Assisted Living or Nursing Home?

What an Assisted Living Facility Can't Do
nursing-home

When aging parents come to the point when assisted living seems like the best choice, it is usually their baby boomer children who see it first. Perhaps the adult children live in another state. Perhaps they are unable to visit Mom or Dad often enough to feel comfortable leaving them alone. The death of a spouse or a gradual loss of independence in self care—any of these reasons may lead to the adult child’s decision to move the parent. As an assisted living facility representative is likely to tell you, it is often the adult children who first come to look the place over, later bringing their parents to see the place for themselves. These adult children are the hidden consumers of services.

RELATED -> FIND ASSISTED LIVING NEAR YOU

Assisted Living vs. Nursing Home Requirements

As the hidden consumers, what do the adult children of aging parents need to understand about these facilities? Very simply: what the facility can’t do. Invariably, the sales pitch tells you what the facility can do, which is fine, and to be expected. But as a consumer, you must understand the difference between assisted living and nursing care. First, an assisted living facility is not a nursing home with fancy furniture. Assisted living is not licensed to give nursing care. Typically, assisted living facilities are places where elderly adults live in a supervised community, with some personal care services available. Meals, social activityies, and help with the activities of daily living such as bathing and dressing are all usually offered at assisted living facilities. In these communities, the focus is on providing a healthy social environment and preventing residents from becoming socially isolated. It's a worthy focus, as isolation is dangerous, and widespread among elders whose independence is declining.

If your parent is in fragile health and seems to be steadily declining physically or mentally, be cautious about choosing an assisted living facility over a nursing home (also known as a skilled nursing facility). No one chooses a nursing home first. Nursing homes are more like hospitals, as they must be to deliver skilled care to frail seniors. But if your aging parent needs nursing care, and must be watched day and night, or you believe that he or she is likely to need such supervision in the near future, it is the only choice. Assisted living facilities are not licensed by Medicare or Medicaid to give skilled care. Some have a separate skilled nursing facility on-site or nearby, but it will have its own license to deliver skilled nursing care. That license does not apply to the assisted living component, even the two facilities are located on the same campus or are operated by the same parent company.

Doctors & Nurses Not Required

Many assisted living facilities do not have any licensed nurse on staff, and may have no nurse connected to them at all. Because they are considered nonmedical facilities, having a licensed nurse is not required by law. Even if a nurse is employed by the assisted living facility, the nurse cannot give hands-on care in the form of dressing a wound, administering around-the-clock insulin, administering oxygen, or other tasks that are defined by the federal and state governments as “skilled nursing care.”

Skilled nursing care may only be administered within a facility that is licensed to do so. Legally, this kind of facility is licensed as a skilled nursing facility, although it may have a different business name that it markets itself as, such as an “extended care” or “long-term care” facility. Medicare and Medicaid also designate these homes as skilled nursing facilities. Because skilled nursing facilities bill Medicare and/or Medicaid for skilled nursing care, they must comply with many complex legal regulations and requirements. Assisted living facilities are regulated by the state Department of Social Services, not the Department of Health, which regulates nursing homes. Assisted living facilities do not have the same safety or administrative requirements as a skilled nursing facility, and they are prohibited from giving care they are not licensed to give.

Limitations to Specialized Care Waivers

There are exceptions to some of the federal and state government’s licensing requirements. For example, a licensed assisted living facility may take care of residents with dementias, including Alzheimer’s disease, if it has a waiver to accept this kind of resident. The facility must also have certain protections in place to prevent injury to its demented residents. However, it is still prohibited from restraining a demented resident who has a tendency to wander. There are many other limitations to what an assisted living facility can do, even with waivers. Taking care of residents with dementia can be unpredictable, and skilled nursing can become necessary as the disease progresses.

When an aging parent has to move out of the family home, or out of a long-term residence of any kind, the move can be difficult, even traumatic. If you are considering assisted living as an option for your loved one, be sure your focus is on the long run. Carefully consider what he or she will need a year down the road. Moving an elder twice within a short period can be extremely hard on both of you, so make your decisions based on the overall picture, not just on what the assisted living facility can do for him or her right now.

As hidden consumers, adult children must be fully aware of the limits of assisted living. Assisted living facilities can be wonderful and supportive environments for residents who don’t need skilled care. If you are considering assisted living for your aging parent, be sure this kind of place is a match for your parent’s needs.


11 days ago, said...

SEEKING FOR MY HUSBAND AND I. HAVE MEDICARE, NOT ENOUGH TO PAY FOR ASSISTED LIVING, DON'T NEED NURSING HOME YET


5 months ago, said...

This is awesome data to know. My mother is understanding that age and my better half and I have been debating which approach to go. My mom truly appreciates living in her home and her wellbeing is better than average right now so we may stay with helped living for the present. In the event that she decreases however we will need to wind up with a nursing home.


6 months ago, said...

