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Senior Living

2009-09-01 14:47:00

Differences in types of residences

Answer: The difference between them is great, as are the needs of those who inhabit them. Generally, each type of senior housing is developed for people with different needs. Independent housing, Sr. Apartments, Adult Housing are all euphemisms for age restricted housing. Only persons who have reached a specific age are allowed to live in these homes. Age restricted, i.e. elderly housing was the only definition or separate group that was allowed to survive when HUD went on a “discrimination” busting rampage in the housing market about 30 years ago. During that time the powers that be decreed that no one had the right to decide they wanted to live with any selected group. Individual housing developments as well as apartment complexes were declared in violation of federal anti-discrimination laws if they chose to rent to any specific group. At the time, developers and apartment owners all catered to the wants of the marketplace. Many complexes were “adult only” for those who didn’t want to contend with children in their busy lives. Often apartment complexes were divided into “adult” and ”family” divisions, where children were excluded from the “adult” divisions. The two divisions usually had their own amenities with separate pools, playgrounds in the family area and “adult only” fitness centers. Most people found the arrangement to their liking. At the time, I had a pre-teen in the house and the arrangement worked well. While we often availed ourselves of the “adults only” fitness center, we were quite happy that our youngster went to the “family” pool and was not privy to some of the more adult shenanigans that went on at the “adult” pool. However, there were a group of women, with children, who filed suit claiming they were being discriminated against, and not allowed to live where they liked with their children. With the very liberal court make-up at the time and HUD’s government-paid attorneys, they prevailed and another freedom of choice fell. However, the separation of senior adults, who at the time were considered a minority, into their own children-less housing was allowed. From time to time, that right has been challenged but survived due to case-law precedents. Basically, the only difference in Senior Housing, and any other is just the restriction on the age of those who are allowed to live there. Senior housing can be independent houses, townhouses, condos, duplexes or apartments, or any other configuration you can think of in housing. The only real division in senior housing is that some of them are also income restricted. In an income restricted complex, (usually built with a government subsidy) only those who receive less than a certain income each year, are allowed to live there. The income restrictions usually allow differing amounts for individuals or couples and are adjusted up each year to allow for inflation. Usually the qualification is judged only on “income” and not assets. For instance, a couple could be millionaires in the value of their stocks, but if the income they received each year was under the limit, they could live in “income-restricted” housing. There are several examples in the Greater Wichita Area of “income-restricted” housing. Assisted Living Facilities (ALF’s) is another form of senior housing, but is designed for those who are not able to care for themselves, and perhaps need differing levels of oversight. Those admitted to “assisted living”, or “residential care” may need something as simple as help taking their medications to stay well or other more advanced levels of care. However, to be able to live in residential care, one must be able to perform most of their own activities of daily living, defined as eating, dressing, toileting and walking. In assisted living, bathing help is available. Residents in “assisted living” often still have their own cars and can come and go as they please. Others have chosen assisted living when they were no longer able to drive and/or wanted the convenience of someone taking care of housekeeping and meal preparation for them. Residential care also allows for couples to share their accommodations if they choose. In some cases, a spouse, who is unable to help their partner as much as needed will choose residential care so they can continue life together in a much less stressful environment, where the chores are taken care of for them, and they can sit back and enjoy life. In an assisted living environment, the majority of the “help staff” usually are certified medication aides who are trained in the dispensing of medications and have previously qualified as certified nursing aides. Due to their training, they are able to watch for health indicators and to alert the licensed nurse when she comes in. They also are able to summon assistance when needs are beyond their training. Sometimes only a door separates the residential care complex from the skilled nursing facility which has licensed nurses on duty, and available for immediate care, 24 hours a day. Nursing Facilities and Skilled Nursing Facilities or nursing homes as they are more commonly called are definitely a step up in care over assisted living. Once a person no longer meets the State mandated criteria for assisted living, they are no longer allowed to live there. An assisted living provider can be seriously penalized for allowing persons who no longer meet state guidelines to continue living in an assisted living facility. Once a person no longer meets assisted living guidelines according to their “care assessment” they are appropriate for care in a nursing home. The “care assessment” is a state test, performed by persons specifically trained in that test, to determine the level of care they need and whether they are qualified for nursing home care. One of the qualifiers is whether the person is capable of performing for themselves their normal “Activities of Daily Living” (ADL’s) as mentioned earlier when we were discussing the qualifications for Residential Care. Nursing home care is much more intense and can vary from helping one with two or three ADL’s to total care. Elderly persons with dementia, who are unable to manage their lives are appropriate for a nursing home, even though they might be perfectly capable of performing all their own ADL’s. They receive the level of care they need, however intense it may be. It is in the intensity of care that Skilled Nursing Facilities (SNF) commonly referred to as “sniffs” differ from Nursing Facilities (NF) “niffs”. A SNF has the staffing and expertise, as well as regulatory certification to provide the higher level of care required by Medicare. A person who has undergone the requisite three-day stay in an acute care hospital and is released needing “skilled nursing” can only receive Medicare benefits from a SNF. Sometimes the ‘skilled nursing” is a form of physical, occupational or speech therapy. It may also include constant monitoring by licensed nurses, or special care that can only be provided by an adequate licensed staff. Nursing facilities, (NF) have licensed nursing staff, and in some cases meet the requirements of Medicare, but have just not been certified. Other times, they are located in more rural areas where adequate licensed staff is difficult to hire and they provide care for those who need a less intense regimen. It is not unusual for a certified Skilled Nursing Facility, to receive a resident from another nursing home which is a NF after that resident has been hospitalized. They provide the Medicare required services, before transferring them back to their original nursing facility when they are appropriately improved. “Rehab to Home” is a favorite expression for those who have completed their hospitalization and need more care, and usually therapies, before being released back home. Much of the Medicare services are directed at getting persons back to their homes in a healthy condition where they can continue to live a more normal life. Whereas, nursing homes used to be a place where persons unable to care for themselves were “warehoused” until released by death, the whole purpose has changed. Today, a nursing home is expected to provide fun exciting activities, appropriate for all of their residents and maintain the highest and best functioning possible. To that end, they provide multiple activity programs, of all types, and exercise programs, which are both fun and effective in maintaining, or improving physical strength and stamina. It is important to try to get residents to a level of functioning where they can return to their homes if possible. I personally became a Nursing Home Administrator after watching my father lie, for his final six months of life in one of the old style, what I called a “Boot camp Nursing Home”. I could not stand the lack of care and the demands made of the residents by the staff. They were told when to eat, when to bathe, when to go to the bathroom, (and ignored if they couldn’t wait). They were given one unappetizing choice of food, and almost forced to eat it. (At an even earlier time, residents had their mouths forced open and food forced down their throats). Today we send a staff member around daily with a menu to let the residents choose their meals and they have a salad or fruit bar. Not only is it looked down upon and a bad business model to operate homes the old way, it is thankfully also illegal. “Culture change” is the watch word now, both in the nursing home and with the State regulatory agencies who oversee them. When I first started what we called person-centered care in 2002, my new staff looked at me as if I was crazy when I told them our residents would be choosing what they wanted to eat, and when they wanted to eat. That they would tell us when they wanted to bathe and whether it would be a shower or bath. They began to like it better when I told them of the choices of activities i.e. recreation that we would be having for our residents, and as caregivers they would be “required” to participate! I remember one staff member in particular that liked the idea of being paid to go fishing, and to the casino with residents. Today’s nursing home is where one goes to improve the quality of life, not end it. At Medicalodges Goddard they work every day to make that day just a little bit better for residents than the day before.