More than 54 million adults ages 65 and older currently live in the U.S., which makes up about 16.5% of the total population. Over the next 30 years, this group is projected to grow even more, to comprise about 20% of the nation. With the older adult population on the rise, many seniors and caregivers are facing the challenge of where to turn when health conditions become too cumbersome to manage from home.
Some seniors ultimately require 24/7 monitoring and care, which is often impossible for families to provide at home. Nursing homes are a helpful solution for those who simply cannot maintain the level of assistance that their loved one needs on their own. Staffed with trained and licensed nurses and physicians, skilled nursing facilities offer a high level of medical, personal, and rehabilitative care. This guide will provide you with an overview of nursing home services so that you can decide if this type of care is best for you or your loved one. We also offer advice on how to choose a nursing home and answer some frequently asked questions about skilled nursing facilities.
What Are Skilled Nursing Facilities?
Skilled nursing facilities, commonly referred to as nursing homes, are long-term care facilities that provide the highest level of care of all of the long-term care options in the spectrum of senior living. Skilled nursing facilities employ a staff of registered nurses, physicians, and other certified medical professionals to provide 24/7 medical care to residents. Residents of nursing homes typically have high-level medical needs such as a chronic condition that requires consistent monitoring, or are recovering from a serious illness or injury and are rehabilitating. Nursing home care is often the next step after a stay in a hospital, as staff can provide a similar level of continuous service.
Nursing Home Care and Services
Nursing homes provide around-the-clock medical care and supervision. In addition to high-level medical care, nursing homes offer a spectrum of services designed to help residents remain healthy. The types of services provided in skilled nursing facilities can be broken down into the following three categories:
- Medical Care: Most residents move to nursing homes because they need the high-level medical care provided. In nursing homes, skilled medical professionals are present around the clock to care for residents. Trained and licensed nurses, nurses assistants, and physicians are on staff to provide care for residents.
- Personal Care Assistance: In addition to medical care, many nursing home residents need assistance with personal care tasks. Nursing homes provide assistance with the activities of daily living (ADLs) like eating, bathing, and dressing.
- Rehabilitative/Post-Acute Care: Some seniors transition to a skilled nursing facility following a surgery, illness, or injury. Many nursing homes reserve a portion of their capacity for these short-term stays. While in nursing care, short-term residents receive rehabilitation services and monitoring of their condition until they are able to return to their usual residence.
Nursing homes differ from other senior communities because the focus is on healthcare, rather than lifestyle. Thus, nursing homes typically offer fewer amenities and extra services compared to assisted living facilities. Some nursing homes offer lifestyle services like laundry and transportation, but most do not offer many planned group activities or have lifestyle amenities like a state-of-the-art fitness center or swimming pool.
Who Should Consider Skilled Nursing Care?
Nursing homes are designed for seniors who need consistent medical care or monitoring, or who are recovering from an acute injury or illness. Some instances when someone should consider skilled nursing care include:
- Seniors living with a chronic condition that requires consistent monitoring
- Seniors living with a terminal condition who need access to around-the-clock care
- Seniors recovering from an acute illness or injury who need rehabilitative services
- Seniors who cannot complete any of their ADLs independently, including transferring
- Seniors who are immobile and bedridden
- Seniors with complex medical needs and regimens who need assistance with medication administration
Who Is Better Suited for a Different Type of Senior Care?
Nursing homes are not the right choice for everyone. In cases when the senior does not need high-level medical care, they should consider another type of senior living. Below, we describe some alternative options.
- If you’re still active, social, and can perform your ADLs independently, an independent living community is a better fit. Independent living communities offer some lifestyle services and amenities such as communal dining, housekeeping, and maintenance, but do not offer personal care assistance or medical care.
- Seniors who need some assistance with their ADLs but do not need regular medical care or have high-level medical needs should consider assisted living. Assisted living facilities are geared towards seniors who are still somewhat social and active, and will offer more activities and amenities than a nursing home.
- Seniors who are living with Alzheimer’s or dementia are better suited for a memory care community. While some nursing homes have memory care wings, a dedicated memory care facility can provide the expertise and personal care that those living with memory impairment need.