Does anyone know how to find which assisted living facilities in the Sun City West/ Peoria, AZ accept Medicaid for payment?


9 months ago, said...

I need a place for my husband He has gotten very weak and cannot stand anymore He is 90 and I am 88 I need some help Jean


9 months ago, said...

I was put into a care home at first, because the psychiatric hospital I was in, needed to empty their beds. Wrong reason to leave hospital. I know. I couldn't have met nicer, warm, friendly people, who lived at the care home with me. One of the male one's used to serenade me, most mornings, as soon as he came downstairs for breakfast. God bless him. He looked after me. He sat with me a lot. How can anything ever come close to that? :) He made my day. I stayed there for six months, until the local council told my social worker, that they refused to pay any more money towards my stay. I was gutted. It wasn't the same, moving to supported living. I feel way more disrespected. Home carer's are abysmal. They sometimes never even turn up. So then I'm left in limbo of course. I'm thinking of going back into a care home. I can't stand living a completely different life. It's too much of a change for me. My mental wellbeing isn't the same.


10 months ago, said...

What kind of medical assessment is needed and by whom should it be given? for assisted living and nursing home.


about 1 year ago, said...

My sister is 62 years old, mentally challenged and is currently living in an assisted living facility. I have to move to another state because of a job transfer (have no choice) and she does not want to leave where she is currently living. Can I leave her there where she is conformable and manage her care from another state ? Has anyone else experienced this issue?


about 1 year ago, said...

Hi everyone, Thanks for your comments! For those seeking help with finding assisted living or who have outstanding questions about senior living options, please do get in touch with our team of family advisors: (800) 325-8591 This is a free, phone-based service that can help you understand your local options, get some starting rates, learn what other consumers have said in reviews, and schedule tours. The service is available seven days a week. We also have an online directory you can peruse: https://www.caring.com/local/assisted-living-facilities


about 1 year ago, said...

My mother is in a nursing home now due to severe medical issues that have improved since residing there. She wants to go to assisted living for privacy, some dignity. She is now in with patients that are comatose and suffer dementia. This is affecting her emotionally , am I doing the right thing in researching assisted living?


about 1 year ago, said...

At assisted living do u have to completely give baths


about 1 year ago, said...

The social worker at a skilled nursing home told me my grandmother's Medicaid would not cover their skilled nursing home even though she has dementia and they said she has to move to an assisted living home. She has been bounced around between family member, and now after being there for a little over a month, she has to move?


almost 2 years ago, said...

Perhaps a little more info on what a person's condition should be that would make a "skilled nursing facility" the appropriate choice.


almost 2 years ago, said...

I'd a cousin with dementia indeterminate Lost memory etc. (Idon't speak English I speak Spanish) but my cousin live here from 40 years ago hi is American resident He don't accept your illness and don't accept any help Could I information for that problem with him?


almost 2 years ago, said...

This article is highly inaccurate. A nursing home is NOT the same as a skilled nursing facility (SNF). A nursing home provides SUPPORTIVE, non-skilled services only. Patients sent to a nursing home have limited/no potential for improvement. On the contrary, a SNF is skilled due to the facility providing multidisciplinary services (I.e. physical, occupational, and speech therapy).


almost 2 years ago, said...

For Medicare questions, go to Medicare.gov. You will also find phone numbers on that site to call.


almost 2 years ago, said...

My mother is almost 96, and suffers from severe dizzy spells. She is also to the point where it is difficult for her to get up of a toilet, or out of a chair. l was laid off of my job two years ago, but have been a caregiver for her since then. It is too difficult for me handle now. Are there low cost nursing homes?


about 2 years ago, said...

After a 3 day hospital admission (not observation stay), Medicare A will pay for UP TO 100 days of a SNF stay. It is not a guaranteed 100 days, but only as the individual is meeting fairly strict Medicare guidelines for the rehab stay. Even with that...Medicare only pays 100% of the first 20 days. After that there is a daily copay of ~$152 for days 21-100. Supplemental insurance plans may or may not cover that cost.


about 2 years ago, said...

This is great information to know. My mom is getting that age and my wife and I have been debating which way to go. My mother really enjoys living in her home and her health is really good right now so we might stick with assisted living for now. If she declines though we will have to end up with a nursing home


over 2 years ago, said...

3 days in hospital admitted by dr. And then medicare will pay for 3 months.


over 2 years ago, said...

My dad has dementis and is almost 95 amd lives in assistef living for dementia. Recently he has fallen 2 x this week and thank God he just has bruises and superficial wounds. Should I move him to a skilled nursing , the thing is he has to be admitted to a hospital for 3 dats so that medicare will pay for 3 months.and I am not too fond of nursing homes. Ideas any one


over 2 years ago, said...

Husband has been in an assisted living facility and then a board & care facility. Now, it looks like it's time for a nursing home - very difficult & painful decision for me to make.