1. 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, before a crisis occurs. 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.

Have a professional evaluate 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.

You might find the following questions helpful in determining the right time to move your loved to a supported environment:

  • 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?

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

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 assistants (CNAs). The facility is required to have a medical director and house physician. This facility cares for very frail residents who are totally dependent on nursing care. This facility typically has a short-term rehabilitation unit for residents needing rehab between hospital and home.

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

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

Things to pay special attention to include:

  • Is she able to get dressed, bathe, and cook for herself?
  • How much help does she need to manage her finances?
  • Does she have a history of falls?
  • Does she know what to do in an emergency situation?
  • Is her judgment good regarding potentially unsafe situations?
  • Is her judgment good regarding potentially unsafe situations?
  • How much assistance does she require for her health-care needs, i.e. 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.

The State of Missouri Department of Health and Senior Services provides a screening tool called the DA-124C or Level One Nursing Facility Pre-Admission Screening for Mental Illness/Mental Retardation or Related Conditions. Physicians and staff at many facilities use this form to evaluate individuals’ physical and/or mental deficits and to help determine 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 in a wheelchair, may have to move to a skilled nursing facility due to the inability to make an unassisted pathway to safety, which is a requirement 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.

4. Where can I go for assistance and information on senior topics, such as financial assistance or long-term care facilities?

The Missouri Department of Health and Senior Services (http://health.mo.gov/seniors/seniorservices/) provides comprehensive online resources 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.