Care Arrangement: Personal Care Home

As a primary caregiver or family member of a dementia patient, selecting the right type of care arrangement can be filled with a lot of information and plenty of confusion. Often, on the surface, a number of care arrangements can seem like the same thing with different names. But it is only when you dig deeper that you come to realize that each type of care arrangement has its own variable that need to be looked at one by one. In this article, we aim to deconstruct a type of care arrangement that can often be mistaken for a regular residential home or residential care facility. This type of care arrangement is known as personal care home.


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WHAT IS A PERSONAL CARE HOME?

Personal care homes are privately owned and operated residential homes for seniors and older adults who need assistance with, or supervision of the activities of daily living. The usual services provided by a personal care home include: lodging, food service, and one or more types of personal services to small groups of adults who are not related to the owner or administrator by blood or marriage. 

People who are admitted to personal care homes do not require on-site health or nursing services but may require the service of a visiting professional. These homes are licensed. Any individual wishing to reside in a personal care home must be assessed as appropriate by the staff of the facility. It should be noted that as a private business, personal care homes are within their limits to set their own fees.

While personal care homes usually accommodate individuals with lighter care needs, some do provide care to those with greater care needs, such as dementia patients. Some facilities offer memory care, including 24/7 care provided by trained dementia care specialists with a home-like atmosphere. In addition, each resident’s day is filled with engaging programming uniquely designed for their individual needs and interests.

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PERSONAL CARE HOME VS. ASSISTED LIVING FOR DEMENTIA PATIENTS

Personal care homes should not be confused with special care homes (i.e. long-term care homes/nursing homes), which are a part of the publicly-funded health system and serve residents with more extensive level of care. Although assisted living residences and personal care homes seem like they provide similar care to their residents, the former usually has the capability and capacity to care for individuals whose needs are far greater and also for a greater duration of time. They are also governed by the Department of Public Welfare whose regulations maintain certain limits on the care and setting that they can provide.
To simplify it, assisted living residences are different from a personal care home in the following 2 ways:
  • CONCEPT – An assisted living residence is specifically designed to allow residents to enjoy assisted living to “age in place” for as long as possible.
  • CARE LEVEL – Assisted living residences aligned with the “aging in place” concept will provide residents with more care as their needs increase without the need to move. When living in a personal care home, a person whose health needs become too great will be transferred to a skilled nursing facility, as it is prohibited for a personal care home to provide acute medical care.

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PERSONAL CARE HOME VS. CARE AT HOME FOR PATIENTS

There are also some differences between a personal care home and obtaining care at home. When the patients are receiving home care they may receive regular visits from family or a home care worker to help with personal care, shopping and preparing meals. Relatives or caregivers may also live with the person. Some pros of this type of care are:
  • The patient can stay in their own home.
  • The patient can stay close to the things that are familiar to them.
  • The patient can retain full control over the care and support received. However, it can be lonely and despite alarm systems and regular visits from carers, the patient can still be at risk. Also, the patient may not like support workers coming to their home.
  • The value of patient's home isn’t taken into account when calculating how much they have to pay towards their care.
A personal care home is a place where the patient can live (often with a spouse) while having their care needs met by trained staff. Some personal care homes also have accommodation and support for older people with dementia. It is beneficial because there is always trained staff around to help and people to socialize in addition to having organized activities. There will also be no need to worry about utility bills, meals, and household chores. Especially for dementia patients, it is safer than being alone at home.
There are, however, some cons to staying at a personal care home:
  • All the person’s belongings will need to fit into a small designated space which may leave them feeling a loss of independence
  • They may not enjoy the company of the other residents in the home.

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THE NUMBERS BEHIND PERSONAL CARE HOMES

Although there is no official statistic data for personal care home facilities in the United States, in 2011 a representative state, Pennsylvania, had more than 1,200 licensed personal care homes serving approximately 46,500 residents.

