While most aging people would prefer to stay at home rather than moving to a nursing facility, this may become necessary because of their condition. Some medical issues cannot easily be treated at home, and they may require constant monitoring and professional assistance. In other situations, a resident does not have serious health conditions but lacks access to resources or assistance from family members. They may need to move into a nursing facility because they are unable to live by themselves. About 10 percent of all stays in a nursing facility last three years or more, and about a third last more than a year.
When you are considering which type of facility works for your loved one or you, you should review the different levels of care that are available. Some facilities will offer more than one level of care. If someone is struggling with an acute condition, they will want to make sure that the care is sufficiently intensive and that the staff is skilled in treating that specific condition. If someone could live at home but simply needs to move into a nursing facility as a practical matter, they may prefer a facility that offers enjoyable activities rather than a high level of monitoring and active nursing care.
Skilled Nursing Facilities
People who need careful attention and professional assistance may benefit from receiving services at a skilled nursing facility. This type of facility will have a registered nurse on duty at all times, and the staff will include licensed vocational or practical nurses who can provide 24/7 nursing services. Most people do not spend more than a few weeks in a skilled nursing facility. A stay there most commonly follows treatment in a hospital for a serious illness or injury. The cost can be expensive and may not be entirely covered by Medicare, Medicaid, or private insurance.
Skilled Nursing at a Glance
24/7 nursing services
High level of care
Often used by individuals who have experienced a serious illness or injury
High cost; possibly not entirely covered by Medicare, Medicaid, or private insurance
Some skilled nursing facilities function as departments in hospitals. These provide extremely high levels of care and diligent monitoring, as well as more sophisticated treatments and therapies. Like other skilled nursing facilities, they are designed for short-term stays following treatment in a hospital for a serious illness or injury. Unlike other skilled nursing facilities, the cost tends to be covered completely by Medicare, Medicaid, or private insurance.
Intermediate Care Facilities
People who have chronic but not acute illnesses may choose to live at an intermediate care facility, which is often part of a skilled nursing facility or a custodial care facility. Long-term stays in these facilities are more common than in skilled nursing facilities. The staff provide a combination of medical care and personal assistance. As with a skilled nursing facility, a licensed nurse is always on duty. Most often, people receive care in an intermediate care facility when they are going through a longer recovery period from an illness or injury but do not require the sophisticated care provided at a skilled nursing facility. Medicaid may cover some of these costs, although Medicare does not. Private insurance usually does not cover these costs unless the insurer provides prior approval.
Intermediate Care at a Glance
Combined medical care and personal assistance
Often used by individuals with chronic rather than acute conditions
May be covered somewhat by Medicaid, but probably not by Medicare or private insurance
Custodial Care Facilities
These facilities do not provide a high degree of medical care, focusing instead on personal activities and recreational and social opportunities. They lightly monitor the physical condition of residents but are best suited to people who do not need regular attention. They cost much less than the options above. Medicare and private insurance supplements do not cover any of these costs. Medicaid may cover the costs if the resident qualifies for it, and residents who are veterans may obtain some coverage through VA benefits. If you get long-term care insurance, this may cover some or all of the costs.
Custodial Care at a Glance
Focused on providing recreational and social opportunities
Light health monitoring
Lower cost; may be covered by Medicaid, VA benefits, or long-term care insurance, but probably not by Medicare or private insurance supplements
Choosing a Long-Term Care Facility
Unfortunately, not every facility provides the welcoming, homelike environment that you would hope to find, even if it meets the technical requirements. A resident should retain their dignity and quality of life to the extent possible, while receiving the appropriate care. You can ask for referrals from your doctor or the hospital that treated your loved one or you, as well as any family members and friends who may have gone through similar experiences. Local community organizations, government agencies, and national private organizations like the American Association of Homes for the Aging also may point you in the right direction. If a patient suffers from a specific condition or disability, they may want to get advice from an organization dedicated to that area, such as the American Cancer Society or the Alzheimer’s Disease Foundation.
You may want to check to see whether a facility is certified by the Healthcare Financing Administration before choosing it. This means that it meets standards imposed by the federal government. The vast majority of nursing facilities are certified, so a lack of a certificate may be a red flag. (However, sometimes a facility does not get certified simply because it does not want to accept people on Medicaid.)