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What Level of Care Should I Be Looking For?

Recovery from illness, or living with a chronic, progressive condition, varies from person to person. No two people are alike and response to illness as well as treatment is rarely simple. Often there are cycles of being and feeling better and being and feeling worse, moving between multiple care settings, and utilizing a mixture of support services. 

For example, if someone has had a stroke, he or she has many options for rehabilitation. Here are some possibilities:

home > hospital > home with assistance and in-home health care > home alone

home > hospital > rehabilitation in a skilled nursing home > home with assistance from family members

home > hospital > rehabilitation in a skilled nursing home > move to long-term care in a nursing home or assisted living community

The path taken depends on various factors unique to each individual, including:
  • One's ability to take care of himself or herself without assistance;
  • One's goals for recovery, and where and how those goals will be best achieved;
  • The services, supports and types of settings available in one's area  (e.g. home health care, in-home care, adult day services, assisted living, nursing homes);
  • Available resources (e.g. financial, insurance, family and friends,
  • government);
  • Privacy needs; and
  • Spiritual and cultural preferences.

It is important for elders and family members to talk about their preferences and learn about what is available in the area before being faced with a health crisis. Unfortunately, the reality is that most people don't think about long-term care until there is a crisis and a need. Hospital stays are typically very short. Families are given little notice that the person is going to be discharged. If the person is unable to return home and needs to go to a nursing home for rehabilitation, the choice is often limited to where a bed is available. While there is an appearance of choice, that is commonly not the case.

Ask your doctor, nurse practitioner, hospital discharge planner, or other health and social service professionals to explain all of the possible options so that you can decide on the ones that best fit your situation. However, not all health and social service professionals are up to date on the care options in your area. Discharge planners, case managers, social workers, or nurses who work for hospitals or insurance companies work for the organization or company, not necessarily for you. Hospitals are often pressured to get you or your family member out of the hospital quickly, not necessarily to find the best place for follow-up care. There are professional geriatric care managers who (for a fee) help people find care options. Usually, the bottom line is that you or your family members have to be your own care manager by determining what you need and finding the services that are right for you.

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