What are Nursing Homes?

Resident with DaughterWhat comes to mind when you hear the words nursing home: a run-down facility, bed-ridden residents and a noticeable urine smell? That’s the image many people seem to have, and is a stereotype often perpetrated by movies, television and the media. But stereotypes aren’t always reality, and that image shouldn’t be how one judges a nursing home today.

As providers of long-term care, nursing homes are subject to inspections to ensure their residents receive a high quality of life in a well-maintained setting. Just as assisted living communities allow seniors to experience a new lease on life, nursing homes offer the skilled care that cannot be found elsewhere.

The difference between nursing homes and assisted living

Before assisted living communities became a care option for families, seniors would typically remain at home with family members providing care until a debilitating illness or injury required nursing care, which the family could not provide. They may have required the skilled nursing care found in a hospital but without the life-threatening conditions which required a hospital stay. Nursing homes bridged this need, and are often the type of community which springs to mind when people say they are looking for a place where their parents may receive supportive care.

But a nursing home is not synonymous with an assisted living community for a variety of reasons. An assisted living community does not provide skilled nursing services, and these communities are often private pay only. In contrast, nursing homes accept Medicaid and Medicare in addition to private pay or health insurance. Residents at an assisted living community are also capable of carrying out activities of daily living (ADLs) such as bathing, dressing and toileting with some or minimal assistance. In contrast, nursing home resident require more support with ADLs.

Activity of Daily Living % of Residents Needing Help
Bathing 96.1%
Dressing 90.9%
Toileting 86.6%
Eating 56.0%
 *From the Long-Term Care Services in the United States: 2013 Overview.

Nursing homes may be free-standing buildings or part of a larger community campus, whether a hospital or continuing care retirement community. Continuing care retirement communities, which offer residents comprehensive care for their life at the community, have health care centers which offer skilled nursing services or other advanced health care services. These health care centers may accept residents who aren’t part of their community when space permits. What can lead to further confusion is that some facilities no longer use the title of nursing home, and instead describe themselves as health care centers.

Demographics of nursing homes

According to a 2013 study produced by the National Center for Health Statistics, those 85 and older comprise 42.3 percent of nursing homes’ population, while 14.9 are younger than 65. More than two-thirds of nursing home residents are women.

Community life

Man with CaregiverThough residents may not be as active as their counterparts at an assisted living community—card games are the default activity which many people associate with nursing homes—nursing homes strive to provide engaging activities which encourage socializing and promote overall well-being. Activities are offered every day and can include outings to the local zoo, social hours, manicures or musical entertainment. Pet visits are also an important part of community life. Family involvement is also encouraged, and family members are invited to attend family nights or community dinners.

Features that are commonly found at nursing homes include a beauty/barber salon, library, game room and landscaped courtyards. If the community offers different care types, such as skilled nursing and Alzheimer’s and dementia care, the building may be arranged into wings so residents needing similar care live together.

Living arrangements are typically private or semiprivate rooms which may already be furnished or can be decorated with personal furnishings upon moving in. These rooms do not include kitchenette or a washer/dryer.

Services offered at nursing homes

In addition to providing skilled nursing care, nursing homes may also offer social work services, mental health or counseling services, therapeutic services, pharmacy or pharmacist services, or hospice care. The responsibilities of housekeeping, laundry and transportation to appointments are also handled by the community’s staff.

The costs of a nursing home

Skilled nursing care is one of the highest long-term care costs, and nursing homes are among the most expensive long-term care facilities. They have a national median daily rate of $212 for a semiprivate room or $240 for a private room, according to Genworth’s Cost of Care Survey 2014.

The states with the most expensive median nursing home costs are:

State Minimum Daily Rate Maximum Daily Rate Median Annual Rate
Alaska $452 $954 $240,900
Connecticut $296 $595 $155,125
Hawaii $263 $690 $135,050
Massachusetts $235 $508 $134,320
New York $150 $650 $130,670

The states with the least expensive median monthly nursing home costs are:

State Minimum Daily Rate Maximum Daily Rate Median Annual Rate
Oklahoma $125 $310 $57,488
Louisiana $104 $350 $58,765
Missouri $120 $297 $59,860
Arkansas $110 $250 $62,415
Kansas $145 $302 $63,875

*From the Genworth Financial 2014 Cost of Care Survey. Based upon the daily rate for a private room.

How to select a nursing home and what to expect during the assessment process

Once you find a community that is within your affordable price range and desired location, it is important to assess the community, not only to determine whether your loved one will feel welcomed but whether its staff properly care for residents.

Finding inspection records on nursing homes

Nursing homes are required to be licensed and inspected by a state agency charged with oversight of long-term care facilities. Nursing Home Compare is the well-known resource for finding the ratings of nursing homes, and oftentimes nursing homes will boast they have a 5-Star Quality Rating. However, this system has been subjected to scrutiny for relying on self-reported data that does not reveal a complete picture of deficiencies or complaints filed against a facility.

Unlike assisted living communities, whose inspection records may not be available online, more often than not, a nursing home’s inspection records are available online to the public. These inspection records are available from each state, either online or through a public records request. Most states also require nursing homes to post or make available their most recent inspection results upon request. By viewing several years’ worth of records, you can see if there are patterns of failing to follow procedure and whether the violations are life-threatening or minor.

Touring a nursing home

Before moving your parent to a community, take the time to take a tour and see its community life for yourself. Ask to join residents for lunch and see the interactions between residents and staff, but also visit during random times of the day, rather than just during dining or activity hours, to see how residents are cared for. Because touring may be overwhelming, be sure to bring a checklist with you to note certain features of the community, such the overall physical appearance or any odors. And most importantly, do not be afraid to ask questions and trust your instincts about a community.

The assessment process

After finding a nursing home that will be a good fit for your loved one, the community’s clinician will perform an assessment to determine the level of care and services needed. This will form the basis of your parent’s care plan. The community’s priority is keeping residents safe, and during the assessment, you should share your parent’s complete medical history, whether it is frequent falls, forgetful moments or substance abuse. No matter how sensitive the information, you should feel safe disclosing it, because the clinician is not there to judge and will maintain confidentiality. If your parent’s substance abuse, or another sensitive issue, doesn’t come up during the admissions process, do not count this as fortunate but rather as a red flag to search for another community. Clinicians can tell when information is being withheld based upon a review of a person’s medical history and how the family acts during the interview.

Life after move-in

It will likely take some time for your parent to adjust to his/her new home, but if you have done your homework, the nursing home’s staff will quickly make him/her feel like part of the community. Family nights and community-wide celebrations are a few of the events that allow for families to spend time with their loved ones in a celebratory way. And with trained nurses on hand 24 hours a day, you can be confident your parent will require the nursing care needed to improve his/her quality of life.

Written by SeniorHomes.com’s Andrea Watts.

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