The 3 Different Levels of Care for Assisted Living

A man and his nurse.

Assisted living facilities are versatile senior living communities that offer different levels of care to residents. Living in their own apartments can ensure older adults their independence while still providing that their ever-changing needs are met. Care plans are drawn up upon enrollment and are often assessed and revised as your loved one’s needs change. The ability to do so is done through a needs assessment that evaluates the level of care necessary to best maintain the health of a resident. Some residents require more assistance, while some can perform their activities of daily living (ADLs) completely independently. Support and management of resident’s health care needs also contribute to the amount of care needed. 

The more help a senior needs, the higher the level of care provided will be. This level of care directly affects the amount of staff and supervision needed to assist your loved one, not to mention the level of training for them to properly care for these needs. Thus the level of care also directly affects the price of residency. In this article, we will go over the common 3 levels of care in an assisted living facility, and how they are often defined, assessed, and priced.

State-to-State Variations

Unlike nursing home communities, there is no nationwide definition for assisted living. It is the states who license and regulate assisted living facilities. Therefore the rules, regulations, and procedures vary from one community to another, even if they are in the same state. For this reason, it is difficult to clearly define what constitutes the level of care, and how many there are in each facility. Some communities offer many of the same services as a skilled nursing facility. This is done by utilizing home health agencies or staff members with the proper training. Other communities may focus strictly on ADLs, like helping to feed, dress, and bathe patients. And some may have focused memory care units, which are made strictly for the supervision and assistance of Alzheimer, dementia, and memory loss residents. The restrictions of what can and can’t be done at a facility are all determined by the licensing. All that being said, we will now define the varying levels of care on a broad scope to help you get an idea of what you can generally expect. 

Assisted Living Levels of Care

As we just mentioned, the type of assisted living facilities varies wildly. However, there are typically 3 levels of care at any given facility, regardless of the license. Keep in mind that the levels of care can sometimes range up to 5 levels.

Level 1 Assisted Living Definition-Low Level of Care: This individual is mostly independent. A low level of care refers to a resident needing occasional assistance or support in one or more personal care or health care areas. He or she may need to be reminded to perform ADLs. A low level of supervision or assistance may be required for some to make sure that the ADLs are done correctly and safely. Some other examples include needing help getting to doctor visits, simple medical treatments, managing occasional behavior changes, or help to participate in social or recreational activities. 

Level 2 Assisted Living Definition-Moderate Level of Care: This level of care refers to a resident who requires substantial assistance or support in one or more health care or personal care areas. This individual may be able to independently perform some ADLs, but need help with others. For example, he or she may be able to feed themselves but are unable to get on or off the toilet. Other examples of common areas of support at a moderate level are helping to get to doctor’s visits, performing needed medical treatments,  or managing behavior changes.

Level 3 Assisted Living Definition-High level of Care: A high level of care refers to a resident who needs extensive and frequent assistance in the areas of several personal care or health care needs. This resident has mental or physical impairments that affect their ability to perform multiple ADLs. They may require total assistance from multiple caregivers. Some examples include ensuring doctors’ visits, administering medications, performing ADLs, performing necessary medical treatments, managing frequent behavior changes, and ensuring the resident engages in social or recreational activities. 

Memory Care: It should be noted that memory care programs are run a little differently than the typical residential care plan. Memory care units in assisted living facilities house residents with forms of dementia like Alzheimer’s disease, or have memory-loss issues. These programs are focused on resident engagement and safety. The trained staff guide residents in activities that allow the resident to feel more independent. Often gourmet meals are provided, which helps promote independence and dignity in a calm fine dining environment. Since a memory care unit is a more specialized approach, it often falls outside the realm of the ordinary assisted living level of care plans. Therefore they are assessed and priced differently. 

Level of Care Assessment for Assisted Living

To determine the level of care needed for a new resident, a needs assessment will be conducted. The needs assessment is typically done by an assisted living facility nurse or staff member as a pre-screening for admission. The outcome of the assessment will help develop your loved one’s personal care services plan. It is also possible that the facility may determine your loved one will be better served in a different kind of senior care facility, like a nursing home.

The assessment will inventory and rank the mental and physical condition of your loved one, as well as his or her ability to perform ADLs. In some facilities, a points system is used to rank the prospective resident’s ability to do each task, and to what degree. Then, depending on the number of points accumulated, the level of care will be determined. Different facilities categorize the levels of care differently. Therefore it is best to research how your facility’s assessment system works to be sure what level of care will be received. 

The following are some of the areas the needs assessment test will cover to determine your loved one’s level of care:

Behavioral Condition: An analysis of a senior’s behavior is necessary to determine whether or not he or she can comply with policies of the facility, can respond to staff direction, and can respect other residents, staff members, and property. Behavior is assessed to make sure your loved one won’t jeopardize the health and safety of themselves and others. On a level of care assessment test, the behavior could range from a low-level of care when described as “consistently appropriate” and a higher level of care when he or she is a “safety risk to self and others.”

Mental Condition: A prospective resident’s cognitive and mental condition will be assessed to see if they are experiencing confusion or dementia. This is a huge determination of how much staffing they might need to assist your loved one. Dementia sufferers and other confused persons could experience wandering which means constant supervision. On an assessment test, they could be ranked anywhere from “consistently normal cognitive function”, a low level of care, to a higher level of care described as “accelerated dementia requiring frequent staff intervention.”

