Imagine these scenarios: Your elderly parent is being released from the hospital. Living alone is no longer an option, or more care is required than the spouse or you can provide. What do you do?

Maybe your parent is having trouble living alone. Nutritious meals are not being made, housekeeping is not being done and assistance is needed with bathing and dressing. Maybe medications are not being taken properly. Where do you turn?

“In 1994, there was a big shift in long-term care options,” said Deborah Poulton, director of residential services at Eastern Agency on Aging. “Up until then, basically the elderly lived at home or moved to a nursing home or boarding home. Now there are more long-term care options.”

“Assisted living” is an umbrella term that covers several levels of congregate housing and residential care. Each provides levels of service that can be widely varied.

Congregate housing is defined as residential housing that consists of a private apartment with a bathroom and kitchen. There must also be a central dining room where a program of congregate housing services provide residents with meals.

There are four types of congregate housing:

. Congregate housing type I provides basic housekeeping, one meal per day in the central dining room, laundry services, chore service, transportation, recreation and services coordination, such as with Eastern Agency on Aging or a home health agency. This type is not required to be licensed, and does not provide personal care assistance such as help with dressing, bathing or eating. Usually rent subsidies are available through housing authorities or rural development.

. Congregate housing type II provides the basic services listed above, plus personal emergency response and some personal care. Licensing is optional. Rent is often subsidized. Often, services are brought in from area agencies and either paid for privately or through a state program if the tenant is eligible.

. Congregate housing type III provides two to three meals per day in the dining room, housekeeping and chore service, transportation and recreation, service coordination, personal assistance, laundry, health monitoring, unscheduled assistance, 24-hour staffing and administration of medication. Licensing is required. Currently there are no type III facilities in this area.

. Congregate housing type IV provides all of the services above, as well as intermittent nursing services. Licensing is required and staff is on duty around the clock. Normally, these facilities are private pay, however some state subsidies are available for services in six sites statewide. One of these is Freeses Assisted Living in Bangor.

A person must meet certain criteria to be accepted at a type IV facility. This also holds true for those receiving a service subsidy.

“Applicants must need help with at least two activities of daily living [ADL], such as dressing, eating, bathing and so on to qualify for Freeses,” said Poulton. “Or they must need help with one ADL and two instrumental activities of daily living [IADL], such as using the telephone, handling finances, shopping, and getting to appointments.”

There are also two levels of residential care facilities:

. Residential care level I is a facility with a licensed capacity of six or fewer residents. These were formerly called Adult Foster Homes. Unlike congregate housing with private apartments, these facilities may have residents share a bedroom and bathroom. They can be either Medicaid-reimbursed or private pay. The services are similar to those provided at congregate levels III and IV.

. Residential care level II facilities provide the same services as level I, but are licensed for seven or more residents. These were formerly called boarding homes.

The decision whether to enter a residential care facility or congregate housing level III or IV is largely a matter of personal choice. Other factors include the preference for a room versus an apartment, and which kinds of housing are available in the community at the time of need.

“Each type of housing is different, and each has its own description of who can best be served in that particular setting,” said Poulton.

When seeking an assisted living facility, she emphasized, it is crucial to ask many questions, including the following:

. What types of services are provided?

. Is this an apartment or single room?

. What is the cost of the service package?

. Is there subsidy or Medicaid coverage for some or all of the cost?

. Is the facility licensed? Remember, if personal care or medication administration is part of the service, licensing is required.

. What level of supervision or security is provided? (This is important if wandering or dementia is an issue.)

. What is the level of staffing?

. Is there staff on duty around the clock?

Request a copy of the program description and admission policy to better determine the limitations of the service.

“Most importantly, visit and tour the facility, and discuss philosophy of care with the director and staff,” said Poultin.

This is a brief overview of what options are available and the differences in levels of care. For details about any of the facility types or services offered, call Eastern Agency on Aging.

Carol Higgins is director of communications at Eastern Agency on Aging. For more information about assisted living, call Deb Poulton at 941-2865.