For the last 20 years, Nancy Haney has operated a personal care home in Rices Landing, Greene County, caring for people who can't care for themselves.
Haney's Personal Care Home on Carmichaels Street has the capacity to serve eight residents, and it is full. “I have a waiting list, and if I opened another home tomorrow, it would be filled immediately,” she said.
One of those residents has end-stage Alzheimer's, a horrible disease that has robbed the 83-year-old woman of her dignity and her mind.
Dolores Jackson has been at Haney's Personal Care Home since 2009, and Jackson's family cannot be more grateful for the care she has received.
“The employees take time to talk to family members, talk to the resident, and they come to love them,” said Jennifer Faddis of Carmichaels, one of Jackson's four daughters. “We have known Nancy for years, and we know Mom is in the right place.”
Haney, who lives at the well-kept state Department of Public Welfare-licensed house with two living rooms, a kitchen and individual residents' rooms, said over the years she has cared for more than one Alzheimer's patient at a time.
“These are the tough cases,” Haney said. “Sometimes they can't communicate anything. They can't express pain if they are not feeling well. And while few are mobile, some can be combative, but not Dolores,” she said.
Haney said her home is equipped with warning devices on outside doors to alert staff in the event a resident attempts to leave without supervision. “I have never had anyone wander off the grounds, but I have had a resident or two get up at night and walk into other residents' rooms.”
Haney realizes her job is seven days a week, 24 hours a day. But she also realizes there is a big need for more personal care homes in Greene County. “Without these small personal care homes, many of these people would have nowhere to go,” she said.
When a person with dementia has no options for home care, or has exhausted options to stay with family, relatives may seek a personal care home or assisted living residence.
The Pennsylvania Health Care Association estimates on its website that 70 percent of people currently turning 65 will require long-term care in their lifetime, and they will receive care for an average of three years.
Matt Jones, director of licensing for the DPW in Harrisburg, said the personal care home has a long tradition in this area.
“Southwestern Pennsylvania, including Washington County, was the cradle of the personal care home industry in Pennsylvania,” Jones said. “It developed as a cottage industry with private homes taking in neighbors and providing care for them 30, 40 years ago.”
Based on listings available on the DPW website, the Observer-Reporter contacted each personal care home in Washington and Greene counties to compile a brief resource guide, and the responses are listed in the accompanying chart.
Although the Commonwealth of Pennsylvania regulates both personal care homes and assisted living residences, it does not keep a count of how many residents have Alzheimer's disease or dementia because that number could fluctuate widely.
“You may have a home in the city of Washington that has zero people with dementia, and tomorrow, a family member may bring in a person with dementia,” Jones explained. “We require every home to do a pre-admission screening to be sure they can meet those needs and do a description of services based on staffing requirements.”
Personal care homes are not required to have medical staff, such as a doctor, registered nurse or licensed practical nurse, but those that do can care for people with complicated medical needs. Or, they may have a social worker, geriatric services or mental health professionals. “Every personal care home has a different population,” Jones noted.
Jones said the laws that separately regulate personal care homes through Chapter 2600 and assisted living residences, through Chapter 2800 of Pennsylvania Code No. 55, “are two of the most comprehensive and effective adult residential licensing regulations in the country.”
Chapter 2600, which was enacted in 2005, has more than 270 individual regulatory requirements, while Chapter 2800, which took effect in 2011, falls under the Department of Aging and has many more individual requirements.
While one might assume that every personal care or assisted living residence accepting Alzheimer's or dementia patients would have to have what is known as a specialized, secured-care dementia unit, that is not the case.
“Those with Alzheimer's or dementia do not have to be served in a secured-care unit,” Jones said, “Particularly people with beginning stage dementia. Some people with dementia are in regular personal care homes, but they have higher staffing ratios,” he said.
“In some cases they use a 'wander guard,' a sensor that will sound an alarm if someone with dementia approaches a door. Other places don't have wander guards or they provide visual supervision that people with dementia need. Not all personal care homes have the capacity to provide this level of supervision, but many do. Any personal care home that has the capability may serve people with dementia.”
The state defines a personal care home as a facility that provides 24-hour care for four or more individuals who require 24-hour assistance with the activities of daily living and who are unrelated to the operator of the home. Jones described those activities as “bathing, dressing, meal preparations, shopping, making appointments – most of the things that most of us do independently. “You don't need a license if you're caring for relatives or three or fewer people.”
When choosing a facility, an applicant or prospective resident should compare his or her own needs with the description of services offered. “Personal care homes vary widely,” Jones said. “They may serve only younger persons with mental illness or those who do not have intense needs.”
“An assisted living residence is so similar that you could walk into a personal care home and assisted living residence today and not know the difference,” Jones said.
According to the state Department of Aging, “assisted living residences are different from personal care homes in three ways: concept, construction and level of care. Assisted living residences embody the concept of allow a resident to 'age in place' without having to move to a licensed long-term care facility when their needs increase.”
In personal care homes, bedrooms may be shared by up to four people.
Assisted living residents have bigger living areas than in personal care homes, similar to a studio apartment, and they are not forced to share a living unit. Assisted living residents have a private bathroom and hookups for kitchen appliances, although not necessarily the appliances themselves. A sink and hookups are required so that if a resident wanted them and was capable of using them safely, they would be available. The assisted living resident must also have a food storage area.
Regarding the classifications, “the regulations are 95 percent identical,” Jones said. “There are a few site differences, a few service regulations.” Assisted living residences are also allowed to directly provide supplemental medical service.
There are 35 licensed assisted living residences in Pennsylvania's 67 counties, including two in Washington County: Hawthorne Woods Assisted Living, 791 Locust Ave., Washington, which has an 81-bed capacity; and Strabane Woods, a UPMC senior community, 319 Wellness Way, Washington, which has a 100-bed capacity. There are no designated assisted living residences in Greene County.
“Assisted living residences can accept Alzheimer's or dementia residents as long as they can meet their needs,” Jones said