Medical Needs: You and your loved one will need to supply past medical history as well as an evaluation from their current primary care physician. The facility may conduct an in-house medical exam. Some health and issues and conditions they will pay particular attention to include: vision or hearing problems, incontinence, arthritis, cancer, heart issues, diabetes, and digestive disorders. Knowing exactly what sort of medical issues exist enables the facility to accurately anticipate your loved one’s medical care needs. The level of care will vary depending on how much support is needed for management, treatments, and medication services. 

Special Support Needs: If your loved one requires any kind of special support, this will be documented in the needs assessment. Special support could include anything from a special diet, oxygen assistance, or mobility assistance. 

Personal Care and Hygiene Needs: Your loved one’s ability to take care of themselves will be assessed. This includes personal care, bathing, hygiene, grooming, and whether or not they can use the bathroom unassisted. On the bathing portion of a needs assessment test, the level of care range could be anywhere from a low-level for “independent with bathing and showering,” to a high level for “assistance 4 times a week.”

Once your loved one has been admitted to the facility, the care plan can be adjusted. The needs will inevitably change as time goes on. A needs assessment should ideally be done by the staff every few months or when the staff thinks a change is needed. Also, remember that any changes will affect the cost. Check with your assisted living facility to find out their policy on the frequency of assessment tests, and notifications on pricing changes. Next, we will touch on the various ADLs and what level of care services your loved one may expect, based on their current ability to perform each. 

Activities of Daily Living (ADLs) and their Level of Care

Bathing:  Bathing is one of the most dangerous situations seniors may face daily. This is because of the chance of shower-related falls that cause injury. Bathing, of course, is also imperative for residents’ hygiene. Seniors who can shower on their own without help are at a lower level of care than a senior who needs someone present or needs to be reminded to bathe. Someone at a middle level of care might need assistance with shower or bath preparation and possibly some verbal cueing but can mostly complete the task on their own. For these residents, it might be helpful for someone to be nearby if they are at risk of falling. If the resident is has a shower or bath more than two times a week, the level of care may go up simply due to the addition of manpower to accommodate that need. A higher level of care would be used for someone who needs one or more caregivers to help with bathing.

Dressing: Seniors who are otherwise quite independent may have trouble dressing and undressing. They may have trouble with small buttons and hooks due to reduced manual dexterity. Or they may just have trouble picking out clothes to wear depending on the occasion or the weather. Someone who can complete the task on their own would qualify for a low level of care. The level of care would increase as does the amount of physical assistance necessary and times a day someone needs assistance.

Grooming: Grooming would include tasks such as teeth brushing, hair styling, and brushing, as well as shaving. This sort of assistance may be necessary for someone who has a decreased range of motion in his or her shoulders. Someone who cannot perform any of these tasks will be needing a high level of care.  

Feeding: Residents need help with feeding for various reasons. Some are able to feed themselves but cannot cut up their food. This may require a low level of care assistance. Higher levels of care would be necessary for those who have a choking risk and need someone present simply for safety. A higher level of care would also be necessary for a resident with limited upper body function and needs help feeding themselves.

Mobility: Mobility, or ambulation, refers to the ability to get from one place to another. Getting help with this necessary function comes with varying levels of care. Residents who are able to get around on their own, or with a cane, walker, wheelchair, or scooter without help can qualify as a low level of care. What causes the level of care to go up is how much assistance is needed from staff members to get around. When someone requires assistance walking or standing, this could be perceived as a higher level care because they cannot get around independently.

Toileting/Incontinence: Toileting refers to getting on or off the toilet, and also includes any hygiene or incontinence needs a resident has. Someone who is able to complete this task independently, including changing their own protective underwear, is considered to be at a low level of care. Anyone needing hands-on or verbal assistance, or has the community order incontinence products instead of providing their own, will require a higher level of care. 

Medication: A resident who is able to fill and take medications without help is regarded to need a low level of care. Residents who are physically unable to open pill bottles or administer their own injections would probably be regarded as a moderate to high level of care. Those who rely on daily reminders of medication management but are able to complete the task themselves probably would be considered to need a moderate level of care. 

Pricing Based on Level of Care

Depending on the level of care your loved one needs, assisted living communities can be much more affordable than home care or a nursing home facility. The monthly rates at an assisted living facility change and can vary widely. This all depends on the location, amenities, and level of care. The typical range is $3,000 to $6,000 on average, and plans are on a month-to-month basis. So you can expect to pay about $3,000 a month for a low level of care, ranging to $6,000 for a high level of care. You can compare this to the average cost of a nursing home which ranges $5,000 to $10,000 a month. And home care is $4,000 per month, based on 40 hours of care per week. You can easily infer from this that assisted living is quite affordable, and is a valid option, especially for those with a low level of care who desire independent living. 

Keep in mind that Medicaid can help pay for assisted living if your loved one has low income and few assets. But Medicare, however, does not help pay for assisted living. 

Assess Your Loved One’s Level of Care and Plan Accordingly

Assisted living is a long-term facility where the quality of life flourishes. You and your family members can rest assured that your loved one will be provided the right amount of assistance for his or her level of care needs. But if however, upon reading this article you have decided that assisted living option is not right for you, be aware that there are so many senior living options to choose from. Perhaps more short-term care is needed, such as at a skilled nursing facility. Or, a bigger senior living community might be what your loved one needs. Continuing care retirement communities meet a variety of different needs, offering independent living, skilled nursing, and assisted living all in one place. Or, perhaps, your loved one is in more advanced stages, whereas a nursing home might be more appropriate. Consider the highest well-being of your loved one, what level of care is needed, and plan accordingly. We here at CareAsOne wish you and your loved all the best.

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