Nursing Home Services and Costs

Nursing homes provide services to residents who need skilled services but do not require hospitalization. Nursing homes often provide both short term rehabilitation stays for residents recovering from illness, surgery or accidents as well as long term care for seniors with more serious medical needs. Learn more about services provided by nursing homes

What Are Nursing Homes?

A nursing home is a place of residence for individuals who cannot adequately care for themselves yet do not require hospital-level care.(1) Skilled nursing facilities — also known as convalescent care facilities, long-term care facilities and congregate living health facilities — provide a standard of care that undoubtedly exceeds the government's definition.

Nursing homes vary in terms of cost, appearance, and services offered. Some nursing homes are state-funded, while others are privately operated. Short-term nursing care is offered for patients who recently underwent surgery, are recovering from an acute illness or injury, or who need rehabilitation services. Similarly, long-term nursing care is offered for individuals who live with a chronic illness, terminal condition or cognitive disorder. Typically, individuals with chronic illnesses will permanently remain in nursing homes, where they have immediate access to the level of care that they need.

A nursing home's appearance is often dependent on the type of care it offers. Nursing homes that provide medical care to recovering patients are designed to match the individual's needs. These homes may be set up like hospitals, with nursing stations on each floor and providing various types of therapy. Physical, occupational and speech therapy are services that are often included in these facilities. Facilities that cater to long-term residents have a homier atmosphere and are generally less restrictive in their day-to-day schedules. Residents are more than welcome to use kitchens and other facilities of the home. Additionally, staff members are highly encouraged to develop relationships with the residents.

Memory care facilities specifically house individuals with Alzheimer’s disease or dementia. Although these homes typically house the elderly, memory care facilities are open to individuals of all ages. Many nursing facilities allow friends, relatives, and couples to share a room as well.

Nursing Home Regulations

Before 1986, state law alone governed nursing homes. However, after the Institute of Medicine issued a report on the quality of nursing homes in the U.S., it was evident that many residents were dissatisfied with the quality of care that they received. States were doing a poor job of regulating long-term care facilities, which led to the Nursing Home Reform Act the following year.

Congress enacted the Nursing Home Reform Act in 1987. The Nursing Home Reform Act set new provisions for facilities that wish to participate in Medicare and Medicaid programs. This act raised the standards for care in the nursing home setting, tremendously. Today, both state and federal laws govern nursing home facilities.

Per the Nursing Home Reform Act, all convalescent care facilities must offer services and activities designed to help residents attain or maintain the highest practicable mental, physical and psycho-social well-being.(2) Prior to enrollment in a nursing facility, the resident must undergo an initial comprehensive assessment to determine their functional capacity. Subsequently, the facility must develop a care plan designed to ensure the resident's well being as well as providing opportunities for improvement. The care plan also includes methods geared towards preventing further deterioration of the resident's ability to dress, ambulate, bathe, groom, eat, toilet and communicate.

Each nursing facility will provide services that resonate differently for every resident. However, long-term care facilities must offer the following:

• Nursing and Related Services: The goal of a nursing home is to ensure patient safety and comfort. Staff accomplish this by performing ongoing palliative and preventative care.
• Rehabilitative Services: Long-term care facilities offer specialized rehabilitative services including speech, occupational, physical, respiratory, cognitive and vocational therapy.
• Medically Related Social Services: Nursing home staff provide medically related services, including treatment for medical conditions and medication management.
• Individualized Dietary Services: The meals in convalescent homes must meet the daily nutritional requirements and the unique dietary needs of each resident.
• Professional Directed Program of Activities: Nursing home residents are privy to an ongoing program of activities that are directed by a qualified professional. These activities must peak the interests of each resident while working to advance their mental, physical and psycho-social well being.
• Emergency and Routine Dental Services: When residents require dental care, the nursing home must accommodate their needs.
• Pharmaceutical Services: Staff members are responsible for accurately acquiring, dispensing and administering all drugs and biologicals to all residents.
• Room and Bed Maintenance: Residents have the right to a clean and well-kept room.
• Personal Hygiene Services: If a resident is unable to bathe, dress, groom or perform other basic personal care services for themselves, the nursing home staff must provide the necessary assistance.

