Geriatric psychiatrist Charles “Chip” Reynolds III has for decades been one of Pittsburgh’s and the nation’s leading scholars and
Long-term housing options
The toughest part of a family member’s health decline for many loved ones is acknowledging that it’s no longer feasible for the person to live at home, thus launching the search for an acceptable setting offering 24-hour care. Such transitions can be confusing, costly and emotionally painful, often all at once.
Every family has its own threshold for determining when such a step is needed. Sometimes it comes when a person is no longer safe in his own home, such as someone with dementia who might use appliances dangerously or wander away from home. Dealing with a messy and frustrating condition like incontinence can be the tipping point for some caregivers who have tried their best to keep a family member home as long as possible.
When it’s time to find a long-term care setting, it’s important to know the distinctions in Pennsylvania among three types of licensed facilities:
Personal Care Homes -- At a wide range of sizes and price levels, these facilities have 24-hour staffing to supervise four or more adults who may need some monitoring or assistance but do not have serious medical conditions. Regulated by the Department of Human Services, personal care homes usually offer communal meals and some group activities, but residents also typically have a level of independence and are able to care for their own needs. Government funding to support such care is restricted to very low-income individuals, mainly those receiving SSI benefits. There are some 1,200 personal care homes in Pennsylvania, including 134 in Allegheny County, with an online directory and inspection reports available at http://www.dhs.pa.gov/citizens/searchforprovider/pchdirectory/index.htm#.Vo1wo2d0zcs
Assisted Living Centers -- This was initially a marketing term using by many larger and newer personal care homes in Pennsylvania to differentiate themselves from more traditional operations. Assisted living became its own state-licensed category under regulations that took effect in 2011, but it has not grown as anticipated. The state imposes higher requirements than personal care homes for the type of living space and care that must be offered to residents, but government financial help originally envisioned for assisted living has not materialized. Assisted living can be viewed as an intermediate step offering more help to residents than personal care homes and less than nursing homes, but it is a private-pay system in which residents cover the full cost of care. There are only about three dozen assisted living centers in the state, a minority of them in southwestern Pennsylvania, with a directory and inspection reports available at:
Nursing Homes -- The Pennsylvania Health Department licenses about 700 nursing homes across the state, including 62 in Allegheny County, in which care is provided for individuals with serious physical and/or mental disabilities. Staffing and training requirements are higher than in the other types of facilities and costs are the highest, ranging up to $100,000 annually for private-pay residents. Some patients stay short-term for rehabilitation funded through Medicare, but costs are also covered long-term by the state-federal Medicaid program for those who qualify based on modest income after spending down assets. A directory of nursing homes and their inspection reports can be found at:
Families deciding where to place a loved one often choose based on a close location, making convenience for visiting their No. 1 priority, but experts recommend taking other aspects into account as well. They recommend taking personal tours of facilities, noting the cleanliness of the institution and the condition of residents and their interaction with staff. Reports from government inspections also may be helpful and are available online or upon request at the facilities. Consumer advocates recommend that possible locations be scouted and researched in advance rather than waiting for an emergency that might require a hasty move, such as upon someone being discharged from an unexpected hospital stay.
The best advice typically offered to families for helping assure quality care of a resident in any facility is to be a regular visitor, including in evenings and on weekends. It helps one become familiar with the routine and staff and lets them know someone is regularly checking up on the resident’s care.
The federal Centers for Medicare & Medicaid Services provides a ratings system for nursing homes and other information and advice to consumers through its “Nursing Home Compare” website: https://www.medicare.gov/nursinghomecompare
If residents or families feel they have been mistreated by a facility, there is a long-term care ombudsman available through each Area Agency on Aging who is to assist in working out problems. Ombudsmen lack enforcement powers to compel any action by the facilities, but they can be useful in negotiating concerns and disagreements. The ombudsman for Allegheny County may be reached at 412-350-4234, and a list for other counties is available here: http://www.portal.state.pa.us/portal/server.pt?open=514&objID=616640&mode=2.
There is also a statewide hotline available 24/7 to report concerns about elder abuse in any type of setting: 1-800-490-8505.
Rachael Wonderlin, 28, is a gerontologist and dementia care consultant who has been a staff member specializing in care of those with
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