When it comes to data from residential care communities, which include personal care homes, adult care homes, board care homes, and adult foster care, in 2014, there were an estimated 835,200 participants enrolled in residential care communities. Of this, 39.6% were people who had been diagnosed Alzheimer’s or another form of dementia.

Source: Harris-Kojetin L, Sengupta M, Park-Lee E, et al. Long-term care providers and services users in the United States: Data from the National Study of Long-Term Care Providers, 2013–2014. National Center for Health Statistics. Vital Health Stat 3(38). 2016.

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RATIO OF PATIENTS TO CAREGIVERS

Personal care homes provide staffing 24 hours a day. Homes with 11 or more residents have night staff on duty. Whereas in homes with 10 or fewer residents, they must have a staff on call throughout the night.

Usually, the ratio of caregivers and nurses to patients is very good because these centers have no more than 10 individuals. However, this can vary and highly depend on the facility. It is best to be aware of the different facilities’ caregiver to patient ratio. The average tends to be about 2 carers for every 6 residents and 1 nurse for every 10 residents during the day. 

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WHEN IS A PERSONAL CARE HOME A GOOD FIT

Personal care homes can be a good idea when the patient tends to be alone at home or if their caregiver is unable to provide the necessary care. It is also a safer option as these facilities can provide a more homely setting, albeit smaller than an actual home. These facilities offer personalized care to a small group of adults, which helps create the more personal, homely living environment.

There are many advantages to living in a personal care home. There is a family atmosphere in these small settings. The staff-to-resident ratio also tends to be higher than other types of residential care facilities. Those who live in these homes get plenty of attention and very personalized service. In fact, personal care homes are highly praised for their homely appearance and environment. For seniors wishing to stay in a smaller, community-based setting and still maintain some independence, personal care homes are a great fit. 

Some personal home care facilities have qualified and trained staff to help dementia patients with even their most personal needs and medical care. However, once the illness progresses to a certain level, it will be necessary to move them to a more specialized facility. 

For individuals who do not need or want 24-hour access to medical care, personal care homes and adult family homes can bridge the gap between complete independent living and an institutional care facility. They provide attractive accommodations, professional caregiving services, and extra security. Residents can benefit from the close relationships they form with other residents, alleviating the feelings of loneliness and depression which are often associated with aging. Residing in a communal residential facility can also decrease the financial and physical burden of owning and maintaining a home as the housing costs are shared among all of the residents.

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SERVICES AT PERSONAL CARE HOMES

The services and standards for personal care homes vary from state to state. Personal services include individual assistance with supervised care in:

  • Health management including self-administered medication, medication management and transportation to doctor's appointments
  • Assistance with ambulation and transfer
  • Assistance with essential activities of daily living such as meals, bathing, grooming, dressing, toileting, housekeeping, and laundry
  • Comfortable private, or semi-private, rooms
  • Social programs and activities

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FINDING A PERSONAL CARE HOME

Resources

There are many personal care homes located across the United States. One of the first places you can go to collect information is your local or regional Alzheimer's Association.

Websites

The internet is also a great place to search for personal care home facilities in your area. Below is a list of websites that can help you:
NOTE: A Place for Mom will assist you in finding a new place for your loved one in exchange for the value of 2 months of what you pay in the location your loved one is placed in 

WHAT TO LOOK FOR WHEN SELECTING A PERSONAL CARE HOME?

Personal care homes can vary greatly in their home style, their mix of residents, and their management style. So it is very important to personally visit each home that you are considering. It is crucial to make sure the home you choose is a good fit, and when it is, it will feel like an extension of your own home. 

Once you have a list of homes, talk with a health care professional at your local home care office or Assessment Unit and decide which homes would best meet you or your loved one’s care needs.

Prepare a list of questions that you would like to ask the personal care home operator. Start by calling them up to ask your questions. The next step would then be to schedule an appointment to visit the home and meet with the operator, the management, and staff. Visit as many personal care homes as you feel necessary before making a final decision. 

After visiting each home, consider all the information you have gathered. Select the personal care home that offers the features that is most important to you or your loved one, and can meet your loved one’s care needs well.

