Assisted living
Assisted living residences or assisted living facilities (ALFs) provide supervision or assistance with activities of daily living (ADLs); coordination of services by outside health care providers; and monitoring of resident activities to help to ensure their health, safety, and well-being. Assistance may include the administration or supervision of medication, or personal care services provided by a trained staff person. Assisted living as it exists today emerged in the 1990's as an alternative on the continuum of care for people who cannot live independently in a private residence, but who do not need the 24-hour medical care provided by a nursing home. Assisted living is a philosophy of care and services promoting independence and dignity.
There is no nationally recognized definition of assisted living in the US. Assisted Living facilities are regulated and licensed at the state level. More than two-thirds of the states use the licensure term "assisted living." Other licensure terms used for this philosophy of care include Residential Care Home, Assisted Care Living Facilities, and Personal Care Homes. Each state licensing agency has its own definition of the term it uses to describe assisted living.
Types
As varied as the state licensing and definitions are, so are the types of physical layouts of buildings that provide assisted living services. ALFs can range in size from a small residential house for three residents up to very large facilities providing services to hundreds of residents.
People who live in newer assisted living facilities usually have their own private apartment. There is usually no special medical monitoring equipment that you would find in a nursing home, and their nursing staff may not be available at all hours. However, trained staff are usually on-site around the clock to provide other needed services. Where provided, private apartments generally are self-contained; i.e., they have their own bedroom and bathroom, and may have a separate living area or small kitchen.
Alternatively, individual living spaces may resemble a dormitory or hotel room consisting of a private or semi-private sleeping area and a shared bathroom. There are usually common areas for socializing, as well as a central kitchen and dining room for preparing and eating meals.
Typical resident
Statistically, an assisted living resident needs assistance with an average of three ADLs.
A typical assisted living facility resident would be a woman in her mid- to late 80's who does not need the intensive care of a nursing home but prefers more companionship and needs some assistance in day-to-day living.
Residents of assisted living facilities need not be concerned with daily meal preparation, because a central kitchen and dining facility typically provides three meals each day. The central dining facility also allows for visiting with others without having to leave home. This greatly reduces the isolation that elderly, disabled people may suffer when living alone and who are afraid (usually for physical reasons) to leave their homes.
Special needs
The residence may assist in arranging the appropriate medical, health, and dental care services for each resident. The resident generally chooses his or her medical doctor and dental services.
Residents who have periods of temporary incapacity due to illness, injury, or recuperation from surgery often are allowed to remain in the residence or to return from a rehabilitation center, skilled nursing facility or hospital if appropriate services can be provided by the assisted living residence. It is important to remember that assisted living residences are a bridge between living at home and living in a nursing home. Assisted living residences do not typically provide the level of continuous skilled nursing care found in nursing homes and hospitals.
More recently built facilities are designed with an emphasis on ease of use by disabled people. Bathrooms and kitchens are designed with wheelchairs and walkers in mind. Hallways and doors are extra-wide to accommodate wheelchairs. These facilities are by necessity fully compliant with the Americans with Disabilities Act of 1990 (ADA) or similar legislation elsewhere.
The socialization aspects of ALFs are very beneficial to the occupants. Normally the facility has many activities scheduled for the occupants, keeping in mind different disabilities and needs.
Many ALFs also serve the needs of the mentally ill community, primarily people with some form of dementia including Alzheimer's disease, but also others as long as they do not present an imminent danger to themselves or others. In the United States, legislation enacted by each state defines not only the level of care, but often what conditions are prohibited from being cared for in such a home.
From Wikipedia, the free encyclopedia
Elderly care
Elderly care or simply eldercare is the fulfillment of the special needs and requirements that are unique to senior citizens. This broad term encompasses such services as assisted living, adult day care, long term care, nursing homes, hospice care, and in Home care.
Cultural and geographic differences
The form of elder care provided varies greatly among countries and is changing rapidly. Even within the same country, regional differences exist with respect to the care for the elderly.
Traditionally elder care has been the responsibility of family members and was provided within the extended family home. Increasingly in modern societies, elder care is now being provided by state or charitable institutions. The reasons for this change include decreasing family size, the greater life expectancy of elderly people, the geographical dispersion of families, and the tendency for women to be educated and work outside the home. Although these changes have affected European and North American countries first, it is now increasingly affecting Asian countries also.
