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Differences between nursing homes, assisted living and aged care communities

Benjamin Franklin put it best: “Nothing in life is certain except death and taxes,” but with daily advances in science, technology, and healthcare, Americans are living longer than ever*. However, this blessing has presented modern American families with a unique dilemma: how to plan and prepare for your retirement?

Have you been on a road trip lately? Almost every freeway is adorned with large billboards announcing the locations of newly proposed communities where couples can spend their retirement years dedicated to leisure pursuits. I doubt you’ll find a local newspaper that doesn’t have at least one ad promoting the amenities of a local assisted living facility. Try searching the internet for “nursing homes in Virginia” and thousands of websites will come up. Every day new facilities with different programs are being built and marketed nationwide.

Is such a facility right for you and your family? If so, which facility? We often hear the terms “retirement home,” “nursing home,” and “assisted living facility,” but rarely think about what those terms actually mean. However, the differences are striking and it is imperative to understand these differences when making decisions for yourself or your loved ones.

NURSING HOMES

In Virginia, a nursing home means any facility with the primary function of providing long-term care, nursing services, and health-related services on an ongoing basis for the treatment and inpatient care of two or more unrelated individuals**. Simply put, a nursing home is a facility for someone who requires less care than a hospital but needs day-to-day medical care.

The Virginia Department of Health licenses such facilities and has established policies governing various aspects of their operations, programs, staffing needs, etc.***. For example, a nursing home must: (a) have written policies and procedures regarding the treatment of residents and the care of residents that are available to residents and their families (12VAC5-360-20); (b) provide emergency medical services within 15 minutes under normal conditions (12VAC5-360-50); (c) be subject to unannounced on-site inspections of the care facility by government officials (12VAC5-371-60); (d) have a written agreement with one or more physicians licensed by the Virginia Board of Medicine to serve as medical director (12VAC5-371-230); and (e) each resident must be under the care of a physician licensed by the Virginia Board of Medicine (12VAC5-371-240).

In addition, nursing home residents are also granted certain rights under Virginia Code §32.1-138. See http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+32.1-138. Nursing homes are the most regulated and structured housing options for our seniors who require some level of day-to-day health care. If the facility provides care through Medicare and Medicaid programs, it is considered a “Certified Nursing Facility” (Virginia Code §32.1-123; Virginia Code §32.1-127) and must comply with both federal and state laws.

Of course, the more rules and regulations that define and control the day-to-day operations of a nursing home, the greater the responsibility of the staff. These are the people who are entrusted with the day-to-day task of caring for your loved ones and ensuring they comply with state and federal laws. No matter how beautiful and attractive the facility may be, the staff makes the difference whether your darling is cared for and nurtured or not.

A nursing home is best suited for someone:

  • Who needs daily health care – such as help getting on and off? Take medicine? or use the toilet.
  • Who may have dementia or Alzheimer’s and as a result be unable to eat and/or bathe daily without a reminder or help?
  • Who is recovering from a fall or accident and is therefore unable to walk, dress and/or eat unaided

FURNISHING FOR ASSISTED LIVING

“Assisted Living Facility” means an adult nursing home licensed by the Virginia Department of Social Services to provide some level of services to adults who may have physical or mental disabilities and need at least moderate assistance with activities of daily living . Within assisted living, there are two types: regular assisted living for those seniors (typically) who need help with one or more daily activities; and intensive assisted living for someone who may be unable to perform activities due to mental and/or severe physical impairment (12VAC30-120-450).

The Virginia Department of Social Services licenses assisted living facilities but does not regulate the way the Department of Health and Human Services regulates nursing homes. Although Virginia has guidelines governing aspects of assisted living facilities, they are limited: An assisted living facility must: (a) provide or coordinate personal and health care services; and (b) provide 24-hour supervision.

