Elder Care

What is elder care?

Elder care covers a wide variety of issues. This includes choosing an appropriate healthcare provider to care for an aging person. It also includes making decisions about moving an older adult from home to a residential care setting. Many older adults are living healthy, active, and independent lives. But as more people reach their 80s and 90s, the number of older adults needing help with daily living increases. The responsibilities of those who provide care for them increase, too.

What is involved in choosing a healthcare provider for the older adult?

Different stages in life can need different healthcare providers. For older adults, it's important to have a primary healthcare provider who understands the special needs of older people.

Many types of healthcare providers care for older adults. These providers include family practitioners, internists, and geriatricians.

• Family practitioner. Provides healthcare to family members of all ages.

• Internist. Specializes in internal medicine, generally for adults.

• Geriatrician. Specially trained in elder care and in managing many complex and advanced illnesses.

Choosing the right primary healthcare provider is an important decision. Generally, you want a healthcare provider who is skilled and well trained. You also want a provider who cares for and about the person. Other things to think about include:

• Will my insurance pay for office visits and healthcare provider services?

• Is the healthcare provider a solo practitioner, or are they part of a group practice?

• Does the healthcare provider accept Medicare patients? What are the practice's Medicare policies and procedures?

• What are the healthcare provider's managed care and other insurance affiliations?

• Is the healthcare provider's office in a convenient and safe location?

• At which hospital does the healthcare provider treat patients?

• Am I comfortable with the age and gender of the healthcare provider?

• Are there any language barriers?

• Is the healthcare provider a good listener and communicator? Do they explain things clearly, fully, and patiently to the person and their family or caregiver?

• Do they encourage the person to ask questions, including uncomfortable topics, such as memory loss or age-related sexual issues? Are such questions answered in an understanding, respectful manner?

• What is the healthcare provider's policy about continuing to follow patients who move to residential care centers?

• Does the healthcare provider have training in aging-specific conditions, such as memory loss, functional decline, and end-of-life issues? 

• Does the healthcare provider have training in or are they comfortable with providing palliative care to their patients?

What is involved in interviewing the healthcare provider?

Once you have selected two or three possible healthcare providers, it's a good idea to visit their offices and ask them questions about office policies and their approach to elder care. For example:

• How far in advance do I have to make an appointment for a nonemergency visit?

• How are emergency visits handled?

• Do you treat many older adults?

• How do you feel about having family involved in healthcare decisions?

• Do you continue to follow people if they move to a local residential care facility?

• Are telemedicine visits a choice?

What is involved in getting ready for the appointment?

To make the most of each visit to the healthcare provider's office, it's best to plan ahead. The following guidelines may help you to prepare for the appointment:

• Know all the basic information that is likely to be asked of you (see Basic Information Form below).

• Bring medical records or have them sent ahead.

• Know what medicines the person is taking. These include prescription medicines, over-the-counter medicines, and vitamin and herbal supplements.

• Know all diagnosed medical conditions.

• Bring along a family member to act as a second set of eyes and ears for the older person.

• Write down questions beforehand. Include any concerns you would like to discuss with the healthcare provider.

• Bring a notepad and pencil or a tape recorder with you to record instructions (if this is permitted) and take notes.

When visiting the healthcare provider, it’s best to have the following basic information available. This can help make your visit as productive as possible. You may use this Basic Information Form to help you get ready for your next medical appointment.

Selecting an elder care facility

It’s hard to know when the time is right for an older adult to move from home to a residential care setting. This can be one of the most difficult decisions a family must make. Many people keep caring for the person at home. This is done even though it becomes physically and emotionally exhausting for them to do so. Sometimes, moving to a residential care setting may become the most realistic decision to make sure that the person will get the best care.

Moving from home into a residential care facility should be considered when one or more of the following things is true:

• The older adult needs round-the-clock care.

• The older adult can’t manage eating, toileting, and bathing (activities of daily living) without help.

• The older adult is prone to violent outbursts (physical or verbal), or is a danger to themselves or to others.

• The older adult has wandered away from the safe surroundings of home or neighborhood.

• The caregiver's health and well-being are negatively affected.

Types of out-of-home choices for older adults

Many types of out-of-home care choices are available for older adults, depending on the level of care needed. These may include:

• Assisted living facility (ALF). ALFs provide maximum independence for older adults who remain relatively active and healthy. Typically, a healthy spouse and an impaired spouse can live together in an ALF. Most ALFs feature apartment-style living with individual kitchens, and many services for older adults. These include 24-hour security, transportation, and recreational and social programs.

• Residential care facility (RCF). RCFs are for those who can no longer live alone and independently, but who don’t need skilled nursing care. At an RCF, the older person can receive help with personal hygiene, grooming, or other activities of daily living. They can also have bedside care for minor and short-term (temporary) illnesses. Typically, RCFs offer rooms, not apartments. They provide some recreational and social services for older adults.

