Resdential Home Care Options for Persons With Alzheimer’s & Dementia

If the person with Alzheimer’s or other dementia prefers a communnal living environment or needs more care than can be provided at home, a residential facility may be the best option. Different types of facilities provide different levels of care, depending on the person’s needs.

Types of residential care

A good long-term care facility should feel comfortable and homelike. Feeling at home offers privacy and provides opportunities to meet with other residents.Learn about the different types of residential care to determine which one best fits the needs of the person with dementia.

Retirement housing 
Retirement housing may be appropriate for individuals with early-stage Alzheimer’s who are still able to care for themselves independently. A person may be able to live alone safely, but has difficulty managing an entire house. Generally, this type of senior housing provides limited supervision and may offer opportunities for social activities, transportation and other amenities.

Assisted living (also called board and care, adult living, supported care)
Assisted living bridges the gap between living independently and living in a nursing home. It typically offers a combination of housing, meals, supportive services and health care. Assisted living is not regulated by the federal government and its definitions vary from state to state. Not all assisted living facilities offer services specifically designed for people with dementia, so it is important to ask.

Nursing homes (also called skilled nursing facility, long-term care facility, custodial care)
Nursing homes provide round-the-clock care and long-term medical treatment. Most nursing homes have services and staff to address issues such as nutrition, care planning, recreation, spirituality and medical care. Different nursing homes have different staff-to-resident ratios. Also, the staff at one nursing home may have more experience or training with dementia than the staff at another. Nursing homes are usually licensed by the state and regulated by the federal government.Alzheimer’s special care units [(SCUs) also called memory care units]
SCUs are designed to meet the specific needs of individuals with Alzheimer’s and other dementias. SCUs can take many forms and exist within various types of residential care. Including assisted living facilities, and they may or may not be locked or secure units. Such units most often cluster settings in which persons with dementia are grouped on a floor or a unit within a larger residential care facility. Some states have legislation requiring nursing homes and assisted living residences to disclose their fees and list the specialized services their SCU provides, including trained staff, specialized activities and ability of staff to care for residents with behavioral needs. Because laws vary, it is important to ask specific questions about what type of care is provided in a SCU to ensure that the level of care is appropriate for the person.

Continuing care retirement communities (CCRC) 
CCRCs provide different levels of care (independent, assisted living and nursing home) based on individual needs. A resident is able to move throughout the different levels of care within the community if his or her needs change. Payment for these types of facilities can include an initial entry fee with subsequent monthly fees or payment may be based solely on monthly fees.

When living at home is no longer an option

Get support

Join our ALZConnected online community and get advice and support from other caregivers facing similar situations. There may come a time when the person with Alzheimer’s disease or dementia will need more care than can be provided at home. During the middle stages of Alzheimer’s, it becomes necessary to provide 24-hour supervision to keep the person with dementia safe. As the disease progresses into the late-stages, round-the-clock care requirements become more intensive.

Making the decision to move into a residential care facility may be very difficult, but it is not always possible to continue providing the level of care needed at home.

The questions below may helpful when determining if a move to residential care a good option:

  • Is the person with dementia becoming unsafe in their current home?
  • Is the health of the person with dementia or my health as a caregiver at risk?
  • Are the person’s care needs beyond my physical abilities?
  • Am I becoming a stressed, irritable and impatient caregiver?
  • Am I neglecting work responsibilities, my family and myself?
  • Would the structure and social interaction at a care facility benefit the person with dementia?

Even if you planned ahead with the person for a move, making this transition can be a stressful experience. You may feel guilty and wonder if you are doing the right thing. These feelings are are common. Families that have been through the process tell us that it is best to gather information and move forward. Keep in mind, that regardless of where the care takes place, the decision is about making sure the person receives the care needed.

Choosing a care setting

Find the right fit.

