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There is a great range in the levels of care available in what are broadly termed "nursing facilities." Hospital-based skilled nursing facilities provide short-term, intensive medical care and monitoring for people recovering from acute illness or injury. Other facilities -- what used to be called "rest homes" -- provide long-term room and board and 24-hour assistance with personal care such as dressing, eating and moving about and daily nursing and other healthcare monitoring, though no intensive medical treatment.
Many people would prefer to remain outside a nursing facility but because of their condition, circumstances or the unavailability of in-home services or affordable assisted living residences, they can only receive adequate care in a residential nursing facility. Unfortunately, as sometimes makes the news, some facilities exist with substandard living conditions and even dangerous lack of care. Still others give basic care that meets technical health standards but offer little else, and have an atmosphere that is debilitating or demoralizing to the residents.
There are, however, excellent nursing facilities that provide high-quality care while assisting residents to maintain active lives with a full measure of dignity. But because there are many levels and types of nursing and personal care, the task is to find a good, affordable facility that is right for you.
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Care in nursing facilities ranges from intensive 24-hour care for the seriously ill, which is called skilled nursing care, to long-term personal assistance and health monitoring with very little active nursing or custodial care. Some nursing facilities provide only one level of care, while others provide several levels at the same location.
Most people who are in nursing facilities cannot function without 24-hour monitoring and extensive personal assistance and nursing care because of illness or physical or mental limitations. But some residents are in relatively good physical and mental health, but too frail to live alone at home. If they had more family or resources, many of these people might be able to make do with extensive home or residence in an assisted living facility. For lack of an alternative, they become nursing facility residents.
In any case, the task is to find a good and affordable nursing facility that provides not just care, but the right type of care. For someone with severe physical or mental limitations, it is crucial to find a facility that provides the kind of attention and care that meets the individual's specific needs. For people who need little or no actual nursing care, the task is to find a facility that provides physical, mental and social stimulation rather than merely bed and food.
The hardest part may be footing the bill. Nursing facilities of all levels are very expensive, but depending on the type of care needed and the type of insurance you have, you may get some help covering the cost. Skilled nursing facilities run between $200 and $500 per day, although stays there are relatively short and Medicare or private health insurance usually pick up much of the tab. Custodial nursing facility care -- the kind that may last for years -- costs between $3,000 and $10,000 per month. Neither Medicare nor medi-gap private insurance supplements pay any of the cost of custodial care. Long-term care insurance, for those who have it, may cover some of the cost of custodial care. And Medicaid pays the full cost of custodial nursing facility care for people with very low income and few assets. Some veterans may also find coverage for custodial care through the Veterans Administration.
If the federal government certifies a facility, it may also be more affordable. The Healthcare Financing Administration has certified about 85% of all nursing facilities; HCFA certification means that the facility is eligible to receive Medicare and Medicaid payments. Some facilities do not meet HCFA standards. Other facilities charge high prices and simply do not want to accept residents who depend on Medicaid payments. Unless you have an unlimited supply of money to pay for long-term care, make sure that any facility you consider is certified. Certification means that the facility meets some certain minimum health, safety and care standards. And certification also means that if someday you should need and qualify for Medicaid coverage for your stay, you will be able to receive it without having to move to a different facility.
Hospital-based skilled nursing facilities, also known as extended care facilities, are departments within hospitals. They provide the highest levels of medical and nursing care, including 24-hour monitoring and intensive rehabilitative therapies. They are intended to follow acute hospital care due to serious illness, injury or surgery.
Unlike other nursing facilities, hospital-based facilities are not for permanent residence, but for a short term until a patient can be sent home or maintained elsewhere. Hospital-based facilities are very expensive ($200 to $500 per day), but the average stay is generally almost always for a matter of weeks only and, for those who qualify, is usually well covered by Medicare or private insurance.
Non-hospital-based skilled nursing facilities (SNFs) provide a relatively high level of nursing and other medical care, as well as personal care and assistance, for people whose illnesses or impairments require close monitoring.
Around-the-clock nursing is available from licensed vocational or practical nurses; with at least one supervising registered nurse on duty at all times. In addition to nursing, most other prescribed medical services can be provided, including various rehabilitative therapies. A SNF is almost always for short-term recovery from a serious illness, injury or surgery that required hospitalization. A few people may spend months in a SNF, but most stays are for a matter of days or weeks.
The cost of SNF care ranges from $200 to $500 per day. Medicare, Medicaid and private insurance will pay for SNF care, but only up to specific coverage limits.
Intermediate care facilities (ICFs) provide less nursing and other medical care than SNFs. ICFs are for long-term residents with chronic illness or impairment whose conditions are not as acute as those of SNF residents and who are usually ambulatory.Staff is geared as much toward personal care and assistance as to medical care, although there is always a licensed vocational or practical nurse on duty. ICFs generally care for people who need a long recovery period from serious illness, injury or surgery, but who no longer need quite the level of nursing care and high-tech monitoring that a SNF provides.
Costs range from $150 to $400 per day. There is no coverage by Medicare and private insurance coverage is rare, probably with prior approval required. Medicaid, however, may cover much of the cost of ICF care.
Very few facilities are set up to be ICFs alone; most are part of a SNF or a custodial care facility.
The type of facility that houses long-term residents provides what is called custodial care: personal assistance and low-level nursing care, but not intensive medical care. Sometimes referred to as rest homes or nursing homes, these custodial care facilities (CCFs) are considerably less expensive than SNFs or ICFs and provide social and educational activities, as well as organized exercise, in addition to monitoring residents' physical conditions. Because CCFs do not provide extensive medical care, they are appropriate for people whose physical and mental conditions do not require constant attention or intervention.
Because of the limited medical and nursing care they offer, CCFs cost about $100 to $250 per day, considerably less than SNFs or ICFs. However, the length of stay in a CCF is often months or years at a cost of $35,000 to $100,000 per year. CCFs come in all shapes and sizes, from 20-bed facilities in converted private buildings with homey atmospheres to 100-bed facilities with large common areas and extensive social, physical and educational activities.
Many people who suffer from Alzheimer's or other forms of dementia need regular, close monitoring and considerable personal assistance. They need the intense care provided by a nursing facility, but a different kind of care than is required by people who have only physical limitations. Not all facilities that provide good care for people with physical limitations do a good job with residents who suffer from dementia.
Some nursing facilities specialize in care for people with Alzheimer's or other disorientation. A few provide this type of care exclusively. More commonly, a general nursing facility will have a separate section or wing -- often referred to as a Special Care or Dementia Unit.
To be effective and humane, the special care must consist of more than mere segregation from other residents. Some places are physically constructed to address the problems of disorientation: a circular design to ease traveling about; few doors, none unlocked to the outside; a protected interior courtyard or patio for fresh air and exercise; a plan and a place for nighttime wanderers; electronic or video monitoring. But most important, good facilities provide staff who are specially trained to handle the difficulties of dementia sufferers rather than relying on medications and restraints.
Unfortunately, the special unit or wing at some facilities offers little more than a higher price. The fact that a facility has a separate unit does not guarantee that the care provided there is particularly well suited to dementia sufferers. As with all the other aspects of a nursing facility, base your assessment of such a unit on the information you receive from your eyes and ears more than what you glean from brochures or sales pitches.
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