Ask to see the home’s license. This license must be posted at all times and will list the name of the person or corporation that holds the license. The licensee is responsible for all of the care provided in the personal care home.

Be sure to verify some of the following items:

  • Look to see what conditions may be listed on the license. Conditions may sometimes limit a personal care home from providing a certain type of care.
  • Ask to see a copy of the rules of the home.
  • Explain to the operator the required care needs. Ensure that these care needs can be met properly.
  • Talk to the operator, staff, and residents about the services provided, such as staff coverage, recreational activities, religious services, transportation, etc.
  • Inquire about the experience and training of the operator and staff.
  • Ask to see the bedroom and bathroom that your loved one will be using.
  • Ask to see a menu plan and inquire about special diets, if needed.
  • When you visit the home, take a look around to see what activities residents are doing (for example, playing cards, visiting, etc.). Check to see if there are organized activities offered on a regular basis in the home.
  • Ask the operator about what it costs to live in the home, what is received in return and if there are extra charges for additional services.
  • Observe the home’s atmosphere. Is it a pleasant, happy and comfortable environment?
  • Ask the operator for references from former residents or family members of former residents.
  • Speak to the references to know about their experience with the home.

HOW TO GET PLACED IN A PERSONAL CARE HOME

In order to find the right personal care home for your loved one, you will have to start out by learning about your options. You can get excellent information on the types of facilities available and the services they provide through your local alzheimer’s or dementia associations as well as the resources described above. Usually these organizations can provide information that is tailored for people with dementia.

Additionally, you can also approach any other caregivers that you know of to ask about their experiences with such facilities. Even your loved one’s doctor can be a good starting point in terms of researching the personal care homes in your area. The internet is also a great resource as you can procure a lot of information from the comfort of your home.

Once you have assessed your loved one’s needs and progress of dementia and feel that they would benefit from staying at a personal care home, you should contact a case manager, clergy member, financial planner, hospital discharge planner, physician, or social worker to inquire about facilities in the area. It is advisable to personally check out the different facilities you have optioned in order to be fully informed and satisfied.

Once you have selected a personal care home, the manager or owner will ask you or your loved one to sign an admission agreement. An admission agreement is a contract between the licensee of a personal care home and you or your loved one. The agreement puts into writing the care, services, and fees agreed upon. 

The agreement must be signed by both you (i.e. the resident) and the licensee. You will be given an original admission agreement document. You can request that a family member be provided a copy of the agreement. It is important to keep this document in a safe place. Ensure the following items are included in the admission agreement:

  • Resident fees
  • Notice period required for rate hikes
  • List of basic services provided by the facility and any relevant costs
  • List of additional services provided and any relevant costs
  • Payment period
  • Method of payment
  • Refund conditions
  • Notice period for termination of agreement (when initiated by either parties)
  • Notice period for rate revisal due to changing care needs
  • Right and privileges of the resident
  • Rules of the personal care home
  • Rules and applicability of insurance coverage on personal belongings
  • Description of accommodation to be provided to the patient by the facility

Any changes to the agreement must be made to both the licensee’s agreement and you or your loved one’s agreement. These changes must be initialed by both parties and dated. The admission agreement should be signed before moving into a personal care home. Read the admission agreement before signing it. You may want your family and/or lawyer to review it as well. Take note to not sign anything you do not understand.

VISITING

Depending on the personal care home, visiting hours are usually from early morning (8AM) until night time (7PM). Although Personal Care homes can have more limited hours then other care arrangements such as nursing homes and assisted living, this is largely for a residents safety and well-being and to minimize disturbances to other residents. Homes will also host "family day" and holiday get togethers to encourage families to visit their loved ones. 

Generally, homes are okay with family visiting the residents whenever necessary, with the proper communication from the families. 

COST

Personal care homes charge you based on costs associated with room and board, along with the cost of staff to assist and administer medical care. These rates are often priced daily or monthly and should include a breakdown of the costs.

