Differences in Assisting Living and Nursing Homes

When it is no longer possible for elderly people to live independently, many families have to choose a live-in facility wher their aging family member will be cared for. The numerous options available as a rule can be divided into one of two categories: either assisted living facilities or nursing homes. Selecting the right care facility can make the difference in happiness, vigor and life duration of elderly members of the family.

Two Types of Live-In Facilities
The major distinctions between assisted living facilities and nursing homes are the following:

• Assisted living institutions value and encourage independence of their residents.
• Nursing homes provide much more medical care than assisted living.

Although these distinctions may seem rather clear, the decision on where to accomodate an elderly person is far less so, especially as age and health affect capabilities of an elderly person.

Nursing Homes

Nursing homes put more emphasis on rehabilitating residents and getting them back into the community. As a rule, they provide a private or shared room with a private or shared bathroom. In some of them couples are allowed to stay together. However, here the emphasis is put on patient care, which is why the general atmosphere has precluded much privacy or a sense of "home".

Nevertheless, there is a growing tendency to make some Nursing Home living arrangements more homelike. For instance, it can be achieved by using natural fibers and lighting, or by creative architectural design.

One more great change that is beginning to appear is in nurse's stations. A Skilled Nursing Facility nurse’s station, which used to be centralized for efficiency, can now resemble a reception area where residents and medical staff can easily interact.

The level of medical care in Nursing Homes is slightly below that of a hospital. However, although these care facilities do not provide surgery, they are arranged to give intensive, constant medical attention.

Because nursing homes still are much like hospitals, they are usually not seen as attractive residences to spend long periods of time. People with better health try to avoid them as developing options allow, and seniors who stay in nursing homes are in worse health conidtion than those in the past. Thus, in 1977, 30 percent of nursing homes residents were able to dress themselves; whereas by 1999 only 13 percent could.

Very often people are relying on nursing homes for short-term acute care after hospitalizations instead of staying in them for years. As a rule, the length of stay in nursing homes is about half what it used to be in 1996.

However, the number of nursing homes residents is gradually decreasing because more and more options become available for old people who need to be assisted. The institutions of assisted living offer elderly people who need a little help, but can care for themselves, a very nice alternative to moving into a nursing home.

Assisted Living Facilities

Assisted living is established to serve the needs of people who need assistance with general daily activities such as bathing, dressing, and cleaning up, rather then people who need constant nursing care.

In addition, assisted living institutions pay greater attention to personal privacy then most nursing homes.

Residents of assisted living facilities are usually more independent and capable. They are capable of taing part and enjoying everyday activities, as a rule with no assistance at all.

However, the definition of assisted living is unclear, and many people think that it's nothing more than a euphemism for a nursing home. Although there are some generally accepted differences, assisted living has no standard model. That is the reason why looking for a place for seniors to live can be a confusing experience.

Thus, an assisted living settlement could be a trailer in the back of somebody's yard or 600 apartments in a glistening tower in downtown New York, which proves how greately definitions and laws differ from state to state.

The following factors are important pieces of information that families with elderly members should take into consideration as they choose between assisted living facilities and nursing homes:

1. Assisted living facilitieshave no legal right to give medical care to their residents. A family is considered responsible for making sure residents are getting the medical care they need. Thus, even if an elderly person doesn't need extensive medical care now, in case (s)he will in the nearest future, a nursing home may be a better option to consider.
2. It is essential for an elderly person to go through a thorough physical and mental health exam before choosing a live-in facility. The early symptoms of potentially devastating conditions, such as Alzheimer’s, can be identified, and it may require the medical care that only a nursing home offers.
3. Some extra services are usually offered by assisted living facilities , and most of them are charged extra for. Such services as assisting residents in dressing, eating, bathing, etc., are also provided at assisted living residences, but for an extra fee. The more help an elderly person needs, the more expensive his cost of care will be in assisted living facility, and in all likelihood he should be housed at a nursing home.

