While serving on our Council on Aging, I spoke before our local City Council and Planning Commission many times supporting the addition of a new assisted living facility or skilled nursing facility in our community. I prefaced every presentation by saying I was sure I would never have to go to one of these facilities, because I was always going to remain healthy and mobile myself; however, maybe someone else would need one. Then I would mention that just maybe I would need one myself if I should fall and break my hip when leaving the Council Chambers!
Unexpected accidents and health problems are part of life. We cannot control them all, but we should be aware of services and facilities available in our community in case they happen to us. I volunteer with Shop Ahoy, a wonderful nonprofit organization that shops for and delivers groceries to homebound people. Last week I talked with several friends about what happens to people after a hospital stay if they don’t have anyone to care for them at home. My friends were aware that there were different types of facilities, but they did not know what the differences were.
I decided then that my next posts would be about skilled nursing facilities (SNFs) and assisted living facilities (RCFEs) and what distinguishes them. I am ever grateful for my 11 years as a Long Term Care Ombudsman which has given me a real education in this area.
Many seniors who end up in a Skilled Nursing Facility go directly after a hospital stay. They are ready to leave the hospital but are not ready to go home without care. Recovery from a bad fall and possible resulting surgeries frequently require a rehabilitation stay, hopefully in a local facility.
SNFs are usually divided into two areas of care: one is rehabilitation oriented with the purpose of getting the person back to their home or assisted living facility as quickly as possible. To facilitate the recovery and rehabilitation, SNFs employ Registered Nurses, and Physical, Speech and Occupational Therapists. The other area is long-term custodial care.
If skilled services are needed to achieve your medical goal, many services can be paid for by Medicare. The first 20 days are fully covered and services up to 100 days may be covered if you are continuing to meet your medical goal. This type of care can also be referred to as post-acute care.
Most nursing facilities in our area also offer long-term custodial care in addition to their skilled care. The biggest differences are the type of medical care needed and the length of the stay. If a person is not able to return to their home or assisted living facility after a hospital stay and a period of rehab in a SNF, they may require indefinite custodial care. This includes non-medical help like bathing, grooming, medication management and help with mobility. Medicare does not cover this care but does continue to cover the medical expenses of the senior.
Nursing home care is very expensive in California, averaging from $7,500 to $10,000 a month for a private room. If a person is already Medi-Cal qualified (Medicaid in other states), or can become qualified based on low income, this program can pay for nursing home expenses only if deemed medically necessary by the physician and cannot be delivered in a non-custodial setting with home health aides.
Many seniors today want to stay in their own homes. Home health agencies can provide skilled care at home with nursing and other medical professionals. If the at-home care is prescribed by a physician on a short-term basis, it can be covered by Medicare, health insurance, Veteran’s benefits and long term care insurance. On a longer term basis, this type of care may not be covered by insurance.
My friends asked whether they could choose the facility where they wanted to go after a hospital stay. Unfortunately, this is not usually the case. When it is evident that a person is not ready to return to their home or assisted living, hospital discharge planners work to find a suitable facility for their rehabilitation. I live in a city of almost 140,000 people with a growing percentage of seniors. We have 3 skilled nursing/nursing facilities that provide rehab and custodial care and one that is part of a Continuing Care Retirement Community (CCRC) where priority is given to their own residents from other levels of care. If a facility is not available in our community, discharge planners will locate a facility in a neighboring community, even though it is ideal to place people locally where their family and friends can visit easily.
We definitely cannot plan for every event, but it is so important that we are familiar with our options if we or a loved one suddenly needs skilled or custodial care. Please let us know of any experiences you may have had in this area or any questions you have.
(Two organizations to contact for information about or issues with nursing home care are the Long Care Ombudsman program in your community or California Advocates for Nursing Home Reform (CANHR) at 800 474-1116.)