Senior living facilities are called by many different names, each providing slightly different levels of care and service: assisted living, nursing home, board and care, continuing care communities, adult foster care -- to name a few. Since these different names can be confusing if you are trying to obtain information about living options for seniors, it is preferable to focus on the type of facility you are seeking and the services offered rather than on the name.
Personal care
The amount of help with personal care that is available to residents is a major consideration when selecting an adult care facility. Activities of daily living (ADLs) are the routine activities such as bathing, dressing, grooming and toileting. Attention to these needs may have been a significant consideration in the decision to move to a board and care or adult home. While residents are supposed to receive help with these needs, that is not always the case. In reality, the staff at adult care facilities may not have the time to give to each resident on a daily basis and residents often assist each other in small ways such as doing buttons.
Housekeeping services
Board and care staff members are responsible for the general cleaning of common spaces, residents' rooms and bathrooms and they also provide supplies such as toilet paper and soap. Laundry service for linens and residents' clothing may also be provided.
Activities
Most states require that board and cares provide some activities as part of their daily routine, but adult foster homes have no such requirement. Most activities programs in board and cares are minimal and sedentary, usually including bingo, movies and crafts. Some facilities encourage their residents to join neighborhood senior centers or other community programs for recreation and socialization. Oversight agencies rarely focus on these activities during surveys.
Medication management
There is a great deal of controversy around the issue of management of medication, an important function carried out by staff members at board and care facilities. In some facilities qualified staff members administer medication to residents even where there is no regulatory requirement to do so. However, in many facilities medications are routinely handled and distributed to residents by staff members with no particular training in this area and often they have other duties in addition to medication management. Furthermore, there are substantive differences among facilities in the methods used for storage and administration of medications as well as in record keeping.
Meals
Proper nutrition is a major issue for most senior citizens, many of whom live alone. Often they don't feel it worthwhile to shop and cook only for one person and do not pay much attention to meal preparation. Poor nutrition can aggravate existing health problems as well as contributing to new ones. In addition, some medications must be taken before, with or after meals, making meal preparation an important consideration in selecting a board and care or adult foster care home in which food is included in the facility's rate.
Many state agencies that regulate board and cares have specific requirements for meals including the prominent posting of daily or weekly menus.
Although there are minimum requirements for nutrition, that does not mean that the food will be to everybody's liking and food preferences are important to everyone. For a person with an ethnic preference for a certain style of cooking, it makes sense to look for a facility that offers what is preferred. In addition to preferences, a resident may have special dietary needs such as kosher meals or vegetarian meals and, while some facilities are strictly kosher, others accommodate a small number of kosher or vegetarian meals by purchasing frozen meals. Most board and care facilities provide special diets such as salt-free or low-fat meals when recommended by a resident's healthcare provider. A facility will usually ask for medical documentation of any special diet necessitated by a medical condition.
Residents are free to eat out if they prefer, but the facility is not required to pay for meals taken elsewhere and do not refund money to a resident for uneaten meals when food is included in the board rate. Similarly, residents may usually arrange to have guests eat with them in the dining room, but generally advance notice is required and a fee may be charged to the resident.
In an adult foster care home food issues should be worked out in advance with questions asked to clarify issues such as the availability of snacks, access to the refrigerator and having guests at meals.
Meal supervision
Board and cares are expected to monitor their residents so that someone should notice if a resident loses his/her appetite or seems to be missing many meals, Some residents simply may need to be reminded that it's mealtime, but others may need to be encouraged to seek medical attention to determine the reason for a loss of appetite. Staff-to-resident ratio plays an important role in monitoring residents' eating habits. In a large facility such as a board and care with hundreds of residents, it may be difficult for staff to notice that a particular resident has not been eating, while in a small facility the chances are better that someone may notice.
Medication management
The issue of medication management in board and cares raises the issue of other populations served by these facilities. Some board and cares admit only elderly residents with no history of psychiatric illness, while others have a mixed population. This is something to be aware of when considering a board and care facility. Most non-elderly in board and cares are mentally ill persons who have been discharged from institutions or from psychiatric units of general hospitals. There also are elderly residents in board and cares who have psychiatric histories. These residents usually take medications to control their symptoms and they should be closely monitored.
Board and cares also are permitted to admit residents who are at least eighteen years of age and disabled as long as they meet other eligibility requirements (i.e. they are ambulatory).
Having a mixed population in a board and care is not necessarily a negative thing. One advantage of facilities that serve the mentally ill is that they often are required to have more staff on site and/or provide better training for staff members. Staff members usually watch for changes in behavior and appearance and are more alert to such changes, which can be a positive benefit for all residents as can the mix of age groups. The elderly often welcome having younger residents in the same facility and the younger disabled or mentally ill residents may appreciate having the elderly around to provide a family-style environment.
Licensing and inspection
Board and cares and adult foster homes are licensed and inspected by state oversight agencies. It is usually the Department of Health that fulfills this function, but in some states it may be the Department of Social Services. The easiest way to find out which agency has this responsibility is to check the latest inspection report (also known as survey report). It is required that the most recent inspection report be posted where it is easy for residents and visitors to view it. Board and cares and adult foster homes are not accredited as are hospitals and other health related-facilities. However, some of the larger facilities may be members of trade associations having certain standards for membership. Check the blue pages in your telephone book for the information. You can also check www.agingcare.com/Local, enter your area, and find the information that way.
Unlicensed facilities
In view of the scarcity of affordable living arrangements for low or modest income elderly, unlicensed board and cares and adult foster homes operate outside the purview of licensing agencies. These facilities often are informal arrangements providing room and board to the frail elderly where all involved benefit. However, the possibility of exploitation of a vulnerable population exists where unlicensed facilities continue to operate and it is advisable to avoid these facilities in favor of those operating lawfully.