“Long Term Care: Levels of Care, Personal Options, and Regulatory Requirements” Wednesday, June...

“Long Term Care: Levels of Care, Personal Options, and Regulatory Requirements”

Wednesday, June 17, 2015- Noon (EDT) This webinar will be focused on the long term care industry and the mire of acronyms, settings, regulations, and requirements. The goal of this session is to help individuals understand the differences between the various levels of care and identify which type of facility may be most appropriate for the very specific needs of our elders. We will also address the recent evolution of this vitally important industry and discuss the possible future it may hold including: skilled nursing , assisted living, enhanced assisting facilities, adult Home, and personal care home. . . What does it all mean?; where the industry has been and where it appears to be going; and how to identify the most appropriate type of facility for your loved one’s specific needs.

Kathy Sindoni, RN, BSN, Owner/Chief Consultant, Katasin Consulting, LLC Kathy has been a registered nurse for 22 years and has been professionally engaged in the Assisted Living Industry since 2001. Kathy is the owner and Chief Consultant of a professional consulting business which serves operators in the Assisted Living Industry. Her consultation services are primarily focused on licensure, quality care and services for residents, regulatory compliance, and program development. Kathy travels throughout New York State and her services provide her with an insider’s view of a multitude of different facilities under many different types of licensure. Her company is an Industry Partner to the Empire State Association of Assisted Living (ESAAL). Kathy also serves on the Assisted Living Services Committee which acts as an advisory panel to ESAAL’s board of directors and also works very closely with the NYS Department of Health. Kathy has previously served as a Healthcare Coordinator at Alterra (Brookdale) Sterling House and Clare Bridge Cottage, in Ithaca, NY, from 2001-2005. She then served as the Administrator and Director of Nursing at Bridges Cornell Heights, in Ithaca, from 2005-2013

Long Term CareLEVELS OF CARE,

PERSONAL OPTIONS, AND REGULATORY REQUIREMENTS

Kathy Sindoni, RN, BSN

---------------------Owner/Chief Consultant

Katasin Consulting, LLC

Where are you in the process?

I know I will have to coordinate long term care soon, but I’m just starting to research the process.

I’ve been coordinating long term care for 0-2 years.



I’ve been coordinating long term care for 10+ years.

I’ve coordinated long term care in the past.

None of the above.

Who finds this whole selection process confusing?

I do!

Not me.

….Why is it so confusing?

Levels of Care I’ll discuss todayAdult Day Care

Certified Home Health Agency (CHHA)

Licensed Home Care Service Agency (LHCSA)

Personal Care Homes

Adult Care Facility and Assisted Living Residence (ACF/ALR)

Enriched Housing Programs (EHP)

Assisted Living Program (ALP)

Special Needs Assisted Living Residence (SNALR)

Enhanced Assisted Living Residence (EALR)

Continuing Care Retirement Community (CCRC)

Skilled Nursing Facility (SNF)

Which care options do you have experience with? Adult Day Care



Personal Care Homes








None of the above

Adult Day Care Typically Monday through Friday 8:00am-5:00pm

Social, Medical, and Special Needs (Dementia) Sometimes a senior center-type location Sometime within an assisted living facility or nursing home

Advantages• Ability to maintain employment

• Provides respite care• Social interaction and stimulation• Enhances ability to remain at home

• More affordable than facility placement

Disadvantages•Typically only available on weekdays and

during daytime hours• Care giving needs outside of the daycare

program still remain


Part-time, intermittent health care and support services

Help patients determine the level of services they need

Either provide or arrange for other services including physical, occupational, and speech therapy, medical supplies and equipment, and social worker and nutrition services.

May be reimbursed by Medicare, Medicaid, private payment, and some health insurers.

Advantages• Supplemental care and support in the home

• Provides some respite to caregivers• Enhances ability to remain at home

• More affordable than facility placement•Covered or supplemented by Medicare/Medicaid

entitlements

Disadvantages• Limited services and hours available

• Typically only in the home for a couple of hours , a few days per week

• Care giving needs for the majority of the day still remain

• Caregivers sometimes need to learn skilled tasks such as injections and dressing changes

Licensed Home Care Services Agency (LHCSA)

Provide same or similar services as CHHA’s but are private pay only.

Often privately owned and may or may not be for-profit.

Advantages• Supplemental care and support in the home

• Provides some respite to caregivers• Typically more accessible than CHHA’s

• Number of service hours available are less limited than CHHA’s

• Enhances ability to remain at home• May be more affordable than facility placement

depending on the number of service hours required

Disadvantages•Care giving needs for the remainder of the day

still remain• Can be quite expensive for a significant

number of service hours (typically $20-25/hr for aide service)

• Not covered or supplemented by Medicare/Medicaid entitlements

Any Questions about…

Adult Day Care?Certified Home Health Agency (CHHA)?Licensed Home Care Service Agency (LHCSA)?

Use the chat box to enter your questions.

