summary for the content below with explainations.

Nursing Homes As we have just explained, older adults may progress through various institutional care facilities depending on their health status. We will begin describing in more detail each of these facilities with a discussion of the institutions that provide active nursing care. A nursing home is a type of medical institution that provides a room, meals, skilled nursing and rehabilitative care, medical services, and protective supervision. The care provided in nursing homes includes treatment for problems that residents have in many basic areas of life, including cognition, communication, hearing, vision, physical functioning, continence, psychosocial functioning, mood and behavior, nutrition, and dental care. To manage these problems, residents typically need to take medications on a regular basis. Residents of nursing homes may also receive training in basic care as well as assistance with feeding and mobility, rehabilitative activities, and social services. A nursing home may also have a rehabilitation unit in which residents receive intensive treatment to restore previous levels of functioning. Rehabilitation units typically include occupational and physical therapy services in addition to medical care. Referring back to Figure 12.1, acute rehabilitation typically follows hospitalization. Nursing homes are certified by state and federal government agencies to provide services at one or more levels of care. A skilled nursing facility is a type of nursing home that provides the most intensive nursing care available outside of a hospital. Nurses and other health care workers in this type of facility can apply dressings or bandages, help residents with daily self-care tasks, and provide oxygen therapy. They are responsible for taking vital signs of their patients, including their temperature, pulse, respiration, and blood pressure. In an intermediate care facility, individuals who do not require hospital or skilled nursing facility care but do require some type of institutional care receive health-related services. These facilities provide health and rehabilitative services as well as food but do not have intense nursing care services available. Nursing home services have become a big business in the United States. In the year 2017, expenditures for nursing homes (including those attached to retirement communities) totaled 166.3 billion dollars or about 4.7% of total expenditures (Centers for Medicare & Medicaid Services, 2019d). Figure 12.2 shows the cost breakdown for nursing home compared to other types of long-term care. As you can see, the yearly average private-pay facility is approximately $82,000 USD for a semiprivate room

Residential Care Facilities An alternative to a nursing home is a residential care facility, which provides 24-hour supportive care services and supervision to individuals who do not require skilled nursing or health-related care. Residents receive meals, housekeeping, and assistance with personal care such as bathing and grooming. Some residential care facilities may provide other services, such as management of medications and social and recreational activities. Housing complexes in which older persons live independently in their own apartments are known as assisted living facilities. The residents of these facilities pay a regular monthly rent that usually includes meal service in communal dining rooms, transportation for shopping and appointments, social activities, and housekeeping services. These facilities are professionally managed and licensed and may represent one of several levels of care provided within the same housing community, including health care services, in some cases. The cost for living in an assisted living facility may range from hundreds to thousands of dollars a month. In some states, funds may be available through government support programs for those who cannot afford to live in these facilities on their own. However, most residents pay the rental and other fees out of their own funds.

COMMUNITY-BASED FACILITIES AND SERVICES Older adults who choose not to live in a residential facility but still need some type of care can take advantage of a number of support services that allow them to live independently in their own homes. Some of these services are offered by volunteer groups at no cost to the individual. Others are fee-based, some of which may be paid for by Medicare. The residential environment of the older adult can be conceptualized along four dimensions, including the aesthetics and safety of the local area, convenience of access to shops and services, positive regard and mutual help among neighbors, and the attractiveness and ease of accommodation within the home. Each of these represents qualities of the physical environment, rather than the perceived environment. Research evaluating their contribution to the older adult's adaptation to the community suggests that the reality of the environment plays a crucial role in influencing well-being and satisfaction (Rioux & Werner, 2011). The concept of aging in place refers to the principle that with appropriate services, older adults can remain in their own homes, or at least in their own communities (Gillsjo et al., 2011). Taking advantage of the same multi- disciplinary focus so important for institutional care, older adults can benefit from interventions that allow them to maintain their autonomy and previous patterns of living (Szanton et al., 2019). The aging in place movement should also be bolstered by advances in digital technology that can supplement the services provided to older adults by connecting them to online sources of support. Other assistive technology advances can also benefit older adults living at home, including adaptive toilets that allow height and adjustment.