In most western countries, elder care facilities are freestanding assisted living facilities, nursing homes, and continuing care retirement communities (CCRCs). In the United States, most of the large multi-facility providers are publicly owned and managed as for-profit businesses. There are exceptions; the largest operator in the US is the Evangelical Lutheran Good Samaritan Society, a not-for-profit organization that manages 6,531 beds in 22 states, according to a 1995 study by the American Health Care Association.
Given the choice, most elders would prefer to continue to live in their own homes (aging in place). Unfortunately the majority of elderly people gradually lose functioning ability and require either additional assistance in the home or a move to an eldercare facility. The adult children of these elders often face a difficult challenge in helping their parents make the right choices. [1]
Medical versus social care
A distinction is generally made between medical and social care, and the latter is much less likely to be covered by insurance or public funds. In the US, 86% of the one million or so residents in assisted living facilities pay for care out of their own funds. The rest get help from family and friends and from state agencies. Medicare does not pay unless skilled-nursing care is needed and given in certified skilled nursing facilities. Assisted living facilities usually do not meet Medicare's requirements. However, Medicare does pay for some skilled care if your relative meets the requirements for the Medicare home health benefit.
Thirty-two states pay for care in assisted living facilities through their Medicaid wavier programs. Similarly, in the United Kingdom the National Health Service provides medical care for the elderly, as for all, free at the point of use, but social care is only paid for by public authorities when a person has exhausted their private resources.
Elderly care emphasizes the social and personal requirements of senior citizens who need some assistance with daily activities and health care, but who desire to age with dignity. It is an important distinction, in that the design of housing, services, activities, employee training and such should be truly customer-centered.
However, elderly care is focused on satisfying the expectations of two tiers of customers: the resident customer and the purchasing customer, who are often not identical, since relatives or public authorities rather than the resident may be providing the cost of care. Where residents are confused or have communication difficulties, it may be very difficult for relatives or other concerned parties to be sure of the standard of care being given, and the possibility of elder abuse is a continuing source of concern.
Improving Mobility in the Elderly
Impaired mobility is a major health concern for older adults, affecting fifty percent of people over 85 and at least a quarter of those over 75. As adults lose the ability to walk, to climb stairs, and to rise from a chair, they become completely disabled. The problem cannot be ignored because people over 65 constitute the fastest growing segment of the U.S. population.
Therapy designed to improve mobility in elderly patients is usually built around diagnosing and treating specific impairments, such as reduced strength or poor balance. It is appropriate to compare older adults seeking to improve their mobility to athletes seeking to improve their split times. People in both groups perform best when they measure their progress and work toward specific goals related to strength, aerobic capacity, and other physical qualities. Someone attempting to improve an older adult’s mobility must decide what impairments to focus on, and in many cases, there is little scientific evidence to justify any of the options. Today, many caregivers choose to focus on leg strength and balance. New research suggests that limb velocity and core strength may also be important factors in mobility.[2]
From Wikipedia, the free encyclopedia
Nursing home
- SNF redirects here. For the sports show, see NBC Sunday Night Football.
A nursing home, skilled nursing facility (SNF), or skilled nursing unit (SNU), also known as a rest home, is a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living. Residents include the elderly and younger adults with physical disabilities. Adults 18 or older can stay in a skilled nursing facility to receive physical, occupational, and other rehabilitative therapies following an accident or illness.
United States
In the United States, nursing homes are required to have a licensed nurse on duty 24 hours a day, and during at least one shift each day, one of those nurses must be a Registered Nurse. In April, 2005 there were a total of 16,094 nursing homes in the United States, down from 16,516 in December, 2002. Some states have nursing homes that are called nursing facilities (NF), which do not have beds certified for Medicare patients, but can only treat patients whose payments source is Private Payment, Private Insurance or Medicaid
Services
Services provided in nursing homes include services of nurses, nursing aides and assistants; physical, occupational and speech therapists; social workers and recreational assistants; and room and board. Most care in nursing facilities is provided by certified nursing assistants, not by skilled personnel. In 2004, there were, on average, 40 certified nursing assistants per 100 resident beds. The number of registered nurses and licensed practical nurses were significantly lower at 7 per 100 resident beds and 13 per 100 resident beds, respectively.
