The Senior Living Glossary: What is Assisted Living, Skilled Nursing Facility (SNF), Memory Care, CCRC, Supportive Living, Etc., and WHO PAYS?

What does it all mean? The Selfhlelp Home is helping families understand the common terms used in senior living. This helpful article will help those who are considering senior living for themselves or a loved one, and will help you understand what is the different between skilled nursing and assisted living, for example, and who pays for coverage.

Senior Living Glossary of Terms: Let’s start with the basics, what are ADL’s?

ADL stands for Activities of Daily Living.

You may hear this term being used. Here is what it applies to. ADL’s are the basic self-care tasks that individuals typically perform on a daily basis to take care of themselves and maintain their independence. ADLs are essential for functioning independently in daily life and include tasks related to personal care, mobility, and household management. Common examples of Activities of Daily Living include:

1. Personal Hygiene: Activities such as bathing, grooming (including brushing teeth, combing hair, shaving), and toileting.
2. Dressing: The ability to select appropriate clothing, put it on, and fasten buttons, zippers, or other closures.
3. Eating: The ability to feed oneself independently, including skills such as using utensils, cutting food, and swallowing safely.
4. Transferring: Moving from one position to another, such as getting in and out of bed, chairs, or a wheelchair.
5. Mobility: Walking or moving around independently, including activities such as standing, sitting, and maintaining balance.
6. Continence: The ability to control bowel and bladder function independently.

The assessment of ADLs is often used in healthcare settings to evaluate an individual's level of functional independence and determine the appropriate level of care or support needed. Difficulty performing ADLs can be an indicator of physical or cognitive impairment and may require assistance from caregivers, healthcare professionals, or supportive services to help individuals maintain their quality of life and independence.

Senior Living Glossary of Terms: The Levels of Care offered in Senior Living Communities

Communities vary and may offer one of more level of care. It is important to consider how many different levels of care a community provides depending on the age and needs of the person moving. ??For example, communities that only offer Independent Living may not be the best option for a person who will most likely need more assistance down the line.

Independent Living

Independent living communities are designed for residents who can live on their own and do not require assistance with activities of daily living(ADLs). These communities often provide amenities such as housekeeping, transportation, meals, and social activities to promote a maintenance-free lifestyle for older adults.

Assisted Living

Assisted living facilities are for older adults who need some assistance with activities of daily living (ADLs). Daily tasks such as bathing, dressing, medication management, and meal preparation, but do not require the level of medical care provided in a nursing home. These facilities offer support services tailored to individual needs while promoting independence and social engagement. In many communities residents live in apartments with kitchens or mini kitchens.

Memory Care

Memory care communities specialize in providing care for older adults with Alzheimer's disease, dementia, or other memory-related conditions. They offer a secure environment with staff trained to assist residents with memory impairment, often providing specialized programming and activities to support cognitive function and quality of life.

Skilled Nursing Facility (SNF)

Skilled nursing facilities, also known as nursing homes, long-term care, or skilled care communities, provide around-the-clock medical care for older adults with complex medical needs or those recovering from surgery, illness, or injury. They offer services such as skilled nursing care, rehabilitation therapy, and assistance with activities of daily living. Most SNF’s also offer Short -term rehabilitation. Before selecting a community, you can check the ratings of a skilled nursing facility online, with the Centers for Medicare and Medicaid (CMS).

Continuing Care Retirement Community (CCRC)

CCRCs offer a continuum of care within one community, allowing older adults to transition between independent living, assisted living, and skilled nursing care as their needs change over time. This model provides a sense of security and long-term planning for older adults, ensuring they can age in place and receive the appropriate level of care as they age.

Supportive Living

In Illinois, "supportive living" refers to a specific type of residential care setting designed to provide housing and supportive services for adults who require some assistance with activities of daily living (ADLs), but do not need the level of care provided in a nursing home. Supportive living facilities must have a supportive living designation from the State of Illinois and is primarily funded through the Medicaid Home and Community -Based Services (HCBS) Waiver Program, that provides financial assistance to eligible individuals who require supporting living services. This service offers a combination of housing, personal care services, and healthcare coordination in a residential setting.

