Selecting a nursing home or long-term care facility is a little bit like shopping for a car. Most of us begin with an idea of the type of vehicle we need, then we dream a bit. Eventually, we settle for something practical that fits our budget.
Of course, choosing a nursing home where you or a family member will live is a far more important decision than buying a new car. But there are a great number of choices depending on cost, needed services, and living preferences.
Nowadays, independent living communities, assisted living facilities, nursing homes, and the like are catering to more and more people with a variety of care needs. Below are brief descriptions of some of the different types of facilities available.
Home care provides a limited amount of assistance with routine activities (such as shopping, meal preparation, and getting to medical appointments) to individuals who desire and are able to live independently in their own homes, and who do not require constant medical care. Home care may also be provided when a higher-level of care is necessary, but this can prove to be expensive and difficult. You may be able to take advantage of community services in your area that are provided by volunteers.
Often termed “congregate care,” there is a broad spectrum of independent and assisted living care options available to seniors with varying needs. “Independent living” facilities are specifically designed to accommodate social and recreational activities within a community of seniors; they do not offer any complementary domestic services, such as meal preparation.
“Assisted living” or “residential care” tend to combine independent living facilities with shared services such as dining, laundry, and housekeeping—and in some cases, medication management and other personal services. They also include some shared living spaces and provide access to social and recreational activities and transportation. Unlike nursing homes, assisted living communities do not provide extensive medical care.
Intermediate care facilities provide additional assistance with daily activities beyond what assisted living provides, such as help with bathing and eating. “Board and care” homes are subsidized group living arrangements that provide help with daily activities to low-income seniors who do not require the level of care of a nursing home. Nursing homes go a step further by providing true nursing care at a full-time level once only available through hospitals. Unlike at hospitals, however, residents of nursing homes are still free to come and go as they please.
The mission of hospice care is to provide supportive, as opposed to curative, care to terminally ill patients in order to make them as comfortable as possible. It is specifically funded for those whose life expectancy is 6 months or less. As such, hospice combines care at medical facilities with varying degrees of home care in order to provide around-the-clock assistance and/or monitoring.
Your primary consideration in selecting long-term care should be the type and level of care you need. Many facilities specialize in caring for specific health conditions, such as heart problems or dementia. You also need to consider your budget, any existing coverage you have, proximity to family and friends, and overall daily environment.
Because there are so many options in a given area, it helps to collect information on several facilities and compare them. Also, be sure to visit every facility you are seriously considering in person. To help you get started, Medicare offers a comprehensive listing of US nursing homes by state. The list includes basic information such as type of ownership, number of residents, and whether the facility participates in Medicare programs. The American Association of Retired Persons (AARP) offers information to consider as you choose a housing option.
Nursing home care can come at a significant cost. Medicare pays for some nursing home care costs, but generally only for an initial period—not over the long-term as most people need.
AARP recommends that seniors buy special insurance to help finance their long-term care, and most financial planners recommend saving for long-term care as part of retirement planning. A number of organizations or insurance companies offer long-term care coverage. See the article long-term care insurance for more information.
Besides financial considerations, there are other important concerns. Is the nursing home in question close to friends and family who will visit often? How are certain amenities, such as pharmaceutical services, handled there? (For example, some nursing homes allow people to use a pharmacy of their choice to fill prescriptions; others handle all prescriptions in house.) It’s also important to ask which hospitals a facility has contractual relationships with, should residents require hospitalization.
Advocacy Centre for the Elderly
Alternatives to nursing homes. Medicare website. Available at: http://www.medicare.gov/nursinghomecompare/Resources/Nursing-Home-Alternatives.html. Accessed June 23, 2016.
Nursing home care. Center for Disease Control and Prevention website. Available at: http://www.cdc.gov/nchs/fastats/nursing-home-care.htm. Updated April 27, 2016. Accessed June 23, 2016.
National nursing home survey. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nchs/nnhs.htm. Updated April 24, 2015. Accessed June 23, 2016.
Last reviewed June 2016 by Michael Woods, MD