bandages. Overall, home health care services include the following:

Nonmedical home care services are provided by home care aides who visit and support your elder while assisting with his or her normal day-to-day activities, such as the following:

Both types of caregivers will help your loved one remain in his or her own home or with you for as long as possible.

Private Caregivers

The third option available to you is to hire a private, non-agency-related individual to act as a caregiver. This might include a retired nurse who wants to work part-time, a former health care agency aide, or some other individual trained and experienced in the health care industry. Many families seek to hire a private caregiver with no affiliation to a home health or home care agency because an independent caregiver often charges less. While this may be financially beneficial, there can be certain consequences or risks to you and your senior if you choose to do so.

Tax Considerations

As an employer, your first responsibility is to verify that the caregiver you hire is legally qualified to work in the United States by requiring the potential employee complete an Employment Eligibility Verification (I-9) Form and reviewing documents showing the employee’s identity and employment authorization such as a US Passport, Certificate of US Citizenship, Certificate of Naturalization, or Permanent Resident Card.

You will also need to be responsible for processing, withholding, and paying payroll taxes to the government. In addition, as an employer, you must comply with all federal and state wage and hour laws and regulations as well as paying for state unemployment insurance.

Workers’ Compensation and Liability Issues

There are additional responsibilities aside from payroll taxes involved in hiring a caregiver who is not an employee of a home health/home care agency. As an employer, you are required to provide worker’s compensation. In some states, it is a criminal offense if you do not comply.

Typically, caregiving is an extremely physical job, and the caregiver is particularly at risk for injury if your loved one’s needs require substantial exertion such as lifting dead weight, assisting in transferring from a bed or a chair, or providing support while showering or bathing. If your caregiver sustains injuries while performing caregiving duties, you or the individual receiving care may be responsible for medical expenses and disability payments. Typically, homeowner’s insurance will not cover a caregiver for an employment-related personal injury.

There is also the liability of your employee possibly injuring another person. If, for example, the caregiver accidentally trips an older friend visiting your senior and that person breaks a hip, or if the caregiver has a car accident while running errands and injures the other driver, you may find yourself subject to a lawsuit if you aren’t carrying proper insurance. You can save a lot of financial and emotional stress if you consult with your insurance professional beforehand to identify what types of insurance you may need to protect yourself.

Abuse or Exploitation

Most individuals who become caregivers do so out of a strong desire to help others. But there will always be those who will take advantage of the vulnerable. This is especially easy if your loved one is frail, functionally limited, or has cognitive impairment, and the caregiver is left alone with your senior with little or no supervision.

Abuse and exploitation can take on many forms, such as physical abuse, ignoring boundaries and developing inappropriate relationships, or stealing possessions or money and identity theft. If you are a private employer, it can be challenging to discover any previous issues your new caregiver may have been involved in.

Your first step toward ensuring the applicant is safe to have in your home and caring for your loved one is to ask for references, follow up with phone calls, and conduct a criminal background check. This should alert you to any obvious signs that the applicant has had problems with previous employers.

Next, verify what training the caregiver has received to provide caregiving services. If the person has attended certification programs, ask for copies of the certificates. If the training was on the job, request information on whom you can contact to discuss the applicant’s performance and abilities.

Finally, establish boundaries. It is easy for a caregiver to become too familiar with a patient. If the person provides care for any length of time, strong bonds may be formed and both sides may forget what’s appropriate and what’s not. Draw up an employment contract that states clearly what the job description is and what behaviors or actions will not be acceptable and will result in dismissal.

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When faced with making a decision about who will provide caregiving services to your loved one, you need to take into account a variety of questions.

If choosing a private individual, it is advisable to consult with an attorney and an accountant to ensure that all agreements and arrangements meet required safeguards and obligations. It is also responsible to investigate your state’s small business laws to make sure you are following all rules and laws.

Interviewing Professional Home Health Care Agencies or Private Caregivers

Once you’ve made the decision that you need to enlist help, there are specific questions that should be asked in order to ensure that you will be receiving quality assistance. Here are sample questions that should be asked and that will guide you in your interview process.

If you are at a loss as to where to begin searching for a private caregiver, there are organizations such as Care.com that can assist you in finding candidates and running background checks.

