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Settings for Care for Older People

By

Debra Bakerjian

, PhD, APRN, University of California Davis

Last full review/revision Jul 2020| Content last modified Jul 2020
CLICK HERE FOR THE PROFESSONAL VERSION
Topic Resources

Health care practitioners may provide care for older people in a variety of settings.

Practitioner's office

Most older people receive medical care in their primary care doctor's office The Primary Care Practitioner Typically, the entry point into the health care system is a primary care practitioner (also known as a primary care physician [PCP], general doctor, or family doctor), usually a doctor but sometimes... read more . The office may be in a medical office building, a clinic, a hospital, or elsewhere. Diagnostic tests, such as blood tests or x-rays, are often done in a doctor’s office. Some doctors' offices offer treatments, such as physical therapy.

Hospitals

Hospitals Hospital Care read more provide the most comprehensive medical care. For older people in particular, staying in a hospital increases the risk of problems Problems Due to Hospitalization Just being in the hospital can cause certain problems, particularly infections (called hospital-acquired infections). Other problems include Problems associated with extended bed rest, including... read more such as infections, pressure sores, confusion, and incontinence. Because of these risks, older people should be hospitalized only if they are very ill. Older people may enter the hospital through the emergency department or be scheduled for admission by a doctor.

A doctor (who may be the person's primary care doctor, a specialist, or a staff doctor at the hospital) is in charge of the person’s care in the hospital. Sometimes several other doctors are involved. Nurses, who are available 24 hours a day, provide much of the care. A nurse is always available, but doctors may come and go at more irregular times.

Many other people may help provide care in a hospital. They include

Observation care is care within a hospital for people who are not well enough to go home but are not ill enough to meet the requirements for actual hospital admission. With observation care, practitioners can do tests and give treatments for a day or two before deciding whether people need to be admitted. Such people are observed briefly in an emergency department, a special observation unit, or a regular hospital room, even though they are not actually admitted to the hospital. The difference between admission and observation is important because Medicare Medicare Current details regarding funding and availability of medical care in the United States remain unsettled. The reader is referred to the Centers for Medicare & Medicaid Services and The Henry... read more considers observation care an outpatient service. Thus, Medicare does not cover rehabilitation services after observation care.

Surgical centers

Surgical centers are places where same-day surgery or other procedures may be done. Such procedures include those that typically require anesthesia, that are too complicated to be done in a doctor’s office, but that do not require an overnight stay in a hospital. Common examples are endoscopy, colonoscopy, and removal of cataracts. Surgical centers may be located in a hospital or be a separate, free-standing facility.

Many communities without hospitals have surgical centers. Then, people can have procedures in their own community without needing to travel to a more distant hospital.

Rehabilitation facilities

After discharge from the hospital, people with a severe disability may need to continue their recovery in a rehabilitation facility Rehabilitation read more . A rehabilitation facility may be located in a hospital or a nursing home. These facilities provide skilled nursing care and physical, occupational, and speech therapy. Usually, people need to have been admitted to a hospital for 3 days to be eligible for Medicare to pay for the rehabilitation facility. A waiver of the 3-day hospital stay requirement is available in some cases, including with some Medicare Advantage plans.

When people are admitted to a rehabilitation facility, an interdisciplinary team tries to anticipate how long their stay will be. For older people, the stay may range from a few days to a few months. Goals for progress are set, and progress is evaluated every day. Thus, the types and amount of therapy can be adjusted as needed.

Some older people may be able to stay at home and get rehabilitation therapy as an outpatient at a rehabilitation facility.

Home health care

People who are frail or who have recently been discharged from a hospital or rehabilitation facility often need care in their home. This care is often provided by family members and/or friends. But when such help is not available or when older people need more help than family members and friends can provide, older people may be eligible to receive home health care services from a home health care agency Care of Older People in the Home Older people may need care in their home when they are frail or weak, particularly after they have been discharged from the hospital or a rehabilitation facility. Simple care is usually provided... read more Care of Older People in the Home . These agencies send registered nurses, therapists, home health aides, and/or social workers depending on the person's needs and insurance coverage.

Currently, the number of practitioners who will visit people in their home is increasing. A house call can be very helpful because it is more convenient for older people, and it enables practitioners to see how people are doing in their usual living environment.

Community services

In the United States, one source of support services and health care in the community is a senior center. These centers provide social, recreational, and educational activities, and some serve meals—an important service for people who cannot prepare their own.

Day care centers Day Care for Older People Day care for older people may involve Treating a problem Maintaining the person's condition Providing social activities or mental health care (such as group therapy) People can go to day care... read more are another community-based service. Day care centers charge for services. However, they can provide a break for caregivers during the day so that caregivers can, for example, keep their job. Some day care centers also provide some health care. For example, these centers may have a nurse and/or nursing assistants on duty. The nurse can check blood pressure, make sure people are taking their drugs as instructed, and provide health information. Nursing assistants can help make sure that older people's toileting needs are taken care of and that they are fed as needed during the day. When there are medical concerns, the nurse may contact the person's primary care practitioner or family members. Some day care centers provide day care for people with mild to moderate dementia, and some provide physical and occupational therapy.

Other services available in the community include meal programs (such as Meals on Wheels), transportation services, help with daily activities, support groups, and respite care. Some religious communities provide many of these services. These services are usually inexpensive, and some are free.

People can obtain information about community services, including senior centers, from the hospital discharge planning or case management department, home health care agencies, local health departments, and religious communities. Senior centers can also be found by looking in a local telephone book or on the Internet.

