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Senior Living

2001-05-01 10:25:00

What are the real differences between assisted living and a nursing home?

Question: What is the difference between nursing home care and assisted living care?

Answer: As America continues to age, more and more seniors, as well as their adult children, are faced with the dilemma of choosing between a nursing home and an assisted living residence to serve as the primary care giver.  This is a time of anxiety, fear, helplessness and rejection.  This decision is never an easy one but as the assisted living industry has exploded onto the scene as a viable alternative to senior housing over the past decade, the decision-maker now has more options available.  Often the question is asked, "What is the difference between nursing home care and assisted living care?"  The answer is not one-worded.  Many variables come into play when searching for an appropriate care setting for a loved one; and no one wants to make a wrong decision about the selection of a residence as guilt is already at a premium during the whole process.  The assisted living industry started in the early 80's in what was dubbed "board and care" homes.  These were usually six to eight room houses that were converted by owners to care for elderly family members.  A small nominal fee was charged for those not of the family tree and the fee usually covered room and board as well as meals and nothing more.  As the idea spread throughout the country, momentum began to build for the need to provide an alternative to nursing home care.  In the late 80's to early 90's, several developers across the country formed companies whose sole mission was to build and manage free-standing assisted living residences.  Hence, the boom was on.  The assisted living model was built and developed on the philosophy of "aging in place".  Under the umbrella of aging in place were the philosophies of dignity, privacy, individuality, independence, choice, and a home-like environment.  These terms were the foundation by which the industry would use to replace the nursing home industry as the provider of choice. The answer to the question above is simple... money!  Care for the aging population in a nursing home setting is usually funded through federal funds while assisted living is still generally a private pay industry.  This reason alone can begin to explain the biggest differences in care that is given in both settings.  Usually, a nursing home is given "x" amount of dollars per day to care for a resident that is set forth by the state legislature.  Normally, the amount that is allotted per resident on a daily basis is not anywhere near what an assisted living residence will charge on a private pay basis to care for a senior.  This is the biggest reason why most nursing home rooms are set up for two residents with a shared bathroom.  Because of the lack of federal funding, the nursing home industry must double up residents in each room in order to receive maximum funding to provide staff and other expenses.  Assisted living on the other hand, usually charges a monthly fee for a private apartment complete with its own bathroom and usually includes a living room, kitchenette, and bedroom.  In addition to private apartments, which promote individuality, independence, choice, and a home-like environment, assisted living residences usually equip their residences with individually controlled heating and cooling units that are controlled by the resident, security coded entrances to promote safety, larger hallways to promote a home-like environment, carpeting throughout the building (other than bathrooms) to again promote a home-like environment, and several other amenities that separate them from the nursing home industry.  Once one tours an assisted living residence and compares that visit to a nursing home setting, assisted living will win hands down.The bigger difference between the two care settings is the amount of care that can be provided in that particular setting.  Most assisted living residences are licensed in the state in which they do business.  Usually through the state department of health and environment.  As opposed to nursing home regulations, the assisted living industry is regulated differently in each state, as there are currently no federal regulations to police the assisted living industry.  The federal government is reluctant to get involved in regulating the assisted living industry simply because of the fact that it is still primarily a private pay business.  This has benefits and drawbacks.  First, the benefits: because the assisted living industry is a private pay industry, it allows providers to charge market rates for apartments and care which allows them to include in that rate enough of a cushion to carry out the philosophies of dignity, independence, individuality, choice, and a home-like environment.  The amount of rent charged in a assisted living residence is usually enough to allow these providers to staff the building with the appropriate number of staff members to meet the needs of the residents and to provide the residents with an environment that is worlds apart from that of a nursing home setting.  Because each state regulates the assisted living industry differently, services that are provided vary from state to state.  Most states require that residents of assisted living are ambulatory if they choose to reside in that setting.  In addition, most assisted living providers cannot provide skilled services in their setting.  These are the services that are normally found in a nursing home setting.  Other than ambulation and skilled services, most assisted living providers offer a wide array of services which are usually more geared to the social needs of residents as opposed to the medical needs of residents which are served in a nursing home setting.  As the industry grows, the range of services that can be provided in an assisted living setting seems to be expanding.  Because the assisted living industry is strictly a private pay industry, it does not serve those who do not require the skilled services of a nursing home but do not have the funds to afford residing in an assisted living residence.  