As our parents age, or as we age ourselves, the question often arises: what are the different levels of senior care? In assisting the elderly, the most important thing is helping to maintain their dependency by being able to keep the elderly in their environment, and in their community. However, there are times when you have no option, but to seek help from a skilled nursing home. To be able to respond to the needs of the elderly, there are geriatric and gerontology options.
Geriatric care is defined as the set of actions and levels of help and support, both hospital and out-of-hospital, institutional, home, health, psychological and social. All these levels are intended to provide interdisciplinary care, with the collaboration of multiple professionals who work in a coordinated and organized way for the benefit of the elderly in all its aspects, progressively and adapted to the needs of each moment.
Geriatrics is a specialty of medicine defined in old age that prevents, diagnoses, treats, and rehabilitates holistically. This discipline serves the elderly through a comprehensive assessment and multidisciplinary collaboration with other professionals in medicine, nursing, psychology, and social work. Geriatric doctors are experts in the aging process, chronic pathologies, the effects of medications, and in the detection of different geriatric syndromes. In addition, they know the social and health resources in the community necessary to offer adequate care. They are also experienced in creating the most appropriate wellness plan for the elderly.
Levels of Care in Geriatrics
Below are some of the levels of assistance available to the elderly:
In primary care, the main agents are the family doctor (the one who has always been providing service to the family) and the primary nurse, who, working together, attend to the elderly in the community. Those who maintain a considerable degree of capacity for ambulation and able to go outside the home are treated in the consultations, while the more limited would enter the different home care programs.
In the most complicated cases, the help of the home care program and support teams are usually requested. They can also be coordinated with home geriatrics teams, which may be available from different hospitals, depending on the health area. The importance of primary care lies in the longitudinal and long-term vision of the elderly. Primary care also involves lasik surgery, if vision is a problem, and digital hearing aids, if hearing becomes an issue. Most primary care professionals understand the elderly need for care and go to lengths to ensure optimal care and interrelation with the community.
In the event that the elderly person falls into an acute illness, hospital admission may be necessary for their control and recovery. In many hospital settings, acute geriatric units are available, in which the focus of the elderly patient with acute illness is primarily geriatrics. However, medical professionals take into account the characteristics of the presentation and evolution of the diseases in the elderly. More than half of hospital stays are for elderly people, and that is why acute units are essential in hospitals. In these units, the acute phases of specific diseases of old age are attended to. Currently, the aspiration is to implement this service in each hospital in the country with the aim of attending to each geriatric patient accordingly.
One of the objectives of these units is to reduce the functional deterioration that hospital admission can cause. Several studies point to the benefit of the acute unit compared to hospitalization in conventional units. It is a useful care resource both for the patient (less functional deterioration and less probability of residential admission at discharge) and for the health system.
Mid-stay or Functional Recovery Unit
This unit has the purpose of recovering the functions that have deteriorated after the acute phase, which means treating the recovered person. This type of recovery unit seeks to recover the functions of the elderly person for their incorporation and adaptation to their environment and community. Thus, the quality of life and personal well-being are improved. Through a comprehensive assessment and a multidisciplinary team, the most beneficial therapeutic plan is adapted. The most frequent pathologies are stroke and hip fracture. For this reason, the orthogeriatric and stroke units are the most established with a similar intervention.
Day Care Center
This is geriatric day care for older people in the community. In day hospitals, functional recovery and geriatric syndrome are intervened by teams from different disciplines. In the United States, they are not scarce. The day centers offer support to the elderly and their families when they are still able to continue to exist within the community. The homes or centers for the elderly help the independent elderly to socialize, while the therapeutic day centers offer containment, prevention, rehabilitation, and family support (rest and discharge from the main caregivers) to patients with certain pathologies, as in the case of dementias.
The home care geriatric or in-home personal care service aims to respond to the large number of older people living at home with some degree of dependency and chronic diseases. It is a resource to support hospital work, as an option upon admission to hospitals and whenever the socio-family situation allows it.
The maintenance of the elderly person in their own environment and inadequate conditions is perhaps the key objective of geriatric assistance. The role of the family is fundamental. Nothing is more important than these so-called informal care options. There are three levels of home assistance:
1. Home social care, for people who live alone, with little support or dependence, where it is so necessary to \”help the helper.\” They are the so-called low-tech care. Its enhancement (greater number of hours of coverage) is an obvious need. Volunteering can play an important role here, reducing even the days of institutionalization of the people they serve.
