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Sheltered Care

Sheltered Care Communities

The needs and fancies of older people are as varied as there are people. An optimist would say that while compromises must be made, with planning and research, a fair match between an elderly person's capacity and suitable accommodation is possible, so varied now are the living quarters on offer for older persons.

Selection

Selecting a new home at any time is stressful, but selecting a home when one is older is very difficult indeed - if only because places will likely be in short supply. It is often a sudden crisis that sparks off consideration about whether a move into a care home might be necessary. Decisions may have to be made in a hurry and there is often strong, sometimes conflicting advice offered by family and friends, or by professional advisors such as doctors or care managers. Even when there is an opportunity to plan, there will be difficulties for the older person and their friends and relatives when a dwelling change is in the offing. A cool head, serious attention to detail and a strong focus on the task of matching needs with available accommodation is a must.

Checklist of Essential Requirements

An added puzzle to be solved is the precise meaning of terms such as: sheltered housing; retirement housing; housing for the elderly, shared/sheltered housing schemes. They tend to mean different things in different circumstances, so it is useful to start with a checklist of essential requirements rather than relying on definitions and descriptions.

Skilled Care Facilities provide an intense level of nursing care as prescribed by the resident's physician on a 24-hour basis.This level of care is for persons requiring assessment and oversight by a registered nurse, administration of a medication regime that may involve monitoring and intervention, administration of medication or fluids by an intravenous route,tube feedings, rehabilitation and/or discharge planning.

Sub-Acute Care is provided to patients who require a higher level of skilled care as a transition from hospital to home or to an outpatient rehabilitation facility.The services may be provided in a special unit of a hospital or in a skilled nursing facility. The following are the most commonly seen services in a facility that offers sub-acute care: respiratory/ventilator care, care following outpatient surgery, oncology, rehabilitation or management of several complex medical conditions.

Hospice Care is a combination of at-home and facility-based services designed to help those terminally ill and their families to live as comfortably as possible.

Sheltered Care Facilities provide housing, meals, housekeeping, and assistance or supervision with medication and activities of daily living. Dietary needs are met through general diets or by therapeutic, medically prescribed diets. Access to a variety of social and recreational activities is made available.

Intermediate Care facilities provide 24-hour nursing care and assistance with activities of daily living, medication administration, restorative care, social services, therapeutic activities and case management. The professional staff can be expected to provide a variety of therapeutic methods including:

  • Individual therapy.
  • Play therapy.
  • Group therapy.
  • Couple therapy.
  • Stress management.
  • Follow-up to psychiatric hospitalisation.
  • Medication administration and monitoring.

Independent Living Communities offer individual apartments with areas for group socialising and dining. Residents are generally self-sufficient and require no special care, but choose to have certain services provided for them. Services may include meals, housekeeping, personal care, transportation, and social and recreational activities. Costs for services may be charged for as used or included in the weekly/monthly fees.

Subsidised Sheltered Housing is usually made available through financing from the local health board or the Department of Social Welfare. Low-income residents pay 30% of their allowances for rent; and the local Government welfare office pays the difference. Managing agents may offer social and recreational opportunities. Typically on-site staff do not provide other services.The waiting list is commonly very long for such subsidised facilities in most urban areas.

Shared Housing is a home or apartment that is shared by a small group of older adults (typically four to ten residents) who have private sleeping quarters but share the rest of the residence. Sponsoring organisations may provide staff and services such as meals, laundry and cleaning. In some arrangements, residents share the housework and other responsibilities.

Assisted Living is for those individuals who need assistance with one or more activities of daily living but do not need ongoing nursing care. Typically services include assistance with bathing, dressing, grooming, meal preparation, housekeeping, etc. It may be available as a program within facilities providing independent living or sheltered care; or it may function in a stand-alone residential setting.

In general, custom-built sheltered housing schemes are designed to meet the needs of the elderly so, one can anticipate there will be a scheme manager or warden and an emergency alarm service. There are often communal facilities such as a lounge, laundry, guest-flat and garden. Meals are not normally provided but some schemes include a restaurant and may arrange hot meals.

There are many different types of sheltered/retirement housing schemes. They may be for rent or for purchase. Schemes usually comprise between fifteen and sixty dwellings which may be bed-sitters, self-contained flats, bungalows or luxury apartments. Methods of paying for care range from buying complete packages, which may include purchase or lease of the apartment/unit to subsidised housing.

According to the Irish Council for Social Housing, persons on Local Authority housing lists may be eligible 'for consideration by Social Housing organisations'. The first step is to request an application form from the Local Authority (Council), which, when completed, should be returned with a short letter explaining circumstances and the need for housing. A list of Housing Association addresses can be acquired from:

Irish Council for Social Housing, 50 Merrion Square East, Dublin 2. Telephone: 01 - 6618334
Website: www.icsh.ie

The minimum age for persons entering sheltered housing is usually sixty, sometimes fifty-five or even fifty. Sheltered or retirement housing appeals to people who like living independently but want the reassurance of knowing that assistance is on hand if there is an emergency.

Selection Guidelines

While it is obvious that each person will have individual requirements and preferences, these guidelines may be a useful prompt during the early stages of the search for new accommodation. It is important to match the needs and care requirements of the individual with the following in mind:

  • The location - address, near friends?
  • Proximity of shops, banks, parks, doctors, pubs.
  • Are there hills to climb or busy roads to negotiate?
  • Transport - bus stop, DART, LUAS/Train, garage for car.
  • Communal facilities for whatever social events are in favour.
  • Pets - allowed or are there too many?
  • Design - lifts, wide doorways, windows easy to open, light switches and electric sockets within reach.
  • Noise - insulation, lift and machinery noise.
  • Security - Main door/gate and individual entrances, security locks and alarms.
  • Residents / tenants associations.
  • Maintenance - heating system, waste collection, garden and common area maintenance.
  • Increased level of care available - yes / no.