Learn about different levels of care for the elderly. Seniorly explains common senior care types and how an older adult might progress through them.
It can be intimidating to start researching senior living, especially as there are many different terms that might be new to you. If you’re wondering about the different levels of care for the elderly, we can help explain these new terms and compare them to each other, so you have a “low” to “high” scale to work from.
We’ll also explore levels of care within assisted living. Many assisted living communities use their own scale to determine how much care their residents need.
Low level of care for seniors/no care
Independent living is just that: seniors living independently within their own condos or homes in a 55+, or independent living senior community. They have full kitchens to prepare their own meals (even if group dining is an option) and might still have their own cars. Seniors living in CCRCs (continuing care retirement communities) might start out in the independent living side of the community, and age in place: moving to the assisted living wing when necessary and sometimes even into memory care, if they need it and their CCRC has this capability.
Seniors in independent living typically don’t need or receive any help with the activities of daily living (bathing, dressing, eating, etc.): in this sense, even if they are living in a senior living community, they are not receiving long term care. Although they probably get to skip out on lawn care, snow removal, and other maintenance that the community fees cover, as well as enjoy other communal events and amenities.
Medium level of care for seniors
Assisted living is when trained caregivers help seniors with the activities of daily living (or ADLs: a medical term you’ll hear frequently when discussing senior care). When seniors are having trouble getting around (safely), eating (perhaps due to motor issues), or grooming (bathing, dressing, etc.), caregivers can help them with these tasks every day. You can receive the equivalent of assisted living care in your own home, with in-home care, or you can move into an assisted living community. Assisted living communities offer residential care and typically provide group dining, socialization with peers, and accessibility and safety features as well as the availability of round-the-clock care.
Assisted living staff can help seniors take medication on time and correctly as well as help them with toileting or getting out of bed in the morning. Assisted living facilities usually offer suites or rooms that can be private or shared with a roommate, depending on seniors’ preferences and what they can afford. You can also find assisted living care in board and care homes, which are much smaller than typical assisted living communities, usually operated out of a single family home.
High level of care for seniors
Aging adults often eventually need more care than assisted living can provide. Typically, this means that in addition to help with ADLs they also need medical care. Or, they might temporarily need more intensive care, perhaps after surgery or illness. Skilled nursing facilities (SNFs, and sometimes called simply “nursing homes”) can provide medical care for as long as seniors need it. Seniors that need wound care, injected medication, rehabilitation therapies, or other skilled nursing care, can find this kind of care at SNFs. Some assisted living communities will allow you to bring nurses or other outside specialists in, especially if it will just be for a limited time.
Seniors with diagnosed Alzheimer's or dementia can have widely varying needs. Some might have memory issues for years and still only need some daily reminders, while others with advanced cases will need help with everything from bathing to eating. Because each case is unique, it's a little difficult to fit memory care facilities into a low-to-high care level framework, but in general, you can think of them as being on the higher end of the scale, since they are designed with extra security for wandering residents and hire specially trained staff.
Some assisted living communities use a scale to determine how much care a resident needs. For some communities this might be a scale of 1-3, for others it might be more nuanced and go from 1 to 5. For example level 1 care might mean that a senior needs help with one ADL, like dressing, or just reminders about taking medication, while level 5 care could mean that a senior needs help with four or more ADLs throughout the day.
This scale helps community staff understand what each individual resident might need day-to-tay, and it helps them to evaluate residents over time, to adjust their care as their needs change. When you’re visiting or evaluating assisted living communities, ask staff if they have such a scale and how they define each level of care. Also, be sure to ask if there is a level at which they might not be able to care for your loved one, or at which additional caretakers may need to be brought in. There may come a time when your loved one will need a more secure environment, with staff trained in memory care. Or, if your loved one requires medical care beyond help with personal care, they may need either to move to a skilled nursing facility or, if the assisted living facility allows it, nurses, rehabilitation therapists, or hospice workers might be able to tend to your loved one in the home they’ve know in their assisted living community.
You might come across the terms “low acuity” or “high acuity” when discussing care levels for older adults. These medical terms often refer to the staffing-to-care-needs ratio of individual patients in hospital settings, but to simplify it, low acuity patients need very little care in comparison to high acuity patients.
Whether you and your loved one are looking for in-home care or a senior living community, the levels of care provided by each will progress along similar lines. Most in-home care providers offer help with ADLs, while home health care involves medical care, and could be considered a higher level of care.
If you aren't sure what level of care your elderly loved one needs, consider consulting with a geriatric care manager. Also keep in mind that assisted living communities will want to evaluate your loved one so that they can get an accurate idea of their daily needs and decide whether their care services will be a good fit for them. They will tell you if they feel your loved one needs a higher level of care than they can provide.
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