The Continuum of Senior Care

Many older adults will enter a healthcare setting at different points in their lifespan due to the aging process.  Here is a description of the choices available to help with understanding the different types of healthcare settings.

The Acute Care Hospital focuses on acute illnesses, injuries, exacerbations of chronic diseases such as cardiopulmonary conditions, orthopedic problems, and various cancer treatments.  The goal is to promote recovery or maintain the level of functioning through quality care and preventing complications.       

Acute Rehabilitation is an intensive, interdisciplinary approach to providing care.  The team can consist of nurses, therapists, physicians, and other specialists, providing three or more hours of combined therapies. Referrals can be due to conditions such as stroke, head trauma, neurological diseases, amputation, spinal cord injury, and orthopedic surgery.    

The Transitional/Progressive Care Unit is for medically stable patients who are beyojnd the acute illness or injury phase, but are not ready to return home.  They may need short-term skilled nursing due to wound care, gait training, or intravenous therapy.  The goal is for patients to transition to wellness.

Long-Term Acute Care Hospital (LTACH) may be a stand-alone hospital or located within a hospital.  The LTACH provides extended medical and rehabilitative care to patients with clinically complex problems who need hospital-level of care for an extended period, usually about 25 days.  

Home Health Care is for people who may be homebound due to a serious illness or disability.  Physical, occupational, and speech therapies that are medically necessary must be ordered by a healthcare professional to show that the patient's health condition qualifies them for home health services in order to be reimbursed by insurance as allowable expenses.

Long-Term Care Facilities are often referred to as nursing homes and are subject to federal standards.  Most residents are not able to take care of themselves due to illness, disability, or dementia.  Services provided can be rehabilitation, skilled care while recovering from surgery, extended illness, dementia care and wound care.  Some Long-Term Care facilities have dedicated units for middle to late stage Alzheimer's diesase and other dementias.

Adult Day Services are delivered in a group setting and can include health care, meals, and activities.  This is usually done by a combination of organizations, such as churches, hospitals, or healthcare systems to provide care.  The advantage of an Adult Day Services program is that a person can stay at home, then go to the center during the day to receive services while their caregiver goes to work or to have respite.  This arrangement is good for people with chronic health conditions, cognitive impairments, limited mobility or physical disablilities, and safety concerns about being home alone.

The Assisted Living Facility can be a freestanding facility or part of a long-term care facility.  Residents can function on their own, but may need assistance with activities of daily living or are in need of a safer environment.  Assisted living facilities provide meals and activities.  They have common rooms for games and entertainment to promote socialization.  Assisted living facilities are licensed by the state Department of Social Services and abide by quality standards set by the state.

Continuing Care Communities offer a range of levels of care, from independent living to skilled nursing care in a nursing home setting, where residents can move to a higher level of care as needed.  Sometimes this would involve moving to a different area of the community, and sometimes it would invlve receiving home health care services where they are.  The Continuing Care Community's emphasis is on wellness and health promotion so that residents can maintain the highest level of functioning.

Foster Care or Group Homes provide a homelike atmosphere for older adults who can perform some activities of daily living and need help with others.  The residents may have different physical and medical needs.  The home size can vary from just a few residents to eight.  In Virginia,  group homes of four or more residents are licensed by the state Department of Social Services.

Hospice Care is a holistic, interdischplinary approach to care that provides palliative care to those patients nearing the end-of-life.  Hospice is based on the coordination of all health care professionals to manage pain for and make the person as comfortable as possible.  Hospice care can be delivered in a range of settings, from an assisted living facility to a nursing facility, at home or in a hospital, or as a stand-alone facility.

The information in this article is a condensed version of "Understanding the Continuum of Senior Care" (2013) Senior Care Central, LLC.  Used with permission 1/6/2014.


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