It is estimated that the lifetime probability of suffering from some form of cognitive impairment is 68% for individuals sixty-five or older. Although assisted living facilities are thriving all across the country, many seniors require full-time professional supervision. Anyone who is over the age of sixty-five has a 43% chance of spending time in a nursing home. Nonetheless, making this transition can be overwhelming. This is why it is important to learn about elderly care and have a realistic image of what we can expect once we join one of these communities.
What are Nursing Homes?
A nursing home is a space that is similar in form to a hospital and provides medical, as well as personal care. With highly-trained nurses on call 24/7, special care units for dementia patients and a medical station on each floor of the building, these locations are designed for seniors who cannot be cared for at home, but also do not require full-scale hospitalization.
Old age comes with many benefits, but also with emotional hardship and many possible health complications. While retaining all of our freedom might be our dream, many of us will require assistance and constant supervision after a certain age. But this does not need to stunt our independence. Senior care is evolving every year and, although nursing homes have a fairly poor reputation, new legislation and reform makes it a promising and quality option to consider for you or your loved one. Assisted living may not be enough if your relative requires sustained supervision or other medical services that they would only receive within a hospital or a nursing home. With that in mind, it is crucial to differentiate between facilities and ensure that your chosen location provides adequate care.
The Difference Between Nursing Homes and Assisted Living
For many families, assisted living is the right choice. It offers personal care, help with activities of daily living (washing, grooming, dressing, eating, toileting) and an engaging social circle. It also has qualified staff ready to intervene in case of emergencies, as well as a cozy setting for residents. However, these types of communities cannot offer complex medical services or 24/7 supervision in the same way that nursing homes do. The latter emphasize healthcare and are aimed at seniors who have serious medical needs. Moreover, assisted living communities typically take in residents for a lifelong period, whereas nursing homes can serve only as temporary rehabilitative centers. This means that they take in patients who have recently suffered a heart attack, stroke, injury or accident of some sort and offer them specialized nursing care until their condition improves. Approximately a quarter of individuals in nursing homes stay there for less than three months. In addition, these care centers do not only cater to the elderly – although 63% of their patients are over the age of sixty-five, the remaining 37% are sixty-four-years-old or younger.
Another difference is the type of care offered by these two communities. Assisted living provides its residents with housing, supported living, assisted care and residential care, whereas nursing homes focus on extended care, intermediate care home and long-term care. The latter puts forth a team of nursing experts who offer the following services: managing patient care, giving injections, treating infected wounds, handling aspiration devices, healing skin diseases and inserting catheters. All of these are procedures that you do not regularly find within assisted living facilities. When it comes to personal care, this includes help with the following activities: bathing, eating, dressing, going to the bathroom, continence management, applying creams for minor skin conditions, walking around, using wheelchairs, administering medication, and changing dressings or treating non-infected wounds. Although nursing homes are less focused on personal care and centered more on medical intervention and assistance, they still offer most of the features mentioned above.
Lastly, assisted living generally provides more independence for its residents. The location is usually similar to an apartment and has private rooms available, the staff gives seniors a great deal of leeway in decorating their personal space and there is plenty of recreational space. On the other hand, nursing homes offer conditions that are similar to that of a hospital setting. They put forth both shared and private rooms, typically have less space reserved for recreational activities and not as much freedom when it comes to residents accommodating their surroundings. However, both facilities provide communal living areas and dining rooms. Furthermore, nursing homes safeguard their patients more effectively and have a staff that is specialized and better equipped to handle medical emergencies and other crisis situations.
How do you know if a Nursing Home is right for your loved one?
The line between assisted living and nursing homes if often not clear, given that the former might accept nursing services in certain circumstances. However, the two communities serve different needs and work for different people. If your loved one has a mild health condition, needs help with one or two tasks of daily living and needs to be supervised in order to avoid injury, then an assisted living facility might be the right choice. Conversely, if your relative needs assistance with personal care such as bathing or eating, they need to take a variety of medications, they require medical monitoring, as well as specific medical treatments and possibly emergency equipment, then a nursing home is their best bet. Similarly, if your loved one has recently suffered an accident, injury or infection or they are weakened due to illness, then a nursing home will be most fit to provide them with medical and personal care.
