Levels of Care 101: Nurses Help Caregivers

As my friend and I settled into a quick bite of lunch, I casually asked her, "So how are your parents getting along?" I knew she had been taking care of her elderly folks for several years. While they lived fairly near her, they both had a number of health problems and between her work at the hospital and her own family, she had a hard time juggling all the responsibilities. Joan's eyes filled with tears. "I just don't think I can do it anymore. They don't want to leave home, but we have to make a change. I'm not sure where to turn."

Caregiving is always busy, but it can become consuming and so draining that often caregivers run the risk of losing their own health and well-being. When people come to you as a professional nurse with that kind of SOS, do you know what to say?

I asked Joan a few more questions, and she continued to vent, her pent-up feelings spilling out as she tried to eat to finish her sandwich. "I wish I understood more about the facilities around here. I just don't have time to go visit."

I tried to help by outlining a few of the basics about different facilities in our area. Starting with the most independent living available, I then shared with her everything in between to the highest level of care at the nursing home. These general descriptions fit many places in the United States.

Home with help

This is usually the #1 choice for people who realize they need some extra assistance. They often want to stay home as long a possible and begin the process of hiring help, either privately or through home care services. While this can be a satisfactory arrangement for many, it quickly becomes very expensive for a long-term arrangement. It is also difficult to find just the right kind of help-someone who can assist with meals or medications or personal care. Currently, there are new trends in electronics that show promise in helping the elderly stay longer in their own homes, everything from monitors, to remote controls to voice-activated technology.

Independent living

These types of facilities have individual apartments, sometimes of varying sizes. They often include meals and housekeeping but rarely medication administration or nursing care inside the apartments, unless arranged privately. Residents must be able to do their own self-care, get to meals and function independently, for the most part. These types of facilities are private pay unless they are government subsidized.

Assisted Living

The range of care at assisted living facilities is growing. In general, the residents are required to be mobile in some way, whether ambulatory or with an assistive device. They receive personal care assistance, medication administration, all meals, laundry, and housekeeping. While residents need to be able to evacuate, many assisted living now allow current residents who have a hospice diagnosis to remain in their apartments, as long as they have help. The elderly who reside in assisted living can often take advantage of extra services such as transportation to medical appointments, and help with management of acute illness. Most of these facilities are private pay, although some long-term care insurance will cover it (Only 10% of the elderly have long-term care insurance according to Forbes Magazine).

Memory Care Assisted Living

These types of units are usually locked and cater specifically to patients experiencing memory loss, often secondary to Alzheimer's/Dementia or other similar disease processes. Patients here receive the same type of care as assisted living but with additional services geared toward helping relieve anxiety and decrease problem behaviors. Sometimes these facilities are free-standing and at other times they are a hall attached to a regular assisted living.

Rehabilitation Facilities

Patients often receive this type of care after a time of illness, an accident or a fracture. Intended to help restore function and improve the patients' ability to perform their ADL's, rehab units have specific goals, expectations, and deadlines that help to guide care. While in a rehab facility, the patient would get therapy directed to improving functional outcomes. Paid for by Medicare and insurances, time allowed in rehab is determined by carefully crafted and pre-determined guidelines.

Nursing Homes

Nursing homes care for several categories of patients, including those who require rehabilitation. They take care of residential patients (those with chronic care needs) and hospice patients who are not able to be at home. Nursing home patients who are there for rehab may have their stay covered by Medicare; those who are there for residential care are private pay (or insurance for the 10% of the population that carries long-term care insurance). Of those who are there for residential care who are also receiving hospice benefits, the room and board portion of their care remain the responsibility of the patient and family. The fact that long-term nursing care is not covered by Medicare comes as a shock to many who are needing to find a higher level of care for their loved ones. However, once the patient has spent expended all their resources, the government will begin to pay for nursing home care through Medicaid programs for the indigent.

As Joan and I finished lunch, she talked some more about hiring help and beginning the process of investigating local assisted living facilities to see if she could find something that matched her parents' needs. I encouraged her to seek out a support group. As we went our separate ways, she smiled, "It helps just to talk it out!"

Joy Eastridge