A Guide To Care Facilities
Senior citizens, their families, and their friends deal with a multiplicity of facilities. Most people find the differences between them confusing. Below is a listing of a number of different types of facilities, with each one’s primary characteristics, and some local examples of that type of facility.
Acute Care Hospital
This is what people normally think of when they think of a hospital. These facilities provide inpatient medical and surgical care for people with serious medical problems. In Central PA these facilities all have Emergency Care Units (ECU), and admission to the hospital is frequently, though not always, through the ECU.
Examples: Holy Spirit Hospital, Pinnacle Health’s Harrisburg Hospital and Community, General Hospital, Penn State Hershey Medical Center, and Carlisle Regional Medical Center.
Long Term Acute Care Hospital (LTACH)
These hospitals are specialty hospitals. They receive referrals from Acute Care Hospitals for complex medical cases which may need an acute level of care for several weeks. They are sometimes confused with Rehab Hospitals, but while they provide therapy services, their primary focus is medical care, not rehabilitation. Some insurance companies require precertification before they will pay for an LTACH.
Examples: Life Care Hospitals of Mechanicsburg (formerly Healthsouth Regional Specialty Hospital) and Select Specialty Hospitals (Camp Hill and Harrisburg).
Rehab Hospital
These facilities provide rehabilitation services on an inpatient basis for patients who are medically stable and who require and can participate in at least three hours of therapy sessions over the course of the day. The Center for Medicare and Medicaid Services (CMS) has developed a list of 13 diagnostic categories that especially benefit from a Rehab Hospital. CMS requires that a certain percentage of all Rehab Hospital admissions come from these 13 diagnostic categories. Many insurance companies require precertification before they will pay for a Rehab Hospital. Some Rehab Hospitals are freestanding facilities, while others are part of an Acute Care Hospital.
Examples: HealthSouth Rehab Hospital, Pinnacle Health’s Helen M. Simpson Rehabilitation Hospital, Penn State Hershey Rehabilitation Hospital, and Carlisle Regional Medical Center’s Inpatient Rehabilitation Program.
Nursing Home
Nursing Homes can be known by several names: Extended Care Facility (ECF), Skilled Nursing Facility (SNF), or Nursing Home (NH). They provide both long-term care for patients with chronic disabling conditions and short-term rehabilitation for patients who may not need a Rehab Hospital but cannot return directly home from an Acute Care Hospital. With the provision of an increasing amount of rehabilitation many nursing homes incorporate the term “rehabilitation” in their names.
Examples: HCR Manor Care, Forest Park Health Center, and Claremont Nursing and Rehabilitation Center.
Assisted Living Residence (ALR)
These facilities officially began being licensed in Pennsylvania in 2011. They are residential facilities which provide personal care as well as nursing services. The concept behind ALRs is “Aging in Place.” The goal is that once an individual moves into an ALR, he or she will never have to move again; services will come to him or her as physical needs for care increase, rather than having to move to a Nursing Home setting.
Example: as of June 2011, the only licensed ALR in Cumberland and Dauphin Counties is at Bethany Village.
Personal Care Home (PCH)
Until Pennsylvania created an official license for ALR, many Personal Care Homes were known as Assisted Living Facilities; they can no longer use the term “Assisted Living” unless they have an ALR license. A PCH is a residential facility which provides room and board as well as a certain amount of assistance with a person’s Activities of Daily Living (ADLs). It is expected some PCHs will also obtain a license for an ALR. Due to differences in their licensing requirements, if a facility has licenses for both PCH and ALR, the two units must be separate from each other.
Examples: Graysonview, The Woods at Cedar Run, Country Meadows, Emeritus Senior Living, The Bridges at Bent Creek, and Ecumenical Communities.
Independent Living Facilities
These are facilities that provide room and board and have an activity program for the people who live there. They do not assist with personal care, but residents may arrange for assistance with their ADLs through home care agencies.
Examples: Essex House and The Manor at Oakridge.
Continuing Care Retirement Community (CCRC)
These facilities have multiple levels of care: Independent living cottages and/or apartments, that may or may not include meals; PCH and/or ALR units; and NH units. People who move to a CCRC usually move in at either the independent or personal care level and plan to remain for the rest of their lives, moving to higher levels of care if their health and functional abilities decline. These facilities usually have significant entrance fees, that are affordable to only 10 % of the population. A distinguishing feature of CCRCs is that they will care for a resident for the rest of the resident’s life, even if the resident runs out of money.
Examples: Bethany Village, Messiah Village, Cumberland Crossings, Frey Village, and Green Ridge Village.