As shown in the table below, assisted living facilities are not required to provide medical care and/or provide medical staff to assist your dependent. Additionally, in the absence of an obligation to provide such services, the question arises as to whether they owe a duty to warn or treat residents with diseases or diseases that could be transmitted from other residents.

While a nursing home has many nurses and doctors hired to monitor residents, assisted living is more like an apartment building or college dorm where laundry and meal services are provided and residents are left to their own devices for the rest of the day .

An assisted living facility is best suited for someone:

  • Who is basically self-employed, but can’t or doesn’t want to prepare their own food or drive to doctor’s appointments?
  • Someone looking to downsize and anticipating needing help with washing, cooking etc. in the near future.
  • A couple where one spouse is independent but may need assistance with feeding and/or taking care of the other spouse’s needs.

CONTINUOUS CARE AGE COMMUNITY

In Virginia, you may also see ads for a senior citizen community. They pop up all over our favorite college towns and tourist destinations.

A Continuing Care Retirement Community provides care based on your current needs. As with an insurance policy, the resident pays an entry fee and periodic adjustable payments, which in turn provides the resident with a package of housing and healthcare services that the CCRC is committed to providing when those housing and healthcare services are needed. For example, if you only want help with food upon entering, that is the only service provided. If you need intensive physical therapy or, heaven forbid, day-to-day care for a person with dementia, the CCRC offers assisted living or nursing home services as part of your contract. Continuing care contracts are regulated by the Virginia State Corporation Commission’s Virginia Bureau of Insurance.

Many CCRCs may provide nursing home services either on-site or at licensed off-site facilities (12VAC5-360-10). While you may enter the retirement community as a very healthy, independent, and capable resident, your contract with the community, and with it the facility’s obligations to you, will change as your needs change.

A Continuing Care Retirement Community Facility is best suited for someone:

  • Who is fundamentally independent but anticipates the need for daily health care for themselves or a spouse in the near future?
  • Someone who is physically disabled and would not be able to care for themselves or a spouse if the disability worsens.

With at least three very different choices, it is very important that you do your research:

To research assisted living facilities in Virginia, visit the Department of Social Services website: http://www.dss.state.va.us/facility/search/alf.cgi.

To research nursing homes, visit Medicare’s website: http://www.medicare.gov

LAST BUT NOT LEAST

It’s always best to speak to a family member of a current resident and take time to get to know the staff, no matter what type of facility you’re looking at. If searching and researching isn’t enough, check out the table below – a comparison of the statutory duties of a nursing home versus the statutory duties of an assisted living facility in Virginia.

MANDATORY or REQUIRED

OLD PEOPLE’S HOME

ASSISTED LIVING

Duty to care for and monitor the health of residents?

YES

NO

Doctor obliged to monitor residents?

YES

NO

Each resident is cared for by a Virginia Board of Medicine-licensed physician;

YES

NO

Do nurses have to be on staff?

YES

NO

Must offer rehabilitative services?

YES

NO

Is there a need for ongoing advice from a Registered Dietitian or a Staff Dietitian?

YES

NO

24-hour care required?

YES

YES

Is a written plan required when the resident is admitted?

YES

YES

Employees have to undergo a criminal investigation?

YES

YES

Monitored by the Virginia Center for Quality Health Care Services and Consumer Protection

YES

NO

Supervised by the social welfare office

NO

YES

*Life expectancy has increased dramatically over the past century, from 47 years for Americans born in 1900 to 77 years for those born in 2001. The same factors — improved medical care and prevention efforts — that are partly responsible for the dramatic increase in life expectancy have also led to a large shift in the leading causes of death in the United States over the past century, from infectious diseases and acute diseases to chronic diseases and degenerative diseases.” The State of Aging and Health in America 2004 published by the Center for Disease Control, available at http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf.

**See generally Virginia Code §32.1-123, as amended, and Virginia Administrative Code §12VAC5-360-10.

*** Under Virginia law, it is a crime to operate a nursing facility without a license. See 12VAC5-371-30 generally.

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Amine

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