Generally speaking, when an individual living at home can no longer be assisted with "scheduled care" (either by family or home health agencies) - and requires more "care on demand", assisted living becomes an attractive option.
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This would include assistance that is available 24-hours a day - whenever the resident needs it. Protective oversight, on-going medication management, nutritional support and personal assistance with dressing and bathing are all examples of care on demand.
Many residents live their remaining years quite comfortably in the assisted living setting. Since supportive care is provided (assistance with bathing, medication monitoring, meal preparation), living in an assisted living setting can significantly reduce the risk of serious health setbacks that might necessitate a higher level of care. In addition, Medicare home health services, rehabilitation and even Hospice services can all be accessed in an assisted living community. Certainly meeting a resident's needs is the number one priority and should a higher level of care be required, skilled nursing (both short and long-term) is a viable next step.
Skilled nursing and rehabilitation care is reserved for individuals with often complex medical needs requiring the "skill" of licensed nurses and therapists. Skilled nursing and rehabilitation is appropriate for seniors recovering from stroke or surgery that needs intensive, 7-day a week therapies. In addition, if a resident regularly requires the assistance of another to move from bed to chair, or is confined to bed due to their condition, they are generally more appropriate for the skilled nursing and rehabilitation setting.
What is Assisted Living?
An assisted living residence provides a combination of housing, supportive services and health care designed to meet the needs - both scheduled and unscheduled - of those seniors who need help with activities of daily living such as bathing, dressing, meal preparation and medication monitoring (Assisted Living Federation of America). Most states define a resident appropriate for assisted living care as one who can negotiate a pathway to safety in case of emergencies with no or little assistance from another person. These are broad definitions and each state regulates this level of care a bit differently.