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As people age and gradually lose mobility or cognitive functions, they naturally need more assistance, sometimes in the form of intermediate care, which provides older adults with the opportunity to live independently without moving into a nursing home. Of course, the level of assistance needed will vary depending on the severity of their condition. 

It is, then, important to understand what senior care options are available so that when the time comes for older adults to seek care assistance, they can make an informed decision while finding the appropriate level of care that best meets their needs. Let’s take a look at some care options below. 

Assisted living care

Assisted living facilities help seniors with daily care services when they can no longer live independently. Typically, residents will be 55 years old or older and be in relatively stable condition with manageable chronic illnesses, so they will not be bedridden or need extensive medical care. However, residents will need assistance and support with activities of daily living (ADLs) from caregivers like CNAs and nurses who oversee resident care. 

Before being admitted into an assisted living facility, potential residents must complete a physical assessment and provide their medical histories to determine their health, physical condition, and level of care needed. 

While amenities and services may vary depending on the state and facility, most will usually provide the following services:

Assisted living is a popular care option for seniors because they receive personalized care while maintaining their independence in a comfortable and homelike environment. There are also ample social activities and access to healthcare, so residents can rest assured knowing their medical needs will be met. 

Intermediate care facilities

Intermediate care facilities (ICFs) provide nursing and supportive care to residents on a sporadic skilled nursing care basis under the supervision of a physician. However, they do not offer continual nursing care nor are they licensed to treat incontinent or non-ambulatory residents. Therefore, if seniors need these services, they will need to go into a skilled nursing facility (SNF) or nursing home that provides higher medical care. 

Seniors who need intermediate care often live in private residences and have some chronic illness or another ailment that prevents them from living independently. Residents will also need assistance with ADLs and a higher level of medical care than assisted living residents. However, their condition is not as extreme as skilled nursing residents, and they do not require full-time medical assistance.

Typical services offered in intermediate care facilities include:

A nurse is providing intermediate care to an older lady at home so she can continue to live independently without moving into a nursing home.
Intermediate care allows older adults to live independently without moving into a nursing home.
  • Treating residents with complex ADL needs, such as toileting, dressing, bathing, grooming, eating, and getting in and out of bed 
  • Assisting with medications, including ordering, reviewing, and administering
  • Supervised care from on-site physicians and nurse practitioners
  • Housekeeping and laundry

An intermediate care facility is often considered the midway option between assisted living and skilled nursing care, providing an attractive alternative for older adults.

Skilled nursing care

A skilled nursing facility (SNFs) primarily focuses on medical care and rehabilitation. Typically, there are two types of residents in SNFs or nursing homes: 

  • Short-term residents are usually released from a hospital and need rehabilitative care to recover from surgery, injury, or illness. They stay for a transitional period between the hospital and home, typically for 20-30 days. During their temporary stay, residents will access goal-orientated rehabilitation services (physical, occupational, and speech therapy) before returning home to live their active and independent lifestyles.
  • Long-term residents move into a skilled nursing facility for extended stays or, in some cases, permanently. These residents usually suffer from severe chronic illnesses or debilitating medical conditions, requiring constant care and supervision. The ongoing skilled nursing care often involves a combination of clinical, therapeutic, and daily personal care, significantly improving residents’ quality of life.

While skilled nursing facilities will offer different services, most residents will use the following services:

  • Nursing care, such as wound, custodial, and cardiac care
  • Nutrition therapy
  • Post-stroke recovery and rehabilitation
  • Pulmonary rehabilitation
  • Rehabilitation services, such as physical, occupational, and speech therapy
  • Housekeeping and laundry

As mentioned earlier, depending on a person’s condition and needs, the level of care and assistance will vary. However, when older adults need ADL assistance but do not want to give up their independence, an attractive option is intermediate care because it offers all the benefits of a nursing home but maintains their independence.

In the next section, we will dive deeper into intermediate care and why it is a popular care option for older adults. 

What Is an Intermediate Care Facility?

An intermediate care facility (ICF) is a type of long-term care facility that provides residents with supportive nursing care. Traditionally, an ICF was designed to care for those with mobility problems, mental disabilities, and chronic illnesses. However, they also admit elderly adults because they have some or all of the same ailments. 