Short-Term Rehabilitation

Short-term rehabilitation, otherwise called “Post-Acute Care” refers to a specialized form of care provided to individuals who require rehabilitation services following an illness, injury, surgery, or medical event and normally a hospital visit.? This type of rehabilitation is typically aimed at restoring function, mobility, and independence in a relatively short period, with the goal of transitioning the individual back to their home or a lower level of care. Before selecting a community, you can check the ratings of a skilled nursing facility online, with the Centers for Medicare and Medicaid (CMS).

Short-term rehabilitation programs are often offered in skilled nursing facilities (SNF) or rehabilitation centers where residents must stay overnight and may include a combination of physical therapy, occupational therapy, and speech therapy, depending on the individual's needs. The specific services provided are tailored to the individual's condition and goals, with a focus on improving strength, flexibility, coordination, mobility, and activities of daily living.

Common reasons for short-term rehabilitation may include:

1. Recovery from orthopedic surgery, such as joint replacement or fracture repair.
2. Rehabilitation following a stroke or neurological condition.
3. Management of chronic conditions such as heart failure or COPD.
4. Post-hospitalization recovery from illness or injury.
5. Transitioning from a hospital stay to home.

Short-term rehabilitation programs typically have a defined length of stay, which can range from a few days to several weeks, depending on the individual's progress and goals. The interdisciplinary care team, including physicians, therapists, nurses, and other healthcare professionals, collaborates to create a personalized rehabilitation plan and monitor progress throughout the stay.

Insurance coverage for short-term rehabilitation can vary depending on several factors, including the individual's insurance plan, their specific medical needs, the type of facility providing the rehabilitation services, and the duration of care required. Here are some common types of insurance coverage that may apply to short-term rehabilitation:

Who Pay’s for Short Term Rehabilitation?

Payment for short-term rehabilitation services can come from various sources, depending on the individual's insurance coverage, financial resources, and eligibility for government assistance programs. Here are some common payment sources for short-term rehabilitation:

• Medicare: Medicare Part A typically covers short-term rehabilitation services provided in a skilled nursing facility (SNF) following a qualifying hospital stay. Medicare may cover up to 100 days of skilled nursing care per benefit period, with certain eligibility criteria and coverage limitations. Individuals must meet Medicare's criteria for skilled care and have a physician's order for rehabilitation services.
• Medicaid: Medicaid coverage for short-term rehabilitation services varies by state and may cover skilled nursing care in a nursing facility or rehabilitation center for eligible individuals with low income and limited resources. Medicaid eligibility requirements and covered services differ by state, so it's important to check with the state Medicaid agency for specific information.
• Private Health Insurance: Some private health insurance plans may cover short-term rehabilitation services, including skilled nursing care, physical therapy, occupational therapy, and speech therapy, depending on the individual's policy coverage and benefits. Coverage may vary widely among insurance plans, so it's essential to review the plan's benefits and contact the insurance provider for clarification.
• Long-Term Care Insurance: Long-term care insurance policies may provide coverage for short-term rehabilitation services, including skilled nursing care, in a nursing facility or rehabilitation center. Coverage and benefits under long-term care insurance policies vary based on the specific policy terms, including benefit periods, daily benefit amounts, and eligibility criteria.
• Veterans Affairs (VA) Benefits: Veterans who qualify for VA health care benefits may be eligible for short-term rehabilitation services through the VA system, including skilled nursing care, rehabilitation therapy, and other supportive services. Eligibility for VA benefits is determined by factors such as military service, disability status, and income.
• Private Pay: Individuals who do not have insurance coverage or who do not meet eligibility requirements for government assistance programs may pay for short-term rehabilitation services out of pocket. Short-term rehabilitation costs can vary depending on the level of care required, the length of stay, and the specific facility providing services.

