Time marches on and so do we. Before we know it, we are older and so are our parents or loved ones. Caring for them and being sure their needs are met become a prime concern especially when they begin to not be able to care for themselves as they used to. This dilemma touches most every family. The thing to avoid is to remain under a veil of ignorance by not understanding your options and waiting until the last minute to make an abrupt and often uniformed decision. Care for the elderly is of utmost importance. This will be addressed in a comparison between adult day care, assisted living, and nursing home care.



Adult day care has the shortest care periods and usually lasts up to 8 hours a day and 5 days a week. People with Alzheimer's, the feeble, the physically handicapped, those infected with HIV/AIDS, people with declining brain function and the hearing and visually impaired are included in this type of care. It serves as respite for busy caregivers and offers social and recreational activities, meals, therapy, health and social services. Usually there is an assessment made of the needs of each person before they enter the program. It is also important to find out how physically able they are because adult day care does provide rehabilitative services and personal care. One of its greatest advantages is that it helps people remain independent and be able to live with loved ones as long as they can plus it gives caregivers the break they often need.

Funding can come through Medicaid if the person qualifies, need-based scholarships, some medical insurance, long-term care insurance or tax credits for dependent care. Medicare doesn't cover adult day care. Usually centers are non-profit (80% of them) and charge anywhere from $25-$75 a day. This will vary according to location. Transportation is also provided. There are full-time nursing services and these places are licensed by the state.

The next step up in care, if the elderly are not living with friends or family, is assisted living. It is for seniors who are somewhat independent and who need more care than a retirement community has available. The focus is on allowing for individual residents' independence, need for privacy, choice, and safety. The services offered are personal (bathing, dressing, transferring, toileting, and eating), health care (which also involves management of medications), social and physical activities, 24-hour supervision, education, laundry, linen, housekeeping, unit maintenance, shopping, meal preparation, money management and transportation. A person can occupy a furnished or unfurnished studio or 1-bedroom unit with a bathroom. Some places have a shared bathroom. Also some units may have kitchenettes or even a full kitchen.

A potential resident is assessed according to physical and cognitive abilities, mental awareness, medical history (including medications being taken) and some personal history to find out if assisted living is a good option. Family members are encouraged to continue being a part of the resident's life and are welcome to attend social activities throughout the year and on holidays. Usually assisted living places have a full-time nurse and trained staff. Meals are eaten in a dining room and assistance is given when needed. Activities are planned throughout the day and residents have the choice to attend or not. Church services are held, some being a specific denomination and there is usually a non-denominational gathering. Assisted care is regulated by the state.

Sources of funding can include personal funds, assistance for families, Social Security, Medicaid, and long-term care insurance. The cost varies, depending on the size of the unit, the services needed and location. It's between $1,000 and $2,000 per month, the average being $1,873.

The nursing home is the most intensive in care (along with adult family care homes). The residents have definite physical needs. They usually have physical or mental disorders or happen to be too feeble and/or unable to move around, bathe or prepare their own meals. Their ADL's (Activities of Daily living) are minimal and low functioning. As a general rule, there will be no recovery or ability to take care of themselves, so assistance is a necessity for most or all ADL's. There are definite medical needs too.

Nurses and nursing aids are available round the clock. Because of the residents' needs, nursing homes are staffed with that in mind. There is full management of medication and it is administered according to a physician's orders. A person can obtain a private room if he/she is paying with private funds. Normally, there are 2 people to a room. Meals are brought to them or residents are taken to the dining area. Besides full assistance, nursing homes offer rehabilitative services, exercise, social activities, laundry, housekeeping, and prepared meals. Families and friends are encouraged to visit.

The cost depends on where the home is and what the surcharge is that is attached for private payers versus Medicare and Medicaid. Approximately 70% of nursing home costs are paid by the state and federal governments. The government pays part or all of the fees for about 85% of the residents. Another funding option is long-term care insurance. The actual cost is somewhere around $114 a day or more and can go well above $2,000 a month. This varies depending on the location and the services required.

In summary, adult day care involves hours of care, while assisted living and nursing homes offer more care progressively. It helps to research all the residential and financial options. AARP is a valuable source, as well as Medicare. There are a wealth of other websites that will help relatives and friends find the right place for their loved ones and the phone book lists companies and people that have a network to draw from. Quality care of our elderly is essential. Knowing what can be done is being done, brings a sense of peace of mind.