Choosing a Skilled Nursing Facility or Long-Term Care Facility

The choice of a skilled nursing facility or long-term care facility is challenging, and chances are good that you, along with many Americans will someday be faced with the need to find such a facility for yourself or a loved one.  What’s the difference in the two you ask? The care provided in a skilled nursing facility is more comprehensive and Medicare pays substantially more of the services.  Skilled nursing facilities are also designed generally to rehabilitate a person so he or she can return home.  Long-term Care facilities are similar in nature to their title; providing long-term care for those in need.

How many Americans must make the decision to choose these types of facilities you ask?  According to the National Institute on Aging (as of 2015) there were approximately 4.7 million seniors utilizing home-health care; 730,000 in assisted living facilities and 1.4 million in skilled nursing facilities (a/k/a long-term care facilities).  According to current statistics published by nursinghomediaries.com, 5% of the older population lives in nursing homes with an average life-expectancy of six months upon admittance.  If that trend continues, 3.9 million of the 78 million baby boomers will find themselves in a long-term care facility during their lives.

Because the choice of a skilled nursing facility or long-term care facility will be so important to many American families, care should be taken to make the process strategic.  The types of facilities seniors have to choose from today are increasing.  Just twenty years ago, the choices were somewhat limited.  The older population in need of help primarily lived in their home or in a nursing home or skilled care facility.  Today, there are approximately 15,600+ nursing homes in the United States according to the Centers of Disease Control and Prevention so it goes without saying that driving by a facility, watching a television ad, or reading a promotional brochure will not be sufficient if you hope to make a well thought out choice.  The following is an example of a strategic checklist when looking for a great facility.

Step 1: Determine the Level of Care Required for Your Senior Adult

Long-term care isn’t limited to a residential care facility.  It can occur in many places.  While many Americans will be treated in a long-term care facility, others will receive less involved treatment such as skilled nursing care at their home or in an assisted living facility, special retirement community or senior center.  The determination of where treatment will occur should result from an analysis of the type of care to be provided; more specifically, is the care “medically necessary” care or merely “custodial” care.  Medically necessary care is covered by Medicare, but custodial care is not always covered by Medicare.

To help evaluate what level of care will be required by your senior adult, ask if the person seeking care will need help with any of the following:  eating, dressing, bathing, getting in and out of bed, using the bathroom, remembering to take medicine, shopping, paying important bills, transportation, housework (cleaning, laundry, etc.).  While this list is not exhaustive, it does provide many of the most important daily tasks for senior citizens.

Step 2: Evaluate the Finances

Let’s face it, the amount of money a senior adult has impacts the type of facility they can choose and the type of services they can receive.  On its website, LongTermCare.gov reports the national average costs of long-term care were as follows in 2016:  $225 a day or $6,844 per month for a semi-private room; $253 per day or $7,698 per month for a private room; $119 a day or $3,628 per month for a shared room (single bed unit); $20.50 an hour for a health aide; $20 an hour for homemaker services; and $68 per day for services in an adult day health care center.  People often experience sticker shock regarding long-term health care, so take time to evaluate the complete financial picture before choosing a facility.

The evaluation of a financial picture also involves exploring all sources for funding.  The following represent some examples of the ways in which people fund long-term healthcare.

• Personal savings: This one is obvious.
• Long-term Care Insurance: Long-term care insurance can be effective but often too expensive if the senior waits too long to purchase a policy.  Because insurance coverage varies widely, be sure to review a policy’s coverage fully with your agent before completing the purchase.  Some plans cover many items while others may include medical equipment and in-home care only.
• Medicare: Medicare is conditional coverage.  If conditions exist, it may pay for certain skilled nursing or home health care.  If the senior adult does not qualify, it may not pay for daily living care or other luxury items.  Visit www.medicare.gov to see if you meet the eligibility conditions for coverage
• Medicaid: Medicaid is primarily a state program and its coverage varies greatly from state to state.  Generally, eligibility is income-based with the most help being offered to those with low incomes and limited resources.
• PACE:  Medicaid.gov defines the Programs of All-Inclusive Care for the Elderly (PACE) as a program that “provides comprehensive medical and social services to certain frail, community-dwelling elderly individuals, most of whom are dually eligible for Medicare and Medicaid benefits.”  A successful applicant must be 55 or older, live in a PACE service area, be eligible for nursing home care, and be able to live safely in the community.  According to my brief research on the program, only one Missouri location exists (Alexian Brothers Community Services-St. Louis, St. Louis, MO).
• Veterans benefits: The Department of Veterans Affairs (VA) does offer some of its participants long-term care if they are eligible.  Make sure these benefits don’t conflict with your other forms of coverage like long-term care insurance, Medicare and Medicaid.
• Accelerated Death Benefits: This is a life insurance policy rider that can provide cash advances against future death benefits while the policy holder is still alive.
• Reverse Mortgages: A reverse mortgage is a type of home loan for older adults that allows an owner to remove equity from a home without selling it.  These loans can sometimes seem too good to be true.  Momma always said, “If it seems too good to be true, it probably is.”