It's important for individuals and their families to review their insurance coverage, understand their benefits, and explore available payment options for short-term rehabilitation services before seeking care. Additionally, individuals should communicate with healthcare providers and insurance companies to ensure that services are covered and that any out-of-pocket costs are understood.

Respite Care

What is Respite Care? Respite care in senior living refers to a short-term care option designed to provide temporary relief or support to caregivers who are responsible for the ongoing care of an elderly loved one. This type of care allows caregivers to take a break, attend to their own needs, or address other responsibilities while ensuring that their loved one receives the necessary care and support.

Respite care services are typically offered by assisted living facilities, nursing homes, or residential care homes, although some home care agencies also provide respite care in the individual's own home. Here are some key aspects of respite care in senior living:

Temporary Stay: Respite care services allow older adults to stay in a senior living community or care facility for a short period, ranging from a few days to several weeks, depending on the individual's needs and the availability of accommodations.

Care Services: During their stay, residents receive assistance with activities of daily living (ADLs) such as bathing, dressing, grooming, and medication management. Depending on the level of care provided by the facility, residents may also receive assistance with meal preparation, housekeeping, and transportation.

Safety and Security: Residents in respite care benefit from the safety and security provided by the senior living community or care facility. Trained staff members are available around the clock to respond to emergencies and help as needed.

Socialization and Activities: Respite care offers residents the opportunity to participate in social activities, programs, and recreational opportunities provided by the senior living community. This can help residents stay engaged, active, and socially connected during their temporary stay.

Relief for Caregivers: Respite care provides much-needed relief and support for caregivers, allowing them to rest and recharge, attend to their own health and well-being, or take care of other personal or family responsibilities. This break from caregiving responsibilities can help prevent caregiver burnout and improve the overall quality of care provided to the senior.

Who Pays for Respite Care?

The payment for respite care can come from various sources, depending on the individual's circumstances, the type of respite care provided, and the available financial resources. Here are some common sources of payment for respite care:

• Private Pay: Individuals or their families may pay for respite care services out-of-pocket. This payment method allows for flexibility in choosing respite care providers and arrangements, but it requires the financial means to cover the costs of care.
• Long-Term Care Insurance: Some individuals may have long-term care insurance policies that cover the costs of respite care. Long-term care insurance policies typically have specific coverage limits and eligibility criteria, so it's essential to review the policy details to determine coverage for respite care.
• Medicaid: In some cases, Medicaid may cover respite care services for eligible individuals, particularly those who qualify for Medicaid waivers that include home and community-based services (HCBS). Medicaid coverage criteria and availability of respite care services vary by state, so it's important to check with the local Medicaid office for specific eligibility requirements.
• Veterans Benefits: Veterans may be eligible for respite care services through programs such as the Department of Veterans Affairs (VA) respite care benefit, which provides short-term care to support caregivers of eligible veterans. VA benefits may cover respite care services for eligible veterans and their caregivers.
• Nonprofit Organizations and Charities: Some nonprofit organizations and charities offer financial assistance or grants to individuals in need of respite care services. These organizations may have specific eligibility criteria and application processes.
• Government Programs: Some local, state, or federal government programs may offer financial assistance or subsidies to support respite care for individuals with disabilities, older adults, or caregivers in need of temporary relief. Eligibility criteria and availability of government-funded respite care programs vary by location.

Senior Living Glossary of Terms: At Home Services

Home Health:

Home health refers to medical services provided in a patient's home by healthcare professionals. These services are typically prescribed by a physician and are aimed at assisting patients with medical needs following illness, injury, or surgery. Home health services may include skilled nursing care, physical therapy, occupational therapy, speech therapy, and medical social work. The goal of home health is to help patients recover and manage their conditions in the comfort of their own homes. Home Health is typically prescribed by a doctor following a hospital visit or short-term rehabilitation stay at a SNF and is typically covered by insurance.