Nursing facilities that participate in the Medicare and Medicaid programs are subject to federal requirements regarding staffing and quality of care for residents.[1] In 2004, 98.5% of the 16,100 nursing facilities nationwide were certified to participate in Medicare, Medicaid, or both.
Medicare covers nursing home services for beneficiaries who require skilled nursing care or rehabilitation services following a hospitalization of at least three consecutive days. The program does not cover nursing care if only custodial care is needed — for example, when a person needs assistance with bathing, walking, or transferring from a bed to a chair. To be eligible for Medicare-covered skilled nursing facility (SNF) care, a physician must certify that the beneficiary needs daily skilled nursing care or other skilled rehabilitation services that are related to the hospitalization, and that these services, as a practical matter, can be provided only on an inpatient basis. For example, a beneficiary released from the hospital after a stroke and in need of physical therapy, or a beneficiary in need of skilled nursing care for wound treatment following a surgical procedure, might be eligible for Medicare-covered SNF care.
SNF services may be offered in a free-standing or hospital-based facility. A freestanding facility is generally part of a nursing home that covers Medicare SNF services as well as long-term care services for people who pay out-of-pocket, through Medicaid, or through a long-term care insurance policy. Generally, Medicare SNF patients make up just a small portion of the total resident population of a free-standing nursing home.
Medicaid also covers nursing home care for certain persons who require custodial care, meet a state's means-tested income and asset tests, and require the level-of-care offered in a nursing home. Nursing home residents have physical or cognitive impairments and require 24-hour care.
Almost no one can afford to pay for nursing home care "out of pocket."[clarify] They cost $5,000 per month or more.[clarify] Some deplete their resources on the often high cost of care. If eligible, Medicaid will cover continued stays in nursing home for these individuals. However, they require that the patient be "spent down" to poverty levels first, thus depleting their life savings.
Government regulations and oversight
All nursing homes in the United States that receive Medicare and/or Medicaid funding are subject to federal regulations. People who inspect nursing homes are called surveyors or, most commonly, state surveyors.
The Minimum Data Set (MDS) is part of the U.S. federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes. This process provides a comprehensive assessment of each resident's functional capabilities and helps nursing home staff identify health problems.
For United States homes, the Centers for Medicare and Medicaid Services has a website which allows users to see how well facilities perform in certain metrics (see "Nursing Home Compare Tool" in the external link section below). CMS also publishes a list of Special Focus Facilities - nursing homes with "a history of serious quality issues."[2][3] The US Government Accountability Office (GAO), however, has found that state nursing home inspections understate the number of serious nursing home problems that present a danger to residents. The GAO concluded that while CMS oversight has improved, there are still weaknesses in its oversight of nursing homes.[4][5]
Care homes for adults in England are regulated by the Commission for Social Care Inspection.
Nursing homes are subject to federal regulations and also strict state regulations. The nursing home industry is considered one of the two most heavily regulated industries in the United States (the other being the nuclear power industry).[6]
Consumer choices
Current trends are to provide people with significant needs for long term supports and services with a variety of living arrangements. Indeed, research in the U.S as a result of the Real Choice Systems Change Grants, shows that many people are able to return to their own homes in the community. Private nursing agencies may be able to provide live-in nurses to stay and work with patients in their own homes.
When considering living arrangements for those who are unable to live by themselves, potential customers consider it to be important to carefully look at many nursing homes and assisted living facilities as well as retirement homes, keeping in mind the person's abilities to take care of themselves independently. While certainly not a residential option, many families choose to have their elderly loved one spend several hours per day at an adult daycare center.
Beginning in 2002, Medicare began hosting an online resource known as Nursing Home Compare . The program is intended to foster quality improving competition between nursing homes. Informed consumer choice has long been missing from decisions regarding the placement of the elderly in need.
The website My Patient Guide provides a directory of New Jersey nursing homes and assisted living communities, along with a question-and-answer section.
