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 FYI - Health Care Definitions - Seniors Long Term Care & Nursing Home Issues -
 FYI - Health Care Definitions - Seniors Long Term Care & Nursing Home Issues -
FYI - Health Care Definitions
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Dr Jodee Beth Graifman Meddy DO, Dubois, PA Dr. Jodee Graifman Meddy, DO, MS, LNHA

Co-founder of
Dr. Jodee Meddy is a nationally acclaimed Doctor, Licensed Nursing Home Administrator and an expert on Long Term / Extended Care issues and Nursing Homes.

FYI - Health Care Definitions - This section defines the kinds of care available, as well as the state oversight agency responsible for ensuring quality within facilities or programs. This list is in alphabetical order; however, for clarification purposes, I've include a chronological list of how a person progresses through the continuum of care.

Adult care facilities (ACF's) provide congregate meals in a safe environment, along with activities and, in most cases, field trips or special programs.

Most ACF's offer private rooms to residents with either private or shared bathrooms. The type of ACF which seniors live in are usually called "adult homes" or "enriched housing" programs (see definition, below). 

While some ACF's have nursing personnel on staff, and possibly a medical director, they do not have the capacity to provide intensive medical services.  

ACF's are also the type of facility that run assisted living programs. The definition of assisted living is included later in this section. In other states, assisted living may be part of a different type of facility. Also in other states, ACF's are sometimes referred to as "intermediate care" or "board and care" homes.

Oversight agency: State Department of Social Services, through their Office of Housing and Adult Services

Adult day care comes in two forms -- one called adult day health services (or "medical model"), the other called adult day care (or "social model"). Patterned somewhat after child day care services, these programs offer a safe, secure, stimulating environment for persons whose family circumstances allow them to remain in their homes in the evenings (and possibly on weekends), but who need some sort of supervision during the daytime.

Adult day care is particularly appropriate for a person whose needs are ordinarily met by their own family members, especially when those family members may have to work outside the home but are generally at home in the evenings and on weekends.

Social model adult day care is, as the name implies, oriented toward the social aspects of life and may include games, memory orientation exercises, music, dancing and reading in a supervised atmosphere. Social adult day care programs also organize field trips and special events. 

Most social programs do not have a medical component, such as a full-time nurse or physician on staff; however, staff at social programs maintain close contacts with the client's personal medical team in order to report observed significant changes in health care.

Medical model adult day health care, on the other hand, has a strong medical component, is usually staffed by at least one full-time registered nurse able to administer medicine and perform routine medical tasks, as well as on-site physician back-up when needed. Most medical models have an affiliation with either a hospital or nursing home and provide social activities on top of medical services. Some adult day health care programs specialize in one segment of the population or another (for example, the blind, AIDS patients, etc.).

Oversight agency: State Department of Health

Assisted living is administered through adult care facilities (ACFs) and consists of a "marriage" between the ACF and home and personal care agencies. Assisted living allows a person living in an ACF to remain in that setting even if he or she becomes more frail and needs extra medical or personal care services. While assisted living is relatively new in this state, it has been highly successful in other states by: (1) being most appropriate for the resident and disrupting the resident's life less than transfer to a higher-care facility would be; and (2) being more cost-effective than other institutionalized care would be.

Some organizations have constructed senior housing facilities, which are enhanced by bringing in a number of personal-assistance services, such as housekeeping, personal care, and home care, through a licensed agency. However, while these facilities can provide services similar to the State's definition of assisted living, they are not regulated in the same way and can often operate in a manner outside the state's purview. Any such facility still must offer its health services through a licensed home care agency, which will be regulated and licensed through the Department of Health.

Community services is a broad term applied to any program or service available to the frail elderly, disabled, or chronically-ill. These may include (but are not limited to):

  • hospice
  • meals on wheels (or home-delivered meals)
  • friendly visiting
  • adult day care (both medical and social models--see definition above)
  • personal care
  • home care
  • housekeeping and maintenance services
  • comprehensive outpatient rehabilitation

Sometimes, if community services allow a person to stay in his or her own independent environment, several of these options will be "packaged together" to allow that independence to continue until it is no longer appropriate.

Continuing care retirement communities (CCRCs) are a new but important component in providing long term care services. CCRCs enable a person to enter at a low level of care, such as housing, and, as his or her needs progress, so too will the community's ability to take care of him or her on the same campus. CCRCs consist of many different levels, beginning with senior apartments and advancing to adult care facilities and nursing homes. This same-site approach means that the client will receive the kinds of service he or she needs without having to leave the same general environment.

CCRCs frequently require a large, one-time payment from applicants to cover the costs associated with the convenience of having all the tools of the long term care continuum based on one campus. This, essentially, helps to pre-pay for the resident's anticipated health care needs. Additionally, CCRC residents usually pay a monthly maintenance fee to cover utilities and amenities. (A portion of the monthly fee also helps to prepay healthcare services.) However, that monthly fee does not rise significantly when a resident needs more complex care, so residents are able to budget for what the costs will be over their lifetime.

