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Assisted Living and Long-Term Care: A Primer

Assisted Living and Long-Term Care: A Primer

Long-term care isn’t a topic most of us want to think about. As a health care admissions director for Bethany Village continuing care retirement community, I educate people in the pros and cons of the services available for the aging. Many times, I find myself delivering this type of information during a crisis, which makes careful consideration of their options very difficult.

I’m hoping this article will serve as a primer on the scope of services available in assisted living, what type of issues require skilled nursing care and the costs associated with them. Knowing as much as possible before you, a loved one or a parent needs supportive services is always the best strategy.

In a broad sense, assisted living is a lifestyle that supports people’s independence and strives to make it possible for residents to live with people who are physically, socially and cognitively similar for as long as possible.

Tasks that may have required asking for help – such as driving to appointments, cleaning, doing laundry or preparing meals – are provided for you in assisted living.

There are two rules of thumb that require skilled nursing care rather than assisted living.

  1. People in wheelchairs who require more than one person to transfer them from the chair.
  2. Those who have a serious clinical need or who would not be able to access help from behind a closed door.

Typical Assisted Living Services

Many assisted living communities offer graduated levels of services and prices. Those include:

  • Assistance with daily living tasks or just the security of having staff nearby
  • Moderate assistance with getting dressed, eating, daily assistance with hygiene and incontinence and medication management
  • A person requires assistive services but also has a health issue such as diabetes or an ostomy bag or is exhibiting behaviors associated with memory loss

Some states, including Pennsylvania, offer another option for long-term care called a Personal Care Home. These are a good option for individuals who need assistance with activities of daily living (dressing or bathing), medication management or memory support. They offer many of the same services as assisted living centers and are less expensive. However, Personal Care centers do not have to meet the same staffing requirements, staff education or “opt out of services” requirements, just to name a few things.

When you look at providing residents with the ability to age in place over the long term, assisted living often begins to look like the better choice.

Here’s a hypothetical example that explains the difference. If you’re doing research into Personal Care and Assisted Living, it’s important to ask what specific health services they can legally provide and what level of staff member would administer those. Let’s say Mrs. Smith lives in a personal care center and is admitted to the hospital because she contracts an infection. After a few days, the hospital is ready to discharge her, but she needs IV antibiotics. A personal care home might not be able to take her back; she would need to go to a nursing home where an RN is on staff until her IV antibiotics regimen was complete. That’s a lot of added stress for Mrs. Smith and her family members.

Confronting age-related decline is difficult for the person experiencing them and their loved ones. Acknowledging that those issues may require moving to a new home is more challenging yet. Keep in mind that moving during the midst of a medical crisis is the greatest challenge of all.

I see people every day who are in desperate situations – a parent has been injured and is unable to return home, a person with memory issues has gotten into a car and ended up lost for several hours, a relative has been found wandering outside in 20-degree weather.

Have a plan in place. Research your local aging services and long-term care communities. It is important to do this before a crisis limits your choice for the best possible care. Finally, schedule a tour of several communities to be sure that the one chosen is a good fit. In addition to these basic guidelines, the Assisted Living Foundation of America has evaluation resources on their website.

Key Questions for Long-Term Care Providers

  1. What medical issues and acuity level can you treat? You want a place that will allow you or your loved one to remain there for as long as possible. This is a major benefit of a continuing care retirement community. Skilled nursing and rehab services are on campus, and residents can easily move between levels of care if they have a temporary illness or injury.
  2. What are your staffing levels and staff training requirements? Often, the level of assistance a community can provide is linked to the presence of a RN or LPN.  Ask about the state’s requirements for staff training, if it is specific to the service they’ll be providing, such as memory support, and if the facility has its own additional training.
  3. What services are included in the daily rate?  Housekeeping, laundry and meals are services that are included in the rate for Assisted Living (or there is an “opt-out of services” option for a small reduction in the rate). In some Personal Care homes, something like laundry services would be an ancillary charge.

Are You Prepared for Long-Term Care Costs?

Long-term care costs vary widely across the United States. Here’s a national comparison of monthly assisted living charges.

At Bethany Village, in Mechanicsburg, Pa., daily rates start at $221 for people who are not already residents of our continuing care retirement community. Residents pay less. The highest assisted living rate is typically for memory support, due to staffing needs and security issues. Some of our competitors’ rates are slightly lower, but we feel our services, staff levels and training justify the additional cost.

Skilled nursing is more expensive. Our daily rates start at $355. Especially when you are looking at memory support, long-term care costs adds up quickly.

Medicare does not cover skilled nursing unless it is following a hospital stay for rehabilitation. Medicare will cover up to 100 days as long as the resident is making progress in a therapy program. Medicaid will cover skilled nursing if you meet your state’s financial need guidelines.

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