What is assisted living?
Assisted living is often confused with a nursing home but they are
vastly different. An assisted living facility or an
ALF, is for people of all ages… not just
older adults… who need “custodial care” or help with daily activities such as using
the toilet, bathing, dressing, shopping, taking medicines, and preparing food. Assisted living facilities are not covered
under Medicare, as they are not medical facilities. They are paid for with private funds and/or
longterm care insurance. The basic rate
for an ALF is about $3550 per month or around $42k per year. There are also extra costs for supplies,
personal care, medication distribution, personal hygiene assistance, bandage
changing, laundry, and other services (Tracy & DeYoung, 2004).
A nursing home or skilled nursing facility is known as a
SNF, is a place for people who need nurses, doctors, therapists, and skilled
individuals caring for them based on medical need. Most nursing homes have medical specialists
on hand 24 hours a day. Some people are
admitted to nursing homes to recover following hospitalization or for therapy
after hospitalization. Although most
patients in SNF’s are older adults, 34% are under the age of 65, mostly people
with disabilities or severe injuries. It
is a myth that the majority of older adults die in nursing homes. Only 25% die in nursing homes and this means
that 75%.... the overwhelming majority…. do not die in nursing homes.
Both ALF's and SNF's have secure memory care units for people with dementia who need specialized care and/or may wander away from the facility.
The daily average cost for a nursing home is $248 for a
private room or $239 for a shared room. Medicare
pays a small portion of SNF care but the majority is paid out of pocket. After a three day hospital stay, Medicare
pays for only the first 100 days in a SNF for a patient who requires
specialized care. No, there is no Medicare Fairy.
Medicaid is a needs-based medical program for the indigent
and there are special rules about qualifying for nursing home care. Current rules vary and so lots of checking
and paperwork is required. Hiding funds
is not only fraud but impossible so please do not even consider it: “Lookback
rules” apply in all states.
Nursing homes are usually hospital-like with a fixed
schedule, nurses stations, shared rooms, and call buttons. They typically have occupational therapy,
physical therapy, speech therapy, and medical care on site. Some SNF’s are more home-like with flexible
schedules, and have kitchens, shared spaces, and a neighborhood
atmosphere.
Whether moving to an ALF or SNF, there is a psychological
adjustment associated with relocation. In
their study about adjustment to moving into an assisted living facility, Tracy
and DeYoung (2004) found that involuntary relocation created negative feelings
and voluntary relocation resulted in a more positive adjustment. Life satisfaction increased up to eighteen
months with feelings of isolation, loneliness, and alienation diminishing
gradually. They found that older adults
who moved into a dependent facility had higher levels of anxiety and depression
than older adults moving into independent living situations. Tracy and DeYoung (2004) found three common
negative themes expressed by older adults moving into assisted living; a loss
from giving up driving and cooking their meals, awareness of becoming increasingly
dependent on others, and acknowledgment
of deteriorating health. However, older
adults participating in the study also found empowerment in making choices for
trips, meals, meetings, church services, social activities, and exercise
programs. One woman stated, “It is a
matter of attitude. If you decide that
it is an adventure, the next stage in life, then you accept it and go on from
there” (p. 30). Although moving from
home into an ALF requires a major life adjustment that may result in negative
feelings initially, moving into an ALF is for some is “a little bit of heaven”
(p. 33).
Resources:
State Health Insurance Counseling and Assistance Programs
[SHIP] www.medicare.gov/Nursing/Payment.asp
Tracy, J.P. & DeYoung, S. (2004). Moving to an assisted living facility:
Exploring the transitional experience of elderly individuals. Journal
of Gerontological Nursing, 30(10), 26-33.
