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Americans are living longer and living well for longer periods of time. This has created a relatively new and growing area of healthcare and provider services, known as elder care. Elder care covers a wide variety of issues. This includes choosing an appropriate healthcare provider to care for an aging person. It also includes making decisions about moving an older adult from home to a residential care setting. People ages 65 and older are the fastest growing segment of America's population. Many older adults are living healthy, active, and independent lives. But as more people reach their 80s and 90s, the number of older adults needing help with daily living increases. The responsibilities of those who provide care for them increase, too.
According to a 2016 report (the most recent statistics available) from the U.S. Department of Health and Human Services' Administration on Aging:
The older population (people age 65 or older) numbered 47.8 million Americans.
The number of older Americans, age 65 and over, is projected to increase from 47.8 million in 2015 to about 98 million by 2060.
Today, people who reach age 65 have an average life expectancy of an additional 19.4 years (20.6 years for women and 18 years for men).
Different stages in life can require different healthcare providers. For older adults, it is important to have a primary healthcare provider who understands the special needs of older people.
Many types of healthcare providers care for older adults. These providers include family practitioners, internists, and geriatricians.
Family practitioner. Provides healthcare to family members of all ages.
Internist. Specializes in internal medicine, generally for adults.
Geriatrician. Specially trained in elder care and in managing many complex and advanced illnesses.
Choosing the right primary healthcare provider is an important decision. Generally, you want a healthcare provider who is skilled and well trained. You also want a provider who cares for and about the person. Other things to think about include:
Will my insurance pay for office visits and healthcare provider services?
Is the healthcare provider a solo practitioner, or is he or she part of a group practice?
Does the healthcare provider accept Medicare patients? What are the practice's Medicare policies and procedures?
What are the healthcare provider's managed care affiliations?
Is the healthcare provider's office in a convenient and safe location?
At which hospital does the healthcare provider treat patients?
Am I comfortable with the age and gender of the healthcare provider?
Are there any language barriers?
Is the healthcare provider a good listener and communicator? Does he or she explain things clearly, fully and patiently to the person and his or her family or caregiver?
What is the healthcare provider's policy about continuing to follow patients who move to residential care centers?
Does the healthcare provider have training in aging-specific conditions such as memory loss, functional decline, and end-of-life issues?
Does the healthcare provider have training in or are they comfortable with providing palliative care to their patients?
Once you have selected 2 or 3 possible healthcare providers, it is a good idea to visit their offices and ask them questions about office policies and their approach to elder care. For example:
How far in advance do I have to make an appointment for a nonemergency visit?
How are emergency visits handled?
Do you treat many older adults?
How do you feel about having family involved in healthcare decisions?
Do you continue to follow people if they move to a local residential care facility?
To make the most of each visit to the healthcare provider's office, it is best to plan ahead. The following guidelines may help you to prepare for the appointment:
Know all the basic information that is likely to be asked of you (see Basic Information Form below).
Bring medical records or have them sent ahead.
Know what medicines the person is taking. These include prescription medicines, over-the-counter medicines, and vitamin and herbal supplements.
Know all diagnosed medical conditions.
Bring along a family member to act as a second set of eyes and ears for the older person.
Write down questions beforehand, including any concerns you would like to discuss with the healthcare provider.
Bring a notepad and pencil or a tape recorder with you to record instructions and take notes.
When visiting the healthcare provider, it’s best to have the following basic information available. This can help make your visit as productive as possible. You may use this Basic Information Form to help you get ready for your next medical appointment.
Basic Information Form
Date of birth
Social Security No.
Additional insurance provider
Primary healthcare provider's name
List diagnosed medical conditions:
List past surgeries and year performed:
List all medicines:
(Name of medicine)
Prescription or other?
It’s hard to know when the time is right for an older adult to move from home to a residential care setting. This can be one of the most difficult decisions a family must make. Many people keep caring for the person at home, even though it becomes physically and emotionally exhausting for them to do so. Sometimes, moving to a residential care setting may become the most realistic decision to make sure that the person will get the best care.
Moving from home into a residential care facility should be considered when 1 or more of the following things is true:
The older adult needs round-the-clock care.
The older adult can’t manage eating, toileting, and bathing (activities of daily living) without help.
The older adult is prone to violent outbursts (physical or verbal), or is a danger to himself or herself or to others.
The older adult has wandered away from the safe surroundings of home or neighborhood.
The caregiver's health and well-being is negatively affected.
