1. What are the different levels of care available to Seniors and what are the differences between each?

The different levels of care and the definition of care for each are as follows:

  • Independent Living: A residential living setting for elderly or senior adults that may or may not provide hospitality or supportive services. Under this living arrangement, the senior adult leads an independent lifestyle that requires minimal or no extra assistance. Generally referred to as elderly housing in the government-subsidized environment, independent living also includes rental-assisted or market-rate apartments or cottages where residents usually have complete choice in whether to participate in a facility's services or programs.

  • Assisted Living/Residential Care Facility: This living arrangement is a state-licensed community offering assistance with daily living activities. These facilities have medical personnel assisting with medication, administration, dressing, bathing and social activities. This is often referred to as a Resident Care Facility (RCF I or II).

  • Skilled Nursing Facility: This is a state-licensed long-term care facility that offers 24-hour medical care provided by registered nurses (RNs), licensed practical nurses (LPNs) and certified nurse assistant (CNAs). The facility is required to have a medical director and house physician. This facility cares for the very frail residents who are totally depedent on nursing care. This facility typically has a short-term rehabilitation unit for residents needing rehab between hospital and home.

2. How do I determine which level of care my loved one needs?

As a caregiver, you should determine how much help your loved one needs on a daily basis and how safe he/she is in the home.

Things to pay special attention to include:

  • Is he/she able to get dressed, bathe and cook for him/herself?

  • How much help does he/she need to manage his/her finances?

  • Does he/she have a history of falls?

  • Does he/she know what to do in an emergency situation?

  • Is his/her judgment good regarding potentially unsafe situations?

  • How much assistance does he/she require for his/her health-care needs (medication, insulin injections, dressing changes)?

To be safe, you might want to contact an Eldercare Specialist to help determine the level of care your loved one needs. This specialist is trained to assess your loved one’s ability to function and determine the level of care required.

We Can Help! Please contact:

Yvette Scott, LPN Supervisor, (314) 531-1413, ext. 231.
yscott@maryryderhome.org
or
Timothy J. Butler, Executive Director, (314) 531-1413, ext. 236.
tbutler@maryryderhome.org

3. When is the best time to consider moving my loved one to a different level of care?

Simply put: Before a crisis. For seniors needing assistance with daily tasks, living alone is never the best solution. In-house services are not always reliable. And not only can staying at home be lonely, it can also be risky. While the decision to move can be very difficult, it can also lead to an improved quality of life for your loved one and yourself.

There are no rules regarding the best time to move; however, you might find the following questions helpful:
• Is your loved one safe at all times in his/her current living situation?
• Are you able to provide the social interaction your loved one needs?
• Is your role as a caregiver taking a toll on your other relationships?

4. Where can I go to get assistance and/or information on Senior topics, such as financial assistance, long-term care facilities, etc.?

The Missouri Guide for Seniors (www.dhss.mo.gov/SeniorServices) is a comprehensive online guide containing detailed information, as well as answers to frequently asked questions, on an exhaustive list of Senior topics. Topics include financial assistance, health care, home and community services, long-term care facilities, housing consumerism, your rights, estate planning, legal assistance and the Missouri Aging Network. It is an excellent resource to determine what assistance and/or services are available for your loved one.

5. How do I know if my loved one needs to move to a supported environment?

If that thought has ever occurred to you, then it is time to act. Have a professional evaluate you the person. Many people can hide certain mental or physical deficiencies (via compensating techniques) in the familiarity of their own home. It may take a physician or case worker with experience with seniors to identify safety risks. Remember that individuals will often hide things; they do not want to lose their independence. Often it can be hard to determine what their capabilities are.

6. What level of care is appropriate for my loved one?

There is a screening tool from the State of Missouri Department of Health and Senior Services called the DA-124C or Level One Nursing Facility Pre-Admission Screening for Mental Illness/Mental Retardation or Related Condition form that physicians and staff at many facilities use to evaluate individuals. It helps to evaluate a person’s physical and/or mental deficits and is used to help determine placement at the appropriate level of care.

The appropriate level of care is also determined by case workers based on physical functioning. For example, someone who is quite sharp mentally but limited to a wheelchair may have to move to a skilled nursing facility due to the inability to make an unassisted pathway to safety (required for RCF I or II or Assisted Living). Alternatively, someone with limited mental capacity (perhaps early dementia) yet fully ambulatory may be able to stay in the lower level of care as long as they can make the unassisted pathway to safety.

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