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Where Is
Chapter Long-Term
Care Received?
LEVELS OF CARE
There are two broad levels of long-term care: skilled and non-
skilled.
Skilled Care
Someone with an acute condition that requires intensive medical
attention will normally require a short period of skilled care.
This type of care would likely fall into the category of short-term
care because the duration of the need for care is almost always less
than 100 days.
The two objectives of skilled care are:
• Assist the person and provide them with comfort if the con
dition is terminal. This type of care is often referred to as
hospice care.
or
• Assist the person during a recovery period.
Skilled care is sometimes covered by public and private health
insurance programs and by Medicare. For example, we knew the
owner of a window cleaning company who fell off a roof one morn-
ing and broke just about every bone in his body. The prognosis
given by his physician was full recovery. He did fully recuperate,
22 Chapter 2: Where Is Long-Term Care Received?
A board and care home may offer residents the same services as
an assisted living community, a skilled nursing home, or in some
cases, an Alzheimer’s facility. Generally, however, most board and
care homes do not offer skilled nursing or medical services and are
not the solution for severely disabled people. But they can provide
a safe, supportive environment for people who want to actively
make choices about daily life and health care while maintaining as
much independence as possible.
Some board and care homes serve the needs of those with similar
conditions. For example, some specialize in care for people in the
middle to late stages of Alzheimer’s disease. Others only care for
early-stage Alzheimer’s patients. Some are only licensed to care for
those with a mild mental impairment or to assist those who need
relatively minor help (reminders, meal service, laundry, housekeep-
ing help, and driving services).
Since the federal government does not certify board and
care homes, the quality of care provided can vary widely.
In some areas, the local government enforces only minimal regu-
lations with periodic inspections for compliance. Therefore, it
is important to find someone you trust to help you with the
decision to place a loved one in a board and care home. Have
family members, a lawyer, and a financial professional review con-
tracts before entering into an agreement or paying an entrance fee.
Also, do some research on the home, including:
• Checking for complaints with the state licensing agency
• Asking for and checking references
• Making unscheduled, unannounced visits at different hours
• Checking www.seniorresource.com
Assisted Living Communities
The most common long-term care delivery system for the first
two decades of the twenty-first century will be the assisted liv-
ing community. Assisted living is the fastest growing type of care
setting because it meets the needs of people who cannot make it
entirely on their own but do not need or want the skilled nursing
care and institutional environment of a nursing home. In contrast to
nursing homes, typically viewed as places where “old folks go to
Chapter 2: Where Is Long-Term Care Received? 29
About 1.6 million people age 65 and older live in nursing homes.
The average age of residents is 82, with women constituting the
majority of residents.
We place nursing homes last on the continuum of care because:
• Most people will only go into a nursing home as a last resort.
• By planning ahead for long-term care, it is very unlikely you
will need to enter a nursing home for an extended period of
time.
Nursing homes are by far the most institutional setting on the
delivery-of-care spectrum. They are designed to provide mostly
medical care to severely physically and cognitively disabled
patients during their declining months or years. A variety of studies
have shown that elderly patients who spend longer than two years
in a nursing facility rarely return home.
Unlike all the other types of care explained above, a physician
must certify a resident’s need for nursing home care. The physi-
cian must visit regularly and assume responsibility for the patient’s
overall treatment of care.
As with any type of long-term care services, the quality of care can
vary widely from one nursing home to the next. Unfortunately, the
quality of care provided is mostly determined by our ability to pay
for care. A nursing home, like any business, must cover its operating
costs. This isn’t easy with the monies received from Medicaid reim
bursements, especially for nursing homes that want to offer high-
quality services (for more on Medicaid see Chapter 4: Who Pays for
Long-Term Care?). As a result, many nursing homes limit the number
of beds available for welfare patients.
Private pay patients are assured “bed availability” and quality
care in the facility of their choice. By planning ahead long before
there is a need for care, you and your family will have more con-
trol over your long-term care delivery options (including possibly
avoiding nursing home confinement), as well as the quality of care
you receive.
The American Health Care Association is a good resource for
information about nursing homes (www.ahca.org, 202-842-4444).
Chapter 2: Where Is Long-Term Care Received? 35
Auntie Mae “Blossoms”
in Assisted Living
Auntie Mae is the perfect example of the typical
assisted living resident. A widow in her 80s, she lived
alone for many years, supporting herself by taking on
work as a seamstress. During a visit, I noticed she
was behaving strangely, almost as if she were having
hallucinations. After a visit to the doctor and a subse-
quent review of her medications, it was determined
that Auntie Mae had been taking too much medica-
tion. We attempted to organize her medication sched-
ule so she wouldn’t forget she had already taken her
medication and double-dose. But without someone to
remind her, she’d forget to use the reminder system
and once again found herself in a drug-induced fog.
Where Is
key Long-Term Care
points Received?
➤ Skilled care is provided when intensive medical
attention is required. Medicare and most private
insurance plans cover skilled care.
➤ Non-skilled care, also known as custodial care, is
provided when the prognosis is progressive deterior
ation over a long period of time (100 days or longer)
with little chance of recovery. Custodial care is
not covered by Medicare, Medicare Supplement
insurance, or private health insurance.
The Continuum of Long-Term Care includes all
the settings in which long-term care services are
provided:
➤ The family home remains the preferred environ-
ment for receiving long-term care.
➤ Board and care homes are private dwellings that
offer care in a home-like environment for a limited
number of people who need minor assistance.
➤ Assisted living communities provide personal
assistance and low-level nursing care, all on the
same campus.
➤ Continuing Care Retirement Communities offer
facilities ranging from apartments for independent
and active residents to assisted living arrange-
ments and, in some cases, skilled nursing care.
➤ Alzheimer’s facilities offer unique floorplans and
provide the special care required by those who
have been diagnosed with Alzheimer’s disease.
➤ Nursing homes provide mostly medical care to
severely physically and cognitively disabled
patients during their declining months or years.