 

Compared results from National Nursing Home Survey and from an industry-sponsored survey of the assisted living

A recent survey carried out in 2004 (National Nursing Home Survey) and from an industry-sponsored survey of the assisted living gives some important information about the difference between these two settings. Compared results from these surveys reveal the ways in which these two types of services are intersecting and ways in which they still differ.

It has been revealed that the demographic characteristics of the resident populations being served in assisted living and nursing home settings are surprisingly similar. Nearly 76 percent of both of them are women, the medialage is about the same, and residents being served at assisted living settings are to a certain degree more likely to be widowed. However, when it came to primary source of payment, the differences turned out to be stark. Medicaid payments were received by 69 percent of long-stay elderly people staying in nursing homes compared to only 8 percent of assisted living residents. The industry survey has shown that an average income of assisted living residents amounted only to $15,688, so many of these residents are very close to Medicaid eligibility despite the fact that they and their families are the primary payers.

Differences and similarities between people living in these two types of institutions are also indicated by measures of functional disability and types of diagnoses.When measuring the number of disabilities in activities of daily living, nursing home residents of long–stay are distinctly more disabled with an average of four limitations compared to two among assisted living populations.     However, the residents look markedly similar when the percentages with specific physical and mental health diagnoses are compared. Although heart disease and stroke are more typical of nursing home residents than of assisted living residents, they both have about the same percentages of residents with diabetes and pulmonary disease. As for cognitive and mental health diagnoses, both types of institutions have roughly the same percentage with depression. Nevertheless, the percentages of mental diseases are higher among the populations living in nursing homes.

The dementia data for both surveys underevalues the total number of cases of dementia in assisted living and nursing homes. Most other surveys show that half or more of people residing in both types of care institutions have various forms of dementia.  For instance, a federal data base called OSCAR reveals that as much as 46.4% of nursing home residents had dementia in June 2007. 

Paying For Assisted Living

1. Individual Private Pay

Individuals may use their private money sources to pay for the accomodation and services provided in assistant living facilities. Depending on residences, charges can range from one thousand to several thousand dollars per month.

2. Supplement Security Income

For seniors that qualify based on income and rpoperty, Congregate Care Level III Supplement Security Income will pay for the services of open rate adult home and enriched housing program. Some providers, but not all, accept Supplement Security Income as payment fully.

There are several aging-in-place programs in various types of assisted living facilities. Some residences have the license which gives tehm the right to operate an Assisted Living Program, which gives Medicaid funding for eligible individuals that would otherwise live in a nursing home. Residents of Enhanced and Special Needs Assisted Living facilities have only two payment alternatives: their personal savings and a long term care insurance policy.

3. Long Term Care Insurance

As a rule, most long term care insurance policies have an assisted living benefit, either directly or through a home health care payment. These policies differ as to the amount of coverage, and the conditions that the policy holder is obliged to meet in order to access the benefit.

 

Paying For Nursing Homes

Residents of nursing homes are eligible to private insurance and Medicare payment for nursing home care only for limited periods of time after a hospital stay.

• An elderly person must have been hospitalized for at least 3 days.
• An elderly person must go to the nursing home within 30 days of the hospitalization.
• Only the first 20 days are fully covered by the insurance; after that there is a daily deductible.
• There’s a hundred day limit related to anyone hospital stay and diagnosis.
• An elderly person must be making a regular progress, documented by medical staff.  If there is no progress, insurance coverage ends.

 

References

Redfoot, D. (2007). How Do the Residents in Assisted Living and Nursing Homes Compare?

Center for Excellence in Assisted Living. Retrieved 19 December, 2008 from http://www.theceal.org/column.php?ID=16

Brustein, J. (2006). Nursing Homes And Alternatives. Retrieved 19 December, 2008 from

http://www.gothamgazette.com/article/issueoftheweek/20060529/200/1870

 

Nursing Homes: Skilled Nursing Facilities. Retrieved 19 December, 2008 from

http://www.helpguide.org/elder/nursing_homes_skilled_nursing_facilities.htm