Nursing Homes Vs Home Health Care
Home health care is an option for seniors who can still mostly care for themselves. Home health care is ideal for anyone who wishes to maintain independence longer and often allows your loved one to age in place. Theres a difference between home care, which is non-medical assistance, and home health care, which includes medical and non-medical assistance. Both take place in the clients own home based on their needs and schedule and are ideal for anyone who prefers to remain in their own home. However, dont confuse them with hospice, which also takes place in the home but is considered end-of-life care with medical treatment provided to clients who are expected to live about six months or less.
Non-medical in-home care includes custodial care for seniors who only need help with activities of daily living. Home care workers, also called caregivers, are professionally trained to help clients maintain a safe environment and provide companionship. However, they dont provide medical care. Home care is cheaper than home health care, which offers the same services plus medical care. The level of care required for home health care requires the experience of a registered nurse, which makes it much higher in cost when compared to non-medical home care and higher than nursing homes.
Cost Of Nursing Home Care
Prior to a discussion of the financial options available to help pay for nursing home care, it is helpful to understand the costs involved. In 2020, the national, daily average cost for nursing home care for a shared room is $255. The least expensive states are located in the Southeastern U.S., the South Central region, and the Mid-West, where the daily cost is closer to $165 $200. The most expensive area of the country, excluding Alaska and Hawaii, is the Northeast and New England, where the daily cost averages in the $350 $415 range. A state-by-state breakdown of nursing home costs is available further down this page. Interesting to note is that Alzheimers care in skilled nursing homes is usually subject to the same fee structure as regular nursing home care. This differs from assisted living communities, which typically charge 20% 30% over their standard fees to care for an individual with Alzheimers.
The table below shows the high variability in nursing home care costs throughout the 50 states. The first column is sorted alphabetically and the second column is sorted by way of increasing average daily cost.
2020 Nursing Home Care Costs by State
Our Nursing Home Nightmare
The year before her heart attack, Mom fell and was hospitalized for several days. After the hospital stay, she spent about two weeks at an inpatient senior rehabilitation center. This facility also served as a nursing home for long-term care residents. Mom was happy while she was recuperating there, and everything seemed fine with the staff and the care and physical therapy she was receiving.
After Moms heart attack, we suddenly realized that her current living arrangement was no longer safe. We needed to find a quality nursing home where she could live permanently and receive the care and supervision she needed. Naturally, the first place we thought of was the senior rehab facility she was already familiar with. This facility was only a few minutes drive from the hospital, which made it seem like a win-win situation for all of us.
Because we had previous experience with this skilled nursing facility, we didnt bother checking its online reviews, stopping in to speak to the administrator or taking a tour. They already had a bed available and accepted residents on a Medicaid-pending basis, so we signed the admission forms, began the Medicaid application process and moved Mom right in.
As you might imagine, I was both furious with the facility for mistreating her and racked with guilt for placing her in this awful situation. I had trusted this nursing home based upon our previous experience there and it turned out they were completely neglecting my mother and her needs.
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Nursing Homes Vs Assisted Living
Nursing homes and assisted living differ in important ways, although some people may think of these two types of senior care facilities as synonymous. Both nursing homes and assisted living facilities offer housing, meal services, and help with personal care. However, seniors in assisted living communities are generally active and relatively independent, although they may need help with certain daily tasks. Nursing home residents typically have debilitating health problems or serious chronic conditions that require 24-hour care, skilled nursing services, or rehab therapies.
Like assisted living, nursing homes also offer social activities for residents, although options may be more limited than in assisted living facilities. This is because nursing homes often focus on medical care, while assisted living communities aim to improve quality of life through personal care and social engagement.
Talking To Your Loved One About Nursing Home Care
Elder care is a difficult but important topic that families ultimately cant avoid. Having regular conversations about senior care before an emergency situation arises is often best. Planning ahead will give you and your family time to think about options and discuss what you need to do to prepare.
However, if your aging parent needs immediate help, its time to hold a family meeting. Consider your family dynamics to decide who to include. If your senior loved one is in good mental health, it may be a good idea to involve them.
Set aside dedicated time, without distractions, to discuss their needs and potential solutions. Its also important to be open to having a series of conversations before your family agrees on the right senior care choice.
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An Older Spouse Is Having Trouble Managing The Caregiving
Perhaps they are becoming too frail to cope with the physical demands of caregiving. Or they may have been diagnosed with their own serious illness, such as difficult-to-control diabetes or a heart and lung disease. Even with help from family and friends who do not live in the same house, an older spouse or partners health can decline more quickly if theyre acting as a caregiver and have done so for many years.
