Many people don’t know the difference between Nursing Homes, Retirement Communities, Assisted Living, RBCFs, etc. They assume that when Mom or Dad get sick, they go to the nursing home. There was a time when that was the only option. Now you have a plethora of places to select from. Not all of them are appropriate, and only Nursing Homes are currently covered by Medicare. The others are covered either out-of-pocket or through reverse mortgage loans, or with Medicaid when the senior is classified as “poverty level”. It gets complicated with Medicaid/Medicare coverage and you can read more directly at Medicare’s site. Hopefully, this will change soon, because a majority of seniors who do need help, don’t need all of the services of a nursing home. I can tell you from personal experience, that there are big differences between them, and none of them were appropriate for my mom, or my dad unfortunately. You can read my article “There’s No Place Like Home” to read more.


It’s really difficult for anyone to relate to what you’re going through when it comes to senior care, unless they are going through it themselves. We can all empathize, but we cannot truly see the complexity of the experience. You’re not only talking about a physical move to another place, but the emotions that go along with it: guilt, anxiety, relief, confusion. It’s not that easy. And just like a new parent, such as myself, it’s alot like choosing daycare, only you’re sending your parents away to live somewhere away from you, and away from what they may have considered home for years.

When It’s Time
There are many reasons why people decide to send their parents to places outside the home. Here are a few:

• 24-hour care. You may be the only person, or you may have a family of your own. Either way, it can be physically impossible to provide the 24-hour assistance that your loved one may need.
• Your health is starting to get affected.
• Your loved one has violent outbursts or behavior that is dangerous to themselves or others.
• Wandering behavior
• Your loved one can’t do basic activities of daily living such as: hygiene, eating ,etc.

Type of Facility
Selecting a facility can be a long and arduous process, especially if you really have no idea what the difference is. Hopefully this list can help you get a better understanding of what each facility offers. Then, when you are ready to select one, you can go to a resource such as what I recommended in my article about “Searching for Senior Housing”, or speak to a professional at your local elder agency, or you can speak to the facility’s administrator directly.

Types:
• Assisted Living
• Continuing Retirement Communities
• Residential Care Facility
• Intermediate Care Facility
• Skilled Nursing Facility
• Special Care Units
• Psychiatric Locked Facilities

• Assisted Living Facilities- These types of facilities allow the senior to be fairly independent by providing apartment-style or dormitory style type living. These are best for relatively independent persons or in cases where the spouse and the impaired spouse want to stay together. This was the case, for my parents. Depending on the facility, there may be a simple kitchenette, like what you would find at a hotel.

  All of them have a main dining hall, or several dining halls and serve scheduled meals throughout the day. Sometimes the kitchen remains open if seniors just want to relax. There are even snack bars and convenience stores on site. There is transportation, recreation, 24-hour security, housekeeping and custodial services such as: bathing, dressing, eating, and toileting assistance. Sometimes, they may offer psychological and emotional behavioral therapies. It’s rare that an assisted living facility would offer skilled nursing care.

  Assisted Living is costly and depending on where your loved one lives, can range anywhere from $1000-3000 plus a month. One of the assisted living places we looked at had a cost of $8000/month.

• Continuing Care Retirement Communities
  These are good for a “one-shot” deal. They are also very expensive but can provide a guarantee of lifetime shelter for residents. They have housing for every stage. This is similar to where my sister’s mother-in-law lives. They have individual one-story homes with garages (where she is), and on the same campus, there is a dementia unit, assisted living, hospital and nursing facility.

  The way it works is, the residents can move from one type of housing to another as their needs change. Luckily for Betty, she is still strong and able to remain independent in her own home. You can find out more information about Continuing Care Retirement Communities at AARP’s website.

  
  

• Residential Care Facility
  These are also known as “board and care homes”. My parents also had a short stint at one of these. They are cheaper alternatives to traditional assisted living. Costs range from $1000-3000+/month. These homes are residential homes licensed by the state’s department of social services. These homes can be seen as a “home away from home”. It’s like a family setting. Each person has their own room or they share rooms for a cheaper price. There are no more than 6 people in a house, unless the board and care is a large facility with many rooms. But typically, a board and care may have 4-5 bedrooms. It’s a much more intimate atmosphere. These homes are appropriate for those who do not need skilled nursing services.

  Keep in mind that these are non-medical facilities. Residents are assisted with daily needs such as cleaning, bathing and eating. The downside to these would be similar to living at home where there may or may not be activities to do, unlike traditional assisted living where there are plenty of activities for seniors to do. These homes are not covered by Medicaid because they are not medical facilities. However, arrangements can be made with the owner or administrator to use monthly SSI payments to reimburse the facility.

• Intermediate Care Facility
  There are not too many of these. These type of homes offer assistance with bathing, dressing ,getting out of bed, and some provide nursing care. However, these homes do not provide 24-hour skilled nursing services. ICFs are not licensed to accept incontinent patients or those who are non-ambulatory. Generally, these are a little cheaper than Skilled Nursing Facilities.
• Skilled Nursing Facility
  These are also known as
  nursing homes, convalescent homes and rest homes. These provide 24-hour nursing care under the supervision of a Registered Nurse or a Licensed Vocational Nurse. Skilled Nursing Facilities are equipped to provide more extensive care, such as administering injections, monitoring blood pressure and caring for residents on ventilators. They also care for patients who require intravenous feeding. These facilities also provide custodial care. In addition, some other services may be offered such as: Physical Therapy, Speech Therapy and Occupational Therapy. This is the most expensive type of facility.

  Medicare only covers the medical services, not the custodial. It will pay 100% for Days 1-20 and from Days 21-100, the resident is responsible for about $100/day. They are either discharged or kept in the facility if the doctor approves and they feel the patient needs to stay for more rehabilitation. This co-pay is normally out of pocket until the patient’s assets are almost entirely exhausted. It is then that they are able to qualify for Medicaid (after reaching a certain income requirement) and pay for the rest of the services.

• Special Care Units
  These are type of units are for those who have Alzheimer’s disease/dementia. They are normally designated areas of Assisted Living or Skilled Nursing Facilities. Not all assisted living and skilled nursing facilities have SCUs. Special Care Units, like the one at the larger assisted facility my mom stayed at, had special staff and security measures for wanderers. We had to buzz in, whereas, other areas in the assisted living facility were open to other residents and the public. This also not certified for Medicaid and is very expensive.
• Psychiatric Locked Facilities
  These facilities provide 24-hour nursing care for those with violent, disruptive or wandering behaviors. Unlike Skilled Nursing, doors lock from the inside and have secured walking areas. In order to be placed here, voluntary consent must be set or a conservatorship must be obtained. State-administered psychiatric facilities may be fully or partially publicly funded.

Evaluating Care Facilities
As I said, this is a difficult decision to make. You really have to do your homework and visit many places, interview people, use a search agency and get personal referrals to see if a place will be right for your loved one. There are differences in philosophies of care, policies, preferences. For instance, some assisted living facilities, such as Silverado Living do not allow any kind of restraints on a patient. They feel it is both a safety hazard and a hindrance to rehabilitation. And unlike a skilled nursing facility, where medication is often prescribed for behavioral problems places like Silverado encourage behavioral therapies first before requesting the resident’s family to request medicine.

All of these places have an Ombudsman contact for any type of problem or violation that may occur. Many of these places, especially the larger ones, have Social Workers on-site as well as Geriatric Care Managers who can assist the families with long-term planning.

*credit Southern Caregiver Resource Center

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