Personal Care Homes 24 hour residential care in a supported setting Either in the residential home of the owner(s) or the owner(s) must live at the home Some state specific restrictions regarding the number of people that may live in the home Prohibits the owner(s) from arranging for care services

Advantages• Provides supervision, safety and

support• Provides caregivers with respite and

peace of mind• Meals, housekeeping, laundry, and

transportation• Typically less expensive than Assisted

Living Facilities

Disadvantages• These residences are not licensed and,

therefore, do not have Department of Health regulatory oversight or surveillance• Care giving and medical needs must be

arranged for and coordinated by the resident, family, and/or responsible party•Smaller settings and often have limited life

enrichment or stimulation

Adult Care Facility & Assisted Living Residence (ACF/ALR) 24 hour residential care in a licensed, regulated, and supported setting. Variety of sizes and are able to directly provide or arrange for care services. ACF’s are also often referred to as Adult Homes but also include the Enriched Housing

Program (EHP)-see next slide. ALR’s may or may not have an Enhanced Assisted Living Residence (EALR) certification. Of

note, ACF’s are not allowed to advertise themselves as providing “assisted living”.

Advantages• Are licensed, do have regulatory oversight and

surveillance• Provide supervision, safety and support• Provide respite and peace of mind

• Meals, housekeeping, laundry, transportation , and life enrichment activities are provided

•Direct care & assistance with activities of daily living • Typically less expensive than

Skilled Nursing Facilities

Disadvantages• Retention standards may limit resident’s

ability to remain at this level of care•Skilled nursing services are not allowed to be directly provided by the facility UNLESS

there is an EALR certification in place.

Enriched Housing Programs (EHP) Basically the same as ACF’s and also may or may not have

an Enhanced Assisted Living Residence (EALR) certification. Originally intended for independent apartment-type

settings and are allowed to have kitchens, stoves, and microwaves.

Advantages• May have a microwave or cooktop stove in

the apartment• Greater independence with meals

• Only required to attend one congregate meal per day

• Otherwise basically the same as the ACF

Disadvantages• Diminished oversight by staff if not

attending all congregate meals


Personal Care Homes?Adult Care Facility and Assisted Living Residence (ACF/ALR)?Enriched Housing Programs?



Not to be confused with the Assisted Living Residence (ALR). Program that is Medicaid subsidized and exists within an ACF

facility. Allotted number of bed allocations annually and they are,

therefore, in limited supply throughout the state.

Advantages• These have all of the same advantages as the ACF and EHP but have the added

benefit of financial subsidy • This is the only financially subsidized

program available within the Adult Care Facility/Assisted Living

level of care

Disadvantages• Difficult to obtain due to limited availability

• Have to meet the same financial qualifications as Medicaid thus may have to

wait while “spending down”• Have to time the financial qualification and

available bed opportunity which can sometimes be challenging

Special Needs Assisted Living Residence (SNALR) Same as Adult Care Facilities but have a focus on special needs. (memory care) May or may not have an Enhanced Assisted Living Residence (EALR) certification. Have additional regulatory requirements to meet due to their special needs population. In regards to geriatric care, the special needs group is typically individuals with some form of

dementia. Of note, facilities lacking this certification may not advertise that they provide specialized dementia

care.

Advantages•Have specialized service plans, safety measures, staffing

patterns, and additional staff training to accommodate for and adequately serve the special needs population• Have the added safety of a “wanderguard” system in

place, as well as, additional staffing requirements•Training of staff is intended to provide more appropriate

care and management of behavioral challenges • They are typically less expensive than Skilled Nursing

Facilities

Disadvantages• May be limited availability in the community of

choice• Often at least some behavioral and cognitive

challenges associated with dementia that may affect other residents

• There are regulatory retention standards related to behavior management that could, in certain

circumstances, result in an individual being required to move to a higher level of care


Certification that must be applied for and approved by the DOH. Adjunct to an underlying ACF, EHP, or ALR license and allows facilities to

provide additional services not allowed for in the base licensure. Services are primarily related to assistance with transfers, ambulation,

unmanaged incontinence, feeding, medical equipment (such as oxygen), and skilled nursing services such as dressings and nursing assessments.

Advantages• Allows a resident to remain in a facility longer and

“age in place”• Some services, such as dressing changes, may be provided by facility staff rather than having to arrange

for outside agencies or family coverage• Residents, in many cases, may remain at the facility

through end of life• There may be higher staffing ratios and/or nursing staff present to accommodate the higher level of acuity• They are still typically less expensive than Skilled

Nursing Facilities

Disadvantages• May be limited availability in the community of choice•There may be an alteration in the atmosphere due to the

higher level of acuity (i.e. wheelchairs, hospital beds, assistance with feeding)

• There are still certain circumstances that could result in an individual being required to move to a higher level of

care (i.e. immanent danger to self or others, 24 hour skilled nursing needs, skilled nursing needs that exceed

that particular facility’s EALR certification). *Residents and families do, however, have the ability to provide additional services to accommodate the needs

and remain in the facility.


