What is the difference between Continuing Care and Skilled Care?

Question:  My sister and I are caregivers to our mother and have been for quite some time.  However, we still don’t understand what the difference is between Continuing Care and Skilled Care.  Would you please define these two elder care terms for us?

Answer:  Skilled care is ideal for patients who cannot live independently due to fairly pronounced physical or cognitive ailments.  Although the level of care delivered is not the same degree as in an acute care situation that necessitates a hospital visit, a patient receiving skilled care must generally be monitored by a team of skilled nurse providers and other health team members, twenty-four hours a day.  The most common location for a patient to receive skilled care is in a nursing home, which is now commonly referred to as a skilled nursing facility (“SNF”). 

In contrast, the term “continuing care” generally refers to care provided in some sort of a facility that can accommodate a wide variety of capabilities in its residents – ranging from complete independence to a need for quite a bit of care and assistance.  There are now many so-called continuing care retirement communities (“CCRC’s”) that offer this sort of spectrum of care to residents.  In a CCRC, seniors can “age in place,” meaning the resident does not need to relocate when their deteriorating health means an increasing level of care is required.  That can give residents a sense of comfort and can decrease their anxiety about what will happen in a health crisis. 

Sometimes, a health issue is so pronounced there is no other option than for a brief of long-term residency in a SNF, since a CCRC may have an upper limit to the level of care they are equipped to handle.  Sometimes, a CCRC may have a separate portion of the facility that is effectively its own skilled nursing facility.  There, a resident may be able to stay in their original residence from full independence up until assisted living, but then relocate when skilled nursing is required.  A small move to a different area within the same facility would likely be less traumatic than relocation to an entirely different, unfamiliar SNF. 

What are the advantages and disadvantages of a CCRC?  The obvious advantage is the desirability of living somewhere where the resident can likely receive whatever type of care they need for the near foreseeable future.  Because many residents in a CCRC need little or no care, it will be easier to participate in activities to stay active and to find peers with which to socialize.  The main disadvantage of a CCRC is they can be quite expensive and they do not accept residents on Medicaid. 

What are the advantages and disadvantages to a skilled SNF?   The main “advantage” so to speak is a SNF may be the only place in which a resident can be taken care of properly.  For example, many CCRC’s simply cannot care for a resident who developed pronounced dementia, whereas many (but not all) SNF’s may be equipped for that sort of patient.  A disadvantage of SNF’s is that almost all the residents will be quite frail and/or very ill.  For a senior who is only moderately weak or having slight difficulties, it will probably be demoralizing to now be surrounded by the very sick.  

Financially speaking, the private pay cost for SNF’s are extremely expensive, so expensive that patients are unable to bear the costs out-of-pocket for very long.  However, almost all SNF’s can and do accept residents on Medicaid.  For those that have the financial means, and assuming a senior’s heath conditions permit it, residency in a CCRC can be highly desirable. 

The key point to bear in mind is it is undoubtedly advantageous to start planning for long-term care long before there is a health care crisis.  For some seniors, their primary concern is to make sure they are well-cared for, and in the residence setting they find most desirable.  Many seniors would also like to take steps to make sure the assets they have worked a lifetime to accumulate are not squandered unnecessarily.  I highly recommend that a senior and/or the family of a senior consult with a competent elder law attorney as soon as they can, when they are financially sound and they are in good health.  That is the ideal time to devise a good plan that addresses both health needs and financial issues, for the present and for the future, that is also flexible enough to be updated and adapted when family circumstances do change.

Henry C. Weatherby, Attorney at Law
Weatherby & Associates, PC
Bloomfield, Connecticut
Premium Member of the national ElderCare Matters Alliance, Connecticut chapter

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