Independent, Assisted, and Skilled Care, Oh My!

By Jenny Grant, LMSW

What Are The Differences?


Mom is getting older, has been widowed for several years, and the house is just too much to maintain. She’s a bit lonely, so she’s not eating very well, but she’s able to shop for her groceries and enjoys seeing her friends at the store.  She has fellowship at Church on Sundays, but misses having the companionship she had with dad on a daily basis.  We all live far away and call her often. It sounds like she’s taking her medications correctly, keeping up with her doctor’s appointments, and keeping the house clean.  She has chronic back pain, so keeping up with the house and yard are getting to be difficult for her. 


Perhaps It’s Time For An Independent Living Facility

Independent Living Facilities provide the comforts of home in a private handicap accessible apartment, surrounded by others in the same boat as mom, described above.  She would be able to go to a dining room for all three meals or make things she loves for herself in her own kitchen or kitchenette. She can drive herself places or take the facility bus with others.  Mom can keep the doctors she’s familiar with, take medications on her own, and have home care or sitter agencies come in to help her with things, if needed. She would even have an emergency call system in her apartment, plus a pull cord in the bathroom and bedroom for emergencies. It would be just like living at home, plus socialization. And, no more worrying about the lawn or replacing gutters!


Mom and dad have been married for 50 years, and we’ve noticed that dad’s health problems are starting to get worse.  Mom has her own health problems but is still very agile and involved in the community.  However, we’ve noticed her increased fatigue due to the added stress of taking care of dad.  She’s let her own doctor’s appointments lapse because she worries about leaving dad alone. Mom gets easily flustered when she helps dad with his medications and insulin shots, and she’s had to call the fire department several times for help getting dad up after he’s fallen in the shower.  Despite their health problems, they love to go out for dinner and listen to live music on Friday nights.  Mom knows she needs more help with dad but doesn’t want to be separated from him.  


Assisted Living May Be The Solution

Assisted Living facilities cater to people who need a little extra help with bathing, dressing, medications, housekeeping, laundry, and meals. There is a nurse on duty 24/7, and many facilities offer “daily wellness checks”. Mom and dad could move in together.  They could still go out driving to their usual haunts, if safe to do so, or use the facility bus to go on outings with others.  Or, they can stay in and enjoy the camaraderie of other residents, entertainment, and activities.  If mom or dad needed help getting a little stronger, due to a fall or illness, the facility has on-site Physical, Occupational, and Speech Therapists. The assisted living option usually gives family members considerable peace of mind.  


Mom was diagnosed with dementia a few years ago but is still very social.  She uses a walker and needs us to remind her to use it. She is always looking for something to do, and the neighbors have called us several times to come get her from their house because she couldn’t remember how to get back home.  We were busy with other things and didn’t even know she had left the house! We feel unqualified to help her stay stimulated, as well as keep her safe. 


 Assisted Living With Memory Care

Assisted living with memory care provides the same services described above, but in a secured area of the assisted living building.  There is usually a code to get in and out of this area, and residents can come and go with family and staff, just not on their own. Some facilities use a code for the elevator so residents who may wander cannot access them (Facilities that don’t have a secured area have what’s called the Wanderguard system.  A resident wears a small bracelet on their arm or ankle which locks the exit doors if they come near them).  The activities in memory care are designed for people with dementia or Alzheimer’s Disease, to help preserve memory and stay stimulated and busy.  The resident can wander throughout their unit freely


Dad’s health has been declining for some time.  He recently had a stroke and fell at home, breaking a hip. The hospital staff said he may never be able to return home again. Now what?   


Skilled Nursing Care

Skilled nursing, also known as “long-term care”, or “nursing home care”, is for patients with complex medical issues that often cannot be managed at home.  Some patients are admitted to the rehab unit in a skilled nursing facility for physical, occupational, or speech therapy.  If dad is unable to return home after therapy has ended, he can stay at the facility to be cared for.  Other residents are admitted straight from home into a private or shared room.  The facility provides a podiatrist, optometrist, and dentist on-site, plus a recreational therapist, in many cases.  The ratio of staff to patients/residents is greater than in assisted living.  Dad can receive help with medications, bathing, dressing, eating, toileting, housekeeping, and laundry. Each facility has a medical director (physician) who makes rounds and orders medications. 

Figuring out what level of care is right for your loved one is not an easy task.  A Care Manager can help get your loved one assessed or diagnosed properly so there can be an appropriate placement the first time. This will save you money in the long run.  It is easy to procrastinate on finding the right place, but investigating these options now will be much easier and pleasant than waiting for a crisis to happen.  If you can include your loved one in the decision-making process, even better! Don’t wait for the hospital to make the decision for you.

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