Types of Senior Care: Definitions and Comparisons

The financial options and care coverage available to help pay for senior care is dependent on, among other things, the type of care required. For example, some government programs will help pay for a skilled nursing facility, but not in-home care. If you are just beginning the research process, it is helpful to have an idea about the type of care you or your loved one will require. Also please be aware that type of cares are often referred to by many different names.

Skilled Care vs. Custodial Care
At the highest level there are two types of care, skilled and custodial care. Skilled care describes services that can be given only by skilled or licensed medical personnel. Custodial care (also called non-skilled care) helps with activities of daily living (ADLs), such as bathing, dressing and eating.  This is typical for seniors with Alzheimer's / dementia.  Both skilled and custodial care can be provided at home, in adult day care or in residential care such as nursing home or assisted living.

Palliative Care and Hospice Care
Palliative is a type of medical care that focus on relieving patients of their pain and suffering instead of medical care with the objective curing or treating the underlying conditions.  Hospice care, on the other hand is an encompassing approach to treat terminally ill patients in the last weeks or months of their lives.  While hospice very often includes palliative care, not all persons receiving palliative care are in hospice.  

Care Management Services
Geriatric Care Managers (GCMs) help families create and implement long term care plans for their loved ones, they provide care management services instead of providing hands-on care themselves. Typically this includes an in-person needs assessment, the development and review of a care plan and arranging and monitoring care services.  Approximately 35% - 50% of GCM offer financial planning for eldercare as well.

GCMs are also be referred to as elder care managers, case managers and service or care coordinators.  In addition to a certification from the National Association of Professional Geriatric Care Managers (NAPGCM), many are licensed by their different professional backgrounds; which include social workers, nurses, therapists and assisted living or home care professionals.   There are both public and private care managers.  Medicare and Medicaid will sometimes pay for public GCMs under a HCBS Waiver program, but do not pay for private ones.  Long term care insurance, if available, may help.  

In addition to the convenience, time-savings and security they provide, Care Managers can save families money because their needs assessments align an individual’s present condition with only those services that are necessary at that time.

Care Locations

At Home / In-Home Care - If provided at the senior’s home, Home or Personal Care Aides provide custodial care. They bathe and dress the senior, help with laundry, cooking and accompany them to doctors’ appointments or on other errands. Home Health Aides offer skilled care such as checking patients’ pulse, temperature or respiration. They assist with braces, artificial limbs and other medical equipment such as ventilators.

At Adult Day Care - In a manner similar to Children’s Day Care, Adult Day Care provides elders with supervision and care in a structured setting during daytime hours allowing their caregivers to go to work. There are two types of Adult Day Programs. Adult Social Day Care offers basic health services, meals and activities while Adult Day Health Care provides intensive health services for individuals that might otherwise need to reside in a skilled nursing community.

In Residential Communities - There are four categories of residential communities and each is referred to by many different names.

1) Independent Living / Senior Living – homes within a complex that offers transportation, security and recreational activities, but no health care services.

2) Assisted Living – residences provide help with activities of daily living including basic health services, recreational and social activities but not skilled nursing care.

3) Skilled Nursing Homes – residences with 24/7 care by licensed health professionals including all housekeeping, medical and social needs.

4) Continuing Care Retirement Communities – residences that provide a continuum of care from independent living to assisted living to skilled nursing. These are designed to enable seniors with progressively declining health to remain in a single residential location or give healthy seniors the peace of mind that all their future needs are covered.