This article tackles the living options available to older adults, 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)
  • Definition of a Nursing Home (NH) or Skilled Nursing Facility
  • Key Differences between Assisted Living Facilities and Nursing Homes
  • What Assisted Living Facilities Offer
  • What Nursing Homes Offer
  • Nursing Home Patients
  • Tips for Talking to Aging Parents about Moving to a Facility
  • Final Thoughts

Quick Summary

There is a considerable amount of confusion and questions that older adults and their families have when looking into living options and special care needs. 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 plans. You may have 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 your loved one needs.

Definition of an Assisted Living Facility (ALF)

Assisted living facilities may also be called residential care, adult living, or supported care. The various names of an assisted living facility reflect the housing and amenities that are provided to those residents who do not necessarily require medical care, but who either no longer can live alone or just prefer not to have the hassle. Assisted living residences aim to provide a place where residents can remain as independent and self-sufficient as possible, with the promise of assistance when needed. ALF’s provide a combination of housing, meals, care and support, social activities, 24-hour supervision, and usually health-related services. As individuals needs change, these facilities usually provide different levels of care at different costs, and some are affiliated with nursing facilities to ease the transition should your loved one’s care needs grow over time.

Definition of a Nursing Home

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 patients that require a higher level of care. Thus, nursing homes are mainly for adults with serious medical needs. Many nursing home residents have physical or mental health problems that require attention from trained professionals. Approximately half of nursing home residents have dementia, and more than half are bed or wheelchair bound. However, many individuals in nursing homes also stay temporarily for a few months to receive rehabilitative care after incidents such as strokes or heart attacks.

Key Differences Between Assisted Living Facilities and Nursing Homes

It is not uncommon for some older adults and their families to confuse assisted living facilities and nursing homes. They often do not know which environment is more suitable for them and their unique needs. Although assisted living facilities and nursing homes are very different, they also 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 consisting of different levels of nurses and other medical team members, including physicians.

On the other hand, assisted living facilities are a more recent development in senior care that cater to those who require less intensive care and want to maintain their independence. These facilities provide mid-level custodial care, also known as assistance with 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.

Residents who live in assisted living facilities enjoy a degree of independence as contrasted with those who live in nursing homes. 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 some assisted living facilities may resemble nursing homes, many licensed facilities are drastically different. The facilities range from converted houses that look more 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 with 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 most cases, an assisted living facility is privately paid while a nursing home is paid by many sources, including Medicare and Medicaid.

Quick Fact:
There are six types of activities of daily living (ADL’s). They consists of eating, bathing, dressing, toileting, transferring (walking), and continence.

What Assisted Living Facilities Offer

Assisted living facilities are a great solution for many individuals. When a loved one’s own home is no longer an option, ALF’s fit the bill nicely.

ALFs are frequently eager to fill their rooms, and you’ll be treated to a grand tour each time you visit one of these facilities and inform them that you are looking to place a loved one. Narrow your search to a handful of facilities that are close to you or to one of your siblings, and make as many inquiries as you can from friends or family members who may have someone in an ALF, or from medical or social services people to whom you may have access.

You can get a referral service to take you on tours, 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 and other tasks 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 working with persons 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.

Quick Fact:
There are eight types of instrumental activities of daily living (IADL’s). They consist 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 typically 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 can enjoy the option of choosing the type of space they want to occupy, provided the space is available. They can typically 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.

What Nursing Homes Offer

A key difference between assisted living and nursing homes is that 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 trained 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 older adults; they house anyone who requires 24 hour care.

Quick Fact:
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, loved ones may require extra attention and monitoring from family members and friends.

Nursing Home Patients

Patients are under constant medical supervision and more often than not, in need of assistance with daily living. Furthermore, they 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, patients are unable to leave the facility on their own. There are some small nursing homes that exist, but the majority of them are large and accommodate 100 patients on average.

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 making sure seniors or other patients are assisted with ADL’s.

Tips for Talking to Aging Parents about Moving

These decisions can be overwhelming, and sometimes adult children can feel extremely guilt ridden over placing their parents in a facility. It can also be very difficult to convince an older loved one that he or she can no longer live independently. Many older adults resist this transition because they may feel like they’re being forced out of their homes and relinquishing their independence. Here are a few tips to ease this process:

  • Know your options: Know about different types of care available in your community and your/your parent’s financial situation
  • Have ongoing and early conversations about future plans: It will be less threatening if there’s not an immediate need
  • Encourage your loved one’s involvement in these decisions: If healthy enough, have them come with you to tour facilities and allow them to voice their preferences
  • Be positive about housing options: Use a positive tone of voice and be cognizant of your language (e.g. “community” instead of “facility”)
  • Recognize why they may want to stay at home: If home care is not possible, discuss their needs and do what you can to support their control and independence
  • Learn about the progression of their illness: If your loved one has a progressive disease like Alzheimer’s, know what to expect with time and research the services provided by different facilities. You may not want their life to be disrupted multiple times as their disease worsens.

Final Thoughts

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 likely 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 decline, and they suddenly require more medical assistance.

July 3, 2017
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