When it comes time for families to consider placing a loved one in a nursing home or assisted living facility, there are a lot of factors to consider. Where is it located? Who is in charge? What sorts of activities does the nursing home offer?
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You’ll need to investigate these types of questions to find the right fit for your loved one.
Our guide can walk you through what nursing homes are, why we need them, who lives in them and how much they cost.
What Is a Nursing Home?
In general, nursing homes are long-term care facilities that provide a wide range of services and care. More specifically, these facilities are often divided into two categories: nursing homes and skilled nursing facilities.
— Nursing homes. Nursing homes provide assistance with one or more activities of daily living, such as eating, preparing meals, bathing, dressing, going to the toilet and managing medications.
— Skilled nursing facilities. These facilities, on the other hand, provide specialized services, such as physical or occupational therapy, and care from licensed professionals.
The two terms are often used interchangeably or under the umbrella of “nursing home,” even though they offer slightly different services.
These facilities also play a critical role in ensuring care is available to those who need it — and many Americans do.
“More than 1.4 million people live in over 15,500 Medicare- and Medicaid-certified nursing homes across the nation,” says Dr. Michael Tehrani, a geriatric physician and founder and CEO of MedWell Medical in Long Beach, California.
In addition, the Centers for Disease Control and Prevention reported that, in 2018, there were 1.7 million beds in licensed nursing homes in the United States.
[SEE: Nursing Home Red Flags You Should Watch Out For]
Who Lives in Nursing Homes?
It’s a common misconception that nursing homes and skilled nursing facilities care only for the elderly.
In its May 2022 report, the National Center for Health Statistics noted that the majority of long-term care service users were age 65 or older, with 83.1% of nursing home residents being in that older age bracket. That means 16.9% of residents were younger than age 65 — a sizable minority.
Those younger residents (and some of the older residents) may not be planning to stay in a facility for the duration of their lives; rather, they may need rehabilitative care after a surgical procedure or injury. Some younger people with certain disabilities that require constant care, such as severe developmental disabilities, may also live in a skilled nursing facility.
This means that inside every facility, some patients can be quite sick, while others may need less intensive care, says Dr. Tanya Gure, section chief of geriatrics at the Ohio State University Wexner Medical Center in Columbus. Some patients may be nearing the end of their lives, and others may be residing there temporarily after a hospital stay to recuperate before going home.
These differences in nursing home populations and their myriad needs aren’t always discussed.
“There is some misperception about nursing homes,” Gure says. “Some of it is based on an antiquated image. I just want to emphasize that these facilities serve a huge variety of patients and can be a critically important resource.”
Let’s take a closer look at the breakdown in residents and their care needs.
Medical conditions
Residents in nursing homes typically have at least one chronic condition for which they need some ongoing medical care. According to the NCHS report, arthritis affected 27.6% of nursing home residents, and heart disease affected 20.1%. About 34% of residents had diabetes, and 76.9% had hypertension. Depression was also common, with 48.8% of nursing home residents having this diagnosis.
While some people may assume that nursing home residents all have cognitive difficulties, such as Alzheimer’s disease or other forms of dementia, that’s not the case. Just less than half — 49.1% — of nursing home residents had a diagnosis of Alzheimer’s disease or another form of dementia, the NCHS reports. The prevalence of Alzheimer’s disease or dementia, however, was higher in long-stay residents (57.6%) versus short-stay residents (35.8%).
Nursing home residents’ cognitive impairments require appropriate resources and care, which is why some people move into a nursing home. Safety can also be a big factor for seniors aging in place at home, and that may mean it’s time to move from home care to a nursing home.
Likewise, some residents have also experienced falls or other injuries that have necessitated more intensive care. The NCHS reports that some 19% of long-term nursing home residents had experienced a fall.
A 2018 study that looked at population data from the National Vital Statistics System, the Web-based Injury Statistics Query and Reporting System, and the Medicare Current Beneficiaries Survey estimated that non-fatal falls led to about $50 billion in total medical costs.
[READ: How to Choose a Nursing Home: Qualities to Look For.]