Do You Provide Special Care For People With Dementia
Having one who needs help with memory care or who may be in the early stages of dementia, is an important question when looking at nursing homes. This is a specialized level of care that requires certified professionals who are experts and experienced in senior care.
At StoneBridge, we provide this level of memory care and work hard to ensure that each residents daily lives are enriched and that they achieve the highest level of cognitive function.
Our therapies include a wide variety of care from different areas like nutrition, stimulation, relaxation, spirituality, exercise, creative expression, and medical management. We understand how hard it is to put the care of your loved one in someone elses hands, but we assure you at each StoneBridge Senior Living facility we are up to the challenge.
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Choosing A Nursing Home
To choose the right facility for yourself or a loved one, you first need to decide on the location. Compile a list of the facilities and addresses, telephone numbers, and look them up on the internet to gather initial information about the nursing homes you may be interested in.
Next, you must browse Medicare.gov, where you can view the results of long-term care facility surveys, and compare the ones that may be of interest to you.
You can now choose the nursing homes you want to consider, and go to the facilities and visit them! You can also call ahead of time to ask questions about special care needs or other questions you may have. It’s always good practice to call and schedule an appointment showing up in person.
Skilled Nursing Facility Services
Services and amenities at skilled nursing facilities focus on medical care with 24-hour medical supervision and help with activities of daily living, such as bathing, dressing, using the bathroom and getting in and out bed. Your loved one may need to be in a skilled nursing facility if they are on a respirator, require regular physical or occupational therapy, are recovering from surgery or have wounds that require ongoing medical care. Skilled nursing facilities provide 24-hour staffing by licensed or registered nurses, with other staff members typically including social services and rehabilitation teams.
Health-related care and services offered at nursing homes vary by facility, but federal requirements specify that each nursing home must provide the following
- Nursing and related services
- Routine dental services as covered under your states plan
- Room and bed maintenance services
- Routine personal hygiene items and services
- Specialized rehabilitative services for treatment of a mental illness or intellectual disability
If a resident is unable to perform activities of daily living on their own, nursing facilities must also provide services to maintain good nutrition, grooming and personal and oral hygiene. They may also provide other services, including:
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Complex Medicare Payment Rules
Medicare pays for nursing home care only if you meet specific criteria.
The arithmetic is complex. Under specific limited circumstances, Medicare Part A, the component of original Medicare that includes hospital insurance, provides coverage for only short-term stays in skilled nursing facilities, most often in nursing homes. Some Medicare Advantage plans may differ.
Payment starts with doctor’s order. A doctor might send your loved one to a skilled nursing facility for specialized nursing care and rehabilitation after a hospital stay. If the patient had a stroke or serious injury, recovery could continue there.
In such instances, original Medicare can pay a portion of the cost for up to 100 days in a skilled nursing facility. But the patient must be admitted to the skilled nursing facility within 30 days of leaving the hospital after being a hospital inpatient for at least three consecutive days, and the nursing care must be for the same illness or injury or a condition related to it.
No continuous care. To qualify again for new nursing home coverage, the patient must not be hospitalized or receiving skilled care for 60 days. Then a new hospitalization as an inpatient for three days or more can kick off another 100 days of partial coverage.
Without Medicare, seniors can pay out of their own pockets or spend down their assets until they qualify for Medicaid. Private-pay rates at nursing homes can be expensive, and so are the amenities.
Chapter : Before Your Mother Enters The Nursing Home
Helping your mother get the most out of her nursing home stay, is a job that starts before she enters the home. If she is moving into the home because of some kind of medical or personal crisis, you may not have the time to do all the things we talk about in this chapter. But do take the time to read it, and then use your best judgment about what you are able to do. Read this chapter even if your mother has already moved into the nursing home: it almost certainly will give you information you do not now have and should know.
1. Make a list.
Before your mother enters the nursing home, make a list of her immediate needs, even those you think are obvious. Although the staff will do formal assessments1 after your mother moves in, there are some things that you know best, or that have to be taken care of from the very first day.
Your list should include:
2. Talk to the nursing home staff.
Bring your list with you to the nursing home before your mother moves in. Go over your list with the Director of Nursing before your mother enters the home, so the staff can be prepared for her admission.
Ask the Director of Nursing what needs to be done to make sure the kitchen staff will meet your mothers special dietary needs as soon as she moves in.
A note of caution about nursing home staffing:
3. Ask about filling prescriptions.
4. Precautions about other residents
5. Get the residents rights statement.
You can find a copy of the residents’ rights summary here.
