What Is A Nursing Home?

A nursing home, also called a skilled nursing facility, is a long-term care option for seniors who don’t need to be in a hospital but can’t be cared for at home. Nursing homes provide the most extensive medical care a senior can get outside a hospital.

Along with skilled nursing care, nursing homes can provide residents with other personal care and health services. These services include assistance with the activities of daily living (ADLs), rehabilitation such as physical, occupational, and speech therapies, and around-the-clock health monitoring. 

Nursing homes are ideal for seniors that require a high level of daily care and medical attention. Seniors with chronic illnesses, worsening health problems, declining functional status, and complex medical needs can benefit from the care provided by nursing homes.

SNF services can vary from one facility to the next, and they often include the following:

• Room and board
• Assistance with ADLs (bathing, dressing, walking, eating, etc.)
• Administration of medication
• 24-hour emergency care
• Social and recreational activities
• Rehabilitative services (physical therapy, occupational therapy, speech therapy, wound care, pain management, etc.)

Nursing homes are for people that require complex and highly demanding levels of personal and medical care and are unable to live on their own. On the other hand, assisted living is for seniors capable of living independently, but need help with basic daily activities like bathing, dressing, etc. Living in nursing homes is also more expensive than staying in assisted living facilities.

Care homes are residential settings that provide 24-hour care and support for seniors who need assistance with ADLs and instrumental activities of daily living (IADLs). In addition to assisting seniors with essential daily tasks, care homes can help with IADLs such as housekeeping, laundry, medication management, telephone use, and scheduling appointments.

Although care homes provide care and services 24 hours a day, these services are not at the same level as a nursing home’s higher level of care. Also, while care homes always have on-site staff members for care and support, they’re not necessarily medical staff like in most nursing homes. Conversely, since residents don’t require ongoing medical care, a care home offers more varied activities for seniors than nursing homes.

Below are some of the top benefits for seniors living in a nursing home facility:

Caregivers, families, and residents have peace of mind knowing that on-site staff is available to provide 24-hour health services and health monitoring. In addition, the nursing staff can also assist with medication administration, provide emergency medical treatment, and give general health guidelines when needed.

One of the primary reasons seniors cannot live independently at home is the increasing difficulty of performing the basic activities of daily living (ADLs), including bathing, dressing, walking, eating, etc. Nursing homes assist with ADLs to relieve seniors of this burden.

Seniors who live alone are at risk of falling, tripping, and injuring themselves. Nursing homes are designed to accommodate seniors in a safe and structured environment. These facilities have improved lighting, non-slip rugs, and furniture arrangement that reduces tripping risks.

Nursing homes are ideal for seniors who require advanced levels of medical care and rehabilitation services. Many facilities offer physical therapy, occupational therapy, speech therapy, wound care, and memory care (Alzheimer’s disease and other forms of dementia).

Many older adults who live alone suffer from loneliness, depression, and feelings of isolation, which are linked to poorer health. Nursing homes may offer some community events or activities and encourage residents to socialize in common areas and during group activities.

According to Genworth’s Cost of Care Survey in 2021, the daily median cost of long-term nursing home care in the United States is $260/day for a semi-private room and $297/day for a private room. This comes to an average monthly rent of $7,908 for a semi-private room or $9,034 for private accommodations in a U.S. nursing home. 

The actual cost of long-term nursing home care will depend on several factors like the facility itself, the state, and if special services are needed and which type. Some nursing homes offer all-inclusive rates, while other facilities may charge residents more for specialized services like physical therapy or memory care.

Moreover, the cost of nursing home care varies considerably based on the state. Generally, nursing care costs are more expensive in states with a higher cost of living, such as New York or Washington, than in states with a lower cost of living, like Louisiana and Missouri. 

While it’s common for people to pay for nursing home care privately, there are various financial assistance and resources you may use to fund your care.

While Medicare is not designed to cover long-term care, including nursing homes, seniors can tap into this resource for short-term stays in a limited capacity. Specifically, the coverage for nursing home care only applies if you’re admitted to a hospital for at least three consecutive days and within 30 days after discharge. Furthermore, a doctor must mandate the patient to receive specialized care and rehabilitation.

Medicaid will cover 100% of the long-term care costs of eligible seniors at a Medicaid-approved skilled nursing facility. But there are rare cases where beneficiaries have copayments for certain services. To qualify for Medicaid, the resident must meet the state’s financial eligibility and level of care requirements. Please feel free to read the Medicaid Eligibility guidelines to learn if you or a loved one is qualified.

The U.S. Department of Veterans Affairs offers financial assistance to seniors that require long-term nursing care due to service-related injuries and disabilities. Veterans without service-related injuries or disabilities may also apply for VA benefits if they meet specific requirements such as household income. To apply, please complete the VA Form 21-0779.

In addition, the National Association of State Veterans Homes (NASVH) operates dozens of state-approved nursing facilities where veterans can avail of low-cost, long-term care. Please search the National Association of State Veterans Homes directory for a complete list of VA-operated nursing homes across the U.S.