This caused the federal government, recently, to look at the feasibility of allotting federal funds to be used by low income seniors to supplement the cost of assisted living.  This decision has not had much movement on Capital Hill but many states have adopted waiver programs to assist these seniors in their respective states.  Again, the benefit to this is that many low income seniors are afforded the right to live in an assisted living residence, but most research has found that the amount of money that is allotted each month for these residences is not enough to allow the assisted living provider to continue to provide the same kind of services that it was intended to provide.  Look at the demise of the nursing home industry.  Most of these providers set out with good intentions when entering the nursing home business, but because of the lack of funds that are provided by the federal government, most of these facilities end up with low staffing ratios, unhappy staff, very few programs, and not much left to provide anything additional.  This has caused much debate as a recent study showed that 30% of all nursing home residents do not receive the skilled care needed to be in that setting.  Of that 30%, very few had the private funds to afford assisted living, even if it was available in their local community.  The assisted living industry would support a federally-funded program to assist low income residents with the cost of assisted living but they will not support it if it impedes on the providers ability to provide the kinds of services that have set it apart from the nursing home industry.  In addition, as with receiving any federal money comes a host of government regulations, which usually requires several staff members just to keep up with all the paper pushing that goes hand-in-hand with receiving Uncle Sam's money.  The assisted living industry stance is that by requiring the enormous amount of paperwork and the staff dollars required to keep current with this, it takes dollars away from programs intended to benefit a resident in an assisted living setting.  Among other reasons, this may be why the debate on allotting federal dollars to fund the assisted living industry is at a stand still.The assisted living model of care is based on providing assistance with activities of daily living (ADL's) and is not staffed to care for the skilled needs of residents.  Assistance with ADL's includes, but is not limited to, assistance with dressing, bathing, toileting, eating, mobility, ambulation, continence, assistance with the administration of medications, verbal reminders for meals or activities, and other non-skilled services.  On the flip side, assisted living providers can arrange for skilled services to be provided to a resident through a home-health agency of the resident’s choice as long as the service is ordered by a physician and that service is overseen by a registered nurse.  Most assisted living providers employ registered nurses but many do not do so on a full-time basis.  In addition, any skilled service that is ordered by a physician usually must be provided by a registered nurse and it is for this reason that assisted living providers help residents find a home health agency of choice to provide this service.  Assisting residents with arranging for appropriate care is at the root of the aging in place philosophy.  It is the intention of most providers to allow residents to utilize their services, complimented by skilled services provided by a home-health agency of choice, if needed, all under one roof so that a resident never has to move again.  Again, the amount of skilled services that can be provided and the frequency of these skilled services vary from state to state depending on regulations.  Because of the enormous success that many assisted living owners and providers have enjoyed over the past decade, many assisted living "'wannabees'" have begun to infiltrate the market.  Because of its private pay status, the assisted living industry is looked to as a "cash cow".  Simply meaning, many developers across this country have decided that they too can slap up four walls, hammer an "assisted living" sign in the front yard, and the cash comes rolling in.  Unfortunately, because of the lack of a uniform standard of regulating the industry, many of these developers have succeeded.  Most adult children looking for the appropriate care setting for a loved one need to be on the lookout for those providers who claim to know what they doing but do not have the operational experience to back up those claims. Adult children and caregivers must do their homework when shopping for an assisted living residence.  One wants to be sure to choose a residence that has a history in your community.  When hiring any new employee, an employer always checks references.  Choosing an assisted living residence is no different.  Start by contacting the social workers and discharge planners at the local hospital to gauge their opinion on a particular provider.  These health care professionals are the referral sources for many families once a loved one is to be released from the hospital and they will only put their reputation on the line for the select few providers who provide the highest quality of services to their residents.  In addition, be sure to check with the state licensing agency that has the authority and regulatory power over the assisted living providers in your state.  Any complaints against any licensed residence in your state is public knowledge and you have a right to know the regulatory history of any provider that you are thinking about choosing for a loved one.  Lastly, keep an eye on the staff interaction with residents while you are touring a particular assisted living residence.  How do they speak and treat the residents that they come in contact with?  Not every assisted living provider has a stellar record of performance but the majority of providers do a very good job in providing an alternative to nursing home care.As you have read, explaining the difference between a nursing home and an assisted living residence is not a short answer.  The differences between the two are numerous.  Bear in mind that nursing homes fill a particular need, a need that may or may not be for you.  Assisted living residences provide an alternative... one that should always be investigated.