Gender and ethnicity
More women reside in nursing homes than men. Roughly 59% of short-stay residents and 66.6% of long-stay residents were women, the NCHS reports. Additionally, the report notes, non-Hispanic white people accounted for 73.9% of nursing home residents.
“The racial/ethnic mix depends on the community,” Gure explains. “More urban areas have a more racial and ethnic mix.”
Gure says that variation in nursing home residents’ ethnic backgrounds is, in part, related to cultural differences and a lack of providers who speak the language or can cook the cuisine. Some cultures also place a big emphasis on families caring for their elders at home.
“That’s been changing over the years, and now more different types of patients are moving into nursing homes,” Gure adds.
How Long Is the Average Stay in a Nursing Home?
Because of the wide variability of care needs across such a diverse population, it can be difficult to determine how long you’ll need care in a nursing home. However, the Administration on Aging reports that women on average need long-term care services and support for 3.7 years, while men average 2.2. years. About 20% of people age 65 will need long-term care support for longer than five years, the AOA notes. Approximately one-third of people the same age won’t need support at all.
Those figures include all kinds of long-term care, including assisted living. For nursing homes specifically, the average stay is one year, and about 35% of people use that type of care, according to the AOA.
Because aging in America can be a socially isolating experience, Gure routinely talks with her patients about their plans for the future, especially if they’re about to undergo an elective surgical procedure or foresee that they might need extra short-term care at some point.
“This is a resource they can utilize so that when they go back home, they are more capable of facing what they find there,” she says.
[Read: 24 Gift Ideas for Nursing Home Residents.]
Costs and Paying for a Nursing Home
Another popular misconception is that Medicare, the federal health insurance program for people ages 65 and older, pays for residency in a long-term care facility. In fact, Medicare only pays for the first 100 days in a nursing home or skilled nursing facility, and only if certain criteria are met, according to experts. For instance, the patient must have been hospitalized for at least three consecutive days before transferring to the nursing home.
“Medicare will pay for the first 20 days of care in a skilled nursing facility at 100% coverage,” notes Diane J. Omdahl, Wisconsin-based president and co-founder of the Medicare consulting firm 65 Incorporated.
For days 21 to 100, there is a daily copayment, which in 2024 is $204 per day. When you get to day 101, Medicare coverage ends and other forms of payment need to be in place. The coverage rules for Medicare Advantage plans are different, so check your specific coverage plan for details.
Because Medicare doesn’t pay for long-term care, people who need nursing home care must pay privately. Finding a way to pay for long-term care can be a big problem for many people, especially given the high costs associated with such care.
According to Genworth Financial’s 2021 Cost of Care survey (the most recent data available), the median monthly cost of skilled nursing in a private room at a nursing home will set you back $108,405 per year, versus just over $94,000 for a semi-private room. But prices can vary a lot depending on where in the country the community is located and which services a senior is using.
For example, Genworth reports that Alaska, Connecticut and Hawaii have the highest daily costs for private nursing homes at $1,036, $499 and $464 per day, respectively. In Alaska, that adds up to a whopping $378,140 per year.
At the other end of the spectrum, Oklahoma, Louisiana and Missouri are the least expensive areas, with per-day private room costs of $200, $199 and $195, respectively. The annual total is between $71,175 and $73,000 per year in those states.
Long-term care insurance policies may be another option to pay for nursing home care, but these policies can be prohibitively costly for many. In most cases, people pay out of pocket until their resources are used up, at which point Medicaid, a joint federal and state program providing coverage to low-income individuals, kicks in to cover costs. In fact, Medicaid is the payment source for the majority of nursing home residents, with 62% using this means, according to the NCHS. But the rules vary from state to state, so it’s important to talk with an advisor to understand your options.
How COVID-19 Affected Nursing Homes
The coronavirus pandemic that started in spring 2020 has had a severe impact on nursing homes.
The Centers for Medicare and Medicaid Services reported that, as of mid-September 2023, there have been more than 1.73 million confirmed COVID-19 cases among residents of nursing homes and more than 1.7 million confirmed COVID-19 cases among the staff of nursing homes. Around 168,150 residents of nursing homes have died of COVID-19.
