Understanding the Four Categories of Long-Term Care Facilities for Older Adults

By Michael Gill, President of Texas Senior Living Locators

There are four categories of long-term care available to senior adult individuals who no longer are able to live independently in a house or apartment:
– Skilled Nursing Facilities,
– Assisted Living,
– Memory Care, and
– Independent Living.
The appropriate category of long-term care to choose depends primarily on two factors:  finances and care needs.

In Skilled Nursing Facilities (SNF), the majority of residents are receiving care paid for by either Medicare or Medicaid. About 20% of an average SNF’s residents are there for a short-term stay—usually three to six weeks—for rehabilitation therapy from physical, occupational, and speech therapists. Medicare residents qualify for this benefit if they have had a hospitalization of at least three nights.  Of long-term SNF residents, more than half are there using Medicaid benefits.

To qualify for Medicaid, a resident must be indigent—have less than $2,100 of monthly income and less than $2,000 of total assets—and must qualify medically. A large majority of Medicaid residents have dementia and cannot safely care for themselves.

The final category of SNF residents are private-pay clients. Typically, these residents have complex medical needs requiring constant nursing support. This includes ventilators, tracheotomies, feeding tubes, IV drips, and other medical requirements. The common theme among SNF residents is “medical necessity.”

The theme in Assisted Living is “custodial care.” While there is some nurse oversight in an Assisted Living, the vast majority of care and oversight is provided by unlicensed caregivers. This care is focused on Activities of Daily Living (ADL), an official industry term that includes activities such as dressing, bathing, eating, transferring, toileting, incontinence, and medication management.

Assisted Living communities also typically provide three meals-a-day, housekeeping and laundry services, transportation to doctor appointments and some stores, utilities, cable TV, and entertainment and activities. Many Assisted Livings can care for their residents through the end of life, including hospice care. In the Austin area, all Assisted Living care is through private pay.

In Texas, Memory Care is technically a sub-set of Assisted Living. But while there are many long-term care residents that could just as easily live in either place, Memory Care facilities have a unique mission in servicing older adults living with dementia or other cognitive issues. The most obvious differentiator between Assisted Living and Memory Care is the secure doors, designed to keep Memory Care residents from wandering away from a safe environment.

But the needs of a Memory Care resident in general are greater than an Assisted Living resident, since almost all dementias are progressively degenerative, rendering those afflicted in need of assistance for longer periods and frequently with difficult-to-manage behaviors. Consequently, Memory Care facilities tend to specialize in residents who are more fragile, in addition to their cognitive impairments. Memory Care is significantly more expensive than Assisted Living and is 100% private pay.

Independent Living, like Assisted Living, consists of apartments surrounding a centralized dining room with a meal plan, plus resident activities. Unlike Assisted Living, the Independent Living facility does not have a license to assist its residents with Activities of Daily Living. Instead, an Independent Living complex usually rents out an office to a non-medical home health agency that does have such a license. Because the outside agency has many clients in the building, it is willing to offer its services in increments as small as a half-hour at a time. In partnership, the Independent Living facility and the health agency can make Independent Living function almost as an “assisted living lite.”

One advantage over a regular Assisted Living is that Independent Living residents are typically healthier from a cognitive standpoint. In addition, the apartments tend to be larger, activities are geared toward more active seniors, and the overall facilities feel less medically-centered. Interestingly, there is little age difference between Independent Living and Assisted Living communities. There is no government benefit that helps pay for Independent Living communities, so it is also 100% private pay.

Deciding on the type of facility that will best serve an older adult’s needs comes down to the healthcare services necessary for the individual’s daily life, and the financial situation of that individual.  From there, it is just a matter of selecting the complex that best meets the family’s and individual’s lifestyle and care needs.

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