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Perception vs Reality

Part 3: Nursing Home vs Assisted Living Communities – Understanding the Differences

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Not planning ahead for care in later years can result in emotional and financial stress when families are forced to decide too quickly on a caregiving solution.
Not planning ahead for care in later years can result in emotional and financial stress when families are forced to decide too quickly on a caregiving solution.

For many years, when seniors could no longer live independently or families were unequipped to care for elderly loved ones, nursing homes were usually the sole option. Things have changed, and today, seniors have many more living options to choose from.

One thing that hasn’t quite changed, unfortunately, is the misconception that all of those choices are synonymous with “nursing home.” This has been exacerbated by the negative connotations associated with nursing homes–often unfairly, sometimes understandably so.

In Part 3 of our three-part series on senior living options, we are looking at the differences between assisted living and nursing homes to help clarify the commonly-held belief that they are one in the same.

This misconception can contribute to families completely avoiding the topic of senior living and/or elder care until an unexpected life change forces them to make a reactive, rather than planned, decision. Not planning ahead for care in later years can result in emotional and financial stress when families are forced to decide too quickly on a caregiving solution. As mentioned in last month’s feature (Part 2), making the best choice for senior living involves making the most informed choice–and sooner rather than later.

So, let’s clarify: Assisted Living Facilities (ALFs) are not nursing homes. Neither are Continuing Care Retirement Communities (CCRCs), although a nursing home–also known as a Skilled Nursing Facility (SNF)–may be an option offered within the setting of a CCRC.

ALFs and nursing homes usually differ in 1) setting, 2) a resident’s level of independence and the level of care provided, and 3) costs.

Different Types of Facility Settings
Assisted Living Facilities may consist of single-family homes or large apartment buildings, all licensed to provide care to seniors. Types of ALFs may include Independent Living, Continuing Care Retirement Communities, and Alzheimer’s and Memory Care.

Aging Tree’s CEO Corey Shenk counsels families, couples, and individuals every day on living options and ways for seniors to maintain their independence. “Assisted living is meant to provide a vibrant atmosphere,” Shenk says.

Depending on the facility and the services it offers, that care may include everything from meal preparation to housekeeping and other daily activities. ALF environments also provide social interaction and additional services such as transportation. They can even have a “country club feel”, offering amenities such as golf courses and spas, although these types of communities come with a heftier price tag.

Nursing homes are often designed as single-level structures with rooms housing from one to three residents who share a bathroom. These facilities generally include a central dining area, rehabilitation area, and spaces where residents gather for social activities. Rooms are traditionally arranged along long hallways, similar to a hospital setting, in order to facilitate ease of care. But design models are changing to encourage more communal living and interaction among smaller groups of residents.

Different Levels of Independence and Care
One of the biggest fears seniors face is loss of independence. In fact, one study found that seniors feared moving into a nursing home and losing their independence more than they feared death.

Yet, maintaining independence is the main goal of assisted living communities. The level of assistance with daily tasks, services, amenities, and costs varies widely among ALFs.

In Florida, the law requires an ALF to use an assessment form that is filled out by a potential resident’s physician. This forms provides the information facility staff need to make the best recommendation for the type of help a resident may require, such as bathing or medication management, and the cost for those services. If a person is “bed bound,” an assisted living facility cannot accept him or her. The common criteria a person has to meet to be able to still reside in an ALF is to be able to “stand and pivot.” Again, the level of care and assistance varies among individual facilities.

Nursing homes provide custodial care–feeding, bathing, dressing, etc.–as well as skilled nursing care and other medically related care 24 hours a day, seven days a week. Federal law requires that these facilities also provide rehabilitative, pharmaceutical, dietary, emergency dental, activities, room maintenance, and personal hygiene services to the patient.

Shenk describes nursing homes as consisting of a “Wing A” and “Wing B,” with A providing rehabilitation and short-term care and B providing long-term care. Shenk says many residents who enter nursing homes do so via the hospital following an illness or injury. Patients enter short-term care and/or rehabilitation in order to regain the level of health they enjoyed before being hospitalized. This helps ensure the best transition back into independent living.

Unlike assisted living facilities or short-term care in a nursing home, long-term nursing home care becomes necessary when a person can no longer function independently due to a high acuity level (i.e., the level of severity of a condition) or a person has no other place to go. In these cases, a nursing home can be the appropriate option.

For individuals needing more care but not wanting full nursing home care, an Extended Congregate Care (ECC), or Limited Nursing Services (LNS), community can be a good solution. Serving as a bridge between assisted living and nursing home care, this type of facility provides a full-time nursing staff for residents and can provide additional care not permitted in a standard assisted living community.

The Differences in Costs and Funding for Care Average Monthly Cost in Orlando
According to Genworth Financial, Inc., the average monthly cost in 2016 for assisted living in Orlando, for example, was $3,250 while the monthly cost of a semi-private room in a nursing home was $7,604. Be aware, these costs vary depending on location, facility, and services.

In the next 20 years, according to the American Senior Communities website, the population of people 85 years of age and older is expected to triple from 5.7 million (in 2011) to 14.1 million.
In the next 20 years, according to the American Senior Communities website, the population of people 85 years of age and older is expected to triple from 5.7 million (in 2011) to 14.1 million.

Another common misconception regarding senior care is that care is covered by Medicare. However, Medicare DOES NOT cover the costs of assisted living or other forms of long-term care and services.

Normally, Medicare or a replacement plan does cover the costs of 30-100 days of short-term care or rehabilitation. Following the maximum stay allowed by Medicare, a patient who still requires care may be transferred to the Medicaid-certified, long-term care (Wing B) of a nursing home. In this situation, the patient will pay out-of-pocket from personal resources, savings, or long term care insurance each month. If those assets are exhausted and the resident is eligible, Medicaid will then cover care.

In most states, Medicaid offers some financial assistance for assisted living, depending on the state’s definition of assisted living, an individual’s eligibility, and other factors. In addition, not all facilities accept Medicaid. Even if a person hasn’t qualified for Medicaid in the past, a nursing home resident may be eligible for coverage.

In addition, the state of Florida provides assistance through its Statewide Medicaid Managed Care Long-Term Care Program health plans: Health Maintenance Organizations (HMOs) and Provider Service Networks (PSNs).

In the next 20 years, according to the American Senior Communities website, the population of people 85 years of age and older is expected to triple from 5.7 million (in 2011) to 14.1 million.

The elder care industry, like other industries, can’t help but change with the times and for the better. New trends, like co-housing, technology usage, and niche socialization activities (as noted in seniorlist.com’s “9 Assisted Living Trends to Watch for in 2016”), point to the ever-evolving structure and services provided through assisted living.

It’s likely the growing demographic of seniors will expect increasingly better options, and these trends will continue in order to meet that demand.

For more information or to talk with a senior care advisor at no cost, call Aging Tree at 1-866-320-8803. We can help you and your family navigate the many aspects of planning for your senior living lifestyle.


Amanda Eastep

Amanda Cleary Eastep is a freelance marketing writer for businesses and universities at Word Ninja. She believes words should not only inform, but also offer encouragement and hope. She blogs about faith, family and life change at “Living Between the Lines.”

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