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Understanding Assisted Living Levels of Care

Kara Lewis
By Kara LewisSeptember 1, 2020
Assisted living nurse helping an elderly woman with her breakfast.

Assisted living levels of care vary depending on each community and how they define them. The level of care your family member receives helps shape their care plan, and influences many aspects of the assisted living experience – from daily caregiver support to cost. To guide seniors and their families through the process of identifying levels of care for seniors, registered nurse and executive director at Heritage Hill Senior Community Lisa Perla shares her expertise.

The needs assessment: determining level of care

Before nurses and other assisted living staff members can develop a senior care plan, they’ll first need to assess your loved one’s mobility, fine motor skills, and medical conditions. Typically, this involves a nurse visit to the home, so they can observe your parent in a natural, familiar environment.

In other scenarios, a nurse from an assisted living community might meet an older adult and their family at a hospital where the senior is receiving treatment, or sit in on a physical therapy session. The nurse will often complete a questionnaire with the family, asking about chronic conditions such as diabetes, oxygen therapy, and other advanced care needs.

It’s common for families to underestimate the level of care their senior loved one needs, says Perla. “Families are very used to covering up, and they don’t do it on purpose,” she says. This is especially true for parents who live with their children, as “the children become so used to doing things for the senior.”

Often, a community needs assessment for seniors will also incorporate physical tests. Perla typically relies on a “get up and go” test, which requires seniors to get up from their chair and take a few steps. This reveals their steadiness and agility. If your parent uses a walker, the test indicates whether they use it correctly.

Can we safely care for this person? That’s my rule of thumb across the board.

Lisa Perla, registered nurse and executive director at Heritage Hill Senior Community

“You can get a good idea of how many people they’re going to need to assist them and what help they’re going to need when they get up in the morning,” Perla says. “It can be so simple, like dropping a pen. ‘Oh, can you help me get that pen?’ The best way of testing fine motor skills is asking someone to do something.”

A look at what each assisted living level of care includes

Levels of care for seniors can look different depending on the specific assisted living community. While some communities may have four levels of care, others could have five or six — all with varying definitions or criteria. Nevertheless, an assisted living levels of care model will follow some general rules:

  • A higher assessment score number represents more care needs, or a more intensive senior care plan at a higher level. At many communities, a senior’s level of care depends on how many of their activities of daily living (ADLs) require staff assistance. This could involve scoring on a point system, in which points are assigned to common ADLs like tray delivery, toileting assistance, and blood sugar checks. A higher number of points translates to a higher assisted living level of care.
  • Level 1 encompasses basic needs, like a wakeup visit in the morning and simple reminders throughout the day, says Perla. As residents need help with more ADLs, they move to a higher level of care. At Heritage Hill, for example, Level 2 accounts for hands-on help with one ADL, such as bathing, while residents at level 5, the highest level, receive assistance with four or more ADLs, such as dressing, grooming, or help with mobility.

When a care plan changes: reevaluating assisted living levels of care

Of course, seniors’ needs change as they age. With this in mind, assisted living staff and caregivers regularly reassess each senior care plan and corresponding level of care. Perla does this through monthly discussions at staff meetings. Other communities may conduct the same physical tests with residents at different intervals.

No matter the community, families are also welcome to share their concerns. Assisted living communities reexamine a resident’s level of care and care plan based on family observations, as well as those from community caregivers.

How level of care affects assisted living costs

The cost of assisted living  varies depending on level of care among other factors. Simply put, greater assistance comes at a greater cost. At Heritage Hill, seniors at level 1 pay no additional fees on top of rent, an application fee, and a security deposit upon move-in. At each level, fees rise by several hundreds of dollars per month. When determining your senior loved one’s level of care, make sure to ask thorough questions about needs assessments, pricing, and payment plans.

When the level of care required exceeds assisted living

While assisted living communities are home to residents with different care needs and at diverse stages in the aging journey, more complex health conditions may signal that skilled nursing or memory care could be a better fit. Examples of conditions requiring more intensive care include dementia, stage 3 and 4 wounds, and brittle diabetes. Additionally, many assisted living facilities do not staff nurses 24/7.

“Can we safely care for this person? That’s my rule of thumb across the board,” Perla says. “Safety is my number one priority. You have to look at each situation for each person.”

Kara Lewis
Kara Lewis

Kara Lewis is a content writer at A Place for Mom. She’s worked in writing, editing, and creative strategy for several years, most recently at Andrews McMeel Universal, Hallmark, and Gannett Media. Her writing has appeared in Bustle, Alma, and The Kansas City Star, among other outlets. She has won awards for digitally conscious journalism, investigative reporting, magazine writing, and poetry.

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