When a person can no longer live independently, or needs an extended period of rehabilitation and convalescence, it can be confusing to determine what is the right choice of care. Fortunately, there are some guidelines which can be helpful. Whatever the final decision, it is important that the family, the person's physician, and the person needing care all be involved in considering the choices and making the decision.

In Texas, different types of care are available for different types of needs. Keep in mind that if you choose a less comprehensive form of care, you may need to make another move and another choice in a short period of time. For this reason, many people try to look ahead and lessen future trauma by choosing a care plan or setting that will easily transition into another, more appropriate one in the next couple of years. The following is a list of the five most common levels of care.

The physician is usually responsible for the patient's entry into the long term care spectrum, through deliberate planning and consultation with the patient, family, and other health care workers.

Subacute or transitional care is one of the fastest growing programs in the health care industry. Subacute Units are often found in acute care hospitals, acute rehabilitation hospitals and in skilled nursing units of long term care facilities. Subacute patients have several payor sources with Medicare being the primary, followed by managed care providers.

The subacute care program is a specialty program specifically designed for the patient who has had a recent illness, change in an old disease process; has a determined course of treatment, and does not require intensive diagnostic and/or invasive procedures.

Patients on the subacute unit have a shorter length of stay (approximately 7 - 30 days), and have an illness or treatment plan requiring multiple treatments: respiratory therapy, physical, occupational or speech therapies, IVs, lab work, and/or x-rays.

Be sure to check that your choice is licensed by the state as a personal care facility. Like nursing facilities, assisted living facilities offer meals, laundry and a variety of services to help with things like dressing, bathing, and grooming. In general, residents are expected to be more independent, less needy of monitoring and nursing intervention to prevent developing problems, and able to take their own medications if prompted by a staff member.

In some cases you may find combinations of these services being offered together. For example, one building may house both personal care and nursing home wings, so that a person can be served where most appropriate at any given time.

These are typical family homes - like yours - operated by the owner or by someone the owner has hired. They are not licensed. The state does in most cases, however, require them to meet minimum fire safety requirements, but fewer than the facilities mentioned above. And the state is not required to do any follow-up to ensure compliance. In these homes, only one "caregiver" is required to be present, and he/she is allowed to be away for up to three hours a day without providing a substitute caregiver. This would suggest that a person who needs supervision or medical or nursing monitoring would not be appropriately placed here. Training of any other personnel, if any, is also limited compared to the other levels of care.

This is a variety of services provided by visiting caregivers in one's own home on an intermittent basis. Be sure the home health care agency is licensed by the state, which means they must meet minimum standards. Home health care does not provide around-the-clock care, but can provide specialized services such as physical or speech rehabilitation, procedures and monitoring requiring a registered nurse, and personal services.

The following chart shows the similarities and differences among the five levels of care.