Although our focus is on elder care options, it is important to remember that life-changing conditions that threaten independent living are not limited to the elderly. People of any age can experience challenging conditions due to illness or injury that interfere with normal activities of daily living. When a decline in function renders a person unable to live independently, there are many care options to consider in regard to the kind of care they’ll receive and who will provide it.
It is my desire that the following summary of care options will be helpful to those needing care.
Hospitals
Hospitals usually keep patients with acute medical conditions until the acute condition is resolved. However, this is not always long enough to allow the patient to become independent and safe enough to return home.
Hospitals serve an important function by saving the lives of those with life-threatening conditions, but when patients are medically stable they must move to another type of facility.
Because the present healthcare environment imposes tight funding restrictions on hospitals, it forces them to reduce the duration of a patient’s stay. The allotted time is rarely sufficient to return patients to their prior level of function. At this point, patients and/or their family members must decide what to do next.
The care option that’s right for your circumstances depends on availability, accessibility, price, expectations, and the patient’s age, condition, and recovery potential.
Swing Bed Programs
Progressive hospitals offer Swing Bed Programs. To move from acute care to Swing Bed is no more than a paperwork move. However, patients on the Swing Bed Program can continue to qualify for Medicare benefits as long as they make progress in physical therapy, and as long as they demonstrate good rehab potential.
Rehabilitation is the key to these facilities. Patients are involved in therapeutic exercises, functional training, balance training, and gait training. The Swing Bed Program functions as a skilled nursing facility.
Regional Rehabilitation Centers
Qualifying patients may transfer from an acute hospital to a regional rehabilitation center. These patients receive intensive rehab that usually consists of a combination of physical therapy, occupational therapy, and speech therapy.
Stays are typically one to three weeks, after which the patient must either transition to their home or to another care facility.
Nursing Homes
Nursing homes, referred to as care homes, convalescent homes, rest homes, and elder care centers, vary in size and type. Skilled nursing homes can, in some cases, carry on the rehabilitation the hospital began. If the patient is able to consistently show physical progress and good rehab potential, Medicare may reimburse for a certain number of days.
Physical therapy and occupational therapy can include therapeutic exercises and training in activities of daily living (bathing, dressing, grooming, etc). When patients reach a plateau in their progress, they are either discharged or sent to a non-skilled nursing facility. Medicare does not provide financial assistance for non-skilled facilities.
The best nursing homes provide restorative services. A restorative aide performs simple exercises and assisted ambulation with patients that do not qualify for the skilled services of a licensed physical therapist. Nursing homes are a good choice for individuals who require lots of care or who lack the rehab potential to progress to a rehabilitation facility.
Assisted Living Facilities (ALFs)
ALFs provide care for individuals who have a much higher level of independence than do those who require a nursing home. They usually have a private apartment-like setting where the residents can be reasonably independent. Meals and varying levels of care are provided.
Assisted living facilities are designed for those who have a good degree of independence, yet are not able to live independently in their own homes. ALFs typically do not offer physical therapy, exercise programs, or restorative therapy services, and Medicare offers no assistance.
Adult Foster Homes
These facilities offer a home-like environment and the best possible staff-to-resident ratio. The State allows a maximum of five residents in Oregon Adult Foster Homes. Other states vary. Residents are given home-cooked meals and activities that are relevant to their interests.
In Oregon, adult foster homes are licensed as level 1, level 2, or level 3, based on the experience and capabilities of the care providers. Level 1 foster homes provide for functional residents who require only minimal assistance in their activities of daily living. Level three residents require care in several activities of daily living and may even be bed bound.
Although adult foster homes specialize in elder care and retirement-age residents, people of any age can live in them.
Family Caregiving
Sometimes, families want or need to care for their loved ones in their own homes. This seemingly overwhelming task can be handled in two ways: One way is by hiring personal in-home caregivers to provide the needed care. Someone needs to coordinate the caregivers to ensure consistency. When 24-hour care is needed, the expense can far exceed any of the above options.
A second option is to personally care for your loved one yourself. This could necessitate leaving your job. This ambitious task can be done if you take care of yourself to prevent burnout and to avoid falling ill. If you take this route you might consider having a personal caregiver come in once or twice a week to relieve you.
Transitional Care
Often, patients are not ready to return home after leaving the hospital. Various life-changing conditions, such as a hip fracture, knee or hip replacement, or stroke can make it impossible to safely transition home. Even conditions like pneumonia or bowel obstructions can start the deconditioning process that makes a person less stable on their feet and puts them at risk for falling.
It’s imperative to maximize a patient’s level of function in order to ensure a safe transition home. Transitional care units have emerged to fill this gap. Transitional care units provide various degrees of rehabilitation that can include physical therapy and occupational therapy.