Use our Community Resource Finder to search for local residential care facilities.Search TodayFirst steps:

  • Plan on visiting several care facilities. Take a look around and talk with the staff, as well as residents and families.
  • When you visit a care facility, ask to see the latest survey/inspection report and Special Care Unit Disclosure form. Facilities are required to provide these. The report and the disclosure form can give you a picture of the facility’s services.
  • Visit the facilities at different times of the day, including meal times.
  • Ask the care facility about room availability, cost and participation in Medicare or Medicaid. Consider placing your name on a waiting list even if you are not ready to make a decision about a move.
  • If you will be paying for the facility out of pocket, ask what happens if the person with dementia runs out of money. Some facilities will accept Medicaid; others may not. If you anticipate the need for Medicaid either now or in the future, plan to visit with a lawyer that specializes in elder care prior to moving into a facility to ensure a good financial plan is in place.

Care facility checklist

When choosing a care facility, there are a number of factors to consider, including the staff, the facility, the programs and the type of treatment residents receive. Use this checklist when considering a facility:

Family Involvement

  • Families are encouraged to participate in care planning
  • Families are informed of changes in resident’s condition and care needs
  • Families are encouraged to communicate with staff

Staffing

  • Medical care is provided
  • Personal care and assistance is provided
  • Staff recognize persons with dementia as unique individuals, and care is personalized to meet specific needs, abilities and interests
  • Staff is trained in dementia care
  • Physicians and nurse practitioners on premises and registered nurse on site at all times
  • Staff can handle challenging behaviors
  • Ratio of residents to staff

Programs and Services

  • Appropriate services and programming based on specific health and behavioral care needs are available
  • Planned activities take place (ask to see activity schedule; note if the activity listed at the time of your visit is occurring)
  • Activities are available on the weekends or during evenings
  • Activities are designed to meet specific needs, interests and abilities
  • Transportation is available for medical appointments and shopping for personal items
  • Care planning sessions are held regularly
  • Therapies available such as physical, occupational, speech and recreational
  • Religious services and celebrations available to residents

Residents

  • Personal care is done with respect and dignity; personal care times flexible, based on individual’s schedule
  • Residents are comfortable, relaxed and involved in activities
  • Residents are well-groomed, clean and dressed appropriately
  • Rate of falls for residents
  • Residents with psychiatric illness as their primary diagnosis on the same unit as residents with dementia

Environment

  • Facility is free of unpleasant odors
  • Indoor space allows for freedom of movement and promotes independence
  • Indoor and outdoor areas are safe, secure and monitored
  • The facility is easy to navigate
  • There is a designated family visiting area
  • Resident rooms are clean and spacious
  • Residents are allowed to bring familiar items with them, such as photos, bedding a chair

Meals

  • There are regular meal and snack times
  • Food is appetizing (ask to see the weekly menu and come for a meal)
  • The dining environment is pleasant
  • Family and friends are able to join at mealtime
  • Staff have a plan for monitoring adequate nutrition
  • Staff are able to provide for any special dietary needs
  • Staff provide appropriate assistance based on person’s abilities (for example, encouragement during meals or assisted feeding in advanced stages)
  • There are no environmental distractions during meal time (noisy TV etc.)

Policies and Procedures

  • Family and friends able to participate in care
  • Visiting hours work for the family
  • Discharge policy has been discussed (learn about any situation or condition that would lead to a discharge from the facility, such as change in behavior or financial circumstances)
  • As residents needs change, availability of continuing care
  • Aging in place policy where residents can remain in the facility, even in the same room, throughout the course of the disease
  • Escort to the emergency room if a visit is required
  • Available end-of-life, hospice care


Costs

The cost for care varies widely depending on the type of facility. The national average cost for basic services in an assisted living facility is $45,000 per year *. In a nursing home, the average cost for a private room in a nursing home is $97,455 per year* and the average cost of a semi-private room in a nursing home is $85,775 per year.*

Most families pay for residential care costs out of their own pockets. Types of benefits that may cover nursing care include long-term care insurance (check the policy as certain requirements may need to be met before receiving benefits), Veterans benefits and Medicaid.

Medicare does not cover the cost of long-term care in a care facility. Medicare only covers short-term skilled care after a hospital stay.

*Source: Genworth Financial, Inc. Genworth 2017 Cost of Care Survey. Home Care Providers, Adult Day Health Care Facilities, Assisted Living Facilities and Nursing Homes.

