Choosing Long-Term Care
Choosing Long-Term Care
Karl Steinberg (Associate Medical Director, Sharp Mission Park Medical Group) gives expert video advice on: Who provides long-term care?; What long-term care options are available?; What is a long-term care facility? and more...
Who provides long-term care?
There are a lot of different sources for that, and again a lot of it has to do with how much support a person has as far as family members, loved ones, and sometimes church groups can be of assistance. But generally there's a whole industry that's devoted to providing long-term care. Obviously nursing and nursing facilities, and then also lower levels of care, like assisted living facilities or residential type settings. There are a whole slew of workers of various types that work in those settings to provide long-term care.
What long-term care options are available?
As far as what options are available for long-term care, there are quite a few different kinds and they have a lot of different names. The first is just a private home setting, and have some assistance in-home, either part-time or full-time, from either family or paid care-givers of various types. There's an independent living setting for seniors that typically has very little assistance that's provided. There might be a common area, a dining area, and things like that, and assistance with laundry, things of that nature, but pretty low-level needs. You can move into an assisted-living setting, where there's a range of different services that can be required and that can be provided. From that setting, you can move on into a nursing facility type setting where there is high level custodial assistance, and where they can deal with things like incontinence, or maybe wandering, or things like that. There are also specific communities for dementia patients, and there's the skilled nursing facilities, where a whole variety of medical services can also be provided.
What is a long-term care facility?
What a long-term care facility actually is - I guess it depends on who you're asking - but typically it would be an institutional setting, and the kind that typically would be licensed, and would be regulated either by a state agency or by federal agencies. And in which people would reside for a long period of time and receive various degrees of health care services, or non health care services, such as just custodial assistance.
Are long-term care facilities federally regulated?
Nursing facilities and skilled nursing facilities are federally regulated under Title 42 of the federal code of regulations. The regulations are fairly extensive and they lay out what has to happen when the facilities get inspected and so on. They have to meet those requirements or be in substantial compliance with those federal regulations in order to receive money from Medicare or Medicaid. As far as the other kinds of long-term care facilities, there are no federal regulations, for example, for assisted living facilities, at this time. The reasoning behind it is that they really are not medical facilities. There may be legislation down the line that will regulate them but, for now, that's all basically done on a state by state basis.
What kind of certification is there for long-term care facilities?
As far as the certification that's available for long-term care facilities, the federal certification comes through CMS, which is the Centres for Medicare and Medicaid Services. They license and certify both nursing facilities and skilled nursing facilities, the difference being that in skilled facilities they can do more high level medical stuff like giving IV's and complex wound care and things like that. But in any event, there are also nursing facilities who are not certified. They would only be able to take essentially private patients, and possibly some patients who have long-term care insurance. But in order to get federal money to cover the needs of the residents, you have to be certified.
Why is the type of long-term care facility so important?
I'd say the reason that the type of long-term care facility that you choose is important is because you want it to be as individualized as possible. You want to pick a facility that will meet all the needs of you or your loved one, but you don't want to be at a level that's too high or where you're around people that are, let's say, far more ill than you are. At the same time, you want to be in a place where they can take care of all the needs that you have and where they're not being overtaxed by whatever your needs might be. It's very important to pick a place that's a good fit.
Why are there so many names for long-term care facilities?
There are so many different names for different facilities, as there are different types of long term facilities. It gets more complex as the long-term facilities vary from one state to the next. There are a whole lot of different names. I guess each may have a slightly different spin on how they provide services or what the exact services are that they provide. Essentially independent living, assisted living, dementia care or specialized care. Then there is nursing homes, nursing facilities, skilled nursing facilities and continuing care retirement communities, which are meant to be sort of an aging in place type setting. This type of facility is where you go from the time you don't need any help at all, all the way until you are basically bed bound and they have got the ability to care for you regardless of what your needs are. That is another nice concept.
What is the most common type of long-term care situation in the US?
I'd say the most common long-term care situation for patients in the US is probably the home setting, where they're getting significant care being provided by family members, most often a daughter, but it could be a spouse, it could be a son, a niece, or a variety of different relatives or loved ones who provide care. As far as more institutional settings, I'd say right now nursing facilities are probably the biggest place where people are getting long-term care. Right now I believe there are somewhere in the neighborhood of 1.4 million long-term care residents in nursing facilities, and I would comment that those people that are living in these nursing homes now are much sicker and have much higher care needs than they did even five years ago. So I think there's a shift that's going on now, and will probably continue to go on, where people are going to be moving more into lower levels of care like assisted living. It depends from state to state for what they're allowed to have in the assisted living setting. But I think the great majority of us, given the choice, would prefer being in an assisted living setting than an actual nursing home.