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Getting to Grips with Levels of Elderly Care: Care, Nursing Homes, and Assisted Living Facilities

This article is part of a series on elderly care. The series provides important information about caregiving practices.

Healthcare professionals should always push caregivers and family members in the right direction when they are deciding on what forms of care are most appropriate for the person they are looking after. 

But being informed about different levels of elderly care outside of the doctor’s office is important, because, ultimately, doctors do not make decisions on behalf of their patients in the way that is expected of caregivers and family members.

Learn about the different levels of elderly care, and how determining what their difficulties are can make it easier to choose between different types of care, like support, palliative, and hospice care, and different forms of it, like nursing homes and assisted living facilities.

What Are the Different Levels of Elderly Care?

Levels of elderly care can be split into three categories: early, mid/moderate, and late/progressed elderly care. 

The type of care that may be considered for someone will depend on the severity of the person’s lack of capacity to care for themselves, their prognosis, and the degree to which they need to rely on other people to live.

Take a look below to find out more.

Level One – Early Elderly Care

‘Early’ forms of care are low level and usually limited to supportive care. This suits those that are still able to live independently for the most part.

This means that it will usually be given on a part-time or informal basis, whether or not someone is hired or a family member/friend checks in several times a week.

There will be advanced care planning if the person has received a diagnosis of a progressive disorder, like a terminal illness or dementia.

Caregivers will accompany the person to doctor’s appointments and carry out tasks like grocery shopping on behalf of them.

Specialized medical care isn’t necessary at this stage, and any health conditions will be dealt with by doctors.

Credit: TEDx Talks

Level Two – Moderate Elderly Care

Mid-level care is also largely supportive care.

The difference is that the person’s limitations are more severe, so assisted living will likely be necessary to help them carry out what’s referred to as ‘activities of daily living’ (ADLs)—the tasks of everyday life, like eating, dressing and using the toilet.

This could amount to a full-time or part-time caregiver assisting the person at home with carrying out ADLs.

There may also be the introduction of palliative care, which is intended to encourage autonomy and provide physical and psychosocial relief from pain.

Some form of specialized medical care may also be recommended by professionals depending on the diagnoses given by doctors.

Namely, those diagnosed with dementia beyond the early stages might consider memory care, which is provided at memory care facilities.

Level Three – Late/Progressed Elderly Care

Supportive care isn’t designed for later stages of progressive disorders. Caregivers will instead consider palliative care or hospice care, the latter being the highest level of care alongside round-the-clock nursing.

Since palliative care is focussed on relief from symptoms and encouraging autonomy, it’s more suited for those that, despite having symptoms that have progressed, are still sound of mind.

Hospice care is specialized end-of-life care for those that have a condition that has deteriorated significantly.

This might be a terminal illness, or in the case of dementia, the final stages of the disorder, where the person is unable to carry out any ADLs. 

Credit: The Economists

5 Levels of Care in Nursing Homes

Large scale nursing homes will usually have different units or wards where different levels of care are catered to. 

The specifics of how a facility will divide up levels of care or admit patients will differ widely, but most will follow the kind of three-level model described in the previous section.

The different types of care in each unit or ward can be considered as dependent on the level of care required. 

The five most common are listed below.

Memory Care (low to moderate level care)Designed for patients with memory impairment (usually caused by Alzheimer’s disease). It’s a specialized form of care offered on a short-term basis. Memory care units are usually locked down, so be aware that autonomy is generally limited as part of treatment. 
Skilled Nursing (high level care)Round-the-clock supervision provided by licensed nurses for patients with intensive medical needs. This is considered the highest level of care. Staff can give medication, administer injections, dress wounds, etc. An elderly patient that has just been discharged from hospital might go straight into receiving skilled nursing care.
Residential Living (low level care)Residential units are for those that don’t require specific medical treatments or other forms of specialized care. They may need assistance with certain ADLs, but not all; laundry might be done by someone else, for example. Much like a college dorm, they emphasize community with social areas. It’s the lowest level of care.
Rehabilitation (high level care)Includes various types of treatment, like physical therapy and speech therapy. It might be administered alongside, or instead of, skilled nursing, particularly if they have just had surgery, suffered a stroke, or lost the ability to move or speak. In nursing home contexts, ‘rehabilitation’ does not refer to treatment for drug or alcohol addiction. 
Assisted Living (low to moderate level care)There’s lot’s of overlap between residential living and assisted living, but the latter implies more care is provided. While in a residence, ADLs are mostly left to the person to carry out independently, assisted living units are characterized by much more close supervision. Staff can help with all ADLs, like feeding, getting in and out of bed, and getting dressed.

Create an Action Plan for Caregiving

Developing a unique action plan for caregiving is an important cornerstone in implementing effective care. It helps caregivers keep what’s by nature an exceedingly complicated job as straightforward as possible. 

There’s no template for a plan because every person is different, and so are the needs. But try following some of the steps below to get an idea of what planning will look like.

1. Organization

These days, paperwork is not as excessive as it once was, but any papers acquired from doctors visits, quotes provided by caregivers or facilities, and financial/legal documents need to be properly organized. Keep legal and financial documents separate from medical ones. 

