Choose Your Care

Skilled nursing facilities (SNFs), also known as nursing homes, provide skilled nursing care, personal care, social services, social activities, and physical, occupational, and speech therapy to people who are either newly discharged from an acute care hospital (short-stay) or whose physical or mental conditions prevent them from caring for themselves independently (long-stay). Some nursing homes also offer care for specific conditions such as memory impairment or dementia, or more intensive care for serious chronic conditions including ventilator support for people who cannot breathe on their own.

Short-term nursing home care is generally for those who are discharged from a hospital but cannot take care of their medical or personal care needs independently while they heal. While in the nursing home, they receive care that includes medication administration, nursing treatments, and personal assistance with bathing, eating, toileting, and walking. Many of these individuals receive physical, occupational, and/or speech therapy to help them to regain strength and mobility and restore independence. Most of these individuals will eventually go home (the average short-term stay is about 2 weeks, but not longer than 100 days). Some of these individuals may not get better or they may deteriorate due to medical complications; these individuals may need to continue in the nursing home for long-term care.

Long term nursing home care is designed as a permanent living setting for people who have physical limitations (for example, due to a stroke) or permanent cognitive impairment (such as Alzheimer’s) that requires round-the-clock assistance and some level of skilled nursing care. In most cases, these individuals will remain in the nursing home for the remainder of their lives. However, some will slowly regain enough function that they can go home with family/caregiver support, or they may go home with a family member for hospice care at the end of life.

Home health care is often offered to those who require a limited amount of nursing care intensity and personal assistance. This type of to remain at home and live as independently as possible. The care ranges from help with bathing and preparing meals to rehabilitation services to skilled nursing. A home health team could include:

• Nursing care is provided by either a registered nurse or licensed vocational nurse, who works under the supervision of a registered nurse. Registered nurses manage, monitor, and evaluate the person’s condition. Nurses teach the person and their caregiver(s) the best ways to care for them. For example, they may teach about medications and what to eat and not eat. Nurses also provide medical treatments like wound care. Nurses talk to the person’s healthcare provider and other members of the home health team to create the best care plan.
• Physical therapy is prescribed by a doctor, nurse practitioner, or physician assistant and provided by a physical therapist or assistant to some people recovering from an injury or illness. They use techniques such as heat, light, exercise, and massage to improve or maintain the person’s current abilities or slow their decline (such as walking, sitting in a chair, moving in/out of bed, etc.). This type of therapy helps people with their strength and balance to keep them safe by preventing falls. Physical therapists can also teach caregivers on the best ways to care for the individual at home.
• Occupational therapy is prescribed by a doctor, nurse practitioner, or physician assistant and provided by an occupational therapist or assistant to some people recovering from an injury or illness. Occupational therapy helps people return to or slow the decline of common daily activities (like bathing, dressing, using the toilet, preparing meals, and housekeeping) after illness. Sometimes occupational therapists teach individuals (and their caregivers) how to use special equipment to gain back skills to perform self-care. Examples of special equipment includes slide boards, button hooks, plate holders, and standing poles.
• Speech therapy is prescribed by a doctor, nurse practitioner, or physician assistant and provided by a speech therapist to improve, maintain, or slow the decline of speech and language skills including swallowing abilities. This therapy is used when there has been an illness or injury (such as throat cancer, stroke or other brain injury, or disease like Lou Gehrig’s) that changed a person’s ability to speak or swallow. Speech therapists may use exercises and/or equipment (such as a mechanical device or a communication board) to train and/or help a person in speaking.
• Medical social services are prescribed by doctors, nurse practitioners, or physician assistants and provided by social workers to help people and their caregivers with social and emotional concerns related to the injury or illness. Services can include counseling or help finding supportive community resources such as legal aid, food, utility assistance, or long-term counseling.
• Home health aides help with daily activities such as bathing, dressing, and making a meal while an individual receives home health care.

Hospice care focuses on the quality of life for people and their caregivers who are experiencing an advanced, life-limiting illness. Hospice provides care for individuals in the last phases of incurable disease so that they may live as fully and comfortably as possible. Hospice provides comfort care for terminally ill patients, those with a prognosis of generally six months or less either at home or in a care facility. The goal is to control pain and symptoms rather than to cure the illness. Hospice caregivers who work as a team of medical professionals and trained volunteers help with the patient’s medical, psychological, and spiritual needs and also offer grief counseling for survivors after death.

The California Department of Public Health licenses two types of providers: Hospices and Hospice Facilities.

Hospice: Hospice services are provided in the patient’s home or primary place of residence, or as a service of a Congregate Living Health Facility (CLHF), or to residents of a facility via contract, based on the medical needs of the patient.

Hospice Facility: A hospice facility provides inpatient hospice care. These facilities have a license to provide hospice services with a capacity of no more than 24 beds. Hospice services include, but are not limited to, routine care, continuous care, inpatient respite care, and inpatient hospice care, and is operated by a provider of hospice services.

Caring Info provides additional information on what hospice care offers as well as similar services that are available.