Nursing Home Costs
Nursing home care is expensive, even when compared to other types of long-term care. According to Genworth Financial, the average cost for a semi-private room in a nursing home is $7,756. This can vary depending on one’s location, as healthcare costs do differ from state to state. For example, in Oregon, the average cost of a semi-private room is $10,114 per month. Meanwhile, the average rate for the same type of care in Missouri is $5,080.
No matter where you live, costs will always be higher for a private room in a skilled nursing facility. The national average cost for a private room is $8,821, compared to the $7,756 for a shared room.
Financial Assistance for Skilled Nursing Care
Skilled nursing care is expensive, and many seniors and their families seek financial assistance to cover the cost of care. Below, we explain some of the most common financial assistance options available to help pay for skilled nursing care. Note that not all options are available to all seniors, but seniors who are in true financial need should have access to some form of assistance.
Medicaid is the primary payer for nursing home care in the United States, meaning that a large portion of long-term nursing home residents uses Medicaid to pay for their care.
Nursing homes must be licensed and certified by the state agency as a Medicaid Nursing Facility in order for coverage to be available. Additionally, your income and financial assets must meet specific requirements in order to qualify. If you are eligible, Medicaid will cover all or close to the full cost of long-term care. Qualification requirements vary by state, but generally include factors such as ongoing medical issues requiring skilled nursing care, income and asset limits, age and marital status.
Learn more about Medicaid eligibility.
Unlike Medicaid, Medicare (also known as Original Medicare), does not offer long-term assistance for those with chronic health conditions. Instead, the program provides a short-term solution for those seeking skilled nursing care while recovering from an illness or injury. However, Medicare’s coverage comes with a long list of requirements that you must meet to be eligible for assistance. For example, you must spend at least three days in the hospital for an illness or injury. Within 30 days of your hospital discharge, you must need skilled nursing care for the same ailment that initially caused your hospitalization.
Also referred to as convalescent care, this limited-time assistance pays for 100% of 20 days at a nursing home facility. Over the following 80 days, Medicare recipients are responsible for paying a portion of the daily expense. If you have a Medicare Supplemental Insurance plan, your insurance will pay the remaining cost for the final 80 days of coverage. However, there is a 100-day deadline to keep in mind, as Medicare and Medicare Supplemental Insurance will not cover any costs after you reach this maximum.
Learn more about Medicare eligibility.
As a Veteran, you may be eligible for long-term care in a nursing home covered by Veterans Affairs (VA). The amount of financial assistance depends on factors such as your income, service-connected disability status, and insurance coverage. VA offers around-the-clock skilled nursing care at three types of facilities. The first, Community Living Centers, are VA nursing facilities created to feel like home. Another option, Community Nursing Homes, are non-VA nursing homes that VA contracts with to ensure close-by care for Veterans around the country. And State Veterans Homes are state owned and operated facilities that provide full-time care for Veterans and their non-Veteran family members. Note that in order to qualify, you must be signed up for VA healthcare and live near one of the above facility types.
Learn more about Veterans Assistance and long-term care services.
The Social Security Administration provides full benefits to those staying in a skilled nursing facility for 90 days or less, but only under certain circumstances. In order to qualify for this benefit, you must report to the administration that you are staying in a nursing home for 90 days or less and need Supplemental Security Income (SSI) benefits to maintain your permanent living arrangement during your facility visit. You must also provide a signed statement from your physician stating that your nursing home stay is not expected to last more than 90 days. If Medicaid covers more than half of your nursing home care cost, then your SSI benefit is limited to $30 per month. In some situations, you may not be eligible for any SSI benefit.
Learn more about Supplemental Security Incomes Benefits.
How to Choose a Nursing Home
There are many factors to consider when looking into a skilled nursing facility. Below, we break down the three main things to look for in a nursing home, and what specific factors to consider when trying to choose the best fit.
Nursing Services and Staff
Seniors typically do not transition to a nursing home until it is medically necessary, so the availability of nursing services and quality of nursing staff should be a top priority. If you’re unsure whether you or your loved one are the right fit for a nursing home level of care or want to ensure the services you need are provided, ask the following questions.
