Assisted Living Facility vs. Skilled Nursing Facility: The Basics

Your mom is ready to move into a place where someone is around all the time when she needs extra help, or your elderly dad is having surgery and needs rehab before coming home. When you entrust your loved one to an assisted living facility or a nursing home, you want what’s best for them.

So what does the admissions process look like for each of these facilities, and what are some other basics you should know?

First, let’s start with some definitions. An assisted living facility is a place where a person who is getting older can live in a balanced environment of personal autonomy and communal living. The resident lives independently and can continue to do and own many things like they did before arriving at the facility. The benefit of an assisted living facility is on-site staff to help your loved one and other elderly residents with daily living and other tasks (such as making sure the resident takes their medication three times a day, or helping them get dressed).

A nursing home, on the other hand, is a facility in which a resident needs around the clock nursing care. Around the clock care can be necessary because of the resident’s ongoing, chronic medical conditions, or due to recuperation and rehabilitation following surgery. A nursing home admission can be short-term for rehabilitation, or long-term for ongoing care.

Assisted Living: Is Your Loved One a Good Candidate?

The last thing you want to do is limit your loved one’s freedom or autonomy if it can be avoided. The unfortunate reality, though, is that many older people get to a point where they need a little extra help with their daily activities. How do you know when your loved one is ready to join an assisted living facility?

One possible sign is when they begin to neglect cleanliness and upkeep around the house. Sudden weight loss may indicate your mom is struggling to remember her daily medication or is having trouble preparing her own meals. If your dad is experiencing falls at home, or is restricting his movement to one or two rooms of the house, that may indicate he is having trouble with balance and ambulation.

Consider assisted living when your loved one neglects cleaning, loses weight or falls often.

When it appears that your loved one is having trouble taking care of themselves, it may be time to transition to a facility where they can get the assistance they need to continue to be comfortable and safe.

Those entering an assisted living facility typically have limitations in performing “activities of daily living,” including hygiene and mobility. If the limitations are more extensive than that, assisted living might not be a good match. For instance, mobility can be an important deciding factor in whether a loved one might be placed in assisted living, a skilled nursing facility, or at home with home healthcare.

The Admissions Process

The admissions process for an assisted living facility is drastically different than the admissions process for a nursing home. While an assisted living facility should be carefully chosen to meet the needs of the new resident, you may not have any say at all in which nursing home or rehabilitation center your loved one is sent to. Both require vigilance and involvement on your part to ensure your loved one’s safety, but each admissions process works very differently.

Assisted Living: Resident Admissions

When a person is choosing an assisted living facility, several factors go into finding the best fit. Here is a helpful video breaking down the differences in the admissions process between assisted living facilities and nursing homes:

Documentation to Provide at Admission to an Assisted Living Facility

  • Medical Records
  • Social Security Card
  • Insurance Card
  • Copy of Any Living Will or Power of Attorney
  • Emergency Contact Information

Skilled Nursing: Patient Admissions

As discussed in the video above, when it comes to which nursing home/rehabilitation center a patient is sent to after surgery, the decision is often out of the patient’s hands. The hospital may be contractually bound to send post-surgical patients to certain nursing homes.

If you do get a choice, be sure to do your homework. Convenient location is important, but you’ll want to visit each facility you’re considering. Observe and evaluate until you find the facility that best matches the needs of your loved one. And, when at all possible, try to include your loved one in the decision-making process.

Is That Assisted Living Facility Good Enough?

Unlike the nursing homes admissions process, the assisted living facility admissions process is largely under your control. So how does a family member decide if an assisted living facility is the right match for their loved one?

First, determine if the facility provides the services your loved one needs to flourish. Physical therapy might be consistently offered, but what about mental health services like counseling? Do you need a facility geared towards a particular illness, like Alzheimer’s or Parkinson’s disease? Make a list of your priorities before beginning your search. Remember, the services your loved one needs may change and expand as time passes.

Most care in assisted living is private pay, meaning that Medicare and other insurance does not pay for the care. If you or your loved one has long-term care insurance, check the policy and the facility rules regarding when and how much the insurance will pay. Some higher level care, like medication administration, costs extra, in addition to the several thousand dollar monthly fees. Make sure you see a list of all potential charges, and are prepared to increase monthly rent if your loved one’s needs change.

Tip: Wait times to get into assisted living facilities can be several months.

Special Considerations: Alzheimer’s in Assisted Living

An assisted living community may have a Special Care Unit dedicated to supporting and helping patients with Alzheimer’s and other dementias. For this unit in particular, there must be a sufficient number of specially-trained staff to serve the resident population effectively.

These Special Care Units (SCUs) also frequently require additional security measures and dementia-friendly architecture to protect disoriented residents. SCUs must be inspected and approved by the Division of Health Services Regulation before they can call themselves SCUs.

Tip: Many assisted living facilities offer “memory care units” instead, which are not inspected and approved, and are merely locked units without specially-trained staff. Ask which kind is in the facility you’re considering, if an SCU is important to your loved one.

Proper staffing is key for SCUs. Staffing a facility is not about meeting bare minimum regulations and otherwise penny-pinching in resident care for the sake of profit. Facilities should be “staffing to acuity,” which means making reasonable staffing assignments based on how much care the residents in that unit or wing need.

Do not assume that your well-meaning physician, physician assistant, or nurse practitioner understands the difference between a skilled nursing and assisted living facility. It is the duty of the assisted living facility to assess your loved one and determine whether it can provide the care your loved one needs. Question their decision based on what you know about your loved one’s needs.

Ask nursing facilities about privacy, mental health & illness services & financial planning.

