But What does it Actually Mean?

IT can be difficult enough to know where to start when looking for seniors’ accommodation without having to wade through acronyms, jargon and three different ways to say the same thing. Because there is no one ‘language’ in retirement homes, each property or company has their own way of referring to such. Here we breakdown some of the most common terms used and what they really mean.

1. The difference between an ‘actual’ retirement home and a ‘senior’s living building’: This is the first thing to be aware of; some residences refer to themselves as offering ‘retirement living’ but they’re not a licensed retirement home by definition of The Retirement Homes Act, 2010. Essentially, a senior’s building can provide meals, laundry and housekeeping services, but it provides no ‘care’. On the other hand a retirement home provides at least two of the 13 care services outlined in the Act, which can include meals, continence support, assistance with bathing, administration of medication, help with dressing and personal hygiene. To operate as a retirement home in Ontario, a residence must be licensed by the Retirement Homes Regulatory Authority (RHRA) which provides governance and oversight and makes sure the homes are compliant with the Act. It also upholds the Residents Bill of Rights. A Senior’s Building has no regulator and residents there have no other protections than what is law for all of us.
2. IL, ISL, AL, MC….oh my!.  The terminology for the levels of care offered is actually pretty standard across the industry, but understanding of what each means can be difficult to grasp. We have many calls from family members who say that their parent or loved one ‘needs assisted living’, but when we chat further, it’s often Mom or Dad doesn’t need the true definition of ‘Assisted Living’ but instead requires some oversight and support with things.

All licensed retirement homes offer Independent Living (IL). This is pretty much as it sounds; the resident is independent and autonomous and may not need care support at all, but they don’t want to cook for themselves anymore, or they’re looking to make new friends and have a better social life. As one of our clients succinctly put it, ‘I no longer want to have a “to-do” list’. Independent Living in a retirement usually comes with the following inclusions built into your rent.

• Three full meals a day along with all snacks and beverages
• Weekly housekeeping
• Weekly laundry of linens and towels (some homes also include personal laundry, others it’s an additional charge)
• Utilities such as heat, hydro and electricity
• A pendant or call bell system to alert staff if needed
• Access to 24/7 nursing support in case of accident, emergency or not feeling well
• All programming, events and activities
• Basic phone, cable and internet (some homes provide the service but charge extra)

Then, there is Independent Supported/Supportive Living (ISL). This is when the resident is still fairly autonomous but can benefit from some additional help, maybe with medication management or a bath/shower. 

Assisted Living (AL) is often a dedicated floor within a retirement home that has a higher staff to resident ratio and dedicated Personal Support Workers (PSWs) and a nurse. Residents who benefit from being on an AL floor include those with mobility challenges, or those needing assistance from others to go to the bathroom, to get up from bed or a chair, or someone to be beside them as they walk/need portering in their wheelchair. Sometimes an assisted living floor is a good place for those with cognitive decline too, if they also have heavier physical care needs.

Those homes that state they offer Memory Care (MC) will have a secure floor dedicated to those residents suffering from a cognitive decline. If the resident is still mobile, then a secure floor is usually always recommended. Certainly too if they are at risk of wandering or if they might be exit seeking (wanting to leave when a door opens) or if they have agitation around a certain time of day (sundowning) and want to leave. Memory Care and Assisted Living floors usually have their own dining areas, their own lounge and activity spaces and their own, dedicated 24 hour staffing.

3. Who’s Who? Again, each home will have its own titles for management and staff, but a basic rule of thumb for any building will be:

• • Executive Director or General Manager – the person in ultimate charge of the home. 
  • Director of Care or Health and Wellness Manager – the licensed nurse (be it an RN or an RPN) who is in charge of all care plans, directing the nursing team and the ultimate decision maker within the home for care provision.
  • Sales manager/consultant; Leasing manager/consultant; Lifestyle coordinator/manager/director – is the marketing person whose job it is to rent the suites and fill the building. They are usually the first point of contact for those reaching out and looking for information.
  • Culinary manager, Food services manager, Catering Director – the person in charge of all meals and the kitchen staff. This person will know if the home is able to accommodate specific dietary requirements and can explain to you their processes with certain foods, like how they ensure gluten free is not cross contaminated for example.
  • PSWs – Personal Support Workers who are trained and certified. There may also be a reference to a UCP which stands for Unregulated Care Provider. UCPs can carry out care duties under the supervision of the nurse and can be trained and certified by a pharmacist to be able to hand out medications.

4. Medical Jargon. Just like the abbreviations for the levels of care; IL, ISL, AL and MC, you may come across industry care terminology that is not familiar. Likely if you have had a recent stay in hospital or a rehab facility, some of these references may have been mentioned. Some of the more common are:

• • ‘Baseline’: in a healthcare setting, a baseline is essentially where you’re at right now with your physical, mental and emotional health. Your regular ‘baseline’ prior to a fall and hospital stay may have been fully independent. Now, you need some support. It might be discussed that this is now your new baseline. Or equally, that it’s anticipated that you will return to your original baseline with rehab.
  • ADLs (Activities of Daily Living) refer to tasks that each of us must be able to perform to remain fully independent including toileting, personal care, dressing, transferring safely from one space to another, and eating.
  • iADLs (Instrumental Activities of Daily Living) refer to more intricate activities like banking, cooking, driving to an appointment and arranging that appointment, safely managing medications including refills and dispensation/taking when prescribed)
  • A 1PA or a 2PA – refers to one or two people (care staff) being needed to assist you with your Activities of Daily Living. It stands for a one person assist or a two person assist.

5. How does all this work? In Ottawa, there are more than 100 licensed retirement homes. Not all offer the same levels of care but those that do will have their way of pricing. Essentially, this is one of three ways:

1. 1. All care is a la carte – your rent covers the base inclusions as per point 2. but anything you  need support wise is added on at an extra cost. For instance, if you need medication management, that will be a certain charge. If you need bathing assistance, that will be another. Toileting support, another charge. If your care needs are few then this can be a great option. As your care needs increase, it might not be feasible to pay for all the add ons.
   2. Care is packaged – again your base rent is one price but then you can purchase a ‘package of care’ or ‘care minutes’ as an add on. This is either inclusions per level (like Level 1 is medication management, personal laundry and an assisted bath. Level 2 might be all of that plus help with toileting and night checks. Level 3 is all of that plus transfer and ambulation support and full incontinence care), or they may offer  60, or 90 minutes a day of individualized care depending on what you need.
   3. Care is all inclusive – this is all one price of care and room, and regardless of what you need (to a certain extent) it is included. This will be medications, bathing, night checks, help with transfers, ambulation support, continence care from supervision right through to full assistance, as well as morning and evening support with getting up, dressed, personal hygiene. If additional care is needed, then it is usually added as another 30 or 60 mins.

If you are fully independent and need no extra assistance then you will pay the room rental rate each month. A permanent lease does not have HST added. A short or respite stay for less than 30 days is subject to HST.

6. I’m so confused: Don’t be. There is a LOT to process but that’s why we at Solva are always here to guide you step by step of your journey and explain everything.