Question

Discuss the various components of long-term care services in the United States. Specifically, what are the differences between retirement centers, assisted living facilities, and skilled nursing facilities. What other options might be available to support the elder or the person needing extensive assistance in the community?

Answer 1

Long-term care (LTC) includes a wide range of medical and support services provided over an extended period of time. Long-term care is not limited to the elderly; in fact, 43% of individuals requiring long-term care are younger than the age of 65. The vast majority of long-term care recipients are older, however, with a projected seven out of ten people over the age of 65 requiring some form of long-term care services in their lifetime. By the time an individual reaches the age of 75, there's a 50% chance they'll need long-term care.

The health and long- term care needs of the elderly and disabled are linked closely to the entire healthcare system. Long-term care is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods. Long term care is focused on individualized and coordinated services that promote independence, maximize patients' quality of life, and meet patients' needs over a period of time. It is common for long-term care to provide custodial and non-skilled care, such as assisting with normal daily tasks like dressing, feeding, using the bathroom. Increasingly, long-term care involves providing a level of medical care that requires the expertise of skilled practitioners to address the multiple chronic conditions associated with older populations. Reform efforts can consider the long-term care needs of the Medicare population in order to improve the quality and cost-effectiveness of these services. Long-term care can be provided at home, in the community, in assisted living facilities or in nursing homes. Long-term care may be needed by people of any age, although it is a more common need for senior citizens.

Retirement living/independent living. Independent or retirement living focuses on a self-sufficient lifestyle for seniors. These residences might be part of self-contained retirement communities or high-rise apartment complexes, among other models. Costs vary widely based on location, services (like housekeeping) and activities offered. Wellness centers may be available on-site.

Assisted living. Assisted living facilities offer services such as medication management and light personal care within a supervised setting. Housekeeping, prepared meals and assistance with daily personal care are available. Assisted living is known for its focus on group and individual activities and efforts by staff to prevent residents from feeling isolated. Medical services, such as nurse practitioners who follow residents, are available. "Assisted living also has different levels of care that someone would buy into," Avitabile says. Residents who need lighter care might opt for medication management, check-in services and morning assistance getting out of bed and showered.

Skilled nursing facilities. The terms nursing home and skilled nursing facility are often used interchangeably, because the types of care involved often overlap, but they aren't identical. Skilled nursing facilities are more likely to have a consistent presence of nurses or physicians and offer rehabilitation services such as occupational, physical and speech therapy. SNFs and nursing homes fall under different sets of regulations.

Different types of long-term care are available within community-based care organizations and care communities.

In-Home Care

Long-term care in the home is often provided by a family member, but care providers may be enlisted to provide housekeeping, personal care, home health aide and skilled nursing services. Rehabilitative services may be performed in the home or at a community-based service location depending upon circumstances. In-home care may not be feasible if care needs are extensive or medically intensive.

Assisted Living

Long-term care in an assisted living community provides assistance with ADLs, basic healthcare, housekeeping, meals and medication management in a home-like setting. Assisted living communities promote self-sufficiency and strive to offer residents a high level of independence. Assisted living is the intermediate step between independent living and skilled nursing.

Adult Day Health Care

Adult day health care provides a break to caregivers during the day. Health services, therapeutic services, social activities and meals are provided at a community- or facility-based location during the day as a part- or full-time service during the day for adults who need assistance or supervision, with the care recipient returning to their home in the evening. This type of service allows the primary caregiver to continue working, to run errands and take care of other business or to take a break from the demanding activity of caregiving.

Memory Care

Although a community may have both assisted living and memory care, the two are not synonymous. Memory care communities provide the vigilant care required for the care recipient dealing with Alzheimer's and dementia. This care includes a structured environment with set schedules and routines, plus round-the-clock supervised care in a secure, locked-down facility.

Skilled Nursing

In a skilled nursing center, round-the-clock skilled nursing care is provided by licensed and trained nursing professionals. Residents generally have high care needs and complex medical conditions. Licensed nurses are onsite 24/7 and a doctor is on call at all times. Ambulances remain available to transport patients to hospitals in the need of an emergency. Skilled nursing care centers offer services ranging from short-term care for a rehabilitative stay to long-term extended stays. Continuing care retirement community. CCRCs offer a tiered approach for aging adults. Typically, residents move into single-family apartments or condominiums designed for independent, healthy adults. As their needs change, they can transition to on-site assisted living or nursing home facilities. Continuing retirement care communities represent a significant financial investment, with hefty upfront entrance fees and monthly charges.

Medical foster care. Also known as adult foster care or residential care homes, medical foster homes are private homes that are run by a trained caregiver. For military veterans with chronic medical conditions that meet the nursing-home level of care, the Department of Veterans Affairs oversees its Medical Foster Homes Program. Availability is limited, although the VA is working to expand the program. Other older adults who have chronic physical or cognitive health needs and require assistance in daily living activities – yet prefer a noninstitutional setting – can seek adult foster arrangements, too. Adult foster care homes are not covered by Medicare.

Nursing homes. Nursing homes provide medical and personal care services beyond what's available in assisted living. Nursing care, 24-hour supervision, assistance with activities of daily living and three daily meals are standard. Most nursing home residents have chronic physical or mental health conditions, or both. Nursing home residents can receive prescribed treatment and personal care as needed.