What Kind of Care Comes After Assisted Living? Your Guide to Next Steps

According to a report from A Place for Mom, the number of Americans aged 65 and older is projected to double in the next several decades, leading to a greater need for diverse senior care options. Understanding what kind of care comes after assisted living is a critical step for many families navigating the continuum of care.

Quick Summary

Options following assisted living include skilled nursing facilities for round-the-clock medical attention, specialized memory care for dementia, palliative hospice care for end-of-life comfort, and advanced in-home care services.

Key Points

• Skilled Nursing Facility: Provides 24/7 medical supervision for complex health needs and rehabilitation.

• Memory Care Unit: Offers a secure and structured environment tailored for individuals with dementia or Alzheimer's.

• Advanced In-Home Care: Allows seniors to age in place by supplementing with medical (home health) or non-medical services.

• Hospice Care: Focuses on comfort and symptom management for those with a terminal illness, available in various settings.

• Continuing Care Retirement Community (CCRC): Provides a seamless transition between care levels within a single community.

• Early Planning is Key: Addressing potential transitions before a crisis occurs leads to a smoother, more person-centered outcome.

• Assess Needs Professionally: A doctor's evaluation is critical for determining the appropriate level of care required.

Navigating the Senior Care Continuum

For many older adults, assisted living provides an ideal balance of independence and support. However, as health needs evolve due to aging, chronic illness, or a new medical condition, the level of care provided in an assisted living community may no longer be sufficient. Families then face the challenging but important decision of determining the next step. This guide outlines the different types of care available after assisted living, helping you make an informed choice that best supports your loved one's well-being.

Skilled Nursing Facilities: When Medical Needs Increase

If a loved one’s health declines significantly, they may require care that an assisted living facility is not equipped to provide. A skilled nursing facility (SNF), often referred to as a nursing home, offers the highest level of medical care outside of a hospital setting. Unlike assisted living, an SNF has licensed nurses available 24/7 to manage complex medical needs.

What to Expect in a Skilled Nursing Facility

SNFs are designed for individuals who require constant medical supervision or intensive rehabilitation. The services typically include:

• 24-Hour Nursing Care: Oversight by registered nurses and licensed practical nurses for medication administration, IV therapy, wound care, and monitoring of chronic conditions.
• Rehabilitation Services: Physical, occupational, and speech therapy for recovery from a surgery, illness, or injury.
• Comprehensive Assistance: Full support with activities of daily living (ADLs), such as bathing, dressing, and eating, for residents who are largely dependent on caregivers.
• Long-Term vs. Short-Term Stays: While some residents move to an SNF for permanent, long-term care, others are there for a short-term rehabilitation stay before returning home or to a lower level of care like assisted living.

Memory Care: A Secure Environment for Cognitive Decline

For individuals with Alzheimer's disease, dementia, or other memory-related conditions, a specialized memory care unit is often the most appropriate option. These facilities, which can be standalone or a secure wing within a larger community, are specifically designed to provide a safe, structured, and supportive environment.

The Focus of Memory Care

Memory care goes beyond the services of general assisted living to address the unique challenges of cognitive impairment. Key features include:

• Enhanced Security: Features such as alarmed doors and enclosed outdoor spaces to prevent wandering and ensure resident safety.
• Specialized Staff: Caregivers with advanced training in dementia and memory care, focusing on communication techniques and managing challenging behaviors.
• Structured Routines: Consistent daily schedules to minimize confusion and anxiety, often including cognitive-boosting activities like music therapy, art classes, and reminiscence sessions.
• Dementia-Friendly Design: Layouts and decor are often chosen to reduce stress, improve navigation, and create a calm, predictable environment.

Advanced In-Home Care: Aging in Place with More Support

Some seniors and their families prefer to remain at home even as care needs increase. In-home care services can be expanded to provide higher-level support, but it's crucial to understand the difference between medical and non-medical care.

Home Health vs. Home Care

• Home Health Care: Medically focused services provided by licensed professionals like nurses or therapists. It is often covered by Medicare for a short-term, medically-necessary period and includes things like wound care, injections, and physical therapy.
• Non-Medical Home Care: Provides assistance with daily activities and companionship from non-licensed caregivers. Services include meal preparation, light housekeeping, errands, and medication reminders. This can be combined with home health services for a comprehensive care solution.

Hospice Care: Comfort and Dignity at the End of Life

When a loved one is facing a terminal illness with a prognosis of six months or less, hospice care becomes the focus. The goal shifts from curative treatment to comfort and quality of life. Importantly, hospice is a service, not a place, and can be delivered wherever the patient resides, including an assisted living facility or their own home.

