What care homes for the elderly are called varies from state-to-state. In California they are Residential Care Facilities for the Elderly (RCFE’s), but are commonly referred to as Board and Care Homes. In Florida they are called ALF’s, Assisted Living Facilities. To cut through the confusion of terminology it is best to look at the level of care that is offered by a care home. Regardless of local terminology, the level of care distinctions remains the same almost everywhere. The three primary distinctions in level of care are: Two important variants on these basic categories are: Independent Living Facilities. Just as it sounds, Independent Living facilities provide a congregate living situation for persons who are able to live without personal assistance beyond housekeeping and meals. Usually such facilities are not required to be licensed by the state. Even though some very early dementia patients could exist in such an environment for some time, we would never recommend this. In addition to being unlicensed and not providing a deeper level of care, the mere fact of moving, or having to move too often, can be detrimental to the person with dementia. Assisted Living Facilities. These are care homes that specialize in providing some level assistance with the basic Activities of Daily Living (bathing, dressing, grooming, eating, toileting, etc.). Which activities the care home will assist with—and the degree of assistance they offer—vary by both state requirements and individual care home preferences. For example, many homes will not offer feeding assistance as a service because their staffing will not support it. Likewise, even though licensed to provide incontinence services, many homes will choose not to accept a person who has bowel incontinence. Or they may refuse to accept a prospective resident who urinates in inappropriate places. Most families seeking care for a loved one with a dementing illness will find that Assisted Living is the best level to look at. Since this is the case we have another page of information just on Assisted Living Facilities. To further determine the advisability of Assisted Living vs. Skilled Nursing see the pages Red Flags and Paying. The Red Flags-Unacceptable in Assisted Living? page gives you a quick list of the conditions that may be by state law from Assisted Living Care Homes. The Paying for Assisted Living page looks at the financial requirements, options and concerns involved in selecting the appropriate level of care. As noted above, Assisted Living Care Homes may be called by a wide variety of names. Always look to the help they provide with the Activities of Daily Living to determine if the facility is at the Assisted level or is an Independent or Skilled facility. At ALZCARE® we work exclusively with Assisted Living Care Homes. We specialize in determining which homes can provide care for dementia care (not just those that are Special Care Units). See the About Us page for more information or give us a call at 1-866- ALZCARE. Skilled Nursing Facilities (SNF; aka Nursing Home or Convalescent Hospital). Skilled Nursing Facilities are intended for individuals who require an extremely high degree of ongoing personal care such as in Late or Final Stage Dementia, for those who need a period of rehabilitation and therapy following an injury or hospitalization, or who need specific medical care that cannot be performed in an Assisted Living setting (see Red Flags). Many times people who have no personal financial resources and who qualify for Medicaid (MediCal) enter Skilled Nursing Facilities rather than an Assisted Living Care Home (see Paying for Assisted Living). Special Dementia Care Units. Sometimes referred to Special Alzheimer’s Care Units, these are facilities that specialize in the care of persons with dementing illnesses. Typically they would have greater security to protect wanderers, staff that is trained to a higher level to deal with common behavior difficulties (resistance, combativeness, etc.) and a program of activities that is tailored to the needs and abilities of persons with dementia. Special Care Units may be part of a larger facility, either Skilled or Assisted, or they may be a stand-alone facility (at either the Skilled or Assisted level). In some states there are additional, special licenses or requirements before a facility can call itself a Special Care Unit (at either the Assisted or Skilled levels), In other states there are no such regulations. So besides needing to determine the kind, quality and depth of special care such a facility provides, you also need to determine if it is at the skilled level or assisted level. Then you need to find out if this designation is regulated by the state or not. Continuing Care Communities (CCC)/Life Care Communities (LCC). Imagine a community that had all of the above on one campus. You could move in as an independent person and then have all of your needs taken care of until your death. Sometimes it works that way, sometimes it does not, but the idea is very appealing. The basic idea is having all levels of care at your disposal. But to enter the community you must pay. The amount varies tremendously, but can be many hundreds or thousands of dollars. In some cases you are purchasing real estate in the deal, in some cases not. This may or may not go to your heirs upon death. An important note in considering such communities is the Life Care vs. Continuing Care distinction. In sum, a Life Care Community must follow stricter standards in providing you with care. These standards include keeping you should you run out of money, keeping you in your apartment rather than moving you to a facility and so on. Naturally it is more complex than can be presented here, but be aware that there is a difference and that you must understand the differences under your state laws in order to make an informed choice. But the real question for us is the dementia care aspect. Not many Communities (CCC or LCC) currently have Special Dementia Care Units. Most CCC’s have clauses in the contract you sign that says they will find appropriate care if a person develops any condition, such as a dementing illness, for which they cannot provide appropriate care. Further complicating the matter is that most CCC’s want people to move in when they are at an independent level. For families considering the placement of a loved one with a dementing illness, CCC’s might be a possibility, but must be examined very cautiously. You can count on us to guide you through the maze of options.
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