What’s in a name?
During my career in the field of care of elderly people, I have noticed an exponential expansion in terminology used to describe accommodation and care services. Yesteryear’s names were quite simple. Generally, dependant on the level of care needed, it was referred to either as retirement villages or frail care facilities. Today retirees are confronted by a plethora of names including aging-in-place, step-down, lifestyle villages, sub-acute care and a host of others designed to impress, but which most times merely adds to the confusion
Every profession has its buzzwords to create the illusion that things are far more complex, and therefore valuable than they really are. Why? …Because the more complicated it sounds, the more willingly people are to part with their money. Sub-acute care sounds so much more professional than step-down and cottage care more enticing than supported living. An additional reason for the tendency to concoct more technical names, is possibly due to the fact that medical aid “hospital plans” might view such places more worthy of covering i.e. more akin to hospitals? Sadly, however, often the result is that we purchase without ascertaining the true nature of the care that we have chosen. This article seeks to clarify the terminology used; to explain … “What is actually in the name?” Some often misunderstood healthcare terminology is as follows:
At the top of the list is hospitalization, where a person is admitted either to a State or private hospital, hopefully, to recover. In truth, however, when you receive the invoice, you may either need to be immediately re-admitted to ICU… or you may perhaps even wish that you hadn’t recovered! Prices vary greatly, with some private hospitals charging R6, 000 per day for ICU and R3, 000 per day for general wards.
Step-Down, Sub-Acute, Post-Operative and Convalescence Care
Second in the care ladder are step-down care, sub-acute care, post-operative care and convalescence care. These are all very similar and provide a higher level of care than frail care. They will be referred to under the generic term “step-down.” A person requiring step-down care has normally undergone treatment in a hospital due to illness or an operation and is requiring temporary care to recuperate before returning home. Most medical aid schemes will fund the care of this nature, albeit on a limited time-scale. (There is a common misconception that the term Step-down, also refers to lower levels of care provided within a normal Frail Care facility… however, this is not true. Step-down units require formal accreditation; specialized medical equipment as well as compliance with strict regulatory conditions).
The third rung down is fully-fledged Frail Care facilities, which are invariably attached to retirement facilities. These cater for patients needing significant care assistance; such may include support with dressing, toileting, washing and regular attendance and turning during the night. The Frail Care unit is ideally managed by a registered Sister. The patients may include both mentally and physically frail elderly, as well as people suffering from dementia, such as Alzheimer’s, Vascular and other forms. Frail care Homes are also known as Care Centres; Advanced Care units; or Healthcare Centres. (In current times, what used to be described simply as Frail Care, is sometimes even sub-divided into low-care, mid-care, and high-care). It is essential to remember a Frail Care facility does exactly what the name suggests – it offers care…not nursing!
The fourth rung down, assisted living, is sometimes also known as supported living, medium care – or mid-care. Assisted living units are residential facilities which provide care on a 24-hour basis to moderately frail elderly people who are incapable of coping with all the tasks associated with daily living. They may require assistance with bathing, toileting and medicine administration. Such assistance may include the onsite services of healthcare workers, as well as the provision of meals when required.
This differs from situations where people living independently, either in private dwellings or in individual cottages in retirement villages, hire private care staff to attend to their needs on a frequent or even on a 24/7 basis. The main difference being that in-cottage care staff are normally provided by retirement villages themselves (mostly staffed from the frail care facility) This form of care often comprises 2 or 3 visits per week; or for example every evening to assist with bathing etc. It may also be of a temporary nature – for example in response to an illness or surgical procedure.
Two facility names omitted are those of an Old Age Home and a Nursing Home, as these models derive mainly from the UK where the former is defined as: “A multi-residence housing facility intended for old people. The usual pattern is that each person or couple in the home has an apartment-style room or suite of rooms. Additional facilities are provided within the building”
Living in retirement and care accommodation can provide an extremely pleasant lifestyle, and a healthcare safety net – but choose wisely. Do not rush into purchasing a unit in the first facility you encounter. Investigate fully, shop around, get promises in writing, and read the fine print, as it is probably the largest and most important decision of your life. And remember not only do you get what you pay for… you get what you ask for… So get it right!