The Hospice Care Team

The hospice team collaborates with the patient, family, and existing care providers to create a personalized plan. The team typically includes:

• A physician: Oversees the medical care.
• Registered nurses: Manage pain and symptoms.
• Social workers: Provide emotional and practical support.
• Spiritual counselors: Offer guidance for spiritual and emotional needs.
• Trained volunteers: Provide companionship and assistance with errands.

Continuing Care Retirement Communities (CCRCs)

For those who plan ahead, CCRCs offer a seamless transition between care levels within a single campus. A CCRC, also known as a Life Plan Community, allows residents to move from independent living to assisted living, and finally to skilled nursing or memory care without leaving their familiar community.

Benefits of a CCRC

• Aging in Place: Ensures residents can stay in one community as their needs change.
• Convenience: All levels of care and amenities are located on the same campus.
• Predictable Costs: Some CCRC contracts offer predictable monthly costs, though an initial entrance fee is required.

Comparing Post-Assisted Living Care Options

Feature	Skilled Nursing Facility (SNF)	Memory Care Unit	Home Health Care	Hospice Care
Primary Focus	24/7 medical care and rehabilitation	Specialized dementia and cognitive care	Medical recovery and maintenance at home	End-of-life comfort and symptom management
Environment	Clinical, hospital-like setting	Secure, structured, dementia-friendly	In the comfort of the individual's home	In the individual's home or facility
Staff	Licensed nurses, therapists, CNAs	Specialized dementia-trained caregivers	Licensed medical professionals	Interdisciplinary team (nurses, social workers, etc.)
Best For	Complex medical needs, post-surgery recovery	Alzheimer's, dementia, and related conditions	Short-term medical needs after an illness/injury	Terminal illness prognosis of 6 months or less
Duration	Short-term or long-term	Long-term	Intermittent, short-term	End-of-life

How to Plan for the Transition

Choosing the right option requires careful consideration and planning. It's often best to begin this process before a crisis occurs. Here is a step-by-step guide to help you navigate the transition.

1. Assess the Needs: Honestly evaluate the senior’s current and future care needs. This includes physical, medical, and cognitive health. Consult with their doctor for a professional assessment.
2. Research Options: Explore the different types of care available in your area. Look at skilled nursing facilities, memory care units, hospice providers, and in-home care agencies.
3. Tour and Interview: Visit facilities and interview potential in-home care providers. Pay attention to the staff's training, the environment, and the services offered.
4. Consider Finances: Evaluate the costs of each option and determine how it will be funded. Resources like long-term care insurance, Medicare, Medicaid, or private funds can all play a role.
5. Involve the Senior: Include the individual in the decision-making process as much as possible to ensure their preferences and wishes are respected. This helps them feel more in control and less resistant to the change.
6. Utilize Professional Help: Don't hesitate to seek guidance from social workers, geriatric care managers, or transition specialists. For additional resources, the National Institute on Aging provides information on long-term care facilities and planning: https://www.nia.nih.gov/health/assisted-living-and-nursing-homes/long-term-care-facilities-assisted-living-nursing-homes.

Conclusion: Making the Right Choice for Your Loved One

When a person requires more support than assisted living can offer, a range of options can provide the necessary care and comfort. The decision of what kind of care comes after assisted living depends on the individual's specific needs, health status, and preferences. Whether moving to a skilled nursing facility, transitioning to a memory care unit, arranging for more comprehensive in-home services, or focusing on end-of-life hospice care, each path is a crucial step in ensuring a loved one's safety, dignity, and quality of life. By understanding the choices and planning proactively, families can navigate this transition with greater confidence and peace of mind.

Frequently Asked Questions

What is the primary difference between assisted living and skilled nursing?

Assisted living provides help with daily activities but has limited medical staff, while a skilled nursing facility offers 24/7 medical supervision and complex care from licensed nurses and therapists.

When should someone consider memory care instead of assisted living?

Memory care becomes necessary when a person with dementia exhibits behaviors that require a more secure environment, specialized care, and a structured routine to ensure their safety and well-being.

Can a person receive hospice care in an assisted living facility?

Yes, hospice care is a service, not a location. An independent hospice provider can work with the assisted living staff to provide end-of-life care and comfort to a resident.

What is a Continuing Care Retirement Community (CCRC)?

A CCRC is a campus that offers multiple levels of care, from independent living to skilled nursing, allowing residents to transition as their health needs change without having to move to a new community.

Is home health care covered by Medicare after assisted living?

Medicare typically covers short-term, medically necessary home health care if prescribed by a doctor, but it does not cover long-term non-medical care or daily living assistance.

How do I know if my loved one needs more care than assisted living provides?

Signs may include increased falls, unmanageable chronic conditions, frequent hospital visits, significant cognitive decline, or a staff recommendation that a higher level of care is required.

What role do families play in the transition to a higher level of care?

Families are crucial in assessing needs, exploring options, communicating with care providers, and providing emotional support to ensure a smooth and respectful transition for their loved one.