A list of definitions and services provided at different levels of residential care.

Comfort, convenience, and safety are important components of your loved one’s environment, and the following list can help you determine which type of residential care facility might best serve his or her needs.

Independent Living Communities

In independent living retirement communities, the care recipient has full choice and control over all aspects of his or her life. He or she must be independent in all aspects of daily living such as bathing, dressing, being mentally alert, having bowel and bladder control, and being able to walk. These communities provide a living environment for individuals of a certain age and come in many housing styles, including single-family dwellings, townhouses, duplexes, high-rise apartments, condominiums, and mobile homes, which are either rented or owned by the individual. Additionally, the variety of services offered varies between retirement communities, with some offering only police and fire protection and others offering social and recreational activities as well.

Assisted Living Facilities

Assisted living facilities, which are also called congregate housing, are suitable for individuals who need little or no help. Each individual lives in his or her own apartment, and these are often equipped with emergency signaling devices. All residents use shared spaces, which usually include living rooms, dining rooms, or laundry rooms. Minimal services, ranging from central dining programs to organized recreational activities, health, transportation, housekeeping, nonpersonal laundry, and security services, are also usually available.

Residential Care Facilities

Residential care facilities, which also are called board and care homes, personal care homes, sheltered housing, or domiciliary care homes, offer housing for individuals who need assistance with personal care or medical needs. This means that the facility is normally state licensed and meets minimum staffing requirements. The facility is staffed 24 hours a day.

To be eligible for residential care facilities, an individual usually must be fairly mentally alert; able to dress, feed, and take themselves to the toilet; able to eat meals in a central dining room; and need no more than moderate assistance with personal care or behavior supervision. Check with the specific facility for any policies concerning walkers or wheelchairs.

These facilities usually feature studio or one-bedroom apartments that lack kitchens, but have private bathrooms and storage units. Occasionally, these facilities offer only shared rooms, which can be a difficult adjustment for many. Be sure to check into the living arrangements at the facility first. Additional services include meals, social activities, laundry, and housekeeping services.

Continuing Care Communities

Continuing care retirement communities, or multi-level care facilities, provide a nice balance between the skilled nursing home, assisted living facility, and the independent living facility or retirement community. It assures the care recipient independent living as long as possible, while providing for nursing assistance if or when it is needed. This type of living arrangement can be particularly useful to couples who are often in need of different levels of care and who wish to maintain a strong relationship.

These facilities offer many services, including personal conveniences (haircuttery, banks, library); organized social and recreational activities; educational programs; exercise classes; craft and woodworking activities; gardening space; transportation; and health care. Because these activities can be costly, the entrance fee and monthly charges are often quite large. Additionally, entrance restrictions normally specify a minimum age, as well as a minimum level of health and finances. Entrance lists are often months or years long for such facilities.
 
Nursing Homes

Nursing home care provides help for a seriously ill care recipient. These facilities offer 24-hour supervision, nursing care, rehabilitation programs, and social activities. If you are not sure if a nursing home is an appropriate care facility for your loved one, ask these questions:

• Does your loved one need specialized health care services?
• Is a nursing home the only option where your loved one will receive the medical care he or she needs?
• Are you emotionally and physically exhausted and ready for a break from your caregiving role?
• Does your loved one need post-hospital rehabilitation following an illness or injury?
• Have other alternatives been exhausted?
• Is a nursing home more cost effective than other living alternatives?

The level of care provided by a nursing home can be either intermediate or skilled. Intermediate care is given to individuals who need assistance with activities of daily living and some health services and nursing supervision, but not constant nursing care. This type of care is usually requested by a doctor and given by a registered nurse. In contrast, skilled nursing care is given to individuals who need 24-hour medical supervision, skilled nursing care, or rehabilitation. Again, a physician’s request may be needed for admission. Additionally, a few facilities offer a third level of care—custodial care. Individuals receiving custodial care need supervision with personal care and other daily living activities, but do not require the help of a practical nurse. Individuals suffering from dementia, including Alzheimer’s disease, are often given this type of care.

You should investigate nursing homes as soon as possible for two reasons. First, it is always easier to make critical comparisons when you are not facing an immediate emergency. Additionally, you should give yourself time to consider more than one facility because these types of facilities are often in high demand.

When investigating nursing home options, find out whether the facility is government certified. If your loved one plans to use Medicare or Medicaid for payment, check the limited coverage of these as well by contacting the local Social Security Office.

Whether your loved one chooses an independent living community, assisted living facility, residential care facility, continuing care facility, or nursing home, the ability to live in a comfortable and safe environment is extremely important. After you have selected the type of residential environment that best fits his or her situation, be sure to interview multiple facilities before selecting the one that you feel is right for your loved one.

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