ICFs can be both stand-alone facilities or part of a branch within a larger skilled nursing facility that supports less-serious health conditions. They usually serve residents on a short to mid-term basis, offering a hybrid of custodial care, combining personal services like ADLs with nursing care.     

For this reason, intermediate care facilities primarily provide three levels of care

Intermediate-light care

Light intermediate care assists residents who need a limited amount of help, usually with one or two daily activities, such as bathing or changing. The assistance may include supervision and, when required, the occasional behavioral management assistance. 

Intermediate-moderate care

Moderate intermediate care usually assists with three to four supervised daily activities, such as taking medication twice a day, using the restroom, and bathing once daily. Depending on a resident’s condition and needs, residents may also need behavioral management. 

Intermediate-heavy care

This is the highest level of intermediate care, which assists residents with all ADLs (transferring, dressing, feeding, toileting, personal hygiene, and continence.) Residents who need heavy, intermediate care will also need behavioral management, supervision, and around-the-clock care. 

Depending on the facility, ICF services may vary to include services from occupational and physical therapists, social workers, and dietitians. Furthermore, some facilities may also offer full ADL assistance, as well as provide services for housekeeping, laundry, transportation, and medication reminders.  

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Why Integrate the ICF Model with Intermediate Care

The International Classification of Functioning, Disability, and Health (ICF) is a healthcare model that organizes functioning and disability information. The primary purpose of the ICF model is to coordinate healthcare services, so caregivers can assess internal factors, such as patients’ needs, mental health, and intellectual disabilities, with external factors, like societal participation, gaining a comprehensive review of a patient’s medical needs. 

A nurse who works in an intermediate care facility is taking a resident's pressure.
An intermediate care facility (ICF) is a type of long-term care facility that provides residents with supportive nursing care.

It is an instrumental model for patients with disabilities because it provides standardized patient assessments so caregivers can create personalized care plans to support patients with disabilities. 

While the ICF model is not directly used in intermediate care facilities, the framework can be helpful because it allows caregivers to better understand intermediate care, including reablement, so they can track patient needs and progress while evaluating interventions. 

Furthermore, intermediate care facilities regularly provide custodial care to disabled and elderly residents. So understanding the importance and significance of how internal and external factors play a role in patient care and recovery is highly beneficial to caregivers.  

Past studies show that the ICF model can improve communication among healthcare professionals, leading to more efficient and effective rehabilitative care in intermediate care facilities. Rehabilitative care requires the interdisciplinary management of a patient’s functioning, health, and disability. 

Managing these factors can provide a coherent view of a patient’s health from an individual, biological, and social perspective. But this will depend on the intermediate care facility’s rehabilitation measures and practicability improvements on the ICF core sets. Therefore, as the ICF model develops and improves within the medical community, this will improve communication between patients and healthcare professionals working in intermediate care facilities for the developmentally disabled. 

How Much does Intermediate Care Cost?

Let’s finish today’s topic on intermediate care by looking at the cost of care. According to Genworth statistics from 2020, the annual median cost for intermediate care in the long-term care setting is significantly cheaper than skilled nursing facilities. 

A nurse is using the ICF model to assess a resident's mental health and intellectual disabilities.
The ICF model coordinates healthcare services so caregivers can assess patients’ needs, mental health, and intellectual disabilities.

The median cost for homemaker or home health services, which help seniors with ADL assistance, costs between $53,768 to $54,912 annually, which is similar to the annual cost for assisted living facilities, which is approximately $51,600. However, nursing homes charge considerably more because they require more specialized and medically trained staff. Therefore, the average median cost for a semi-private room in a nursing home is nearly double, costing $93,075, while a private room is $105,850. 

While the cost of intermediate care may be lower than skilled nursing facilities due to lower operating costs, the figures above are still substantially large and by no means affordable for the average person. To further complicate matters, intermediate care does not explicitly focus on medical services and provides more rehabilitative assisted living services, which means such residents do not qualify for Medicare reimbursements

However, a “loophole” does exist for mentally disabled adults who need daily ADL assistance and may qualify for Medicaid eligibility, as they can receive government support in that way. Alternatively, if the resident has a private long-term care insurance policy that covers intermediate care, they may also receive financial assistance. Unfortunately for all other seniors, intermediate care costs are funded privately by the resident or their families. 

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