Words To KnowNathan J. Mazur
The senior care business has all kinds of words and phrases that professionals in the industry like to use to describe different therapies, options, situations, etc. My experience is that a lot of these just confuse people, and make it even harder to make an educated decision. With that said, below is a list of the most commonly used words and phrases in the senior care business, and what they actually mean for you as you make decisions.
Home care services are provided by a Medicare certified home health care agency. These services are typically paid for by Medicare, and are available to someone when they need physical therapy, occupational therapy, speech therapy, other therapies, wound care, or nursing follow-ups. With this type of home care, someone from the home care agency will usually visit twice weekly for about an hour or so. This service also generally only lasts for a short while, usually 6 weeks or less. Home care is a supplement to any consistent care that your loved one needs, and you shouldn’t count on this type of home care services to help your loved one remain in their home. It’s brief periods, and not long-term. If your loved one requires assistance consistently in the home, then you are going to want to hire what’s called a “private duty home care agency”.
Independent living is exactly as it sounds. It’s an environment built for people who are still relatively independent. Residents usually have their own apartments, and can manage most things by themselves. Apartments sometimes have stoves, and other times they do not. Meal plans are always available (and usually taken advantage of). There are a lot of activities offered, and outings planned, since most of the residents are still able to take advantage of those kinds of things. DO NOT mistake independent living for assisted living. Once your loved one starts requiring actual assistance with caring for themselves, it’s time to find another facility quickly before they decline more rapidly than they need to. “Assisted living” offered in independent living facilities is never a recommended service by our team. The highest item on the care chart that independent living can safely handle is helping with medications. Anything in addition to that is dangerous, and the best the staff can typically offer is 2-hour checks, which are completely inappropriate for someone who truly needs care.
Assisted living is just a marketing term. There’s no such thing as a license for assisted living. In Michigan, facilities are licensed as a “group home” or a “home for the aged”. Independent living facilities offering “assisted living” services are doing so without a license. So assisted living is a broad term that simply defines an industry of providing care services to those who need it.
Private Duty Home Care is when you hire someone to come into your loved ones home and care for them there. Most providers provide services by the hour, and most require at least a 3 hour minimum for the agreement. On average, people may hire a private duty home care agency for 4 hours in the morning, 4 hours at night… or 12 hours during the day… or 12 hours during the night. Schedules can be customized entirely to the needs of the family and their loved one. This is a great service to keep someone in their home for as long as possible, but keep in mind that the time may come when the services either become too expensive, or your loved one requires too much care and assistance to remain in their home safely.
This is the technical term for “nursing home”. Nursing homes used to be the place where seniors ended up at the end of their life. Now assisted living has almost completely replaced that, except for Medicaid provided services (which is also changing). Nursing homes/Skilled Nursing Facilities are now mostly a place for rehab after an accident, injury or medical issue. Most seniors who I have helped throughout my years did NOT require a nursing home.
When someone falls or has an injury or health issue, often after the hospital (and sometimes surgery) they will be discharged to a skilled nursing facility. This facility is in charge of daily rehab in order to attempt to get that person back to where they were before their accident or issue. Medicare will pay for UP TO 100 days of rehab. After those 100 days (usually ON that day or before it) your loved one will be discharged. The secret though is that if your loved one stops improving, or improves too much, they may issue a discharge far before those 100 days are up. I have worked with many families who are told on a Thursday that their loved one is being discharged the next day. It’s unfortunate, but it’s how the industry works.
These are companies and people who you will find online, or be introduced to by a social worker in a nursing home who offer to help you find a good facility for your loved one, if they are unable to return home. Their sales pitch is that they know the market, know who good homes are and who the ones are that you should avoid, and that they are free of charge to you. Unfortunately as in most situations, nothing is completely free. These consultants charge the facilities where your loved one moves a huge commission for their services. Often this fee is as high as 1.5 times the monthly rate your loved one is paying. I have seen commissions charged by these people as high as $5,000. I have no problem with someone helping and getting paid for their help. I do however have an issue when that placement person is not providing all of the potential options (some of which may be the best options) to a family simply because they cannot get paid by all facilities. If you would lie clarification on this, please give me a call directly. I do not recommend working with these placement consultants, as you truly do get what you pay for with many of them.
Hospice is a term that most are familiar with, however most don’t understand. Hospice is a service that is paid for by Medicare that is an extra support to your loved one, and the family as well. In order to be admitted to hospice, your loved one must have an order for evaluation written by a physician, and then must qualify with the hospice company themselves. Hospice has many diagnosis’ that will qualify someone to receive the services. Most people feel that “hospice” means that the person will be dying soon, and that is not necessarily the case. We have had people remain on hospice for over 1 year in the past. A facility should be familiar with hospice and how to use it to your loved ones advantage if it is in fact possible. It means less co-pays for you, no more costs for briefs, and more eyes on your loved one consistently (including a nurse dedicated to your loved one). We highly recommend it and our clients use it often, as long as they qualify to do so.
Seniors often require things like a wheelchair, walker, hospital bed, and more. When this happens, as long as a physician will write an order stating that it is in fact medically necessary, Medicare will pay for these things. We work closely with our members to make sure that their loved one is getting the support they need and deserve from any medical equipment that they qualify for.
In the past, group homes were designed more for people who had developmental issues. Now however there are many small group homes that care for 6 residents that specifically cater just to seniors. The right environment with the right management can equal a perfect fit for someone who wants a smaller place. We are very careful recommending these types of facilities, as there are unfortunately many that have disappointed us in the past. There are still several great ones though, and financially they are usually less expensive than a larger facility.
There are also larger group homes. A group home can remain under that license if they provide care for 20 or less people. Large group homes are highly recommended by our team because they combine a small environment with a good opportunity to socialize.
A home is licensed with the State of Michigan as a home for the aged if they are licensed for more than 20 residents. This is still considered assisted living (just as group homes are).
In Michigan there are many ways to open and operate an unlicensed assisted living facility. I have seen many unlicensed facilities that actually are run better and managed better than licensed ones, so please don’t disqualify a facility just because it’s unlicensed. But just like a licensed facility, there are many things that should be focused on to determine if the facility is in fact a good fit for your loved one. The loopholes that allow unlicensed facilities are the reason that independent living facilities can offer assisted living services without a license. (You would be surprised to find out that some of the largest providers of assisted living in Michigan do not have a license)