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Health Care Continuum

By Patrick Formato

If you would like more information about this topic or any other topic contact Patrick Formato, Esq.

As our population ages, an ever increasing number of individuals will require assistance with their activities of daily living (ADL). ADLs include but are not limited to: toileting, transferring, grooming, bathing and eating. The type of care required will determine where that individual will receive those services.

The continuum of care varies with the level of assistance required. There services can fall into two categories: (1) non-medical and personal care services and (2) skilled care or nursing services. Below we have summarized the types of cares that an Elder Law Attorney should be familiar with when discussing planning options with an elderly client.

Non-Medical and Personal Care Services

(1) Social Day Care Program. These programs provide social interaction and activity for an individual in a supervised setting.

(2) Respite care. This type of care can be provided in an adult home or at home on an as needed short term basis. Respite care allows the caregiver the opportunity to care for themselves without the worry of caring for their loved one.

(3) Adult home. A facility such as this provides personal care and homemaking assistance in a residential/institutional setting. See 18 NYCRR §487.

(4) Expanded In-Home Services for the Elderly Program (EISEP). This program provides supportive services to an older individual in their home or apartment.

(5) Enriched housing. This type of housing provides transportation, homemaker assistance and limited personal care in a residential setting. See 18 NYCRR §488.

(6) Residence for Adults. The residence provides case management, activities and supervision. However, these residences do not provide personal care. See 18 NYCRR §490.

(7) Family-type Homes for Adults. This is a smaller version of an adult home for four or less residents. See 18 NYCRR §489.

(8) Adult Foster Homes. This type of program provides limited personal care services in a family setting.

(9) Shared Living Residence. This living arrangement consists of three to ten unrelated personal living in the same dwelling unit.

(10) Accessory apartments. The apartment is attached to a dwelling such as a mother/daughter house.

(11) Elder cottages. A residence located on the property of a family member or other individual who does not require care.

Skilled Care or Nursing Services

(1) Licensed Home Care Services Agency (LHCSA). The agency provides personal care services, nursing services and other skilled care at home. See Public Health Law §3602.

(2) Certified Home Health Agencies (CHHA). The agency provides nursing and home health aide services and medical supplies as well as either physical or occupational therapy, speech pathology, nutritional services and social work services. The CHHA is distinguished from a LHCSA because of the stricter regulations of CHHA and the comprehensive nature of the services provided and the need for a coordinated care plan. See 10 NYCRR §763.3.

(3) Long Term Home Health Care Program (LTHHCP). This program provides nursing services, home health aide services, physical, occupational and respiratory therapy, speech language pathology, audiology, social work, nutritional services, personal care and homemaker services. See 18 NYCRR §505.21 and 10 NYCRR §763.3.

A LTHHCP can only be provided by a CHHA, RHCF or hospital. See Section 10 NYCRR §762.1.

(4) Medical Model Adult Day Care. This program is provided in a Residential Health Care Facility in accordance with an individualized health care plan including medical, nursing and social services. See 10 NYCRR §425.

(5) Assisted Living Programs. This program combines home health services with an adult home or enriched housing services. The home must either be a CHHA or a LTHHCP or contract with a CHHA or a LTHHCP. See 18 NYCRR §494.

(6) Residential Health Care Facility (RHCF). This is a traditional nursing home.

(7) Assisted Living Facility. This type of facility provides residential, personal care, meal preparation and housekeeping. The individuals live in independent units. The facility will provide personnel to assist a resident with their activities of daily living.

(8) Life Care Communities. This program provides comprehensive services along with a continuum of care from housing to skilled nursing care. See 10 NYCRR Section 900.

(9) Continued Care Retirement Communities. This community is similar to the Life Care Community which will include a range of care including nursing care.

(10) Congregate care facilities. These facilities are independent living complexes that provide transportation and special programs. These facilities do not provide personal or medical services.

As one can see, there are a wide range of programs and facilities to accommodate an older individual with their care needs. Elder Law attorneys should be fully aware of all options available to their clients including the scope of services, payment options and limitations of each program.

An excellent publication discussing housing alternatives and the changing demographics is Housing Alternatives for an Aging Populations by Devinder Brar and Bridget E. Holohan, Government Law Center at Albany Law School. The publication was published in the NYSBA Elder Law Section Fall Meeting 1999. In addition, one can contact the Department of Aging for information.