Palliative Care Services

There is a relatively new resource available to individuals who have a serious medical condition or illness like congestive heart failure, kidney failure, HIV/AIDS, or Parkinson’s disease and are in need of a higher level of care but are not ready for end of life hospice care. Palliative care focuses on improving quality of life by providing patients with specialized medical care that will relieve symptoms, such as the following:

Palliative care can also improve your loved one’s ability to tolerate medical treatments and gain strength to carry on with daily life.

Patients and their families face a great deal of stress during an illness and may experience symptoms like fear, anxiety, hopelessness, or depression. Through palliative care, treatments may include counseling, support groups, family meetings, or referrals to mental health providers. Your care provider can also help with practical issues such as explaining complex medical forms or answering insurance questions.

Palliative care promotes a proactive approach to care and is provided through a team that includes a doctor, nurse, social workers, and perhaps other experts such as nutritionists, massage therapists, pharmacists, and spiritual counselors. Your team will work with you and your senior to support your family by not only controlling symptoms but also helping you understand treatment options and goals. Care may be given at any time and at any stage of an individual’s illness, from diagnosis on. Moreover, palliative care can be provided in addition to curative care.

Palliative care is offered through organizations like hospitals, hospice, home care agencies, cancer centers, or skilled nursing facilities. If you believe your loved one would benefit from this, speak with his or her doctor and ask if your loved one is a candidate for it.

Care is paid for through personal funds, private insurance, or through programs provided by select hospitals or skilled nursing facilities.

Hospice Services

Hospice is a unique health care option available to patients and their families who are faced with a terminal illness. It can be an invaluable resource for families and caregivers who are doing everything possible to tend to their elder in the last stage of life. The surprising fact is that many people don’t understand that hospice programs not only provide comfort to an individual during those final days or months when he or she is dying but can also be a tremendous support system for the family and those who are actively involved in their loved one’s care.

While most hospices share the same philosophy toward end of life care, their services may differ. Hospice is considered a medical specialty like cardiology, oncology, or pediatrics, so each hospice is its own company and may choose to provide certain services and not others. Barbara Volk-Craft, PhD, MBA, RN and Director of Program Development for Hospice of the Valley in Phoenix, Arizona, explains how many hospice programs operate and how hospice care can benefit you and your loved one.

While the focus will be on making your loved one as comfortable as possible by managing pain and symptoms, hospice teams can assist the family on the more practical side of care, such as bathing your senior, helping with medical equipment, administering medications, providing assistance with paperwork, or finding resources. They also make available invaluable emotional support through grief and spiritual counselors before, during, and after the death of your elder.

Hospice end-of-life care focuses on caring, not curing, and believes that every person has the right to die pain-free and with dignity and that its purpose is to provide the necessary support to do so. Services are primarily brought in to the private home or through hospice acute centers. In some states, services can also be offered in nursing homes, hospitals, and long-term care communities.

To qualify and receive hospice care, your loved one’s physician must state that death can be expected within six months. However, nobody can predict when death will actually happen, so this does not mean that care will only be provided for six months; it can be provided as long as the physician and hospice team recertify that your elder’s condition continues to remain life limiting. Every sixty days, the doctor will need to reevaluate and state that your senior still qualifies for hospice services.

There are four levels of care provided through hospice.

Your loved one’s hospice team would likely consist of a doctor, nurse, social worker, counselor, chaplain, home health aide, and trained volunteers. Some of the services the team can provide include the following:

Most hospices are certified through Medicare and must adhere to a core set of services that are available to all patients receiving hospice care. Individual hospices can selectively add to their program with additional services such as massage therapy or pet therapy. Hospice services are provided free of charge, regardless of a person’s ability to pay. Hospice care is paid for through the Medicare Hospice Benefit, Medicaid Hospice Benefit, and most private insurance companies. If your senior does not have coverage through these sources, hospice programs will work with you and your loved one to ensure services are delivered.

Care Communities

Although most people will say that their main desire is to remain in their own home or with family as they age, that may not always be the best solution to meeting your elder’s needs.

Let me share the story of Karen, who faced the same dilemma so many caregivers face each day, to illustrate how easy it is to ignore the growing signs that a different living arrangement is needed.