Who Pays for Home Health?

• Medicare: Medicare Part A and/or Part B may cover home health services for eligible beneficiaries. To qualify for Medicare coverage, the individual must be under the care of a physician, require skilled nursing care or therapy services, be homebound (unable to leave home without considerable effort), and receive services from a Medicare-certified home health agency.
• Medicaid: Medicaid may cover home health services for eligible individuals, particularly those with low incomes or who qualify for Medicaid waivers that include home and community-based services (HCBS). Medicaid coverage criteria vary by state, so it's essential to check with the local Medicaid office for specific eligibility requirements.
• Private Insurance: Some private health insurance plans may offer coverage for home health services, although coverage varies widely depending on the specific insurance policy. Coverage may be available for skilled nursing care, therapy services, and other medically necessary services prescribed by a healthcare provider.
• Veterans Benefits: Veterans may be eligible for home health services through programs such as the Department of Veterans Affairs (VA) Home-Based Primary Care program or other VA health benefits.
• Private Pay: Individuals or their families may pay for home health services out-of-pocket if they do not qualify for coverage through Medicare, Medicaid, or private insurance. This option is common for those who have the financial means to cover the costs of care themselves.

Home Care:

Home care encompasses a broader range of non-medical services provided to individuals in their homes to assist with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). This type of care is often provided by trained caregivers or home health aides who assist with tasks such as bathing, dressing, meal preparation, medication reminders, light housekeeping, and companionship. Home care is commonly utilized by older adults or individuals with disabilities who need assistance to remain independent and safe at home.

Who Pays for Home Care?

• Private Pay: Individuals or their families may pay for home care services out-of-pocket. This is common for those who have the financial means to cover the costs of care themselves.
• Long-Term Care Insurance: Some individuals may have long-term care insurance policies that cover home care services. These insurance policies typically have specific coverage limits and eligibility criteria.
• Medicare: Medicare may cover certain home health services for individuals who meet specific criteria, such as being homebound and requiring skilled nursing care or therapy services. However, Medicare does not typically cover non-medical home care services.
• Medicaid: Medicaid, the joint federal and state program that provides healthcare coverage to low-income individuals, may cover home care services for eligible individuals. Medicaid home and community-based services (HCBS) waivers may be available to cover personal care services for those who qualify.
• Veterans Benefits: Veterans may be eligible for home care services through programs such as the Department of Veterans Affairs (VA) Aid and Attendance benefit or the VA's Home Based Primary Care program.
• Private Insurance: Some private health insurance plans may offer coverage for home health services, although coverage varies widely depending on the specific insurance policy.
• Self-Directed Care Programs: In some states, individuals receiving Medicaid may have the option to participate in self-directed care programs, where they have greater control over their care and may use Medicaid funds to pay for services provided by family members or hired caregivers.

Private Caregiver:

A private caregiver is an individual hired directly by a client or their family to provide care and support in the client's home. Private caregivers may offer a variety of services, including personal care, companionship, meal preparation, light housekeeping, transportation, and medication reminders. Unlike home health services, private caregivers typically do not provide medical care or therapy services. Clients often choose private caregivers for more personalized care and flexibility in scheduling.

Who pays for a Private Caregiver?

