Right Service, Right Place, Right Time: Part II

Right Service, Right Place, Right Time Part II

As we discussed last month, almost all caregivers will reach a point when they need help providing care.  We indicated that we should assess the needs and plan ahead for the Right Time to add services.  Now, we should look at the Right Service and the Right Place.

When the time comes to seek help with caregiving responsibilities, caregivers may be overwhelmed by the vast array of options available.  Where do you start?  It is helpful to divide services into in-home/community-based and residential/housing options.  Then, we can look at the alternatives as a continuum from minimal assistance to total assistance and from intermittent to continuous help.

If someone needs minimal assistance with one or a few tasks, it is fairly easy and convenient to bring that service to the home. In-Home or Community-based services may be an option.  There are numerous individuals and agencies that will provide chore services, like housekeeping, yardwork, transportation, bill-paying, grocery shopping, prepared meals and so on. If you need assistance with personal care, like bathing, grooming, and dressing, there are individuals and non-medical agencies who will assist with these services as well. And if the need includes nursing or medical care, licensed home health agencies can provide skilled nursing and therapy services.

If the services become more intense, requiring specialized equipment, maybe the house can be modified for greater accessibility—grab bars, shower chairs, special tubs, lifts, ramps, wider doors, and so on.  Several companies in our area are available to consult with homeowners about the possibility of renovating the house.  If home modifications are not feasible, or if more than one person is required to perform a task, adult day care may be the perfect option.  The individual can remain living in their house or apartment, but spend one to five days at a center where staff can provide personal care and medical needs.  

Home and community-based services work well if the needs can be met in predetermined blocks of time.  Home care agencies generally have a minimum visit time during which services must be provided.  After that visit, if additional needs arise, the person is on his/her own.  Adult day care covers most of the day, Monday through Friday, but not evenings, weekends and holidays. Closing the gap with home or community-based services can be costly and impractical.  It may be necessary to consider a change in living arrangements.

Residential Services (Housing options) can provide a complete package of services, including the home maintenance and chore services as well as personal care and nursing services.  Residential alternatives may be preferred for people who have needs that occur throughout the day and night.  These needs might range from medication administration several times a day, to assistance to use the bathroom, to 24-hour supervision, monitoring and response to sudden unexpected requests for help.  Residential care providers are able to provide incremental services as needed throughout the day and night, including weekends and holidays.  In addition, they provide increased opportunity to socialize with friends and neighbors.

Many different terms are used to describe housing options for older adults and people with disabilities.  It is beyond the scope of this article to describe these in detail, but here is a guide to help you distinguish the various housing options.


Types of Housing

Type of License


Senior Apartment

(Also referred to as  Adult Communities, independent living)

No License required

Like any other apartment complex, but tenants must be 55yrs of age or older. No other services available. May have some social activities.

Congregate Housing

(Also referred to as  Retirement Community or independent living)

No License required

Similar to senior apartments, but includes meals and may offer housekeeping, and other non-personal care related services.

Assisted Living

(Also referred to as Apartments with Services, Group Homes)

Residential Care Apartment Complex (RCAC)

Adult Family Home (AFH), Community-Based Residential Facility (CBRF),

Provides all of the services of congregate housing with the addition of personal care and nursing services.  RCAC provides full apartment accommodations.  CBRF generally offers single rooms, but may provide apartments. AFH are group homes for up to four (4) individuals.

Memory Care

(Also referred to as Dementia Care, Alzheimer’s Group Homes)

Adult Family Home (AFH), Community-Based Residential Facility (CBRF)

Provides all services of general assisted living, with special treatment for managing dementia, including a secured environment to prevent unsafe wandering.

Nursing Home

(Also referred to as Health Care Center, Subacute, Post- Acute, Rehabilitation Center)

Skilled Nursing Facility (SNF)

Provides a level of intense rehabilitation and nursing services for people who are recovering from an acute illness or injury. Generally not a longer term residential option, unless care needs are very high.

When it comes time to explore these options, caregivers should consult with someone at the Aging and Disability Resource Center.  Whether you are considering community-based or residential options, the staff at the ADRC are extremely knowledgeable and ready to help.  They can provide specific information and direction on how to proceed.  And, remember: plan ahead—don’t wait until you are overwhelmed or in a crisis.

 This blog is part of a two part series that is feature in the ADRC's Newsletter.