Still in her bathrobe, Mom was surprised to see you at the door for a planned lunch date. Improvising, you told her you had a yearning for one of her PB&J sandwiches instead. 

At her kitchen table, you realized that you’ve danced around scenarios like this before. 

Overdue payment notices in the mail, missed meals and occasional incontinence issues are easy to brush off individually. But they’re starting to add up. 

Quite frankly, it kind of scares you. 

Are you purposely dismissing these signs because you don’t know what to do or where to start? It’s hard to admit, but it’s time. 

In the past, you’ve talked openly with her about long term care options. She wants to maintain her independence and doesn’t want to burden you and your family with directly caring for her. 

Knowing that the better long term care facilities have long waiting lists, it makes sense to start searching for a long term care facility that’ll help your mom. 

So, how do you start sorting this out? 

You’re familiar with some of the facility-based long term care options. If you can unravel the differences between assisted living, memory care and nursing home facilities, you can help her make a better-informed decision about her future care. 

Here’s the key:

Once you’re clear on the type of long term care services that’ll help your loved one, you can zero in on the long term care facility that provides that type of care. 

Think of it like grocery shopping. Without a list, you’re wandering the aisles aimlessly. With it, you’re focused and get exactly what you need. 

Let’s take this long term care shopping puzzle one piece at a time and get grounded with some terminology that you’ve probably heard, but may not completely understand. 

Ready? 

1. Breaking It Down: What is Long Term Care & Who Needs It? 

According to The National Institute on Aging, 

“Long-term care involves a variety of services designed to meet a person's health or personal care needs.... These services help people live as independently and safely as possible when they can no longer perform everyday activities on their own.​” 

The variety of services mentioned here are typically offered as two distinct types, skilled services and non-skilled services. 

To put it another way, people who need long-term care may receive a mix of assistance offered through the two main types of care services: 

● Skilled services encompases any medical care that’s provided by licensed health professionals, like RNs or physical therapists. 

● Non-skilled services help with personal care and everyday tasks. 

Let’s take a deeper dive to better understand the differences between long term care non-skilled and skilled services. Before we do, keep our first key point in mind. 

Key Point 1: The kind of Community and type of care needed will vary based on whether you need skilled or non-skilled care. 

2. ADLs and IADLs: What are the long term care non-skilled services? 

Non-skilled care services focus on helping with day-to-day personal care and adult living activities. These custodial care activities are categorized based on their complexity level. 

Activities of Daily Living (often referred to as ADLs), are daily personal self-care tasks that independent adults perform. These are:

• Bathing
• Self Feeding 
• Toileting
• Getting Dressed 
• Transferring  (i.e. from bed to chair)
• Continence

Assistance with personal care activities, such as help with bathing or toileting, is a non-skilled long term care service. Some seniors like your mom may need just a little help, where others may be fully dependent upon someone else to help them. 

More complex adult tasks are called Instrumental Activities of Daily Living (or IADLs) and include:

• Telephone Use 
• Shopping 
• Housekeeping 
• Laundry
• Arranging 
• Transportation
• Food Preparation
• Managing Medications
• Managing Finances

Non-skilled long term care also includes assistance with managing more complex adult living activities like grocery shopping, preparing meals and maintaining a clean living area. 

The U.S. Department of Health and Human Services points out that most long term care is not medically related, but instead is the help provided with everyday tasks (ADLs and IADLs). 

Wait. Help with everyday tasks? 

This challenges a common preconception about those who need long term care. 

An individual’s medical condition alone is not the primary factor in determining their need for long term care. 

Key Point #2: ADLs, also called "activities of daily living," and include daily activities like bathing or needing help with laundry. They determine the type of care needed and the cost. 

3. What are long term care skilled services? 

Medical care provided by licensed health professionals is categorized as skilled services. 

Long term medically related needs, such as monitoring vital signs, wound care, or assistance with ventilators or braces over an extended period of time requires long term care skilled services (sometimes called skilled nursing services). 

This can include services from physicians, nurses, and physical therapists. These specialists may be on staff at a nursing home or other long-term care community. Services can also be

provided on an as-needed basis while living in a long-term care community. This includes offsite appointments like at a kidney dialysis center or visit with a medical specialist. The type of long-term care you choose will be based on whether this type is needed and to what extent. For example, independent living homes don’t provide skilled care but nursing homes will. 

Key Point #3: Skilled care is provided by some community types and involves care provided by licensed medical professionals. Examples can include assistance with a ventilator or wound care provided by a nurse. 

4. How to Determine When a Senior Needs Long Term Care A loved one’s need for long term care may come on gradually or arise as a result of a sudden injury or illness, such as a stroke. In either case, consult with the patient’s healthcare provider or team to understand future or imminent long term care needs. 

A geriatric care assessment is another option that’ll help understand the quality of your loved one’s life and any challenges with their current living situation. The Institute on Aging states that the advice of a geriatric assessment will help to answer “How well is an aging adult able to take care of themselves, and what help will they need to undergo the basic and higher necessities of life?” 

