What Level of Care Does Your Loved One Need?

When looking at a facility option in Arizona, there are many types of facilities to choose from.  The type of facility required is based on the physical and functional needs of the resident.  Below is a breakdown of the facility types available and what they offer. Your Care Manager or Aging Life Care Professional will be familiar with the best care solutions in your area and provide the advice you need to make the best decisions for your loved one.

Independent Living in Arizona

These communities are geared for the independent senior.  They often have organized activities/outings for the residents.  Many have a clubhouse and a pool on the property as well as other amenities.  The residents either own their home and are responsible for the maintenance or they rent their living space like a traditional apartment.  These properties are not appropriate for a person who needs assistance with their activities of daily living.

Assisted Living in Arizona

The Assisted Living Federation of America (ALFA) defines an Assisted Living residence as a combination of housing, personalized supportive services and health care designed to meet the needs – both scheduled and unscheduled – of those who require assistance with activities of daily living.  In Arizona, the Department of Health Services (DHS) licenses Assisted Living homes and centers.  Assisted Living homes are licensed for ten (10) or fewer residents and residents usually have either a private or a semi-private bedroom.  Assisted Living centers are licensed for eleven (11) or more residents and usually are set up as apartments.  Assisted Living residences typically charge a monthly rent.  Additional charges may be added to cover the cost of services required by the resident.  There may also be a one-time, non-refundable facility fee due at time of move in.

In Arizona, there are three levels of care available in Assisted Living homes and centers and many facilities offer more than one level of care:

1. Supervisory Care Services – general supervision, including daily awareness of resident functioning and continuing needs, the ability to intervene in a crisis and assist in the self-administration of prescribed medications.
2. Personal Care Services – assist with activities of daily living that can be performed by persons without professional skills or professional training, and includes the coordination or provision of intermittent nursing services, and the administration of medications and treatments by a licensed nurse.  Must meet all the requirements also of the Supervisory Care Level.
3. Directed Care Services – programs and services, including personal care services, provided to persons who are incapable of recognizing danger, summoning assistance, expressing need, or making basic care decisions.  Must meet all requirements of Supervisory Care and Personal Care levels.

Most Assisted Living communities provide the following either as part of the monthly rate or for an additional charge:
• A minimum of one meal per day, many provide all three
• Housekeeping services
• Transportation
• Social and recreational activities
• Medication management
• Laundry services
• 24-hour security and staff availability
• Emergency call systems for each resident’s room
• Assistance with eating, bathing, dressing, toileting, and walking
• Access to health and medical services

Facilities licensed by the state should be checked out for deficiencies (enforcement actions).  This can be done by contacting the Arizona Department of Health Services or going to their website http://azdhs.gov/licensing/medical-facilities/index.php.

Memory Care in Arizona

Memory Care centers are a specialty form of Assisted Living designed for the person suffering from a memory disorder.  The physical environment and the programs provided in a Memory Care setting are specifically tailored to the individual, with the goal of nurturing independence while maximizing quality of life.  Memory Care settings are a secure environment to protect those who wander.  In addition the staff at these facilities have had additional training in the care of persons with dementia.  In Arizona, Memory Care centers are licensed as Directed Care.

Skilled Care in Arizona

In Arizona, Skilled Nursing Facilities are also licensed by DHS.  Licensed nursing care facilities provide the highest level of medical care for persons who are not able to perform their activities of daily living.  The care is provided by nursing professionals under the direction of a physician.  Skilled Nursing care is often used for acute, short stay care after hospitalization.  These stays may be covered by Medicare after discharge from a hospital.  Long-term care in a skilled setting is reserved for those who need nursing care on a regular basis but do not require hospitalization.  These stays are not covered by Medicare, although Medicaid (if eligible) and long-term care insurance will often cover part of these costs.  Often these facilities also provide services such as speech therapy, physical therapy and occupational therapy.

