The time may come when your elderly mother, father or other loved one cannot fully care for themselves. You’re not the only one asking, “Does my mom need assisted living, or a nursing home?”
These scenarios are common: Overall, 70% of people currently age 65 or older need some kind of long-term care, according to a U.S. Department of Health and Human Services report.
In order to understand the difference between assisted living communities and nursing homes, it’s important to note that “nursing home” is sometimes used as a broad term to encompass all types of elderly care. However, nursing home care, also called custodial care, is only one of the many available options.
Long-term care residences include:
— Assisted living communities.
— Skilled nursing facilities.
— Continuing care retirement communities.
Assisted living communities and nursing homes are two of the most common types of facilities for long-term care. It’s worth knowing the difference between the two well before the time comes to make a decision.
[READ: Assisted Living Checklist.]
What Is Assisted Living?
The main difference among the long-term care options, other than cost, is in the level of care each can provide, says Roxanne Sorensen, an aging life care specialist and owner of Elder Care Solutions of WNY in Buffalo, New York, a case management consultancy.
Assisted living is for seniors who can no longer safely live independently but don’t require much assistance with daily care. These residents can still take care of themselves, but they could use a hand with daily nonmedical needs and activities, including:
— Mobility, such as help getting up from a chair.
— Day-to-day housekeeping duties and chores.
— Social enrichment activities.
— Medication management.
— Transportation to medical appointments or stores.
Some assisted living residents have their own apartments, while others share a room. Residents typically have access to common areas like the dining room, gym and community rooms.
Most communities offer three meals a day for those who prefer not to cook, 24-hour supervision, security and housekeeping services. They also typically provide opportunities for socializing and recreational activities with other residents. Many assisted living communities even allow pets.
[READ: Understanding Assisted Living]
What Is a Nursing Home?
Nursing homes offer a higher level of daily care, security and supervision in comparison to an assisted living community. They may be the best choice for seniors who require long-term care to address their physical and/or emotional needs, including:
— Help with walking and mobility.
— Administration of oral medications.
Nursing homes are also more appropriate for seniors who need round-the-clock medical care for conditions such as dementia or the effects of a major stroke.
Although nursing home care is often confused with skilled nursing facilities, the purpose of an SNF is to accommodate a shorter-term stay, typically less than two months. SNF care requires the care of a licensed medical professional to provide skilled services, such as wound care, IV medication administration or catheter care. SNFs also have short-term rehabilitation services, such as physical, occupational and speech therapy.
Some people require nursing home care for only a short period, often after being in the hospital, and they go home once they recover. But most nursing home residents have physical or mental health conditions that require them to be cared for and supervised for the rest of their lives.
One crucial difference is in payment options. It’s important to sort out what Medicare and Medicaid will pay for regarding assisted living versus nursing home care.
[READ: Nursing Home Facts and Statistics.]
What Does Medicare Cover?
Medicare is a federal health insurance program for people age 65 and older, certain younger individuals with disabilities and people with end-stage renal disease. Medicare payment criteria for assisted living versus nursing home is essentially the same: Medicare does not cover senior care without a specific skilled nursing need, which encompasses most nursing home and assisted living facilities.
However, the original Medicare plan provides limited coverage for medically necessary skilled care at a nursing home or in your home. In addition, it provides coverage for short-term skilled care for an injury or illness, under certain conditions.
No version of Medicare, such as Medicare Advantage or Medigap, pays for assisted living. Most Medicare Advantage plans do not cover nursing home or custodial care.
Medicare and supplemental Medicare programs also cover some skilled nursing care at SNFs. To determine potential benefits, you’ll need to verify the plan’s Summary of Benefits or speak with an insurance broker for advice on which plan is right for you.
What Does Long-Term Care Insurance Cover?
To pay for assisted living, you can purchase a long-term care policy through a private insurance company.
The majority of long-term care insurance policies also allow you to use them to pay for:
— Adult daycare.
— Hospice care.
— Memory care.
— Nursing home care.
Many people purchase long-term care insurance between the age range of mid-50 and mid-60s. Insurance companies typically screen individuals for eligibility. Each policy has its own eligibility criteria, Sorensen adds.
“There are policies that require a full medical exam and may even want to review your medical records,” Sorensen says. “Other policies may only do a phone interview and do a prescription check to see what medications the person is taking.”
Some insurers may check with the Medical Information Bureau, which maintains a database of medical and nonmedical information (such as dangerous hobbies) that its member insurance companies use to try to mitigate risk and lower costs. Such a check may show if you’ve been turned down for any other policies.
Conditions that may preclude someone from being eligible for a policy include:
— Oxygen therapy use.
— Wheelchair dependency.
— Knee or hip replacements.
— Use of a cane.
Average annual premiums could range from $2,220 for a single man who’s 55 to $3,700 a year for a 55-year-old single woman with health issues, according to AARP. Couples who purchase this kind of insurance pay less per individual.
What Does Medicaid Cover?
Medicaid is a federal program, funded jointly by states and the federal government, that provides health coverage to nearly 85 million people, including:
— Low-income adults.
— Pregnant women.
— Elderly adults.
— People with disabilities.
Some assisted living facilities do not accept Medicaid and are private pay only, says Howard S. Krooks, an elder law attorney practicing in Florida, New York and Pennsylvania with the AmLaw 100 firm Cozen O’Connor. He currently serves as chair of the Florida Bar Elder Law Section, is a past president of the National Academy of Elder Law Attorneys and a past chair of the New York State Bar Association Elder Law Section.
Medicaid, on the other hand, does cover nursing home care because states are required to do so under federal law. That is often the only way some can cover the cost.
“It is so prohibitively expensive” to live in a nursing home, Krooks says. “I have found over the last 10 to 20 years that fewer people are able to afford that level of care,” which he notes can cost up to $12,000 a month in Florida and $17,000 a month in New York. “With costs continuing to escalate year after year, it is crucial to have a plan in place to meet your long-term care needs.”
When it comes to long-term care facilities, the National Institute on Aging identifies two alternative options:
— Board and care homes. Known as residential care facilities or group homes, these are small homes of 20 or fewer residents living in shared or private rooms. Like assisted living communities, these homes can provide personal care and meals but not nursing or medical care.
— Continuing care retirement communities. Sometimes called life care communities, CCRCs offer different levels of service, such as independent housing, assisted living and a skilled nursing facility, all on one campus. Residents can start at one level of care and move into higher care as they require it.
How Do You Choose?
Elder care professionals can assess the needs of each potential resident using a scale to measure the activities of daily living, which include factors like the ability to eat, toilet, maintain personal hygiene and walk.
The more assistance needed, the higher the level of care — and cost — is required. Most assisted living communities automatically include some activities of daily living in their basic plan, then charge more for others, like laundry or medication management.
A mistake many make is not understanding the difference between levels of care, says Anthony Cirillo, a health, aging and caregiving expert and president of The Aging Experience.
“Choosing between types of care is difficult,” he says. “Don’t bear the burden yourself. Consider that hospital clinicians and discharge planners often are unfamiliar with the different services and target populations of assisted living communities and nursing homes.”
Cirillo suggests enlisting a geriatric physician and a geriatric care manager to help you navigate through the different long-term care choices. “The lines are hazy. You often find residents in assisted living that should be in a nursing home and vice-versa. If Mom and Dad need more than custodial care and require a nurse more times than not, use that as a benchmark to consider a nursing home.”
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Nursing Home vs. Assisted Living: What?s the Difference? originally appeared on usnews.com
Update 03/16/23: This story was previously published at an earlier date and has been updated with new information.