Many types of out-of-home care options are available for older adults, depending on the level of care needed. These may include:
Assisted living facility (ALF). ALFs provide maximum independence for older adults who remain relatively active and healthy. Typically, a healthy spouse and an impaired spouse can live together in an ALF. Most ALFs feature apartment-style living with individual kitchens, and many services for older adults. These include 24-hour security, transportation, and recreational and social programs.
Residential care facility (RCF). RCFs are for those who can no longer live alone and independently, but who don’t require skilled nursing care. At an RCF, the older person can receive help with personal hygiene, grooming, or other activities of daily living. They can also have bedside care for minor and short-term (temporary) illnesses. Typically, RCFs offer rooms, not apartments. They provide some recreational and social services for older adults.
Skilled nursing facility (SNF). SNFs are also known as nursing homes, convalescent centers, and rest homes. At SNFs, older adults receive continuous nursing services under the care of a registered nurse or licensed vocational nurse. SNFs can provide more extensive care services than assisted living or residential care facilities. Such services include IV (intravenous fluids), blood pressure monitoring, medicine injections, and care for patients on ventilators. SNFs often provide recreational, rehabilitative, and social programs for residents.
Others. Special care centers are available for people with particular medical conditions, such as Alzheimer's disease or dementia. Special psychiatric facilities may be an option for people with violent or disruptive behaviors, or people who present a danger to themselves or others.
Is the facility staff willing to have you take a tour and stop in at mealtime to visit with residents?
What care services are provided and do these services match your own individual needs?
How much input do residents and their families have in daily life and care?
What choices of accommodations are available?
Are there graduated levels of care available? For example, can residents move from an assisted living environment to a higher level of care as needed?
What personal items can be brought from home? What items are not allowed?
Can residents have their own car on the premises?
What is the visitation policy?
Does the facility have a certain religious affiliation? If so, is your loved one happy with this affiliation?
How would an emergency situation be handled by the facility? This includes a fire or severe winter storm. Does the facility have an emergency or crisis management plan in place?
Is the facility clean and tidy throughout? Are sanitary standards strictly enforced?
Are appropriate safety measures taken? These include clearly marked fire exits, well-lighted hallways, bathroom grip bars, and an in-room emergency call system.
Is the facility located in a safe and convenient location?
Is 24-hour security provided?
Are individual rooms bright, cheery, and roomy?
Do room arrangements allow for privacy?
Do individual rooms have windows, allowing for natural light and a pleasant view?
Are the common areas (activity rooms, lobby, and gathering rooms) large, bright, and well kept?
Is the dining room welcoming, spacious and not too crowded? Is it easy to move around in?
Is the kitchen area clean and organized?
Respect for the older individual:
Does the facility have a written policy about residents’ rights and responsibilities? Is it made readily available?
Is the staff trained to treat residents with dignity and respect?
Are residents and their families involved in developing the individual care plans?
What is the number of staff members available per shift?
Is the staff friendly and respectful of residents?
Are continuing education and training a priority?
Specifically, what staff medical services are provided? Does the facility offer healthcare providers, nursing, physical therapy, respiratory care, and occupational therapy?
What is the resident-to-nurse ratio?
Is nursing care provided 24 hours a day?
What are the credential requirements for the nursing staff?
Licensure and certification:
Is the facility licensed by the state?
Is it licensed to provide Medicare and Medicaid coverage?
Which services are included in the standard rate? Are other services provided for additional fees?
What are the facility's Medicare and Medicaid policies?
Is a healthcare provider available for emergencies?
Are personal healthcare providers allowed to follow residents at the facility? Or does a facility-appointed healthcare provider treat residents?
Does the facility have arrangements with a nearby hospital in case of an emergency?
Is emergency transportation available?
Is a well-rounded program of social and recreational activities available for groups and individuals? For example, does the facility offer outdoor outings, arts and crafts classes, movie outings, exercise classes, and reading clubs?
Does the facility stay active and connected with the surrounding community?
Are outside trips and activities planned regularly?
Are meals provided at the facility, and what are the meal plan options?
Does a licensed dietitian approve all menus?
Can the facility accommodate people with special dietary restrictions?
For people who want to take some meals in privacy, is there a small kitchen or kitchenette available in the individual room or apartment?
Does the facility provide chaplain services?
Is a rehabilitative specialist or physical therapist available for rehabilitation?
Is massage therapy offered?
Are housekeeping and laundry needs available? If so, are they included as part of overall fees or provided at an extra cost?
Is transportation available for trips to the local shopping center, grocery store, library, and bank?
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