2. No one doubts that home care is the protagonist of prevention and assistance for the elderly who live in the community, from the healthy elderly to the sick, through the fragile or at risk. More and more older people with complex problems residing at home need specialized home care assistance. In some cases, they may have clinical problems with an important chronic and dependency component, difficult to manage. When home care professionals can, they increasingly consult with specialized geriatric teams to receive their technical opinion and the use of the corresponding geriatric level of care if appropriate.
3. Specific geriatric care at home is sometimes very essential. There is no clear evidence that home hospitalization is feasible and efficient with more complex elderly patients, understood as “a service that provides active treatment by health professionals at the patient\’s home. It could also be for a limited period of time, of pathologies or problems that would otherwise require in-hospital care in an acute unit or hospice inpatient care. However, in our healthcare context, other experiences based on the following basic principles have proven very useful.
• Aimed at the oldest and most complex elderly, with a high degree of dependency.
• Be an alternative to unnecessary hospitalization, but never to the necessary one.
• That the social and family conditions at home are adequate.
In the first place, for home care, the collaboration of social workers can be provided to help meet basic needs (hygiene, food, mobilization, and transfers, etc.), more or less prolonged over time. Service and care would usually be administered throughout the day (from a few hours to being permanently at home). An important help is telecare, in which health and personal support are provided by telematics and by telephone to elderly people who live alone with limited independence, activating resources at home when necessary.
Once the patient is stabilized, they go to intermediate, rehabilitation, or convalescent care. This can be done either in medium-stay hospital areas. This is where intensive recuperative and therapeutic care is offered. They can also consider staying in day hospitals, where the patient comes from home to undergo rehabilitation, of less intensity than in the medium stay, or even in home care, in cases that do not tolerate or require high levels of rehabilitation. There is usually a pain management physician in most rehab centers.
In certain cases, a restoration to the level of independence prior to the acute episode is not possible. Depending on the needs, different levels of care are offered. Long-stay hospital units are for the most unstable patients. In case of stabilization, but without the possibility of recovery, if he can be cared for by his family at home, it becomes the responsibility of home care, either from the hospital or by specialized units (in the earliest stages). Care can also come from primary care, although the ideal is comprehensive collaboration between both teams. In case of not being able to be cared for at home, there are assisted residences, which provide care for patients with severe dependency, but clinically stabilized.
Geriatric assistance is also available in community centers. Indirectly, they also favor the permanence of the elderly at home. These are levels of care that are highly demanded by family members, probably more than the residents themselves, which is a fact to take into account. They are of three types:
1. Day centers for people with physical dependence, where attention is paid to the basic personal, therapeutic, and sociocultural needs of the people who require it, promoting their autonomy and permanence in their usual environment. They are ideal places to at least maintain the achievements that have been made on functional recovery at other levels of care (day hospitals, etc.).
2. Day centers for people with dementia. There are a majority of opinions about its advantages for patients. This includes delay in cognitive decline, improvement in quality of life, improvement in behavioral disorders, etc. There are more doubts as to its influence on the delay of admission to an institution. As in the case of day centers for people with physical dependence, they are ideal levels of assistance for training family members and caregivers, as well as for the creation of self-help or support groups.
3. Geriatric day hospitals or clinics for men are also optional. Desirable as a hospital care level, they are still an option. Their cost is not excessive and they are adaptable to local circumstances. In any case, they seem to be more effective when they are aimed at older people who need rehabilitation.
In the event that the elderly person cannot stay in their community or be cared for by their own, there are residential centers, both public and private or subsidized. They can be assisted, for patients with clinical and health needs, as well as for patients with a lesser degree of dependence. Many of these residential centers are equipped with a video surveillance system so that patients can feel safe while receiving care in a space outside of their familiar surroundings.
The purpose of the centers for the elderly is to provide health care (from different disciplines) and social care. People who live in a residence can do so temporarily or indefinitely, benefiting from specialized professional assistance. These centers can be public, private, and concerted.
In practice, it is the nursing homes for the elderly that carry out this type of assistance. They are defined as an open gerontological center, for personal development and for interprofessional social and health care, in which people with some degree of dependency live temporarily or permanently.
Do your research as to the quality of care provided in some residences. Perhaps market competition is forcing prices to be adjusted too much (which will affect the services provided), and to admit older people with high care complexity.
In order to prevent dependency situations and continue living in the community, the different professionals and experts serve the elderly in a coordinated and organized manner. At its different levels of care, geriatricians and multidisciplinary teams work for the benefit of each elderly person, adapting to their particular needs at each moment.