- Does the facility provide 24-hour RN coverage? Even though it is federally mandated that all facilities have 24-hour LPN coverage, there are some duties that only an RN is qualified to perform, such as IV administration.
- What qualifications do the nursing assistants hold? Are the nursing assistants all certified?
- Can the nursing staff handle advanced care needs such as wound therapy?
- Does the facility use contract agencies?
- Does it appear as if the nursing staff is enjoying their work? Is morale high throughout the building?
- Does each patient have individualized plans of care?
- Does the facility have a physician on-site or a contract with a visiting physician?
- What therapy services does the facility offer?
The best way to assess a facility is to take a personal tour. When in-person touring is not possible, ask the community to arrange a live virtual tour via video chat. Whether touring in-person or virtually, pay attention to:
- Are the hallways clean and free of clutter?
- Are the residents’ rooms clean and free of clutter?
- Are the rooms decorated with personal belongings, or are they barren and hospital-like?
- Does the staff address the residents respectfully?
- What types of bedrooms are available: private, semi-private, triples, or quadruple occupancy?
- Are there areas for the family to gather for visits or special occasions?
- How are residents dressed? Are they still in their pajamas late in the day, or are they properly dressed?
- If touring in person, do you notice any odors?
Dining and Lifestyle Services
Dining is not only an opportunity for nursing home residents to eat, but an important opportunity for socialization and camaraderie. And planned activities are vital in the long-term care setting, providing cognitive stimulation and preventing isolation. When choosing a facility, consider the following:
- What type of dining program is offered? Some skilled nursing facilities offer restaurant-like dining, while others serve all residents the same meal with limited opportunity for alternatives.
- Are residents encouraged to eat in the dining room?
- Are residents who are unable to feed themselves assisted by facility staff?
- Can the kitchen accommodate special dietary needs?
- Are there activities my loved one would enjoy?
- Is there diversity amongst the activities?
- Are there outside activities?
- Are there activities that will take them off-premises?
- Do the residents participate and enjoy the planned activities?
Whether facing chronic medical issues or recovering from an illness or injury, choosing the right nursing home is a vital factor in ensuring reliable comfort and care for you or your loved one. Putting in extra effort to research facilities, take tours, and read reviews is worth the peace of mind that comes as a result. You can visit the Medicare website and simply enter your location to find and compare nursing homes around you. The Centers for Medicare and Medicaid Services also created a Five-Star Quality Rating System to help you compare facilities and identify areas about which you may want to ask questions.
Frequently Asked Questions
How do you know when your parent needs a nursing home?
As our parents age, it can be difficult to know when it’s best to consider a nursing home. If your parent needs healthcare provider services on a daily basis or needs constant supervision, it could be time to begin looking at facilities. Additionally, if they need assistance with identifying medication, maintaining their household, or other daily activities like dressing or bathing, then a nursing home might be the best next step.
How long do seniors live in nursing homes?
Although the reasons for seeking a nursing home vary from chronic health conditions to injury rehabilitation, the average length of stay in these facilities is only 5 months. The majority of residents have relatively short visits, with 65% staying less than one year. It’s important to keep these statistics in mind when participating in care planning for you or your loved one.
What is the difference between a nursing home and a retirement home?
Nursing homes are skilled nursing facilities that are designed to provide 24/7 medical care and assistance with daily activities in a comfortable, home-like setting. On the other hand, retirement homes (also known as assisted living communities) are facilities that help seniors maintain their independent lifestyles, while also providing on-site care as needed. There are many different kinds of retirement homes, including continuing care retirement communities and congregate care.
Is home health care cheaper than a nursing home?
The average cost of home health care is $4,385 a month. Residential skilled nursing care (nursing homes) costs about $8,821 a month for a private room and $7,756 a month for a shared room. These prices vary greatly depending on your state of residence, so it is recommended that you research costs in your area. Keep in mind that basic home care and home health care offer different services. Home health care will always be more expensive than basic home care because it includes high-level medical assistance.
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