When your loved one can no
longer care for herself, it's time to find help. But
what kind of care environment is best?
The good news is you have
options, more than you think. Making the transition
to a new care environment or modifying a current
one, like a home isn't as difficult as you might
think. In general, there are four common care
environments: Home
Health Care, Assisted
Living Facilities, Nursing
Homes, and Adult
Daycare Centers. Continuing
Care Retirement Communities usually
provide several care environments within a
multi-building campus.
Home Health Care
Receiving care in the home
is perhaps the most flexible of all options.
Caregivers who come into the home can provide
services that range from stand-by oversight for a
few hours a week to round-the-clock care. When you
engage a home health care agency, they will supply
caregivers with the appropriate skills during the
time that you request. Before you plan for services
with a home care agency, you should get an
assessment of your loved one's care needs. Sometimes
the agency can arrange this assessment, and it
should be performed by a registered nurse.
Generally, most agencies
want visits to last for at least 3-4 hours, and some
have weekly minimums as well. If you request a
caregiver in the home 24-hours a day, the agency
will usually split the time into two 12-hour shifts.
Unique state labor laws also factor into staffing
for full-time caregiving. Some agencies will provide
"live-in" caregivers, but there are requirements as
to where and when they are allowed to sleep and how
much free time they have.
An alternative to working
with a home health care agency is to hire an
independent caregiver directly. Because they work
for themselves, you pay them directly.
Home health caregivers can
range in skill level from untrained companions, to
homemakers, to skilled nurses. Many have completed
programs to be Certified Nursing Assistants or
Certified Home Health Aides, meaning they are
trained to handle health issues such as mobility,
nutrition, toileting, hygiene and behavior. These
certifications may not mean that they are able to
provide nursing care such as medication
administration, injections or wound care.
Cost: The
annual cost of home care varies greatly with the
number of hours per day that are
needed. With
the national median rate at $19/hour for a licensed
home health aide, 40 hours of care a week would cost
$43,472 per year*. The cost of independent care
providers is generally lower than those employed by
an agency.
Assisted Living Facilities
There is no standard model
for assisted living residences. They vary in size,
appearance and types of services they provide.
Assisted living facilities are a popular choice
because they tend to have a variety of social
programs and offer a community setting where
residents can live relatively active lives. On a
visit you might find an exercise room, a pool, hair
salons, and a community garden. Residents can take
part in group sessions and social activities
throughout the day and some type of religious
worship service during the week.
Although residents may
receive periodic nursing care in the facility as
needed, this care is not provided on a continual
basis. For instance, the staff may administer
medications (take it from the container and give it
to the resident) but most residents are expected to
take their medications with assistance that is
limited to reminders and/or set-up in special
dispensers. The staff is really there to help
residents who need some assistance during the day
but not continuously. In fact, many facilities won't
accept a resident who is bedbound most of the time
or cannot move about on their own without a
continual risk of falling.
Special accommodations can
be important in choosing a care giving environment.
Some facilities feature special units designed to
care for residents with dementia, such as
Alzheimer's disease, throughout declining stages of
disability. Some facilities have separate sections
for residents who have higher levels of disability.
But other facilities feel that it is best to keep
all residents socializing together this can be an
important factor in choosing the facility best for
your loved one.
For the more independent
resident, you may want a unit with a small kitchen,
or one that allows pets. You are typically expected
to bring your own furniture, and almost all
facilities have a dining room that serves meals
three times a day.
Cost: The median
monthly room and board rate for a one-bedroom
residence in a traditional assisted living facility
is $3,300, or $39,600 per year*. The annual cost of
an assisted living residence is primarily driven by
the size of the unit (one bedroom vs. studio or
shared) and the level of assistance that is needed
on a daily basis.
Nursing Homes
There are generally two
types of care available in a nursing home:
short-term rehabilitative care and long-term care
for chronic conditions. Patients receiving
rehabilitative care, most often due to an acute
illness or surgery, may continue staying at the
facility as a long-term care patient if they do not
recover the ability to live in their previous
environment. Usually the long-term care units are in
a separate area of the facility and the patient will
have to change rooms.
In addition to
rehabilitative therapies, most nursing homes are
staffed to provide for daily medical needs and to
accommodate patients who are bedbound or who require
significant assistance with some or all activities
of daily living. If a patient experiences an acute
illness or trauma the nursing home will contact
local emergency services for treatment or
hospitalization.
While medications can be
administered at all levels of assistance, most
nursing homes require that prescriptions and refills
be filled by the nursing home staff, usually from a
pharmacy of the nursing home's choosing. Nursing
homes can usually accommodate patients with mild to
severe dementia but if a resident displays combative
behavior, they may be discharged to another facility
with a special unit for these patients.
Nursing homes, in addition
to providing medical assistance and personal care,
will often support social and community activities.
Staff and recreational assistants are usually
available to help those with physical or mental
disabilities participate.
In a nursing home you might
have a choice between a private room or semi-private
room. Rooms may have a private bathroom or the
bathroom may be shared by two rooms. Meals are
provided three times a day in a community setting or
delivered to the patient's room if required.
Cost: Daily rates
are most common. The national median daily rate for
a private room is $222 per day, which equates to
$81,030 per year*. The annual cost of a nursing home
room is determined by the type of room that is
occupied and any additional charges for non-care
services such as laundry, telephone or cable
connections.
Adult Daycare Centers
Adult day care centers
provide programs for adults in a community-based
group setting. These programs are generally planned
to provide a variety of health, social and related
support services in a protective setting during part
of the day to adults who need supervised care
outside the home. Adult day care facilities and
adult day care centers are available in many cities
and towns. They can operate on a nonprofit or public
basis, and can be affiliated with multi-service
entities such as home care, assisted living, nursing
facilities and hospitals, religious and other
non-profit organizations. The most appropriate
choice for you will depend on your loved one's care
needs and their ability to participate in social
programs.
You might consider an Adult
Day Care Center when your loved one:
- is unsafe when left
alone
- seems unable to manage
daily activities
- has extended daily
periods of isolation
Cost: There
are a wide range of costs among Adult Daycare
Centers. They range from $40 a day to over $100 per
day depending on services offered, reimbursement and
region. The national average cited by the National
Adult Day Services Association is $61 per day**.
Adult Day Care center is not usually covered by
Medicare. Some coverage aid may be available through
a state or federal programs (e.g., Medicaid, Older
Americans Act, and Veterans Administration).
See the Care Library Article
titled What
Is a Continuing Care Retirement Community and 9
Questions to Ask When Hiring a Care Provider for
help with questions to ask and what to look for when
selecting a provider.
* Genworth 2012 Cost of Care
Survey
** National Adult Day Services Association
(nadsa.org) Overview and Facts, retrieved on
December 29, 2011
Source: Genworth Financial
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