Choosing the Right Level of Care Begins with Understanding All of Them
By the Massachusetts Senior Care Assoc.
Massachusetts has a broad array of care options and a national reputation for quality. Understanding the different types of healthcare services offered by providers is the first step to determining which care option best fits your needs.
Skilled Nursing and Rehabilitation
Nursing facilities provide both short- and long-term care services for older adults and people with disabilities or chronic illnesses.
Of the more than 120,000 people Massachusetts Senior Care Assoc. members care for annually, close to two-thirds return to their community within one month after a brief, post-hospital, rehabilitative stay. With ever-shortening hospital stays, skilled-nursing facilities have become the preferred choice for discharged hospital patients who need short-term transitional care before they can return safely to their homes. Those who cannot live safely and comfortably at home receive precisely the care and community they need as long term residents of Massachusetts’ nursing and rehabilitative facilities.
Short-term care is available for individuals who have been hospitalized and need a period of medical monitoring and/or rehabilitation before returning home. Often referred to as subacute or transitional care, this kind of care can be provided in a free-standing nursing facility or a hospital-based skilled-nursing unit. Most stays are for fewer than 30 days, after which the patient usually returns home. This kind of care can be beneficial after a surgery or a prolonged hospitalization, or for rehabilitation following a stroke or other serious medical event.
Long-term care is available for people who are unable to live safely and comfortably at home, require 24-hour nursing care and support, and need help with many of the activities of daily living, such as eating, dressing, toileting and bathing. When considering long-term nursing facility care, it is important to discuss the issue thoroughly with the person involved and his or her personal physician before the situation becomes an emergency. Finding the right facility can take time, and since some facilities have waiting lists, it helps to plan ahead so space will be available when it is needed.
Among the services provided are 24-hour nursing care; rehabilitative care such as physical, occupational, speech, and respiratory therapy; and help with personal care such as eating, dressing, toileting, and bathing. In addition, a growing number of nursing facilities provide post-operative rehabilitative care, inpatient and outpatient rehabilitation, Alzheimer’s/dementia specialty care, respite care, restorative and residential care for people with multiple sclerosis and other neurological disorders, pediatric specialty care, and acquired brain-injury specialty care.
Assisted-living residences are for older people who no longer feel comfortable or safe living alone, but do not need 24-hour nursing and medical care. While assisted-living residences monitor the well-being of their residents and help coordinate health services by licensed outside agencies or providers, they do not provide these services directly and are not designed for people with serious medical needs. State law prohibits assisted-living residences from admitting or retaining individuals who need skilled nursing care for more than 90 days in a 12-month period.
Assisted living residences combine apartment-like living with a variety of support services, including meals, assistance with activities of daily living such as bathing and dressing, on-site staff to respond to emergencies and help with medications, housekeeping and laundry services, social and recreational programs, and 24-hour security.
Assisted-living residences have one- or two-bedroom units with private bathrooms and entry doors that lock. Some units may also have a living or sitting room. In addition to a group dining area, assisted-living residences typically provide either a private kitchenette or access to a communal cooking area. Units are usually furnished with a resident’s personal belongings and furniture.
Continuing-care Retirement Community
Continuing-care retirement communities (CCRCs) combine independent retirement housing, assisted-living services, and nursing facility care, usually on the same campus, to allow elders to have their current and future care needs met at one location. As a senior’s needs change, he or she can choose from among the services and care settings available.
CCRCs are another option for older people who no longer want the responsibility of caring for a house and want the peace of mind of knowing that they have planned for their future long-term-care needs. Most CCRCs require incoming residents to be fully capable of independent living upon entering, or may impose conditions based on certain pre-existing conditions. However, some CCRCs allow residents to enter their assisted-living units directly from the community.
CCRCs also provide assisted-living services (either in separate assisted-living units or to individuals residing in the independent living units) and 24-hour nursing-facility care.
Most independent-living units in a CCRC consist of one or two bedrooms, a living room, a kitchen, and a full bathroom. CCRCs typically have a number of common areas, including one or more resident dining rooms, and many also have libraries, hair salons, convenience stores, exercise and game rooms, and banking facilities.
Other Care Options
• Adult day health programs, also known as adult day care centers, provide supervision, recreation, health, and personal-care services during the day to older people so that family caregivers can work or attend to other responsibilities. All adult day health programs must meet minimum standards set by the Massachusetts Medicaid program, also known as MassHealth. Adult day health programs are provided either on a private pay basis or through Medicaid.
• Adult foster-care programs match elders who are no longer able to live alone with families willing to provide room and board and personal care. Families are paid a stipend by MassHealth for elders who are Medicaid-eligible. Some adult foster-care funding is also available to pay for assisted-living services for people who are clinically and financially eligible through the state’s Group Adult Foster Care Program.
• Congregate housing facilities provide a living arrangement in which elders have a private bedroom and share common space with others. Support services are usually available to help elders maintain their independence. Most congregate housing sites are sponsored by local municipal housing authorities or nonprofit organizations. Public congregate housing is partially subsidized by the state or federal government.
• Home-based services help individuals live independently at home and are provided by home health agencies, visiting nurse associations, and state-funded home-care corporations (called aging services access points, or ASAPs). They include homemaker services to maintain household functioning, including help with home management, shopping, meal preparation, and light housekeeping; and personal care, including bathing, dressing, grooming, and toileting. They may also provide health services; home health aides provide basic healthcare services such as personal care, recording temperatures and checking pulses, changing simple bandages, and assisting with self-administered medications, while licensed nurses and therapists provide skilled nursing care and therapeutic services.
• Hospice care serves patients with a life-threatening illness and a life expectancy of six months or less. Hospice care may be provided in the home, nursing facility, or hospital, and the hospice team works cooperatively with the patient, family, physician, and other caregivers to provide specialized care that is focused on comfort, not cure. The hospice team includes the patient’s physician, hospice medical director, registered nurses, home health aides, licensed social worker, bereavement counselor, pastoral counselor, rehabilitation therapists, and volunteers.
• Resident Care Facilities (RCFs), also known as rest homes, provide housing, meals, 24-hour supervision, administration of medications, and personal care to individuals who do not routinely require nursing or medical care.
• Respite care is short-term care provided at home, in a nursing facility, or in an assisted-living residence to give families caring for elders at home some time off from their caregiving responsibilities.
• Finally, independent-living senior communities are an option if you want to live on your own, but don’t want to have all the chores that go along with having a home. It’s also a great option for people who want to live in a community with other seniors. Depending on the community you choose, you can rent an apartment either at the market rate or, if your income level applies, a lower rate. They are often specially designed with things like railings in bathrooms or power outlets higher up on the wall. They may also offer a 24-hour emergency call service if residents need help right away. Some facilities may also offer services like meals, transportation, social activities, and other programs.