Special housing for the elderly varies widely. Life-care communities (or continuing care retirement communities) are the most comprehensive, providing apartments for independent living and a range of services, including skilled nursing care. Most life-care communities have a single campus; some provide services at several sites. With congregate care, older persons live in individual apartments or rooms and receive selected services. Congregate care differs from a life-care community in that the residents do not own their units, and there is no commitment to provide care over time as residents’ needs change. Foster, domiciliary, and personal-care homes generally offer room, board, and some supervision. The availability of these housing options, particularly those providing supervision, is woefully inadequate in most communities.
Hospice care provides services intended to improve the quality of life for terminally ill patients so they can live the remainder of their lives as comfortably and peacefully as possible. Many aspects of hospice care are being adopted by care providers in the general health system and have been suggested for patients with certain illnesses (eg, Alzheimer’s disease), even when death is not imminent.
Respite care refers to services that allow family members time away from caregiving responsibilities. Services range from an in-home visit of a few hours by a volunteer or paid worker to institutional stays of several weeks. Respite care continues to evolve as a valuable resource for those coping with the stresses of providing care to an aged spouse, sibling, or parent.
Community mental health centers provide ambulatory psychiatric care and other services to residents in catchment areas. Generally, the number of elderly persons who actually receive these services is much smaller than the number of persons who need them, but several centers have special outreach programs, nursing home consultation, and other services for geriatric patients.
Adult day care serves persons who need supervision or medical services during the day but who can spend evenings with family members or in other supportive environments. Two types of adult day care exist: the adult day hospital and the multipurpose, social, day-care center. Some adult day hospitals focus specifically on psychiatric patients. Despite significant fragmentation in funding and regulation, adult day-care centers have increased from 800 in 1987 to nearly 3000 in 1992.
Senior centers provide opportunities for social contact and recreational activities. They also serve as convenient sites for health screening, nutrition and education programs, and outreach activities. Most offer meals on weekdays, and some have extensive health and social service programs, including adult day care.
Nutrition programs provide two types of services—congregate meals and home-delivered meals. Congregate meals not only contribute to nutritional health but also provide opportunities for social contact, educational programs, and outreach efforts. Meals for the homebound or meals-on-wheels provides an important service to elders who are unable to shop, prepare meals, or follow special dietary regimens.
Home health care includes a wide range of services, such as skilled
nursing care; occupational, physical, and speech therapy; medical so
cial services; physician care; nutritional and dietary services and
meals; homemaker services; home health aide services; respiratory
and IV therapy; and medical supplies, including drugs and medical ap
pliances.    . .
Monitoring services such as telephone networks and friendly visitors,
keep health care systems in touch with chronically impaired or frail
persons living at home. These services can be a secondary function of
other services.    /