This article tackles the living options available to a senior person, with particular emphasis on assisted living facilities and nursing homes. Here are the sections that will be discussed:
- Quick summary
- Definition of an Assisted Living Facility (ALF) and a Nursing Home (NH)
- Preliminary differences between assisted living facilities and nursing homes
- What assisted living facilities offer
- What nursing homes offer
- Nursing home patients
- Differences between nursing homes and assisted living facilities
- Final thoughts
There is a considerable amount of confusion and questions that families and seniors have when looking into living options and special care. Trying to figure out which living option is best for your loved one can cause a lot of indecisiveness, stress, and falling behind on making or updating contingency planning. This poses questions such as: What is assisted living? How is assisted living different from independent living or a nursing home? How am I to determine which living option is best for my loved one? And, can my loved one not stay at home with the help of a home care agency? Knowing the answers to these important questions would be very helpful, and they often have to start with knowing the level of care that the loved one needs.
Assisted living facilities and nursing homes serve specific purposes with some fundamental differences. Assisted living facilities may also be called residential care, adult living or supported care. The various names of an assisted living facility reflect on the housing and amenities that are provided to those seniors (or residents) who does not need a high level of medical care, and who either no longer can live alone or prefer not to.
Nursing homes are also called skilled nursing facilities as they are capable of providing skilled nursing help and, for the most part, have agreements with hospitals to transfer to them patients that require a higher level of care.
Residents who live stay in assisted living facilities enjoy a degree of independence as contrasted with those who live in nursing homes.
It is not uncommon for some seniors and their families to confuse between assisted living facilities and nursing homes. Because of this lack of fundamental understanding, they often do not know which place is more suitable for them. Although assisted living facilities and nursing homes are very different, they indeed have a few similarities. A nursing home is the term that has been commonly used for many years for senior residences that offer health care. They are licensed facilities that hold transfer agreements with hospitals for patients that require either long-term care or short-term rehabilitation services. Nursing homes provide a higher level of continuous care which includes a staff of different levels of nurses and other medical team members, including physicians.
On the other hand, assisted living facilities is a more recent type of senior care that caters to those who seek less care and more independence. These facilities provide mid-level custodial care, also known as activities of daily living (ADL’s). An individuals’ ability to perform the basic ADL functions is important for determining the type of long term care that is needed.
There are six types of activities of daily living (ADL’s). They consists of eating, bathing, dressing, toileting, transferring (walking), and continence.
Assisted living facilities are a great solution for the many. When a loved one’s own home is not an option, ALFs fit the bill nicely. In the overall balance between positive and negative factors, for tens of thousands of us in each community or cluster of communities, they come out ahead.
ALFs are frequently eager to fill their rooms, and you’ll be treated to a royal tour each time you visit one and announce that you are looking to place a loved one. Narrow your search to a handful that are close to you or to one of your siblings, and make as many inquiries as you can from family members who may have someone in an ALF, or from medical or social services people that you may have access to.
You can get a referral service to take you around, much like a real estate agent if you were looking to buy a property. In this case, the ALF would pay the referral service.
An ALF is exactly what it purports to be, a residence where professional caregivers assist the residents with their ADLs (activities of daily living). They are licensed and kept in check by the state governments in each state. They have to have RNs and Home Health Aides in certain ratios set by the licensing authorities. They also have a dietician on board, as well as an activities director whose duties include providing exercise and activities, usually mornings and afternoons.
Their Marketing Director will take you around and highlight the following talking points:
- They provide a secure and comfortable environment
- Your loved one gets a room to himself or herself
- Their staff assist with all ADLs on an as-needed basis
- There are always one or more RNs on staff
- They provide companionship and socializing opportunities among the residents
- They have an activities director on board, with activities usually twice a day
- The high point of the day: dinner in the big dining room
- Some also accept and specialize in patients with dementia
The first important thing to note is that assisted living facilities are “private-pay” establishments. They may be covered by some long-term care insurance policies, but they are not covered by government programs such as Medicare and Medicaid. Some ways to pay for “long term care” at an ALF include private funds or personal out-of-pocket payments, financial assistance from an individuals’ veterans affairs (VA) pension, and there are other financial options as well.
On average, the cost of an ALF is approximately $3,950 per month for a regular resident, and $5,100 per month for supervised memory care. While an assisted living is defined as a facility that provides assistance with ADL’s, some facilities also provide memory care in specials wards or wings within the facility.
Assisted living facilities are also viewed as “independent” living options, notwithstanding the fact that they have the safeguards and resources in place for residents who need more support. Support services include the basic 24-hour assistance with ADL’s such as toileting, dressing, bathing, transferring (walking), continence and eating when necessary. In addition, in some cases, an individuals’ level of independence may be assessed through instrumental activities of daily living (IADL’s). These activities include skills that are necessary to live in a community without assistance. Considering the fact that assisted living facilities are regulated at the state rather than the Federal level, some states allow facilities to offer medication assistance and/or medication reminders. They however do not offer complex medical services.
There are eight types of instrumental activities of daily living (IADL’s). They consists of telephone usage, shopping, cooking, housekeeping, laundry, using transportation, handling medications, and handling finances.
Although the services that are offered in assisted living facilities are less complex, residents have access to multiple 24-hour emergency call systems. These emergency call systems are located throughout their personal space such as in their rooms, suites, apartments, bathrooms, and hallways. In addition, the staff is readily available to meet their needs. Assisted living facilities provide access to health care and medical services customized to an individual’s specific need.
