Senior Living Facility Options


Are you having difficulty caring for a loved one and looking for assistance in placement?  As a podiatrist who has worked in various different types of senior living facilities for 15 years, I wish to describe the choices solely from an outside medical provider perspective.  I will begin with the highest level of health care going to the lowest.

1. Skilled nursing facility.  These are also called health care centers, and look like hospital wards with a nursing station.  They provide care for seniors with the greatest need, such as those who are bedbound, need tube feeding, wheelchair-bound, or need help transferring, eating or bathing.  Residents may also have had a major injury, illness or hospitalization, and may be staying at this type of facility for a short time.  They are one step below the care typically given in a hospital.

2. Adult family home.  These are houses usually privately owned by a nurse, and staffed by nursing assistants.  These staff members often live on site.  They care for patients who have a wide range of needs.  Some homes may have patients who come and go as they please.  Other homes may have patients who have mental health issues.  Others homes may house those with dementia.  Yet others, those with physical needs similar to patients in skilled nursing facilities.  There is a set number of residents who can live in these houses, usually around 6.  This represents a low staff to patient ratio.  Some nurses may own multiple homes and group patients in the various homes with similar needs.  Others may have one home with patients representing a range of needs.

3. Senior living communities.  These are larger facilities with dozens or hundreds of residents, and may be part of a large chain of facilities.  They may have different levels of care.  Independent living patients have very minimal services provided by the staff of the facility.  It is very much like apartment living, where the patient handles their own affairs, and may participate in the activities of the facility.  Assisted living patients usually remain in the facility and have some services provided.  Outside conveniences are often brought in.  There may be meals provided, exercise programs, a gym, a pool, games, a hair salon, massage.  One nurse may be present to coordinate medications for the entire facility, and there may be nursing assistants to administer the medications.  Memory care patients are required to remain in their unit, and have activities that help them to remember their past, such as childhood games or songs.

To summarize, senior living communities are concerned about the social and convenience needs of seniors. They may be large, nicely decorated buildings, with employed nurses in a corporate environment. Skilled nursing facilities are concerned with health needs and look like hospitals. Facilities may have a combination of the above types.  Adult family homes are private practice nursing homes that cater to a variety of needs.

The priority of podiatry care in these facilities will vary.  Podiatrists are typically invited to come to the facility to attend to the foot and ankle medical and surgical needs of residents on a 61-day interval, according to Medicare guidelines. In skilled nursing facilities, the priority of this care is very important, and nursing staff works closely with podiatrist to maintain the patient’s overall health.  Adult family homes have provider-to-provider relationships, which may also become close and long-standing.  Health care needs are important in these types of facilities.

In senior living communities, however, there is a greater turnover of staff including nursing and managerial staff. A staff member may initially establish a podiatry program as a convenience for residents, but because of turnover, the communication, coordination of care and continuity of these programs is often lost.  Subsequent teams may not even know that a podiatrist comes, or why.  Senior living communities are best if they are small, specialized, care for a certain demographic, not part of a corporate chain, and have established staff that doesn’t turn over quickly.

The most important questions to ask a facility when considering placement are:

  1. Ask as many staff members as possible how long they have been working there.
  2. If possible, obtain a list of current and previous nurses, and how long they have been with the facility.
  3. Ask staff, residents and their families what they perceive the quality of care to be.
  4. Ask them what they think of the management and their commitment to care for residents.