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.
QUICK LINKS - TOPICS COVERED:
- WHAT IS A PERSONAL CARE HOME?
- PERSONAL CARE HOME VS. ASSISTED LIVING FOR DEMENTIA PATIENTS
- PERSONAL CARE HOME VS. CARE AT HOME FOR PATIENTS
- THE NUMBERS BEHIND PERSONAL CARE HOMES
- RATIO OF PATIENTS TO CAREGIVERS
- WHEN IS A PERSONAL CARE HOME A GOOD FIT
- SERVICES AT PERSONAL CARE HOMES
- FINDING A PERSONAL CARE HOME
- WHAT TO LOOK FOR WHEN SELECTING A PERSONAL CARE HOME?
- HOW TO GET PLACED IN A PERSONAL CARE HOME
- DOES INSURANCE PAY FOR PERSONAL CARE HOMES?
- COMMON ISSUES
- FILING COMPLAINT TO PERSONAL CARE HOME MANAGEMENT
- FILING COMPLAINT AGAINST PERSONAL CARE HOME FACILITY - OMBUDSMAN
- EXPULSION / DISCHARGING
- TRANSITIONING INTO A PERSONAL CARE HOME
- WHEN IS IT TIME TO FIND A NEW CARE ARRANGEMENT?
- MEDICATION REBALANCING – GERIATRIC PSYCHIATRIC UNIT
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.
PERSONAL CARE HOME VS. ASSISTED LIVING FOR DEMENTIA PATIENTS
- 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.
PERSONAL CARE HOME VS. CARE AT HOME FOR PATIENTS
- 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.
- 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.
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.
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.
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.
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
FINDING A PERSONAL CARE HOME
ResourcesThere 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.
WebsitesThe 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:
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.
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.
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?
RESOURCES FOR PAYING
ERRORS IN MEDICATION MANAGEMENT
- 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.
- 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
- 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 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
- 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?
- 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
EXPULSION / DISCHARGING
Resistance from Your Loved One
Items to Bring When Moving
Tips for Personal Care Home Transition
- 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.
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.