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Differences Between Nursing Homes, Assisted Living & Continuing Care Retirement Communities
Benjamin Franklin said it best – “nothing in life is certain except death and taxes” but with daily advances in science, technology and health care, Americans are living longer than ever*. These blessings, however, pose a unique challenge for today’s American families: How to plan and prepare for retirement.
Have you taken a road trip recently? Almost every major road has large signs offering places that are planned for couples to spend their retirement years enjoying themselves. I doubt you’ll find a local newspaper that doesn’t have an ad for an assisted living facility. Try searching for “nursing homes in Virginia” on the Internet and thousands of sites will appear. Every day new facilities offering different programs are being built and sold across the country.
Is such a place good for you and your family? If so, where is it? We often hear the terms “retirement community,” “nursing home,” and “assisted living facility” but don’t really think about what these terms mean. The difference, however, is surprising and it is important to understand this difference when choosing for yourself or your loved ones.
UNAMALA HOUSES
In Virginia, a nursing home means any facility that has the primary function of providing long-term nursing care, nursing care and health-related services on a continuous basis, for the treatment and care of two or more unrelated patients**. In short, a nursing home is a place for someone who needs less care than a hospital, but needs daily medical care.
The Virginia Department of Health recognizes such facilities and has established guidelines that govern various aspects of their operations, programs, and staffing needs, etc. *** For example, a nursing home must: (a) have policies and procedures related to resident support and resident care management available to residents and their families (12VAC5-360-20); (b) providing emergency medical care within 15 minutes, at all times (12VAC5-360-50); (c) anonymous testing of nursing facilities by public employees (12VAC5-371-60); (d) have a written agreement with one or more physicians licensed by the Virginia Board of Medicine to act as a medical director (12VAC5-371-230); and (e) each resident shall be under the care of a physician licensed by the Virginia Board of Medicine (12VAC5-371-240).
In addition, nursing home residents are afforded certain rights outlined in Virginia Code §32.1-138. See http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+32.1-138. Nursing homes are well-managed and well-organized facilities for our Seniors who require daily care. 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 federal and state laws.
Of course, there are many rules and regulations that define and regulate the daily activities of the nursing home, the responsibility of the staff is great. These are the people who will be tasked with the day-to-day work of caring for your loved one, and making sure they are following state and federal laws. Regardless of how good or beautiful the place may be, the staff will make the difference between your loved one being cared for and encouraged, or not.
A nursing home is good for someone who:
- Those who require daily health care – such as assistance getting in and out of bed; taking medication; or using the toilet.
- Who may have dementia or Alzheimer’s and therefore, cannot eat and bathe every day without reminders or assistance;
- Those recovering from a fall or accident are therefore unable to walk, dress or eat without assistance
LIVING CENTERS
“Residence facility” means a residential facility for the elderly that is licensed by the Virginia Department of Social Services to provide a level of assistance to adults who may be physically or mentally challenged and require limited assistance with activities of daily living. Within assisted living, there are two types: regular assisted living for the elderly (mainly) who need assistance with one or more daily activities; as well as having a highly assisted life for a person who is unable to do things due to mental and/or physical impairment (12VAC30-120-450).
The Virginia Department of Social Services licenses the facilities but does not regulate how the Department of Health manages nursing homes. Although there are Virginia guidelines that regulate aspects of assisted living facilities, they are limited: Assisted living facilities must: (a) provide or coordinate personal and health care services; and (b) provide 24-hour supervision.
As shown in the table below, assisted living facilities are not responsible for providing medical care and/or having medical staff to assist your loved one. Also, without the obligation to provide such treatment, there is a question as to whether they are responsible for warning or treating people with diseases or diseases that can be transmitted from other people.
Although a nursing home will have many staff nurses and doctors employed to care for the residents, assisted living is more similar to an apartment or college building where laundry and meals are provided and people are alone for the rest of the day.
A support center is suitable for a person:
- One who is independent but unable or unwilling to prepare meals or drive to the doctor’s office;
- Someone who wants to cut back and anticipate the need for help with laundry, cooking, etc. in the near future.
- A family where the husband or wife is independent but may need help in feeding or providing for the other’s needs.
CONTINUOUS SERVICE PROVIDING COMMUNITY
In Virginia you can also see ads for retired people. It’s popping up around our favorite College Towns and Tourist destinations.
A Continuing Care Retirement Community provides care tailored to your needs. As an insurance policy, the resident pays an entrance fee and a variable fee from time to time, which provides the resident with a package of housing and medical care that the CCRC must provide when residential and health services are needed. For example, if you come in, all you want is help with your meals, then that’s the only service that will be provided. If you need intensive care or God forbid, day-to-day care for a Dementia patient, CCRC has assisted living services or nursing home services available under your contract. Continuing care contracts are regulated by the Virginia Bureau of Insurance for the Virginia State Corporation Commission.
Most CCRCs may have nursing home services available on-site, or at an approved off-site facility (12VAC5-360-10). Although you may be entering the retirement community as a healthy and responsible individual, as your needs change, so will your relationship with the Community and the community’s responsibility to you.
A Continuity Retirement Facility is suitable for a person:
- Those who are independent but expect the need for daily care for themselves or their spouse soon;
- Someone who is disabled and unable to care for themselves or their spouse if the disability worsens.
With at least three different options, it’s important to do your research:
To search for housing in Virginia, visit the Department of Social Services website: http://www.dss.state.va.us/facility/search/alf.cgi.
To search for nursing homes, visit the Medicare website: http://www.medicare.gov
AND LAST BUT NOT DONE
It’s always a good idea to talk to a relative of your current host and spend time getting to know the staff, regardless of the type of property you’re looking for. If looking and searching isn’t enough, then consider the chart below – comparing nursing home legal services compared to nursing home legal services in Virginia.
DUTIES or NEEDS
FIRST HOUSE
HELPFUL LIFE
Responsible for providing nursing care or monitoring the resident’s health?
YES
NO
Does the doctor have to supervise the residents?
YES
NO
Each resident must be supervised by a physician licensed by the Virginia Board of Medicine?
YES
NO
Do you have to have nurses on staff?
YES
NO
Do you need to provide medical care?
YES
NO
Do you need ongoing consultation from a registered dietitian or a nutritionist on staff?
YES
NO
Is 24 Hour Monitoring necessary?
YES
YES
Do they have to make a written plan for accepting a resident?
YES
YES
Should employees be subject to prosecution?
YES
YES
Overseen by the Virginia Center for Quality Health Care Services and Consumer Protection
YES
NO
It is managed by the Department of Social Services
NO
YES
*Life expectancy has increased dramatically over the past 100 years, from 47 years for Americans born in 1900 to 77 years for those born in 2001. These same factors—improvements in health care and prevention—are partly responsible for the increase. the interesting thing about the age of people’s life is that people live longer. it also led to a major shift in the leading causes of death in the United States over the past 100 years, from infectious and chronic diseases to chronic and non-communicable diseases.” The State of Aging and Health in America 2004, published by the Center for Disease Control, is available at http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf.
**See more, Virginia Code §32.1-123, as amended by Virginia Administrative Code § 12VAC5-360-10.
***It is a crime under Virginia law to operate a nursing home without a license. See details, 12VAC5-371-30.
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