If a subsidized rate is requested, a financial assessment is completed to determine the amount of subsidy that may be available. A Personal Care Home Benefit is available to eligible lower-income seniors living in personal care homes.

To live in a personal care home can often cost only half of nursing home care, and in some states, it is even more affordable than assisted living care. However, the cost can vary depending on the geographical location of the residential care home, as well as, the types of services needed. Personal care homes can cost anywhere between $1,500 a month and $4,500 per month. The cost can also vary depending on room privacy. A personal care home typically runs at $2,200 per month for a shared bedroom and $3,500 per month for a private bedroom. The national median annual cost is $43,539.

The cost of personal care homes with dementia care can be higher and range around $5,000 to $6,000 per month. As memory care requires a larger staff to resident ratio and additional training to ensure the safety of all the residents, the cost is usually higher than other communities. Similar to regular personal care homes, the cost can vary depending on factors such as level of care needed, the size of the room, whether a room is private or semi-private, and/or geographical location of the facility. In 2012, the U.S. national average cost of memory care for a single resident was almost $5,000 a month. This cost does vary widely depending on the care facility. For example, some facilities charged as low as $1,500 per month and while others were as high as $7,000 per month.

In both cases, there may be additional costs involved for things like trips out, hairdressing, any therapies or additional services not covered in the basic fees. You should check on this with the personal care home management and understand it thoroughly.

DOES INSURANCE PAY FOR PERSONAL CARE HOMES?

Some long-term care insurance policies may pay for personal care home costs. Medicaid-health insurance that helps pay for medical and long-term care for people with low income often covers fees for people who can't afford the cost of private care. However most personal care homes will ask you to pay privately for a year or two before converting to Medicaid. Still some facilities don’t accept Medicaid at all. Medicare on the other hand doesn’t usually cover personal care homes as it does not include custodial care.

RESOURCES FOR PAYING

When opting for a personal care home, it is important to ensure that your loved one will be able to stay there without facing financial troubles. Besides insurance, your loved one’s savings and other assets such as their home, car, etc. can come in use to pay for their care. It might be possible to obtain loans to pay for the car, but this should be done very carefully as you also need to pay it off over time or risk losing your assets.
COMMON ISSUES

UNLICENSED

Most privately owned homes are licensed and regulated at the state level. This means that in order to operate, each care home must submit itself to regular inspections by state health inspectors who verify the quality of the nutrition, care, and health of residents as well as continual upkeep to the facilities. Some states even require background checks of all caregivers employed at the care home as a requirement for licensure. This ensures that residents of adult family homes are receiving the highest quality of care from a qualified staff. 
When your loved one has been entered into a personal care facility, keep up with their licensing status to ensure that they remain adherent to regulations and quality levels set by the relevant health authorities. 

ERRORS IN MEDICATION MANAGEMENT

Although rare, errors in medication can and do occur in various care facilities. However, it should be noted that most of these should not cause major health issues to the patient. The following is a list of examples regarding how medication errors may occur:
  • Crushing or slicing medications that should not be split.
  • Inadequate fluids with medications.
  • Inadequate food or antacids with medications.
  • Failure to properly shake, mix, or “roll” the medication.
  • Improper administration of eye drops.
  • Improper use of metered dose inhalers (MDIs).
  • Allowing elder patient to swallow sublingual tablets. 
The most common negligent medication errors include:
  • Medication dose omission or under dose
  • Medication overdose or multiple doses
  • Administration of expired medication
  • Incorrect medical product, strength of product, or form of product
  • Incorrect time, duration, or rate of medication administered
  • Incorrect medication administration technique
  • Incorrect patient or documentation
  • Patient monitoring error following medication administration
  • Outdated, or expired, medication order 