General Services Offered

When searching for a nursing home for you or your loved one, you’ll discover that the services offered will vary greatly. However, some services are more standard than others. Those include the following:

• Activities of Daily Living (ADL) / Instrumental Activities of Daily Living (IADL):
  • Bathing and showering
  • Dressing
  • Continence
  • Toileting
  • Functional mobility
  • Self-feeding
• Meals: While nursing homes encourage residents to feed themselves, they prepare all meals for their residents.
• Housekeeping: Staff keep the facilities clean and take over home care services, such as laundering.
• Wellness Programs: Wellness programs are designed to promote physical activity and interacting socially with other residents. Wellness programs include tai chi, yoga and balance and fall prevention.
• Organized Activities: Nursing homes plan organized activities around seniors’ interests and capabilities. These activities include but are not limited to ice-cream socials, musical events, board games, holiday programs, and sensory stimulation.
• Religious and Lifestyle Services: Religious services may include visits from religious leaders, bereavement support, end of life matters, regular faith services and religious-related field trips.

Specific Nursing Home Services

If you or your loved one require more individualized care, consider a long-term care facility. Long-term care facilities provide more specialized services, such as the following:

• 24-Hour Medical Care: Many nursing homes typically provide 24-hour supervision and care to residents.
• Registered, Licensed Practical Nurses and Certified Nursing Assistants: Nursing homes staff certified nursing and medical providers to accommodate the needs of residents.
• Physical Therapy: Physical therapy is offered for residents who broke bones, underwent surgery or are recovering from another physical ailment.
• Occupational Therapy: Occupational therapy can help residents develop function as well as enhance their sense of competency and personal happiness(3).
• Respiratory Therapy: Respiratory therapy can improve the outcomes for residents with pneumonia, asthma, lung trauma, emphysema, and other lung diagnoses.
• Speech Therapy: Speech therapists in skilled nursing homes may concentrate on literacy, articulation, and stuttering. However, speech therapists can shift their focus to swallowing and memory problems if the resident requires those specialized services.
• Rehabilitation: Rehabilitation is geared toward residents who need short-term recovery services until they can once again care for themselves.
• Dietitians: Dietitians are responsible for food sanitation, food handling, service procedures, and equipment. Additionally, dietitians create unique care plans aimed to minimize nutritional complications in each resident.
• Dental Services: Per federal law, residents in all nursing homes should have access to emergency and standard dental care.
• Laboratory Services: Some nursing homes have in-house lab services to conduct blood tests. Lab services include metabolic profiles, CBCs and protein levels.

Is a Nursing Home Right for Your Family?

There are several types of continuing care retirement communities (CCRCs) that offer more comprehensive care and treatment than others. Nursing home residents require more extensive care than residents of other types of CCRCs, such as assisted living facilities and residential care communities. Before you or your loved one make the transition, you first need to decide if a nursing home is a good fit.

Nursing Home Vs. Assisted Living

Assisted living communities provide assistance with ADLs, limited supervision and some medical care. However, they do not provide skilled nursing care, 24-hour supervision or extensive medical care, as many nursing homes do(4). Similar to nursing homes, assisted living communities offer planned activities, laundry and housekeeping services, meals, transportation, exercise, and wellness programs.

Nursing Home Vs. Skilled Nursing

Nursing homes and skilled nursing homes are not the same. Nursing homes generally provide more basic personal care services to long-term residents, while skilled nursing homes offer more extensive, rehabilitation services. The goal of a skilled nursing facility is to improve the resident's short-term condition until they can transition back into their own home.

Nursing Home Vs. Residential Care Homes

Residential care homes cater to individuals who live in a residential setting rather than in their own home. Residential care homes usually offer more personalized services compared to an assisted living or nursing facility. However, like assisted living communities, these types of homes focus more on helping residents with their ADLs and enriching their lives than they do on medical care or rehabilitation.

When Do You Need a Nursing Home?

