When considering how to take care of an aging parent or loved one after a hospitalization, fall, or as a progressive disease such as Alzheimer’s/dementia progresses, there are many elder care options to consider.
Which option chosen should align with patient centered care, meaning the selection should be based on the client’s unique strengths, needs and values, resources, family and community support and income.
Researching elder care options often reveals four different categories of care; assisted living, nursing or rehabilitation facilities, adult day care or in home care services, including private duty nursing or caregiving services.
Assisted living communities are elder care facilities regulated in California by the CA Dept. of Social Services, Community Care Licensing Division. Another industry term for assisted living is continuing community care. This elder care option involves moving into a senior care community, in a private room, small apartment, or shared room. The assisted living community will typically offer meals in a dining room, daily activities with community members, exercise programs, outings, and will handle medication management. Assisted living is not home health care and medical needs are not provided by the assisted living. This elder care option is not appropriate for someone who is bed bound, needs constant safety monitoring (unless in a locked memory care unit) or 24 hour care, or someone who needs ongoing skilled nursing care.
Skilled Nursing or Rehabilitation Facilities are the appropriate elder care option when someone is experiencing an acute illness, recovery from a fall, surgery or injury, recent discharge from a hospital, or someone who meets the needs for Medi-Cal or Medicare funded skilled nursing admission. The skilled nursing facility, licensed by the California Department of Public Health, provides meals and help with activities of daily living, along with medical care including physician care, nursing care, physical, occupational or speech therapy. Skilled nursing admission is most often limited to less than 100 days, but can be more and even is a permanent elder care option for seniors who are unable to afford assisted living or homecare options.
Adult day care is an elder care option for an adult who has support at home overnight, but who may benefit from extra activities during the day such as exercise, arts, crafts, medication management, companionship and meals. It is not usually funded by health insurance, but adult day care is often subsidized by government agencies or private foundations to keep the daily costs lower. This elder care option includes and evaluation and screening before the client is admitted. It may be a good solution for a younger couple where one spouse has Alzheimer’s/dementia and the other is still in the workforce.
In home care services fall into three groups, traditional and Medicare Certified home health care, private duty nursing and non-medical homecare or caregiving/personal care attendant services.
This elder care option takes place in the client’s home. Home health care is short term, funded by Medicare or typical health insurance if the patient is homebound, and includes intermittent visits by an RN. PT, OT, or home health aide. This is not shift care, daily care or custodial care, the visits are up to 45 minutes and must be initiated by a doctor’s order. Some Medicare Advantage plans will fund very short hours of help with a home health aide if certain conditions are met.
Homecare/companion care/personal care aide in home services are non-medical in nature and are provided by a licensed homecare agency or a home health agency. The caregiver/personal care aide assists with activities of daily living including meal preparation, bathing, dressing, transfers and ambulation, range of motion exercises, medication reminders or help with medications that are self-administered. Constant safety monitoring is available for those who have memory issues or cognitive impairment associated with Alzheimer’s/dementia or other diseases.
Homecare/companion care/personal care in the home is funded typically by private pay or long term care insurance, although some with limited resources and income may qualify for Medi-Cal waiver homecare through IHSS.
Private Duty Nursing care is another elder care option when a client needs medical care at home, such as shift care, which is not funded by insurance. Only a licensed home health agency can provide private duty nursing in California. The care must include doctor’s orders and a plan of care and may be covered by long term care insurance, if applicable.
Need help deciding what kind of home care you or your loved one needs? Check out this article here.