Step 3: Compare the Finances with the Level of Care Required

Not all senior adults will require a long-term care facility.  Several utilize the assistance of less-involved services.  Because there are nearly as many types of long-term care as there are types of seniors in need, you should compare the funds available with the types of various care providers in your area.  The following are just some of the most common forms of long-term care:

• Community Service Centers: Some communities have service centers that provide meal programs, games and activities and transportation services among other things.  These less invasive services can supplement home health care to keep costs down.
• Home Care: This one is obvious.  Historically, family, friends, volunteers, and professionals came to a senior adult’s home to provide necessary services.  Remember, it wasn’t until the nineteenth century that nursing homes even existed.  When home care is used, the help provided is generally limited to daily tasks such as shopping, transportation and cooking.
• Assisted Living Facilities: These facilities provide 24-hour assistance and health care in a residence-like setting.  These more invasive services often cover everything such as bathing, eating, dressing, and taking medicine.
• Nursing Homes: Nursing homes provide long-term care to people who cannot rehabilitate or live productively at home or in a community setting.  Their nursing and rehabilitation services generally include meals and help with daily events.  There are several types of nursing homes:
  • Skilled Nursing Facilities: These nursing homes provided 24-hour nursing and monitoring and are considered one of the more exhaustive and expensive choices for care.
  • Intermediate Care Facilities: These nursing homes are designed for intermediate-term health care for residents with a chronic illness, but 24-hour attention is not required.
  • Custodial Care Facilities: These nursing homes designed to provide are more social, educational and physical activities than the above-written facilities.

Step 4: Tour the Facilities

No television ad, radio spot or brochure can provide the information found through a physical inspection.  You feel better when the mechanic shows you that broken tie rod before making the repairs right?  That same peace of mind comes from touring any potential care facility before investing thousands of dollars annually.

Remember the needs of your loved one and prepare a list of potential questions and concerns to ask during any tour.  Ask hard questions such as the following examples:

• How long has the administrator worked at this facility?
• How are emergencies responded to at this facility?
• How do you prevent pressure sores?
• Do you provide special care for dementia patients?
• Are there physicians on staff or on call?  If on call, how often do they come to the property?
• What is the ratio of staff to patients?
• What is your staff turnover?
• How often can visitors come and what is the protocol for visitations?
• How are staff members trained?  Do they each know first aid and CPR?
• Detail the costs for the resident including premium services like haircuts, nails, dental, vision and psychological?
• Does the facility have liability and/or malpractice insurance?
• How many insurance claims occurred at this facility in the last three years?
• What if any state or federal reprimands has this facility received?
• What kind of food do you serve?  Can residents eat what they want?
• Is reliable transportation available?
• Are pets allowed?
• Is smoking allowed?
• Describe your security features?
• Are you certified to accept Medicaid if the resident runs out of money?

States with licensing regulations provide ratings and surveys on each facility so research the state’s department of aging for information or ask each residential care facility for its own survey.  Don’t allow the facility’s outside facade and interior glamour fool you.  While these features are nice for guests and family, a facility’s most important feature is the experience and background of the staff and administration.  Of course, potential residential care facilities must be clean and tidy.  But each resident should also be clean and tidy.  Do residents remain in pajamas late into the day or are they dressed and ready for daily tasks?  Speak with residents.  You can rarely walk through any facility without at least one resident willing to have a conversation.  How the staff reacts to your conversation with a resident will also go a long way to showing you how they treat their residents.

Before choosing a residential care home, make sure all of your questions are answered.  Although it may be preferable for seniors to live at home, many spend their last days in assisted care facilities or retirement homes because of a medical condition or circumstance outside of their control.  Choosing a long-term care facility can be difficult, so follow these steps to make the process a little easier.

Todd Miller owns and operates the Law Office of Todd Miller, LLC, 1305 Southwest Blvd., Suite A, Jefferson City, Missouri 65109 www.toddmillerlaw.com (573) 634-2838.  Mr. Miller earned his juris doctorate from the University of Missouri School of Law in 1999.  He was most recently recognized as Advisor of the Year by GolfInc. Magazine.  He is ranked a Superb Attorney with a “9.9” rating by AVVO and annually receives the Client Distinction Award by Lawyers.com. He writes and lectures on various legal topics and you may find him on Facebook, Google+, LinkedIn, and Twitter or by emailing staff@toddmillerlaw.com.