“Long Term Care: Levels of Care, Personal Options, and Regulatory Requirements”
Wednesday, June 17, 2015- Noon (EDT) This webinar will be focused on the long term care industry and the mire of acronyms, settings, regulations, and requirements. The goal of this session is to help individuals understand the differences between the various levels of care and identify which type of facility may be most appropriate for the very specific needs of our elders. We will also address the recent evolution of this vitally important industry and discuss the possible future it may hold including: skilled nursing , assisted living, enhanced assisting facilities, adult Home, and personal care home. . . What does it all mean?; where the industry has been and where it appears to be going; and how to identify the most appropriate type of facility for your loved one’s specific needs.
Kathy Sindoni, RN, BSN, Owner/Chief Consultant, Katasin Consulting, LLC Kathy has been a registered nurse for 22 years and has been professionally engaged in the Assisted Living Industry since 2001. Kathy is the owner and Chief Consultant of a professional consulting business which serves operators in the Assisted Living Industry. Her consultation services are primarily focused on licensure, quality care and services for residents, regulatory compliance, and program development. Kathy travels throughout New York State and her services provide her with an insider’s view of a multitude of different facilities under many different types of licensure. Her company is an Industry Partner to the Empire State Association of Assisted Living (ESAAL). Kathy also serves on the Assisted Living Services Committee which acts as an advisory panel to ESAAL’s board of directors and also works very closely with the NYS Department of Health. Kathy has previously served as a Healthcare Coordinator at Alterra (Brookdale) Sterling House and Clare Bridge Cottage, in Ithaca, NY, from 2001-2005. She then served as the Administrator and Director of Nursing at Bridges Cornell Heights, in Ithaca, from 2005-2013
Long Term CareLEVELS OF CARE,
PERSONAL OPTIONS, AND REGULATORY REQUIREMENTS
Kathy Sindoni, RN, BSN
---------------------Owner/Chief Consultant
Katasin Consulting, LLC
Where are you in the process?
I know I will have to coordinate long term care soon, but I’m just starting to research the process.
I’ve been coordinating long term care for 0-2 years.
I’ve been coordinating long term care for 2-5 years.
I’ve been coordinating long term care for 5-10 years.
I’ve been coordinating long term care for 10+ years.
I’ve coordinated long term care in the past.
None of the above.
Who finds this whole selection process confusing?
I do!
Not me.
….Why is it so confusing?
Levels of Care I’ll discuss todayAdult Day Care
Certified Home Health Agency (CHHA)
Licensed Home Care Service Agency (LHCSA)
Personal Care Homes
Adult Care Facility and Assisted Living Residence (ACF/ALR)
Enriched Housing Programs (EHP)
Assisted Living Program (ALP)
Special Needs Assisted Living Residence (SNALR)
Enhanced Assisted Living Residence (EALR)
Continuing Care Retirement Community (CCRC)
Skilled Nursing Facility (SNF)
Which care options do you have experience with? Adult Day Care
Certified Home Health Agency (CHHA)
Licensed Home Care Service Agency (LHCSA)
Personal Care Homes
Adult Care Facility and Assisted Living Residence (ACF/ALR)
Enriched Housing Programs (EHP)
Assisted Living Program (ALP)
Special Needs Assisted Living Residence (SNALR)
Enhanced Assisted Living Residence (EALR)
Continuing Care Retirement Community (CCRC)
Skilled Nursing Facility (SNF)
None of the above
Adult Day Care Typically Monday through Friday 8:00am-5:00pm
Social, Medical, and Special Needs (Dementia) Sometimes a senior center-type location Sometime within an assisted living facility or nursing home
Advantages• Ability to maintain employment
• Provides respite care• Social interaction and stimulation• Enhances ability to remain at home
• More affordable than facility placement
Disadvantages•Typically only available on weekdays and
during daytime hours• Care giving needs outside of the daycare
program still remain
Certified Home Health Agency (CHHA)
Part-time, intermittent health care and support services
Help patients determine the level of services they need
Either provide or arrange for other services including physical, occupational, and speech therapy, medical supplies and equipment, and social worker and nutrition services.
