How Should You Choose a Nursing Facility?

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When they can, seniors typically choose to live independently. Some remain in a family home while others downsize or enjoy the comfort of a retirement community. Seniors who need assistance coping with health conditions may depend on family members for help. They may instead opt to reside in an assisted living facility. 

When their need for assistance includes nursing care, seniors may decide that residing in a nursing facility is their best option. Seniors who make that choice need to consider the kind of nursing facility that will best meet their needs. Having narrowed the field, seniors and their family members should consider several factors in deciding which nursing facility to select.

Nursing Facilities vs. Assisted Living Facilities

While there is some overlap, nursing facilities differ from assisted living facilities in the nature of the care they provide. Staff members at an assisted living facility help residents with their activities of daily living. Depending on their needs, residents might receive help with bathing, eating, getting dressed, or other personal care activities.

Assisted living facilities typically have at least one registered nurse on staff, although some facilities keep nurses on-call and only summon them to the facility as they are needed. Non-medical assistance is typically provided by staff members with job titles like aide, personal care assistant, or attendant.

Assisted living facilities are suited to seniors who can live independently with a bit of help. Seniors with health conditions that need around-the-clock care and monitoring will be better served by a nursing facility that focuses on the delivery of healthcare in a residential setting. 

Some seniors need temporary nursing care as they recover from surgery or a health condition. Others will likely need nursing care for the rest of their lives. Choosing a nursing facility begins by recognizing that different facilities offer different services. They provide services that match the needs of their residents.

Skilled Nursing Facilities

A skilled nursing facility is a residential living environment that is staffed by medical professionals. Staff members include registered nurses and licensed practical nurses. They often include physical therapists, speech pathologists, and audiologists.

A skilled nursing facility typically provides short-term, around-the-clock care to patients who are recovering from a serious injury, illness, or medical procedure. They may need rehabilitation services to recover the ability to walk, grip, speak, or breathe freely.

Like assisted living facilities, skilled nursing facilities assist residents with the activities of daily living. Since residents are recovering from serious health conditions, however, skilled nursing facilities focus on the delivery of medical services. They do not usually offer the same recreational activities or social environment that residents of an assisted living facility enjoy. Since residents are expected to regain a significant degree of independence, rooms in a skilled nursing facility are designed to be occupied temporarily, not as a place of permanent residence.

Rehabilitation centers are closely related to skilled nursing facilities. While the terms are often used interchangeably, rehabilitation centers are often specialized units in hospitals. A rehabilitation center usually provides intense daily therapy for a relatively short time (usually less than a month). A skilled nursing facility combines rehabilitative services with a high level of nursing care. Stays of up to 60 days in a skilled nursing facility are not uncommon.

Nursing Homes

Nursing homes provide residential care to patients who do not need to be hospitalized. Most nursing home residents have health conditions that cannot be managed at home, even with the help of a caretaker or visiting nurse.

Nursing homes are staffed by skilled nurses and aides. A physician supervises patient care, although medical care — including monitoring the patient’s condition and dispensing medication — is generally delivered by the nursing staff. Other medical professionals, including physical therapists, may also be available as needed.

Choosing a Nursing Facility

When families agree that an older family member needs specialized nursing care, the first decision involves the kind of care they need. Unlike skilled nursing facilities, nursing homes typically provide long-term care. When rehabilitative care may allow a patient to live at home or in an assisted-living facility, a skilled nursing facility is usually a better option than a nursing home. After conducting a full medical assessment, the patient’s medical care team can help the patient and family members decide upon the patient’s best residential option.

Federal rules require hospitals to prepare a discharge plan for Medicare patients who need nursing assistance after a hospital discharge. The plan should specify necessary care after discharge, identify healthcare issues that will need to be addressed in a new setting, and advise the patient and family members about resources that may help them meet the cost of continuing care. Discharge plans are an important resource that can help families make decisions about the need for residential care in a nursing facility rather than home care.

Families should research local nursing facilities before deciding which would be best for their loved one. The federal government gathers information about the quality of nursing facilities based on health inspections, adequacy of staffing, and performance. A comparison tool helps seniors evaluate nursing homes (including some skilled nursing facilities), inpatient rehabilitation centers, home health services, and other providers.

In-person visits help families get a sense of how well a facility is maintained. The National Institute on Aging suggests making more than one visit at different times of the day to get a sense of whether staff members seem stressed or overwhelmed. An unannounced visit at a mealtime may provide more insight than a scripted tour that the facility can prepare in advance.

Family members should be prepared to ask questions about the services the facility provides, the number of skilled nurses who are on staff and present each day, the cost of services, and the insurance plans that the facility accepts. A comprehensive Medicare checklist provides additional insight into observations that families should make and questions they should ask when visiting facilities.

Family members should share a discharge plan with the facility to make sure it can accommodate the patient’s needs. For example, not all facilities offer dementia care or specialized pain management services.

Finally, before signing a contract with a nursing facility, a knowledgeable family member should read the contract carefully. If it does not appear to match representations that the facility is making about costs or services, it may be wise to ask the family lawyer to explain the contract in more detail.

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