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A Place For Mom To Go Broke
With the Covid-19 Pandemic underway and stay-at-home orders in place over most of America, everything has changed. That includes how much television I watch. Between binge watching the latest shows on Netflix, I was watching the news today hoping for some sign that life was going to get back to normal soon. During the commercial break I saw an ad from A Place for Mom that made me so upset, I felt the need to write about it to expose the ugly truth behind this otherwise innocuous company. I especially feel the need to and expose the boondoggle known as A Place for Mom because they are actually hurting seniors.
A Place for Mom is a company that is a nursing home referral service. As the name implies, A Place for Mom will help people find a facility to place their parent when the parent needs long-term care. This is a free service to the user or at least is inaccurately billed as free by the company. If the company were a true non-profit that used donations to help guide people in time of crisis, that would be great. Thats basically how they present themselves to the public. But A Place for Mom is not the virtue of altruism not even close.
A Place for Mom addresses the cost issue on their website. In the FAQ section it says: WILL THE COMMUNITY CHARGE ME MORE IF I USE YOUR SERVICES? The answer provided by A Place for Mom is enlightening:
Visit And Evaluate Several Local Care Facilities
When taking tours of different facilities, try your best to take your parent with you. Keep the vibe fun, light, and positive. As you tour each assisted living center or nursing home, try to do these things:
- Observe how the staff members interact with residents and visitors
- Observe the length of time cognitively- or physically-impaired residents are left alone
- Take note of how quickly staff members respond to urgent situations
- Find out if the facility provides appropriate care to residents with needs similar to your parent
- Spend time with other residents and visiting family members for their opinions of the facility
- Ask the kitchen how they handle special dietary needs. Try their meals for yourself
- Look into the facility’s security situation and whether the facility has a dedicated section for residents with dementia
- Take a look at the living quarters and envision how your mom or dad’s room could be decorated and furnished
- Inquire about the facility’s procedures for handling medical emergencies.
- Discuss with the facility’s administrator about availability, cost, funding options, and the required steps for admitting your loved one
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Assess Your Ability To Pay
Your options may be limited if your loved one does not have long-term-care insurance or other financial resources to pay for care. Assisted living costs $3,600 a month on average, Kell says, and memory care runs about $4,700 a month on average. Skilled-nursing facilities cost an average of more than $6,700 a month and can reach as high as $10,000, Kell says.
Health insurance and Medicare do not cover this sort of long-term care. If you’re a veteran, you might be able to get help paying for long-term care from the Department of Veterans Affairs. Medicaid rules vary by state, but in general the government program does pay for long-term-care services . However, your loved one basically has to deplete his or her assets to become eligible. Medicaid does cover assisted living in more than half of the states if the cost is less expensive than a nursing home, says Byron Cordes, president of the National Association of Professional Geriatric Care Managers. But the waiting list to get Medicaid coverage for assisted living is long, he says.
What Is Nursing Home Care
Nursing home care generally refers to care that provides 24-hour nursing to residents who cant be cared for at home. It is considered a last resort since the care is very expensive compared to assisted living. According to Genworth, nursing home costs in 2019 averaged around $7,500 a month for a semi-private room and a little over $8,500 per month for a private room.
Monthly costs can also vary depending on the state you reside in. Over time, it is very possible to deplete assets to the point where you may need to qualify for Medicaid.
Nursing home care can also refer to skilled nursing facilities following a hospitalization that qualifies someone for Medicare coverage. This is considered a short-term rehabilitation stay following a three-night stay in the hospital for an illness or injury. After fulfilling the rehab program set by a doctor, patients either go home with home health care or are referred to long-term nursing home care.
These are some of the criteria for long-term nursing home care:
- Ones inability to perform activities of daily living . This includes bathing, dressing, hygiene, taking clothes off and putting on, using the toilet, transferring, and eating.
- Medical needs such as catheter care, IV medications, injections, and wound care.
- Cognitive impairment due to dementia or some other neurological problem can prevent someone from living safely without 24-hour supervision.
- Behavioral problems like aggression or sexual acting out.
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There Are More Frequent Accidents And Injuries At Home
Falls and other injuries may signal that the person is becoming unsafe in their current home. This can have nothing to do with your vigilance and care it may simply mean that its time for 24/7 professional help. If accidents and injuries to the person are becoming more common, reassess the living situation thats in their best interest.
Going to a nursing home is about the ability and desire of the caregiver to give care and the needs of the person who needs care.
CYNTHIA EPSTEIN, A LICENSED CLINICAL SOCIAL WORKER AT NYU LANGONE HEALTH