May be reimbursed by Medicare, Medicaid, private payment, and some health insurers.
Advantages• Supplemental care and support in the home
• Provides some respite to caregivers• Enhances ability to remain at home
• More affordable than facility placement•Covered or supplemented by Medicare/Medicaid
entitlements
Disadvantages• Limited services and hours available
• Typically only in the home for a couple of hours , a few days per week
• Care giving needs for the majority of the day still remain
• Caregivers sometimes need to learn skilled tasks such as injections and dressing changes
Licensed Home Care Services Agency (LHCSA)
Provide same or similar services as CHHA’s but are private pay only.
Often privately owned and may or may not be for-profit.
Advantages• Supplemental care and support in the home
• Provides some respite to caregivers• Typically more accessible than CHHA’s
• Number of service hours available are less limited than CHHA’s
• Enhances ability to remain at home• May be more affordable than facility placement
depending on the number of service hours required
Disadvantages•Care giving needs for the remainder of the day
still remain• Can be quite expensive for a significant
number of service hours (typically $20-25/hr for aide service)
• Not covered or supplemented by Medicare/Medicaid entitlements
Any Questions about…
Adult Day Care?Certified Home Health Agency (CHHA)?Licensed Home Care Service Agency (LHCSA)?
Use the chat box to enter your questions.
Personal Care Homes 24 hour residential care in a supported setting Either in the residential home of the owner(s) or the owner(s) must live at the home Some state specific restrictions regarding the number of people that may live in the home Prohibits the owner(s) from arranging for care services
Advantages• Provides supervision, safety and
support• Provides caregivers with respite and
peace of mind• Meals, housekeeping, laundry, and
transportation• Typically less expensive than Assisted
Living Facilities
Disadvantages• These residences are not licensed and,
therefore, do not have Department of Health regulatory oversight or surveillance• Care giving and medical needs must be
arranged for and coordinated by the resident, family, and/or responsible party•Smaller settings and often have limited life
enrichment or stimulation
Adult Care Facility & Assisted Living Residence (ACF/ALR) 24 hour residential care in a licensed, regulated, and supported setting. Variety of sizes and are able to directly provide or arrange for care services. ACF’s are also often referred to as Adult Homes but also include the Enriched Housing
Program (EHP)-see next slide. ALR’s may or may not have an Enhanced Assisted Living Residence (EALR) certification. Of
note, ACF’s are not allowed to advertise themselves as providing “assisted living”.
Advantages• Are licensed, do have regulatory oversight and
surveillance• Provide supervision, safety and support• Provide respite and peace of mind
• Meals, housekeeping, laundry, transportation , and life enrichment activities are provided
•Direct care & assistance with activities of daily living • Typically less expensive than
Skilled Nursing Facilities
Disadvantages• Retention standards may limit resident’s
ability to remain at this level of care•Skilled nursing services are not allowed to be directly provided by the facility UNLESS
there is an EALR certification in place.
Enriched Housing Programs (EHP) Basically the same as ACF’s and also may or may not have
an Enhanced Assisted Living Residence (EALR) certification. Originally intended for independent apartment-type
settings and are allowed to have kitchens, stoves, and microwaves.
Advantages• May have a microwave or cooktop stove in
the apartment• Greater independence with meals
• Only required to attend one congregate meal per day
• Otherwise basically the same as the ACF
Disadvantages• Diminished oversight by staff if not
attending all congregate meals
Any Questions about…
Personal Care Homes?Adult Care Facility and Assisted Living Residence (ACF/ALR)?Enriched Housing Programs?
Use the chat box to enter your questions.
