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The Four Primary Kinds of Care Providers

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 $24/hour* for a licensed home health aide. 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 $4,300*. 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 $290 per day,*. 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:

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 $74 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).

* Genworth 2020 Cost of Care Survey

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