Assisted living communities provide support to seniors who could benefit from extra assistance with daily tasks and routines. One of the biggest perks of assisted living care is the ability to customize that assistance to each individual resident, ensuring everyone gets what they need to succeed and feel their best. Most communities provide this tailored support by offering different care levels that are based on individual needs and abilities. Understanding more about these care levels can help you make a good decision on a community for your loved one’s current and future needs.
Assisted living levels of care are designations given to each individual resident that classify how much support they need for daily care. Communities want to be able to tailor their approach to each individual resident’s needs and preferences. Classifying residents with appropriate levels of care allows management to determine staffing and supply needs, as well as to ensure that team members are getting appropriate training so that they can give individualized support without rushing.
Depending on each community, levels of care in assisted living can be based on support needs for activities of daily living (ADLs). The levels are based on support needs and daily functioning rather than formal medical diagnoses. More support with more ADLs means a higher level of care category while less support with fewer ADLs means a lower level of care. While levels of care are common at most assisted living communities, they do vary from community to community and even from state to state.
Some communities use numbered care levels, while others use points-based or customized care plans.
Assisted living communities work hard to develop levels of care and the parameters of each level. The process begins with an assessment before moving into the community. The assessment measures a base level of care and is typically done before moving into a community, as well as annually and then upon any significant change.
The assessment typically uses past medical information and physician information. It also sometimes includes an interview from a nurse from the community, where they ask the new resident and their family members questions to determine how much support the person needs with daily care. The nurse then uses information from multiple sources to determine the type of support the resident will need and assigns a level of care.
The initial assessment includes a review of past medical records, including any recent details from hospital stays or family concerns. The physician will likely chime in here, giving their recommendation for support needs.
Each individual community has its own assessment process, but it is common for the process to include a nurse review of:
This initial assessment will set the level of care, but once the resident moves into the community and the team members begin to get to know the resident even more, that level might be changed in the first few months.
Activities of daily living (ADLs) are a common way for assisted living communities to measure support needs and make level of care recommendations. Activities of daily living include all the tasks that we all do to take care of ourselves each day, such as dressing, grooming, bathing/showering, eating, toileting (or incontinence management), ambulation, and transferring. Medication management can also be included in this list, even though it is technically an instrumental activity of daily living (IADL).
Depending on the community, level of care can be increased if the senior needs:
For example, a senior who needs only verbal reminders with showering and dressing tasks will be at a lower level of care than a senior who needs stand-by assistance with showering, grooming, dressing, and ambulation tasks.
Levels of care for seniors are meant to be flexible, changing as the needs of the resident change. While regular assessments happen annually at most assisted living communities, level of care needs can also be reassessed at any time. A resident who is coming out of a hospital or SNF stay, for example, might need to increase their level of care for a short time while they are recovering and getting back into their routine at their community.
Level of care assessments are typically tied to the care plan review process. This means that the interdisciplinary team of professionals at the community get together with the resident and family member to talk about how things are going and if the resident is succeeding in meeting their health and wellness goals. Sometimes, a level of care adjustment can give the resident the additional support they need to feel more comfortable, safe, and healthy.
It is important to understand the level of care definitions at each assisted living community you are considering, as each community can have different parameters. You don’t want to be surprised by anything once you move your loved one into the community. However, here are some common examples of different levels of assisted living .
Residents at the lowest level of care are quite independent and require just occasional support. This support is typically verbal cueing. An example could be a senior who needs a caregiver to knock on his door to remind him that it is time for lunch because he lost track of time while tending to his potted garden on the patio.
A senior who is at the lowest level of care can perform activities of daily living independently. They are well-groomed, have good hygiene, and can manage their own schedule.
Residents who require moderate assistance typically need support with 1 or 2 activities of daily living. They may need a caregiver to come into their apartment and verbally cue them to get up for the day. They may need that caregiver to help them decide what to wear and to stand by while they are getting dressed or showered to ensure safety.
A senior who is at a moderate level of care is independent with the majority of activities of daily living, but they might need some support with a few ADLs due to pain or mobility. They may feel safer if a caregiver is nearby during tasks like showering.
Residents who require increased support need hands-on or extensive assistance with 1-3 activities of daily living each day. An example could be a senior who needs hands-on assistance with dressing and grooming in the morning as well with showering in the evening. This senior might also need support with transferring from their dining room chair to their walker for safety or fall prevention.
Residents who require extensive assistance need hands-on support with almost every activity of daily living. A senior who needs a caregiver to help them with 3 ADLs, would meet this qualification.
Finally, sometimes assisted living residents require a more specialized type of living environment. Memory care residences are often available in assisted living communities and offer an environment designed to meet the challenges that come with cognitive decline. Staff members are specially trained in best practices of dementia care, and the days are structured to provide familiarity and comfort. Most seniors living with some type of dementia will need specialized care in order to remain safe and healthy. Signs this type of care is needed might include wandering, getting lost, or having more difficulty keeping up with daily tasks.
Every resident who lives in an assisted living community receives access to amenities and services that offer a safe, low-maintenance lifestyle. Caregivers are always available around-the-clock and are there to help all residents with anything they need. However, designating levels of care in the care plans of residents allows caregivers to understand how much time they may need to spend with different residents, as well as to help them note when something seems different about a resident. For example, if a resident is at a low level of care but suddenly needs lots of hands-on support with multiple ADLs, this is a notable change that the caregiver will need to report to their supervising nurse.
Someone on a higher level of care might require hands-on assistance or stand-by support with activities of daily living as well as medication management. In addition, higher levels of care parameters might mean more time is spent supporting the resident with mobility and ambulation, dining and nutrition, and other daily living support.
With this extra caregiver time and support, higher levels of care are billed at a higher monthly cost than lower levels of care. This additional cost goes to increasing caregiver staff during peak ADL times as well as training, supplies, and more. Ensure you speak to each assisted living community you are considering to learn more about the costs for levels of care, as well as the process for billing when the level of care changes.
The staff members at the assisted living community you choose will designate the level of care your loved one is at. However, you can work with the staff at the communities you are touring to get an estimate of care level needs now and in the future by being honest about the type of support your loved one needs. Be sure to consider these factors:
Being realistic with your loved one’s challenges will only help the assisted living staff be able to provide the appropriate support for them. It will also help you and the community have a candid dialogue about costs associated with levels of care.
When you are searching for an assisted living community, here are some questions to ask to ensure you won’t be surprised by any level of care expense or policy.
It is common for seniors to require higher levels of care as they age due to disease progression, new medical conditions, or other factors. Assisted living staff should notice this decline and be able to communicate with you and your loved one prior to an increased level of support being needed. For example, it is very uncommon for a senior to be at a Level 1 on Tuesday and then suddenly be at a Level 3 on Wednesday. Instead, the best practice is for the assisted living staff to notice changes in mobility, strength, cognition, or other factors and to plan for increased support in the near future. This way, family members can plan for additional costs.
All residents are unique, but signs that a higher level of support may be needed could include:
Assisted living communities are excellent solutions for seniors who can benefit from additional support and the peace of mind that comes with knowing caregivers are always available to help out. These communities are also mindful that changes will come with age, and a level of care system gives them more opportunities to care for residents for many years to come.
When you’re searching for a community that can meet your loved one’s current needs, make sure you are familiar with the level of care system so that you can rest assured your loved one will also receive support as their future needs change and evolve. Ask lots of questions and be honest about your loved one’s needs and your expectations.
At Legend Senior Living, we aim to support residents for as long as we can with personalized and flexible support. Learn more about an assisted living residence near you.
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