Choosing the right level of care for your loved one can be a stressful, time consuming process and experience.  Time and time again, the initial conversations we have with families is about what level of care seems to be most appropriate.  There is a lot of misinformation and preconceived notions about the various levels of care and what is likely the most appropriate level of care. 

Below is a breakdown of all the local levels of care:

Nursing home – Many of us grew up visiting our older family members in what were once known as “nursing homes”.  Most of today’s nursing home are called Skilled Rehabilitation Facilities or Intensive Care Facilities , often operating under the same roof, but under different funding sources and operations. 

• Skilled Rehabilitation Facilities - These facilities provide a short stay that offers rehabilitation (targeted physical therapy) after events such as a fall or stroke, most often after a hospitalization. A rehabilitation stay is typically ordered by a person’s treating doctor and must also be authorized through one’s Medicare plan. Medicare can cover up to 100 days in a skilled facility per benefit period, however if progress is being made during the rehabilitation stay and the person achieves maximum benefit of physical therapy the Medicare plan will only pay for the length of time that the rehab is needed. 

Average cost: Approved stay covered under Medicare.  $275-350 a day to pay privately.

Assisted Living- Assisted living communities have taken the place of the “nursing homes” of the past.  Assisted living communities offer a private apartment, typically with a kitchenette within a safety net of 24/7 caregiving staff, nurse oversight, meals, housekeeping, medication dispensing, activities, and transportation. This level of care is great for someone who continues to maintain independence but needs daily assistance. Communities typically offer studios, one-bedroom apartments and many communities offer two-bedroom apartments, as well. Room rates are based on the size of the apartment and care rates are based on individual care needs, monthly costs can ebb and flow according to your loved one’s caregiving needs. If a couple occupies an apartment, there will be a second person monthly fee and the second person will also have their own monthly care costs.

Residential Care Facility (RCF)- Many individuals need more caregiving services than a large assisted living community can provide.  A residential care facility can offer a smaller setting with a higher staffing ratio than other levels of care.  Most of these communities are one level communities that offer meals, nurse oversight, 24/7 caregiving and activities.  A typical RCF room are about the size of a large bedroom with a private or shared bathroom. Most often these rooms are only single occupancy, therefore couples would be in separate rooms. 

Rent and care can be paid for using long term care insurance, private funds, and/or veteran’s benefits.  

Adult Care Home (sometimes called an Adult Foster Home)- This is often a misunderstood and underutilized level of care. In Oregon, adult care homes can have a maximum of five residents and are licensed yearly by the state or county and have a high level of accountability.  Adult care homes are private family homes operated by the homeowner or a live-in resident manager. Care homes can offer a high level of care for various medical conditions and dementia related care.  Homes are required to offer six hours of activity per week, this is not to include watching television or family visits. During the day are at least 1-2 caregivers present and one caregiver at night to accommodate occasional night needs.  This level of care is perfect for someone who is less social but needs 24/7 supervision and care. The major benefit of this level of care is that there are consistent caregiver staff and a high level of supervision.  

Memory Care- Memory care can offer a high level of supervision and is often an ideal level of care for someone who is physically active or would benefit from social activities.  It is also likely the safest level of care for someone who is an exit seeker or chronic wanderer.  Typically, residents have a private or shared open room with a private or shared bathroom. Meals, snacks, caregiving services, activities and some transportation are included in the monthly base rent.  Some communities offer a flat monthly rate for both rent and care while others offer a monthly rent rate and the care rate is based on individual needs.