It is important to note that both types of facilities provide three healthy, nutritious meals every day, laundry and housekeeping services, transportation, some form of supervision and favorable circumstances for social interaction. There are also issues regarding cost that you must take into account before making a final decision. For instance, assisted living generally requires you to dig into your life savings, whereas nursing services are usually covered by Medicaid (a joint federal and state program that provides coverage for senior care) and Medicare (a federal program which offers temporary funding for skilled nursing facilities, a type of nursing home).
If you still cannot decide which type of care is more suited for you or your loved one, take the time to visit both your chosen nursing homes and your desired assisted living facilities. Once you have had some experience and interaction with the staff there and you can observe the environment and its patients firsthand, you will find it easier to decide which community is a better fit for your needs, budget and long-term goals.
What Types of Care Do Nursing Homes Provide?
Care needs change over time. To know if your loved one will adjust and feel healthy, happy and at ease in their future home, it is essential to familiarize yourself with the different types of care offered by the community. Featuring nursing staff and therapists, these facilities guarantee 24-hour assistance with activities of daily living, regular meals, transportation, security, on-call doctors, laundry services, toileting, social activities, medication assistance and housekeeping.
That being said, nursing homes provide primarily medical care. This means that the staff members (trained nurses, medical directors and attending physicians) assess the overall health of the patients, they oversee and help with medication use, they conduct examinations and administer various treatment regimens. They also offer 24/7 assistance and prevent or manage medical emergencies.
Aside from medical care, these communities offer rehabilitative and nursing care. This entails injections, wound or infection treatment, health assessment and restorative care for heart conditions, orthopedic issues and post-hospital recovery. In addition, they offer different types of therapy, including physical, occupational, speech and respiratory therapy. The staff can help your loved one heal from injury, inflammation and disease, as well as help with pharmaceutical and dietary services.
Nursing homes also have special units which offer a form of memory care for patients with Alzheimer’s Disease, DLB (Dementia with Lewy Bodies), vascular dementia, Huntington’s Disease and mixed dementia. The treatment options employed generally include activities which improve cognitive function, memory and problem-solving skills, social interaction, therapy and medication. Lastly, a nursing home also provides hospice care for seniors who are nearing the end of life. This type of care is not focused on curing or halting the progression of a certain disease or condition, but rather on making the sufferer comfortable and at ease. It is a patient-centered approach which addresses social, emotional and spiritual needs and offers support, pain relief medication and counseling.
There are two primary types of nursing homes: intermediate care facilities and skilled nursing facilities. The former is designed for patients who are in need of constant medical care and therapy, assistance with performing activities of daily living and help with managing their health condition (for example, dialysis, pain alleviation or feeding tube placement). The main unique feature of an intermediate care facility is that it has Certified Nursing Assistants (CNAs) on-call every minute of the day and during the night. These highly-skilled professionals provide assistance primarily with routine tasks such as eating, dressing and personal hygiene, but also help with administering treatment, overseeing medication needs and providing wound care or different types of therapy. It is important to note that a CNA is regarded as much more qualified than a standard Licensed Practical Nurse (LPN). This is due to the fact that the former receive more extensive training, they require additional examination and certifications, and they also have studied a more comprehensive coursework that teaches them in-depth about how to provide patient-centered medical care and support.
On the other hand, skilled nursing facilities (SNFs) are more widely-known and offer around-the-clock medical supervision and assistance, as well as a continuum of care for post-hospital patients or those in need of rehabilitation. Typically, these locations have a restorative function and are sometimes only temporary shelters for seniors. For instance, a great number of patients transfer from a hospital setting to an SNF, they go through physical or respiratory therapy, and eventually move on to an intermediate care facility (which will look after them long-term, even after they have recovered from the initial condition). Skilled nursing implies a more advanced level of medical care that is invariably provided by specialized staff members like a physical therapist or a registered nurse (RN).
