The Right Care

Finding the Right Care

There are many options and types of setting in which to receive long term care services. Making the right choice is a personal decision based on individual needs and resources available. It is sometimes easy for individuals or family members to make assumptions about the types of care that are needed or appropriate based on limited personal experience or suggestions from friends.

Where long term care services can have such an impact on an individual’s well-being the best advice we can give is to explore the options by visiting with several providers and asking their advice. If you can call in advance, even a couple of hours, to schedule time to meet with a social worker, administrator or admissions coordinator you will find most professionals willing to share their expertise with you and you may identify options that you might not have considered.

Below is a summary of a wide variety of services that relate to long term care services and may help you understand options available.

Understanding Care Options

Levels of care are defined by state licensure, federal rules as well as by different reimbursement systems. Common terms and levels of care that you will hear used are as follows:

Acute Care is the diagnosis and treatment of a disease or condition that is typically for a short period of time. Community and Specialty hospitals are the main providers of acute care. A patient is usually treated for a brief but severe episode of illness. Patients are usually discharged as soon as diagnostic activity is complete and the patient is stable following completion of any surgery, procedures or treatments. Discharge may be made to the patient’s home with or without follow up services or to another type of health care provider for continuing or “post-acute” care.

Post-Acute Care or Short-Term Care is a broad term that applies to medical care following up an “acute care” hospital stay. It may include a stay at a hospital based “Inpatient Rehabilitation” unit or “Extended Care” unit or a stay in a free standing Inpatient Rehabilitation Facility or Skilled Nursing Center. It may also apply to “skilled” Home Care such as provided by a Visiting Nurse Association. When used in the context of nursing home care, post-acute or short-term care refers to “patients” admitted with the intent to return home to their prior residence usually within 10 to 100 days.

Post-acute care may include rehabilitative therapy, respiratory therapy, administration of intravenous medications, nutritional support such as enteral feeding, treatments of incisions or wounds as well as education and training of a patient to provide on-going care.

Long-Term Care (LTC) refers to services which help meet both the medical and non-medical need of people with a chronic illness or disability who cannot care for themselves for long periods of time. Long-Term Care encompasses:

Skilled Nursing Care is provided in a licensed nursing home. It may include medical treatment of wounds, pain management, physical and occupational therapy or intravenous infusions of medications as well as monitoring of the patients medical condition.

Long-Term or “Custodial” Nursing Care is provided in a licensed nursing home. It includes as needed; medication administration, supervision for safety, assistance with or provision of total care with bathing, grooming, toileting, dressing, eating or ambulation.

Assisted Living / Residential Care / Supported Residential Care: Assisted Living covers a range of services usually providing supportive services such as meals, medication supervision and assistance with bathing and grooming. Typically and historically, at least in New Hampshire, these services have been at a lower level of care or assistance than found in licensed nursing homes as individuals were required to be able to self- evacuate the residence in case of emergency. This level of care is less well defined and is in transition to include higher levels of care. New Hampshire’s licensure regulations refer to “assisted living” in two levels of care; they are Residential Care and Supported Residential Care.

Home Care refers to a variety of services and nursing or medical care that may be provided in an individual’s “home”. Home may include a private residence as well as an apartment in an Independent Living or Assisted Living community. Home care may include “skilled” services similar to those provided in a nursing home such as; administration of medications or intravenous infusions, physical therapy or wound treatment. It can also be the provision of support services to assist with activities of daily living such as provided in a nursing home or assisted living center. Home care also is often used to refer to “homemaker” services such as house cleaning, laundry, meal preparation or shopping assistance to help someone with limited abilities.

Adult Day Care services are state licensed and provide opportunities for clients to socialize and participate in activities while receiving assistance with eating or toileting. Some programs are structured to provide services specifically to individuals with memory impairment. Services may vary but programs may offer transportation to and from the day care center as well as providing showers with assistance.

Independent Living, Congregate or Retirement Living: These terms refer to residential communities that offer non-medical support services such as: meals, housekeeping, transportation and often social activities. Personal care or nursing care if needed may be arranged through a “home care” agency but residents in such settings are fairly independent, cognitively intact and usually self-ambulatory. Independent Living residential communities can be found as free standing communities, on the same campus of other long term care services such as adjacent to assisted living or nursing homes or as a component of a Continuing Care Retirement Center.

Continuing Care Retirement Centers (CCRCs) typically combine several levels of care into one integrated campus. They usually provide Independent Living as well as Assisted Living and Nursing Home care. The unique feature of CCRCs is that they also serve as an insurance vehicle for long term care by virtue of how they offer services. Typically a sizable up-front admission fee is charged that may be tens or hundreds of thousands of dollars and in exchange residents are guaranteed care and treatment for specified time in the centers assisted living or nursing home if they require such care in the future. Arrangements and services vary from one CCRC to another. In New Hampshire CCRCs are also regulated by the state Insurance Department because they provide both housing and “insurance” for future care needs.