Long-term care includes a range of nursing, social, and rehabilitative services for people who need on-going assistance. Lengths of stay typically average greater than 30 days. While most residents of long-term facilities are elderly, young people also need long-term care during an extended illness or after an accident. Long-term care facilities provide a range of services including custodial, intermediate, rehabilitative, and skilled nursing care (White & Truax, 2007). Several types of facilities are available as options for the elderly and their families to choose from.
Various names used for the different facilities denote the type of care provided. Examples include independent living, assisted living, continuing care communities, nursing homes, adult day care centers, and senior citizens centers. The choice of facility depends on the type of care needed by the elderly person. Home health care services are a rapidly growing segment of the health care system. Home health care enables the person to receive health care at home while allowing the individual to retain some measure of independence (Matthews & Berman, 2007).
A growing number of patients recovering from surgery or a major illness are referred by their doctors to skilled nursing facilities. These provide an important, less expensive alternative to hospitalization. Medicare may cover some of your costs of staying in a skilled nursing facility, but strictly limits how much it will pay (Baker, 2007). You’ll need to make sure your stay will be covered at all. You must meet two requirements before Medicare will pay for any nursing facility care.
You must have recently stayed in a hospital, and your doctor must verify that you require daily skilled nursing care (Matthews & Berman, 2007). Most nursing facilities provide what is called custodial care – primarily personal, nonmedical care for people who are no longer able to fully care for themselves. Custodial care often lasts months or years, and is not covered at all by Medicare. For the most part, custodial care amounts to assistance with the tasks of daily life: eating, dressing, bathing, moving around, some recreation.
It usually involves some health related matters: monitoring and assisting with medication, providing some exercise or physical therapy. But it is ordinarily provided mostly by personnel who are not highly trained health professionals, and does not involve any significant treatment for illness or physical condition (White & Truax, 2007). Nonhospital-based skilled nursing facilities (SNFs) provide a relatively high level of nursing and other medical care, as well as personal care and assistance, for people whose illnesses or impairments require close monitoring (Cress, 2007).
Around-the-clock nursing is available from licensed vocational or practical nurses, with at least one supervising registered nurse on duty at all times. In addition to nursing, most other prescribed medical services can be provided, including various rehabilitative therapies. An SNF is almost always for short-term recovery from a serious illness, injury, or surgery that required hospitalization. A few people may spend months in an SNF, but most stays last only days or weeks (White & Truax, 2007). The cost of SNF care ranges from $200 to $500 per day.
Medicare, Medicaid, and private insurance usually pay for SNF care, but only up to specific coverage limits (Baker, 2007). Continuing care retirement centers are small-scale retirement communities that provide a highly supportive environment, based on a concept of continuing care. They provide multiple levels of housing under the same administrative umbrella with an independent living arrangement as a starting point for new residents. Various levels of nursing care are also available (White & Truax, 2007).
Continuing care centers offer retirees numerous structured programs and opportunities for passive leisurely pursuits. However, few if any contain outdoor recreational facilities, and if commercial services are available, they are limited in number and scope (Cress, 2007). Continuing-care retirement centers generally operate under non-profit sponsorship. They tend to be located in urban areas, although some are found in rural settings. As in the case or retirement residences, these communities are located in all parts of the country.
They represent about a third of the retirement communities in the country and contain an estimated population of 124,000 retirees (Baker, 2007). Residents of continuing care retirement centers are housed in either building complex or multicare campus, or in a single structure. Campuses typically contain a mix of residential buildings, dining facilities, meeting rooms, and medical facilities. Residential structures range from congregate apartment buildings to free-standing cottages and town-houses.
If the center is housed in a single structure, all medical facilities, dwellings, and support services are housed under one roof (Matthews & Berman, 2007). Full health and medical services are offered to older persons from their early, independent retirement years to a period when they are totally dependent. These communities enable an older person to have a completely independent life while being assured that health care and other support services are available later within the building or complex (Baker, 2007). Continuing-care retirement centers offer three levels of nursing care: skilled, intermediate, and personal or sheltered.
They may also contain an infirmary for temporary nursing care. To staff these facilities, an assortment of health-care professionals is available, including nurses, physical therapists, social workers, and physicians. Because of the wide range of supportive services, continuing care retirement centers have the highest resident-to-staff ratio (White & Truax, 2007). In addition to medical and social services, continuing-care centers offer residents the opportunity to pursue various social and recreational interests.
Many have facilities and programs for arts and crafts, games, classes, billiards, and choral groups. As in the case of the retirement residences, they rarely have facilities for active outdoor sports such as golfing, tennis, and swimming. Most continuing-care communities contain a congregate dining area, a snack bar, a library, a chapel, a beauty shop and barber shop serviced at specified times throughout the week, lounges for informal gathering, and sometimes a gift shop and small convenience grocery (Baker, 2007).