“People who live in nursing homes are usually the frailest because they are typically elderly with multiple advanced chronic conditions,” Tehrani explains. “The smallest challenges will have the biggest effect on them because their immune system is very compromised to begin with.”
In addition, the close contact with others that occurs in congregate care settings like nursing homes and skilled nursing facilities means that any infectious disease has a good chance of moving through the population quickly.
In an effort to curb transmission, many facilities severely restricted visitation by loved ones, which created a series of added complications and increased feelings of isolation for those residing in nursing homes.
Cal Stein, a partner at Troutman Pepper in Boston, says that the pandemic also forced massive changes on facilities; they had to adjust operations to “harmonize” their practices with “the regulations and guidance that focuses on prevention, with the practical capabilities of the facility, the staff and the residents.”
While the rules enacted at the height of the pandemic were intended to keep residents and staff safe, they weren’t universally adoptable, which created potential liability for some facilities.
The fallout from this difficult period continues as the pandemic lingers. One study of the COVID-19 outbreak and response in Connecticut found that the prevalence of symptoms of depression increased by 15% among residents right after the peak of the COVID-19 outbreak. Some facilities have been sued for negligence by grieving families who lost loved ones during the pandemic.
For their part, many of the defendants in such suits pointed to a patchwork of state-based laws that shield nursing homes from liability during certain public health crises like the COVID-19 pandemic. But many suits are still working their way through the courts.
All of this has put pressure on nursing homes, many of which have been left short-staffed because of the pandemic and subsequent societal changes. A 2021 survey from the American Health Care Association and the National Center for Assisted Living found that 94% of nursing homes faced staffing shortages. The Consumer Voice noted that “staffing standards in almost every state remain severely low.” KFF reported that as of March 2022, “one in four nursing homes nationally reported a shortage of at least one type of staff.”
The shortage is so concerning that in September 2023, the Biden administration announced reforms to improve the safety and quality of nursing home care that includes mandates for adequate staffing levels.
It’s not over yet. As of late November 2023, COVID-19 cases were climbing again, in line with seasonal increases of other respiratory infections, such as colds and the flu. When COVID numbers rise, it could impact whether families are able to visit loved ones in nursing homes in person.
“Some families might have to go back to virtual visiting and impose strict guidelines like social distancing,” Tehrani says.
If you’re looking for a nursing home or a long-term care facility for a loved one now or if you will in the near future, take care to do some extra diligence to ask about their procedures and policies regarding infection control and how staff are working to keep residents safe from COVID-19 and other contagious diseases, such as pneumonia. Tehrani also recommends asking how the facility handles medical emergencies.
The CMS’ COVID-19 Nursing Home Data site offers more data and information about how nursing homes are navigating this crisis.
U.S. News’ Best Nursing Homes
As you’re looking at nursing homes, also consider U.S. News’ Best Nursing Homes ratings. For 2024, U.S. News evaluated more than 15,000 nursing homes on several indicators of quality, including:
— Patient and resident outcomes, such as infection rates.
— Staffing levels.
— Reliance on antipsychotic drugs.
— Health inspection results.
Among the findings were three statistics of note:
— Of the nursing homes assessed, 436 consistently (on 20% or more days) failed to meet current federal requirements mandating that a registered nurse be available for at least eight hours a day, seven days a week.
— Only 701 nursing homes (fewer than 5%) met both existing requirements and the more stringent staffing requirements proposed by the Biden administration.
— Among 22% of nursing homes, at least 1 in 4 residents received antipsychotic drugs. Government investigators have concluded that some nursing homes use antipsychotics and related drugs inappropriately, putting nursing home residents at risk.
U.S. News ratings appear in two categories: short-term rehabilitation and long-term care. You can search by location to find the closest, highest-performing nursing homes near you.
More from U.S. News
The Best Gift Ideas for Nursing Home Residents
Best Exercises for Preventing Falls in Older Adults
The Best and Most Unique Nursing Home Activities for Seniors
Nursing Home Statistics: What to Know in 2023
originally appeared on usnews.com
Update 11/30/23: This story was previously published at an earlier date and has been updated with new information.