This is a familiar scene across the country—children afraid or unable to convince their loved ones of the merits of assisted living. The tragedy is that the fear and frustration revolves around ignorance and misconceptions. With a proper understanding, assisted living can be a positive, life-enhancing experience.

The Purpose of Assisted Living

Assisted living can be a highly desirable solution for families. It is a bridge for that large gap between being able to live completely on your own and needing skilled nursing care. It allows residents to live as independently as possible while providing as much personal care and support services as needed. The variety of housing options provides an atmosphere suitable for all levels of care—ranging from someone who is completely independent but understands there may be a need for services in the future to a resident suffering from advanced Alzheimer’s and needing a secured environment now.

Communities are designed to provide help with the activities of daily living (ADL) such as bathing, grooming, medication management, mobility issues, and more. Usually, residents have had some sort of decline in health and need help performing one or more ADL. They may start out with minimal assistance, and as their needs increase, the support and assistance will increase accordingly.

The Benefits of Assisted Living

When you first consider the possibility of moving your loved one to an assisted living community, it is usually with a sense of finality. Your senior has lost the ability to live alone or with family, and it may seem as if this is the beginning of the end. It’s possible you haven’t considered the benefits of assisted living aside from the assurance of general care and support.

While every resident and family may experience a different outcome depending on their own personal situation, the following are some of the additional and unexpected benefits your loved one may receive living in a community.

Safety

As most people age, they become frail and the risk of falling increases. Following an accident, younger people might be able to brush themselves off and move on, but the chance of an elderly person suffering a severe injury and ending up in the hospital is high and the consequences can be serious. Accidents may result in not only hospitalization but also disability or even death. One fall can turn into a life-changing event.

Assisted living communities concentrate heavily on the physical safety of their residents. Here are some of the steps taken to prevent falls and injury.

However, physical safety is not the only focus. Assisted living communities place great emphasis on securing the community from crime or acts of nature. What a great relief for a family or a senior to know they no longer have to worry about safety inside their home and being alone in the case of an intrusion or natural disaster. Common security measures or procedures include the following:

Another safety feature is the protection against potential scam artists or family members that would take advantage of their senior relatives. While no community should handle its residents’ finances, a certain level of awareness and monitoring can be provided with regards to who is visiting the resident and the reactions to these visitors. Solicitation and abusive behavior are not tolerated and would be reported to other family members or the proper authorities.

Nutrition

As we age, it’s not uncommon for our tastes to change or to lose our appetites. In addition, grocery shopping and cooking can become difficult, if not impossible. Weight loss or lack of nutrition can have serious consequences for anyone who is suffering from health issues or overall decline. Maintaining a healthy weight range is very important for all of us, but it is especially critical for the elderly.

Too much weight can trigger unwanted side effects, such as the following:

But too little weight can trigger its own set of problems, such as the following:

Assisted living communities provide nutritious and appetizing meals for their residents. In larger assisted living communities, it’s not uncommon to find restaurant-style dining provided in one or more settings and possibly a bistro for complimentary snacks, newspapers, and socialization. Smaller group homes will feature homemade meals catering to an individual’s tastes and preferences. Depending on the community, one to three meals—along with snacks—are provided daily for residents, and special dietary needs for conditions such as diabetes, heart disease, or allergies can be easily accommodated.

For a senior who has stopped preparing meals or is only eating prepackaged food, there is a risk of severe malnutrition and unwanted weight loss. Having balanced and nutritious meals prepared and then being supported with gentle encouragement to eat more frequently will lead to better health. With proper nutrition and hydration, residents often experience an overall improvement in their health within a few months of moving to a community.

Transportation

Many assisted living communities offer transportation within a certain radius. Residents can give up their car keys and remain as mobile and independent as they were behind the wheel. They don’t have to feel trapped at home or dependent upon others. Communities offer transportation for a large variety of outings such as the following:

These services are equally as freeing to a family member who has been providing transportation services.

Housekeeping

In assisted living, basic housekeeping is provided regularly. In a private group home, you will see staff cleaning daily, and in the larger assisted living centers, housekeeping will visit weekly or biweekly. Trained staff will also handle maintenance and other not-so-routine tasks such as cleaning out the fridge, washing windows, and changing light bulbs or air filters. Being able to give up the day-to-day responsibilities of managing a home can increase the comfort and safety for older adults. It also frees up their time to enjoy more pleasurable activities.