• Skilled nursing facility (SNF). SNFs are also known as nursing homes, convalescent centers, and rest homes. At SNFs, older adults receive continuous nursing services under the care of a registered nurse or licensed vocational nurse. SNFs can provide more extensive care services than assisted living or residential care facilities. Such services include IV (intravenous fluids), blood pressure monitoring, medicine injections, and care for patients on ventilators. SNFs often provide recreational, rehabilitative, and social programs for residents.

• Others. Special care centers are available for people with particular medical conditions. These include Alzheimer's disease or dementia. Special psychiatric facilities may be a choice for people with violent or disruptive behaviors, or people who present a danger to themselves or others.

What to consider when selecting an elder care facility

In general:

• Is the facility staff willing to have you take a tour and stop in at mealtime to visit with residents?

• What care services are provided and do these services match your own individual needs?

• How much input do residents and their families have in daily life and care?

• What choices of accommodations are available?

• Are there graduated levels of care available? For example, can residents move from an assisted living environment to a higher level of care as needed?

• What personal items can be brought from home? What items are not allowed?

• Can residents have their own car on the premises?

• What is the visitation policy?

• Can residents bring a pet? Can pets be brought in to visit?

• Does the facility have a certain religious affiliation? If so, is your loved one happy with this affiliation?

• How would an emergency situation be handled by the facility? This includes a fire or severe winter storm. Does the facility have an emergency or crisis management plan in place? How did the facility manage the COVID pandemic, and how would it manage a future pandemic?

The facility:

• Federal and state laws must be followed for audio and video monitoring (for both the facility and the resident). What does the facility contract say about cameras in the building?

• Is the facility clean and tidy throughout? Are sanitary standards strictly enforced? Does the facility have a clean fragrance when you enter and throughout the building?

• Are appropriate safety measures taken? These include clearly marked fire exits, well-lighted hallways, bathroom grip bars, and an in-room emergency call system.

• Is the facility located in a safe and convenient location?

• Is 24-hour security provided?

Rooms:

• Do room arrangements allow for privacy?

• Do individual rooms have windows, allowing for natural light and a pleasant view?

• Are the common areas (activity rooms, lobby, and gathering rooms) large, bright, and well kept?

• Is the dining room welcoming, spacious and not too crowded? Is it easy to move around in?

• Is the kitchen area clean and organized?

Respect for the older individual:

• Does the facility have a written policy about residents’ rights and responsibilities? Is it made readily available?

• Is the staff trained to treat residents with dignity and respect?

• Are residents and their families involved in developing the individual care plans?

Staff:

• What is the number of staff members available per shift?

• Is the staff friendly and respectful of residents?

• Are continuing education and training a priority?

• Specifically, what staff medical services are provided? Does the facility offer healthcare providers, nursing, physical therapy, respiratory care, and occupational therapy?

Nursing care:

• What is the resident-to-nurse ratio?

• Is nursing care provided 24 hours a day, seven days a week?

• What are the credential requirements for the nursing staff?

• Who is the director of nursing and what are that person's credentials?

Licensure and certification:

• Is the facility licensed by the state?

• Has the facility received accreditation based on the states quidelines?

• Is it licensed to provide Medicare and Medicaid coverage?

• Have any formal investigations been done? And if so what were the outcomes?

Costs:

• Which services are included in the standard rate? Are other services provided for additional fees?

• What are the facility's Medicare and Medicaid policies?

Medical considerations:

• Is a healthcare provider available for emergencies 24/7?

• Are personal healthcare providers allowed to follow residents at the facility? Or does a facility-appointed healthcare provider treat residents? Who is that person and what are their credentials?

• Does the facility have arrangements with a nearby hospital in case of an emergency?

• Is emergency transportation available?

Activities:

• Is a well-rounded program of social and recreational activities available for groups and individuals? For example, does the facility offer outdoor outings, arts and crafts classes, movie outings, exercise classes, and reading clubs?

• Does the facility stay active and connected with the surrounding community?

• Are outside trips and activities planned regularly?

Nutritional needs:

• Are meals provided at the facility, and what are the meal plan choices?

• Does a licensed dietitian approve all menus?

• Can the facility accommodate people with special dietary restrictions?

• For people who want to take some meals in privacy, is there a small kitchen or kitchenette available in the individual room or apartment?

Additional services:

• Does the facility provide chaplain services? Can arrangements be made for transportation to church services?

• Is a rehabilitative specialist or physical therapist available for rehabilitation?

• Does a hairdresser or barber offer services at the facility.

• Are housekeeping and laundry needs available? If so, are they included as part of overall fees or provided at an extra cost?

• Is transportation available for trips to the local shopping center, grocery store, library, and bank?