CCRCs and life care in particular (see definition below) are relatively new in this state, although they have been very successful in other states and have been attractive for those who have chosen to move to bordering states over the past few years in order to take advantage of this option.  

Oversight agency: State Department of Health

Enriched housing is a program typically located in an adult care facility or senior housing facility, providing housekeeping, shopping and personal care services for those in need. Enriched housing allows a senior citizen to remain in his or her own apartment, even after he or she may have become more frail and can no longer perform what health care professionals call the "activities of daily living" (such as walking, cooking, dressing, etc.).
Oversight agency: Department of Social Services

Home care consists of medical or personal care services provided in the individual's home. Home care agencies are certified by the state as either part of the long term home health care program (LTHHCP) (also called "nursing home without walls") or as a certified home health agency (CHHA). 

The services these agencies provide may be fairly simple, ranging from monitoring blood pressure to coordinating medication, to the highly complex, such as intravenous infusion therapy or care for AIDS patients. Home health agencies also can provide personal care, which includes such functions as bathing or housekeeping, to maintain a person in his or her own home.

Oversight agency: Department of Health

Life care is a type of continuing care retirement community (CCRC--see definition, above) where the resident is guaranteed skilled care for as long as they reside at the CCRC

Nursing homes provide 24-hour medical and social services to the frail elderly and chronically-disabled populations of our state. These facilities represent the most complicated--and, hence, the most expensive--level of care and are aimed at providing services to those persons who need high-intensity medical care and supervision.  

Families of persons who suspect that their relative or friend requires nursing home care must understand that the prospective resident/client must undergo a screening process to ensure that, indeed, nursing home care is indeed appropriate for them, and that a lower level of care would not be more suitable to fulfilling the needs of that particular client. The screening process consists of a health care professional filling out what is called a patient review instrument (or PRI), which assesses the applicant's ability to complete activities of daily living (ADLs), such as walking, bathing, dressing, etc., as well as a health assessment to encompass all physical and psychological problems the applicant faces. The PRI determines a "score," which then demonstrates the individual's actual medical and social needs.

After the PRI is completed, the screening process (actually called Screen) begins. If a person is in the hospital and is being transferred directly from the hospital to a nursing home, hospital social service or discharge planning staff will assist in obtaining a completed PRI and Screen. If the person is at home or in a community-based program, a certified home health agency should be contacted to complete the PRI and Screen. Under these circumstances, a home visit is usually necessary. During the home visit, any caregivers that might have first-hand knowledge of the patient's condition should be there to meet with the professional who completes the PRI and Screen. This is crucial, since a caregiver can sometimes be more realistic about a person's condition than the person is on their own. Be honest with the evaluator, since this will help to give a realistic impression of exactly what the person needs in a nursing home or other facility.

Once a person has been accepted for nursing home placement, he or she will also undergo a much more intensive assessment process within the nursing home, called the minimum data set plus (MDS+). This is a comprehensive review of the resident's history and needs, and is an integral part in the overall assessment of the resident so that an individual care plan may be designed for that person.

Oversight agency: State Department of Health

Respite is a service that helps caregivers in gaining a short break from their caregiving duties, whether for personal or medical reasons. When a caregiver needs a short break for whatever reason, he or she can make advance arrangements for respite care for the person in their charge. Respite care is frequently delivered in a residential setting (such as a nursing home) and can provide the relief needed when a caregiver needs to rest or have surgery, for example. 

Also known as "short term scheduled stays," respite care services are in short supply, and should be reserved as far in advance as possible to make sure that the services are available when needed. 

Oversight agency: State Department of Health

Senior housing facilities consist of apartments for independent living for the elderly. Most of these buildings have handicapped-accessible bars in the bathrooms, emergency-pull cords in the bathroom and bedroom, and some even have appliances and sinks custom-designed to accommodate the needs of people in wheelchairs.

Subsidized housing requires that applicants meet certain income specifications in order to be considered for an apartment. Typical subsidized housing programs include: Section 202, Section 8, Section 236, and Mitchel-Lama or Housing Trust Fund. 

Market-rate housing is not subsidized and is open to people whose incomes enable them to pay the monthly rents, which are typical for that area of the state. 

Oversight agencies:

  • The United States Department of Housing and Urban Development (HUD)
  • State Division of Housing and Community Renewal

From least restrictive to most intense care, then, the continuum of care is:

  • Housing
  • Adult care facilities
  • Enriched housing
  • Assisted (Adult homes) Living
  • Home care
  • Adult day care programs
  • Nursing homes

* Continuing care retirement communities/life care communities contain components of all levels of the continuum of care
Health Care Definitions - seniors Long Term Care & Nursing Home Issues -
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