Laundry

While assisted living communities perform linen service weekly or as needed, residents have the option of continuing to do their main laundry themselves in their own home if appliances are available, or they can pay to have staff take care of their laundry needs. Most communities have communal laundry facilities and many are coin free—all the resident needs to provide is the detergent. It’s not uncommon for communities to also offer dry cleaning runs and ironing.

Friends

Communities encourage residents to engage in conversation, social activities, and to develop relationships with other residents and staff. Staff, ambassadors, or welcome committees greet new residents, making sure they aren’t alone when they first move in and making sure they have someone to eat and attend activities with until friendships blossom. Even if some seniors struggle in the beginning and avoid social contact, there will be someone there to gently provide encouragement until they come out of their shell.

Pets

Without a doubt, the thought of having to give up a pet can be a deal breaker when discussing and investigating the possibility of moving to assisted living. Thankfully, communities have increasingly recognized this important relationship and in many, animals are fully embraced with open arms. Not only will you find cats and dogs, but some residents will have birds, fish, rabbits, and other small animals. These facilities have reported an increase in the overall health of their residents and some even claim an increase in the residents’ projected life spans!

Activities

What did your loved ones enjoy doing before the move? Were they active and involved in the local senior center or did they prefer maintaining a small herb garden on their patio? For some, a robust game of cards or rummikub is enjoyed. Their minds are still sharp and they enjoy the competition. Others may seek more relaxing activities, such as watching television or a movie with friends or reading quietly at home or in the library. Assisted living communities focus on providing a variety of activities that will provide social and/or mental stimulation for all residents, regardless of abilities or interest.

One of the most important activities for seniors is sharing a meal. This is the perfect setting for people to come together and interact, sharing stories of their day, remembering past events, and discussing life in general. While mealtime may not be a big deal to those who are younger and active, meals may be the only activity some residents are able to participate in, and they provide a rich source of social stimulation.

Stimulation comes in many forms, and it’s important for family and friends to understand that what one resident desires or needs doesn’t necessarily suit another resident. For those with dementia—especially Alzheimer’s disease—it may be more interesting and pleasurable to interact one-on-one with a caregiver or visitor and talk about the past, relating stories of their childhood, wedding, babies, and pets.

Remember, even if a resident does not participate in an activity, simply being near others and watching or listening will provide a level of stimulation that person would not receive living alone at home.

Health Care

Although the professional and medical qualifications of each assisted living community may vary, they offer similar benefits to their residents. Many have nurses on staff or on-call 24 hours a day, and it is common practice for doctors to contract with communities and visit regularly. Residents may sign up with these doctors, eliminating the need to leave the community for appointments other than those with specialists. In some instances, services such as x-rays, blood work, therapies, and dentistry can be brought directly to the community.

If a resident wants to retain his current doctors, and transportation is provided at the community, he will be able to use the center’s bus or town car to get to the appointments and free up the family from that responsibility. This can be a tremendous relief for family members struggling to keep up with their own responsibilities and making sure Mom or Dad attend all their medical appointments.

The community’s nurse and care giving staff will work with the resident, his doctor, and the family to create a team and oversee all the resident’s health care needs. They will supervise medications, coordinate and follow up on doctor’s visits, monitor vitals, and much more. Most communities recognize that monitoring a resident’s well-being includes not only the physical health needs but also his mental and emotional state. They will work with the family to ensure that their loved one is as healthy and happy as possible.

Quality Time with Family

In a care giving situation, it can be difficult for all parties involved to recognize the effect circumstances have taken on personal relationships. Roles become reversed when children care for parents. Family members disagree and divide over caregiving responsibilities. Romantic intimacy is lost when one spouse cares for the other. One of the most powerful benefits assisted living can offer is the return and healing of family roles.

Once the primary caregiving responsibilities are handed over to the community and its staff, relationships can return to their previous roles. Instead of spending your time together providing care, quality time can be spent enjoying each other’s company.

Types of Residential Eldercare Communities Available

One of the most difficult decisions you will make is when you reach the conclusion that your loved one is unable to remain in his or her own home or live with family, and there needs to be a change in living arrangements. Assisted living becomes the appropriate option when there have usually been numerous emergencies or difficulties in providing suitable care at home and all other options have been exhausted.