Use a Checklist for Vetting a Facility

Once you narrow down your options, remember that the devil is in the details. For tips on smart questions to ask, AARP’s Caregiving Checklist can be useful:

  • What kind of written care plan do you get to see?
  • Does the facility have tested emergency procedures for crises that might arise?
  • What about secondary services, like a hair salon?

The state publishes inspections and citations for low-quality services and care on its website for the public’s use and review. The regulations governing assisted living facilities are not as strict as for nursing homes, but the state does inspect those facilities, and issues fines and other penalties for violations.

As you can see, there are quite a few differences between the scope and capabilities of assisted living facilities and nursing homes. In addition to your evaluating potential facilities, the facilities will evaluate prospective residents before admission. If the facility feels they don’t have the resources to properly care for the resident, they may not admit him or her. Instead, the resident may be directed to a different type of facility.

What Is an Arbitration Clause and Why Is It a Problem?

Arbitration is a way of solving legal disputes between businesses without using the court system. In arbitration, the parties present their cases to a trained arbitrator, who makes a legally-binding decision on the dispute. The idea behind arbitration is that, since courts are slow and highly technical, a private alternative could be more efficient and cost-effective for sophisticated business people. So what’s the problem?

For starters, private arbitrations were intended to streamline the litigation process between businesses, not healthcare providers and patients. Pre-dispute arbitration requirements in the medical arena can be inherently unfair, and not in the best interest of patients and their families.

Mandatory arbitration clauses mean you cannot exercise one of your constitutional rights to trial by jury, but must plead your case to a “neutral” arbitrator in a closed proceeding that you can’t typically talk about later. On top of all that, arbitration awards generally can’t be appealed.

That’s why you want to do your best to be on the lookout for a pre-dispute arbitration clause in the assisted living facility contract. Is agreeing to an arbitration clause a condition of admission to the facility? If so, that’s a red flag to avoid that facility.

Tip: If you see the word “arbitration” anywhere in the contract, there’s a good chance you’re consenting to mandatory arbitration by signing it. Cross through the provision if it is part of the larger contract, or refuse to sign that page of the contract. You want to be able to utilize all options of the justice system if you ever need to hold a facility accountable for their negligence. If you choose to arbitrate a dispute after the dispute arises, that is entirely your decision; however, sneaking a provision past an unsuspecting new resident is never right.

Paying for Long-Term Care

Assisted living typically is private and costs thousands of dollars a month. Here are three possible ways to cover these costs:

Out of Pocket

The simplest solution, when possible, is paying care bills with your own resources. With the high monthly price of assisted living, this option is simply not available to many of us.

Insurance

The right kind of long-term care insurance will cover your assisted living expenses with little or no money out of pocket. However, you will need to know ahead of time what the requirements are for coverage. Some require that the resident needs assistance with three or more activities of daily living. It’s best to be aware before starting the process. Life insurance policies can sometimes be drawn on or converted, as well.

VA Benefits

In certain circumstances, veterans and their spouses may be eligible for financial assistance with assisted living bills. Applications are processed by the VA based on medical and financial need.

How Things Can Go Wrong

There are millions of elderly Americans who either reside in a nursing home or live in an assisted living facility. Unfortunately, our loved ones are not always treated with the care and dignity they deserve at their long-term care centers.

Watch: Is your loved one experiencing sudden weight loss, mood changes, or unexplained injuries? How to detect signs of neglect or abuse.

Common Injury Risks in Assisted Living

Here are some typical ways in which your loved one may be at risk in their long term care facility:

  •     Obstructed walkways, poor lighting, and other fall hazards
  •     Incorrectly stored or administered medication
  •     Lack of security
  •     Improperly hired, trained, or supervised employees

To try to solve any of these injury risks before they become a crisis, contact the Long-Term Care Ombudsman for advocacy assistance.

Do Assisted Living Facilities Have To Report Falls?

Under the Assisted Living Administrator Act, administrators of these facilities have requirements to fulfill in order to be in compliance with state law. In addition to being certified, administrators have reporting requirements for adverse events such as falls. An administrator “shall report any incidents of suspected abuse, neglect, or exploitation of persons residing in an assisted living residence…to the Health Care Personnel Registry.”

The Registry has an Investigations Branch that receives these reports, investigates them, and takes administrative actions that are listed on the Registry. A “pending” allegation investigation listing is added when the Investigations Branch determines that an investigation is in order. If the complaint is substantiated after the facility or an employee is given due process to defend themselves, a permanent “finding” listing is added to the registry.

Common Injury Risks in Nursing Homes

Nursing homes are regulated differently than assisted living facilities, but elderly residents of both can often end up with the same types of injuries. Some of the most common injury risks in nursing homes include:

The fact that the elderly often fall victim to abuse and neglect, while some companies profit handsomely off of them, is an injustice. Can you hold the care home that failed your loved one accountable? Contact us any time for a free case evaluation.

You Are Not Alone

At an assisted living facility, the goal is to make residents more safe — not less. I hope these resources and tips have helped you as you prepare to admit your loved one to a new environment.

Remember: State oversight and licensing agencies can be your allies for issues you identify with the day-to-day service at an assisted living facility. Get some critical information from our assisted living overview.

Questions on advocating for your loved one in a nursing home? Our nursing home abuse and neglect overview will help guide you.

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About the Author

Kaitlyn Fudge practices personal injury, consumer protection, business litigation, class action, mass tort, product liability, and whistleblower claims law in both North Carolina and South Carolina for the Law Offices of James Scott Farrin. She received 18 different recognitions in law school, including the Jessie and Elizabeth Leonard Valedictorian Award. Kaitlyn has experience working at the Wake County Attorney’s Office and is a member of the North Carolina Bar Association.