One of the worst fears for many people is that they will end up in a nursing home. If you are over 60, you probably have at least thought about whether at some point, you will have to move into a community designed for seniors. More often, this consideration occurs because something has changed, making living independently in you own home more difficult. It could be triggered by the death of a spouse or an illness that makes it difficult to function alone, or it could be due to advancing age and infirmity. Most people, like myself, don’t want to think about such a possibility, preferring to assume they will stay in their home, and consequently until the decision is thrust upon us don’t think about it and don’t know what alternatives there are. Fourteen percent of working people think they are likely to need such services at some point. In fact, sixth-six percent do.
What follows are brief descriptions of the major alternatives that represent different needs and levels of care. It is useful to know the choices whether for yourself or a family member or a friend. If nothing else, it is worth being acquainted with the vocabulary. The choices are arrayed from the least intense to the more intense services.
Senior Communities: These are residences set up for seniors. They may be arranged as town houses or as an apartment complex. They are appropriate for relatively independent seniors who are ambulatory and have little in the way of disability. Often, they have recreational facilities, such as a gym or swimming pool, and they may offer services such as housekeeping and dining, but they don’t offer nursing care or help with “Activities Of Daily Living” (ADLs such as independently ambulating, dressing. bathing, self feeding, personal hygiene and grooming, toilet hygiene and continence). Therefore, these communities are for high functioning seniors, who will have to move elsewhere if they become unable to care for themselves.
Home Health Care: Home health services are adjunctive services that can be brought into a home of someone who is unable to travel to receive care, and which are essential to a person who wants to remain at home rather than in an institution. The services are generally adjunctive to the care provided by family or friends. They include, intermittent skilled nursing care (such as physical evaluation, wound care, IV administration), physical and occupational therapy, speech therapy, medical supplies and devices. Medicare parts A and B will pay for most of these things. Medicare does not pay for 24-hour home care, meals, homemaker services (laundry, shopping, house cleaning, personal care). To receive Medicare coverage, a doctor must certify that the person is housebound and must order the services, and the nursing services must be intermittent, not continuous. Often, home health care is supplemented by a home health aide who takes care of the more custodial tasks and is paid by the patient or family. Other services that can be added to home health services are senior day care centers, meals on wheels and senior transportation services.
Assisted Living Facilities: For some, it may be too expensive or difficult to remain at home. In the last two decades, there has been an explosion of alternative care facilities, sparing seniors the agonizing choice between home and nursing home. The alternative is an Assisted Living Facility where the person can live in a group setting in which they have a room and can get assistance with ADLs, such as dressing, bathing, grooming and has someone available on site 24 hours a day. The individual must be ambulatory and generally takes meals in a communal dining room. The facility usually provides services such as house keeping, shopping, assistance with medication, ambulating outdoors, but does not provide medical or nursing services. Board and Care facilities are another form of Assisted Living, but it is provided in a private home.
Skilled Nursing Facility (SNF): SNFs are one step up from assisted living and one step down from a hospital. In fact, a SNF is often used following a hospitalization as a transition to going home. A SNF can provide full time nurses, a doctor who rounds daily. In addition to help with ADLs, they can provide medication management, wound care and a variety of rehabilitation services such as physical therapy and speech therapy. The differences between Assisted Living and a SNF is the availability of these nursing and rehabilitative services. Medicare provides coverage for a SNF, for up to 100 days after an acute hospitalization.
Nursing Homes: What is the difference between a SNF and a Nursing Home? Unfortunately, the terms are sometimes used interchangeably. In fact, some facilities may have both SNF and nursing home sections. Basically, a SNF must be licensed by Medicare and usually meets a higher standard of care than that required of a Nursing Home. Nursing homes are usually licensed by the state. Nursing homes are staffed by nurses and nursing assistants who can provide assistance with ADLs, meals, medication and management of minor wounds and catheters. Generally, they provide care that a healthy person could manage on their own. They generally don’t provide rehabilitative services or care of more complicated problems. A nursing home may be the permanent residence of handicapped (physically or mentally) or frail individuals, and such is considered to be “custodial care”. The cost of a nursing home can run $100,000 to $200,000 per year depending on location and the facility. Medicare will not pay for custodial care. Medicaid will pay, but the person must spend down their financial resources to qualify for Medicaid.
Continuing Care: These facilities provide multiple levels of care, independent living, assisted living and skilled nursing, and a person moves up the scale as they age and need more care. They generally require a person to be independent when they enter. They are a good choice for someone who is still independent and wants the security of knowing that they can remain in the same facility when their needs become greater. These facilities usually provide various forms of recreational facilities, meals and transportation. They are expensive and not affordable for most. There is usually a substantial fee to buy in ($100,000 to $1,000,000, depending on what is covered, the desirability of the location and the facility) and a significant monthly charge ($1,000 to $6,000).
Other resources: Long-term care insurance is a policy usually purchased while one is working, which will defray a proportion of the things not covered by Medicare. Aging Life Care Professionals, or Geriatric Care Managers, are individuals who are expert at knowing the resources available in their geographic area. They can help guide a client and/or their family to the local resources, examine the alternatives, help assess costs and be an ombudsman for the person involved. If they have been certified as an Aging Life Care professional by the ALCA, it guarantees a level of knowledge and training.
Obviously, this is a cursory look at a very complex subject. It is a starter kit. If possible, it is worth consulting with an Aging Life Care Professional if one is in the process of considering alternatives.