Aside from these two central types of nursing homes, there is also a community involving Congregate Living Health Facilities (CLHF). This is a residential home that offers inpatient medical assistance, but also social, dietary, pharmaceutical and recreational services. Featuring 24-hour skilled nursing on an extended basis, the healthcare provided in these facilities is more intense than that of an SNF, and almost as sharp as what you would normally find in an acute care hospital. This type of nursing home is usually aimed at helping patients who are severely injured or disabled, who are suffering from a life-threatening condition or have been diagnosed with a terminal illness. You can also find a form of skilled nursing (alongside independent living and assisted living services) under the roof of a Continuing Care Retirement Community (CCRC).
Lastly, there are several subservices offered within an SNF. These include: intermediate care facilities (ICFs, offer supportive and inpatient care short-term), pediatric day health and respite care facilities (PDHRCFs, put forth an exhaustive program involving different types of therapy in an inpatient setting; also look after children and teenagers of twenty-one years of age or younger who are injured, ill or have a terminal condition), and ICF for developmentally disabled (ICF-DD, offer assistance to those who do not require continuous care, but do need nursing supervision and developmental aid).
How Much do Nursing Homes Cost?
The monthly cost of a nursing home can be anywhere between $4,350 and $24,000, depending on what state you live in and the services you are looking for. The average shared room cost $235 per day back in 2017. It is estimated that nursing home prices grew by 7.5% annually from a little over $8,500 in 1977 to $60,249 in 2004. This growth has continued ever since and nursing homes are currently the most expensive form of senior care. That being said, the cost of this type of assistance will vary greatly depending on your location. For instance, states like Oklahoma and Texas charge up to $150 per day for nursing homes, whereas the Northeast communities and states like Alaska and Hawaii can charge a standard $800 every day.
There are several outlets for financial assistance that you can turn to if you are in need of funding and cannot afford skilled nursing care without it. These include, but are not limited to: Medicare benefits (covers 100% of the cost for the first twenty days of the month, followed by 80% of the rate during the next eighty days), Medicaid (can pay between 45% and 55% of the total price or 100% of the cost at a Medicaid-approved SNF), reverse mortgages (only for homeowners of sixty-two years of age or older), long-term care insurance, relocation (moving to a different area of the country where the cost is lower, can reduce the payment by up to $5,000 every month), Veterans Assistance for Nursing Homes, and nursing home tax deductions.
How to Choose a Nursing Home
Determining which nursing home to enlist for is not an overnight decision, but a process. Firstly, you need to understand what type of care you or your loved one requires. Start by asking yourself what kind of health and personal care services your relative needs, how often they require them and what kind of medical supplies or equipment is necessary. In addition, do not overlook dietary preferences or needs and look for a facility that can accommodate them. You can ask close friends and people you trust for local communities, get a recommendation from your doctor, visit medicare.gov/nursinghomecompare or call your health state department to find nursing homes in your desired area.
After compiling a list of your favorite locations, check to see what type of therapy is available within the community, what type of personal and medical assistance they offer, but also what kind of staff they employ (what is their training and experience). You should research and gather as much information on the facility as possible before your visitation. That way you are already prepared, you know what to ask and you can assess if the services are as good and reliable firsthand as they are on paper. You should also look into laundry and housekeeping services, the types of meals they serve (do they look tasty, healthy and nutritious?), as well as their rooms (are they well-kept, comfortable and safe?).
Here are some questions to ask yourself or the staff during your visitation, before you make your final choice:
- Is the location of the nursing home secure?
- What training has the staff there received?
- How will you keep in touch with your private doctor after joining the nursing home?
- What does the facility’s menu look like?
- What is the facility’s policy on pain and medication management?
- Does the community organize recreational, social or cultural activities and events for the residents to attend?
- How do the staff members interact with the patients? Are they caring, calm, respectful and competent?