Organization is something that needs to be done consistently, but it’s also a good place to start in terms of planning.

2. Numbers, email address, personal details

Whether it’s on a phone or in an address book, a list of essential contact information needs to be made at least twice, for the caregiver and for the person being cared for. 

This will include the phone numbers, email addresses, and any other relevant personal details (e.g. addresses) of doctors, nurses, healthcare centers, next of kin, close family members and friends, trusted taxi services, helplines, and so on.

3. Personal information document

The personal information of the person being cared for needs to be contained in a single document. This isn’t just a phone number or email address. Include the following:

  • Full name
  • Address
  • Phone number
  • Carers full name and contact details
  • Social security number
  • Medicare/Medicaid numbers
  • Private insurance policy information, including company and number
  • Life insurance policy number
  • Other benefits information

4. Goals & Scheduling

Alongside the person being cared for and their main doctor, discuss short and long-term goals for care/treatment. 

Be realistic–if a person diagnosed with late stage dementia has lost the ability to walk, rehabilitation isn’t possible. Unrealistic goals can be distressing and an annoyance for the person being cared for. 

The caregiver should focus on concise goals that can be contained within a weekly schedule, even if they seem small and insignificant–going for a walk round the block a few times a week, or baking a cake together, for example. 

Schedules don’t necessarily need to be shared with the person being cared for, particularly if the caregiver notices that it irritates or distresses them.

A cup of coffee sits on a diary with a schedule and a list of goals for the month.

Schedules can instead be a way for the caregiver to keep a clear mind about what they intend to do. The doctor will be able to identify the long-term goal of treatment. 

It’s easier said than done, but be emotionally prepared. For most moderate to late elderly care, this is going to be based around comfort and ease rather than recovery. 

5. Legal advice

Finding a solicitor that can be trusted and relied upon will be a great ‘tool’ for caregivers to have moving forward, particularly if a significant loss of mental capacity in the patient is foreseen by doctors. 

When capacity is limited, discussing options for the person’s finances will be inevitable at some point, so it’s wise to head to a lawyer sooner rather than later.

They can recommend the various types of legal routes the caregiver can take to assume control over property and finances on behalf of the person being cared for. 

Caregivers must never do this behind the back of the person being cared for; let them stay in control and make the decisions while they retain the capacity to do so. A caregiver should always prioritize the wishes of the person being cared for.

6. House adjustments

If at-home care is going to be facilitated, adjustments will need to be made to the house based on the recommendations of healthcare professionals to make it safer and more comfortable for the person being cared for.

Thoroughly check the house for possible safety issues and make notes of everything that needs to be removed, like rugs and uneven floor surfaces that can cause trips.

7. Visitations/Quotes from Care Homes

If care is to be administered out of the home, the caregiver will need to tour properties and meet with managers. Locality should, naturally, be the priority here, but checking as many properties as possible is fine. 

Care facilities will have quite different programs, treatment options, and even admission acceptance rates.

Quotes are rarely presented outright on websites or even through phone calls, so be prepared to visit plenty of places. If mobility allows for it, always bring the person being cared for along, so they can be the chief decision maker in determining where they end up.

8. Budget

With organization, goals, legal services costs, quotes from care homes or lists of things to buy or change in the home all arranged, it’s time to begin creating a budget. 

A phone calculator is held above some financial documents.

This doesn’t have to be exhaustive (things are always prone to change, so account for that with a deficit), but it should be as detailed as possible to make it easier to stay on top of finances.

Having a clear budget detailing all the associated expenses is important for making insurance claims to cover the costs of care, especially when care is being carried out by a family member at home. 

FAQ

How do you determine the level of care for elderly?

The level of care for an elderly person should be determined first and foremost through medical needs. Doctors will be able to provide recommendations based on their diagnoses. Other things to consider are the level of autonomy they wish to retain, whether specialist care is required, and prognosis. 

What are the different care levels?

Care can be thought of across three levels: low level, mid level, and late/progressed elderly care. This is how most facilities present the levels. The latter represents the most medically intensive care, while ‘low level’ is for those still retaining a strong degree of mental capacity and mobility.

What is the highest level of assisted living?

What are the types of care given to elderly?

Types of care are extensive. Check out our article on types of care for more detailed information on some of the types of elderly care available. 

Conclusion

Typically, nursing homes and other care facilities observe three distinct levels of care–a low, medium, and high level, representing the degree of assistance which is needed based on the amount of ADLs the person is capable of carrying out.

Be aware that the way doctors, healthcare professionals, and nursing homes assess people will differ across the board. Our advice is not to be taken as strict medical advice, but instead aims to help caregivers better understand and prepare for their role. Always consult medical professionals and lawyers before making medical or financial decisions on behalf of someone else. 

Sources: 
https://avendelle.com/3-phases-of-elderly-care/
https://medcom.uiowa.edu/theloop/announcements/three-different-types-of-care-for-serious-illness-supportive-palliative-hospice
https://culpepperplaceassistedliving.com/assisted-living-levels-of-care/