Keep in mind that long term care needs change as mobility issues change or chronic conditions worsen. If possible, have an open conversation with your senior to understand their thoughts and wishes to help guide future decisions with their care. 

Key Point #4: Get a geriatric care assessment or physician evaluation to determine what kind of long term care may be needed. 

Where Can Seniors Get Long Term Care? 

Naturally, caregiver requirements for seniors depend on the level of assistance that they need. Once it’s determined that your loved one would benefit from long term care and the specific needs have been identified, your next step is to determine the best place for that care. 

For many seniors, long term non-skilled caregivers provide ample assistance to help them “live as independently and safely as possible.” For others, a combination of skilled and non-skilled caregivers can provide the best long term care option. 

Home-Based Long Term Care: Custodial Care & Home Health Care 

Many seniors are able to remain in their homes with the help of long-term custodial caregivers (those who assist with ADLs and IADLs), sometimes arranged through home health care

providers. 

You may be surprised to learn that most long term home caregivers are unpaid family members or friends (NIA: What is Long-Term Care?). 

The problem comes when home-based living or home-based care becomes inadequate, overwhelming or unsafe. For example: 

● A neighbor told you that your mom needed help with unlocking her front door last week. ● Your back-in-the-day socialite mom is obviously lonely. 

● Concern for your mom’s care has consumed your personal and professional life. 

5. What are the Different Types of Long Term Care Facilities? There are several reasons why facility-based care is a good choice for senior long term care: ● Safer and more secure environment 

● Consistent meals 

● Opportunities for physical activity 

● Socialization 

● Consistent help with ADLs and IADLs 

● Full-time, round-the-clock care 

Assisted Living, Memory Care and Nursing Homes are the different types of long term care facilities that offer these services to their residents in varying capacities. 

At this point, you likely have a clearer picture of mom’s care needs and definitions of long term care facility types. 

Now, your questions may be: Which long term care facility type should we choose? How do we match the long term care facility with the services that mom needs? 

More pieces of the puzzle for you to sort through. 

Let’s go over some general statements about the differences in long term care facilities to get grounded once again. 

Key Point #5: The three main types of long-term care communities are assisted living, memory care, and nursing homes. 

6. What is Assisted Living? 

Assisted Living Facilities are home-like residential communities for adults who can generally take care of themselves, but need some day-to-day assistance. Care services offered by these facilities are primarily focused on providing aid with ADLs and IADLs, although additional

services may be available. 

Chef-prepared meals are provided, typically in a central location that helps to encourage socialization. Socialization is a key concept in assisted living. Resident activities, including mealtimes, are centered on mutual interaction. Enrichment opportunities can include organized outings and social events. 

Residents typically have their own private apartment-like living area, equipped with kitchenettes and accessible bathrooms. Pets are often allowed, and couples may be able to live together in this setting. 

Key Point #6: Assisted living provides private-like apartments where seniors can have private kitchenettes and bathrooms and pets and couples can all stay together. 

7. What is Memory Care? 

Memory Care Facilities are typically home-like residential care communities for adults suffering from Alzheimer’s Disease or dementia. Often located within Assisted Living facilities, memory care facilities provide a secure environment that specifically addresses the care and safety needs of cognitively impaired patients. 

Meal time is typically centrally located, similar to assisted living facilities. Social experiences and living environments are specially adapted to enhance the care of memory care residents. Compared to a regular assisted living community, a memory care setting will likely rely on more secure exit doors to minimize residents' risk of wandering outside the building. Assistance with ADLS and IADLS continues but usually with a higher level of care 

Similar to assisted living facilities, residents may have their own secure and accessible living area. Pets may also be allowed. Due to the specific memory care provided, couples are generally not permitted to live together in this setting. However, a spouse could live in another area of an adjoined assisted living facility. 

Activities and events are adapted to the unique needs of residents with memory impairment. These programs, and mealtimes, usually rely on a very regular schedule to provide a smooth and consistent experience for each resident. 

Key Point #7: Memory care provides assisted living services while helping those with Alzheimer’s disease, dementia, or other memory impairment issues. 

8. What is a Nursing Home? 

Nursing Homes (sometimes called Skilled Nursing Facilities) provide care for their residents who have more complex needs. Skilled (medically based) and non-skilled care services are offered to residents based on need.

Meals provided to residents are served either in the residents’ rooms or in a social setting, with accommodations for special feeding or dietary needs. 

Residents live in a more clinical setting, in private or semi-private rooms, but enjoy organized social settings as care allows. 

Key Point #8: Nursing homes are ideal for those needing skilled care from licensed professionals 

Side by Side by Side: Compare 3 Long Term Care Facilities So, back at the facility question again. 

Of course, the primary consideration for choosing an appropriate long term care facility is to understand how the facility’s care services will meet your mom’s current and future needs. 

However, it’s not always that clear-cut. Consideration of spouse or pet accommodations or level of skilled care needed should be weighed. 

In addition, the cost of care, insurance coverage and seeking assistance for paying facility costs is yet another complicated piece of the puzzle to discover. 

While it makes sense to review the services provided by each individual facility, this chart can help to distinguish some similarities and differences between the three main residential facility types.