INCIDENT REPORTS

In cases of medication errors or other issues, there are set procedures for both the staff at the personal care home and the family member of the patient.
In the case of resident elopement, the staff of the personal care home must call the local police department to report the incident within 30 minutes of the staff receiving actual knowledge in accordance with the Mattie’s Call Act. The home must also report the initiation and discontinuation of Mattie’s call to the department utilizing the complaint intake system within 30 minutes of communications with local law enforcement authorities having occurred.
In the case of any serious incidents, the personal care home must report it using the complaint intake system and location designated by the department within 24 hours following the occurrence of a serious incident or the home’s learning that a serious incident involving a resident may have occurred. The serious incidents that must be reported to the department include the following:
  • Any accidental or unanticipated death of a resident not directly related to the natural course of the resident’s underlying medical condition.
  • Any serious injury to a resident that requires medical treatment.
  • Any rape, assault, any battery on a resident, or any abuse, neglect, or exploitation of a resident in accordance with the Long Term Care Resident Abuse Reporting Act.
  • An external disaster or other emergency situation that affects the continued safe operation of the residence.
  • Any circumstances where a member of the governing body, administration, staff associated with or affiliated with the personal care home, or family member of staff becomes associated with an account at a financial institution, will, trust, benefit of substantial value or life insurance policy of a resident or former resident to verify that such gift is knowingly and voluntarily made and not the result of any coercion.
  • When an owner, director or employee acquires a criminal record as defined in these rules.
The incident report, submitted through the facility’s peer review process will be received by the department in confidence and must include at least:
  • The name of the personal care home and the name of the administrator or site manager.
  • The date of the incident and the date the personal care home became aware of the incident.
  • The type of incident suspected, with a brief description of the incident.
  • Any subsequent remedial and quality measures determined through peer review to be taken by the personal care home to make such injury or harm arising from the particular incident less likely to recur.
  • Where the department determines that a rule violation related to the reported incident has occurred, they will initiate a separate complaint investigation of the incident. The complaint investigation report and the report of any rule violation compiled by the department arising either from the initial report received from the personal care home or an independent source is subject to disclosure in accordance with applicable laws.

FILING COMPLAINT TO PERSONAL CARE HOME MANAGEMENT

In the case of negligence or abuse within the personal care home, be sure to report any suspicion or problem to the facility management. Concurrently, you should also report those problems to the state licensing agencies that oversee personal care homes in addition to the Long-Term Care Ombudsman in your area immediately.
It is important to record all the details of the complaint. The more information that you can record; the more effectively the complaint can be handled. Some of the details that you will need on record include:
  • What happened?
  • To whom did it happen?
  • When did it happen?
  • Where did it happen?
  • Who did the abuse?
  • Who was responsible for the neglect?
Personal care home operators must provide residents with their internal complaint resolution process that explains how complaints are handled in the facility. Individuals are encouraged to raise their concerns through the operator’s internal complaint resolution process. If you do not get a satisfactory resolution using the operator’s internal complaint resolution process or by talking to a health authority case manager (where involved), you can lodge a complaint with any of the following entities:
  • The Personal Care Home registry by contacting registry staff. No one should try to prevent you from reporting concerns to registry staff. The operator must continue to provide agreed upon services as outlined in the residence occupancy agreement and personal services plan after a complaint is made.
  • The Patient Care Quality Office for your regional health authority – If you live in a publicly subsidized assisted living residence and feel that your concern about the quality of service delivered by the residence operator has not been addressed, you are encouraged to contact the Patient Care Quality Office for your region if you want to make a formal complaint.

FILING COMPLAINT AGAINST PERSONAL CARE HOME FACILITY - OMBUDSMAN

If you feel that your complaint has not been appropriately addressed by the Personal Home Care registry staff, you may contact the Office of the Ombudsperson who will investigate complaints about unfair administrative decisions or actions of a public agency.
Long-term care ombudsman programs in the complainant's state may be able to assist with filing a complaint against a personal care home to the regulatory agency. A local ombudsman can assist with filling out complaint forms, following up on complaints and advocating for the rights of the residents in the personal care home through local law enforcement agencies and government organizations.