When the time has come to begin the process of seeking which type of community would be most appropriate, you may find yourself confused over the numerous choices offered (or at least the terms used to describe them), including assisted living facility, assisted living center, residential care community, continuing care retirement community, private group home, adult care home, assisted living residence, board and care, family care home, memory care community, and Alzheimer’s special care unit. Although these are all terms for assisted living facilities, there can be significant differences in size, amenities, and atmosphere. They may also not all provide the same levels or types of care. That is why it’s critical to understand what various services different communities provide, what type of care they are licensed for, and the overall atmosphere your senior would experience living there.

Licensing for assisted living facilities is controlled at the state level, and each state has the right to decide how it will refer to these facilities in the state. If you are unsure of the terminology for what you are seeking, visit the websites for your state’s department of health services or the Assisted Living Federation of America. Both are great resources for assisted living communities.

The following information will give you a broad understanding of what you can expect if you are exploring assisted living facilities, and it will help you avoid spending unnecessary time investigating the wrong type of community.

Independent Living Communities

There are many communities that encourage and allow fully independent people to move in even though they are licensed for assisted living. To be a good fit in an independent living community, your senior would need little or no assistance with activities of daily living. Your loved one could go into independent living and have a few minor services brought in to assist him or her until enough care is needed to qualify for assisted living.

A perfect example would be a married couple where the wife is healthy, outgoing, and active, but the husband has early stages of Parkinson’s disease. Although the husband is social and enjoys living at home, his wife is not comfortable leaving him alone in the afternoon while she enjoys time with her friends. What if he fell or needed something while she was gone? Or perhaps it’s becoming too difficult for her to assist him with showering. A good choice would be a community offering both independent and assisted living. They would have their own apartment in the independent section, and some basic services could be provided privately in their residence. The wife could rest assured that her husband could receive any care services needed, and they could still enjoy an active lifestyle using the community’s amenities such as the restaurant/bar, swimming pool, and theater.

Assisted Living Communities

There are usually specific needs that indicate a person requires assisted living rather than independent living. Some of these indicators might include but not be limited to: medication management, regular monitoring for medical conditions, or incontinence management.

Assisted living provides supervision or assistance with activities of daily living (ADL); coordination of services by outside health care providers; and the monitoring of resident activities to help to ensure the resident’s health, safety, and well-being. Assistance may include the administration or supervision of medication or personal care services such as assistance with showering or toileting provided by trained staff. The goal is to provide care but also to help the resident remain as independent as possible.

Any community you are considering should conduct its own assessment of your loved one to determine what services will be required and that your senior is an appropriate fit for its facility. (See Chapter 9 to learn more about specific considerations relevant to seeking assisted living.)

Memory/Dementia Care Communities

Memory or dementia care is for those who have been diagnosed with Alzheimer’s disease or other related dementias. It is for people who are no longer oriented, tend to wander, or present a danger to themselves or to others.

This level of care is very specific, and you will find staff that are trained in dementia care tactics such as distraction and redirection. These communities provide care in a safe, loving environment. While residents can move around on their own within the facility, the main doors to the outside remain locked. A code is required to enter and exit the community to ensure no resident will accidentally find a way out and possibly become lost or injured. Communities usually feature a small private room or a larger shared room. Most feature common areas for the residents to mingle and engage in appropriate activities and may also have secured outdoor courtyards so residents can enjoy being outside in the fresh air.

Continuing Care Retirement Communities

This type of community offers independent living, assisted living, and often memory/dementia care or skilled nursing located on one campus, and residents can move between different levels of care without ever leaving that particular community.

If considering a continuing care retirement community (CCRC), it is important to understand that some of these communities require a large buy-in or entrance fee before moving in—often in the hundreds of thousands of dollars or more! In addition, residents will continue to pay monthly rent and other charges. The buy-in fee is intended to prepay for care and provide the community with operating capital. Potential occupants must look at these communities as an investment, consult with trusted advisors such as an attorney or financial planner, and understand the contract thoroughly before committing.

A common misconception about CCRCs is that a person needs to buy-in in order to live at the community. This is not necessarily true. Many communities will also offer a month-to-month lease with slightly higher monthly fees.

