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Levels of Care
There are many factors to consider when assessing a person’s needs and preferences for care. It may be difficult to know which care setting is best for your loved one, so the following list is designed to describe various types or “levels” of care in general terms. Please note that within each level of care described, there are many choices in terms of types of care and care settings available. OC Elder Law, together with a Geriatric Care Manager, will customize their recommendations based upon the specifics of your particular situation.
Independent Living (IL)
The name of this category seems to say it all – that this living situation is appropriate for individuals who are still able to manage their lives independently. In this setting, the most common services provided are meals (anywhere from 1-3 meals per day), housekeeping, activities, maintenance, security, and transportation. In response to an increasingly aging population with growing care needs, many communities are now offering care services to their “independent” residents. Examples of add-on services include assistance with bathing, dressing, and medication management. An Independent Living community is ideal for individuals who are capable of living alone, interested in having more social contact with their peers, perhaps no longer driving, and who wish to live a “maintenance-free” lifestyle.
Assisted Living (AL)
As the name suggests, this setting is for individuals who need assistance around the clock. Care needs vary greatly from person to person within Assisted Living, and there are many different types of communities (see below) that offer this type of care. Services provided in this level of care generally include: housekeeping, maintenance, security, transportation, meal preparation, periodic monitoring around the clock, shower assistance, dressing and grooming assistance, toileting assistance, medication management or reminders, and activities.
An Assisted Living community is ideal for individuals who need assistance throughout the day due to physical and/or cognitive limitations and yet have some ability to move on their own (even if with the help of assistive devices such as walkers or wheelchairs).
Dementia Care or Memory Care (MC)
Dementia or Memory Care communities are Assisted Living communities that specialize in caring for individuals with dementia. These communities are held to strict state regulations regarding how the community is staffed, how employees are trained, and how the community secures the safety of its residents. As a result, there are lower staff/resident ratios, extra precautions to ensure residents’ safety at all times, and added security to prevent elopement from the community. All Assisted Living services mentioned above are offered in Memory Care settings.
Some Memory Care communities may also offer the ability to continue to care for residents who become bedridden or need assistance with eating. They may also offer a lot of services on-site by medical professionals (e.g., physicians, dentists, and geriatric psychiatrists) to reduce the need to transport residents away from the community. A Memory Care community is ideal for individuals who have moderate to severe dementia, who have a tendency to wander, or who need heavy care.
Board and Care Facilities
Board and Care facilities/homes are typically single-family houses that have been converted into residences for elderly and/or disabled individuals. They house up to six residents in each home. All Board and Care facilities provide the basic Assisted Living services mentioned above but likely fewer amenities and nonessential services. Some homes cater to specific resident needs (e.g., dementia or language spoken in the home). There is a low staff/resident ratio, but note that the caregivers may also be responsible for other things as well, such as cooking and cleaning.
In general, the monthly costs are lower in Board and Care homes compared to larger communities that have more staff and more comprehensive services. A Board and Care home is ideal for individuals who prefer a smaller and more home-like environment, who have specific needs that might not be met in a larger facility, or who have a smaller budget.
Skilled Nursing Facilities (SNFs)
Skilled Nursing Facilities offer medical care for short and long-term patients. There are two types of skilled nursing patients: those who have short-term rehabilitation needs and those who need 24-hour care for the duration of their lives. Short-term rehabilitation services (physical therapy, occupational therapy, and speech therapy) are provided for individuals who are recovering from a specific event such as a hip replacement, stroke, or heart attack.
Long-term (also referred to as “custodial”) care is provided to individuals who need round-the-clock monitoring and total care. This is the most highly regulated level of care available. Skilled Nursing is ideal for individuals who need post-hospital nursing care and therapy prior to going home, or for individuals who are bedridden and need complete care on a long-term basis.
Multi-level Retirement Communities
Multi-level Retirement Communities offer Independent Living, Assisted Living, and sometimes Memory Care on the same campus. Multi-level Retirement Communities are ideal for individuals who are looking to “age in place” as their care needs progress, or couples who have (or anticipate) different care needs.
Continuing Care Retirement Communities (CCRCs)
Continuing Care Retirement Communities (CCRCs) provide Independent Living, Assisted Living, Memory Care (sometimes), and Skilled Nursing on the same campus. This is the only type of community that can care for an individual in practically any care situation – with few exceptions such as behavioral issues. CCRCs are ideal for individuals who are looking to “age in place” as their care needs progress, or couples who have (or anticipate) different care needs.
Since many CCRCs require sizeable entrance fees, they sometimes offer added benefits or incentives to residents, such as priority access to higher levels of care, as well as discounted rates for higher levels of care.
By far, the most preferred place to live for seniors is in the comfort of their own home. Even so, there are many things to consider when determining if home is the optimal setting: the appropriateness and safety of the home environment; the physical, cognitive, mental, and emotional health of the individual; and the availability of trained caregivers and services providers to support the individual. The short and long-term care needs of the care recipient should be considered when deciding to remain at home or transition to a different care setting. Home is ideal for individuals who are cognitively, mentally, and physically capable of caring for themselves (or who have adequate support from loved ones or hired caregivers) and whose homes are safe environments for them to age in place.