There are different options for long-term care and residential care depending on circumstances. Families and residents/clients deserve to be assured of their decision by accessing unbiased, quality of care data to use in their decision making process. This website provides neutral, data-driven information about skilled nursing facilities, home health agencies, hospice agencies, assisted living facilities, continuing care retirement communities, and adult day health care centers.
What’s The Different In Types of Care?
In many situations, a clinician will recommend and order the type of care necessary to meet the patient’s needs (e.g., skilled nursing facility for short term care, home health care, or hospice care). In other situations, individuals will look for and decide what type of care they or their loved one need (e.g., long term skilled nursing home care, assisted living, continuing care retirement community, or adult day health care). Additionally, health insurance or long-term care insurance coverage can also influence the choice of service or provider. Regardless of the clinician and insurance input, some consumer choice will remain, and having quality and patient experience of care data are important for choosing the best care even within financial or medical constraints.
See below for descriptions about the types of care to help identify the reason you are exploring long term care. For resources on these types of care for Medi-Cal/Medicaid or Medicare beneficiaries, please see My Care My Choice – California.
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 a hospital (short-stay) or whose physical or mental conditions prevent them from caring for themselves independently and permanently (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 recovering from a recent illness or injury who have been discharged from a hospital or a nursing home and require a limited amount of nursing care intensity and personal assistance. This type of care allows individuals recovering from a hospitalization or those with chronic health conditions 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 provides comfort care to individuals with a prognosis of generally six months or less to live who are no longer seeking medical treatment. The goal is to control pain and other symptoms rather than to cure the illness. Hospice services are often provided in the person’s home or primary place of residence, but may also occur in a hospital, skilled nursing facility, or hospice facility. California has 8 inpatient hospice facilities and each has maximum of 24 beds available.
Hospice caregivers are a team of healthcare professionals, social workers, and trained volunteers to help with a person’s medical, psychological, and spiritual needs. They also offer education and support, such as respite care, to caregivers as well as grief counseling (bereavement support) for survivors after death.
CaringInfo provides additional information on what hospice care includes as well as similar services that are available.
Assisted Living Facilities support activities of daily living (e.g., bathing, dressing, medication administration, housekeeping, and laundry), and provide communal food service and social activities for adults aged 60 and older. They do not provide skilled nursing care as one would receive in a nursing home. In California, assisted living facilities are licensed by the California Department of Social Services as Residential Care Facilities for the Elderly (RCFE).
Facilities range in size; those with fewer than 10 residents are a type of assisted living facility that are called “board and care”. The smaller facilities usually are in residential or group homes with a private or shared bedroom and dining room/living room setting. The larger assisted living facilities usually have apartment-like suites, restaurant-like dining, and daily organized social activities; very large facilities may have multiple buildings on a campus-like setting. Assisted living facilities may care for individuals who have dementia if the facility meets state licensure requirements (staff training) to meet the needs of all residents. Type of payments commonly accepted include private pay, long term care insurance, and some government sources for those meeting eligibility requirements.
Adult Residential Facilities: Require a residence with daily support (non-skilled nursing) for adults with disabilities?
Adult Residential Facilities support activities of daily living (e.g., bathing, dressing, medication administration, housekeeping, and laundry), and provide communal food service and social activities for primarily adults younger than age 60 who also have developmental, mental health or physical disabilities. They do not provide skilled nursing care as one would receive in a nursing home. In California, adult residential facilities are licensed by the California Department of Social Services.
Type of payments commonly accepted include private pay and some government sources for those meeting eligibility requirements.
Continuing Care Retirement Communities: Interested in a long term care setting that provides increasing levels of care as needs change over time?
Continuing Care Retirement Communities also sometimes called “life care communities” are contractually required to provide a range of increasingly complex care and services to residents as their needs change. The contracts are usually effective for the life of the resident and may consist of one or a series of agreements. The communities can be apartment-type dwellings, high-rise buildings, a subdivision setting, or any other housing design. Most continuing care communities have designated assisted living units and a skilled nursing facility either on or near the facility. In California, the Department of Social Services provides a “Certificate of Authority” for communities to enter into continuing care contracts with persons 60 years or older. Types of payment accepted depend on the level of care being used. Independent living requires private pay, but assisted living and skilled nursing facilities that are part of the CCRC also may accept long term care insurance and government sources such as Medicaid or Medicare (depending on length of stay and program eligibility of the resident).
Adult Day Health Care Centers: Require non-residential, skilled nursing care during the week (or weekends) for adults requiring daily management of health conditions?
Adult Residential Facilities provide organized daytime programs of health, therapeutic, and social services. They serve adults with who are frail, or have chronic disabling medical, cognitive, or mental health conditions and who are at risk of institutional placement. Registered nurses are on the premises to provide care. Some ADHC also have an Alzheimer’s Day Care Resource Center within the ADHC setting. These programs are licensed by the state to provide specialty care to people with dementia.
The ADHC centers accept private payment, payment from state Regional Centers, and