Planning Ahead

Facility Types

There are many different facilities each set up differently to support certain levels of care. It can be a confusing to find the right facility for your loved one. Here are some helpful guidelines that will navigate the waters.

When is a Skilled Nursing Facility/Nursing Home Appropriate?

This level of care is appropriate for an individual who:

Requires total assistance with walking or transfers.
Requires total assistance with eating, bathing and grooming.
Exhibits moods and/or behaviors threatening to self or others.
Has a medical condition requiring 24-hour nursing supervision.
Has experienced an acute episode (i.e. fracture, stroke, etc.) and requires short-term rehabilitation.

Skilled Nursing Facility/Nursing Home:

Skilled-nursing facilities also known as nursing homes are the most comprehensive option for residents who require continual care. They provide 24-hour medical care by registered nurses (RNs), licensed practical nurses (LPNs or LVNs), or nurses' aides under physician supervision. A skilled nursing facility typically offers two levels of care:

Basic Nursing/Long Term Care offers services required to maintain a resident's Activities of Daily Living (bathing, dressing, grooming, eating, etc.). Other provided services typically include laundry, housekeeping, scheduled activities and three meals a day plus snacks.
An interdisciplinary team consisting of nursing, social services, activities and dietary personnel meet regularly with the resident and family members to determine how to meet medical and personal needs. Basic Nursing/Long Term Care is appropriate for individuals with long-term disabilities or chronic illnesses.
Basic Nursing/Long Term Care can be paid privately, through Medicaid (state-supported assistance) and/or through long-term care insurance policies. Fees may include daily room and board (utilities included, although telephone and/or cable television may be an additional cost), medications and personal care products provided by the facility (i.e. urinary incontinence products, grooming and bathing supplies, etc.).

Skilled Care is often utilized on a short-term basis by residents with acute illnesses (i.e. fracture, stroke, etc.) whose goal is to return home. Services may include continuous intravenous (IV) therapy or daily rehabilitation therapy (i.e. physical, occupational, speech, respiratory).
Skilled Care is usually paid through Medicare and/or Health Maintenance Organizations (HMOs). Costs may include:

Daily room and board
Utilities (usually including cable and telephone)
Medications and medical supplies
Personal care products
Medical equipment
Therapy staff

If Skilled Care is completed but it is still not appropriate for the resident to return home or to his or her previous care, other levels of care are available. These include Long Term care, assisted living, congregate care or adult foster homes.

When is an Alzheimer's Care Facility Appropriate?

This level of care is appropriate for an individual who:

Has Alzheimer's disease or a related dementia diagnosis.
Wanders.
Has severe memory impairments.

Alzheimer’s Care Facilities:

Alzheimer's Care Facilities are specifically designed to provide an environment that helps reduce resident confusion and agitation. In many facilities, staff receive training in reality orientation and behaviors associated with memory impairments. Building design features can include color-coded hallways, visual cues and secured wandering courtyards.

Alzheimer's Care services were originally provided in Enhanced Care Units (ECUs) within a Skilled Nursing Facility/Nursing Home. Although ECUs remain a popular and effective alternative, Assisted Living Facilities and Retirement Care Facilities have developed lower levels of care to specifically meet the needs of individuals with an Alzheimer's or related dementia diagnosis.

The design and decoration of an Alzheimer's Care Facility should create a calm environment that plays upon the four senses — sight, smell, taste and touch. Special attention is paid to color and pattern selection. Staff can be trained in reality orientation and validation techniques that enable memory-impaired residents to physically function in the environment without disrupting their sense of reality.

Alzheimer's Care Facilities are usually paid privately, through Medicaid (state-supported assistance) or through private long-term care insurance. Costs typically include:

Daily/monthly room and board
Utilities (telephone and cable may be additional)
Three meals per day
24-hour supervision
Laundry and housekeeping
Scheduled activities

When is an Assisted Living Facility Appropriate?

This level of care is appropriate for an individual who:

Requires assistance with Activities of Daily Living, but still walks (or uses wheelchair, cane, etc.) independently.
Requires medication assistance.
Wants to maintain independence, but also desires the security of 24-hour staffing.
This level of care is not appropriate for developmentally disabled individuals.

Assisted Living Facility

Assisted Living provides a combination of residential housing, personalized supportive services and health care. It is designed to meet the needs of those who require help with Activities of Daily Living, but don't need the skilled medical care provided in a nursing home. Although the services and pricing offered may vary, most Assisted Living facilities provide:

Help with dressing, grooming, bathing and other daily activities
Medication assistance
Meals
Laundry/housekeeping

Assisted Living apartments are usually equipped with an emergency call system, individualized heating/cooling system, bathroom and a kitchenette. A microwave, refrigerator and sink are standard in the kitchen. Three meals a day are provided in a community dining room, and guests/visitors are often invited to dine in the facility for a nominal fee. Various community living areas are also available for residents and visitors to enjoy. Housekeeping services are included. Laundry facilities — a washer and dryer — are often provided on the premises, and personal laundry services may be available for an additional monthly charge.

Assisted Living is not appropriate when an individual is no longer safe within a private apartment and/or requires routine medical assistance from licensed nursing staff.

When is a Congregate Care Facility Appropriate?

This level of care is appropriate for individuals who:

Live independently but want the flexibility of meal and housekeeping services.
Desire a sense of companionship and safety.

Congregate Care Housing

A Congregate Care housing facility combines private living quarters with centralized dining services, shared living spaces and access to social and recreational activities. Many Congregate Care facilities offer additional support services, including transportation, personal care, spiritual nurturing and rehabilitation.

Congregate Care housing is ideal for older adults who can safely live independently but wish to access some residential services. Apartments typically include safety features in the kitchen, bathroom and common living areas. Kitchens are fully equipped, but one meal a day may be offered in a communal dining room. Additional housekeeping and recreational services may also be offered. While health care services are not provided, some facilities allow privately paid home-care assistance for personal or nursing needs.

Apartments are rented on a monthly basis, and since no medical care is included Congregate Care housing is usually paid privately.

When is Independent Living Appropriate?

This level of care is appropriate for individuals who:

Are healthy and active seniors, but do not want the responsibility of a family home.
Are singles or couples who wish to live in a community of senior peers.

Independent Living

Independent Living communities generally consist of homes, condominiums, apartments and/or mobile homes where residents maintain an independent lifestyle. Some Independent Living communities also include subsidized housing that offers rental assistance from the federal government.

Independent living attracts single, older adults and/or retired couples who do not need any medical or nursing care. Some facilities have a minimum age and/or physical exam requirement. Independent living provides a safe, protected and sociable environment among peers. Along with private housing, Independent Living may offer optional meal services, common areas and recreational facilities, including golf, tennis, pool and additional exercise areas and equipment.

Independent Living is typically paid privately on a monthly basis. The rental agreement may include specific conditions of residency and termination clauses that should be read thoroughly.

Continuing Care Retirement Community

Continuing Care Communities, also referred to as Life Care Communities, offer individual apartments or single rooms in a multi-unit building specifically designed for seniors. Services provided range from housekeeping to skilled nursing care.

Created for active older residents, Continuing Care offers the entire continuum of care from Independent Living to a Skilled Nursing Facility/Nursing Home all in one campus setting. All health care needs, with the exception of hospitalization, can be met within the Continuing Care environment. Residents move within levels of care depending on medical need.

Continuing Care communities offer rentals, condominiums or a Life Care arrangement/contract. Fees are paid privately and typically use a monthly arrangement that identifies a set amount to cover housing and potential health care costs.