What is an Intermediate Care Facility?

If you have considered an Intermediate Care Facility for a loved one, there are several things you should know. There is no uniformly accepted definition of this type of facility. Definitions have a few things in common, such as size, but the population for which they are intended is interpreted differently in places and so are the goals and regulations. One of the major misconceptions is that this type of care facility is a type of nursing home.

Defining the Term

There is no clear-cut delineation of what the ICF does, or who is served by the facility. In Britain, the facility is defined as providing services that help people make the transition from hospital care to being at home, and from being dependent to being independent. The ICF cares for the developmentally disabled as well as for the elderly, and there is generally an expectation that the individual will go home at some point.

In the US, the definition excludes care of the general elderly population. Both definitions specify that the facilities must be small, with fifteen or so beds. The Free Dictionary says that the facilities provide custodial care, which is care that is non-medical.

History of the ICF

Provision for the ICF was made in 1971 under the Medicaid program to deinstitutionalize care for the developmentally impaired. It also allowed states to receive matching funds for running the facilities as long as they met standards of management, protecting clients, providing health care services, and other criteria. Nationally there are more than 7,000 facilities but every state has at least one. More than 129,000 persons are served through the program.

How are the Facilities Regulated?

Intermediate Care Facilities are regulated by the individual states. In California, the qualifying facility provides personal care and a place to live for developmentally disabled individuals. Under that delineation, there are different types of ICF. One is the general ICF/DD or ICF/DD-H in which the residents receive developmental support skills such as training and assistance with activities of daily living. This includes hygiene, dressing, taking medications and other activities. The facility serves people with “recurring but intermittent need for skilled nursing care.” Another type is the ICF/DD Nursing which provides general developmental services but also nursing care for medically fragile individuals with developmental disabilities.

There is also a provision that allows residential facilities to obtain a waiver so that they can offer continuous nursing care for a time. In Colorado, the delineations are somewhat different, but still apply only to small, generally four to fifteen –bed, facilities that offer services to the developmentally disabled.

How Do They Function?

The size and level of service offered by a facility determine how many awake staff must be in-house at any time. Staff available but not necessarily on-campus are nurses, occupational therapists, physical therapists, social workers, dietitians and others. Some patients/residents are classified according to the number of activities of daily living for which they depend upon staff help. These activities include hygiene, grooming, exercise, taking medications and so on. Those individuals who can function largely autonomously without a lot of supervision often work in sheltered workshops within the community. According to the Medicaid website, these programs, called Day Programs, are included in the ICF services.

These facilities are sometimes confused with nursing homes, but they are not medical facilities. In the United States they don’t deal with the aging population unless there is some degree of developmental disability. Because of this, Medicare does not offer reimbursement for ICF care. The government is still developing a clear definition of what constitutes an Intermediate Care Facility.

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