- What is the visitation policy at the facility?
- What insurance information can the staff provide you with?
Nursing Home Concerns, Issues and How to Solve Them
Unlike modern assisted living facilities, which have been thriving over the past few years and have become the most popular form of senior care, nursing homes do not have the best reputation. And rightfully so. Since their inception, there has been a myriad of problems involving insurance, quality, environment, staff conduct and service execution. However, many of these circumstances are no longer active concerns and have since been resolved, reformed or drastically improved. Of course, there are still facilities which encompass all of the same issues, but quality nursing homes that treat residents with care, patience and respect are not hard to find. What is important is to know how to discern between communities and evaluate them adequately before making a decision. Here are some of the main concerns involving nursing homes and what you can do to overcome them:
Discrimination against Medicaid-eligible residents
One of the most common and widely-recognized issues with nursing homes is the blatant Medicaid discrimination that goes on behind closed doors. This means that staff members may claim that Medicaid benefits do not cover the services required by a potential resident. The truth is that your loved one is entitled to the same quality, medical assistance and personal care that every other resident in the facility is receiving. Moreover, two thirds of all nursing home patients are eligible for Medicaid and account for half of the community’s revenue.
What you can do to counter this is emphasize the federal law (which prohibits the staff members from discriminating against Medicaid-eligible seniors) and communicate to the nursing home that their finances are irrelevant in the matter. Moreover, according to the Nursing Home Reform Law (NHRL), as long as the facility does not cancel its Medicaid certification, it is legally obligated to provide adequate care to potential residents who are eligible for benefits.
Disregarding the resident’s preferences
Another widespread issue in nursing homes is not making the necessary accommodations for patients who pay for certain services, on account of not having enough staff, funding, schedule flexibility or blatant disrespect. There is no reason why a community should refuse its residents the preferences they have or downright neglect their needs (be it medical or personal). Whatever excuse you have been given by the staff, know that it is your right to be treated with respect, dignity and care. If you cannot resolve the matter any other way, you can ask your representative to explain why this particular change or adjustment would benefit you (physically, emotionally or mentally). You can also write a follow-up letter or make your request during a care planning meeting.
Improper use of physical restraints and medication
Physical restraints may sometimes be used as a method of discipline or for the staff members’ convenience. This type of behavior is absolutely unacceptable and can be penalized by the law. Although the use of physical restraints has decreased significantly over the last two decades, you should still be aware of what you can do in these types of situations, as well as what legal rights you have. Restraints should only be used as a last resort, if all other endeavors to calm down the patient have failed. Additionally, there are several alternatives that can be used instead of immobilizing the resident.
Threatening or carrying out eviction
In the past, staff members have been reported to evict residents for “being difficult” and to use this as a tool of intimidation if patients did not comply with their demands. Former residents would be given only a few days to pack and leave, which is not only morally abhorrent, but also illegal. It is crucial to be informed about your rights and obligations as a nursing home patient. With that in mind, there are only six authentic, legally-sound reasons for eviction:
- The resident’s medical needs cannot be met in the nursing home.
- The facility is closing, bankrupt or going out of business.
- The resident has or does endanger the safety of staff members or other residents.
- The patient no longer requires nursing home care.
- The resident refuses or has failed to pay for the services of the nursing home.
- The patient’s presence in the nursing home endangers the health of the other members.
Remember that crying, shouting for help, refusing to take medication or to eat, wandering the halls, being confused or scared and asking for help constantly are not valid or legal reasons for eviction. In addition, if you are visiting your loved one, pay close attention to see if you notice any of the following: dehydration, reclusiveness, deteriorating mental health, mood swings, refusal to eat, to take medication or to speak, emotional outbursts, bed sores, broken fractures or bones, unexplained weight loss, frequent infections, bruising or cuts. These are all signs that your relative is being abused by their caregiver and should be addressed immediately. You can take legal action against the facility in the event that physical, emotional, financial or sexual abuse is taking place.