You may be struggling with the decision to transfer you or your loved one to a nursing facility. However, if it’s something you are thinking about, the transition may be necessary. Signs that you or your loved one may be ready to move into a nursing home include but are not limited to the following:

• Needs 24-hour medical care and/or supervision
• Requires rehabilitation
• Experiences frequent falls or trips
• Necessitates frequent care from a specialist
• Experiences significant changes in wellness and/or behavior
• Needs help with dressing, bathing, showering, continence, toileting, eating and/or mobility
• Isolates him or herself
• Manages medications on his or her own poorly or incorrectly
• Maintains a pantry that contains little to no nutritional food
• Requires assistance to buy groceries – can’t do it on his or her own
• Eats foods that adversely interact with his or her medications
• Shows signs of memory loss, such as the inability to recognize friends or loved ones, repeating conversations or being unable to converse
• Exhibits limited interest in caring for the home – it is in constant disarray, electrical and HVAC systems are beginning to act up and/or you notice his or her pets are malnourished

How Much Will A Skilled Nursing Facility Cost?

Nursing homes provide such a high level of care, which results in a high monthly fee to match. In fact, the average monthly cost is double that of an assisted living facility. The average monthly fee for a semi-private room is $7,604, while the average for a private room is $8,517 However, it’s important to note that costs vary by region(5). For instance, Oklahoma boasts the lowest average, at $4,867 per month for a semi-private room and $5,627 for a private room. Alaska features the highest average, at $30,219 per month for both a semi-private and private room(6). To get a more accurate idea of what you can expect to pay for nursing home care for your aging loved one, use our Senior Living Cost Index(7).

How To Pay for Nursing Home Care

When you realize that nursing home care is in your or your loved one’s near future, it is advised that you discuss financing as soon as possible. At A Place For Mom, our Senior Living Advisors are prepared to help you explore your options and choose the one that works for you:

• Medicare & Medicaid: Though Medicare will cover major hospital care for all individuals over the age of 65, it will only provide up to 100 days of coverage for nursing care(8). However, to qualify for Medicare, you or your loved one must have been referred by a doctor upon discharge from the hospital. Medicaid is available for low-income individuals or families that have already exhausted all of their assets in paying for nursing home care. Medicaid laws and eligibility requirements vary greatly from state to state.
• Program of All-Inclusive Care for the Elderly: PACE is a program designed to help those who require skilled nursing care services meet their health care needs within their community. To qualify for PACE, an individual must be 55 years of age or older, live in a PACE community and require nursing home-level care(9).
• State Health Insurance Program: SHIP is a state program that receives federal funding to provide free health coverage counseling to local residents with Medicare(10).
• Social Security Disability Income: To qualify for SSDI, you or your loved one must be over 65 years old and have a severe qualifying disability as defined by the Social Security Administration.
• Aid and Attendance Benefits: If you or your loved one qualify for the VA Pension, they also qualify for A&A benefits. These benefits will be received in addition to the Pension. To qualify, you or your loved one must require the assistance of another person to perform ADLs, be bedridden, be a patient in a nursing home or have limited eyesight(11).
• Private Pay: Private pay is the most straightforward way to pay for nursing home costs. Many families pull from their savings and annuities and contribute a portion of their income to long-term care costs.
• Life Insurance: If your loved one has a permanent or whole life insurance policy, discuss the possibility of borrowing against it. Doing so would mean borrowing against the death benefit. The insurance company would use the policy as collateral until the loan is paid off(12).
• Home Equity: If your elderly parent’s home has positive equity, consider selling the home or taking out a reverse mortgage. You may also want to discuss the option of using the home as a rental property.
• Long-Term Care Insurance: Long-term care insurance covers the cost of support services in a variety of settings, including your home, a nursing home facility or a community organization(13).

Your Nursing Home Checklist

Enrolling yourself or your loved one into a nursing home isn’t as simple as enrolling in an independent or assisted living community. Applying for a spot in a nursing home can be tricky. With the A Place For Mom’s checklist(14), you can ensure that you have everything in place to make the transition into a congregate living health facility:

• A physician’s Order for Admission to a Skilled Nursing Facility
• A physician’s Order for Medications and Treatment
• Medical history and physical
• State-required form
• Negative tuberculosis test chest X-ray
• Completed admissions paperwork
• Completed financial assessment

How To Choose a Nursing Home

To ensure the continued well being and safety of you or your loved one, you must take the time to find a quality facility. One of the best places to start is by asking your doctor for recommendations and by teaming up with one of A Place For Mom’s Senior Living Advisors.

Once you’ve narrowed down your options, consider what is most important to you or your loved one. Is it physical therapy, nursing care, meals, a religious connection, special care units for dementia patients or hospice care? Identifying your needs will help you narrow down your list even further.

