Long Term Care Provider Options - Quick Guide
The decision to engage a care provider to assist someone close to you is often difficult to make. The appropriate amount of assistance is not always easy to define, and it’s not always clear what type of care provider would be best. Understanding the types of care available helps you consider the pros and cons of various options.
In general, there are four care environments to be considered. Care in the home, assisted living facilities, nursing homes and adult daycare centers. The annual cost of home care various greatly with the number of hours per day that are needed. With the national median at $26/hour, 44 hours of care a week would cost $59,488 per year1. The median monthly rate for a one-bedroom residence in an assisted living facility is $4500, or $54000 per year1. Nursing homes general charge by the day, the national median for a private room is $297 per day, which equates to $108,405 per year1. One day at an adult day care center median about $72, if these services are used 5 days per week the annual cost would be $20,280 as per Genworth Cost of Care Survey 2021, conducted by CareScout® November 2021. CareScout is a Genworth company.
Each environment offers a range of care and caregivers who have specialized skills. In addition to the cost of care you should consider the descriptions below when sizing up the right care environment for your loved one.
Home Health Care
Receiving care in the home is perhaps the most flexible of all options. Caregivers who come into the home can provide services that range from stand-by oversight for a few hours a week to round-the-clock palliative (hospice) care. When you engage a home health care agency, they will supply caregivers with the appropriate skills during the time that you request. Most agencies want a minimum 3–4-hour timeframe for each visit. Some agencies have a weekly minimum as well. If caregivers are requested to be in the home 24 hours a day, the agency will usually want to split the time into two shifts of 12 hours each. Unique state labor laws also factor into staffing for full-time caregiving. Some agencies will provide “live-in” caregivers, but there are requirements as to where and when they are allowed to sleep and how much free time they have.
An alternative to working with a home health care agency is to hire independent caregivers directly. These are individuals who work for themselves. You pay them directly and must comply with tax laws and labor laws as you are their employer2. These caregivers can range in skill level from untrained companions or homemakers to skilled nurses. Many independent home care providers have completed programs to be Certified Nursing Assistants or Certified Home Health Aides. These providers are trained to handle health issues such as mobility, nutrition, toileting, hygiene, and behavior. They are not certified to provide nursing care such as medication administration, injections, or wound care. The cost of independent care providers is generally lower than those employed by an agency.
Assisted Living Facilities
Most assisted living facilities are staffed to provide help to residents who need some assistance during the day but not continuously. The majority of assisted living facilities will not accept a resident who is bedbound most of the time or cannot move about on their own without a continual risk of falling. Although residents can receive periodic nursing care in the facility as needed, this care is not provided on a continual basis. In some cases, medications may be administered (taken from the container and given to the resident) but most residents are expected to take their medications with assistance that is limited to reminders and/or set-up in special dispensers. Some facilities have special units that are designed to care for residents with dementia. These units do not have the same restrictions and can usually care for someone with dementia, such as Alzheimer’s disease, throughout declining stages of disability.
Assisted living facilities usually offer programs and amenities that support a social, community environment. Transportation for group outings is usually provided, transportation for individuals can sometimes be arranged. Facility amenities may include exercise rooms, pools, hair salons, community gardens and other types of recreational settings. Group exercise sessions and social activities are usually scheduled throughout the day and most facilities provide some type of worship service during the week. Some facilities have separate sections for residents who have higher levels of disability, but other facilities feel that it is best to keep all residents socializing together – this can be an important factor in choosing the facility best for your loved one.
Assisted living facilities sometimes have units with small kitchens, some units may allow pets. Some facilities allow the resident to use their own furniture. Almost all assisted living facilities have a dining room where the resident can receive three meals per day. Some provide for special diets, such as low sodium.
Some assisted living facilities are part of a continuing care retirement community. These communities often have three separate resident facilities – independent living, assisted living, and skilled nursing – and the resident can move to a different part of the community if their care needs change. These communities usually require residents to sign a contract to be part of the community for a specified period, often through the end of their life, and require a large deposit that is not refundable. The resident usually pays a pre-determined monthly fee that does not go up when they move to a higher level of care.
The annual cost of an assisted living residence is primarily driven by the size of the unit (one bedroom vs. studio or shared) and the level of assistance that is needed daily.
There are generally two types of care available in a nursing home - short-term, rehabilitative care and long-term care for chronic conditions. Patients receiving rehabilitative care, generally due to an acute illness or surgery, may continue staying at the facility as a long-term care patient if they do not recover the ability to live in their previous environment. Usually, the long-term care units are in a separate area of the facility and the patient will have to change rooms. In addition to rehabilitative therapies, nursing homes are staffed to provide for daily medical needs and can accommodate patients who are bedbound or who require significant assistance with some or all activities of daily living. If a patient experiences an acute illness or trauma the nursing home will utilize local emergency services for treatment or hospitalization. Medications can be administered at all levels of assistance, the nursing home requires that prescriptions and refills be filled by the nursing home staff, usually from a pharmacy of the nursing homes choosing. Nursing homes can accommodate patients with mild to severe dementia, however, combative behavior may require discharge to another facility with a special unit for these patients.
In addition to medical assistance and personal care, nursing homes also support the social and community needs of the patients. Similar to assisted living facilities nursing homes provide social and recreational activities. Staff and recreational assistants are usually available to help those with physical or mental disabilities participate.
Nursing homes generally have private rooms, semi-private rooms or both. Rooms may have a private bathroom or the bathroom may be shared by two rooms. Meals are provided three times a day in a community setting or delivered to the patient’s room if required.
The annual cost of a nursing home room is determined by the type of room that is occupied and any additional charges for non-care services such as laundry, telephone or cable connections.