Assisted Living Program (ALP)
Not to be confused with the Assisted Living Residence (ALR). Program that is Medicaid subsidized and exists within an ACF
facility. Allotted number of bed allocations annually and they are,
therefore, in limited supply throughout the state.
Advantages• These have all of the same advantages as the ACF and EHP but have the added
benefit of financial subsidy • This is the only financially subsidized
program available within the Adult Care Facility/Assisted Living
level of care
Disadvantages• Difficult to obtain due to limited availability
• Have to meet the same financial qualifications as Medicaid thus may have to
wait while “spending down”• Have to time the financial qualification and
available bed opportunity which can sometimes be challenging
Special Needs Assisted Living Residence (SNALR) Same as Adult Care Facilities but have a focus on special needs. (memory care) May or may not have an Enhanced Assisted Living Residence (EALR) certification. Have additional regulatory requirements to meet due to their special needs population. In regards to geriatric care, the special needs group is typically individuals with some form of
dementia. Of note, facilities lacking this certification may not advertise that they provide specialized dementia
care.
Advantages•Have specialized service plans, safety measures, staffing
patterns, and additional staff training to accommodate for and adequately serve the special needs population• Have the added safety of a “wanderguard” system in
place, as well as, additional staffing requirements•Training of staff is intended to provide more appropriate
care and management of behavioral challenges • They are typically less expensive than Skilled Nursing
Facilities
Disadvantages• May be limited availability in the community of
choice• Often at least some behavioral and cognitive
challenges associated with dementia that may affect other residents
• There are regulatory retention standards related to behavior management that could, in certain
circumstances, result in an individual being required to move to a higher level of care
Enhanced Assisted Living Residence (EALR)
Certification that must be applied for and approved by the DOH. Adjunct to an underlying ACF, EHP, or ALR license and allows facilities to
provide additional services not allowed for in the base licensure. Services are primarily related to assistance with transfers, ambulation,
unmanaged incontinence, feeding, medical equipment (such as oxygen), and skilled nursing services such as dressings and nursing assessments.
Advantages• Allows a resident to remain in a facility longer and
“age in place”• Some services, such as dressing changes, may be provided by facility staff rather than having to arrange
for outside agencies or family coverage• Residents, in many cases, may remain at the facility
through end of life• There may be higher staffing ratios and/or nursing staff present to accommodate the higher level of acuity• They are still typically less expensive than Skilled
Nursing Facilities
Disadvantages• May be limited availability in the community of choice•There may be an alteration in the atmosphere due to the
higher level of acuity (i.e. wheelchairs, hospital beds, assistance with feeding)
• There are still certain circumstances that could result in an individual being required to move to a higher level of
care (i.e. immanent danger to self or others, 24 hour skilled nursing needs, skilled nursing needs that exceed
that particular facility’s EALR certification). *Residents and families do, however, have the ability to provide additional services to accommodate the needs
and remain in the facility.
Any Questions about…
Assisted Living Programs (ALP)?Special Needs Assisted Living Residence (SNALR)?Enhanced Assisted Living Residence (EALR)?
Use the chat box to enter your questions.
Continuing Care Retirement Community (CCRC) Community that has Independent Living, Assisted Living, and a
Skilled Nursing Facility available to its’ members all in one setting. Members of the community may move throughout the continuum of
care and remain on the same campus.
Advantages• Allows residents to remain in a familiar setting
regardless of which level of care they may require at any given time
• Residents almost always remain on the campus through end of life
• All levels of acuity can be accommodated• Depending on the contract, there are few additional
fees regardless of the level of care required and residents have a life care contract that remains in
effect even when their money runs out• Spouses may remain in close proximity to each other
Disadvantages• There may be limited availability in the
community of choice•You must be appropriate for and move to the
independent setting first• There are still certain circumstances that could result in an individual being required to
move to an alternate setting (i.e. immanent danger to self or others)• There is typically a large buy-in fee, in
addition to monthly fees.
