Levels of Care

Independent Living Facilities are next, if it can be afforded. A resident may have a small apartment with a kitchen, where a couple can live especially when only one has dementia. Residents choose where to take meals, perhaps breakfast and lunch in their apartment, but dinner in the dining room. Usually there is access to a driver for trips to the doctor and a menu of additional services. Costs are privately paid either monthly, or a with a buy-in lump sum plus additional monthly charges for services. A similar, low cost, option is Congregate Living covered elsewhere.

The next step is an Assisted Living Facility (ALF) where one may have a compact refrigerator as all meals are taken in the dining areas. Typically each resident gets up to an hour of help in the morning to groom and get dressed and/or ready for bed. For additional cost, medications may be managed by ALF staff, although often family fills a pill box once per week. Costs on Cape Cod for a single room range from $2,700 to $6,000+ per month. Adding a spouse can add as little as $1,500 to the single cost. Some facilities have financial help should a resident's cash run out allowing them to stay on, like Emeritus in Hyannis, MA. Or, the facility may take a percentage of income like Senior Residences in Pocasset, MA.

Assisted Living Facilities for the Memory Impaired have higher staff-to-resident ratios and locked doors to prevent wandering. There is substantial help in mornings, evenings, and with day time toileting and meals. There is near constant provision of simple activities which residents are aggressively encouraged to engage in. The rooms are smaller without kitchen facilities as residents spend little time there. You should see all doors propped open as opposed to the long hallways of closed private doors in the. standard ALF which is more like a hotel. An ALF for Memory Impaired is more like a cruise ship with an activities director and constant action, but with little change in established routines like meal times, table seats, etc. Finally, of course, there is the nursing home level, called "Long Term Care."

Finally there is the Skilled Nursing Facility (SNF), typically called a Nursing Home. According the Merriam-Webster, a SNF is a health-care institution that meets federal criteria for Medicaid and Medicare reimbursement for nursing care including especially the supervision of the care of every patient by a physician, the employment full-time of at least one registered nurse, the maintenance of records concerning the care and condition of every patient, the availability of nursing care 24 hours a day, the presence of facilities for storing and dispensing drugs, the implementation of a utilization review plan, and overall financial planning including an annual operating budget and a 3-year capital expenditures program. No one wants to end up in a nursing home, and I hear dozens of times a month that “I won’t go there, I’ll just die at home.” But, that is not the way is usually happens. You fall, you spend three nights in the hospital and become eligible for Medicare paid rehabilitation (to re-strengthen you after three+ days in a hospital bed) care in a SNF. The SNF cannot discharge you to an unsafe environment, and if you are a serious fall risk, confused and can’t afford daily care in your home–they you stay. It isn’t up to you in many cases.

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