Have you started thinking about moving your loved one from home to a care facility? You may be having these thoughts for a variety of reasons, safety concerns, burnout, increased care needs. First, do not feel guilty for wanting to make this change. You owe no one an explanation. Make the move that is best for the quality of life for your loved one with dementia and yourself.
There are many facilities to choose from and you might be unsure about the difference between an assisted living facility and a skilled nursing facility or a nursing home.
Let’s start with the Assisted Living Facility, also known as an ALF. The main difference is the cost. Living at an assisted living is like being a tenant who pays rent. Your apartment is your home that you pay for monthly. Insurance does not cover the costs. Cost is dependent on your geographic location and care needs. Here in Boston, I have seen costs of 12k a month! All assisted living facilities are not the same. When looking at facilities, you should note the type of services and living arrangements they provide. Many will have independent living, assisted living, and memory care. Independent living comes with no additional care from staff except for meals and some housekeeping. That means no assistance with personal care like showering or medication management. Assisted living, is more expensive but comes with daily care from staff. This care can be multiple times a day and can include showering, dressing, assistance with compression stockings, and medication reminders. This level of care is more appropriate for the earlier and middle stages of dementia. A person in assisted living can be left alone and free to move about the facility but may need some extra help. The highest level of care and the most expensive is the memory care unit. This is a locked area where the highest level of care is provided. Many residents need help with all activities of daily living. Residents are checked hourly and receive assistance with dressing, bathing, incontinence care, medications, and meal set up. There is also more communal activities.
Location matters. Each state has its own regulations that limit what ALF staff is able to do. I live in Massachusetts which has some of the strictest state guidelines. Nurses in assisted livings are not able to administer certain medications, like insulin. Most medications are given by resident care staff which means they are not able to give as needed medications unless the resident asks it, for example, they can only give Tylenol as needed for pain if the resident says, “Can I have some Tylenol my back hurts.” This can be very difficult for a resident with dementia who may be struggling with aphasia or does not remember to ask. Nurses can give as needed medications because they are able to complete assessments. When touring assisted livings ask who gives the residents their medications on the different type of units.
Now, what is a skilled nursing facility? A skilled nursing facility or SNF is a nursing home. SNFs can have multiple types of units. Short term rehab units where patients can come for physical therapy and occupational therapy after a fall, surgery, or illness with the plan to return home. There are also long term care (LTC) units, some of these units can also be locked memory care units. Insurance plays a factor in paying for LTC or living at the facility. Other blog posts will be dedicated to the financial and insurance piece but when looking a facilities you should know that they will ask about finances and do a 5 year look back. Insurance will often cover short term rehab but not long term care. There is also a difference between Medicare, managed Medicare, and commercial insurance plans. In Massachusetts the only long term care payer is MassHealth, if your loved one does not qualify for MassHealth, they will have to spend down their money until they do qualify. SNFs have nursing staff onside 24/7 who can administer most medications and treatments like wound care. They also have MDs, PAs, and NPs on staff. Skilled nursing facilities are able to provide more direct care for patients. Most patients are completely dependent for all care and may be wheelchair or bed-bound. In an assisted living, the patient typically needs to be able to feed themselves if the plate is placed in front of them. In a SNF, staff can provide assistance for feeding and modified diets.
The biggest difference between a ALF and a SNF is the cost and how it is paid for. After that, the biggest difference is the amount of care provided for both personal care and medical care. Choosing a location for a loved one can be stressful, ask questions and take tours. You can also use this website to see how Medicare rates the different skilled nursing facilities near you using quality metrics, https://www.medicare.gov/care-compare/?redirect=true&providerType=NursingHome