Trends
Nursing homes are beginning to change the way they are managed and organized to create a more resident-centered environment, so they are more "home-like" and less "hospital-like." In these homes, nursing home units are replaced with a small set of rooms surrounding a common kitchen and living room. The staff giving care is assigned to one of these "households." Residents have far more choices about when they awake, when they eat and what they want to do during the day. They also have access to more companionship such as pets. Some organizations working toward these goals are the Greenhouse nursing home, the Pioneer Network, and the Eden Alternative. Many of the facilities utilizing these models refer to such changes as the "Culture Shift" or "Culture Change" occurring in the LTC industry
From Wikipedia, the free encyclopedia
Home care
Home care, (commonly referred to as domiciliary care), is health care or supportive care provided in the patient's home by healthcare professionals (often referred to as home health care or formal care; in the United States, it is known as skilled care) or by family and friends (also known as caregivers, primary caregiver, or voluntary caregivers who give informal care). Often, the term home care is used to distinguish non-medical care or custodial care, which is care that is provided by persons who are not nurses, doctors, or other licensed medical personnel, whereas the term home health care, refers to care that is provided by licensed personnel
Concept
(The following definition is applicable in United States and United Kingdom.)
"Home care" and "home health care" are phrases that are used interchangeably in the United States to mean any type of care given to a person in their own home. Both phrases have been used in the past interchangeably regardless of whether the person requires skilled care or not. More recently, there is a growing movement to distinguish between "home health care" meaning skilled nursing care and "home care" meaning non-medical care. In the [United Kingdom], "Homecare" and "domiciliary care" are the preferred expressions.
Home care aims to make it possible for people to remain at home rather than use residential, long-term, or institutional-based nursing care. Home Care providers render services in the client's own home. These services may include some combination of professional health care services and life assistance services.
Professional Home Health services could include medical or psychological assessment, wound care, medication teaching, pain management, disease education and management, physical therapy, speech therapy, occupational therapy.
Life assistance services include help with daily tasks such as Meal Preparation, Medication reminders, Laundry, Light Housekeeping, Errands, Shopping, Transportation, and Companionship.
In the United Kingdom
Home care providers
Homecare is purchased by the service user directly from independent home care agencies or as part of the statutory responsibility of social services departments of local authorities who either provide care by their own employees or commission services from independent agencies. Care is usually provided once or twice a day with the aim of keeping frail or disabled people healthy and independent though can extend to full-time help by a live-in nurse or carer.
United Kingdom Homecare Association (UKHCA)
Domiciliary care providers in the UK are able to join the United Kingdom Homecare Association (UKHCA), which is the professional association of domiciliary care providers in the independent, voluntary and statutory sectors. The Association represents the views of over 1,600 home care providers, each of which agrees to abide by the UKHCA Code of Practice.
UKHCA is often a point of contact for members of the public who wish to contact agencies in their local area using a searchable list of home care providers in the UK. Their leaflet "Choosing care in your Home" is a straight-forward explanation of what home care is and how members of the public can select the best provider for their needs.
UKHCA produces Homecarer magazine, a bi-monthly digest of the latest news and analysis of the domiciliary care sector, and a range of publications for homecare providers, many of which are available to the public.
Statutory Regulation
Home care agencies are regulated by statutory bodies in three of the four home nations. The regulator's function is to ensure that home care agencies work within the applicable legislation:
England
- Regulator: The Commission for Social Care Inspection (CSCI)
- The Care Standards Act 2000
- The Domiciliary Care Agency Regulations 2002
Wales
- Regulator: The Care and Social Services Inspectorate Wales (CSSIW)
- The Care Standards Act 2000
- The Domiciliary Care Agencies (Wales) Regulations 2004
Scotland
Northern Ireland
Legislation covering the homecare sector in Northern Ireland is not yet fully operational (as at December 2007).
Regulator: The Registration and Quality Improvement Authority (RQIA)
- Domiciliary Care Agencies National Minimum Standards (not published as at December 2007)
Research and program accreditation
Lotus Shyu & Lee found that by comparing with nursing home services, home nursing is more suitable for the patients who are not seriously ill and who do not need the services of after-hospital discharging [1]. Modin and Furhoff regard the roles of patient's doctors are more crucial than their nurses and care workers [2]. However from epidemiological view, the risks of some community acquired infections are more higher from home nursing than from nursing home [3]. In regards to financial expenditure, the home nursing is more cost effective than nursing home [4]. The quality aspect of home nursing has been reviewed by Riccio [5].
From Wikipedia, the free encyclopedia
