ALL ABOUT REST HOMES

The May CRC Information Session featured guest speakers, Barbara Hopcroft and Stefanie Caliri, from Hale House, a Rest Home run by Hale Barnard Services for Older People located in the Back Bay of Boston at Claredon and Marlborough Streets.

What are Rest Homes?

Rest Homes also known as “residential care” allows individuals to remain independent active members of the community while receiving needed personalized care without which they might require institutionalization. Massachusetts’ Rest Homes are licensed and monitored by the Department of Public Health as opposed to Assisted Living programs, which legally have a landlord/tenant relationship with residents and are overseen by the Executive Office of Elder Affairs.

Residential Care is appropriate for retirement-aged individuals who are in need of some type of supervision relating either to cognitive or physical limitations. Services offered and specialties vary significantly between rest homes. Some Rest Homes cater to older or younger populations, those who are wheelchair-bound, or those who have more challenging physical or cognitive disabilities. Ms. Hopcroft stressed specialty services and populations vary by Rest Home, and therefore one must fully investigate the residence to make sure it is the appropriate match for a client. Non-profit Rest Homes, due to their historic roots in the community, may have larger endowments that allow them greater freedom to pay higher salaries, for example.

Assisted Living VS. Residential Care

It is helpful to examine the differences between the more familiar Assisted Living Facilities and Rest Homes. Residential Care differs from Assisted Living Facilities on a number of factors:

• Residential Care services and costs are all-inclusive versus Assisted Living, which typically offer basic services with additional services offered at additional cost.
• Residential Care facilities consist of private or non-private rooms within a congregate living situation, in which private rooms do not have locks on doors and individuals have a shared bathroom and common rooms in contrast to the Assisted living’s apartment-style residences.
• Rest Homes are able to dispense medications. Assisted Living facilities can provide reminders, but cannot dispense medications.
• Rest homes accept individuals who receive public assistance* and are typically a lower-cost option than Assisted Living, which may accept a limited number of SSI-G recipients.
  *Please see section on Payment options.

Services

Services include three meals per day, laundry, activities, medical care coordination, medication dispensing, some personal care, transportation coordination, and room cleaning. Also, Ms. Hopcroft explained that community services are often put in place to assist clients to remain in the Residence. Those eligible for visiting nurse services, or services through an ASAP can receive them in the facility. Those dually eligible for Medicare and Medicaid who are enrolled in a SCO have also received supplemental care. Also, in some cases residents of the Rest Home may have a PCA and Hale House staff are able to assist the resident to hire and train the PCAs if needed. Hale house, and some other rest homes contract with certain doctors to be on-site once a week. Residents who choose to get their care from these doctors can do so and it is covered by insurance as if they are seeing the doctors on an outpatient basis. Other services include 24-hour staff with the capacity to dispense medication and assess an emergency situation.

Also, Ms. Hopcroft stressed the importance of the Residential community environment, which allows for staff to closely monitor for changes in residents’ health or behavior.

Admissions Process

Admissions to Hale House and other Rest Homes typically are a more involved application process than that for Skilled Nursing Facilities. Individuals do not often move directly to a Rest Home from a hospitalization as the application and review process typically takes at least a couple of weeks.

Admissions to Hale House

Hale House staff recommends that clients and their families tour the facility prior to the application as the first step in the screening process. Touring the residence can give the prospective client a good feel of the community, care environment, as well as help identify whether or not the physical space will be accommodating to the client’s needs (i.e., ability to manage stairs). Additionally, other resident requirements can be identified and discussed at this time; for example, residents need to be willing and able to come to the dining room for meals. Although not ideal, occasionally staff will screen in a medical environment.

Payment

Rest Homes vary in payment methods, some only accepting private pay; however, in contrast to many Assisted Living Facilities and other Long-Term Care Facilities many Rest Homes accept SSI or EAEDC (Emergency Aid to the Elderly, Disabled, and Children) payments. Medicaid does NOT pay for Residential Care in a Rest Home because no direct medical care is provided; Rest Home fees are for Room and Board. Although cost may vary, Rest Homes are generally thought of as an “affordable alternative” to Assisted Living. The all-inclusive rate for Hale House starts at $32, 600 per annum or roughly $2,700 a month compared to an average of $3,000 to $5,000 in Assisted Living (possibly higher depending upon the level of care needed) .

After Residential Care (Specific to Hale House)

When a Hale House Resident is no longer able to walk or is need of a wheelchair a referral to another Rest Home or Skilled Nursing Facility is made. Although there are elevators in Hale house, the halls are too narrow to accommodate a wheelchair. If an individual suffers a major health event after which they are no longer independent enough to remain at the Rest Home, staff work with clients and social workers to refer to a more appropriate long-term care facility. Note: after a hospitalization Hale house will take a resident back. They consider this the resident’s home and will generally hold the room for them even for extended periods of time if it seems the resident will return.

Finding a Rest Home

As previously mentioned, Rest Homes vary in the populations they cater to and specialty services. It is therefore very important to fully research the residence when considering placement. Information about Residential Care Facilities can be found by contacting the Massachusetts Age Information Center at 1-800-AGE-INFO or http://www.800ageinfo.com. Also, the Massachusetts Aging and Disabilities Information Locator (MADIL) at http://www.madil.org has a database with listings of aging and disability organizations.

Hale House

Hale house is a 60 bed rest home in a Beacon Hill setting converted from four brownstones. It has 4-shared bedrooms, mainly for couples or others who want to room together, and 56 single rooms. As noted before, although there are elevators for those who cannot manage the stairs, due to the narrow hallways, they cannot accommodate wheelchair-users. The typical Hale house client is someone with a physical disability combined with a mental health diagnosis. They accept residents aged “mid 50s” and up. Residents can have a refrigerator in their room, but to retain Hale House’s legal status as a facility (as opposed to a landlord such as in a SRO), bedrooms do not lock and residents may not cook in their rooms. Most rooms have a shared bathroom. Due to the generosity of community donors, Hale House is able to say that they do not turn anyone away based on ability to pay. Hale House is a non-smoking facility.

For more information about Hale House or Hale Barnard Service for Older People visit: www.halebarnard.org or call 617-536-3726.

-Thanks to Barbara Hopcroft and Stefanie Caliri for their presentation and to Barbara Hopcroft for her help with this article.

05/08