Assisted Living Programs (ALP)?Special Needs Assisted Living Residence (SNALR)?Enhanced Assisted Living Residence (EALR)?


Continuing Care Retirement Community (CCRC) Community that has Independent Living, Assisted Living, and a

Skilled Nursing Facility available to its’ members all in one setting. Members of the community may move throughout the continuum of

care and remain on the same campus.

Advantages• Allows residents to remain in a familiar setting

regardless of which level of care they may require at any given time

• Residents almost always remain on the campus through end of life

• All levels of acuity can be accommodated• Depending on the contract, there are few additional

fees regardless of the level of care required and residents have a life care contract that remains in

effect even when their money runs out• Spouses may remain in close proximity to each other

Disadvantages• There may be limited availability in the

community of choice•You must be appropriate for and move to the

independent setting first• There are still certain circumstances that could result in an individual being required to

move to an alternate setting (i.e. immanent danger to self or others)• There is typically a large buy-in fee, in

addition to monthly fees.

Skilled Nursing Facilities (SNF) Traditionally known as Nursing Homes. Considered the highest level of care in the Long Term care

industry. Provide 24 hour, on-site skilled nursing care and have

medical directors.

Advantages• Residents rarely have to leave a SNF and

typically remain at the facility through end of life

• There may be higher staffing ratios and/or more nursing staff present to accommodate

the higher level of acuity• Physician care is available at the facility• They are subsidized by Medicare, Medicaid,

and Long Term Care Insurance

Disadvantages• They exist on subsidies and have fewer private-pay

residents. Therefore, they have some limitations to the services and amount of care they can provide.• There is typically an alteration in the atmosphere

due to the higher level of acuity (i.e. wheelchairs, hospital beds, assistance with

feeding, chairfast residents)• They are typically the most expensive

level of care


Continuing Care Retirement Community (CCRC)?Skilled Nursing Facility (SNF)?


Which care options sound right for you? Adult Day Care



Personal Care Homes








None of the above

Ithaca Area Provider ListingAdult Day Care

Longview, Elizabeth Brewster HouseCertified Home Health Agency (CHHA)

Visiting Nurse Services (VNS)Licensed Home Care Service Agency (LHCSA)

Classen Home Health, Community Health and Home Health, Inc. (VNS), Red Moon Caregivers, Comfort Keepers, Caregivers Home Care

Personal Care Homes Old Hundred, Evergreen

Adult Care Facility and Assisted Living Residence (ACF/ALR) Bridges Cornell Heights (ACF/ALR/EALR), Longview (ACF) ALR/EALR, Elizabeth Brewster House (ACF) ALR/EALR, Brookdale Senior Living Sterling House (ACF) ALR/EALR

Enriched Housing Programs (EHP) Brookdale Senior Living Sterling House (ACF) ALR/EALR

Assisted Living Program (ALP) None in the immediate area. Closest are Waverly, Montour Falls, Binghamton Area, Geneva and Auburn

Special Needs Assisted Living Residence (SNALR)Brookdale Senior Living-Clare Bridge Cottage

Enhanced Assisted Living Residence (EALR)Bridges Cornell Heights, Longview, Brookdale Senior Living-Sterling House

Continuing Care Retirement Community (CCRC) Kendal at Ithaca

Skilled Nursing Facility (SNF)Beechtree Rehabilitation Center, Oak Hill Manor, Cayuga Ridge

Ithaca Area References/Resources• Lifelong, 119 W Court St Ithaca, NY 14850 (607) 273-1511

http://www.tclifelong.org/• Tompkins County Health Department http://www.tompkins-co.org/health/• Visiting Nurse Services

http://www.vnsithaca.org/resources/communitypartners.html• Our Parents https://www.ourparents.com/new_york/ithaca/lifelong• Empire State Association for Assisted Living (ESAAL) http://www.esaal.org• New York State Department of Health www.health.state.ny.us• New York State Do Not Refer List

http://www.health.ny.gov/facilities/adult_care/memorandum.htm• Medicare.gov http://www.medicare.gov/LongTermCare/Static/TypesOverview.asp• Department of Health and Human Services National Clearinghouse for Long Term

Care Information http://www.longtermcare.gov/LTC/Main_Site/Understanding/Services/Facility_Based_Services.aspx

• Facility Locator http://list.assistedliving.com• Special Needs Overview (NYS DOH)• http://www.health.ny.gov/facilities/assisted_living/docs/

special_needs_overview_and_requirements.pdf

http://www.tclifelong.org/

http://www.tompkins-co.org/health/

http://www.vnsithaca.org/resources/communitypartners.html

https://www.ourparents.com/new_york/ithaca/lifelong

http://www.health.state.ny.us/

http://www.health.ny.gov/facilities/adult_care/memorandum.htm

http://www.medicare.gov/LongTermCare/Static/TypesOverview.asp

http://www.longtermcare.gov/LTC/Main_Site/Understanding/Services/Facility_Based_Services.aspx

http://list.assistedliving.com/

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