Skilled Nursing Facilities (SNF) Traditionally known as Nursing Homes. Considered the highest level of care in the Long Term care
industry. Provide 24 hour, on-site skilled nursing care and have
medical directors.
Advantages• Residents rarely have to leave a SNF and
typically remain at the facility through end of life
• There may be higher staffing ratios and/or more nursing staff present to accommodate
the higher level of acuity• Physician care is available at the facility• They are subsidized by Medicare, Medicaid,
and Long Term Care Insurance
Disadvantages• They exist on subsidies and have fewer private-pay
residents. Therefore, they have some limitations to the services and amount of care they can provide.• There is typically an alteration in the atmosphere
due to the higher level of acuity (i.e. wheelchairs, hospital beds, assistance with
feeding, chairfast residents)• They are typically the most expensive
level of care
Any Questions about…
Continuing Care Retirement Community (CCRC)?Skilled Nursing Facility (SNF)?
Use the chat box to enter your questions.
Which care options sound right for you? Adult Day Care
Certified Home Health Agency (CHHA)
Licensed Home Care Service Agency (LHCSA)
Personal Care Homes
Adult Care Facility and Assisted Living Residence (ACF/ALR)
Enriched Housing Programs (EHP)
Assisted Living Program (ALP)
Special Needs Assisted Living Residence (SNALR)
Enhanced Assisted Living Residence (EALR)
Continuing Care Retirement Community (CCRC)
Skilled Nursing Facility (SNF)
None of the above
Ithaca Area Provider ListingAdult Day Care
Longview, Elizabeth Brewster HouseCertified Home Health Agency (CHHA)
Visiting Nurse Services (VNS)Licensed Home Care Service Agency (LHCSA)
Classen Home Health, Community Health and Home Health, Inc. (VNS), Red Moon Caregivers, Comfort Keepers, Caregivers Home Care
Personal Care Homes Old Hundred, Evergreen
Adult Care Facility and Assisted Living Residence (ACF/ALR) Bridges Cornell Heights (ACF/ALR/EALR), Longview (ACF) ALR/EALR, Elizabeth Brewster House (ACF) ALR/EALR, Brookdale Senior Living Sterling House (ACF) ALR/EALR
Enriched Housing Programs (EHP) Brookdale Senior Living Sterling House (ACF) ALR/EALR
Assisted Living Program (ALP) None in the immediate area. Closest are Waverly, Montour Falls, Binghamton Area, Geneva and Auburn
Special Needs Assisted Living Residence (SNALR)Brookdale Senior Living-Clare Bridge Cottage
Enhanced Assisted Living Residence (EALR)Bridges Cornell Heights, Longview, Brookdale Senior Living-Sterling House
Continuing Care Retirement Community (CCRC) Kendal at Ithaca
Skilled Nursing Facility (SNF)Beechtree Rehabilitation Center, Oak Hill Manor, Cayuga Ridge
Ithaca Area References/Resources• Lifelong, 119 W Court St Ithaca, NY 14850 (607) 273-1511
http://www.tclifelong.org/• Tompkins County Health Department http://www.tompkins-co.org/health/• Visiting Nurse Services
http://www.vnsithaca.org/resources/communitypartners.html• Our Parents https://www.ourparents.com/new_york/ithaca/lifelong• Empire State Association for Assisted Living (ESAAL) http://www.esaal.org• New York State Department of Health www.health.state.ny.us• New York State Do Not Refer List
http://www.health.ny.gov/facilities/adult_care/memorandum.htm• Medicare.gov http://www.medicare.gov/LongTermCare/Static/TypesOverview.asp• Department of Health and Human Services National Clearinghouse for Long Term
Care Information http://www.longtermcare.gov/LTC/Main_Site/Understanding/Services/Facility_Based_Services.aspx
• Facility Locator http://list.assistedliving.com• Special Needs Overview (NYS DOH)• http://www.health.ny.gov/facilities/assisted_living/docs/
special_needs_overview_and_requirements.pdf