If you are interested in a CCRC for your senior and are considering a buy-in, take a realistic look at your loved one’s situation before committing such a large sum of money. For instance, if he is ninety years old, suffers from mid- to late-stage Parkinson’s disease, and has been declining over the past year or two, it might not be in his best financial interest to buy-in and give the community a large amount of money up front when he might pass away in the next year or two. A large percentage of that money may not be refundable and will never be put to the use intended.

Skilled Nursing Communities

Skilled nursing facilities, also referred to as nursing homes, offer long- and short-term care for those who suffer from serious or chronic health issues that are too complicated to tend to at home or in an assisted living community.

This type of community provides custodial and skilled nursing care around the clock. Some of the services it can offer that an assisted living community might not include the following:

They are also capable of providing assistance with activities of daily living such as bathing, dressing, and personal hygiene.

Respite Care Communities

Respite care provides short-term, temporary relief to those who are caring for loved ones who might otherwise require permanent placement in a facility outside the home. With respite care, your loved one can go to a community and receive care for a short time while you or the caregiver take a vacation, attend to health issues of their own, or simply recharge. Respite may also be provided to those who are incapacitated because of an accident or illness and who need assistance during recovery. It is not intended for long-term stays. Normal periods of respite might be a few days to a few weeks.

It is important to note that not all assisted living communities provide respite care.

Understanding Levels of Care and Licensing

Every assisted living facility must be licensed by the state in which it operates, and there are three levels of licensing for different types of care. It is extremely important that you understand what level of care the community is licensed for and the services it can legally provide.

Supervisory Care

Supervisory care is general supervision for those residents who are more independent and highly functioning. Caregivers simply provide a daily awareness of your loved one’s ability to function and what his or her needs may be. Limitations include the following:

Supervisory care is minimum assistance. Residents would need to be able to perform functions, such as the following:

Personal Care

Personal care is the next level up from supervisory care. Caregivers are allowed to perform hands-on assistance with activities of daily living such as bathing, dressing, grooming, and mobility. The resident must be able to make basic care decisions, summon assistance, express his or her needs, and recognize danger.

Some needs a resident in a personal care licensed facility might have would include the following:

Directed Care

This is the highest level of care for licensing, and it is given to residents who are unable to make basic care decisions, recognize danger, summon assistance, or express their needs. The caregivers will need to provide direction or perform ADL for the resident, and they are allowed to administer medications or treatments.

In addition to requiring the types of services provided under a personal care license, residents may also need the following:

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When exploring communities, be sure to ask them what level they are licensed for. You can also visit your state’s department of health services and look for its database of licensed communities. This will provide the licensing information as well.

Deciding Between a Large Assisted Living Center or a Smaller Assisted Living Group Home

There are two distinct size differences between all communities. If they have more than 11 residents, then they are considered an assisted living center. If they have 10 or fewer residents, then they are considered an assisted living group home. Remember that these terms may be different in your state. Making the decision on whether you should look at a large center or a group home can be confusing. There are important considerations that can help make the decision very clear.

Large Assisted Living Center

In a large assisted living center, residents typically live in their own apartments, but come together for communal meals, socialization, and activities.

Here are some common characteristics of large assisted living centers.

Smaller Private Group Homes

Smaller private group homes are more intimate, much like a family environment. Residents either have a private room or share a room. Some homes may offer private bathrooms, but many residents share common bathrooms. Residents are encouraged to consider the entire home their own. They are welcome to have company and use the common areas to entertain or to have guests in their room. In most instances, all residents will come together at mealtime, unless there is a reason for someone to eat in their room.

Caregivers are on-site 24 hours a day. Also, the same caregivers are often at the home daily.

Some of the more common characteristics of these homes may include, but are not limited to, the following things.

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As you can see, there are many choices available to you to provide qualified care for your loved one. The issue of who provides that care and where it occurs is a private matter that only you, your loved one, and the family can decide. However, when making these decisions, remember to address not only the health-related needs but also the social, emotional, cultural, intellectual, and spiritual well-being of both the caregiver and the care recipient. When care is taken to identify the most qualified caregiver and the most appropriate living arrangement, the likelihood of successfully meeting physical, mental, and spiritual needs in a qualified and loving manner is greatly increased.