Did You Know...

  • Some senior day care centers have a nurse on duty to provide some health care, such as checking blood pressure.

Post-acute and long-term care

Post-acute care is care immediately after hospital discharge for people who need more care than they can get at home but do not clearly need long-term care. Post-acute care facilities provide a variety of health services including skilled nursing care and physical and occupational rehabilitation to help people regain their strength and function. Most people ultimately return to their home. However, some do not recover all of their function and may require long-term care.

The prospect of needing long-term care services concerns many older people. The likelihood of needing long-term care increases greatly as people age because older people are more likely to develop chronic disorders and to have problems functioning. How long care is needed varies from weeks to years to indefinitely.

Long-term care focuses on helping people maintain function. It helps them do the activities necessary to care for themselves and to live as independently as possible. These activities include basic daily activities (such as eating, dressing, bathing, grooming, and walking) and other activities (such as shopping, balancing a checkbook, doing laundry, and housecleaning). Long-term care includes help with health care such as taking vital signs, monitoring weight, and giving medicine. Most long-term care facilities also provide social and recreational activities.

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Many people have their first experience with post-acute and long-term care after a hospital stay. During an illness or after an injury, many older people lose some or all of the ability to care for themselves. Thus, although they may be well enough to leave the hospital, they may need to go to a post-acute and long-term care facility for rehabilitation and recovery. This move can be physically and psychologically demanding. People have to adjust to many new faces and to new routines for sleeping, bathing, dressing, eating, and other daily activities. The move happens quickly, with little time to adjust.

Most people associate long-term care with a change in residence:

Older people may be particularly concerned about moving to an institution. People live in institutions for a variety of social and economic reasons. The most common reasons are physical problems and/or problems with mental function (cognition) plus lack of adequate social support.

What type of arrangement is possible depends partly on a person's needs (medical, functional, social, and emotional), preferences, and financial and social resources (such as long-term care insurance, availability of state waiver programs, and family members’ willingness and ability to help). One person may be able to live at home with the help of a spouse. Another person with similar problems but without family support may need to go to a nursing home. Learning about the many types of long-term care facilities can help people choose the right time and place for long-term care. Each type of long-term care facility provides different services and levels of health care.

After the type of arrangement is determined, a particular facility must be carefully chosen. Even within each type, facilities differ considerably in environment, services (including health care), activities, living arrangements, and rules. Sometimes the difference is simply a matter of what people can afford, but even within a price range, quality varies.

Delaying the Need for a Long-Term Care Facility

The idea of going to a long-term care facility, particularly a nursing home, does not appeal to most people. The following problems are common reasons for entering a long-term care facility. However, sometimes problems can be solved, and the need for a long-term care facility can be delayed or avoided.

Urinary incontinence: People with urinary incontinence may be hard to care for at home. However, urinary incontinence may be caused by a disorder that can be treated. Treating the disorder may cure the incontinence. People with urinary incontinence, their family members, or their caregivers should talk with a doctor to find out whether treatment is possible.

Problems with doing daily activities: Certain devices can help people function better. A physical or occupational therapist or a home health nurse can observe people in their home and can sometimes help them choose appropriate devices that will enable them to continue to function safely at home.

Dementia: Taking care of people with dementia is difficult and frustrating. However, family members can learn ways of dealing with the behavior. For example, to deal with wandering, family members can place an identification bracelet on the person or purchase or rent a monitoring device. Learning more about how to care for people with dementia may delay the need for a long-term care facility.

Caregiver burnout: Strongly motivated family members can usually provide elaborate and detailed care. However, providing such care can wear them out physically and emotionally. Talking with health care practitioners can help. They can provide information about caregiving support groups and about groups that provide temporary (respite) care.

Financial issues: People can buy long-term care insurance that covers care in the home. This care typically involves helping people with personal care, such as bathing, grooming, and eating. Such insurance may enable people to postpone going to a long-term care facility.

Hospice care

When people have a progressive, incurable disorder, hospice care provides the treatments and services needed to control symptoms, ease pain, and help people and their family members prepare for the death Death and Dying read more . Hospice care may be provided in a

  • Person's home

  • Nursing home

  • Hospice facility

Hospice care Hospice Care Hospice is a concept and a program of care that is specifically designed to minimize suffering for dying people and their family members. In the United States, hospice is the only widely available... read more usually involves a primary care practitioner, nurse, social worker, and others who are trained to care for dying people. For example, pharmacists, counselors, physical therapists, ethicists, and volunteers may also be involved. These practitioners are needed to make sure that all of the person's physical and psychologic needs are met as well as the needs of the family and caregivers. Most people who receive hospice care do not have to go to a hospital before they die. Thus, they can die in a more comfortable, intimate environment, often with loved ones around them. Hospice care also involves helping family members recognize the physical signs that death is near, understand what to do when the person dies, and help them cope with the loss.

More Information about Care for Older People

The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

  • Meals on Wheels: Information on access to nutritious meals and safety checks for individuals whose diminished mobility makes it hard to shop for food, prepare meals, or socialize with others

  • Eldercare Locator: U.S. Administration on Aging's database of services for older people and their caregivers

  • Hospice Foundation of America, Inc.: Information for the public and health care professionals about death, dying and grief

NOTE: This is the Consumer Version. DOCTORS: CLICK HERE FOR THE PROFESSONAL VERSION
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