Most seniors have an aversion to staying at a nursing home. However, once your or your loved one’s needs increase, it’s important to be able to recognize the signs that it’s time for a higher level of care. The below signs indicate you or your loved one may be suited to have your needs met in a skilled nursing facility: 

• New or worsening complex health conditions: Seniors with age-related and chronic illnesses require complex care plans, and the severity of their conditions may necessitate 24-hour emergency care and hospitalization. They’ll get all the care they need in a nursing home.
• Repeated falls or other serious injuries: Simple tasks like moving from one place to the next becomes difficult for seniors, increasing their risk of tripping or falling over. Nursing homes offer a safe space for seniors prone to falls or have fall-related injuries.
• Declining functional status: A senior’s functional ability is typically evaluated based on their capacity to perform the six activities of daily living or ADLs. These activities are eating, personal hygiene, ambulating (mobility), continence, and toileting. As one’s inability to complete ADLs worsens, their needs may exceed what can be provided at home or in assisted living.
• Cognitive challenges: Seniors with Alzheimer’s or other forms of dementia need complex long-term care and a safe environment to live in. Nursing homes have memory care units where dementia patients receive 24-hour supervision, specialized activities, and access to a secure environment.
• Noticeable physical decline: If you notice that your loved one has unexplained weight loss, is wearing dirty clothes, hasn’t shaved, or otherwise shows declining physical upkeep, it may indicate that they need the assistance of around-the-clock care. 

Consider the following criteria when choosing a nursing home for your senior loved one:

• Adequate staffing: Ensure the facilities you’re considering meet the state’s staffing requirements. Also, inquire about employee turnover because high turnover rates can affect the continuity of care.
• Safety and cleanliness: You want a clean and well-maintained facility because it indicates a good nursing home. A clean and safe environment is crucial to the health of your loved one.
• Resident well-being: During your tours of these facilities, pay attention to how the staff treats the residents and if they look happy and engaged. Also, ask to look at the activities calendar to get an idea about the events and social opportunities they provide.
• Location: Most seniors want to live in a facility close to their family and friends. However, it’s always best to ask your loved one and consider their preference on where to live. Also, consider how often you would like to visit them in the facility.
• Cost: Beyond the location, the cost is greatly influenced by whether the senior needs a semi or private room. More importantly, consider your paying options and other financial resources when deciding on a nursing care facility.
• Reviews: Be sure to read online reviews of any nursing home you’re considering, or ask for firsthand information if you know of anyone who’s been in a similar situation. 

A move to a nursing home is never easy and is often an emotional decision. Below are some critical steps to getting someone admitted to a nursing home:

Be sensitive and consider your loved one’s feelings and emotions. Most seniors refuse to live in a nursing home, so it’s important to be empathetic and involve them in the decision-making and planning as much as possible. After all, it’s their life. If you cannot sell the idea of long-term care in a nursing home, try a less pushy approach and allow them to warm up to the idea.

Ideally, you’ll want a nursing home close to home and in a familiar area. Most seniors also prefer to live in a local facility closer to family and friends. Set up appointments to tour several local nursing homes with your elderly loved one. This allows them to get a feel of each facility and see which ones they like best. In addition, observe things like how staff members interact with residents and how quickly they respond to emergencies.

Every state has different Medicaid coverage and requirements. Therefore, check if the state provides Medicaid for nursing home care and the related requirements. Even if your loved one didn’t qualify for Medicaid before, it’s worth rechecking their eligibility since income limits for nursing home care have increased over the years.

A future stay in a nursing home isn’t just difficult for your senior loved one, but it can also be overwhelming for you. Take a step back and reflect on your decisions so far. Discuss it with your loved one if you feel some things need to be changed. Let it all sink in, and maintain a positive and gentle attitude.

The last step is to finalize all the decisions made until this point. Everyone should be on the same page, including key family members and your senior loved one. Gather everyone for a meeting and go over the details. This is the time to plan on how you can work together and delegate responsibilities before, during, and after your loved one’s transition to a nursing home. Lastly, have regular meetings in case of updates or changes.

A common concern for seniors is protecting their assets after a spouse is admitted into a nursing home. Below are some ways to protect your assets from nursing home costs:

Long-term care insurance coverage will help senior couples cover the expenses of a spouse living in a nursing home. However, long-term care insurance costs have significantly increased over the years. Many are apprehensive about this option since they may never use it if they don’t go into a nursing home. 

A Medicaid-compliant annuity is ideal when the other spousal half isn’t admitted into a nursing home. Purchasing a Medicaid-compliant annuity is one way to “spend down” and shrink your resources enough to qualify for Medicaid. Essentially, the healthy spouse will receive monthly payments from the annuity while the other spouse will receive nursing home care subsidized by Medicaid.

Drafting a life estate enables seniors to give property ownership to a spouse legally. In contrast, the other spouse becomes the “remainderman” – the person listed on the deed as inheritor upon the legal death of the property owner. A life estate protects the property from any state government seizure.

An irrevocable trust is a legal entity where seniors can shelter their assets and assign a trustee. It’s a viable option since wealth and assets put in a trust don’t count toward Medical qualification. However, this arrangement doesn’t allow you to make any changes or cancel the trust except under a few circumstances. Assets placed in a trust are no longer yours, and you must assign an independent trustee.