What is Long-Term Care Nursing Homes and Assisted Living ?
The chances are that without realizing it, you might in fact have already tapped into the long-term health care system, although not into a nursing home. We like to think of long-term care as the concern of senior citizens, but the term has a broader legal meaning. Long-term care involves becoming cognitively impaired, or the expectation that you will be unable to manage at least two of the six activities of daily living (bathing, dressing, toileting, transferring, continence, and eating) for 90 days or more. The government and the insurance industry call these activities ADLs for short.
Have you broken an ankle on the slopes or gotten beaned at the softball game? If those injuries required three months of help moving from chair to bed, changing out of your pajamas, or using the toilet, you might have qualified as a long-term care recipient. Nevertheless, for most younger patients, absent a terminal critical illness or debilitating physical ailment, long-term care actually lasts for only a short term (but at least three months), since the patient recovers the ability to carry on the activities of daily living. The need for long-term care, in other words, is a legal determination, based on guidelines set out by law and interpreted by Medicaid and your private insurer. Most of us associate nursing homes with long-term care. In fact, long-term care nursing homes are at the far end of the continuum of care. There are also skilled nursing care facilities or assisted living centers, rehabilitation units, short-term geriatric centers, and, ultimately, home-based care from a variety of community, medical, and religious agencies. Let’s consider the differences that exist in these settings.
Long-Term Care Nursing Homes
The old folks’ home of Ted’s story is now called a long-term care nursing home. Every person over the age of 18 has at least one image of these facilities, with wheel-chairs lining the halls, residents staring vacantly, staff harried and sometimes abrupt. However, we like to think that in the new millennium nursing home life has come a long way—but still not far enough. Think of the facilities this way: A nursing home offers around-the-clock care that goes beyond the physical and emotional capabilities of a single caregiver. Often a licensed nurse manages a staff of assistants who provide the actual custodial care. Nursing homes care insurance may cost as much as double the price of assisted living facilities.
And the typical profile of a nursing home resident? According to a report prepared for the U.S. Department of Health and Human Services, between 75 percent and 86 percent of nursing home residents have some degree of cognitive impairment. These residents typically are married and qualify for support from either Medicare or a private insurance or voluntary health insurance, since they are usually limited in 4.7 out of the six ADLs. Their thinking may be fuzzy, that is, and they may be able to use the toilet but not bathe, dress, eat, or transfer from bed to wheelchair. Sixty-three percent of these residents have moved from another form of long-term care, either an assisted living facility or a home care situation. Twenty-five percent of the residents have come directly from a hospital. When the nursing home residents are publicly funded by Medicaid, they “require” as many as five different types of services, including more medical care, more skilled nursing, and more social services. Privately funded nursing home residents enjoy fewer paid services, perhaps because their insurance policies are not comprehensive enough to cover them.
Long Term Care Assisted Living
Assisted living communities range from those which are a step away from full-time long-term care nursing home care to ones that encourage independence while providing meals, housekeeping, and personal care. If your Aunt Doris moved into an apartment that had maid service, an emergency call button in the bathroom, and daily room checks by one of the staff, she was probably in an assisted living environment. Sometimes such facilities are called adult congregate living facilities or personal care homes.
Like Aunt Doris—and my mother, Ethel—these residents usually see themselves as much better off, both physically and cognitively, than their friends in the nursing home next door. While their diagnoses might be similar to those in nursing homes, assisted living residents often needed help with only 2.8 of the six ADLs. Doris, for instance, had difficulty dressing and bathing herself in the morning, but once she got moving, she played a high-level game of bridge. Here she was not typical, since between 47 percent and 81 percent of long term-care assisted living residents are cognitively impaired.