Help is available

Alzheimer’s Association 24/7 Helpline care consultants can help you with residential care decision-making and provide you support. Call us at 800.272.3900 or visit our online Community Resource Finder tool.

Medicare’s Nursing Home Compare provides detailed information about the past performance of every Medicare and Medicaid certified nursing home in the country.

Argentum offers information about assisted living, a checklist of questions to ask when considering a facility, and a provider directory to identify facilities in a particular area.

The National Long-Term Care Ombudsman Resource Center provides information about federal ombudsman or advocates for residents of nursing homes, board and care homes and assisted living facilities. Ombudsmen provide information about how to find a facility and what to do to get quality care.

Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) website allows you to search for accredited long-term care facilities. An accredited facility is a nursing home or assisted living that meets very high standards of care set by JCAHO.
 

Answers for the “Funding Demand” for Dementia & Alzheimer’s Study

NYU-Affiliated Aliviado Lands $6.1M for Hospice Dementia Care

 October 29, 2018

Aliviado Health, an initiative run out of the Hartford Institute for Geriatric Nursing at New York University’s Rory Meyers College of Nursing, has landed $6.1 million to study how hospice patients can benefit from effective dementia care. Announced Monday, the funding news is yet another example of both the demand for hospice and specialized dementia care services.

Developed by Ab Brody, associate director of the Hatford Institute and an NYU professor, Aliviado teams up with home-based care providers by offering educational materials, training tools, mentorship programs and treatment algorithms focused on dementia care. The $6.1 million in funding for Aliviado — formally launched in August — comes from a National Institute on Aging grant.

The National Institute on Aging is part of the National Institutes of Health.

About 16% of patients in hospice care have dementia as their primary diagnosis, making it the second most common hospice diagnosis after cancer, according to NYU’s Rory Meyers College of Nursing. Hospice providers often have trouble caring for patients with dementia because of the challenge and complex symptoms associated with the set of diseases.

“Despite high rates of dementia in hospice care, little research has been performed on how hospices can best help people with dementia and their caregivers to ensure as high a quality of life as possible during the vulnerable period at the end of life,” Brody said in a statement. “Through further research, we aim to improve the quality of dementia care, support family caregivers, and empower hospice clinicians to provide effective and compassionate care for people with dementia.”

Since launching, Aliviado has been working with large, not-for-profit home health and hospice agencies located across the U.S., Brody previously told Home Health Care News. Aliviado — Portuguese for “relief” — had been planning on partnering with a group of 27 hospice agencies as part of “a future project,” he said.

Aliviado’s grant is for five years and will fund two phases of research. The first will include a year-long process to further tailor Aliviado’s dementia care program for the hospice setting and launch pilots in two hospice agencies.

The second phase, which will last four years, will roll out a randomized clinical trial in 25 hospice agencies across the country, including more than 20 hospice agencies that are part of the National Partnership for Hospice Innovation.

“We are thrilled to be a part of this critically important study to improve care for those with Alzheimer’s and related dementias and their families at the end-of-life,” Tom Koutsoumpas, president and CEO of the National Partnership for Hospice Innovation, said in a statement. “The dementia population is growing rapidly and we are committed to ensuring they have access to the highest-quality hospice care and look forward to partnering on this trial to work toward achieving that vision.”

Washington, D.C.-based National Partnership for Hospice Innovation is a nationwide collaborative of over 60 non-profit, community-based hospice and palliative care organizations.

Alzheimer’s disease — a form of dementia — is the sixth-leading cause of death in the United States, according to the Alzheimer’s Association. Between 2000 and 2015, deaths from heart disease have decreased by 11%, while deaths from Alzheimer’s have increased 123%.

In addition to the member agencies of the National Partnership for Hospice Innovation, other hospice agency partners include Vitas and Providence TrinityCare Hospice in California.

Vitas, one of the nation’s largest providers of end-of-life care, is a wholly owned subsidiary of Cincinnati-based Chemed Corporation (NYSE: CHE), which released its third quarter earning results for 2018 on Monday.

Vitas’ net patient revenue was $302 million during the third quarter of 2018, an increase of 4.4% from the same quarter a year prior, according to the company. Its average daily census was 17,957, an increase of 7.8% on a year-over-year basis.

