What Is The Difference Between Skilled Nursing & Assisted Living

“I’m so confused”,’ complained Sherry Jackson to her close friend, Marcia. “My two brothers have voted against me by insisting that Mom be put into a senior care residence.” Since Sherry’s father died suddenly, her close-knit family was in turmoil. Her mom could surely not live by herself, however, she refused to leave her home to live with any one of her devoted children.

“I’m quite capable of taking care of myself”, her mom exclaimed over and over. It’s true that her mother’s mental capacities were lucid, (maybe because she does her trusty crossword puzzles each morning). However, physically she needs assistance. For example, she’s fallen out of bed several times and her balance is not the best. Also, since Sherry’s dad passed away, her mom
has lost weight. Sherry tries to bring her mom the food she likes, but Sherry often finds it in the fridge after a few days, so she knows her mom is not eating right. Mom has approximately ten different medications to take daily and Sherry is terrified that she or one of her brothers will forget to refill her bi-weekly pill box or she may run out of medicine and not tell them.

Sherry and her brothers are looking into three different options for seniors.
1) Independent living
2) Assisted Living
3) Skilled Nursing Home Care

Sherry’s friend Marcia explained to her the benefits of independent living apartments. “My mom is renting one and she is thrilled. It’s a brand-new place with the appliances, kitchen and bathrooms state of the art and squeaky clean. It is such a major improvement to her previous home which was old and dangerous.” explained Marcia enthusiastically.

Sherry realizes that unfortunately her mom is not in the same category as Marcia’s Mom. Firstly, Marcia’s mom is younger. Secondly, Marcia’s mom is in good mental as well as physical health. It’s true that there is a bell to ring for help and optional bathing and shower helpers, but it is still independent living. No, Sherry realizes, this type of living is not for her mom. Her mom has
begun to need more help since her dad passed on. Her dad was quite strong for his age and compensated for her mom’s physically weakening state. So, what were Sherry’s options with her mom refusing to move in with any of her children?

The transition is easier if children have months to convince parents to sell their homes and move on to senior living accommodations. The best option is to visit different venues and have the parent have a say in the move. With the parent in the driver’s seat, it gives him /her or they the feeling of being in control. But what happens when the decision is urgent? If that is the
scenario, chances are good that the only options would be either assisted living or skilled nursing care. Is there a big difference? You bet there is. We will attempt to offer a few differences, practical, physically feasible and financially attractive.

Skilled Nursing Care

When a person requires constant medical care such as a ventilator, respiratory therapy, third stage ulcers called bed sores and IV-line medication they would be candidates for skilled nursing care. Another way to look at skilled nursing care is to compare it to a hospital setting. Insurance companies will only cover hospital stays for certain time periods or specific medical challenges. A nursing home is sometimes a temporary station for rehabilitation before returning home from the hospital or if the medical and physical demands are permanent then the residency in the nursing facility will be permanent as well. Someone with a feeding tube would be a candidate for a nursing home since this type of person is not capable of taking care of himself. A person who can eat on his own but either won’t or needs his food blended and fed to him, would require skilled nursing care around the clock.

How Much Does Skilled Nursing Care Cost?

Skilled nursing care is more costly than assisted living. A patient’s cost per month is about $7,441 in the United States with costs varying depending on the facility. For Medicaid to agree to pay for skilled nursing care, the resident must first use their own money before the coverage kicks in or be sure to work together with a Medicaid planner to protect personal assets.

Assisted Living

This type of living is the middle child in the trio of independent, assisted, and skilled nursing care. That does not mean that this is the option that is right just because it is the middle of the road. Assisted living is geared to a specific segment of the senior population. For a senior who is insistent on maintaining their independence or someone who is finding a secluded home too much to handle this solution will work optimally as long as the person is fairly mobile and lucid. Assisted living communities provide much needed social events and interactions between residents while the residents still live independently in their own homes. Their amenities include, kitchen facilities, such as electric burners, refrigerators, ovens, and any other appliances that they can utilize to do their own food preparation and cooking. Safety features are offered in the bathrooms so that the resident can bathe and shower independently. (Some assisted living facilities offer optional caregivers who can assist the resident when he or she showers or bathes.) This type of living is primarily paid for out-of-pocket, but there are certain types of financial assistance for veterans, people with specific disabilities and Alzheimer’s.

Memory Care

Just because a senior is having some memory care issues does not negate their entrance into an assisted living facility. These days many assisted living communities will offer memory care in a separate wing or building in the same residence. The same way that a regular assisted living facility will offer recreational activities and trips to town, the memory care facility will do this with additional safeguards such as secured yards, door alarms and specially trained staff members. This type of facility is, of course more costly, about 20% to 30% per month. If a prospective resident is physically active but mentally limited this might be the perfect solution. Check into Medicaid options specifically for Alzheimer’s patients.

How Much Does Assisted Living Cost?

Since there are various types of assisted living facilities, it would be challenging to give an exact price. Some of the brand-new ones would probably be somewhat pricier and some of the extra care is not included. For example, some facilities will include three meals a day and some won’t. Since the Covid pandemic, many professional restaurant chefs who were out of work took the challenge to cook in assisted living facilities, giving the residents an increased appetite with the colorful and delicious restaurant quality entrees. Eating together with other residents also helps to strengthen the appetite.Assisted living costs for the United States average at $4,051 per month with each state and community having their own costs which vary dramatically. Some facilities itemize bills so if a person is new to the residence and in good physical condition they might not want or need to pay for the food. As the resident ages, his living costs will increase since he will need more personal aid. There are also options for all – inclusive fees which include rent, housekeeping, meals, and transportation.

Financial Considerations

Although, it would seem that it would be easier to get Medicaid funding for skilled nursing care, no one would want to put their parents in a place they don’t belong. Unless the senior is in need of all around medical care or is not mobile, the best place to start a transition from private living is at the assisted living facility. Sherry’s mom (at the start of the article) may have been preparing financially for such a life adjusting circumstance. Here are some examples of how seniors cope with entering an assisted living facility.
1) Revere Mortgages: Instead of immediately selling their home, the senior takes out a loan against the value of their home. When the final owner wants to sell, the loan recipient will have to pay back the loan plus interest.
2) Long-Term Care Insurance: Assisted living can be covered under long -term care insurance policies. Make sure that your parents are purchasing the right policy from a reputable company. (There are scams out there.) This policy has to be purchased way before the person will enter an assisted living dwelling.
3) Veteran’s Aid & Attendance Benefit: This program for veterans who were injured while serving and their spouses can be utilized in addition to their basic VA pension.
4) Medicaid Waivers: These waivers for assisted living are increasing each year since the government realizes that assisted living is cheaper than skilled nursing homes.

Putting it All Together

It could be painful for sensitive progeny to transition their elderly parent to a new residence. Seniors, especially, are creatures of habit and living in their own home is something they don’t want to give up. Some assisted living facilities offer monthly trials for potential residents. This could be a great option for someone like Sherry’s mom, who we profiled at the start of this article. Sometimes, even a trip and guided tour to a beautiful facility can change the mindset of the senior. Who knows, he or she might spot an old friend or old flame and their interest can be piqued. So, with lots of love and patience, hopefully caring children such as Sherry will be able to find a safe and positive haven for their aging parents.
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