Serving the Elderly

Senior citizens suffering debilitating conditions or terminal illnesses have numerous choices when it comes to elderly care services and facilities in Alabama. To find the best option for the individual senior, it’s best to fully explore what’s available. Senior advocates recommend seniors and their families take a proactive approach, doing their research well before being faced with a health crisis.

In-home services, such as home health and hospice, will be right for some seniors, and residential options, including assisted living and nursing home care, for others. A number of seniors will transition from one type of elderly care service to another depending upon their changing health care needs. For example, someone suffering a broken hip may require a nursing home stay for round-the-clock skilled care and rehabilitation, but then transition back home using home health services.

In general, to be covered by Medicare or Medicaid, elderly care services must be arranged in tandem with a doctor’s orders. In addition, licensed elderly care facilities perform their own assessments to determine what level of care a senior requires and if the particular facility can accommodate the senior’s needs.

Licensed facilities may be targeted to certain populations, such as Shepherd’s Cove, a 10-bed, in-patient hospice facility offered by Hospice of Marshall County in Albertville. On the other end of the spectrum, elderly care facilities may offer a range of age-in-place options, from independent living through nursing home care. A prime example is Mount Royal Towers in Vestavia Hills, which has multiple elderly care licenses, offers seven levels of care and currently serves about 325 residents.

Here’s a closer look at elderly care options available in Alabama.

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Assisted Living

When seniors aren’t able to care for themselves at home because of a physical or mental disability, but don’t require the constant availability of nursing care, assisted living often is a good option.

Alabama is home to 306 assisted living facilities licensed by the Alabama Department of Public Health (ADPH). About two-thirds of those are traditional assisted living facilities and the rest are specialty care assisted living facilities for those with Alzheimer’s or other forms of dementia.

“Assisted living offers Alabama seniors a broad array of personal choice in location, style and price. There is almost no region of the state that does not provide several options in lifestyle and value, ” says Frank Holden, director of the Assisted Living Association of Alabama.

Visiting a number of assisted living facilities is recommended for those shopping for the right home. It’s also important to interview facility residents and their family members to get a feel for how the facility is run.

While some states provide Medicare funding for assisted living, in Alabama, the care option is only available through private pay. In addition, the industry is highly regulated and obtaining licensing in Alabama is difficult, Holden says. That has put a damper on the number of new assisted living units being built by developers, he says.

“Assisted living is not easily accessible to many Alabama seniors. The recent down-turn in the real estate markets has depressed admission rates because potential residents are waiting to sell the family home before moving to an assisted living community, ” Holden says.

Holden’s group is working to loosen regulatory controls of the assisted living industry and to persuade ADPH not to enact additional patient assessment regulations. The association has launched a statewide study of resident cognition and skilled care needs to present to ADPH.

“The occupancy rate in regular assisted living remains high—in the 90 percent to 94 percent range—and specialty care assisted living facilities continue to run occupancy rates at 95 percent and higher, ” Holden says. “It is clear that market demand will force a more provider-friendly regulatory reform and Alabama will see marked growth when the economy for real estate improves.”

Nursing Homes

A nursing home may be the right option for debilitated seniors who require round-the-clock nursing care whether for a short time for the long term. Fortunately Alabama does provide Medicaid funding for long-term nursing home care for eligible seniors.

Medicare covers short-term stays for major health care and rehabilitation needs, such as when a senior suffers a stroke or fracture. Mount Royal Towers, for example, has a Medicare unit with private rooms and a large rehab center that provides occupational therapy, physical therapy and speech therapy.

“It’s not unusual for a senior who goes to a nursing home for short-term care to later return to the same nursing home for long-term care when it’s needed, ” says John Matson, director of communications for the Alabama Nursing Home Association.

More than 230 licensed nursing home facilities are available across the state. As Alabama’s population ages, the number of nursing home residents will continue to grow, Matson says.

“Because of state Medicaid funding, Alabama nursing homes are able to provide a high level of care for seniors here, ” Matson says.

Many of the state’s nursing home facilities are undergoing, or have undergone, a facelift in recent years. That’s both because aging Baby Boomers have higher expectations than the generation that preceded them and many facilities were built decades ago, he says. Some, such as Mount Royal Towers, have expanded their ability to manage various residents’ health care needs.

“Everyone is different so we always trying to meet whatever needs someone comes in with, if we possibly can, ” says Leesa Lewis, marketing director for Mount Royal Towers.

When shopping for the right nursing home, it’s important to visit multiple facilities and talk with both residents and their family members, Matson says. Medicare offers a nursing home compare website at

“It’s also important to keep someone’s personality and their background in mind. Would the person be more comfortable in a small, rural nursing home, or would they prefer a large facility in a big city? When it comes to nursing homes, one size does not fit all, ” Matson says.

During the 2011 state legislative session, the Alabama Nursing Home Association will sponsor legislation to insure that Alabama continues to provide adequate Medicaid funding for those who need skilled nursing care in a residential setting.