Written by Robert Holly

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More $$$ for Medicare Payments-2019

By Robert Holly | October 31, 2018

Despite industry concerns, the Centers for Medicare & Medicaid Services (CMS) has finalized the Patient-Driven Groupings Model (PDGM) planned to start in 2020. The agency has also finalized several other changes to how home health providers are reimbursed for their services starting in 2019, tweaking remote patient monitoring rules and refining the Value-Based Purchasing Model (VBPM).

CMS projects that Medicare payments to home health agencies in calendar year 2019 will be increased by 2.2% — or $420 million — based on its finalized policies, announced Wednesday.

The reimbursement rate increase is the first the home health industry has received in a decade — and slightly more than what CMS initially suggested in July’s proposed payment rule. The agency originally projected that home health payment changes would increase Medicare payments to home health agencies by $400 million.

Among its provisions, PDGM is designed to remove current incentives to over-provide therapy services by more strongly weighting clinical characteristics and other patient information, according to CMS. PDGM would also mean that the traditional 60-day unit of payment would be halved to 30 days.

PDGM — mandated to be budget neutral by the Bipartisan Budget Act of 2018 — takes into account certain behavioral changes that policymakers expect home health providers to make after the model is implemented. In particular, they include assumed changes to clinical and co-morbidity coding behavior, along with how Low Utilization Payment Adjustment (LUPA) claims are handled.

If no behavioral assumptions are made, CMS estimates that the 30-day payment amount needed to achieve budget neutrality would be $1,873.91. With the behavioral assumptions, that amount drops to $1,753.68 — a 6.42% decrease.

Home health stakeholders have widely criticized the behavioral assumptions, even teaming up with several members of Congress to get them changed or removed in PDGM via multiple pieces of legislation — S. 3545, S. 3458 and H.R. 6932.

“While we had hoped CMS would consider modifications outlined by the home health provider sector when finalizing this rule, this announcement reinforces the need for the industry to continue our advocacy to get the new home health payment system right,” LHC Group (Nasdaq: LHCG) CEO and Chairman of the Partnership for Quality Home Healthcare Keith Myers said in a statement. “We will continue to work collaboratively with CMS and lawmakers in Congress to refine this new payment system to ensure it is based on a data-driven approach and will support the delivery of uninterrupted, high quality home healthcare to older Americans.”

Although language for PDGM is included in CMS’ final home health payment rule for 2019, that does not mean the payment model is set in stone, Amedisys, Inc. (Nasdaq: AMED) CEO Paul Kusserow told investors during a conference call Tuesday. Stakeholders will likely have until Jan. 1 2020 to secure modifications on the model, he said.

The final rule’s implementation language differs than the proposal’s, Joy Cameron, vice president of policy and innovation for ElevatingHOME, told Home Health Care News via email. The proposed rule stated PDGM will be implemented on Jan. 1, 2020, while the final rule states “on or after” Jan. 1, 2020.

“Time to make sure we have it right and necessary vendors and CMS are fully online,” Cameron said.

The final rule’s PDGM language includes 216 more Home Health Resource Groups (HHRGs) than originally proposed because of a Medication Management Teaching and Assessment (MMTA) split, she said.

In addition to the rate increase and finalization of PDGM, the home health final rule also solidifies CMS’ proposal to define remote patient monitoring in regulation for the Medicare home health benefit and to include the cost of remote patient monitoring as an allowable cost on agencies cost reports.

“This home health final rule focuses on patient needs and not on the volume of care,” CMS Administrator Seema Verma said in a statement. “This rule also innovates and modernizes home health care by allowing remote patient monitoring.”

The Partnership for Quality Home Healthcare supports the final rule’s move to include costs associated with tele-monitoring. The Washington, D.C.-based organization also supports changes in the final rule aimed at better payment accuracy related to the MMTA clinical group.

The home health final rule also solidifies substantial changes to rural add-on payments, namely by categorizing counties and equivalent areas into one of three new buckets with varying add-on levels.

The full rule can be accessed here.

Written by Robert Holly