Take your list and call each place on it. Ask questions about the number of residents, cost, wait lists, etc. Plan to visit each facility and to meet with the director and nursing director. Be mindful of indicators of quality of care, such as handicap access, Medicare and Medicaid certification, warm interaction between staff and residents, and residents who look well-cared for. Also, don’t be afraid to ask questions.

Questions To Ask During Your Visit

General

• Are you Medicare/Medicaid certified?
• Has your license ever been revoked?
• Are you currently accepting new patients?
• What is the patient to staff ratio?
• Do you conduct background checks on staff?
• Is transportation available?

Safety

• Is the place well-lit and are the exits clearly defined?
• Are there handrails and grab bars?
• What safety and security measures does the facility use?
• Is there a backup generator or alternate source of power in the event of a blackout?
• Does the floor plan make sense?

Quality of Care

• Does the place smell musty or dirty?
• Are the residents bathed and well-groomed?
• What are the staff interactions like?
• Do residents participate in the activities?
• Do the residents get the same daily caregivers?
• Is the food good and nutritious?

Quality of Life

• Are the residents’ rights posted?
• Do the staff knock before entering?
• Are doors shut while staff members help with dressing and bathing residents?
• Does the facility meet cultural, religious and language needs?
• Are there outdoor areas?
• Do residents have daily routine choices?
• Are personal items allowed?
• Are the staff nice?

Begin Your Nursing Home Search

The search for a suitable nursing home for you or your loved one can seem overwhelming at first. A Place For Mom Senior Living Advisors have helped hundreds of families through the process, and we’re excited for the opportunity to help you. A Place for Mom offers online resources, such as our directory, our database of reviews and ratings, and our personalized one-on-one advice. A Place for Mom will ensure that your search for a quality nursing home ends in success. Contact our team today to begin the process.

Sources:

(1)Nursing Homes. (2019, July 25). Retrieved from https://medlineplus.gov/nursinghomes.html.

(2)42 U.S. Code § 1395i–3 - Requirements for, and assuring quality of care in, skilled nursing facilities. (n.d.). Retrieved from https://www.law.cornell.edu/uscode/text/42/1395i-3.

(3)Living Life To Its Fullest™: Occupational Therapy in Skilled Nursing Facilities. (n.d.). Retrieved from https://www.aota.org/about-occupational-therapy/professionals/pa/articles/skilled-nursing-facilities.aspx.

(4)February 13, 2012. (2012, February 13). Search Tool for Caregivers Looking for Nearby Resources. Retrieved from https://www.aarp.org/caregiving/basics/info-2017/senior-housing-options-tool.html?intcmp=AE-CAR-BAS-EOA3.

(5)Cost of Long Term Care by State: 2019 Cost of Care Report. (n.d.). Retrieved from https://www.genworth.com/aging-and-you/finances/cost-of-care.html.

(6)Genworth Cost of Care (2019, June). Retrieved from https://pro.genworth.com/riiproweb/productinfo/pdf/298701.pdf

(7)How Much Does Senior Living Cost in Your Area? (n.d.). Retrieved from https://www.aplaceformom.com/planning-and-advice/senior-housing-101/senior-housing-costs/senior-living-cost-planner.

(8)SNF Care Coverage. (n.d.). Retrieved from https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care.

(9)PACE. (n.d.). Retrieved from https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/pace.

(10)State Health Insurance Assistance Program (SHIP) - HealthCare.gov Glossary. (n.d.). Retrieved from https://www.healthcare.gov/glossary/state-health-insurance-assistance-program/.

(11)Veterans Benefits Administration, & Office and Policy and Program Management. (n.d.). Pension. Retrieved from https://www.benefits.va.gov/pension/aid_attendance_housebound.asp.

(12)Investopedia. (2019, October 21). How Can I Borrow Money From My Life Insurance Policy? Retrieved from https://www.investopedia.com/ask/answers/111314/how-can-i-borrow-money-my-life-insurance-policy.asp.

(13)What is Long-term Care Insurance? (n.d.). Retrieved from https://longtermcare.acl.gov/costs-how-to-pay/what-is-long-term-care-insurance/.

(14)Nursing Home Checklist. (n.d.). Retrieved from https://www.aplaceformom.com/planning-and-advice/articles/nursing-home-checklist.