Best Way Get Help For Medical Emergency In Two-Story House Differences Between Nursing Homes, Assisted Living & Continuing Care Retirement Communities

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Differences Between Nursing Homes, Assisted Living & Continuing Care Retirement Communities

Benjamin Franklin said it best – “Nothing is certain in life but death and taxes” but with daily advances in science, technology and healthcare, Americans are living longer than ever before*. But this blessing has created a unique dilemma for modern American families: how to plan and prepare for one’s retirement years.

Have you taken a road-trip lately? Large billboards on nearly every highway offer the location of newly planned communities where couples can devote their retirement years to recreational pursuits. I doubt you’ll find a local newspaper that doesn’t have at least one ad promoting the amenities available at a local assisted living facility. Try searching the Internet for “nursing homes in Virginia” and thousands of web pages will appear. Each and every day new facilities offering different programs are being created and marketed across the state.

Are such benefits right for you and your family? If so, any benefits? We often hear the terms “retirement community”, “nursing home” and “assisted living facility” but rarely consider what these terms actually mean. But the differences are interesting and understanding these differences is essential when making a choice for yourself or a loved one.

hospital

In Virginia, a nursing home means any facility with the primary function of providing long-term nursing care, nursing services and health-related services for the treatment and inpatient care of two or more unrelated individuals**. Simply put, a nursing home is a facility that requires less care than a hospital, but requires daily health care support.

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

In addition, nursing home residents are afforded certain rights defined by 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 controlled and structured residential option for our seniors who require some level of daily healthcare. If the facility provides care through the 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 regulate the day-to-day operations of a nursing home, the greater the responsibilities of the staff. These individuals will be tasked with the day-to-day responsibility of caring for your loved one and making sure they are in compliance with state and federal laws. No matter how nice and or attractive the facility is, the staff will make the difference in whether or not your loved one is cared for and encouraged.

A nursing home is best suited for someone who:

  • who needs daily health care – such as assistance getting into and out of bed; taking medication; or using the restroom.
  • who may have dementia or Alzheimer’s and, as a result, are unable to eat or bathe daily without reminders or assistance;
  • One who is recovering from a fall or accident and is therefore unable to walk, dress or eat without assistance

Assisted living facilities

“Assisted living facility” means an adult care residence licensed by the Virginia Department of Social Services to provide a level of service to adults who may have physical or mental disabilities and require at least moderate assistance with activities of daily living. Within assisted living, there are two types: regular assisted living for seniors who (usually) need assistance with one or more daily activities; and intensively assisted living for a person who may be unable to perform activities due to mental and/or severe physical impairment (12VAC30-120-450).

The Virginia Department of Social Services regulates assisted living facilities but does not regulate them the way the Department of Health regulates nursing homes. Although there are Virginia guidelines that regulate 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 reflected in the table below, assisted living has no obligation to provide health care and/or have health care workers available to assist your loved one. Additionally, there is the question of whether they have a duty to warn or treat residents with illnesses or diseases that may be contracted from other residents, without any obligation to provide such services.

While a nursing home will have many nurses and doctors assigned to monitor residents, assisted living is more akin to an apartment building or college dorm where laundry and meal services are provided and residents are on their own for the rest of the day.

An assisted-living facility is best suited for someone who:

  • who are largely independent but may not be able or willing to prepare their own meals or go to doctors’ appointments;
  • Anyone who wants to scale back and expects to need help with laundry, cooking, etc. in the near future.
  • A couple where one spouse is independent but the other spouse may need assistance with feeding or meeting needs

Continuing care retirement community

You can also see ads for retirement communities in Virginia. They’re popping up all around our favorite college towns and tourist destinations.

A continuing care retirement community provides care depending on your current needs. Like an insurance policy, the resident pays an entry fee and periodic adjustments, thereby giving the resident a package of residential and health care services that the CCRC is obligated to provide when those residential and health care services are needed. For example, if upon entering, all you want is help with your meal, this is the only service that will be provided. If you need intensive physical therapy or, God forbid, daily assistance for a dementia patient, CCRC assisted living services or nursing home services are available under your contract. Continuing care contracts are regulated by the Virginia Bureau of Insurance of the Virginia State Corporation Commission.

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

A continuing care retirement community facility is best suited for someone who:

  • who is essentially independent but anticipates the need for daily health care for himself or his spouse in the near future;
  • Someone who is physically disabled and unable to care for themselves or their spouse if the disability worsens.

With at least three different choices, it’s important to do your research:

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

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

And last but not least

It’s always a good idea to talk to a family member of a current resident and spend time getting to know the staff, no matter what type of facility you’re looking for. If looking and researching isn’t enough, consider the chart below – a comparison of the legal duties of a nursing home compared to the legal duties of an assisted living facility in Virginia.

duty or need

Nursing home

Assisted living

Duties to provide nursing care and or monitor the health of residents?

yes

no

Need a doctor to supervise residents?

yes

no

Each resident will be under the supervision of a physician licensed by the Virginia Board of Medicine?

yes

no

Should there be nurses on staff?

yes

no

Will rehabilitation services be offered?

yes

no

Should there be ongoing consultation from a registered dietitian or dietitian on staff?

yes

no

Need 24 hour supervision?

yes

yes

Should residents develop a written plan on admission?

yes

yes

Must criminal background checks be done on employees?

yes

yes

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

yes

no

Monitored by the Department of Social Services

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. These same factors—improved medical care and prevention efforts—are partly responsible for the dramatic increase in life expectancy. The past century has also brought about a major shift in the leading causes of death in the United States, from infectious diseases and acute illnesses to chronic diseases and degenerative illnesses.” The State of Aging and Health in America 2004, published by the Centers for Disease Control, http://www. Available at cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf.

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

*** Operating a nursing facility without a license is a felony under Virginia law. Generally, see 12VAC5-371-30.

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