Options for Housing and Care

Long term care and services can be provided in many different settings, not just in nursing homes or centers where you must live to get the services. A wide variety of care and services are available, from medical care, to assistance with bathing and dressing, to assistance with household chores.

Some care and services are available in more than one setting. In recent years, more and more people are choosing to stay in their homes and arrangements are being made for the care and services to come to them.

You may receive a combination of the services to enable you to live independently for as long as possible. Think about where you want to receive your care and services.

In Home

In general, you have the greatest independence in your home and that is where you may prefer to stay. You don't have to move from your home or apartment to get most long term care and services. Most home health care agencies, homemaker service companies, physical therapists, etc., will make arrangements to visit your home to provide them. Modifications like installation of bathtub safety bars, can be made to yourhome to make it possible for you to remain there.

Under some special programs, even persons requiring 24-hour care could receive the care in their homes and avoid moving to residential care settings or nursing homes. However, the high cost of providing some care and services in your home is a factor to consider.

Examples of care or services that can be provided in your home include but are not limited to:
  • Adaptive Aids/Supplies/Equipment
  • Attendant Care
  • Case Management Services
  • Counseling
  • Health Monitoring
  • Home delivered Meals
  • Homemaker Services
  • Hospice Care
  • Personal Care
  • Respite Care
  • Skilled Nursing Care
  • Therapies
  • Transportation

Residential

In general, you retain moderate independence in a residential setting. If the services you need cannot be provided in your home or your community, you may move to a residential care setting, live there and receive the care and services you need. These settings can offer a wide range of care and services based on your needs.

Generally, room and board as well as personal care services are provided in a residential setting. How much care and services you receive depends on your needs and the management of the residence.

Not all care and services are available at all residential care sites. Some residential care settings can adjust the care and services they provide as your needs change, so you don't have to move to another place if your condition improves or declines.

Examples of care and services in a nursing home setting include but are not limited to:
  • Adaptive Aids/Supplies/Equipment
  • Case Management
  • Counseling
  • Health Monitoring
  • Hospice Care
  • Personal Care
  • Psychological Services
  • Respite Care
  • Room and Board
  • Skilled Nursing Services
  • Social Activities
  • Social Worker Services
  • Therapies
  • 24 hour monitoring
Examples of residential care centers include:
  • Personal Care Homes
  • Assisted Living Facilities
  • Domiciliary Homes
  • Continuing Care Retirement Communities
Examples of the care and services available in residential settings include but are not limited to:
  • Adaptive Aids/Supplies/Equipment
  • Case Management Services
  • Counseling
  • Exercise Programs
  • Health Monitoring
  • Homemaker Services
  • Hospice Care
  • Nutritious Meals and Snacks
  • Personal Care
  • Psychological Services
  • Respite Care
  • Room and Board
  • Skilled Nursing Services
  • Therapies
  • Transportation
  • 24 hour assistance

Community

Some services are available at locations in your community rather than your home. For example, Adult Day Services or Rehabilitation Centers in your neighborhood may be able to provide the care and services you need.

Although you go to these centers for care and services, you may still live in your home or apartment instead of moving to a nursing home.

Examples of the care and services available in your community include but are not limited to:
  • Adaptive Aids/Supplies/Equipment
  • Adult Day Care
  • Case Management
  • Congregate Meals
  • Counseling
  • Exercise Programs
  • Health Monitoring
  • Psychological Services
  • Respite Care
  • Room and Board
  • Skilled Nursing Services
  • Social Activities
  • Therapies
  • Training
  • Transportation
  • 24 hour monitoring

Nursing Home

In general, a nursing home is a setting for persons who require constant care and supervision. In a nursing home, 24-hour nursing care, rehabilitative services and personal care services are available. If you only need room and board, personal care or homemaker services, a nursing home may not be the appropriate setting for you. However, if your needs are such that you require 24-hour monitoring and assistance, they may best be met by a nursing home.

Determining Your Needs

The types of care and services you may need depend on how much assistance you need with your activities of daily living. These activities are essential to day-to-day functioning and include but are not limited to:

  • Bathing
  • Dressing
  • Grooming
  • Eating
  • Getting in and Out of Bed, and
  • Using the Toilet

Pennsylvania's Options Program

The goal of the OPTIONS Program is to give choices to consumers in need of Long Term Care services. The program provides an intensive assessment administered by staff from the local Area Agency on Aging (AAA). If appropriate additional information is obtained from the consumer's primary care physician, this new assessment information is then reviewed and appropriate care alternatives are identified and discussed with the consumer to determine preference. The consumer's preference is considered along with service availability and where possible services are provided to the consumer per their desires.

Services range from those outside the home such as nursing facility or personal care residential home to a wide array of services in the consumer's home such as home health, personal care, etc.

