Health care practitioners may provide care for older people in a variety of settings.

Doctor's Office: Most older people receive medical care as outpatients. That is, they see their doctor in an office, then they go home. The office may be in a medical office building, a clinic, a hospital, or elsewhere. Diagnostic tests, such as blood tests or x-rays, are often done in a doctor's office. If not, they may be done at a nearby clinic. Some doctors' offices offer certain treatments, such as physical therapy.

Hospitals: Hospitals provide the most comprehensive medical care, usually to people who are very sick. Older people may enter the hospital through the emergency department, or they may be scheduled for admission by a doctor.

A doctor (who may be the person's primary care doctor, a specialist, or a staff doctor at the hospital) is in charge of the person's care in the hospital. Sometimes several other doctors are involved. Nurses, who are available 24 hours a day, provide much of the care. A nurse is always available, but doctors may come and go at more irregular times.

Many other people may help provide care in a hospital. They include pharmacists, dietitians, physical and occupational therapists, social workers, medical technicians, nurses' aides, and volunteers.

How long people stay in the hospital depends partly on how sick they are, what the diagnosis is, and, if needed, what arrangements for continuing care can be made after discharge. The health care practitioners involved determine whether and what type of continuing care is needed. This care may be provided in a rehabilitation facility, in a long-term care facility, or in the home by a visiting nurse.

Did You Know... Some senior centers have a nurse on duty for several days a week and provide physical and occupational therapy.

Surgical Centers: Surgical centers are places where same-day surgery may be done. Such surgery involves medical procedures that typically require anesthesia, that are too complicated to be done in a doctor's office, but that do not require an overnight stay in a hospital. Common examples are endoscopy, colonoscopy, and removal of cataracts. Surgical centers may be located in a hospital or be a separate, free-standing facility.

Many communities have surgical centers. Then, people can have procedures in their own community without needing to travel to a more distant hospital.

Rehabilitation Facilities: After discharge from the hospital, people with a severe disability may need to continue their recovery in a rehabilitation facility. A facility may be located in a hospital or a nursing home. These facilities provide skilled nursing care and physical, occupational, and speech therapy.

When people are discharged to a rehabilitation facility, doctors predetermine how long their stay will be. For older people, the stay ranges from several weeks to a few months. Goals for progress are set, and progress is evaluated every day. Thus, the types and amount of therapy can be adjusted as needed.

Some older people need to go to a rehabilitation facility for therapy but do not need to stay there.

Long-Term Care Facilities: When older people need more help than can be provided at home and need it for an indefinite time, a long-term care facility may be appropriate (see see Long-Term Care). Older people or family members can choose among several living arrangements that provide different services and levels of health care:

• Board-and-care facilities provide a room, meals, and some help with daily activities. Some facilities provide certain basic health care.
• Assisted living communities are similar to board-and-care facilities. However, they provide more health care, and most provide 24-hour supervision of the resident if needed. Some of these facilities have a registered nurse on site.
• Nursing homes provide nursing care, including giving residents their drugs, in addition to help with daily activities. Nursing homes have at least one registered nurse on site at all times. They also employ licensed practical nurses and nurses' aides. Some homes provide physical and occupational therapy.
• Life-care communities provide different levels of services and care, depending on need. For example, if people have early dementia, the community may provide only help with taking drugs and an environment where stimulation is minimized. As the dementia worsens, the community can provide help with all daily activities as needed. Life-care communities guarantee that people, regardless of their health, are cared for within the community for the rest of their life.

Home Health Care: After discharge from the hospital, many older people who are well enough to go home need some help with daily activities or with managing their health care. Home health care agencies provide this help. These agencies employ registered nurses, therapists, home health aides, and social workers.

Some people need home health care for a short time after they leave the hospital. For example, a nurse may be needed to change wound dressings. Other people, especially those with a chronic disorder, need home health care for a longer time. People with a heart or lung disorder may need a nurse to visit regularly and check whether they are worsening or improving. The nurse can also adjust a drug dose if needed. Or a nurse may regularly visit people with diabetes to make sure they are following their treatment plan, to monitor drug use, and to adjust doses as needed. A physical therapist may be needed to help people regain strength and balance or recover from a stroke. A home health aide may be needed to help with shopping, preparing meals, going out in a wheelchair, taking a walk, or bathing. A social worker can determine whether people are receiving the services they need and recommend additional services if needed. A social worker may help arrange for rides to and from medical appointments.

Community Services: In the United States, one source of support services and health care in the community is senior centers. In addition to social, recreational, and educational activities, some senior centers serve meals—an important service for people who cannot prepare their own. Often, senior centers are a place where family members who care for a person full-time can take the person and get a break from care (a service called respite care).

Many senior centers also provide some health care. For example, some senior centers have a nurse on duty at least a few days a week. The nurse can check blood pressure, make sure people are taking their drugs as instructed, and teach people about their disorders. The nurse also helps people with health problems determine whether they need to see a doctor. Sometimes the nurse contacts a person's doctor or family members. Some senior centers provide day care for people with mild to moderate dementia, and some provide physical and occupational therapy.

Other services available in the community include meal programs (such as Meals on Wheels), transportation services, help with daily activities, support groups, and respite care. Some religious communities provide many of these services. These services are usually inexpensive, and some are free.

Information about community services, including senior centers, can be obtained from the hospital discharge planning or case management department, home health care agencies, local health departments, and religious communities. Senior centers can also be found by looking in a local telephone book or on the Internet.

Day Hospitals: Day hospitals provide hospital care only during the day. They are usually located in a hospital. They enable people to have complex tests and treatments without having to check into an overnight (inpatient) hospital. Day hospitals are particularly useful for people who need rehabilitation over a period of time—for example, for people who have had a stroke or amputation of a leg. These hospitals also provide meals and transportation to and from medical appointments and therapy sessions.

The primary care doctor or a hospital may send a person to a day hospital. Day hospitals are usually used for a limited period of time (6 weeks to 6 months).

Hospice Care: For people who have a progressive, incurable disorder, hospice care provides the treatments and services needed to control symptoms, ease pain, and help people and their family members prepare for the death (see Death and Dying). Hospice care may be provided in a person's home, in a nursing home, or in a hospice facility.

Hospice care usually involves a doctor, nurse, and social worker trained to care for dying people. Pharmacists, counselors, physical therapists, ethicists, and volunteers may also be involved. These practitioners are needed to make sure that all of the person's physical and psychologic needs are met as well as possible. Most people who receive hospice care do not have to go to a hospital before they die. Thus, they can die in a more comfortable, intimate environment, often with loved ones around them. Hospice care also involves helping family members prepare for the death and understand what to do when the person dies.

Last full review/revision January 2009 by Mary Ann Anderson, PhD, RN