Nursing homes provide 24-hour medical and social services to the frail elderly and chronically-disabled populations of our state. These facilities represent the most complicated--and, hence, the most expensive--level of care and are aimed at providing services to those persons who need high-intensity medical care and supervision.  

Families of persons who suspect that their relative or friend requires nursing home care must understand that the prospective resident/client must undergo a screening process to ensure that, indeed, nursing home care is indeed appropriate for them, and that a lower level of care would not be more suitable to fulfilling the needs of that particular client. The screening process consists of a health care professional filling out what is called a patient review instrument (or PRI), which assesses the applicant's ability to complete activities of daily living (ADLs), such as walking, bathing, dressing, etc., as well as a health assessment to encompass all physical and psychological problems the applicant faces. The PRI determines a "score," which then demonstrates the individual's actual medical and social needs.

After the PRI is completed, the screening process (actually called Screen) begins. If a person is in the hospital and is being transferred directly from the hospital to a nursing home, hospital social service or discharge planning staff will assist in obtaining a completed PRI and Screen. If the person is at home or in a community-based program, a certified home health agency should be contacted to complete the PRI and Screen. Under these circumstances, a home visit is usually necessary. During the home visit, any caregivers that might have first-hand knowledge of the patient's condition should be there to meet with the professional who completes the PRI and Screen. This is crucial, since a caregiver can sometimes be more realistic about a person's condition than the person is on their own. Be honest with the evaluator, since this will help to give a realistic impression of exactly what the person needs in a nursing home or other facility.

Once a person has been accepted for nursing home placement, he or she will also undergo a much more intensive assessment process within the nursing home, called the minimum data set plus (MDS+). This is a comprehensive review of the resident's history and needs, and is an integral part in the overall assessment of the resident so that an individual care plan may be designed for that person.

Oversight agency: State Department of Health

Respite is a service that helps caregivers in gaining a short break from their caregiving duties, whether for personal or medical reasons. When a caregiver needs a short break for whatever reason, he or she can make advance arrangements for respite care for the person in their charge. Respite care is frequently delivered in a residential setting (such as a nursing home) and can provide the relief needed when a caregiver needs to rest or have surgery, for example. 

Also known as "short term scheduled stays," respite care services are in short supply, and should be reserved as far in advance as possible to make sure that the services are available when needed. 

Oversight agency: State Department of Health

Senior housing facilities consist of apartments for independent living for the elderly. Most of these buildings have handicapped-accessible bars in the bathrooms, emergency-pull cords in the bathroom and bedroom, and some even have appliances and sinks custom-designed to accommodate the needs of people in wheelchairs.

Subsidized housing requires that applicants meet certain income specifications in order to be considered for an apartment. Typical subsidized housing programs include: Section 202, Section 8, Section 236, and Mitchel-Lama or Housing Trust Fund. 

Market-rate housing is not subsidized and is open to people whose incomes enable them to pay the monthly rents, which are typical for that area of the state. 

Oversight agencies:

• The United States Department of Housing and Urban Development (HUD)
   
• State Division of Housing and Community Renewal

From least restrictive to most intense care, then, the continuum of care is:

• Housing
• Adult care facilities
• Enriched housing
• Assisted (Adult homes) Living
• Home care
• Adult day care programs
• Nursing homes

* Continuing care retirement communities/life care communities contain components of all levels of the continuum of care.

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