Types of Elder Care

Different Types of Eldercare: an Introduction

The financial options available to help pay for senior care is dependent on, among other things, the type of care required.  For example, some government programs will help pay for a skilled nursing facility, but not in-home care.  If you are just beginning the research process on how to pay for care, it is helpful to have an idea about the type of care you or your loved one will require now and in the future as well as the associated terminology.

Skilled Care vs. Custodial Care

Regardless of the location in which they are provided, at the highest level there are two types of care, skilled care and custodial care.  Skilled care describes services that can be given only by skilled or licensed medical personnel. Custodial care (also called non-skilled care) helps with activities of daily living (ADLs), such as bathing, dressing and eating. Custodial care is typical for seniors with Alzheimer’s or dementia. Both skilled and custodial care can be provided at home, in adult day care or in a residential care setting such as a nursing home, assisted living community or adult foster care home.

Palliative Care vs. Hospice Care

Palliative is a type of care that focuses on relieving patients of their pain and suffering instead of medical care which has the objective curing or treating the underlying conditions.  Hospice care, on the other hand is an encompassing approach to treating terminally ill patients in the last weeks or months of their lives. While hospice very often includes palliative care, not all persons receiving palliative care are in hospice.

Home Care vs. Home Health Care

These terms are sometimes used interchangeably and other times there is an important distinction.  While both types of care are provided in the individual’s home, home care generally means custodial or unskilled care is being provided.  For example, assistance is provided to bathe and dress the individual, help with laundry, cook and accompany them to doctors’ appointments or on other errands.  One may also hear this type of care referred to as personal care although that term is not exclusively for care provided at home.

Home health care refers to a higher level of care which requires medical training.  This includes procedures such as checking the individual’s vitals, respiration and assisting with braces, artificial limbs and other medical equipment such as ventilators.  To be clear, it is not unusual for home health care providers to also provide custodial care during their home visits.

Adult Day Social Care vs. Adult Day Health Care

The term adult day care is also used interchangeably and can refer to adult day social care or adult day medical care.  Adult day social care provides seniors with supervision and care in a structured setting during daytime hours usually to allow their caregivers to go to work.  A variety of activities, meals and some therapies are offered.

Adult day health care typically provides everything adult day social care does but in addition has medical services equivalent or almost equivalent to those found in nursing homes.

Virtual Companion Care

This is a new way of providing home care using Internet technologies.  Elderly persons living at home alone are provided with a tablet computer through which their safety and mood can be monitored, medication reminders provided and most importantly they can interact with others reducing feelings of loneliness and isolation.  Although hands-on care is not provided, virtual companion care holds great promise for reducing the cost of care and improving the lives of elderly persons living at home alone.  Read more.

Care Management Services: Public and Private Options

Geriatric Care Managers (GCMs) help families create and implement long term care plans for their loved ones, they provide care management services instead of providing hands-on care themselves. Typically this includes an in-person needs assessment, the development and review of a care plan and arranging and monitoring care services.  Approximately one third of care managers also offer financial planning for eldercare.

GCMs are also referred to as elder care managers, case managers and service or care coordinators.  In addition to a certification from the National Association of Professional Geriatric Care Managers (NAPGCM), many are licensed by their different professional backgrounds; which include social workers, nurses, therapists and assisted living or home care professionals.

There are both public and private care managers.  Those in the public sector are usually referred to as benefits counselors or case managers while those in the private sector are called care managers.   Medicaid will sometimes provides for care management services under a HCBS Waiver program.  Some long term care insurance policies include coverage of care management as well.

In addition to the convenience, time-savings and security they provide, care managers can save families money because their needs assessments align an individual’s present condition with only those services that are necessary at that time.

Types of Residential Care Comparison

There are four categories of residential care communities and each is referred to by many different names.

1) Independent Living / Senior Living – homes within a complex that offers transportation, security and recreational activities, but no health care services.

2) Assisted Living – residences provide help with activities of daily living including basic health services, recreational and social activities but not skilled nursing care.

3) Skilled Nursing Homes – residences with 24/7 care by licensed health professionals including all housekeeping, medical and social needs.

4) Continuing Care Retirement Communities – residences that provide a continuum of care from independent living to assisted living to skilled nursing. These are designed to enable seniors with progressively declining health to remain in a single residential location or give healthy seniors the peace of mind that all their future needs are covered.