Consumers who receive these services are normally 60 years of age or older and experience some degree of frailty in their physical or mental health status. They range in functional need from being clinically eligible for services in a nursing facility to needing basic personal care services such as help getting dressed. There is no financial eligibility requirement for OPTIONS based services. However, consumers may be required to make a co-payment for services based on income.

The components of the OPTIONS Program are as follows:
  • Assessment for many consumers is the critical step taken by the AAA in partnership with the consumer to determine or re-determine needs and how best the AAA can meet these needs. The assessments include:
    • assessment of need for and provision of services and care management to persons over age 60 with complex, ill-defined problems, problems remaining at home or requiring personal advocacy.
    • assessment of need for and provision of services and care management to persons over age 60 requesting the following Area Agency on Aging (AAA) services: day care, counseling, personal assistance services, home health, personal care, protective services, home-delivered meals, transportation services, respite care, home support services and any other AAA community or in-home service.
    • assessment of persons ages 18 to 59 to determine nursing facility clinical eligibility for those persons looking to access Department of Public Welfare's Medicaid Home and Community Based Services Programs (DPW HCBS) .
    • mandatory assessment for persons applying for medical assistance (Medicaid) for nursing facility care or for placement in a domiciliary or personal care home who are eligible for the State Supplement to SSI; an assessment is also available for any individual who is thinking about nursing facility care.
    • the nursing facility assessment also includes screening for mental illness, mental retardation and other related conditions, and the assessment of need for specialized services.

If the consumer (60 and older) is Medicaid eligible and the Area Agency on Aging has a service opening in the waiver, these services will be provided through the Medicaid 60+ Waiver.

Agency Assessments

There are public and private agencies that can help you figure out what care and services you need. The agencies generally assign case managers who have been specially trained to evaluate your situation and determine your needs. The evaluation is called a functional assessment.

Publicly funded agencies do not charge a fee for completing assessments, but a private agency may. Be sure to ask about charges and fees when you contact one of the agencies.

There are several types of assessments and all require forms to be completed to record your answers. An assessment of needs for home or community-based care and services will generally not be as long or in-depth as one that is done prior to your admission to a nursing home. But, both require you to answer many questions. Be assured that all information provided to a case manager during an assessment is kept confidential.

To complete a functional assessment, a case manager asks many questions about how well you are able to perform daily activities and how much assistance you need. They may ask about the medicines you take and whether you are able to remember to take them. They may ask if you need assistance using the toilet or use incontinence supplies (adult diapers, shields or pads). They may ask questions to determine if you are confused or forgetful and if you live alone or with family. Your answers to these questions help them evaluate your needs and identify the care and services to meet your needs.

The assessment process can be frightening, but the information you provide enables the case manager to understand your situation and your needs. Your answers will also enable the case manager to identify financial programs or resources to help you pay for the care and services. It's to your benefit to answer the questions as well as you can. An example of the most thorough assessment form, the Comprehensive OPTIONS Assessment Form is attached in APPENDIX A .

Housing Options

Domiciliary Care Services for Adults

Domiciliary care is a supervised living arrangement in a home-like environment for adults who are unable to live alone because of demonstrated difficulties: (1) in accomplishing activities of daily living; (2) in social or personal adjustment; or (3) resulting from disabilities. The Area Agency on Aging, is responsible for assessment and placement of residents in domiciliary care homes. They also certify domiciliary care homes. Residents are eligible for a domiciliary care supplement payment if they are eligible for Supplemental Security Income (SSI) or have an income less than the combined federal/state payment for domiciliary care and are not related to the provider. People who are not eligible for the supplement may reside in domiciliary care homes as private pay residents.

Personal Care Homes / Assisted Living Facilities

Personal care homes, sometimes called assisted living facilities, offer room and board and assistance with the activities of daily living (such as bathing, grooming and meal preparation). They are inspected and licensed by the Department of Public Welfare. Older people or their families who are thinking about moving to a personal care home, should consider only those homes with a current license from the Department of Public Welfare. It is also important to have a contract with the home operator which lists the services to be provided and the cost of each service.

To obtain a copy of the current regulations or a current listing of licensed personal care homes:

Division of Personal Care Homes
Department of Public Welfare
P.O. Box 2675
Harrisburg, PA 17105
(717) 783-8391
Nursing Homes

Pennsylvania's Department of Health, Division of Nursing Care Facilities is responsible for the licensing and oversight of Pennsylvania's nursing care facilities. As of April 30, 2001 there were 776 facilities with a total bed capacity of over 96,000. The Department conducts over 5,000 inspections a year. These include licensure and certifications surveys, follow-up surveys and complaint investigations. The Department also operates and maintains the federally mandated Nurse Aide Registry which contains information on over 154,000 nurse aides in Pennsylvania.