If you find it difficult to keep track of all these different levels of care facilities, you are not alone. Even some medical professionals, whose patients come from these facilities, have difficulty remembering what kind of care is provided in each one. Adding to the confusion is that some facilities provide more than one level of care: some Nursing Homes have personal care units and some Personal Care Homes have independent living units. If you are a client of Keystone Elder Law, the Elder Care Coordinator can help you sort through the maze of facilities to find the ones which are appropriate for your particular needs.
The inclusion or the exclusion of any facility on this list is neither an endorsement nor an intentional oversight of any facility. For public information on inspections of licensed facilities, we suggest you view: www.dpw.state.pa.us or www.health.state.pa.us.
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REGISTER HERE for LONG-TERM CARE PLANNINGPower of Attorney
A Power of Attorney can be used to give another person the right to sell a car, home, or other property in the place of the maker of the Power of Attorney. A Power of Attorney might be used to allow another person to sign a contract for the maker of the Power of Attorney (the person who makes a power of attorney is called the “principal”). It can be used to give another person the authority to make health care decisions, do financial transactions, or sign legal documents that the principal cannot do for one reason or another. With few exceptions, Powers of Attorney can give others the right to do any legal acts that the makers of the Powers of Attorney could do them themselves. A General Power of Attorney gives the “power of attorney Agent” or simply “Agent” (the legal name of the person who is authorized to act for the principal) very broad powers to do almost every legal act that the principal can do. When Elder Law Attorneys draft general Powers of Attorney, they still list the types of things the Agent can do but these powers are very broad. People often do general Powers of Attorney to plan ahead for the day when they may not be able to take care of things themselves. By doing the General Power of Attorney, they designate someone who can do these things for them.
Normal Powers of Attorney terminate if and when the principal becomes incompetent. Yet many people do Powers of Attorney for the sole purpose of designating someone else to act for them if they cannot act for themselves. It is precisely when persons can no longer do for themselves that a Power of Attorney is most valuable. To remedy this inconsistency, the law created a Durable Power of Attorney that remains effective even if a person becomes incompetent. The only thing that distinguishes a Durable Power of Attorney from a regular Power of Attorney is special wording that states that the power survives the principal’s incapacity. Even a Durable Power of Attorney, however, may be terminated under certain circumstances if court proceedings are filed. Most Powers of Attorney done today are durable.
Yes. At the time the Power of Attorney is signed, the principal must be capable of understanding the document. Although a Power of Attorney is still valid if and when a person becomes incompetent, the principal must understand what he or she is signing at the moment of execution. That means a person can be suffering from dementia or Alzheimer’s Disease or be otherwise incompetent sometimes but as long as they have a lucid moment and are competent at the moment they sign the Power of Attorney, it is valid even if they do not remember signing it at a later date. At the time it is signed, the principal must know what the Power of Attorney does, whom they are giving the Power of Attorney to, and what property may be affected by the Power of Attorney.
Any competent person eighteen years of age and older can serve as an agent. Certain financial institutions can also serve. There is no course of education that agent must complete or any test that Agent must pass. Because a Power of Attorney is such a potentially powerful document, agents should be chosen for reliability and trustworthiness. In the wrong hands, a Power of Attorney can be a license to steal. It can be a big responsibility to serve as an agent.
For Medicaid
Medicare is health insurance and covers medical services such as physician appointments, therapy, blood tests, x rays, medical procedures and hospitalization. Medicare will sometime pay for rehabilitation in a long-term care facility for a period of 20 to 100 days, but not longer. In long-term care, Medicaid covers the cost of ongoing support services for daily functioning, such as room and board in a nursing home.
Medicaid is a federal program that is overseen by the Center for Medicare and Medicaid Services (CMS). In Pennsylvania, Medicaid is called Medical Assistance and is administered by the Department of Human Services (DHS).
In Pennsylvania, Medicaid funds are not available to pay for assisted living or personal care.
For Medicaid to pay for care in a nursing home, an individual recipient must be determined to need a nursing home level of care by a physician and the local Office of Aging. An individual whose income is not greater than three times the poverty level may keep up to $8,000 of total resources, but may otherwise keep only $2,400. The cash value of life insurance counts as a resource, but one car and a residential home does not count as a resource.
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Keystone Elder Law
At Keystone Elder Law, we believe that the physical, social, legal, and financial considerations of our clients all intertwine. We utilize an interdisciplinary approach to evaluate each area, which allows for the creation of a plan that addresses the concerns of the individual as a whole as well as the family. To this end, our model of practice includes a Care Coordinator (usually a nurse or social worker), whose expertise complements our team of attorneys.
When the road of life is smooth, decisions about legal and financial matters are easy to push aside for “a rainy day.” Planning ahead, however, will allow for more options as you view the map of where you’ve been and where you want to go. Don’t let a crisis limit your choices or derail your plans.
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