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Senior Living Levels of Care – Clearing the Confusion

By Emma Gift, MSW, Kavod Staff Care Coordinator/Social Worker

I have noticed that many people have a hard time understanding the specific levels of care provided in different living situations for older adults. I currently work in Assisted Living at Kavod Senior Life, but I have experience working in independent living, skilled nursing and hospice. In this article I will give a brief explanation of levels and care to help clear the fog and decide which setting may be the best fit for you or your loved ones.

I’ll start with some definitions.

INDEPENDENT SENIOR LIVING is essentially a living situation in which older adults lease an apartment in a building that is designated for people over a specific age (55 or 62, for example).

The facility is not required to provide any care or services. However, there are independent living communities that do require certain activities such as dining or alert systems in order to keep their tenants safe; this is the case at Kavod Senior Life, where we offer 370 apartments for independent living that include a mandatory dining program and check-in system.

Kavod and others like it also offer “a la carte” services such as housekeeping that are an additional cost to the renter.

ASSISTED LIVING is the next step up from independent living in terms of care. The definition from the Federal government, assisted living is defined as “dwellings that provide occupants with assistance for daily living activities and instrumental activities of daily living.” The state of Colorado defines assisted living as “[including] room and board and at least the following services: personal services; protective oversight; social care due to impaired capacity to live independently; and regular supervision that must be available on a 24-hour basis, but not to the extent that regular 24-hour medical nursing care is required.”

The most important thing to remember about assisted living is that it is NON medical. This means that there are no medical personnel (such as doctors, nurses, certified nursing assistants, etc.) on staff per the state regulations.

Additionally, Medicare does NOT cover assisted living because it is non-medical. However, Medicaid may cover assisted living expenses depending on the specific facility and a determination of a person’s income/assets.

The next and highest level of care is SKILLED NURSING, commonly called a nursing home. The federal definition for skilled nursing facilities is as follows: “A licensed Medicare nursing facility primarily engages with the staff and equipment to give skilled nursing care or skilled rehabilitation and other related health services to those who are chronically ill, usually elderly patients.”

Nursing care means all medical needs are handled on site and that doctors, nurses and CNAs are on staff at all times. These medical professionals provide assistance with all activities of daily living; facilities are locked and secured buildings. Assisted and independent living communities are not required to be secured unless they have a memory care unit.

MEMORY CARE is another type of locked facility for individuals suffering with dementia-related illnesses. I won’t discuss this particular type of care in detail, but memory care units can exist on their own or along with nursing care.

Finally, I would like to share the differences in provisions over the spectrum of situations for ACTIVITIES OF DAILY LIVING (ADLs) and INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADLs). ADLs include bathing, grooming, dressing, toileting, ambulating and eating. IADLs include financial management, medication management, shopping, telephone/communication abilities, housekeeping and laundry.

In non-medical communities like assisted living, you will find most help with IADLs with the exception of financial management, which is not permitted.

In more medical settings like nursing and memory care, there is more help with ADLs, specifically toileting and walking/ambulating.

Hopefully these tips will help provide some basic information about what to expect in various long term care settings. Remember – as mentioned previously – that each facility is different and may have its own set of specific rules and stipulations. However, the general concepts stay the same. 

If you’d like more information on Kavod’s Assisted Living or Independent Living, please visit our FAQs to learn more!