To meet the needs of the complex mix of residents, some board and care homes offered a wide range of services. However, available services varied considerably from homes offering little more than room, meals, oversight, and a few services to places that provided or arranged for extensive and skilled nursing services and therapies.
3.6.1 Service Mix
More than three-quarters of the homes reported providing medication storage or supervision, organized activities, recreational trips, and transportation (Exhibit 3-11). Approximately one-quarter of all homes reported providing nursing services.
|EXHIBIT 3-11. Services Provided in Facility|
|Services Provided||Total Population|
|Reminders to take medication||81||3.8|
Differences by Licensure Status. By and large, licensed homes of all sizes were significantly more likely to provide therapy directly to their residents than were unlicensed homes. A “responsible” person is more likely to be present in medium and large licensed homes than in comparably sized unlicensed homes, and large licensed homes are more likely to provide transportation than are large unlicensed homes. Regardless of size, licensed homes were more likely to report providing personal care services. A similar pattern is observed for medication reminders and medication storage (see Table A-7). The average number of health services in a facility was greater in licensed homes of all sizes (Exhibit 3-12). Social services were more prevalent in large licensed homes than in comparably sized unlicensed homes (4.2 compared to 2.9).
With respect to arranging for outside services, the differences were not as consistent. Although small licensed homes were more likely to arrange for nursing and long-term care for their residents than were small unlicensed facilities, large licensed facilities were more likely to arrange for outside transportation for their residents than were large unlicensed homes; most other externally arranged services did not consistently differ by licensure status.
Differences by Regulatory Environment. The pattern of service availability in licensed facilities in limited and extensively regulated States was remarkably similar. We observed few significant differences. Licensed homes in limited regulation States were more likely to manage their residents’ money (64 vs. 31 percent) and to provide medication reminders (90 vs. 79 percent) than licensed homes in extensively regulated States (see Table A-15).
EXHIBIT 3-12. Average Number of Health Services Provided by the Facility by Size and Licensure
3.6.2 Services from External Agencies
Half the homes reported that outside agencies, such as home health agencies, provided nursing care to residents who needed such care on a temporary or episodic basis. In addition, as seen in Exhibit 3-13, 25 percent of the extensively regulated licensed and 23 percent of the licensed homes in States with limited regulation reported that agencies provided ADL/personal care to residents. Approximately one-third reported that some residents attended Senior centers or adult day care programs. About 30 percent of the homes reported that some residents attended sheltered workshops or day activity programs.
No significant differences were observed in the type, or number, of outside provided services arranged by the home, except that in limited regulation States homes were more likely to arrange for sheltered workshop programs than was the case in extensively regulated homes.
3.6.3 Approach to Residents Who Need Nursing Care
Although most homes reported providing many services directly and through external agencies, homes differed on whether residents who needed nursing care could remain in the home. Part of this variation is a function of the facility’s willingness and ability to provide or arrange care. In addition, licensing regulations in some States prohibited board and care homes from admitting or retaining residents who need daily nursing care. A few States, such as Florida and Oregon, allowed daily nursing care to be provided by some classes of board and care homes. Other States limited the services such homes could provide. As a result, there was considerable variation in how homes dealt with residents who needed nursing care. Over half of all facilities reported they provided services with facility staff or arranged for a home health agency to provide care if the resident needed only temporary nursing care. However, 28 percent of the homes reported that they sent the resident to a hospital/emergency room if the resident became ill and needed temporary nursing care (less than 14 days). More than half of all homes reported they would discharge a resident to a hospital or nursing home if the resident needed nursing care for more than 14 days (Exhibit 3-14).
|EXHIBIT 3-13. Services Provided by an Outside Agency to Facility Resident|
|Services Provided by an Outside Agency||Total Population||Licensed Homes|
|Extensive States||States with Limited Regs|
|Senior center/adult day care||34||4.5||34||4.2||36||3.8|
|Shelter workshop/day activities||32||5.0||28||3.8||43||3.8||b|
3.6.4 Services Covered by Monthly Rate
Homes differed in terms of the services covered by the monthly rate. These monthly rates generally cover room, board, personal laundry, special diets, and assistance with eating, dressing, and toileting in all homes. However, in over 10 percent of the homes, there was an additional charge if the resident needed a special diet or personal assistance with eating, dressing, and toileting. Nearly three-quarters of the homes charged extra for incontinence supplies (Exhibit 3-15).
EXHIBIT 3-14. Facility Response to a Resident’s Need for Nursing Services
|EXHIBIT 3-15. Services Covered by Monthly Rate|
|Services Covered by Daily Rate||Total Population|
|Assistance with eating, dressing, or toileting||89||1.8|