“The Legislature is always trying to find ways to cut the budget, so we have to keep fighting for funding. We can’t take it for granted, ” Matson says.

Home Health

Seniors who are confined to their home and periodically need skilled nursing care, physical therapy or speech therapy may be eligible for home health care through Medicare. An attending physician must certify the need for such care. Private pay options also are available.

Alabama has 120 Medicare-certified home health care agencies, and a number are in a growth mode. Always There In-Home Care, for example, has an ambitious plan for adding multiple locations in the coming months. In addition to its branches in Birmingham, Huntsville and Pell City, the company plans to open one or two locations every six months with the goal of covering the state of Alabama.

“Our employees assist our clients from once a month to 24 hours a day, ” says Dee Harrell, president of Always There. “We have always provided nursing and care giving services. Recently, we added another service called care management. Care managers are professionals who provide a more comprehensive assessment, communicate with physicians, coordinate care, and advise families on all services available within our company and in the community.”

Another thriving home health care provider is Alacare Home Health and Hospice with 25 locations across Alabama. The company is headed by John Beard, whose father founded the company in 1970. “Alacare is Alabama’s oldest private Medicare-certified home health agency, ” Beard says.

He notes that national health care reform will require seniors to have a face-to-face meeting with a physician within 90 days prior or no longer than 30 days after receiving home health care. “The requirement will make it more challenging for homebound individuals to qualify for the home health care they need, ” Beard says.

He recommends those shopping for home health agencies ask their physician for referrals. Medicare offers a home health care provider compare website at

Harrell and other members of the Alabama chapter of the National Private Duty Association are advocating state and national regulations that will require consumers to be informed whether a home health company provides workman’s comp and insurance for its workers.

“When a company provides such coverage, the consumer is protected against liability in case a health care worker is injured in their home, ” Harrell says. “When evaluating home health providers, ask if workers are fully insured employees or just uninsured contractors.”


For those deemed by a physician to have six months or less to live and who are not pursuing aggressive or experimental therapies, Medicare covers hospice services.

The physician-directed care covers various health and end-of-life needs. The hospice team includes physicians, nurses, nurse assistants, home health aides, social workers, chaplains, spiritual counselors, and bereavement coordinators and counselors. Medications, medical equipment, and supplies necessary to promote comfort and relieve symptoms are provided as part of hospice.

“Hospice touches so many people’s lives. For the most recent year statistics are available, 41.6 percent of those who died in the United States were under hospice care, ” says Rhonda Osborne, outgoing president of the Alabama Hospice Organization and chief executive officer of Hospice of Marshall County.

Alabama is home to 72 hospice organizations with 184 offices, each of which is licensed by the ADPH. Hospices are required to have a certificate of need from the state and have a limited coverage area.

Hospice services often are provided in the senior’s home so it’s important to check the hospice provider’s coverage area. In-patient and respite hospice services also are available through licensed facilities including nursing homes and hospitals. There are three freestanding hospices in Alabama that provide services targeted to those with six months or less to live. Shepherd’s Cove, for example, has an individualized care team on staff, including a chaplain.

Brief in-patient stays for seniors allow their caregivers the opportunity to take a break and refresh themselves. Long-term, in-patient stays may be necessary when the senior doesn’t have a caregiver available to provide them the daily support they need.

Osborne suggests consumers ask the following questions before choosing which hospice service to use:
• How many nurse visits a week does the hospice provider offer? Some organizations offer one, others two.
• How often and when will other services be provided?
• How fast will the hospice respond if there’s a medical need?
• Are volunteers available to help the senior? What ways can they help the senior and how often will they visit?
• Who will provide bereavement counseling for the caregiver? A staff member or a subcontractor?

“Even after making their choice, seniors and their families should never feel locked in. If they feel they need to change hospice providers, it’s their right to do so, ” Osborne says.

Under health care reform, hospice reimbursement rates provided by Medicare will be lower, so its likely services might be reduced and smaller hospices merge with larger organizations to reduce costs in coming years, Osborne says.

“Of course, it’s hard to say exactly how hospice will be affected in the long run, ” she says.

Another issue facing the availability of hospice services is the Alabama State Governor’s moratorium on the construction of freestanding in-patient hospice facilities. Because Osborne has direct experience with how her own freestanding facility, Shepherd’s Cove, benefits hospice patients, she hopes the moratorium soon will be lifted.

“When a facility is designed and managed specifically for the needs of hospice patients, with a hospice-focused staff, it’s a different environment, ” she says. “Often when we get patients who come in for respite care they resist leaving home, but then after they’ve been here a week, they don’t want to go back home.”

For more information on Alabama’s elderly care options, visit the following:
Alabama Department of Public Health online directory of assisted living and nursing home facilities and home health and hospice providers –
Alabama Nursing Home Association –
Assisted Living Association of Alabama –
National Association of Home Care and Hospice –

Kathy Hagood is a freelance writer for Business Alabama. She lives in Homewood.

By Kathy Hagood

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