Choosing the Right Care

When a person can no longer live independently, or needs an extended period of rehabilitation and convalescence, it can be confusing to determine what is the right choice of care. Fortunately, there are some guidelines which can be helpful. Whatever the final decision, it is important that the family, the person's physician, and the person needing care all be involved in considering the choices and making the decision.

In Texas, different types of care are available for different types of needs. Keep in mind that if you choose a less comprehensive form of care, you may need to make another move and another choice in a short period of time. For this reason, many people try to look ahead and lessen future trauma by choosing a care plan or setting that will easily transition into another, more appropriate one in the next couple of years. The following is a list of the five most common levels of care.

LICENSED NURSING FACILITY

The physician is usually responsible for the patient's entry into the long term care spectrum, through deliberate planning and consultation with the patient, family, and other health care workers.

A comprehensive evaluation of each older person's situation is essential to the provision of the right services at the right time, when issues of long term care arise. This assessment should concern the individual's state of physical and emotional health, finances, and relations with family and others.

Licensed nursing facilities provide the most comprehensive care available, with the most stringent health and safety requirements, and the most trained and professional staff around-the-clock. With more than 40 years of growing expertise and standards of care for the geriatric and disabled person, nursing facilities provide the most complete array of nursing and rehabilitative care, as well as medical monitoring, social, mental and psychological stimulation. Family and volunteer involvement are encouraged. The focus here is on maintaining or enhancing a resident's quality of life, as well as promoting one's independence. Staff-to-resident ratios considerably exceed other options.

SUBACUTE/TRANSITIONAL CARE

Subacute or transitional care is one of the fastest growing programs in the health care industry. Subacute Units are often found in acute care hospitals, acute rehabilitation hospitals and in skilled nursing units of long term care facilities. Subacute patients have several payor sources with Medicare being the primary, followed by managed care providers.

The subacute care program is a specialty program specifically designed for the patient who has had a recent illness, change in an old disease process; has a determined course of treatment, and does not require intensive diagnostic and/or invasive procedures.

Patients on the subacute unit have a shorter length of stay (approximately 7 - 30 days), and have an illness or treatment plan requiring multiple treatments: respiratory therapy, physical, occupational or speech therapies, IVs, lab work, and/or x-rays.

ASSISTED LIVING FACILITIES

Be sure to check that your choice is licensed by the state as a personal care facility. Like nursing facilities, assisted living facilities offer meals, laundry and a variety of services to help with things like dressing, bathing, and grooming. In general, residents are expected to be more independent, less needy of monitoring and nursing intervention to prevent developing problems, and able to take their own medications if prompted by a staff member.

In some cases you may find combinations of these services being offered together. For example, one building may house both personal care and nursing home wings, so that a person can be served where most appropriate at any given time.

FOSTER CARE HOMES

These are typical family homes - like yours - operated by the owner or by someone the owner has hired. They are not licensed. The state does in most cases, however, require them to meet minimum fire safety requirements, but fewer than the facilities mentioned above. And the state is not required to do any follow-up to ensure compliance. In these homes, only one "caregiver" is required to be present, and he/she is allowed to be away for up to three hours a day without providing a substitute caregiver. This would suggest that a person who needs supervision or medical or nursing monitoring would not be appropriately placed here. Training of any other personnel, if any, is also limited compared to the other levels of care.

HOME HEALTH CARE

This is a variety of services provided by visiting caregivers in one's own home on an intermittent basis. Be sure the home health care agency is licensed by the state, which means they must meet minimum standards. Home health care does not provide around-the-clock care, but can provide specialized services such as physical or speech rehabilitation, procedures and monitoring requiring a registered nurse, and personal services.

The following chart shows the similarities and differences among the five levels of care.

	Nursing Facility	Sub-Acute Care	Assisted Living	Foster Care	Home Health Care
Licensed	yes	yes	yes	no	yes
Licensed Nurses	around the clock	around the clock	some facilities	no	periodic visits, if approved
Licensed Administrator	yes	yes	no	no	no
Certified and Trained Nursing Assistants	yes	yes	some facilities	no	yes
Federal Regulators	13 dept./divs.	yes	no	no	yes
State Regulators	10 depts.	10 depts.	2 depts.	1 dept.	5 depts.
Local Regulators	4 depts.	4 depts.	yes	no	no
24-hour Assistance	yes, by licensed nurses & certified nursing assistants	yes, by licensed nurses & certified nursing assistants	yes	residents can be left alone for up to 3 hours	n/a*
Activity Room	yes	yes	yes	no	n/a
Dining Room	yes	yes, usually separate	yes	communal table	n/a
Therapy Room	yes, in Medicare certified facilities	yes, in Medicare certified facilities	some facilities	no	n/a
Laundry Services	yes	yes	yes	yes	n/a
Dietition Approved Menus	yes	yes	yes	no	possibly
Medical Director	yes	some specialty physicians available	no	no	n/a
Social Worker	yes	yes	no	no	yes
Provides transportation to medical appointments, shopping, church, etc.	yes, in most	yes, in most	yes	in some cases	no
Bill of Rights	for residents	for patients	for residents	for providers, not residents	n/a
Social and Recreational Activities	several hours per day	several hours per day	1 activity per week	no	n/a
Carries Liability Insurance	yes	yes	yes	no	n/a
Provides appropriate phone numbers for residents and families to make complaints	yes	yes	yes	no	yes
Who investigates complaints	Texas Dept. of Human Services	Texas Dept. of Human Services	Texas Dept. of Human Services	facility	Texas Dept. of Human Services

*not applicable

TEXAS NURSING FACILITIES THE MOST REGULATED AND SUPERVISED
HEALTH DELIVERY SYSTEMS

FEDERAL Department of Health and Human Services Medicare Medicaid Health Standards and Quality Center for Disease Control Office of Civil Rights Social Security Administration Food and Drug Administration Occupational Safety and Health Act Department of Labor Veteran's Administration Environmental Protection Agency Equal Employment Opportunities Commission Internal Revenue Service

STATE Texas Department of Human Services Advisory Committee for  Licensed          Nursing Facility Administrators Texas Department on Aging Workers' Compensation Commission Attorney General Texas Rehabilitation Commission Texas Department of Mental                 Health/Mental Retardation Texas Employment Commission Office of the State Fire Marshall Texas Natural Resource Conservation Commission LOCAL Fire Marshall Law Enforcement Mental Health/Mental Retardation Authorities City/County Health Department

 

FEDERAL Department of Health and Human Services Medicaid Social Security Administration Occupational Safety and Health Act Equal Employment Opportunities                   Commission Internal Revenue Service

STATE Licensed by Texas Department of Human Services Texas Employment Commission Texas Department on Aging LOCAL Fire Marshall Law Enforcement

 

FEDERAL Department of Health and Human Services Medicare Medicaid Health Standards and Quality Center for Disease Control Office of Civil Rights Social Security Administration Occupational Safety and Health Act Department of Labor Equal Employment Opportunities                   Commission Internal Revenue Service

STATE Texas Department of Human Services Workers' Compensation Commission Attorney General Texas Employment Commission Texas Department of Health LOCAL Law Enforcement

 

FEDERAL Internal Revenue Service

STATE 'Enrolled' with Texas Department of Human Services LOCAL Law Enforcement

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