By Gary D. Fenstermacher
Many elders are accustomed to being urged to prepare a will, advance medical directives, and powers of attorney. Far less often are they urged to inform themselves about long term care and the decisions they may face if confronted with extended illness, injury, or frailty. Despite the fact that many of us are uncomfortable with thinking about long term care, there is much to be gained from being informed well ahead of the need for it.
Long term care refers to both the places and the services that can be accessed when illness or frailty makes independent living too heavy a burden. Sorting through these places and services is no easy task, as there are a host of different words to describe the places where the care is provided and the services offered in those places.
In general, places are either one’s home or a congregate setting. Congregate setting refers to places like assisted living facilities or nursing homes. Very few people involved in LTC like using the words facility or nursing home, but because they are in common use, they help us to locate where we are within the LTC landscape. The services offered in LTC places include assistance with activities of daily living, like bathing or dressing, memory care, hospice care, rehabilitation, and skilled nursing.
The important point here is that any placemay offer a range of different services. For example, the elder may arrange for assistance with daily living activities, rehab therapy, or hospice care at home. Or the elder may choose a congregate setting where these services are provided. A particular congregate setting will typically offer assistance with daily living activities but may or may not offer memory care or rehabilitative services. Large LTC facilities typically offer a wide range of different services on site, while smaller facilities may or may not provide these services. When smaller facilities do offer a broad range of services, the more medically advanced services may be provided by specialty firms that work with a number of different LTC facilities.
What about the much-maligned nursing home? In today’s lingo, these places are sometimes referred to as skilled nursing facilities because that is the service they provide. Skilled nursing, in addition to assistance with the activities of daily living, includes such services as physical and occupational therapy, speech therapy, and advanced nursing care. Though many of these services may be offered in assisted living or memory care places, they are often more robust and expansive in places that specialize in skilled nursing.
Next month we’ll explore what’s involved in choosing between LTC in one’s own home or in a congregate setting.