EXPULSION / DISCHARGING

The administrator or on-site manager must contact the patient’s representative or legal surrogate (if any) when there is a need for discharge or transfer of a resident. The home must provide 30 days' written notice of its intent to discharge or transfer the resident unless an immediate transfer is required. The written notice must be issued to both the resident and the representative or legal surrogate (if any).
In all cases, except those requiring immediate transfer, residents whose needs cannot be met by the home or who no longer choose to live in the home must be discharged or transferred to an appropriate facility based on the discharge and transfer procedures entered into at the time of admission. Where the resident is incapable of making informed decisions and there is no representative or legal surrogate or the representative or legal surrogate is unwilling to act, the administrator or on-site manager must petition the probate court in the county where the home is located for an order authorizing the discharge or transfer. The transferring home must provide a copy of the resident’s file to the receiving facility prior to or at the time of transfer.
Where the department has reason to believe that a resident is receiving or requires continuous medical or nursing care, the department may require the home to discharge the resident. However, the provision of medical, nursing or health services required by the resident on a periodic basis or for a short-term illness, where such services are not provided by the home is permissible.
Upon discharge or transfer of the resident, the home must refund to the resident or representative or legal surrogate, if any, any security deposit made to the home by or on behalf of the resident.
TRANSITIONING INTO A PERSONAL CARE HOME

Resistance from Your Loved One

Although it may be very hard to convince your loved one to undertake change, especially with a dementia patient, a personal care home could actually be one of the easiest alternatives when it comes to convincing someone resistant. A point of advantage for both sides is the fact that personal care homes are not medical care homes. It is place for companionship and where residents are supposed to feel at east and at home. Make it clear to your loved one that this is a place where people of their age live together and socialize together with people to attend to their needs, much like a hotel or a serviced apartment. 

Items to Bring When Moving

You can and should bring everything that would ease the transition such as personal belongings and maybe some furniture, depending on the rules of the institution. Bringing along items that has emotional value to the patient can help ease the transition process.

Tips for Personal Care Home Transition

There are a few things to should consider when making the transition for your loved one to a personal care home:
  • Make sure you analyze every aspect of the personal care home before sending your loved one there
  • Be present for the move
  • Help with the decoration of the new bedroom, make suggestions
  • Act like it is a good thing for everyone, don’t show regret but support the decision and focus on the pros
  • Ask your family for help, everyone who can be present during this time, with a positive attitude, should be encouraged to contribute
  • Be there for every moment of the transition, if possible.

Transition Period

Depending on the personality of your loved one, the transition could take a few days or weeks. In some cases, it may even take months. People in general have a tendency to resist change. This worsens as they age. For dementia patients specifically, it can be extremely difficult and even traumatic as they try to navigate through their confusion and feelings of abandonment. It will deeply affect the family of the patient as well.
But it is important to remain optimistic and appear encouraging. Keep in mind that if you can’t trust your loved one to live alone this is not cruel or selfish. Remember that it is the best possible outcome for everyone involved. Don’t forget to visit regularly and try to involve other family members and close friends too. Your loved one shouldn’t feel abandoned but instead should feel loved and cherish every moment they spend with you.
WHEN IS IT TIME TO FIND A NEW CARE ARRANGEMENT?

The time to find a new care arrangement will become clear when your loved one needs increased assistance in terms of their daily activities, which the staff at the personal care home are unable to provide. Increased medical needs is another reason to look for a new care arrangement. There are several types of residential care arrangements available where your loved ones needs can still be met while keeping the changes to a minimum.

MEDICATION REBALANCING – GERIATRIC PSYCHIATRIC UNIT

With personal care homes being a non-medical establishment, most of the medical arrangement responsibilities fall upon the primary caregiver, a family member, or caretaker. And in order to properly evaluate and decide on the next care arrangement for your loved one, you can consult a geriatric psychiatric unit. Not only do they provide dianosis and treatment for elderly patients experiencing emotional, cognitive, and behavioral symptoms, they also have specialized programs for dementia. The professionals there can advice on the next appropriate care arrangement. If needed, the patient can also be admitted to their unit to receive the necessary treatment over the short term.

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