Nursing Home Level of Care
One of the questions family members or loved ones have is: My loved one has needs, but I am not sure that he or she needs full skilled care in a skilled nursing facility yet. How can I know when care needs have reached a point to consider long-term care? Or do we need to look at assisted living? Where do we start with our care plan? What guidance is available?
Within the care spectrum, there are a variety of options with the “Continuum of Care”: home care, or independent living in a senior residential facility, or intermediate care, or a assisted living residence, or the highest level of care, nursing facility level of care in a skilled nursing facility. The ultimate determination for the appropriate amount of care, particularly initially, will be based upon the loved one’s functional ability to perform the basic activities of daily living (or ADLs). Activities of daily living are assessment tools that judge a person’s ability to perform daily important tasks, such as toileting, preparing meals, bathing, taking the necessary medications, performing basic personal care, contacting medical care if needed, moving to an available exit at a time of emergency, etc. When physical needs accompany mental illness, mental health or Alzheimer’s Disease comes into play, the analysis is a little more complex, but ADLs is a great place to start.
For many older adults, home and community-based services (or HCBS) can provide sufficient care to meet current care needs. This would be considered the lowest need for care, and would allow the person to remain “in place” and live in their home. Once it has been determined that impairment and medical needs have increased and living at home cannot fully ensure the person’s safety, eligibility to stay at home is reduced, and a move to a supervised collective living environment. If, on the full Continuum, the care needs are still relatively low, independent living can be an option, perhaps with some supplemental HCBS services, or perhaps the employment of a limited number of caregivers to provide certain human services or meet certain needs.
The next level of care would be Intermediate Care, or Supportive Care. If a person can no longer live on their own, this might be the next realistic consideration for the loved one. Supportive care falls short of full assisted living, but does provide support services for those with a relatively low level of need.
The final option short of full skilled nursing care is assisted living. Assisted living facilities are equipped to support persons who have needs that must be addressed, but can participate in their own care in certain areas.
Once a person’s healthcare needs reach a point where they can no longer participate in their personal care, health and safety, the loved one will then likely require long-term care services in a long-term care facility. To define this level of care in layman’s terms: the person cannot live safely and a person needs a variety of health services available at all times (i.e. 24 hours a day).
But this is a big step, and again the question arises: But how can we as a family know for sure we are taking the right step? If the answer is not clearly apparent, there are resources available to make the decision that the loved one needs to be a nursing home resident. Your physician, or the medical staff at the person’s current facility (perhaps an assisted living facility) can provide guidance and medical records to help inform the decision. Additionally, the geriatric care manager profession is specifically trained to assist families with these decisions. A geriatric care manager can help you collect and gather information to make a secure, informed decision.