The Continuum of (Long Term) Care

Long Term Care happens in a variety of environments.  While no one can predict how much care any of us will need or when we will need it, there is a somewhat typical progression (Note: a catastrophic event, such as a serious automobile accident or stroke, often directly results in admission to a nursing home following hospital discharge.). 

1. Home Care: The least restrictive environment for receiving Long Term Care Services is your own home.  Home is where your memories are.  You can keep your pets, get dressed or not, rearrange the furniture, change what is hanging on the walls, change the color of the walls, smoke if you must, watch TV with the volume turned up, listen to music, or do almost anything else that you are physically and mentally capable of. 

2. Adult Day Care: The van picks you up at your home in the morning and returns you later that afternoon or early evening.  Adult day care is a true blessing for the otherwise 24/7 at-home caregiver.  Your family knows that you are in a safe place, will be given a good meal, and will be exposed to as much stimulation as is comfortable.  Think about what this means for the caregiver…she (sometimes he) can have a life.  She can be employed, go to school, take care of errands, have lunch with friends, see a movie. 

3. Assisted Living: Residential facilities for people who cannot stay at home because they don’t have someone who can remain with them overnight, or who need a higher level of care than can practically be provided at home.  There are two kinds of assisted living facilities: 1) an “apartment” in a larger building or, 2) a former private home that has been converted into an assisted living  facility with typically 3-6 bedrooms.  Assisted living facilities can provide help with activities of daily living (bathing, dressing, eating, continence, toileting, and transferring) as well as medication administration but always within the limits of their facility-specific licensing.  Some more specialized assisted living facilities accommodate residents who suffer from dementia. 

There is a wide range of assisted living facilities from very basic with limited activities and amenities to very luxurious with high staff-to-resident ratios and full programming.  Rooms/apartments may be private or semi-private with either private or shared bathrooms.  Meals are included.  Most assisted living facilities can accommodate a couple, including a spouse who does not need care.  As you may expect, there is a wide range of costs.

4. Nursing Home: Sometimes called skilled nursing facilities (Medicare and Medicaid definitions).   It is interesting to note that while the general public tends to equate “Long Term Care” with “Nursing Home”, only a very small percentage (10%-12% by most estimates) of people receiving Long Term Care services are in nursing homes.  Most are receiving care in their own homes.  A nursing home is a facility with 24/7 staffing  supervised by a RN or physician and intended for people who need a large amount of ongoing care.  Nursing homes offer semi-private or private rooms and meals.  

As with assisted living facilities, there is a wide range of costs.  The good news is that with proper planning, most people will never need to go to a nursing home.

5. Hospice: For people with an expected remaining lifespan of six months or less.  Hospices provide pain and symptom management, spiritual support, social services and medical care but not treatment to get well again.  Hospice care can be provided in either a separate facility or a patient’s own home.

© Raymond Smith, The Long Term Care Specialist, 2010