• Out-of-Pocket/Private Pay: Individuals or their families pay for private caregiver services directly out-of-pocket. This payment method allows for flexibility in hiring caregivers and negotiating rates, but it requires the financial means to cover the costs of care.
• Long-Term Care Insurance: Some individuals may have long-term care insurance policies that cover the costs of private caregiver services. Long-term care insurance policies typically have specific coverage limits and eligibility criteria, so it's essential to review the policy details to determine coverage for private caregivers.
• Medicaid: In some cases, individuals receiving Medicaid may be able to use Medicaid funds to pay for private caregiver services through self-directed care programs or Medicaid waivers that include home and community-based services (HCBS). Eligibility criteria and availability of these programs vary by state.
• Veterans Benefits: Veterans may be eligible for financial assistance through programs such as the Department of Veterans Affairs (VA) Aid and Attendance benefit, which can help cover the costs of private caregiver services for eligible veterans and their spouses.
• Employer-Sponsored Benefits: In some situations, employers may offer benefits that include coverage for caregiving services for employees or their family members. These benefits could help offset the costs of hiring a private caregiver.
• Nonprofit Organizations and Charities: Some nonprofit organizations and charities may offer financial assistance or grants to individuals in need of caregiving services. These organizations may have specific eligibility criteria and application processes.

Outpatient Therapy:

Outpatient therapy refers to rehabilitation services provided to individuals who do not require overnight hospitalization and can receive treatment on an outpatient basis. Commonly offered to older adults and covered by insurance following a hospital stay or short-term rehabilitation. This can include physical therapy, occupational therapy, speech therapy, and other types of rehabilitative services. Outpatient therapy sessions typically take place in a clinic, hospital outpatient department, some SNF’s offer Outpatient Therapy as a continuation of services such as The Selfhelp Home in Chicago. The frequency and duration of outpatient therapy sessions depend on the individual's condition and treatment plan prescribed by a healthcare provider.

Overall, while there may be some overlap between these terms, they generally refer to distinct types of care and services provided to individuals in their homes or in outpatient settings, ranging from medical care to assistance with daily activities and rehabilitation.

Who pays for Outpatient Therapy?

The payment for outpatient therapy services can come from various sources, including:

• Health Insurance: Private health insurance plans often provide coverage for outpatient therapy services, including physical therapy, occupational therapy, and speech therapy. Coverage details can vary significantly depending on the specific insurance plan, including co-pays, deductibles, and limits on the number of sessions. It's important for individuals to review their insurance policy or contact their insurance provider to understand their coverage for outpatient therapy services and any requirements, such as pre-authorization or referrals from a healthcare provider.
• Medicare: Medicare Part B typically covers outpatient therapy services, including physical therapy, occupational therapy, and speech therapy, when prescribed by a healthcare provider and provided by a Medicare-approved provider. Medicare beneficiaries may be responsible for paying a percentage of the Medicare-approved amount for therapy services, along with any applicable deductibles or co-payments.
• Medicaid: Medicaid coverage for outpatient therapy services varies by state, but it often includes coverage for medically necessary therapy services for eligible individuals. Medicaid beneficiaries should check with their state Medicaid program to understand their coverage for outpatient therapy services and any requirements for eligibility and reimbursement.
• Out-of-Pocket/Private Pay: Individuals who do not have health insurance coverage for outpatient therapy services or who have exceeded their coverage limits may choose to pay for therapy services out-of-pocket. Private pay rates for outpatient therapy services can vary depending on the provider and the type of therapy needed.
• Workers' Compensation: In cases where therapy services are needed due to a work-related injury or illness, workers' compensation insurance may cover the costs of outpatient therapy services. Eligibility and coverage details for workers' compensation benefits vary by state and the specific circumstances of the injury or illness.
• Veterans Benefits: Veterans may be eligible for outpatient therapy services through the Department of Veterans Affairs (VA) healthcare system, which provides coverage for eligible veterans. VA benefits may cover outpatient therapy services for service-connected disabilities, injuries, or illnesses.

It's essential for individuals to understand their coverage options and any requirements for reimbursement when seeking any services. Working with healthcare providers and insurance companies can help ensure that individuals receive the necessary therapy services while minimizing out-of-pocket costs.

These definitions can vary slightly depending on geographic location and specific regulations, so it's always a good idea to research and visit different types of senior living communities to find the best fit for individual needs and preferences.

This information is being provided to you by The Selfhelp Home. To schedule a tour of our community or to learn more about us, please complete the form below and visit us here.