The highlight of the day at an assisted living facility often consists of dinner, offered to all residents in the dining area, In fact, three meals a day are served in the dining area, with snacks provided between each meal. Housekeeping and laundry services are also provided Other services that are offered on site include: a pharmacy or wellness office, barber and hair stylist, and physical therapy sessions. Shuttle buses and transportation is also provided as needed and to go out on outings.
ALF residents enjoy the privilege of choosing the type of space they want to occupy, providing the space is available. They can choose from private apartments, a cottage, a studio, one bedroom, or a shared suite. In any situation, kitchenettes are available with a small refrigerator, and often a few furniture pieces, depending on the facility. These environments are appealing because “it feels like home!” The residents have the option to socialize with other residents and attend exercise and wellness programs. The number of residents in a facility varies and could range from as few as five to as many as 300, but the average is approximately 50 individuals.
Nursing home care is covered by Medicare for the medical side of expenses, and by Medicaid for the long term care. People can pay out of private means as well, or out of long term care insurance policies. Medicaid is for low-income individuals, and to become eligible, prospective beneficiaries must spend down their personal assets on care before coverage kicks in. (Alternatively however, people seeking eligibility in Medicaid can work with a Medicaid planner to preserve assets).
On average, the cost of a nursing home is approximately $6,800 per month. A nursing home provides a long term living option for seniors in need of various levels of medical supervision. It is a place where the individuals are considered patients instead of residents, simply because of the environmental setting and the care provided. It is also a place for individuals who do not need to be in a hospital but cannot be cared for at home, even through home care or home healthcare agencies. Most nursing homes have nursing aides and skilled nurses on duty 24 hours a day.
Some nursing homes feel and look more like a hospital environment. The staff provides medical care, as well as physical, speech and occupational therapy. Depending on the nursing home, there might be a nurses’ station on each floor. They may also have special care units for those individuals who may have serious cognitive conditions. Moreover, nursing homes are not only for the elderly; they house anyone who requires 24 hour care.
A common criticism of nursing homes is that some people find them depressing, and feel as though they do not provide adequate care. As a result, they may require extra attention and monitoring from family members and friends.
Patients are under constant medical supervision and more often than not, in need of assistance with daily living. Furthermore, the patients may no longer be capable of living independently. Individuals usually share rooms, but if there is a couple, they can share a room together instead of with a stranger. Unfortunately, because of their physical and mental inabilities, the patients are unable to leave the facility on their own. There are some small nursing homes that exist, but the majority are large and accommodate on average 100 patients.
Their meals are served in a central dining hall unless a resident is too ill to leave the room. In that case, a staff member will assist with feeding the individual and make sure that the food is specific to their diet. Different levels of care are provided depending on the individuals’ needs. Skilled nursing procedures are offered as part of rehabilitation services which involve wound care, intravenous injections, and feeding. Complex medical services or intensive care treatments are provided by registered nurses; these involve ventilator services, severe wound management, and tracheotomy care. Registered nurses also provide intermediate care if a resident is experiencing a long term physical or emotional illness. Intermediate care involves physical therapy, administration of medication, and medical supervision. Lastly, custodial care is provided by non medical personnel and does not apply to a medical condition. Instead, it involves assistance with ADL’s.
Many people associate nursing homes with limited privacy, as in two beds to a room, with nurses and aids roaming the halls and checking on patients constantly, while also providing medical assistance. Although many assisted living facilities are similar in some ways to nursing homes, many licensed facilities are drastically different. The facilities range from converted houses that look more so like a bed and breakfast, to an enormous campus that has a vast number of apartments. Considering the fact that each state varies in regards to assisted living state regulations, there is a wide diversity of licensed assisted living facilities.
An assisted living facility provides minor medical supervision, as contrasted to a nursing home that provides extensive medical care. Both options provide personal care assistance with ADL’s as well as 24-hour supervision. They also provide security and emergency call systems, housekeeping services, social activities, daily meals, and transportation.
In an assisted living facility, residents feel that they have their autonomy and still have their freedom. As for a nursing home, the individual’s independence is more restricted. Furthermore, in an assisted living facility, residents’ health is not the prime concern, whereas patients’ health in a nursing homes’ health is more relevant and possibly complicated. In most cases, an assisted living facility is privately paid while a nursing home is paid by many sources, including Medicare and Medicaid.
Although the two living options share similar goals and often have services in common, they are very different. It greatly depends on an individual’s mental state, medical needs, and personal requirements. An individual might enjoy the independence of an assisted living or, the constant care of a nursing home.
Before you get into the often vexing business of coming up with the most appropriate living option for Mom or Dad, you need to consider the level of care and assistance that they require, as well as their temperament and preferences in life generally. For example, an outgoing person who enjoys socializing and doing things with people will better thrive in the atmosphere that an assisted living facility offers. There they have daily activities planned for them, with options from playing cards to Bingo and sitting-down exercises. By contrast, nursing homes would be the best option for your loved one if more difficult and time-intensive services are required (such as patients with colostomy bags or other medical complications). A nursing home is very similar to a hospital, and Mom or Dad will receive a lot more one-on-one attention than in an ALF, but they will not have as much privacy or independence.
It is also important to note that it is possible that your loved one will eventually need both facilities, the assisted living facility first, acting as an intermediary step towards the nursing home. They might start out in an assisted living facility and do well, only to later transition to a nursing home when their physical or mental health starts to suffer, and they suddenly require more medical assistance.