Continuing Care Retirement Communities in Arizona

Continuing Care Retirement Communities (CCRC) usually provide independent, assisted and skilled levels of care in one community.  Some CCRCs also offer Memory Care.  This type of community offers a contract that secures living accommodations and services over the long-term.  These communities are designed to provide services over the life of the resident.  There are three common types of contracts used in CCRCs:

• Extensive – covers shelter, residential services, amenities, and unlimited skilled nursing care with little or no increase in the usual monthly payments.  Due to the nature of this contract, the fees are usually higher



• Modified – covers shelter, residential services, amenities and a specified amount of Skilled Nursing Care.  Any additional Skilled Nursing Care required beyond the specified amount is the resident’s financial responsibility.

• Fee-For-Service – covers shelter, residential services and amenities.  Skilled Nursing Care is paid for by the resident as it is used.

Most CCRCs also require a one-time entrance fee in addition to the monthly payments.  Examine the refund policy on the deposit.  There should be a pro-rated refund available based on the length of residence.  Finally, inquire into the financial stability of the CCRC.  Some unlucky families put down a deposit only to find out that the company is on the verge of bankruptcy and the deposit is lost.  Due to the complexity of these arrangements, it is wise to have an attorney review the contract prior to signing.  You can also obtain information on CCRCs from The Continuing Care Accreditation Commission at www.ccaconline.org.

Choosing an appropriate facility can be a challenge.  There are many levels of care and dozens of facilities which offer one or more level of care.  When it is time to look for a facility option, engaging an Aging Life Care Professional (www.aginglifecare.org) can make the process easier.  The Life Care Professional can assess the proposed resident’s needs and then guide the selection process, making the process easier and less stressful.

Make sure to consult an Aging Life Care Professional in Arizona.

Should Mom Still Be Driving?

Whether or not an aging parent should be driving is a question we are frequently asked.  It is a very touchy subject and most children do not want to force the issue with their parents.  Getting a drivers license is a rite of passage that most teenagers look forward to.  Having to give up that license can be very difficult.  It affects a person’s sense of independence.  Once a person surrenders their driver’s license, they are suddenly dependent on others to get around.  Going to the grocery store, going to the doctor and even going out with friends can become difficult without transportation.

There are several warning signs to look if you are concerned about a loved one’s safety behind the wheel.  If you notice any of the following 17 warning signs, it is time to evaluate whether your loved one should continue driving.

1. signaling incorrectly
2. trouble making turns
3. changing lanes improperly
4. confusion at highway exits
5. difficulty parking
6. stopping inappropriately in traffic
7. confusing the brake and gas pedals
8. driving too fast or slow
9. hitting curbs
10. failing to notice stop signs or traffic lights
11. reacting slowly to traffic situations
12. failing to anticipate potential dangers
13. getting lost in familiar places
14. scrapes or dents on car, house, garage, etc.
15. traffic violations
16. near-misses
17. accidents

There are several options for driving evaluation.  One option is to have an evaluation through a driving evaluation center.  Although there are companies that offer these services, many of these programs are offered through larger rehabilitation centers as well.  Another option is to have a physician write a letter to the Department of Motor Vehicles (DMV) expressing their concern about their patient’s driving ability.  Once the DMV receives this letter, they will send out a letter to your loved one either revoking their license or requesting them to come in for a written test and/or an on the road driving test.  Successful completion of the testing is necessary for the license to remain valid.

It can be hard for family members to address the topic of driving safety with their loved one.  Involving the primary care physician in this process can be helpful because it takes the role away from the family.  Another option is to consult with a Certified Care Manager or Aging Life Care Professional.  These care management specialists are typically well versed in the resources to evaluate driving and can facilitate not only the testing, but also put a plan in place to address the need for transportation once the person stops driving.  Again, involving an independent third party takes the pressure off the family and takes some of the emotion out of the situation.

Addressing driving concerns with your loved one can be stressful and very difficult.  It is an emotional topic with significant consequences.  Having a plan to both evaluate your loved one’s driving and to accommodate their transportation needs if they stop driving will help make this difficult task somewhat easier.